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Home My WebLink About0020 CASTLEWOOD CIRCLE - Health 20 Castlewood -Circle Hyannis P : o 273 064 ' i i r tl r � u o G d� a t f TOWN OF BA.RNSTABLE LOCATION ; 4tE W��i� SEWAGE #7SPcO°►`�pN YILLAGE ��,�n�3 ASSESSOR'S MAP & LOT��J? d� I b S NAME&PHONE (-7-7 SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) t�h�.�� b'r-, � � (size) e� , NO.OF BEDROOMS 3 BUILDER OR41� r---manG��:vt5 PERMITDATE: CONUMPME DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by TOWN OF BARNSTABLE LOCATION, .20 CA64 wan t7 C. a — SEWAGE # ?00 0-7 q S VILLAGE • N e AwvV iS ASSESSOR'S MAP & LOT2/2',Z 01 INSTALLER'S NAME&PHONE NO. sow SE,O�ic 7 75 7�6 SEPTIC TANK CAPACITY 1'v a C) LEACHING FACILITY: (type) a DJ24 c,.((5 (size) 2;K(a -7( a 5 NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 1 Z/i S I aC,00 COMPLIANCE DATE: f 2/a 71200 7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of le ching faci 'ty) Feet L ished by 44 /M . i I - • I L TOWN OF BARNSTABLE LOCATION SEWAGE # 79 0 ��5s VILLAGE - / J/S ASSESSOR'S.MAP & LOT 223"O6 INSTALLER'S NAME&PHONE NO. ,6•'O t-14A2 0 SO ff 77S �D i SEPTIC TANK CAPACITY -LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER Lc9 ft-,B Fr PERMIT DATE: '"o =/W�g ; Separation Distance Between th . ..... Maximum Adjusted Groundwater a altory Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � � . �, r. ��,' {;,4I ''' '� �� '[ •/ � �, \ � Y 1� i � �� . _� L �� ' • � � . � 111 - �ty �� . i . i�. r . TOWN OF BARNSTABLE LOC:ATION`; _ C°'�1S�5C� mo/� C!AliPLT SEWAGE # VILLAGE 0,a;1 n,- P ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER .00hrq A PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili ) J / Feet Furnished by �� il 47l f / 57Q r ' *• /t4 i Commonwealth of Massachusetts o?__�3— Na Lf Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments =, 20 Castlewood Cir LJ Property Address tQ Ronald Vath & Hercules Costa r•a Owner Owner's Name information is ' required for every Hyannis MA 02601 03/03/2021 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms Sit* r5(_a on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key:.... 52 Rivers End Road reD Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ®, Passes 2. ❑ Conditionally Passes 3: ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails • � 03/03/2021 Inspector's Signature Date ' The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. CityfTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.'303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 2 bedroom home has an H-10 1000 gallon septic tank with an H-10 D-Box feeding two leaching chambers with stone also the original overflow cesspool is fed by the 1000 gallon septic tank. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 - page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 6-P Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �, 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every y H annis MA 02601 03/03/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: - Number of bedrooms (design): 3 Number of bedrooms (actual): 2 330 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): GPD plus Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) t Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): town water Detail In 2020-56,100 gallons were used and in 2019-51,612 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped'as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is Y required for every Hyannis MA 02601 03/03/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: A ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1000 gallon Sludge depth: - Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness • 5„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the-liquid level was at working level and the tee's and baffle were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 ' i Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . i 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 12 of 18 n Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: .Type: ❑ leaching pits number: ® leaching chambers number: Two ❑ leaching galleries number: i ❑ leaching trenches number, length: I ❑ leaching fields number, dimensions: ® overflow cesspool number: One ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 i i Commonwealth of Massachusetts Title 5 Official Inspection Form c Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA , 02601 03/03/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is Hyannis required for every Y MA 02601 03/03/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately M 0 A B A B OO 1 33'10" 16'11" Q 2 35T' 22' 3 39'4" 21'6" 3 4 35'8" 31'9" 4 5 46' 32' 0 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I i c Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 15 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Castlewood Cir Property Address Ronald Vath & Hercules Costa Owner Owner's Name information is required for every Hyannis MA 02601 03/03/2021 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r DEPARTMENT OF ENVIRONMENTAL PROTECTION a TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION vro O Property Address: 20 Castlewood Circle C-3 2p- Hyannis MA 02601 1 n o Owner's Name: Gonclaves t Owner's Address: Same �l N / Date of Inspection: December 2,2005 Job#05-348 �37 Off' Z co Name of Inspector: PATRICK M.O'CONNELL �„� M Company Name: SEPTIC INSPECTION SERVICES CO. a% Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I An►►►► approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system�� OF/,Af4A Passes Conditionally Passes P TRI K Needs Further Evaluation by the Local Approving Authority = Fails C1 .y ��''o•,�•�RNSP�ti��-�InsPector's Signature Date: 12/2/05 S • � \```` '��►uEnuuaa�� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board';of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow o i 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office, of the DEP.The original should be sent to the system.owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Observed 2-3"of standing water in leaching chambers and tank is not in need of pumping at this time ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Castlewood Circle,Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: TiNo '; Inenantinn Rnrm All v')nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Castlewood Circle,Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Titlra i incnortinn Rnrm All vInnn 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Castlewood Circle, Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No —X— Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X— Liquid depth in cesspool is less than 6" below invert or available volume is less than %2 day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. —X Any portion of a cesspool or privy is within a Zone 1 of a public well. —X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. IThis system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma _No_(Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Titla S Tnenantinn Anrm 411 S/)nnn 4 r Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20 Castlewood Circle,Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks _X_ _ Has the system received normal flows in the previous two week period ? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems`? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Titla S frnonantinn 17nrm rii G/7nnn 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20 Castlewood Circle,Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms):330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required) Laundry system inspected (yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 90,000 gal. = 123 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date: 12/27/00 Were sewage odors detected when arriving at the site(yes or no): No Titla 1� rncnaminn 17nrm 411 U)OMI 6 1 i Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle,Hyannis Owner: Conclaves Date of Inspection: December 2,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: V Materials of construction:—X—cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 8" Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5' long x 5.2' wide— 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tees are intact and clear, liquid level at bottom of outlet invert Recommend pumping tank every three to five years. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Titla C fncnartinn [7nrm r,ri;nnnn 7 Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle, Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No solids or high stains. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I Titla C Tncnartinn Rnrm r,n,;ionnn 8 I � Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle, Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _X_leaching chambers, number: Two 500 gal drywells leaching galleries,number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Observed 34"standing water with no high stains 4 CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): t j TiNa C Incnortinn Rnrm 411 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle, Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Castlewood Circle Driveway Water service #20 18 34 40 22 32 46 Title Incnortinn 17nrm 411 C/7nnn 10 0 Page I I of 1 I OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle, Hyannis Owner: Gonclaves Date of Inspection: December 2,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 12 feet Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Perc test performed prior to repair found no water at 12 feet. Titla C Inenartinn 17^r 4/1;nnnn I I Y_w-...,. w. �.w..- n-..._ s.v tea...�.-��...'..: ..n. :r""" ��. ' ., :'Sx:�.ir� --"'•r---^-F--,wti-�-.._--v.�-�- �......-,r ..�..�-� „-.�_..�---.�, .�✓ � .^.�--4� r. F' / No. cJCV`'7• 52-5 Fee Zoo �- THE COMMONWEALTH'tA OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OFga,BARNSTABLE., MASSACHUSETTS ZIpprication for Vigo f 6pgtem �tCongtruction Verrait Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel C'...«� Oo Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �� L�r►LO ��.f3 C6l)e-0 3,1s-0 ,Y Sr c2ez� Type of uilding: welling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures C YA14� Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /,00J Type of S.A.S. Description'of Soil Nature of Repairs or Alterations(Answer when applicable) Lit/-,-e, CV\A\'1Qt VIt0u5E T'U —L-A-WI- Date last inspected: Agreement: The undersigned agrees to ensure the constructio d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 the En ron ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedµby;�th o e tItUj Signed ` ` Date Application Approved by Date Application Disapproved for the following reasons Permit No. S Date Issued O No. _�Z� �]")S } J` f Fee- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .k PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for dig o0 Y :*potem Conotruction Permit , Application for a Permit to Construct( )Repair( Upgrade'( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. i Owner's Name,Address and Tel.No. Assessor's Map/Parcel Cl lit. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. # S'0 y4t-►`^ S 7 U 1" t Type of Building: ` ,,-Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 4 Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets ` Revision Date Title Size of Septic Tank ,j066) Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (-tin-P C_\n,AKIA t._z :Q) J 7♦ . Date last inspected: Agreement: The undersigned agrees to ensure the constructions and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5'of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued t:by s Bard of ealth. Signed Q Date 9-2 3-c y Application Approved by Date i, Application Disapproved for the following reasons Permit No. LL Date Issued `- ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance ! THIS IS TO CERTIFY,That the On-site Sewage Disposal System Constructed( )Repaired (pl'/Upgraded( ) Abandoned( )by rJ s- ,a-4a rN at �1 r` �t a..�c�►�� (��;�� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 00 L/-0 S' dated9�`-C�� Installer C4 0 r' Designer The issuance of this permit shall not be construed as a guarantee that the sptqp will :nction designed. Date 9- U Inspector d No. (20-j So$ Fee In 0 �1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS liopont *pgtem C notruction Permit ' Permission is hereby granted to Construct( epair( Pgrade( )Abandon( ) System located at =U1 c o'f4�-a C ,«r /�,,2,n421 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of theedate o this per Date: 3_r Approved by r 1 " TOWN OF BARNSTABLE LOCATION.O Ong _ SEWAGE # V1LLAGE ASSESSOR'S.MAP & LOT ol73 �D67 INSTALLER'S NAME&PHONE NO. 75;�1$_D w SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size), NO.OF BEDROOMS " BUILDER OR OWNER 7 PERMITDATE: _ =ag Separation Distance Between thMaximum Adjusted Groundwatty. Feet Private Water Supply Well.and Leaching Facility (If any wells exist Feet i on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet j within 300 feet of leaching facility) IFurnished by R K rl •• CAN G ` out t A ,r No. 2F&"1040- " i� Fee 5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppricatton for Migpool by mem Congtruction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. A,NoSA4 ;AWood Circle, H annis, MA Barrett �� _,,, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) consisting of a D—box and 2 concrete leach chamhPrs With stone all around. Date last inspected: Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B d ealth. Signed 6 Date )-2 Application Approved b Date AW—/� t�� Application Disapproved for the following reasons F Permit No. *00 Date Issued No. 6�� / ��/, Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer- Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS .. r r 01ppIi ratio n jor 'Migpogar *pttem Cone;truction Permit Application for a Permit to Construct( )Repair(/X)(Upgrade(. )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. r Owner's Name,Address and Tel.No. AsNsorsgA,4/FIlwood Circle, Hyannis, MA Barrett Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service _P O Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) 7 Other Type of Building No:of Persons Showers( , ). Cafeteria.( ) } Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.`A.S. Description of Soil Sa nd Nature of Repairs or Alterations(Answer when applicable) 924t.ln_ I�9hsyteTm consisting of a D—box and 2 concrete leach c amhars with -4 stone all around. Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal,system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifr- cate of Compliance has been issued by this B d ealth. 1 � � ..,,, • - . Signed Date Application Approved b Date :�'�-�B�J• =a'�c� Application Disapproved for the following reasons Permit No. Date Issued r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Barrett (fertificate•of Compliance ` THISJS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned'( )by wm F Robinson Septic Service at 20 Castlewood Cirelef Hyannis, MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Pea&V6"' �dated,�� Installer Wm. E. Robinson Sr. Designer The issuance of this ermit shall not be construed as a guarantee that the ti will function as es' d. Date � .�'� ��3/ Inspec r J ,9 k' - ------------------------------------ No. j2a s Fee 1 5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Barrett lwizpozal *pgtem Conttrurtion Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 20 Castlewood Circle, Hyannis, MA y J•. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be cco-mpleted within three years of the date of thi rmit. Date: ��' �ti� �► 11 Approved b =n ' 1 i NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, William E. Robinson,Sr} eby certify that the application for disposal works construction permit signed by me dated Is G-el--V , concerning the property located at 20 Castlewood Circle, Hyannis, MA meets aU ofthe Mowing criteria: = • The failed sysn is connected to a residential dwelling only. There are no commercial or business uses associated th the dwelling. The soil is ed as CLASS 1 and the percolation rate is less than or equal to 3 minutes per inch. -There Me wetlands within 100 feet of the proposed septic stistem — • There are t o private wells within 150 feet of the proposed septic System - There is increase in flow andlor change in use proposed There no variances requested or needed. • The ttom of the proposed leaching facility will-nut- located less than five feet above the ma mum adjusted groundwater table elevation.f Adjust the groundwater table using the Frimptor od when applicable) • the S.A S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed caching facility will mtt be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complew the following: A) Top of Ground Surface Elevation(using G1S information) UI B) -G.W.Elevation _ +the MAXHigh G.W. Adjustment DIFFERENCE BETWEEN A and B — SIGNED L-� DATE: ✓� �� [Sketch proposed plan of system on backs. y:health folder.aen �i .. � /. � � - � �j� � .___ ti .� . r 4� i 1 TOWN OF BARNSTABLE l LOCATION CAS IC. ao wan? Ci2��c— SEWAGE # coo 7c(S VILLAGE N�/,l��vvy i`� ASSESSOR'S MAP & LOT �. 1 INSTALLER'S NAME&PHONE NO. CRPTTr TA'vv r A D A!`rry LEACHING FACII.TI'Y:.(tyPC). t l 4(44 b; (size) -2;4 t2a -,e a S' i ! NO.OF BEDROOMS 3 i BUILDER OR OWNER 'S A P— PERMITDATE: 1 Zli 5 I a;000 COMPLIANCE DATE: i-)t/2 7 i✓0000 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility). Feet . .:•....,;: Edge of Wetland and Leaching Facility(If-any wetlands exist. within 300 feet of le hing faci 'ty) Feet Furnished by �` f3 1,21 i I St; oy 4J� • a � �'?t)� 1 �\ COMMONWEALTH OF MASSACHUSETTS a\ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y�! v� TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 20 Castlewood' Circle, Hyannis, MA Owner's Name: Barrett Owner's Address: Date of Inspection: Name of Inspector: (please print) W i 1 1 i am E. • Robinson Sr. +< 00 Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (5 0 8) 7 7 5—8 7 7 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Secti n 15.340 of Title 5(310 CMR 15.000). The system: zasses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: w i b f� Date: 7-6 D The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heattlror• DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments - •� 1c� �� :�! s Sys- ,3 C �l '�® o..� — j' ��'`` ^ , r ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 F Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: 1 e''L-X 7-- Inspection Summary: Check 6,C,D or E/ALWAYS complete all of Section D A. Sys m Passes: I have not found an information which indicates that an of the failure criteria described in 310 CMR y y 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or rep fired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answ ryes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please expla' . e septic tank is metal and over 20 years old*.or the septic tank(whether metal or not)is structurally unsoun ,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existin tank is replaced with a complying septic tank as approved by the Board of Health. •A me 1 septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicat g that the tank is less than 20 years old is available. I ND ex lain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or ob cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with appr val of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced explain: The system required pumping more than 4 tunes a year due to broken or obstructed pipe(s).The system will pas inspection if(with approval of the Board of Health): . . i broken pipe(s)are replaced obstruction is removed explain: f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: f 2-;k 7-0 c-- C. Further Evaluation is Required by the Board of Health: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failin to protect public health,safety or the environment. I. S stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the sy tem is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2. Sy tern will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syste is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a s rface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 i Page 4 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: 04L!:�A7:o ti D. S stem Failure Criteria applicable to all systems:. You m st indicate"yes"or"no"to each of the following for all inspections: Yes Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50'feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogedis equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E Large Systems: T be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gP Yo must indicate either"yes"or"no"to each of the following: (Th following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary.to a surface drinking water supply r the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped .. Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" n Section D above the large system ktas failed.The owner or operator of any large system considered a signifi ant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.3 .The system owner should contact the appropriate regional office of theDepartment. 4 i i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: 1�=2r7 r e� Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? �.� Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of fhe baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes o Existing information.For example,a plan at the Board of Health. d,�AADetermined in the field(if any of the failure criteria related to Part C is at issue approximation of distance ceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTION FORM :NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20 'Castlewood Circle Hyannis Owner: Barrett_ Date of Inspection: /�z -- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of cur Tent residents: 1, Does residence have a garbage grinder(yes or no):ZL_O Is laundry on a separate sewage system(yes or no):A,_Q [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no): .:b Water meter readings,if available(last 2 years usage(gpd)): 19 9 9-2 0 0 0 36,750 gal. Sump pump(yes or no):LO . 1 9 9 8-1 9 9 9 24 , 750 gal. Last date of occupancy: a- 7-o c,-c CO M RCIAL/INDUSTRIAL Type of a tablishment: Design fl w(based on 310 CMR 15.203): gpd Basis of d sign flow(seats/persons/sgft,etc.): Grease tr present(yes or no): Industrial waste holding tank present(yes or no): Non-sani waste discharged to the Title'5 system(yes or no): Water ter readings,if available: Last d e of occupancy/use: OTHE describe): GENERAL INFORMATION Pumping Records Source of information: i4 Was system pumped as padof the inspection(yes or no): 4 0 If yes,volume pumped:16allons--How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):/'-' 0 6 I I Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: t 3-- -7-b G BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:/(locate on site plan) , o Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) I +I - Dimensions: K Sludge depth: / ' q Distance from top of sludge to bottom of outlet tee or baffle: /-3 Scum thickness: '0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: d ez% T.a w )L Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): G EASE TRAP:_(locate on site plan) Dep below grade: Mater al of construction: concrete metal_fiberglass polyethylene_other (expl ): Dime sions: Scum hickness: Dicta ce from top of scum to top of outlet tee or baffle: Dista ce from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Co ents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as r lated to outlet invert,evidence of leakage,etc.): i + . 7 e Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: e, TI• Tor HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materi 1 of construction: concrete metal fiberglass polyethylene other(explain): Dime ions: Capa ty: gallons Desi Flow: gallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): Dat of last pumping: .Co ents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Z(if esent must be o ened locate on site lan P )( plan) Depth of liquid level above outlet invert: 6_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarm in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection:J 1--,L 7-- � SOIL ABSORPTION SYSTEM(SAS): ✓{locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ _eaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (c pool must be pumped as part of inspection)(locate on site plan) Number and configuration Depth—top of liquid to inl t invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: , Materials of construction: Indication of groundwater nflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate o site plan) Materials of constructi Dimensions: Depth of solids: Comments(note c ition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): aN 9 i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: l 2--y-7,np cy—,, SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. A } �y I . a ' PCs a I I 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Castlewood Circle Hyannis Owner: Barrett Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water -;Z--feet Please indicate(check)all methods used to determine the high ground water elevation: tained from system design plans on record-If checked,date of design plan reviewed: served site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 7. b y � 11