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HomeMy WebLinkAbout0074 CASTLEWOOD CIRCLE - Health as Hyannis P ` A = 273 071 6 i . Y it ° o y e � u 4 b. • 1 7 Y V TOWN OF BARNSTABLE �• LOCATION 47`'i (660Zev 'CV1^t)A-, SEWAGE# 7-o20 .-,w, IL-LAGE . ASSESSOR'S MAP&PARCEL 7-1� —"1 INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITYb LEACHING FACILITY:(type) (Zl (size) 2oX NO,OF BEDROOMS 2 OWNER �'� C®tz �ip VK t� PERMIT DATE: 1 a 3 12,0 COMPLIANCE DATE: hobo !'f 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 r C�L //TOWN OF ARNSTABLE LOCATION 741 6_5fle W-y L""-./' SEWAGE # VULLAGE_ _ S ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK-CAPACITY LEACPHNG-FACILITY: (typs)_=-K�'d 2 _a 6T S (size) 37 ,l'/U'X 1,6' NO.OF;BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility' Feet Private Water Supply Well and Leaching Facility (if any wells exist on site or within 200 feet of leashing facility) j: Feet Edge of Wetland acid Leaching Facility(If any wetlands exist within 300 feet 9fleachin fcili ` `r '�'' feet Furnished by ✓�Cj V ` � P IN �PP- 1 1 ``" 1 TOWN OF BARNSTABLE LOCATION. �� �S�ltuJoo� Ctr�� SEWAGE # 2003-359 V' ,LAGE c�in n i 5 { ASSESSOR'S MAP & LOT 273 ?/ Zns�-►ors The 3 'la+n�ZnSP� �AA'('od -508-055-13Y3 NAME&PHONE NO. � SEPTIC TANK CAPACITY _Il 000 LEACHING FACILITY: (type) $ inr%I+-ra,6cs 54ne_ size) 371X lcd J(,o`' NO.OF BEDROOMS 3 BUILDER OR OWNER _ROnaIa o r e trd s,►g ec+ion / PERMTT 12 10,12005- DATE: DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) NIA Feet Edge of Wetland and Leaching Facility(If any wetlands exist / within 300 fee eaching facili - N/ A` Feet Furnished by Tian k. -T%l�n W W N N o � a H T^ TOWN OF BARNSTABLE �GCAnON C�rSTf-� v�-� SEWAGE # V'ILAGE S ( ASSESSOR'S MAP&,LOT Z73-071 INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY __ �t7 v,!e=� fQV „ IQ LEACHING FACII.ITY: (type) �� a�VT�zUQ (size) r ?Cforl "NO-OF BEDROOMS J r6LDER OR OWNER L-- v,-� ERMTTDATE: 714 03 COMPLIANCE DATE: �3�. 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 Weiland and Leaching Facility(If any wetlands exist '^a within 300 feet of leaching facility) Feet Furnished by f i z 7� TOWN OF BARNSTABLE OCATION L-( G1 SEWAGE # VILLAGE 1- n10.1,IS ASSESSOR'S MAP Cz LOT INSTALLER'S NAME 6z PHONE NO. A & B CAWO 775-6264 'EPTIC TANK CAPACITY ,ow G a"KID LEACHING FACILITY:(type) (size) NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ®S� ! �O DATE PERMIT ISSUED: DATE COMPLIANCE*ISSUED: VARIANCE GRANTED: Yes No ''litlrf-7 �. . � i i— i � I I'1� � � 1, ��.� � � �' ��\ = I ._, w,�T�,.P �``, \ _. � � �� �\ I i sue' _ ;e: \�s I i � �\ I i � ; �-- --_��, I ' i' ' / ' � � � / .� � � , ; i � 1 �i i i �� i ' � i �., t No. +�V O ✓���( Fee -� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLatlon for Misposal *pstem Construction j3Prmit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components 4, j'._�0 A J �'��, Owner's Name,Address,and Tel.No.Location Address or Lot No. C 'L Assessor's Map/Parcel 2 y.n 16qry 61_lkln1 Cr r1 1-i Installer's Nye,6ddress,and Tel.No. ��?,�YVIA- p2 j Designer's Name,Address,and Tel.No. 364 06Q i?,Yv) fe r114- is; &;p 9 rr A,( 5o C*4,fh� o Type of Building: r _ Dwelling No.of Bedrooms Lot Size . sq.ft. Garbage Grinder(hO) Other Type of Building S 11JOe k5141* No.of Persons Showers( ) Cafeteria(. ) Other Fixtures /� Design Flow(min.required) LZo gpd Design flow provided 36 A gpd Plan Date 10120 I Number of sheets Revision Date Title ,nt' �► Z S9l ��r ���/11 Size of Septic Tank o ) Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) kq tl 4 0 h P r I! �fi 17t 'It,q P1k f' 1r�4em — 'i45imll -90j .6AIink- ±211ef-1 Per- pk.h 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 Certificate of Compliance has been issued by this Board alth. Signed` Date Application Approved by 1i Date 1103 Application Disapproved by Date for the following reasons Permit No. o Date Issued Z D No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS f plication for -Misposaf Opstem Construction Permit Application for a Permit to Construct( ) Repair(4pgrade( )'Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. P-7 i.yc 1'_w� / elrOwner's Name,Address,and Tel.No. TT77�' 1�Assessor's Map/Parcel 2 t N�4 Installer's Name,Address,and Tel.No. s�s'^s- !�—p.ZI p Designer's Name,Address,and Tel.No. 36¢'�v frMan4d IDVM�15 G�NJ'P/'✓I%le N+#� � GP�r$hanow So clr�Fh If D c.I G Type of Building; Dwelling No.of Bedrooms 2 Lot Size 7G65 sq.ft. Garbage Grinder(ha) Other Type of Building S ( y yp g I(!,� ' A54W No.of Persons Showers( Cafeteria( ) Other Fixtures /� Design Flow(min required) ZZ 0 gpd Design flow provided 33D .4- gpd Plan Date 1/2-3( Number of sheets 7 Revision Date Title�►r%P F)iC ps91 SvS)tl°Fy �Lgif ` t Size of Septic Tank Type of S.A.S. OFAII er J Description of Soil .es Nature of Repairs or Alterations(Answer when applicable) t6 r1 d D h 9$I<'1 Yitj?,14 r4o f S its` ft - �1-i sjoll -h o T ArVink for IM h , Date last inspected: r- 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 Certificate of Compliance has been issued by this BoaroYAealth. /'� Signed' yea. ._o Date Application Approved byzakl Date Application Disapproved by Date for the following reasons Permit No. 0 LI Date Issued 11 76 o ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) i Abandoned( )by at / r%4e►+®04 e^a r has been constructed in accordance , 2 with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 •mob�- dated 7 j ao Installer 140k�n ,� p ejj j)V'N► S Designer QYId 6ode#9Wr #bedrooms 2 Approved design flo, �j�j D gpd The issuance of this permit'shall not be construed as a guarantee that the system willr li nc ion as desi ed. / Date � )��J V Inspector�jI U r )_ ,1 t✓ f - ---------------------------------------------------------------------------------------------------------------------------- ---------- _ No. 17�. l�e14 Fee I QO, '•� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstetn Construction Permit Permission is hereby granted to Construct( ))1 Repair(%e} Upgrade( ) Abandon( ) System located at 74 �q l�til,� (fl (' 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:Construction must be completed within three years of the date of this permit. Date r I a�t a o Approved by A L �� I Town of Barnstable SHE 1 °4 °' .° Inspectional Services : .nMsrne,.e, ? Public Health Division Thomas McKean,Director 6yq. �0 °jan�uia 200 Main Street,Hyannis, VIA 02601 Office: 508-8624644 Fax: 508-790-6304 q Installer &.Designer Certification Form l Date: LI 20W Sewage Permit#I2f)2© 6--> Assessor's Map\Parcel Z1" C Designer: No A Q• (oV jh Li vjoWr Installer Address: 1 S (1d y of R4 SO Address: y On ZQ_ AS was issued a permit to install a (date) ` (installer) septic system at CS �c} �b� C., r based on a design drawn by (address) Oy.u;r /� d D, o�-pAxr r�awr dated 1 o (designer) 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 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 constructed i "-5 x with the to rms of IAA approval letters(if applicable) .,\V " 70 o RFDID COUGHANOWft t (Itista er's Signature) No. 1093 (Designer's Signature) (Affix Designer's 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. \\toAdcpu\FIGAI.rM%C-WEIt connecASGPTIMesism ccnirication Form Rev 8-I4•I3.I)AC � SOoiL TEST LoOG ' ' DIGNION CAL cCUILATIONSG SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE *461 DESIGN FLOW: 2 BEDROOMS X 110 GPD = 220 GPD WITNESSED BY: DAVID STANTON. HEALTH DEPT. TEST PIT NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 220 GPD X 2 DAYS = 440 GALLONS PERC AT 50 In - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL 66.00 INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 0-8 Ap . LOAMY SAND 10 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 63.00 8-36 Bw LOAMY SAND 10 YR 5/6 •NONE FRIABLE SOIL ABSORBTION SYSTEM: 36-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 55.00 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES NO GROUNDWATER ENCOUNTERED PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. 1 TEST PIT 2 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER THE LEACHING GALLERY DEPICTED CAN LEACH: INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 65.85 BOTTOM AREA = 16.5 x 21.33 0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE -1/2 (14.83 x 6.3) = 305.23 sq. ft. 63.02 10-34 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE SIDEWALL AREA = (16.5+6.5+16.12+ 54.85 4-I32 3 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 10.20+21.33)x2 = 141.30 sq. ft. I - - - --- TOTAL AREA = 446.53 sq. ft. FLOW CAPACITY 0.74 x 446.5 = 330.4 gal/doy 1000 -GALLON SSEPTM TANK. INSTALL THE LEACHING GALLERY AS CONFIGURED BELOW. FLOW CAPACITY = 330.4 gal/day WHICH EXCEEDS THE EXISTING UNIT DIMENSIONS & DETAIL 220 gal/day REQUIRED FOR A TWO BEDROOM DESIGN. J TANK TO BE PUMPED DRY AT TIME OF INSTALLATION AND EXAMINED FRINSTALL NEW PVC OUTLET TEET RUCTURAL EQUIPPED WITH AITY.GAS BAFFLE. 'S O#L A S S O U1T.P 0 NN REPLACE WITH A NEW S YS TEA], CONSTRUCTION DETAIL I in 1500 GALLON TANK TAPER IF CRACKED, ROTTED USE SHOREY PRECAST. 500 GALLON LEACHING DRYWELL OR OTHERWISE 14.83 ft 6.50 ft INSTALL TWO DRYWELL COMPROMISED. 0, UNITS AS SHOWN w �t WITH UP TO 4 FEET OF �b\2 STONE ALL AROUND. 0 / :. NOT h o TO ® �O MARK INSPECTION SCALE RISER WITH �0 NO ® h MAGNETIC TAPE. 8 ft-6 jn A �� I DRYWELL 21.33 ft` UNIT INLET OUTLET COVER COVER 500 GALLON DRYWELL 1,3DROP DIMENSIONSLINE INSTALL ONE INSPECTION RISER DIMENSIONS TO WITHIN THREE INCHES OF FROM - & DETAIL FINAL GRADE & INDICATE = 14 TO LOCATION ON AS-BUILT BUILDING ,� a_:��s �o -_mac, .� �;D,-BOX in �� USE QUID GAS pi' 33 H-10 VEL BAFFLE py�i' in UNIT STONE BASE SEPARATION BETWEEN INLET & OUTLET 1020 TEES NO LESS THAN LIQUID DEPTH CROSS SECTION VIEW CROSS SECTION VIEW INSTALL AN APPROVED GEOTEXTILE FABRIC OVER STONE 0§� 11 .111�#o V -rOOUV o o UDB-3 H20SE Y DIMENSIONS PIPES EXITING' D-BOX TO RUN LEVEL' AND DETAIL FOR 2 FEET BEFORE PITCHING DOWN 28 314 in TO o 24 in 314 In TO 1-112 in GRAVEL EFFECTIVEa 1-112 in GRAVEL in e DEPTH 12 /n MIN -► NM7 -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE Lr) FROM = = STARTING WORK. N TANK q 4) TO -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM p; ^ SAS QO REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC O CODE (310 CMR 15). t�LWCS�I.� usvpo W ; IJ -ECO-TECH RAPID RESPONSE RECOMMENDS THE INSTALLATION \ .\� 6 in STONE BASE (� OF OWMPING FLOWOF FIXTURES & APPLIANCES. AND PERIODIC 21 jn 2 CROSS SECTION VIEW -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. IF . . 0 p - 0 - G� 0 f� TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE 4 in SCH. 40 PVC EL = 67.26 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 66.00 -B0� 3 E MAX��O�� USE H-20- - 63.50(GALILO� PRECASTEXISTING O� �A�� 63.7+- 62.85 °o°�d°�8 DRYWELLEXISTING DETAIL BOX S6 in SM ABSORPTION = 63.02 BASE 62.75 REFER TO EXISTING 6 In STONE BASE IF NEW I6 ft 7-II ft SYSTEM DETAIL BOX 60.75 NO GROUNDWATER BELOW MOTTLING OBSERVED _ 54.85 SEWAGE DISPOSAL SYSTEM PLAN 74 CASTLEWOOD CIRCLE HYANNIS, MA JANUARY 23, 2 220 ETE-4429 PG 2/2 EXISTING SOIL ABSORPTION SYSTEM TO BE ABANDONED IN PLACE. WHERE OLD SAS OVERLAPS NEW GALLERY, THAT PORTION SHALL BE REMOVED LEGEND AND REPLACED WITH CLEAN MEDIUM SAND SEPTIC COMPONENTS PER TITLE 5. EXISTING S Ih 11 ed loon GAL S-1 I44� I�i'u_/ Ol U TaL.a T SEPTIC TANK r tl j,AjASJ o ' WATER LINE �o— DISTRIBUTION BOX ff / r e I� Q P_ F � WATER GATE O TEST PIT V2 ID "Q / GAS LINE ✓ 1 OAS GATE O THIS IS A OQ GARB, , OVERHEAD WIR off CoOLOR R OT UTILITY PLAN ` A OWED POLE USE COLOR PLAN ONLY FOR INSTALLATION -_— FULL DETAIL IS BEST VIEWED IN " FULL COLOR IAN ��A.�MSGS DA❑M ASSUyF ELEVATION 1 � /x° •66.20 OF C E 66 �_ ONCRET � 99.14 ft �� • _ 15 in OAK K LOT 97 AREA = 7665 sf+— rn LAND coa+r PLAN 24349—B r 0 0 ASSR MAP 273 PCL 71 ' (fin rn EXISTING SOIL b7 ® 00 ABSORPTION SYSTEM o m+ I A MINIMAL � � 1 rn Z D GRADING O - - —� < PROPOSED �7 © {O v 0 j 0 - A z X rn 15 in _ i 2 1E OAK W O ---- - - - - G ® S'H D ( Y/ / °� G PAVED DRIVEWAY 15 in (� G OAK �•--v O. Uwas �W 99.0�0 PROPOSED SOIL ABSORPTION 67 SYSTEM -SEE DETAIL PLAN ON BACK SCALE: 1 in = 20 ft 0 20 40 VARIANCE REQUESTED -- - -- — MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. + 0 10 20 310 CMR 15.2110) - SOIL ABSORPTION PRINT ON 8-112 x 14 in SYSTEM TO CELLAR WALL. 20 ft MIN PAPER FOR PROPER SCALE REQUIRED - VARIANCE TO 10 ft ✓ SEPARA TION REQUESTED. THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER HYANNIS, MA SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. 2 �y OFMgsS9 P`ZNOftilgss ���rc SEWAGE DISPOSAL ��, gNNOVQ o DAVID `yos o�`'`` DAVID 9�y�s ��V: S SYSTEM PLAN D• D. r ; -TO SERVE EXISTING DWEI LING q0 u COUGHANOWR n v COUGHANOWR Q �9 No. 1093 No. 461 G A R Y J. 9s ° ¢ L GRAHAM NOT OWNERISI OF RECORD SCALE m a 9 sy R 1 s° ALA �P° 74 CASTLEWOOD CIRCLE HYANNIS, MA p ISS Geo Ryder Rd S PROPERTY ADDRESS s Chatham, MA 02633 Davidcou®Hotmoil.com DATE: )ANUARY 23, 2020 LOCUS MAP 508 364-0894 PG.lI2 JOs- ETE-4429 AB�oE Town of Barnstable Barnstable d Inspectional Services altame;t;aciY1 V 1 a i 9 BARMbA7�ABLE,g! s639. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7787 May 14, 2019 GRAHAM, GARY J 74 CASTLEWOOD CIRCLE HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 74 Castlewood Circle, Hyannis, MA was inspected on 05/02/2019 by Chad Hathaway_, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\74 Castlewood Hyannis.doc Town of Barnstable • tinxtvsraei.e. MASS 94,A 039. °' Regulatory Services Department rFD Mf►l Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ON 1 YEAR DEADLINE CRITERIA V#Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc . , Commonwealth of Massachusetts afar 0`7�1 Title 5 Official Inspection Form:. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F 74 Castlewood Property Address Graham Owner Owner's Name r• information is required for every Hyannis Ma 02601 p-5/2/19 page. City/Town State .Zip Code 'Date of Inspection U I Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information C filling out forms p on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HPS use the return key. Company Name P.O.Box 151 Q Company Address Forestdale Ma 02644 City/Town State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 5/2/19 Inspector's Signre Date The system inspector shall s Z.a-a A�opy this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3,,or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: r 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of*Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. i *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): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass.inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below) ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health):, ❑ 'broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No I ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis i Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7r2612018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current F Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form 0' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: r Source of information: owner pumped 3 years ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: tank unknown leaching Dbox 2000 '-Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 20+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): no evidence of leaks or poor venting l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H10 precast 1000 gallon tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'6"x5' Sludge depth: 8„ Distance from top of sludge to bottom of outlet tee.or baffle 24" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): no signs of heavy decay or leaks and cracks tees in place t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts (p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions:. Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. City/Town State• Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 4" 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.): Dbox over full at time of inpsection and has black staining to riser cover I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 74 Castlewood Property Address Graham Owner Owner's Name - require Y information is Hyannis Ma 02601, 5/2/19 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* r Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): I * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4) infultrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts - (p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leaching chamber dug up and inspected. liquid level to top of chambers Hydraulic failure present 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): . j t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts lw Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions -Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments,61 74 Castlewood . Property Address Graham Owner Owners.Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ®, hand-sketch in the area below ❑ drawing attached separately Dri vet,ax,� l,.) It 3 I 8 3 - 019 ALf - 33 P ti - 33 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: town gis mapping lot el. 66' low in area 40' You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Property Address Graham Owner Owner's Name information is required for every Hyannis Ma 02601 5/2/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included i j t5insp.doc•rev.7/26/2018 Tille 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 18 of 18 V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for-Voluntary Assessments , �b 74 Castlewood Cir ^(� Property Address Premiere Asset Services Owner Owner's Name - information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address C E. Falmouth MA �' 02536 City/Town State Zip CodQp 1-508-495 0905 S13971 Telephone Number License Number ta': B. Certification N "� 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 wasperformed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® ,Passes , ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-1-08 Inspector's Sign ture 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 f 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. t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 or 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System appears to be in good working order with no sign of failure. 4 B) System Conditionally Passes: 1 ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5lnsp•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, „ 74 Castlewood Cir Property Address Premiere Asset Services , Owner Owner's Name 4 information is required for Hyannis MA 02601 7-30-08, every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ' ❑ distribution box is leveled or replaced ` ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ' ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. .1. System will pass unless Board•of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ' ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy"is within 50 feet of a bordering vegetated wetland or a salt marsh `2.}System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ` -❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 o115 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services ' Owner Owner's Name information is required for Hyannis — MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.)- ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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: x You must indicate,"Yes'-or"No"to each of the following for all inspections: Yes No ' '.I ' ❑ ® Backup of sewage into,facility or system component due to overloaded or clogged SAS or cesspool 1 ❑, , ® = 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 cesspoolEl ' ® 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 NOT due to clogged or ❑' ® obstructed pipe(s). Number of times pumped:, ❑. ®' Any portion.of the SAS,cesspool or privy is below high ground water elevation. Any portion'of cesspool or privy is within 100•feet of a surface water supply or ® tributary to a surface water supply. t5lnsp•03/08 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. El ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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`fifes"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. t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5lnsp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of be 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected?_ ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available, last 2 ears usa e. d 190/day 9 ( Y 9 (gP ))� Sump pump? ❑ Yes ® No Last date of occupancy: 6-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on.310 CMR 15.203): canons 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: Last date of occupancy/use: Date Other(describe): t5lnsp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A 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 System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool i ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is Hyannis MA 02601 7-30-08 required for y - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age:• , years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- . . Dimensions: 1000 Gal • Sludge depth: 12„ 20" t 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 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 74 Castlewood Cir ' Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition-with all baffles installed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): a 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): t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition. i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 -- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: i Type: ❑ leaching pits number: ® leaching chambers number: 5-infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: I ❑ 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.): Infiltrators in good condition with no sign of back-up in surrounding stone. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool,must,be pumped as part of inspection)(locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name ' information is required for Hyannis MA 02601 7-30-08 every page. City/Town _ State Zip Code Date of Inspection D. System Information (cont.) 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. Back 6 OOP i . t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Castlewood Cir Property Address Premiere Asset Services Owner Owner's Name information is required for Hyannis MA 02601 7-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no water at 12'. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable �FtHE Tp� Regulatory.Services e BARNsr,BLE, + Thomas F. Geiler,Director MASS. 94, 039. ,.� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number . of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC: Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification �T Important: o When filling out 1. Property Information: Y forms on the computer,use 74 Castlewood Circle Hyannis Ma. 02601 only the tab key Property Address to move your Ronaldo Ferreira cursor-do not use the return - Owner's Name key. 39 George St. Owner's Address Hyannis Ma. 02601 �--- � City/Town State Zip Code Date of Inspection: 12/10/2005 Date 2. Inspector: Brian K Tilton Name of.inspector The Building Inspector of Cape Cod Company Name 265 Casdlewood Dr. Company Address Eastham Ma. 02642 City/Town State Zip Code 508-255-3=9343 Telephone Number Certification Statement: certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1"40 of. Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ ❑ Needs Further Evaluation by the Local Approving Authority. � rQ 12/10/2005 C) In ector's Signature Date _ , The system inspector shall submit a copy of this inspection report to the Approvi g Authority (EfOard of Health or DEP)within 30 days of completing this inspection. If the system is shared Pystem-br has a design flow of 10,000 gpd or greater, the inspector and the system owner hall 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. 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes, ® 1 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: All components in place and functioning normally. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist.which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 l Commonwealth of Massachusetts = Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface.Sewagebisposal System Form M A. Certification (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 Cityrrown State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The,system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State ZipCode Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate 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.] Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form H A. Certification (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection 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. 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GM B. Checklist 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name. Date of Inspection Check if the following have been done. You must indicate"yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑. Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 e Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 74 Castlewood Circle Property Address Hyannis Ma. 02601 Cityrrown State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: vacant Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No '04Water meter readings, if available last 2 ears usage d 131g. g.p.d./'05= 9 ( Y 9 (gpd)): 131g.p.d. Sump pump? ❑ Yes ® No Last date of occupancy: 8/2005 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft„ etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 Cityrrown State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection General Information Pumping Records: Source of information: Owner 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 System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: tank 1997, SAS 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 Cityrrown State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 20 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leaks or failure Septic Tank (locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 5'8"x9'6"x4'10" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 2„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Dip Stick, Baffle Stick, Tape Measure. 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owners Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All tees intact and normal levels rioted, no evidence of backup or leaking. It is recommended that the system be pumped for regular maintanence every 3 years. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 Cityrrown State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil 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.): Level, Equal flow, no evidence of leaks or solid carryover, Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ® innovative/alternative system Type/name of technology: 5 Infiltrators in series Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Lawn over top, no evidence of breakout or hydraulic failure. 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 a. Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form w C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 City/Town State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection 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. C Ij Sr(_E w0oPp CTRCLL I vJ .)we-1 l t V A � dD TEST HOLE A q� tlta� IVo w q� A I 20� �CNCovn{Q�d Z- 24 '� N OT TO SC tI L E A 3 RV o z 13 3 9- 33 f3 33, 74 Castlewood.Cir.septic.doc•11/2004 1 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 V Commonwealth of Massachusetts Title 5 Official .Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 74 Castlewood Circle Property Address Hyannis Ma. 02601 Cityrrown State Zip Code Ronaldo Ferreira 12/10/2005 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Hand Auger test hole within 150' of SAS, 4"dia. 9' Deep no water encountered. (Bottom of'SAS 4' from surface). 74 Castlewood Cir.septic.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 y�FE-E r • COMMONWFALTIJ OF MASSAC14 SETTS rl Board of Health, �a&gylP ,MA. APPLICATION FOP DISPOSAL SYSKM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) - O Complete System Individual Components Location c1g. AQDM-%5 Owner's Name Map/Parcel# a 3 In Address Spy Lot# * 1 Telephone# Installer's Name A �C Designer's Name �u vtCbf�Cn�(1 Address -Ak 5 q(3(-.Modk% Address aS-6 Telephone# ) Telephone# S yg_ }9 Type of Building Lot Size q.ft. Dwelling-No.of Bedrooms !:TlsJc� —vrKr-a cN2514(! Garbage grinder (NA Other-Type of Building No.of persons Showers V,Cafeteria (mil/ Other Fixtures Design Flow (min.required) 33 gpd Calculated design flow Design flow provided 3?51• gpd Plan: Date Number of sheets 1 Revision Date Title Description ofSoil(s) Soil Evaluator Form No. �^ Name of Soil Evaluator 'CCWY14C1 StkMbate of Evaluation a3 DESCRIPTION OF REPAIRS OR ALTERATIONS A-n',J`a(-) DESIGNING ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING M! WAS !NSTXLED IN STRICT ACCORDAIN'CE TO PLAN. The un rsigned agrees to ins the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a es to o to place tem' Aeration until a Certificate f C mpliance has been issued by the Board of Health. 11 Sign- Date 7 !✓- Inspections �t j�� 'ryy j :�.J{. _ 'y. �y�k �,^„ {�,-� j•W r'F�. �h �.� � w��(�.r�.�• •I "�.eV..r•�IVIf1ff'�'{'�ly�'T✓F���u��M,V��"1. ;•I •Y''/'�rl'il�i� '1 �� _w. _4` �Y��T�},�r+� f • l ` k - ., .r" GO Board of Health, �`�Cf>S�C•`�U�2 MA. APPLICATION'FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Re aixUPgrade( Abandon( ❑Complete System�Individual Components t Location �� fin'\ S Owner's Name Map/Parcel#~ Address jAME t Lot# , Telephone# •M. 4; Installer's Name c��C�S 1 C N\C Designer's Name ,..Address '� � 5'F. �CC'mo MA Address 0 Coal ��Y10v�n Q�53b ___—•, Telephone# ` ' Telephone# 5 L4a-0—+9(p (� Type of Building ` :s 1(\2 n4•O- Lot Size , ��� sq.ft. Dwelling-No.of Bedrooms —T u,)c 'F-CI STl pjc, —7-(1<r—C Garbage grinder (*A Other-Type of Building Nf>nP c / No.of persons Showers V,Cafeteria�) Other Fixtures L-c 0C.�c�M IC\ �C��IN J1i1� r 1ac1(� Design Flow(min.required) 330J , gpd._ Calculated design flow �� Design flow provided 33i•eO gpd Plan: Date .� Number of sheets Revision Date Title C �C Description of Soil(s) (". Soil Evaluator Form No. Name of Soil Evaluator CC`CM��iAW'bate of Evaluation '� a 3 't DESCRIPTION OF REPAIRS OR ALTERATIONS A t } The undersigned agrees to install the above described:Individual Sewage DisposaljSystem.in accordance with the provisions of TITLE 5 an� ,/ltlt :� further a CeWeso, ot to place a tem in operation until a Certificatergf Compliance has been issued by the Board of Health. Sign d� g L - W 1 Date X1 4- J v p Inspections r a, _ �— _ 4,v. No. )3 —3 (` �T��jE ¶T14 OF ( (` T(`�. FEE ETTS Board of Health7P-vj-m<,kk,I7f�� . MA. CERTIFICATE OF COMPLIANCE Description of Work: ,{Individual Component(s) ❑Complete System The u ders'gned hereU�T-1 fythat the Sewage Disposal System; Constructed ( ),Repaired X Upgraded ( ),Abandoned (by: qi (— r at t, 1 -UJ �Q,- A 1 4.1 has been installed in accordan e with th t provis on of 310 CMR 15.00 (Title 5) and the app1ved design plans/as-built plans relating to r application No. 3'.3 dated? 60or Approved Design Flow (gpd) Installer !rI T1, . V P Designer: Inspector: _ Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. FEE l� COMMON 14 OF MASSACHUSETTS Board of Health, M110, 111 dT L(]14. DISPOSAL SYSTEM' GY'CONSTRUCTION RUN PERMIT Permission is here ty granted to; C tr -t( ) Repair( )/Upgrade( ) Abandon( ) an individual sewage disposal system at "f here J r t 1 WW1 � rr �IM 11 A as described in the application for Disposal System Construction Permit No. 3-L date1d J4fjo Trovided: Construction shall be completed within three years of the date,o is permjC. All local conditions must be met. f Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date ?/ 4- �3 Board of Health \R CARMEN E. SHA Y (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O.Box 627,East Falmouth,MA 02536 August 4, 2003 RE: Certification of Title V Septic System Installation: Residential Property 74 Castlewood Circle,Hyannis, MA Dear Sir or Madam: On July 29, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 74 Castlewood Circle, Hyannis, MA, based on a design drawn by Shay Environmental Services on July 28, 2003. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With'Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at(508)-548-0796. Sincerely, CARMEN E. SHAY ENVIRONMENTAL SERVICES,INC. ��.��k OF Aor q CARMEN HAY 0. 1181. C ,E. Shay, .S., C.S. \ �o President SA N I TARS*" 5eN • 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N . Ue n. • S25r01 'NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATIO:N TEST AND SOIL EVALUATION EXEMPTION FORM 1 . e.t-"!E hereby certify that the engineered pian signed by me IF UcteC concerning the property located at meets all of the t^I:ov;ng cr�!ena: • • This failed system is connected to a residential dwelling only. There are no _omrnercial or business uses associated with the dwelling, • 'Fhe soil is ciawn-ed as CI.ASS I and the percolation rate is less than or equai to -n.nut:s per inch. The applicant may use historncal data to conclude !his f3c: or may :orduct :are!irrurar% tests 2( the si:e without a health agent present her: :s no increase in !low and/or change in use proposed • There are ;to vastances requested or needed, The bottom of the proposed leaching ,`acili(y will not be located less than fourteen I, fee: 3oove the maximum adjusted groundwater table elevation. fAdiust !hc oundwatc, table using the Ftimptor method when applicable) Please complete the following; �. "f,ap of Grounr_ 5-irrrfa�ce Elevation (using GIS inforr�a!tonl _�._� 5' G.W E Icvar.or, _ •� ad;us(nent for �hi;h G.W. ._ _... = .._.. )'RT:" EN F.. BETWEEN and B DATE: I NOTICE 33sec Jr()n !^e a"�ove r.formauon, a reoair permit wil! be issued for adr^orr.s -na�.imu:r `o ;dd!uonat bedrooms are authorized to (hc future without engtneerec i:ep! C ,v,te C1 plans. Xicum2 Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: �e� aood l tcC�A , c,if Lot No. 1�- Owner. Ut sn c,, Address; SAME Contractor: Address: �x (��}f �•�c3,1mr�.�11�, MA b2e_�tc, Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date 3b month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: t OAppropriate index well.................................................... OWater-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to Z3'� water level for index well........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),-current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water-level adjustment ..............................................:........................................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............................................... . �3•fo li Figure 13.--Reproducible computation form. I 15 TOWN OF'BARNSTABLE LOCATION rtl� SEWAGE # '" VILLAGES 011 ASSESSOR'S MAP&LOT Z7 3"D INSTALLER'S NAME&PHONE Nd77P SEPTIC TANK'CAPACITY fQED LEACHING FACII.TTY: (type) �o�,�P.cLT.eOCZ 2� (size) NO OF BEDROOMS 3 cc BUILDER OR OWNER L r`'J PERMITDATE: TC3 OMPLIANCE DATE: C�3 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'avetlands exist Feet within 300 feet of leaching facility) Furnished by All - "01 t e r , .. _ SECTION A P Y. " , - Ail.OUTLET PPES FROM i11E ARE To 4 SCHEDULE 40 C. . from .,ALL PE E T , . , ' _ _ PROFILE.. LEA'' ,OF ADDITION TO LEACHING SYSTIs`M Dt51R,9U,loh t10X WALL e¢ :. _ R _ ,_12 Existing Foundation � c #dnk , . O Ex 1 house to septic, ,., lair AT Fr. coi+drFtE bw�rt 9 eP _ - 'fit t,t�t LEAST 2 t P T TIN LEY. 100.00 Assumed f�xnk covers rrnust be ,. 3 of i 2 Mbalred soaton F ' TOP OF FOUNDATION E �> �- 1 nnlen.e 3 w1Min is in d 'c. s 3 4;:#0 1 1 2 r, Woat+ed Crushed Ston r . . `. �, ,, b .00 « over SAS-90.00 , .. �,,; , over Tank 98.00 bratle over D-Box 9Y . _ Orada �'Septic r. _ :. .A « Oult£T S _.:.r o _3 H 10 , . is 6' ,HOLE _ Q MO7d11NH11.COVer .. ,. Dist T of SAS ::,ENv.;�t1.50 1 r a ra W,. tie, b - EXISTING > 5=0.01 or .. W 10 r Greater \ ,; _,•, � . to _ _ 1 000 GAL 1ss ++ a a EIGISL tffiE 5•� 0 01 root _ . gee _ x 3 is' ur `U C:' : . EHeotive-Depth;; SEPTIC TANK n :- : + ` . F-Rarl EXIST.FDUNDATEl/ w - o m _ o, H 10 _ units' 30` J U, _s a b.zs a SECTION "CROSS SECTION � PL N SEG 0 OSS SECT 0 ,. � . s _ 3 ..,` _ 3 FULL Evu o s m _ o - , ! +c 10 lncfi s Y_ > M1 0 83 e _ `. Co C1 _ , y `. o ! >6 v> �. a. _ I TRI TI X :> +s n ! ,. _ 3 HOt� H 10 D S _ BU ON `BO s tn.ot s 4 t 37. 5 rn 2 , 1 _ 3 . o y SYSTEM PROFILE S TE ria. tea stone : one m a�o ffectivp Le` t NOT SCALE_ c > o £ h. TO c _ ! nA Not to Scale _o i - 0 4 �. 4 SDIL ABSdRPTICIN .:SYSTEM (SAS) LOCUS MAP ' c 0 2. y - _ 10 NF TA H CAPACITY c )/ R R N 4 in_ot 3 a-tt o I IL TRDR HIGH C ACIT H 10 LI]ADING GED GE D B IE GENERAL NOTES EffeCtiv. Wktth 1Loaa ... Not to Scale - U T OR EQ NALEN ( ) , r I l notification 0 1 -GontraCto .ls:res onslb a for D sofa -notrf cat on WITHIN s w GR P 9 '..NOTE_ ALL (�MPONENT5 t�At15T HAVE RISERS TO TH BELOW ADE , Bottom of Test Hale?Elay.etl7.00 m ., - • NOTE: 0 ALL HEIGHT OF INFILTRATOR IS 18 CTIVE HEIGHT IS 10 and protection of all underground utilities and pipes. No Groundwater Observed O 1u VER �EFFE P 9 Q Pe _ ___---------- —_-- e Septic tank an +s r+ o 'box shall be set 2. The d t u n 1 level _ eve on 6- of 3 4 ! fi, 2 stone. 3 ackfrl s ould be clean:sand or ravel wit no B h g h stones over`3" in ,size. 4. This 's stem is.-subject to`,ins inspection during installation YP 9 b :Carmen 'E. ha Environmental Services Inc. Y 'Shay .. 5. The contractor,shall install this,s stem in accordance i Ti 'Massachusettsto e` a the 'n roved plan TEST - with Title' V of the state,cod pp PERCOLATIONTES and Local Regulations. f rcolatl n Test JULY 0 03 6 If, duringinstallation the contractor encountersan Date o Percolation 3 2a . . . . soil conditions ns or site conditions at are-different ` N F EDA'ARD P. CONWAY ,s c nd o s that Test Performed B `CARMEN E. SHAY _R.S. C.S.E. � _ -es y from. those shown on he""'soil to or 1n our design Results Witnessed B WAIVER per Barnstable B-O.H. om o e s t _ g g SHAY ENVIRONMENTAL SERVICES, INC. Installation must halt & immediate-notification:be • mad to Carmen,'E Shay - Environmental Services -Inc. Percolation Rate. .Less Than -2 MPt ® 36 e Y - o vehi I or h machinery II dive over e 7. N c e heavy . c ry ha i th S, 1 1 d 57 40 A' septic system unless 'noted as H 20 ;septic components. PL I baffles r n I Iends.8. Insta 1 Tuf Tite gas ba es o equals o al out et tee TestHole 77.43 9.: All Distnbu#ion Lnes shalt be 4 diameter Schedule 40 NSF PVC pipes. No: 1 Felled P P -,37.25 23 Lea t - 10, All solidpiping,' tees & fittings shall-be 4 diameter DEPTH ale ELEV. 9 17� .: S Schedule 40 NSF PVC-pipes .with water tight joints. .•, h P P 9 11, Municipal,;Water is Connected to ALL,OF The Residence and Abutting lomr+ 1 • • 3 P 9 Y t: t Pro ernes Within 50 Feet. Sand , fir. '.'j:ti } P e ol 10 YR 3 2 O . TH R PER LIN S «ARE:APPROXIMATE' N o -s x ss:25 k' o� E P 0 TY E AND ox s«,d o� COMPILED FROM THE SURVEY PLAN ,GENERATED BY, . PROJ CT° H MARK r E BENC MERCER 'ENGINEERING INC.< OF NEW 13EDFORD MA _ TEST HOLE �1 � � , ..Loam. C1� _ ..,, , O TOP OF FOUNDATION Z �' SUBDIVISION F N T LEV. 9 00 , ENTITLED SUBDN St0 PLAN 0 LAND OF.CAS LEWOOD CIRCLE o� �: E 9. 1 rR' :: _ " 0 3/e Y "1 (Assumed)` ELEV. 00.00 -. HYANNIS, MA", DATED DECEMBER ,i O, 1956 e 3sBe 9s:oo ----------- --------------- -- --` _�____ _�.-- ----- -----=---'- :AND IS NOT,iN7ENDED TO E A SURVEY,,PLOT,'PLAN ' Medium 99 99 a vEY, 1EXIST. 10W d: b Sand v _ IT SHOULD BE USED FOR:NO PURPOSE"OTHER THAN ' Septic Tank P THE SEPTIC`:SY SYSTEM IN TA Tl N:` �.s r�/e S S LLA O " 7.00 , 6 — 1 - 3 44 F EXISTING LEACH PIT T PUMPED A EX G 0 $E U PED OUT AND FILLED'IN PLACE. EXISTING I E 'LOT 1 tR LOT 16 I . � � - 0'-E. >'YA PP 0 -S -CONTAINING HAT... - 2 BEDROOM I �N r NY'STRI,_ED UT OIL_ CO AIN G t.EAC E e , Iw F '. � ROM THE 'EXISTING, LEACH PIT TO BE DISPOSED o ' aousE '` > I EX S i OF AS PER BOARD..OF HEALTH 'SPECIFICATIONS. I i tYj 74 I , I :. 0 WETLANDS ARE PRESENT WITHIN F N WETLAN _ E ESE TH 20O 0 THE PROPERTY O I I O Perc #1 i -;ASPHP:LT t^ i Depth to Perc. 4o to 58 I LEGEND P QO I DRIVIDMAYIr� P Rate- Less sTha 2 MPI arc o n � I I O ' No Observed ESHWT_, ,� i�_ �, I � , ;� No Groundwater Observed 0144 I� i T LOT 17 I , DENOTES PROPOSED, t ;� � 104X 1 99 -o- _ __ -__ _ �.99 ;.SPOT -GRADE 3 _ ICE 7,673 Square Feet +� � DENOTES EX( TING S 'X 104.46 SPOT GRADE 77.43 PL, r n PROPERTY LINE s1oEwAu< ' !N 11 d 51 - 30 E -- -= J_— -- --- - _ _ 96 PROPOSED `CONTOUR EXISTING CONTOUR C'..A S T�E TIV O O D CIR UJI E DEEP© EE E L 2 a a Access MANHOLES C7 PERCOLATION TEST LOCATION (40 FOOT RIGHT OF WAY) E I 6 FOOT' STOCKADE FENCE S C - r SEPTIC TANK f f _ THE ACCESS COVERS FOR THE SEP C INLET 1 DISTRIBUTION BOX AND LEACHING COMPONENT SET DEEPER'THAN a INCHES BELOW nNISHED _ ou T " •: �-•• 'f '�-- `. MADE SHALL BE RAISED TO iMTHIN t3 OF { FINISHED GRADE tI PLAN ..LOT _ ALS INSTALL TIfF T17E GAS BAfTtE5 OR EOU OF PROPOSED SEPTIC SYSTEM UPGRADE NF R PRECAST CONCRETE STEEL...REI 0 CED ` PREPARED FOR N VIEW : c PLAN E M LI N D K : HASTI N G 3-2e REMOVABLE COVERS J AT . _ .-.._- a , .. , 74 CASTLEWOOD CIRCLE min. clearance .. -- ta" _Trail , e" min. 2" min. inlet to outlet INIFT T- a mkn. '" - - .OUTLET... NY N 1 MA -L W�- A N S Icr _ t , , .,•S.,ter Design_ � Des Calculations 4-0 min. PREPARED BY, mr s.er. tJ th,add dap S rooms. 2 Equivalent to 220 Gal./Day Da 3 0 Gal. Da Min. er Title o : o � -.> Number.of Bed Eq / Y � 3 / Y P ) Garbage Grinder. No . + ge SH Y • � .. Leaching Capacity Proposed. 330 Gal. a Minimum Min, Per Title V ._ - 9 P Y oP � Y � ) � _. i Y _ , a _ .. -__ -,; Septic Tank 3 x 330 Gal. Da 660 USE 1 500 GAL. Septic Tonle. o . Y Sep 1 Y P NVIRON�IENTAL SERVICES, INC. . - � 0 2a 40 `5 � SHA 4 A - o f n ro r f min. in h'` e'-•o" SOIL.ABSORPTION AREA, t)si g percolot n ate a <2 / c c _ Bottom Area. 0.74 a ft. x 3 0 s ft., 273.8 gallons R SECTION :END SEC TION . 9 /sq 9 , 9 P,:O. QOX 627 CROSS SE ION _ � : 4 ft.`: x s . � 58 gallons � Sldewalt Area: 0 7 go /sq, 7 sq.,ft g o <.. � EAST FALMOUTH MA 02536 _ sTE , Providing: 331,80 gallons, P , _ rul7aa AX 08 548 0796 . .. , TEL F 5 SAE: =20. SCALE: 1 — - , . P' Fl TRAT HIGH CAPACITY H 1 UNITS HAVING A 0.83 10 INCHES EFFECTIVE DEPTH, USE EXISTING 10(JO GALLON H 0 SEPTIC TANK use. (s) IN L oR A o ( ) . _ - :SAE, 1 -20 DRAWN BY. CES DATE, .DULY 31 2003 WITH 4:0 OF WASHED STONE ON THE`SIDS AND 3,5 OF WASHED STONE TO BE :USED SH Otd E T A NOT O.SC LE F ON THEENDS. No STONE UNDER. P T I NAME. SD4 9 I?. WG SHEET. 1 0 1 ... ROJEC SD455 F LE 5 P D _, , _