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HomeMy WebLinkAbout0035 CASTLEWOOD CIRCLE - Health 35tCASTLEWOOD�CIRCI;E;��HYANNIS A�,� a�3- ash - . � �� � '��: � - r . � , �. � --- - __ — ---- --- -- ,_ . .. .��. o .. o _ ..: s_ _. ,,___ _. _ c o 0 o o � a �' � �� ° � o � o I o i e o i ° v J a o '. �' � � � � � o 0 o G � � � o i �� o � I r � ` �� o 0 0 0 o � �� � � � � ��� .�� o � o a o ti � a v p °a i e �� � � � i� o � �. � o o o �;�i o � o ��� � � � 1 TOWN OF BARNSTABLE LOCATION 35 Q A5-M.&Ztrtl� Cte SEWAGE# 10 VILLAGE Aq A J fJ ( S. ASSESSOR'S MAP&PARCEL Z'i 3 ^�' 58 INSTALLER'S NAME&PHONE NO. 2000—T Q• 0c,2 ( 60 )T4'7?-S B-7j7 SEPTIC TANK CAPACITY n(0 LEACHING FACILITY.(type) size) _IZ•S X ZI NO.* OF BEDROOMS 3 OWNER t L PERMIT DATE: COMPLIANCE DATE: 3 Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ® Feet Private Water Supply Well and Leaching Facility Of 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 vE,✓T- GA9-AG-E N - H A k7i No. Zoz 1 —3 1 b Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS , fipfitation for Disposal *pstem Construction hermit Application for a Permit to Construct( ) Repair( ) Upgrade($) Abandon( ) ❑Complete System ❑Individual Components ,J- Location Address or Lot No.:3g Cc,641eW00Cj CtrG C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �73 �� nt i�Our`�^e �-• i-���1 ' Installer's Name,Address,and Tel'No. Name,Address,and Tel.No. Ro6e4 % Ov r Co Jam,H, Co -Ex-cH KS' &- 6 J-1 Type of Building: '7 Dwelling No.of Bedrooms 3 Lot Size 0a7 sq.ft. Garbage Grinder( ) Other Type of Building Vp.c; 114 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3.3o gpd Design flow provided 3,36° q gpd Plan Date 7 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Me C M �Qn( 65ee an Nature of Repairs or Alterations(Answer when applicable) (� new svo cj Lj LT Date last inspected: Agreement: t �' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the onmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board h. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons i Permit No._ ?/(}ai I .�'�1 a Date Issued ' No. Zd�- -310 . j 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pphration for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(J) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3.5, N4 If wood cifit t Owner's Name,Address,and Tel.No. r Assessor's Map/Parcel � 3 �$ hytdlt�OV;4n!j AegI Installer's Name,Address,and Tel.No. 6-Og-1}77-0 7 Designer's Name,Address,and Tel.No. R06e4 $ Our- co 343 Wh�ks ?�, F-co -kecH ►SS tev Rd c►w� l+�.,►� Type of Building: m 4�1k 7 7 ` 33-5 — S 13 r Dwelling No.of Bedrooms 3 Lot Size Da sq.ft. Garbage°Grinder( ) r Other Type of Building Q�c��s�^.� th� No.of Persons Showers( Cafeteria( ) r Other Fixtures Design Flow(min.required) 1930 gpd Design flow provided ���•q gpd Plan Date 7 Number of sheets I.-L. Revision Date r Title "W Size of Septic Tank Type of S.A.S. Description of Soil Maw j)nn • 4c'^tr Sep P&^ Nature of Repairs or Alterations(Answer when applicable) SDO Ac, 110 b t 46 a 6 a to Sp 'Date last inspected: Agreement: - I The undersigned agrees to ensure the cons70nmental ction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En Code and not to place the system in operation until a Certificate of Compliance has been issued by this Signed , Date ! / Application Approved by Date / Application Disapproved by Date for the following reasons -Permit No:4- ?i it Date Issued �. / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS,, Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) „� Repaired( .� Upgraded( ) Abandoned( )by 1�01b*4 a Ovr~ at CG.4`,�9-wo0a Cle cle has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No. _1 dated id 2 I + Installer Re)bo,� A our C.o Designer Dr y iU Cri V41�0\� n O W Q-- #bedrooms b Acne M Approved design flow DO O gpd The issuance of this permit shall not be construed as a guarantee that the system will funct•o as designed. Date Inspector e V ` THE COMMONWEALTH OF MASSACHUSETTS_ f PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal l6pstem Construction Permit 01 ! Permission is hereby anted to Construct Repair Upgrade Abandon .. Y!� ( ) P (tom Ply' ( ) ( ) System located at 15 !G&S449 C.1 r-c and as described in the above Application for Disposal System Construction.Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons •tioninust be completed within three years of the date of this permit. 1 Date �0 L Approved by 1 r Town of Barnstable Regulatory Services Richard V.Scali,Interim Director • anisr, t,e, AS& ��$ Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3 Z I Seivage Permit# 0021 —3 9 y Assessor's Map\Parcel '17 3 - 5 8 Designer: 0Av0J Q . (oV&-H4 i 0 W 9- Installer: &( aL CC). Address: 155 Gea lZ yt(eK R Soy kh Address: :S(p3 t'Z�+tTEw VAT C h Et t h g rirl VI'1 D Z6 3 3 WAR bVtOIAMA � Mk O `A On 18 _ mil f> • dcr1— was issued a pennit to install a (date) (installer) septic system at based on a design drawn by (address) ��iV,� ►). �pv l,g, l , AS dated TJl y Z 9, Z(J L l t kew &/1 712► � / (designer) 1 V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constnlcte ,� cc with the terms of the I\A approval 1 ters(if applicable) o� DAVIE--At cyG� COt1GHAN0WR N (Installer's ignature) No. 1093 � F Q (� 901STE (� (Designer's Signature) (Affix Designers Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. Q:\Septic.\Designer Certification Form Rev 8-14-13.doe e e ,, 01Rp 0)73 0 No. pr _ ar a( 0 ! Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for �Digozal *pgtern onotruction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location AAkoress scy 3 jet�v0 n �y�� O ner's Name,Addre s and Tel.No.l �( (v �It � Installer's Name,Adore&W thINCO Designer's Name,Address and Tel.No. 350 Main Street >1 W.Yarmouth, MA 026,73 Type of Building:_ Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow :330 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Na re of Repairs or Alterations(Answer when�a plicable) ffo I— D t 1 1 /` Qoc) a-r-dgYL 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 of ealt Signed Date Application Approved by Application Disapproved for the following reasons Permit No. �r�— ��a Date Issued 7 — 0 —7G ;�:♦.....it.,..�_ tom.. y. ;n-.i �.��-�v u.':^t� u1�c,'�...,.,ti�.� ..-r`rT'-.'wn..Yn�� �`' �,,,�/�J D..-,. p� � .-'^-r .►M-?•,�ice. a+- r .._-� r_�" +-' .mil 4 °' Par O S? ; b� Fee''• ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE., MAS$ACHUSETTS fication for ig ogar *pgtent ongtruction Permit U Application is hereby made for a Permit to Construct( )or Repair( )an'©n-site Sewage Disposal System at: % cam.!,.`. • ..% «.• s Location A ss o of No. O ner's Name,Address and Tel.N0; / 3s C/`}setcJuv� G�;r �ra 11 C��yma� W A nn 13 Installer's Name,AddAs"TdCAN`'Q Designer's Name,Address and Tel.No. 350 Main Street N l W. Yarmouth, MA 02673 1 • I Type of Building: Dwelling No.of Bedrooms % 3 Garbage Grinder( ) Other Type of Building �' t` '` No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -196 gallons per day. Calculated daily flow 190 gallons. Plan Date y/14 Number of sheets Revision Date Title Description of Soil Na re of Repairs or Alterations(Answer when a plicable) !1 I - ( J 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 of ealt Signed 'Date 7-2 U- 9l Application Approved by 1 Application Disapproved for thY following reasons _ J Permit No. ��� - � �� Date Issued 7 - 1 0 L THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or re 'red/replaced(�n by GD for cSi4-1/(/ 6 V/YIAn as 1 -- .� -� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: No. Fee -/A THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE-. MASSACHUSETTS Ji5poga[ *p!tem Construction Permit Permission is hereby granted to to construct( )repair( .,<an On-site Sewage System located at f /C y 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. All construction must be completed within two years of the date below. Date: 7 Vo— Approved by ^ CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL i NVORKS CONSTItUCI'ION PERMIT (WI'1'11OU'I' DESIGNED PLANS) i 1, hereby certify that the application for disposal works construction permit signed by me dated "7 66 concerning the property located at ���(z G ��'' meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system There are nb private wells within 150 feet of the proposed septic system _'o The observed groundwater table is 14 feet or greater below the bottom of the leaching facility ° �- There is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER ]Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan; this plan should be submitted]. c3 350 Main St. • W. Yarmouth, MA 02673 • 775-6264 Division o/Canco Energy Corporation Septic Services • Pumping a Installation ISQv 5'l �8 <L�\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C�s'Ale mo(9cl C t Property Address 0 41-0✓1 O`v ner ON ner's Name information is I1 L�' 1 60l Ao? required for every page. Cityfrown State Zip Code Date 6f Ir spection 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. tnpo out forms:When filling out f A. General Information on the computer, use on the tab 1. Inspector: key to move your cursor-do not kee,the return Name of Inspects _ �y �� 0 Company Name Company Address GS / Gi wl � t%o) �7� City/Town I I State 'qF) —�C2 Zip Code Telephone tuber j License Numrber B. Certification 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. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title7passes MR 15.000). The system: ❑ Conditionally Passes ❑ Fails ❑ Needs rther Evaluation by the Local Approving Authority /zx- - 211,-/--? Inspector' 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 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. ****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. t5m 3/13 7i0o501ficid lrepxtmFa u uface Sewage Disposal System•Pago 1o117 - r ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �ciS T/�G✓OoCr CI ✓' Property Address 1 AN ner ✓-✓� information is Qv ner s Name / required for every 4 h✓1/i oc),to O I -3 page. City/Town State Zip Code Date of Inspectio B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System sses: 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. 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): t5ins•YY13 TIUe 5 official Iris pec6m F arm Subsirlace Sewage Disposal System•Pape 2of 17 t. r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w0C.9 C� c l Property Address Cw ner Cw ner's Name Information is / required for everyL7/ page. City/Town State Zip Code Date of Inspecti n B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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): 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 mannerwhich 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 15^s 3113 Title501fiaal Inspection Form Subsurface Sewage Disposal System•Pape 3of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 2-5 C�s�ktt/00 CC Property Address AIVVIS41-0✓1 Cw ner Cw ner's Name information Is required for every ✓1v1y 0�6�� �� �� page. cityfrown State Zip Code Date of If pection B. Certification (cont.) 2. System will fall 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. 3. Other. 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 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 ❑ L—�/ Liquid depth in cesspool is less than 6" below invert or.available volume is less than day flow ism-3!13 Ti0e5Official lrspecdcnForm Subsurface Sewage Disposd System•Peg 4of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C45 I le(ILIOC9 c/l C/ Property Address Ow ner ON ner's Name information is 4,V1 04 yf required for every page. Cityrrown Stale Zip Code Date of ns ction B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Er""' Any portion of the SAS, cesspool or privy is below high ground water elevation. Cl Any portion of cesspool or privy is within 100 feet of a surface water supply or —/ tributary to a surface water supply. ❑ L� 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 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.] ❑ e system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g pd. ❑ The system fig. 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: 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 D. 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. i5ns•3113 , - Tide 5 Official Inspection Form Subsulwe Sewage Disposal System-Page 5of 17 ' I t Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address �� _,( GS / 1-06V49c9 C/ Ct li' Ow ner Owner's Name information is OC).CO/ required for every G✓1 ��, page. City/Town State Zip Code Date Inspec ron C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes o ❑ 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 Gently 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? ❑r,//❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): o 15irs-3113 TWA S Official lnc pee uon F orm Subsul ace Sewage Disposal S}stem-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form T Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . Property Address Al-d"1 /off Cw nor Cw ner's Name information is X/cl ���I j ���O required for every page. Cityfrown State Zip Code Date of In pection D. System Info r ation Description: 000 6—c`/0P1 C' l l� Cj 17 It, Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection �] Yes No information in this report.) Laundry system inspected? ❑ Yes Leo Seasonal use? ❑ Yes C-Y oo Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date m Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes No Water meter readings, if available: 15ris-N13 Title 5 Of WEI Ins pecticn F orrrt subsirf ace Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts T P-m;,Nm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �� CGSf��G✓00� c/ ✓� Property Address Ow ner Opr ner's Name information is / required for every page. CByr row n State Zip Code Date of Inspec ton D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information �"L Pumping Records: / u� � Source of information: �(/v Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of S sfem: 'Septic tank distribution box soil absorption system p. rP Y ❑ 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): 15re•2l1 J - Tide 5 Of A cial Ins pec Gm F am Suburf ace Sewage Di sposal System•Page 8 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage`Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Owner's Name >/ information is required for every G`✓1 d1/s- page. Cityfrown State Zip Code Date of I spectio D. System Information (Cont.) A(1^4 Approximate age/of all components, date installed (if known) and source of informali n: R of !✓ � +Q�9 N—z � �— S . Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet J Material of constructi;'40 ❑ cast iron PVC ❑ other(explain): _ l Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, eHdence of leakage, etc.): Septic Tank(locate on site plan): ^ l� Depth below grade: feet /J Z0Matednal o nstruction: ncrete ❑ 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: Sludge.dept h: t9re•_313 Tide 5Official ins pocUonFumSubsuiacese9 aoisosalS tem• s � P Ys Page 9of 17 • { Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �S Cis f�ec�oo� C i y' Property Address Cw ner ow ner's Name information is c;1,40/f mot 60/ 2z/�±k-T required for every h�v page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 (� How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): P(4 v-7,4�71 P7 fi 4q)-� f�e�e C_7 t-1 , G r^ // q 0 t-/ 1' �� J�c/ CC) , 'Iz//7i0✓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 t5ins-31113 riae501ficiai inspactionFcrm Subsurface Sewage Disposal System-Page 10d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ 6�,57'-Iet-voo c/ C/ Property Address Al ews4lo 0'z:�-2 ON ner ON ner's Name Information Is G���f � h O /� ? required for every Von ✓ page. Cityfrown State Zip Code Date of Inifpection D. System Information (cost.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Alarm present: ❑ Yes ❑ No Alarm level: Alarm in wonting 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 Ens•3113 - Me5OfBclal irepecfioiForm.Subsulace SewageOispcsal System•Page 11 d 17 i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J� CGs Alewo o �1 C ✓1 Property Address Ow ner Owner's Name information Is required for every 61 114 /S r,)601 � page. CityfTown State Zip Code Date of lv4pection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert �e P7 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.): S� s 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Ons•Y13 NO50ficial Ins pocGmForm Suosirface Sewage Disposal System•Page 12of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ory ner ON ner's Name n ) information isA� required for every page. City/Town 0 State Zip Code Date o Inspection D. System I formation (cont.) I Type: - -tzlVy'��/ IAII1 T Q Gl ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): sNe a h d �O / / •P�r r/I G vl C / ( -7f 0 11 (J/a w / G o,► 114A-e 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. " 1 l5ns•3r13 Title 5Official IrispecticnForrn Subsurface Sewage Cisposal System-Page 13d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessm,nts �s G1zu�1ewov C/ G� r Property Address �✓"f f' /O N 4-7 Ow ner Ow ner's Name information is required for eery page. City/town State Zip Code Date of nspecti n D. System Information (cont.) Comments (note condition of soil, signs 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 hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins•y1J Title 5 Official Ins pecGcnFcrm Subsurfaco Sewage Disposal System.page 14of 17 Commonwealth of Massachusetts --- -= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments llebl,100 � C� Property Address /per i Cw ner Owner's Name information is O Q /� required for every ,4 / page, Cityfrown State Zip Code Date of In pection D. System Information (cont.) 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 pu c water supply enters the building. Check one of the boxes below hand-sketch in the area below ❑ drawing attached separately F A a 2 y Ga - 3 8 C-3 c� _3 - aC), Ons-3113 'ri0e501ficial Inspection F orm:Subvulace Sewage Disposal System-Page 15 of 17 r Commonwealth of Massachusetts HMO Title 5 Official Inspection Form Fj Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments Nv�tj �S Cat j�12 WOIJ�C' C( W Property Address OH ner Owner's Name information is 1 required for every �G✓r'f page. Citylrown State Zip Code Date of I spection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. 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: pate ❑,/ Observed site (abutting property/observation hole within 150 feet of SAS) L� Checke with local Board of ealth -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must de OLA`be how you�9tybli�hQ the high ground elation_/,I, C PI O�) /O tit✓t c�(.✓ AC a PO 4? 0 -5- 62 W 7` tj o Ojc, Before filing this Inspection Report, please see Report Completeness Checklist on next page. .' 15i '3113 Title 5 Official Impaction Fcrm:Subsurface Sewage Disposal System•Page IS of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ _ b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �357/ G✓Oo� � ✓, Property Address Cw ner Cw ner's Name e information is required for every page. Cityrrown C71 State Zip Code Date q Inspectbn E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems) completed Ly' System Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ns•3113 - Title 5 Official Ins pectionFartr Subsirface Sewage Disposal System•Page 17 of 17 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION RECEIVED 35 Castlewood Circle Property Address:Hyannis,Ma Address of Owner: AUG 1�7 2000 (if different) TOWN OF BARNSTABLE Date of Inspection: 5/9/2000 HEALTH DEPT. Inspected by: James Holler I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Holler& Son Construction LLC Mailing Address: P.O. Box 702,Marstons Mills,Ma 02648 Telephone: (508) 420-0280 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: ®Passes ❑Conditionally Passes ❑Needs Further Evaltiation by the Local Approving Authority ❑Fails Inspectors Signature % Date: 00 The system inspector shall su ' a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, orD: A) SYSTEM PASSES: ®I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined", explain why not. E 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 exfrltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 B) SYSTEM CONDITIONALLY PASSES (continued) ❑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). Describe observations: ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑distribution box is leveled or replaced []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 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 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 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 APPROPRIATE)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 to 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 1 of a public water supply well. ❑ The system has a septic tank and soil absorption system and the SAS is with 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 (approximation not valid). 3) OTHER I ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 D) SYSTEM FAILS You must indicate either"Yes"or"No"as to each of the following: ❑I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to 15.304.determine what will be necessary to correct the failure. 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. ❑ ❑ 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. ❑ ❑ Any portion of a cesspool or privy is with 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 with 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes"or"No" as 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 ❑ ❑ 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. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health. ® ❑ 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. ® ❑ As built plans have been obtained and examined. Note if they are not available with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up. ® ❑ The system does not receive non-sanitary or industrial waste flow. ® ❑ The site was inspected for signs of breakout. ® ❑ All system components,excluding the Soil Absorption System,have been located on the site. ® ❑ 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 or the Soil Absorption System on the site has been determined based on: ® ❑ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. ® ❑ Existing information,Ex.Plan at BOH. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 i FLOW CONDITIONS RESIDENTIAL Design flow: 110 gpd/bedroom for SAS Number of bedrooms 3 Number of current residents:5 Garbage Grinder:No Laundry connected to system:Yes Seasonal use:No Water meter readings,if available (last 2 years usage in gpd):N/A Sump pump:No Last date of occupancy:Current COMMERCIAL /INDUSTRIAL Type of establishment Design flow: gpd Grease trap present: Industrial Waste holding tank present: Non-sanitary waste discharged to the Title 5 system Water meter readings,if available Last date of occupancy OTHER:(describe) GENERAL INFORMATION PUMPING RECORDS and source Owner System pumped as part of inspection Yes Volume pumped:1000 gal Reason for pumping:solids and floaiable levels TYPE OF SYSTEM ®Septic tank/distribution box/soil absorption system ❑Single cesspool ❑Overflow cesspool ❑Privy ❑Shared system(y/n)(if yes,attach previous inspection records,if any) ❑I/A Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information:8 years Sewer odors detected when arriving at the site:No SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of inspection:5/9/2000 BUILDING SEWER (Locate on site plan) Depth below grade 24 inches Material of construction❑Cast Iron®40 PVC❑other Distance from private water supply well or suction lineN/A Diameter 4 inch Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK (locate on site plan) Depth below grade 30 inches Material of construction®concrete❑metal❑Fiberglass❑Polyethylene❑other If metal list age is age confirmed by certificate of compliance Dimensions: 1000 gal Sludge depth:30 inches Distance from top of sludge to bottom of tee or baffle 6 inches Scum thickness 8 inches Distance from top of scum to top of outlet tee or baffle over inlet T Comments:System pumped by owner while inspection was occuring due to level of materials in tang: GREASE TRAP (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle Date of last pumping 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 leak,etc.) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued), Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 TIGHT OR HOLDING TANK:❑(Tank must be pumped prior to,or 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: GPD Alarm level: Alarm working?Q yes❑no Date of previous pumping Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:0 Comments(note if level,and distribution is equal,evidence of leaks or solids carryover,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,pumps,and appurtenances,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 SOIL ABSORPTION SYSTEM:(SAS) (locate on site plan,if possible,excavation not required,but may be approximated by non-intrusive methods) i if not determined to be present,explain: Type, leaching pits,number one 1000 gal pit leaching chambers,number leaching galleries,number leaching trenches,number&length leaching fields,number&dimensions overflow cesspool,number: Alternative system: Name of technology Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation,etc.) good leaching capacity,water level was 1 1/2 feet below inlet pipe CESSPOOLS:❑ (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 Material of construction Indication of ground water inflow(must be pumped as part of inspection) Comments:(note condition of soil,signs of hydraulic failure,ponding,and vegetation,etc.) PRIVY❑ (locate on site plan) Materials of construction: Dimensions Depth of solids Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation etc.) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two permanent references,or benchmarks,locate wells within 100'and where public water supply enters house. -F-0 Vv I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:35 Castlewood Circle,Hyannis,Ma Owner:Christian and Laurie Ieronimo Date of Inspection:5/9/2000 Depth to Groundwater ;>1 gfeet Please indicate all the methods used to determine High Groundwater Elevation: ❑ observed from design plans on record ❑ observation of site(abutting property,observation hole,basement sump) ❑ determine it from local conditions ® check with local Board of Health ® check FEMA maps ❑ check pumping records ❑ check local excavators,installers ® use USGS data Describe in your own works how you established the High Groundwater Elevation. (Must be completed) T ' c" TOWN OF BARNSTABLE LOCATION S ty"t/�t/46A) G�� SEWAGE #�� ��O ` VILLAGE IA14 IIIJA ASSESSOR'S .MAP & LOT 6 Sce ' 'INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY �DrDa G'r�l LEACHING FACILITY:(type)��1A) //,,,a A�/� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUIL•DER:OR OWNERS DATE PERMIT ISSUED: 7 - DATE COMPLIANCE.ISSUED: 7-/Z VARIANCE GRANTED: Yes No ��' �P .._.. -y. __ _�,,, e.. .� ._ � � r o � � . r f5. aF��„�c� �, o ._'. �-_ t ' WATER LINE �n •� WATER GATE O ? �ME 01$014 GAS LINE ELEVATION -Q GAS GATE O OVERHEAD WIRE-Qy— T 70.25 Op OF FOUNDP��O [ASSR OT 99 � '8.47 ft EA = 9027 sf+- 69 BOOK 197 PA - 97"�'r�ST�� MINIMAL MAP 273 PCL 58 co 17p? GRADING fT yI°J l/q PROPOSED / 70 / 0 ABOVEOROU SWImMI G .0 THIS IS A Poo �� COLOR 1, PLAN 'o 0 0 USE COLOR PLAN ONLY � / 70 / FOR INSTALLATION C FULL DETAIL IS BEST VIEWED IN W G FULL COLOR �Q G m G � O • Ole 0 FND \T`\ OAK" ^ " P O qVf� I O wA Y HQ �Nf/Z T �p ft \. Aq TO O A - — - __ ._ _ a E) 2 a acoVEHT P/PE 42fr O 78 98 ft L EGENIDD 69 I SEPTIC COMPONENTS EXISTING 1000 GAL 0 p� Q PROPOSED SOIL SEPTICICTANK DISTRIBUTION BOXY ABSORPTION TEST PIT ® SCALE: I in = 20 ft SYSTEM 20 40 -SEE DETAIL l ON BACK 0 10 20 EXISTING PLASTIC PRINT ON 8-1/2 x 14 In CHAMBERS E BE PAPER FOR PROPER SCALE ' PUMPED & REMOVED. GARB • VARIANCE REQUESTED °T MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. OW�� 310 CMR 15.221(7) - COMPONENT DEPTH TO FINISH GRADE. 36 in MAX REQUIRED - VARIANCE TO THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM 60 in OF COVER REQUESTED. DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS.FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. a HYANNIS. MA SEWAGE DISPOSAL s, r ��;1 I b;f. �H Of �c `H Of SSA SYSTEM PLAN T ° ° 1 DAVID yGJ, DAVID OyGJ, -TO SERVE EXISTING DWELLING D. D.CO COURTNEY UGHANOWR can u v No. 1093 No. 461 x L. HEAL Y r, a mg'. wn -� °s ✓�_' PF �� IOWNERIS] OF RECORD �; � EVA�U n;eactP�d SGpt� SojgP�o� 35 CASTLEWOOD CIRCLE =p ° .*4, G ,� HYANNIS. MA .�a ,� 1 4/c 155 Geo Ryder Rd S PROM RTY ADORE•S"S 6d -SL as2 V' T17L Chothom, MA 02633 "`"'`� Dovidcou®HotmoiLcom 17AT'E; DULY 28. 2021 rL O C V S M A REVISED AUGUST 17, 2021 508 364-0894 PG.IiZ �os� ETE-4579 —08/17/2021—10:19 AM— Scale 1:24.5292 DESI N C(�A�LdCULATIOO NSA` SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE *461 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD WITNESSED BY: DONALD DESMARAIS, HEALTH DEPT. SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT PAC AT 50N n - 2RMINlNCCHrINERD CESOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT, INSTALL 69.10 INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 66.43 10-32 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: 32-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 58.10 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES TEST PIT 2 NO GROUNDWATER ENCOUNTERED PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. - 2 MIN/INCH IN C SOILS THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DEPICTED BELOW CAN LEACH: 68.90 INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE BOTTOM AREA = (24 x 12.5) = 300 sq. ft. 66.40 10-30 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 sc. ft. 30-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE TOTAL AREA = 446 sq. ft. 57.40 FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day p /�L� INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 100o 0o GALLON SEPT§C TAN BELOW. FLOW CAPACITY = 330.04 gal/dog WHICH EXCEEDS EXISTING UNIT - DIMENSIONS & DETAIL THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN. TANK TO BE PUMPED DRY AT TIME OF INSTALLATION � AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL S 0§L A§E3 S 0E-?P T§OUV NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. REPLACE WITH A NEW SYSTEM CONSTRUCTION DETAIL I in 1500 GALLON TANK USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL TAPER IF CRACKED. ROTTED OR OTHERWISE DRYWELL 24.0 ft COMPROMISED. UNIT CR O ©O a+ of w w w 41 NOT U) 0 O amok In f TO SCALE N N m ft �� I M� STONE" t 8 ft-6 %n 3.5 ft 8.5 ft 8.5 ft A { 5 INLET OUTLET 500 GALLON DRYWELL COVER COVER DIMENSIONS & DETAIL - - -- - - -_ INSTALL ONE INSPECTION 3 IN DROP RISER TO WITHIN THREE —► /l FLOW LINE INCHES OF FINAL GRADE FROM = .-- & INDICATE LOCATION 10 in = 14 TO ON AS-BUILT BUILDING - '^ D-BOX 48 in p� 36 00 LIQUID GAS o0 01 opp in LEVEL BAFFLE no- _oo���o� 000 � usE ��C�pgaOtOO OO \� RATED L-71W­SYONE BASE IF NEW GJ� UNITS 102 in SEPARATION BETWEEN INLET & OUTLET TEES NO LESS THAN LIQUID DEPTH CROSS SECTION VIEW CROSS SECTION VIEW INSTALL AN APPROVED GEOTEXTILE—\ FABRIC OVER STONE D§SS5� USE SHOREY e a U R§B T§OUV BOX DB-3 H2O 3/4 In TO a 24 In a 3M In TO DIMENSIONS PIPES EXITING D-BOX TO RUN LEVEL 28 1-1/2 In GRAVEL EFFECTIVEo ►-I/2 in GRAVEL AND DETAIL FOR 2 FEET BEFORE PITCHING DOWN in a DEPTH e 46 in 58 in 46 in P' M m i 150 in IN ' Lr) O I S -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE N TANK u� b f 5� STARTING WORK. ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). O-TECHt� MENDS THE 6 In STONE BASE -EC OF LOW FLIOWESPONSE FIXTTURESR& APPLIANCES. AND SPERIODIC ON 21 !n 2� CROSS SECTION VIEW PUMPING OF THE SEPTIC TANK. -SEPTIC TANK NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC TANK. F W p 'F`\%) O 0 C TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO 4 in BE SCH. 40 PVC VENT EL = 70.25 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 In/ft MIN PIPE 6 9.00 D-BOX 5' USE MAX RATED EXIST��3 USE H-20 65.50 UNITS EXISTING 1000 (GALLON you, PRECAST oo� o`a 0 0 00 'rg' 6 in SEPM TANK 66.0+- p� �0ooa� DRYWELL IN,, 64.50 EXISTING REFER TO DETAIL BOX STONE SCHL ABSORPTMN + 64.67 BASE 64.40 M 2n� 6 In STONE BASE IF NEW S u 'STE u -REFER TO 4- EXISTING 87 ft 5-12 ft DETAIL BOX q A ) Af) NO GROUNDWATER V kn BELOW MOTTLING OBSERVED _ 57.40 SEWAGE DISPOSAL SYSTEM PLAN1135 CASTLEWOOD CIRCLE HYANNIS. MAIIJULY 28. 2021 ETE-4579 PG 2/2