HomeMy WebLinkAbout0026 CASTLEWOOD CIRCLE - Health 26 Castiewood Circle
Hyannis . .P
'A = `273 065
d. o
r
TOWN OF BARNSTABLE
-,LOCATION ��-CJT��C)� SEWAGE #
VILLAGE C' n'n�5 ASSESSOR'S MAPa&�0 Oho.
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 6�
'
LEACHING FACILITY: (type)
NO.OF BEDROOMS TM
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE: L /
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
5..
�t
TROY WILLIAMS _ 2
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection (508) 385-1300
19 Hummel Drive
South Dennis, MA 02660
�-\ COMMONWEALTH OF MASSACHUSE'I-I•S
EXECLITIVE OFFICE OF ENVIRONMENTAI. AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
J
'FITLE s
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM 0111M
PART A RECEIVED
CERTIFICATION
MAY 0 6 2003
Property Address: 26 Castlewood Circle
Hyannis,MA TOWN OF BARNSTABLE
Owner's Name: Tom&Judy Dowd HEALTH DEPT.
Owner's Address: 26 Castlewood Circle
Hyannis,MA 02601 O
Date of Inspection:. April 29,2003 / O
Name of Inspector: . Troy M. Williams (( A
Company Name: Troy Williams Septic Inspections \vim
Mailing Address: 19 Hummel Drive
South Dennis, MA 02660
Telephone Number: (508)385-1300
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 %%-as performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The s%,10cm,
Passes .
Conditionalix- (lases
Needs Further Evaluation by the Local Approving Authurit)
Fails
Inspector's Signature: f�s Date: y/.z y /o 3
The system inspector shall submit a copy of this inspection report to the Approving Au11106ty.(f3oard of I lealth or
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
Although system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification is not to be construed as a guarantee of future working condition
Of system,piping or components. This Inspection represents the conditions of the system on the Date of
Inspection noted above.
""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 saute or different
conditions of use.
Title 5 Inspection Form 6/15/2000 naee 1 0f 11
Page 2 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA
Date of Inspection: Tom&Judy Dowd
April 29,2003
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310 C%4R
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"CondZ5 ,1,"section need to be placed or
repaired. The system, upon completion of the replacement or repaed by the Board Health,will pass.
Answer yes. no car not determined(Y,N,ND)in the for the foement . f"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septither metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failnent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approvedrd of Health.
•A metal septic tank will pass inspection if it is structurally sou ,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 bre out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,sett or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
roken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The stem required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass ins ction if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
tr
�t4
2
Page 3 of 1 l
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA
Date of IrtsPectiuu: Tom&Judy powd
April 29,2003
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.
I. S)-stem will pass unless Board of Health determines in accordance with 310 CMR 15.303 )(b)that the
system is not functioning in a manner which will protect public health,safety and the vironment:
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 sal arsh
2. System will fail unless the Board of Health(and Public Wa r Supplier, if any)determines that the
system is functioning in a manner that protects the public h th,safety and environment:
_ The system has a septic tank and soil absorption stem(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface wate supply.
The system has a septic tank and SAS d the SAS is within a Zone I of a public water supply.
The system has a septic tank an AS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic t • and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. ethod used to determine distance
"This system passe f the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and vola ' e organic compounds indicates that the well is free from pollution from that facility and
the presence ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure cri la are triggered.A copy of the analysis must be attached to this form.
3. Other:
r+i
.Lsy
3
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 26 Castlewood Circle
Hyannis,MA
Owner: Tom&Judy Dowd
Date of Inspection: April 29,2003
D. 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 clo2:ed 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
tb 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%:day flow
Required pumping more than 4 times in the last year OTOT_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.
ALt 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 nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis trust be attached to this form.)
A/o (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 desi 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 ove)
yes no
the system is within 400 feet of a surface drinking er supply
_ the system is within 200 feet of a tributary to surface drinking water supply
the system is located in a nitrogen sen ' ve area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply w
if you have answered"yes"to any que on in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large stem has failed.The owner or operator of any large system considered a
significant threat under Sectiop i failed tinder Section D shatj upgrade the system in accordance with 310 CMR
15.304.The system owner sh d contact the appropriate regional office of the Department.
4 r,
Page 5 of I I
I .
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA
Date of Inspection: Tom&Judy Dowd
April 29,2003
Check if the following have been done.You trust indicate"yes"or"no"as to each of the followine•
Yes No
-Z _ f.::: ping information was provided by the owner. occupant, or Board of l lealtll
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?
Z _ 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 diftereni 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
_✓ _ 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)f 310 CMR 15.302(3)(b)]
y 'u<
Page 6 of 1 I
I
OFFICIAL INSPECTION:FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.0
SYSTEM INFORMATION
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA
Date of inspection: Tom&Judy Dowd
April 29,2003 FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 2 Number of bedrooms(actual): ,2
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2 2 0
Number of current residents: 1� _
Does residence have a garbage grinder(yes or no): No
Is laundn on a separate sewage system(yes or no):/_vo (if yes separate inspection required)
Laundry system inspected(yes or no): tN,y
Seasonal use: (yes or no):
Water meter readings, if available(last 2 yearslusage(gpd)): 6►-o z. = 6 yoO s r/toti u _ o 3: 58,oa
Sump pump(yes or no): rvo
Last date of occupancy:
COMMERCIAWINDUSTRIAL '
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 es or no):_
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as pan ofof the`inspe (yes or no): ,v(,
If yes,volume pumped: gallons-- How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank, 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: I G/Ian+ K (Ah� �10'k PST 'IU �IJ F{i{ _ L(.i..✓� �Jt t :N 4. ) 4..J�R � h //S�
Were sewage odors detected when arriving at the site(yes or no):wo
,.0
..
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA
Date of Inspection: Tom&Judy Dowd
April 29,2003
BUILDING SEWER(locate on site plan)
Depth belo�% grade: /9"'t
Materials of construction: [cast iron _/40 PVC ✓other(explain):
Dkiancr fron: private water supply well or suction line: . Al/a —
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: . )1)"
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)
Dimensions: /000 g�/to L
Sludge depth_
Distance from top of sludge to bottom of outlet tee or baftle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: G
Distance from bottom of scum to bottom of outlet tee or baffle: .
How were dimensions determined: /"11--
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet
invert,evidence of leakage,etc.):
Cow w�.� .tae v �a.�, d i 4•!0•�/�; ti S 3�rJ�<✓..._._/�/o .1��,. v_rC Aers,(�y.e
1-eQ ?u " ._<+, _ TG...k
GREASE TRAP:_(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiZlaeneother
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffl
Distance from bottom of scum to bottom of outlet tee
Date of last pumping:
Comments(on pumping recommendations,in and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leak e,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA '
Date of Inspection: Tom&.Judy Dowd
April 29,2003
TIGHT or MOLDING TANK: • (tank must.be pumped at time of spection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiber ss_polyethylene other(explain):
Dimensions:
Capacity: gallons,
Design Flo%%. gallons/day
Alarm present(yes or no):
Alarm level:_ Alarm in workin der(yes or no):
Date of last pumping:
Comments(condition of alarm an oat switches,etc.):
DISTRIBUTION BOX: (if present must be opened)( ate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to tlets 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):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,co ttion of pumps and appurtenances,etc.):
� x
.8
Page 9 of 1 I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA
Date of Inspection: Tom&Judy Dowd
A ril29 2003
SOIL ABSORPTION �YSTtM(SAS): (locate on site plan,excavation not required)
If SAS not located explain'w•h):
Type
leaching pits,number: I- x t ' L,-.-,t P• r �., IZ 2• S )z>h�• J- c�Y �.�. b to�r� P,"}
leaching 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.):
or. , : r /oc - •
w
LIU *I, �- I •-.:t � h.c:..•cr n, t. �c W.i. -� wa i v ....R .✓.-1'{ /-I O ✓G' ww�c./ /Jr..-S�-h'>R—
t"1�/<.r �' L.+ '•� v,J (� e-�C..e_. o / riJ I.e"h 1 I ti
CESSPOOLS: (cesspool must be pumped as pail of inspection) cate on site Ian bud ��
G q u c.✓•o ...;..cam U✓ W ria y�..�
Number and configuration: _ ate/ {_ h�✓� ww�h-hl
Depth—top of liquid to inlet invert: _ �h t• �,.�`S o� /� c `
Depth of solids layer: f
Depth ofscum layer. _ P•�-- "9 �✓ sfw --�6� It lj
Dimensions of cesspool: ---- a 6!�`� r-+ .
Materials of construction: _
Indication of groundwater inflow(yes or
Comments(note condition of soil,sig of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction: _
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydrauli ailure,level of ponding,condition of vegetation,etc.):
n�
;{ " z
9
Page 10 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 Castlewood Circle
Hyannis,MA
Owner: Tom&Judy Dowd
Date of Inspection: April 29,2003
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.
i34X
2S,
35- -
i
y3
1Il O
1 II
i
Page 1 I of
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
26 Castlewood Circle
Owner: Hyannis,MA
Date of Inspection: Tom&Judy Dowd
SITE EXAM April 29,2003
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 32, feet Adjusicd high ground watcr clevation feet
Please indicate(check)all methods used to determine the high ground .cater elevation:
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 docurnentation)
Accessed USGS database-explain: d�, �� z v 2'A 3 Z y, wJ'
You must describe how you established the high ground water elevation:31
V 0 r
u
,30. 1 ,
Z 22
iq
This report has been prepared and the system inspected as of the date of inspection. This report is not a
warranty or guarantee that the system will function properly In the future. There have been no warranties or
guarantees,either expressed,written or implied, relating to the system,the inspection and/or this report.
. II
s-� COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad
DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector
ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119
TeaTicket,Ma.
(508)564-6813
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissi 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 26 CASTLEWOOD DR. HYANNIS MAP 273 PAR 065
Name of Owner ANNETTE SARRO
Address of Owner: C/O ATT.GOAGHEN&LANE 628 BROAD ST.E.WEYMOUTH MA.02189 � p'� 4�999
Date of Inspection: 3119/99
Name of Inspector:(Please Print)JOHN GRACI `
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
,
Company Name: John Graci Title V Septic Inspection
Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636
Telephone Number: (608)664-6813
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 inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:
X Passes The inpection is based on criteria defined in Title V
_ Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is
_ Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does
Fails not imply any warranty or guarantee of the longgevity of the
septic system and any of its components useful life.
Inspector's Signature: ( Date:3/19/09
The System Inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM NOW AND THEN MAINTAINED EVERY TWO YEARS.
revised 912198 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 065
Owner: I ANNETTE SARRO
Date of Inspection:3/19/99
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated
are indicated below.
COMMENTS:
System passes Title V inspection
B. SYSTEM CONDITIONALLY PASSES:
na 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.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not.
na The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
na Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
na The system required pumping more than four 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
revised 9/2/98 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 065
Owner: ANNETTE SARRO
Date of Inspection:3/19/69
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 the public health,safety
and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 31.0 CMR 15.303(1)(b)THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
_ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis 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,Method used to determine distance n/a (approximation not valid).
3) OTHER
nLa
I
revised 9/2198 Page 3 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 066
Owner: ANNETTE SARRO
Date of Inspection:3/19/99
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an 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 112 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 n1a.
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
X Any portion of a 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 I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds,
ammonia nitrogen and nitrate nitrogen.
X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure.
E. LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
°X 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)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 912/98 Page 4 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 066
Owner: ANNETTE SARRO
Date of Inspection:3/19199
Check if the following have been done:You must indicate either"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 None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates
during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined.Note if they are not available with N/A,
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or Industrial waste flow.
X The site was inspected for signs of breakout,
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption
System on the site has been determined based on:
X Existing information,For example,Plan at B4O,H,
X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[1 5.302(3)(b)]
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2198 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 066
Owner: ANNETTE SARRO
Date of Inspection:3/19/99
FLOW CONDITIONS
RESIDENTIAL:
Design flow.-M g.p.d./bedroom
Number of bedrooms(design): 2 Number of bedrooms(actual):2
Total DESIGN flow: M
Number of current residents:2
Garbage grinder(yes or no):NQ
Laundry(separate system)(yes or no): NQ If yes,separate inspection required
Laundry system inspected(yes or no).M
i Seasonal use(yes or no):J(Q
Water meter readings,if available(last two year's usage(gpd): nLa
Sump Pump(yes or no): NQ
Last date of occupancy: nLa
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow: n&gpd(Based on 15.203)
Basis of design flow: n&
Grease trap present:(yes or no):�lQ
Industrial Waste Holding Tank present:(yes or no): NQ
Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ
Water meter readings.if available:n&
Last date of occupancy: n&
OTHER: (Describe)
nLa
Last date of occupancy: n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
IlLa
System pumped as part of inspection:(yes or no):NQ
If yes,volume pumped nla gallons
Reason for pumping: Wit
TYPE OF SYSTEM
X 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)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other: n&
APPROXIMATE AGE of all components,date Installed(if known)and source of information:
1970
Sewage odors detected when arriving at the site:(yes or no): NQ
I
revised 9/2196 Page 6 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 066
Owner: ANNETTE SARRO
Date of Inspection:3/19/99
BUILDING SEWER:
(Locate on site plan)
Depth below grade: ILE
Material of construction:_ cast iron _40 PVC X other(explain)
Distance from private water supply well or suction line: TOWN
Diameter: nLa
Comments: (condition of joints,venting,evidence of leakage,etc.)
Wa
SEPTIC TANK: X
(locate on site plan)
Depth below grade: V
Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain)
Wa
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ
Wa
Dimensions: L 8'6"H 6'7"W 4'10"
Sludge depth: fi"
Distance from top of sludge to bottom of outlet tee or baffle: 2E
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: ic
-
How dimensions were determined: MEASURFn
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
SEPTIC TANK AND ALL COMPONENTS ARE STR TURA YSOUND-RECOMMEND PUMPING SYSTEM NOW AND THEN MAINTAINED
EVERY TWO YEARS.
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain)
Dimensions: n(a
Scum thickness: Wa
Distance from top of scum to top of outlet tee or baffle:-n&'
Distance from bottom of scum to bottom of outlet tee or baffle n&
Date of last pumping: Wa
Comments:
(recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
Wa
revised 9/2198 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 065
Owner: ANNETTE SARRO
Date of Inspection:3/19199
TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n&
Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain)
IVA
Dimensions: Wa
Capacity: nia gallons
Design flow: nta gallons/day
Alarm present: NQ
Alarm level:j3La_ Alarm in working order:Yes_No_ NQ
Date of previous pumping:, n&
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
Wa -
DISTRIBUTION BOX: _
(locate on site plan)
Depth of liquid level above outlet Invert:nla
Comments:
(note if level and distribution Is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
nLa
PUMP CHAMBER: NQ
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NQ ,
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
nta
revised 9/2/98 Page 8 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
I PART C
i SYSTEM INFORMATION(continued)
i
i Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 066
Owner: ANNETTE SARRO
Date of Inspection:3/19/99
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number: 1000 GALLON LEACH PIT
leaching chambers,number: -n&
leaching galleries,number: _n/a
leaching trenches,number,length: n&
leaching.fields,number,dimensions: Wa
overflow cesspool,number: 6'X6'BLOCK CESSPOOL
Alternative system: nla
Name of Technology: _WA
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE SAS IS FUNCTIONING PROPERLY-ALL COMPONENTS ARE TR r TURA Y SOUND-THE 1000 GALLON LEACH PIT HAS NOT HAD MORE
THAN 2'OF WAT
CESSPOOLS: _
(locate on site plan)
Number and configuration: nia
Depth-top of liquid to inlet Invert: nla
Depth of solids layer: n&
Depth of scum layer. nla
Dimensions of cesspool: n/a
Materials of construction: nla
Indication of groundwater: nfa inflow(cesspool must be pumped as part of inspection)n&
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Wa
PRIVY: _
(locate on site plan)
Materials of construction:nla Dimensions:n&
Depth of solids: n&
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
nla
revised 912198 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 065
Owner: ANNETTE SARRO
Date of Inspection:3/19/99
i
I SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes,into house)
n/a
�A It
Eu
t�
1J�
AA a
Aa
Q` 35 4
N4
U 33
61J '13
revised 9/2198 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 CASTLEWOOD DR.HYANNIS MAP 273 PAR 066
Owner: . ANNETTE SARRO
Date of Inspection:3/19199
NRCS Report name: n(a
Soil Type: n&
Typical depth to groundwater: n&
USGS Date website visited: n&
Observation Wells checked: NO
Groundwater depth:Shallow Moderate _ Deep _
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
_ Obtained from Design Plans on record
X Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
_ Checked FEMA Maps
_ Checked pumping records
_ Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
GROUNDWATER IS AT 12+FEET BY USGS MAPS AND CHARTS AND VISUAL.
revised 912/98 Page 11 of 11
_ TOWN OF BARNSTABLE
LOCATION &G, e-- (L010 C 1 SEWAGE #
cj
VILLAGE ASSESSOR'S MAP Cz LOT
I
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY do w5jg:�
LEACHING FACILITY:(type) p9e � i4y- Pam"(size)
NO. OF BEDROOMS PRIVATE WELL O UBLIC WAT
BUILDER OR OWNERS
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
b
f
d
C�
00, ��
� Q �
No..... Ut... Fps..... . .._...._.....
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN -OF BARNSTABLE
I
Allp iration for Disposal Works Ton union trrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (t,.4a.n Individual Sewage Disposal
System at:
....... ,(�__... .. M.Q..`�?lLa .................. r .. !!�-�1--- ---------------------------------------------
motion-Address or Lot No.
---...._.._- _�21E1t1.---- P-.- .............................. ----•----------- -1 S1.. ............................................--........
Owner ` gdllress
Installer Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms.___._?j_.................................Expansion Attic ( ) Garbage Grinder ( )
F-+
'4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria
04 Other
WDesign Flow_________ ________________________________gallons per person per day. Total daily flow......_c,,._ ........................gallons.
W Septic Tank—Liquid'capacity.__.________gallons Length................ Width---------------- Diameter................ Depth................
x Disposal Trench=No_____________________ Width.................... Total .....
Disposal Total leaching area......_.............sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-� Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 -•-•-------------•••--•-•---•-----------------•-------....-----.._..------------------------•-------..........................................................
0 Description of Soil____________________
x
�.,
w =------------------- ----------------------•------------------•-•------------------------------------------------------=----------•-------•••---•--••••--•-•-•-•---•---------------------------------••--
UNature of Repairs or Alterations—Answer when applicable_._. _ ......-_ _ __ .-G_.___ _1.'r___ ...........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Com liance has been issu bo d of health.
Signed ............. ...-- .................. - -------- ..........................
' D�
te
Application Approved B .�n/,- >
PP PP Y .-. ...--.. e y,
Application Disapproved for the following reasons: .-'-------------------------------------------------------------------"--------=---......:-...--------.-........-........-...-........
:..-... ----------------------------------------------------------------------------------- ----------------------------------------
Daze
:: .--.°-:Permit No. ........... �-.................-- Issued ...........------------------...--..--..--..--....------------------
Dace
9 � !
�No.......�6_. ._ Fzs.._..S3
THE COMMONWEALTH OF MASSACHUSETTS D k-
BOA RD- OF HEALTH ���°
TOWN OF BARNSTABLE
Appliration for Diipoottl Works Tonftrtion Fam t
Application is hereby made for a Permit to Construct ( ) or Repair ( L.-an Individual Sewage Disposal
System at:
In � t - ............... .........� I � � �. � ..........................
Lopation=Address or Lot No.
......................t _ ?^.......:�,�` ....alb/---•-•----•---.._..--•-•..... .................. . ... ..............................................
,.-.......... i.t Address
W ............ .... ®�_ .1 ..1ie = �(- f` ll'�fi' ....6....... . -
Installer n Address
Type of Building Size Lot............................Sq. feet
U�1 Dwelling—No. of Bedrooms______ _____________________ _____Expansion Attic ( ) Garbage Grinder ( )►�
Other—Type e of Building No. of ersons____________________________ Showers
0.t YP g ---------------------------- P ( ) — Cafeteria ( )
a Other fixtures _..-•-••------- ------•------- -
Design Flow............ .............................gallons per person per day. Total daily flow____._. 3.6._._____................gallons.
Septic Tank—Liquid'capacity._._._..____gallons Length................ Width................ Diameter---------------- Depth................
Wwl
Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test Results A is Performed by J -__ a ________________________ Date........................................
Test Pit No. L_._._ �.____mmu ,,Per inch' iDepth of Test Pit'y .............. Depth to ground water----------------- -----
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ..................... /
O Description of Soil....................................... ` I
--•••/-
x
V --------------- --•-----....-----------•----...-•--------------...•--••----------------
W
U Nature of Repairs or Alterations Answer when applicable ��e ........
.• -----f......................................................
Agreement: V
The undersigned agrees to install°the aforedescribe&-Indiyidu1,Sewage Disposal System in accordance with
the provisions of TITLE.5 of the State Environmental Codef�--The undersigned further agrees not to place the
of Compliance has been issugd b y=the boa d f health.o „system in operation until a Certificate .�
r
.. �j
L 7 _mare`
A licauon Approved B r........=^..... \t ¢ A ...--�/ c7
PP _. PP y -- Date
Application Disapproved for the following reasons:' . .................................................
% -
r
................................................. ..---...----------- ...
:....... '........a...............:..Dace...... .. Daze.................
PermitNo. �i1....."._ �................. Issued ----------------------------------------- .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ./
TOWN OF BARNSTABLE
C�ex#tf 4ate of ( uLm finnrj�
THIS IS TO CERTIFY, That the Individual Sewage Disposal System c o Eructed ( ) or Repaired
by ..........................G.�4..Qr .1z4.. - .......
Installer w
at .......................... ..........0.. .... ....: .....
. ............................
has been installed in accordance with the provisions of TITLE 5'of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ....... ...: ........... dated ...f' .. '.. ..--.....-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BI CONSTR F AS A GUAR 'NTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATEI�.- / q--P................................................................ Inspector./. f' t .-... ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
nn TOWN OF BARNSTABLE
No...�(J....� - FEE... .C ...r.
Disposal Murky Tuntrudiun prrm t
Permission is hereby granted....... . .�� . ._ °.�.( �. ..................
to Construct ( ) or Repair ( ,-)--an Individual Sewage Disposal System
at No...............04-:_..........11_..12 ... �.
.................••-••-----••-••-.._............_.
Street
as shown on the application for Disposal Works Construction Permit No.!��Dated.__._,. .:72.1!.7.f ..........
�oard of Healt".
e
DATE..... .........................................
FORM 36508 HOBBS&WARREN,INC..PUBLISHERS