HomeMy WebLinkAbout0112 CASTLEWOOD CIRCLE - Health �. _ ...._-._._-.._ - .• 4v ., �..-_._---�• _--•_.ter-'----�-�--•._ `� -�.`Z." -`- }
112 CASTLEWOOD CIRCLE, HYANNISn
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TOWN OF BARNSTABLE Q
LOCATION C-A S�� W o onX C► C e SEWAGE# —
VILLAGE Ain"A t'S ASSESSOR'S MAP&PARCEL 173 -A%i* b 74
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INSTALLERS NAME&PHONE NO. 9:x.eo,.yoJ-i'o�
SEPTIC TANK CAPACITY ;5x , "y`p,,,�-� (Ole 0
LEACHING FACILITY:(type) .Z 6-arS (size) I Z
NO OF BEDROOMS 3
OWNER l/!/
PERMIT DATE: 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 leaching facility) ��;.1�W-t4l Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
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No.�J� ".• Fee l QV
THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppYltation for Vsposal 6potetn ConstrUttlon Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No..//a Ca Sr-PctJ c( C.%` Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. G177 Designer's Name,Address,and Tel.No.
/`t !mil
Type of Building:
Dwelling No.of Bedrooms Lot Size 7e7 t/ sq.ft. Garbage Grinder( )
Other Type of Building Rec No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd gpd Design flow provided 336 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /GGo Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 of Health Q
S►gne Date —
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. �� G Date Issued
Iv. ...,....x.,r+'rirY^-��.vw.:.n•i':qy't�'L.'wTy�-+.::V-'�.•.r�^✓r--.^ ,..':r�.--.-,eK�.•.,...yy,�..;...ram..-�...n........-,-._.....�.._r ...... ..�..,.v�."t5=`"Y�.u'S.nv::.,,..F'°Yves.-ea..ti+'.. .-. *xw.�:k. . ..- .. `v
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No. k `S,I i)t rk, ^'r f Fee
THE'C,OMMONWEALTH OF MASSACHUSET7S Entered in computer: Yes
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS
pfication for Disposal 6pstem Construction'])ermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components .
Location Address or Lot No.//_,7 Co S//Pc< Ct�- Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. SGv 6,/77 Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms ? Lot Size •7� sq.ft. Garbage Grinder( )
Other Type of Building —/��C No.of Persons Showers( ) Cafeteria'( )
Other Fixtures „s
{ Design Flow(min.required) :=O gpd Design flow provided 3 3y gpd
} Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /GGO Type of S.A.S.
Description of Soil . r
1
Nature of Repairs or Alterations(Answer when applicable){� ,
Date last inspected:
Agreement:
r 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 of Health.
_ ApplicationApproved-liy' -� Date
;ram;
Application Disapproved by Date
for the following reasons
Permit No. ^� / Date Issued
-- .-- ----------- • - - - - - -------------------------------- -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by /�s��i < 5; r
/ J
at // �'�Sf�� l�iG�iCl �i r has been constructed in accordance �7 l
with the provisions of Title 5 and the for Disposal System Construction Permit No_,Qa dated
Installer Designer ��
#bedrooms Approved design flow �0 gpd
The issuance of this permit shall not be construed as a guarantee that the system will
/function_as designed. oE
j Date Inspector �¢�►�A n� � �I/ /I���
f / 1/
No. % Fee G v'
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(� )
System located at //
1
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:Constructio
n be omplleted within three years of the date of this p rmit.
Date [ Approved by ��--
Town of Barnstable
'"E' Regulatory Services
Thomas F. Geiler, Director
• BAM9rABLL
KASaPublic Health Division
Thomas NlcKean, Director
200 Main Street,Hyannis,MA 02601
Office: 503-362-4644 Fax: 503-790-6304
Installer & Designer Certification Form
Date: Sewage Permit# ssessor's iVlap\Parcel a7 � 076
Designer: ' V''l Installer: D tS /✓ UG(.�?n2
Address: Address:
On '1 1 _ /'d-4 was issued a permit to install a
(da ) (installer)
septic system at 11'Z- C46 11E WOOD Cl(ZC L-E based on a design drawn by
I IInp,A� (address)
dated YfALI
(designer
X l 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.
I certifv 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.
• ������, U.F.. Mgs�gcy
�� d4 DAf�N� E G
�
(Installer's No: 11440
'PEC/siE
SANITAOI'a ,ib 01
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNST LE PUBLIC HEALTH DIVISION. CERTIFICATE OF'
CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q: Health/Septie/Designer Certification Form 3-16.4doe
Doi_: 1 s 11r1,665 04-07-2009 12_ 13
BARNSTABLE LAND COURT REGISTRY
NOTICE OF DEED RESTRICTION
RESIDENTIAL
The Town of Barnstable Board of Health requires, that based on 310 CMR 15.214, Title
V, Nitrogen Loading Restrictions, the following restriction(s):
- Existing Dwelling Restricted to two (2)bedrooms.
Be placed on the property located at 112 Castlewood Circle, Hyannis, MA 02601;
Assessors Map: 273 Parcel: 076, As Deed is recorded at the Barnstable County Registry of
Deeds, on Land Court Document# 169358.
As plan of land is recorded at the Barnstable County Registry of Deeds on subdivision plan
24349-B (Sheet 2) dated May 1965, drawn by Mercer Engineering Corp, Surveyors.
Surveyors and filed in the Land Registration Office at Boston, MA, a copy of which is
filed at the Barnstable County Registry of Deeds in Land Registration Book 256, Page 81
with Certificate of Title No. 32871 and said land is shown thereon as Lot 12.
r;
I, caner of the property referenced above acknowledge
the deed restriction eing placed on the property.
&" .--- - i L D /
Owner's Signature to
The person named above:
Acknowledges the foregoing instrument to be his/her free act and deed, before me.
Notary Pu h
My Commission Expires
Haley L.Madigan
Notary Public
J' My Commission Expires January 30.2015
Y 3� �,� ' Commonweafth of Massachusetts
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ii•••e•e�,.n ic+..+.4
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APPLICANT: pCR- N W�L'y�(L
ADDRESS: 112- Cf TL, - JDOD Cif q�kN 01S 'vim,
DESIGN FLOW: ggppd /REVIEWED BY: DATE: b� GL01
N/A OK NO
Le al boundaries denoted [310 CMR 15.220(4)(a)]
Street, Lot, tax parcel number and lot number noted on plan [310
CMR X
Locus Provided [310 CMR 15.2204(t)
Plan proper scale?(1"=40' for plot plans, 1"=20'or fewer for
components) [310 CMR 15.220(4)] X
Easements shown [310 CMR 15.220(4)(b)]
System located totally on lot served [310 CMR 15.405(1)(a) for
upgrades]- if not, a variance is required 310 CMR 15.412(4)]
Location of impervious surfaces (driveways, parking areas etc.)
[310 CMR 15.220(4)(d)] X
Location all buildings existing and proposed 310 CMR
15.220(4)(c)] x
Location and dimensions of system components and reserve areas
[310 CMR 15.220(4)(e)] X
S stem Calculations [310 CMR 15.220(4)(f)]
daily flow
septic tank capacity (required andprovided) X
soil absorption system (required andprovided)
whether system designed for garbage grindet
North arrow [310 CMR 15.220(4)( )]
Existing and proposed contours [310 CMR 15.220(4)( )] X
Location and log of deep observation holes (existing grade el. on
each test) 310 CMR 15.220(4)(h) X
Names of soil evaluator and BOH representative [310 CMR
15.220(4)(h) and (i)]
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 1.5.220(4)(i)]
Percolation test results match loading rate?-[310 CMR 15.242] X ,
Certification statement by Soil Evaluator 310 CMR 15.220(4) ')] X
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR X
15.220(4)(n)]
Location of every water supply,public and private, [310 CMR
15.220(4)(k)] X .
Address (2 aksT fGVi00-0 CAkA r-- / 4yo iJl S/AAA\, Sheet l of 7
within 400'feet of the proposed system location in the case YY
of surface water supplies and rayel packed public water supply' /\
within 250 feet of the proposed system location in the case
within 150 feet of the proposed system location in the case
of private water supply-wells X
Location of all surface waters and wetlands located up to 100 ft.
beyond setbacks listed in 310 CMR 15.211 and any catch basins
located within 50 ft. 310 CMR 15.220(4)(1)] J`
Water lines-and dther-subsurfacelifilities located [310 CMR
15.220(4)(m) (if water line cross see 310 CMR 15.211(1) 1 ) X
Profile of system showing invert elevations of all system
components and the bottom of the SAS 310 CMR15.220(4)(o)] X
Stamp of designer 310 CMR 15.220(1) and 310 CMR 15.220(2) X
Stamp of Registered Land Surveyor(required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)] X
Test Holes adequate (two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2) or as x
.approved for an upgrade under LUA at 310 CMR 15.405(1)((k)]
Test hole adequate to demonstrate four feet of suitable material?
310 CMR 15.103 4)
Test Holes adequate to confirm adequate groundwater separation?
[310 CMR 15.103(3)] )C
Benchmark within 50-75' of system 310 CMR 15.220(4)( )] )C
Materials specifications noted? [various sections of 310 CMR
15.000]
System components not> 36" deep (unless Local Upgrade
Approval or LUA.requested)f310 CMR 15.405(1(b
i
Address 12 `�' "TW�� l�l t2 A'I`�I��S Sheet 2 of 7
� • 4
Size OK? '[310 CMR 15.223(1)]
Inlet tee located ten'inches below flow line 310 CMR 15.227(6)]
Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR
15.227(6)] X
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)]
Note regarding installation on stable compacted base [310 CMR
15.228(l)] A*t-
Separation between inlet and outlet tees (no less than liquid
depth) 310 CMR 15.227(2) �(
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CMR 15.227(5)) or permitted for X
upgrades under LUA 310 CMR 15.405(1)(k)]
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.2228(l) and 310 X
CMR 15.232(3)(f)]
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (b 7/07) [310 CMR 15.228(2)] X
Access to within 6 " of grade - one port for systems<1000gpd,
two fors stems>1000 gpd 310 CMR 15.228(2) X
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2)] X
> 10 ft from building foundation [310 CMR 15.211(1)] UK� Pet 7,?)I
Buoyancy calculation Required/Done 310 CMR 15.221(8)
H-20 Where appropriate? 310 CMR 15.226(3)]
Setbacks from resources [310 CMR 15.211] X
Required when other than single-family dwelling or flow>1000
d [310 CMR 15.223(l)(b)] x
First compartment 200% daily flow; Second compartment 100%
daily flow 310 CMR 15.224(2) and (3)]
"U"pipe through or over baffle, outlet of each compartment with
as baffle or approved filter 310 CMR 15.224(4)]
Address I I Z CASK&WOOD Utz— N y&AI 6 fW C Sheet 3 of 7
a �
I .
Located at least ten feet from any water line? [310 CMR
15.222(2)] X
Disposal piping at least 18" below water line (when water and
sewer cross, see 310 CMR 15.211(1)[1])
Cleanouts required/provided ? 310 CMR 15.222(8)] �(
Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)]
Slope of server line not less than 0.01 (1/8"/ft) 0.02 preferable
[310 CMR 15.222(6)] )(
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c)]
Siphonproblem/(leachfield below pump chamber)
Endca s or vent manifoldspecified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310
CMR 15.252(2)(h)]
Materials specified (310 CMR 15.251(5) specifies various pipe
types allowed)
t' }
Stable compacted base [310 CMR 15.22](2) and 310 CMR
15.232(2)(a)]
Splash plate•or baffle tee required on inlet/provided?(when
pressure sewer to d-box or steep pitch of gravity sewer) [310
CMR 15.323(3)(a)]
Riser if deeper than 9" 310 CMR'15.232(3)(f)]
Inside minimum dimension 12" [310 CMR 15.232(2)(b)]
Minimum sum 6" [310 CMR15.232(3)(e)]
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)] �C
Capacity (emergency_storage above working=design flow)? [310
CMR 231(2)] X
Proper setbacks [310 CMR 15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20"MUST BE
TO GRADE [310 CMR 15.231(5)]
Service components accessible (not too deep,with piping,
disconnects accessible)
Alarm floats - alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.231(6)and (8)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)]
Address CI�5�1 G 1�1 LS � Sheet 4 of 7
- y -
ON
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR
15.240(1)]
Required separation togroundwater? 310 CMR 15.212).]
Aggregate specified as double washed [310 CMR 15.247(2)]
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.241]
Inspection ports specified and within Yfinal grade? [310 CMR \>
15.240(13)] x
Breakout requirements met?(No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and X
Guidance Document]
Chambers and Gal. in trench configuration supplied with inlet X
every 20 ft. [310 CMR 15.253(6)]
Each structure with one inspection manhole (if>2000 gpd must
be tograde) 310 CMR 15.253(2))
Aggregate I' minimum-4' maximum. 310 CMR 15.253(1)(b)]
2' sidewall credit maximum [310 CMR 15.253(1)(a)]
In bsd configuration, inlet every 40 s . ft. [310 CMR 15.253(6)]
_ - e
Width 2'minimum 3' maximum [310 CMR 15.251(1)(b)] ,
100 feet-maximum length 310 CMR 15.251 1) a
Minimum separation 2x effective depth or width whichever
eater(3x if reserve between trenches) [310 CMR 251 1)(d)]
Situated along contours [310 CMR 15.251(2)]
Breakout OK? [310 CMR 15.21](1)[4] and Guidance Document]
IN: On
minimum 2 distribution fines 310 CMR 15.252(2)(a)]
Maximum separation between lines 6' 310 CM R15.252(2)(d
Maximum separation between lines and outside of bed 4' [310
CMR 15.252(2)(e)]
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. [310 CMR 15.252(2)( )]
Separation between,-beds 10' minimum. [310 CMR 15.252(2)(f)]
Bottom area used in calculations only 310 CMR 15.252(2)(i)
Address I l Z W
C V i vl ftNNlS ' Sheet 5 of 7
Pressure Dosed System ? Provided pump and piping v
calculations as re uired. 310 CMR 15:220(4)(r)]
Pressure dosing required on all systems>2000gpd or alternative
systems undef-.medial approval [310 CMR 15.254(2) and I/A
Remedial Use A royals]
If used in gravelless system - make sure jet is directed as not to
scour soil interface [Guidance Document]
Inspections once per,year (systems<2000 gpd) or quarterly
(>2000 d good to note on plan [310 CMR 15.254 2)(d)] x
Construction in fill - Did the plan specify that the fill shall meet
the specification of 310 CMR 15.255(3)? X
Im ervious barrier and/or retaining wall ? Guidance Document]
Impervious barrier installation must be supervised by
desi ner [310 CMR•15.255(2)(b)] X
Retaining wall must be designed by Registered Professional
Engineer [310 CMR 15.255(2)(a)] �(
Side slope not exceed 3:1 ? 310 CMR 15.255(2) k
Breakout requirements met? [310 CMR 15.252(2) and
Guidance Document] ' x
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) [3,10 CMR 15.255 (2)(e)] X
Check DEP Approval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge k
to scour soil interface '
x . - p
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions?
Is the technology being properly applied and does it meet all
DEP Approval Conditions?
Is there a note on the plan regarding the requirement for
[perpetual maintenance agreement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Has applicant submitted a copy of a maintenance
Are the variances listed on the plan ? [310 CMR 15.220
(4)( )
RLS Stamp necessary on plan if a component is within five
feet of property line [310 CMR 15.412(4)]
New construction or increased flow proposed - [Refer to 310 X CMR 15.414]
��4� W /+ qlt
Address_ �1 Z !�� �j1,l�i{,Gflq�*O� 'w Sheet 6 of 7
• . dG
Mi
Is the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and
310 CMR 15.216 - also refer to Policy regarding upgrades of such
existing systems]
Is the system proposed on the same lot as served by private well ? x
[310 CMR 15.214(2)]
Are the nitrogen loads proposed in compliance? [310 CMR x
15.216(1)]
Purriping to septic tank ? [ 310 CMR 15.229
Shared System 310 CMR 15.290
Address
l l Z NTLIF,wx69 (/`kG6e n ti 4WlPv� Sheet 7 of 7
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
consistency,%Gravel
it q
fS
'-36 Lo,4,r, v /z '118
NEV- S
DEEP OBSERVATION HOLE LOG Hole# Y
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
/ - Consistency.%Gravel)
011' -tt IOYR3I/ k(A
7 3 l to 615
1146o: 'Aod 2 sy71
DEEP OBSERVATION HOLE LOG Hole# N A'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cons istencv. o Gravel
DEEP OBSERVATION HOLE LOG Hole# /V A
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con ist ncy.%Qmvgl)-
Flood Insurance Rate May:
Above 500 year flood boundary No— Yes
Within 500 year boundary No X Yes,, e�
Within 100 year flood boundary No x Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the
area proposed for the soil absorption system? e S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (o (date)I have passed the soil evaluator examination approved by the
Department Enviro mental Protection and that the above analysis was performed by me consistent with1
the required-rat 'n expertise nd experience described in 3.10 CMR 15.017.
Signature Dateo o— 0
Q:ISEPTIC\PERCFORM.DOC
Town of B A r nstable. P#
Department of Regulatory Services
Public Health Division Date v
PLAM
e$ 200 Main Street.Hyannis MA 02601
' e tee Pd. �
Date Scheduled i
i
Foil suitability Assess 'ektfior Se e isposar f e
Performed By: a,C Witnessed By. 1
i .
LOCATION& GENERAL.INFORMATION Ida uCG
ffld
Location Address'. I,1� CAM;F—WOOD c Q Owners Tlame MM��um-(E- rs
�j tf �1C Address l(2 (fr�-$jjcwoc),o Gt2
6 ti o 3 J h/i S. Mid
Assessor's Map/Nmel: ���� Q j(o I Engineer's Name
I.
NBW CONSiRU!L'ON REPAIR i Tel e phone# S0 k 36 2-- Zg ZZ
Land Use 1Zcs t de,Ll` O1't Slopes(40) S l Surface Stones
> >ZJ U ft Drinking Water Well t
Distances from: Open Water Body VDU ft Passible Wee Area
l0 ft . Other
Drainage Way ft. Property Line 0ft
I
'a
SKETCH:(Street name,dimensiods%f lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes)
• i
I ..
' t
i
i •
I I
Parent material(geologic) A(t 0�7T�+a I Depth to Bedrock a
I Weeping from Pit Face _ A
Depth to Grouadwatdr. Standing Water in Hole:' /
Estimated Seasonal High Groundwater
ltl l J'l
DATE TION FOR SEASONAL HIGH WATER TADLE
I • ln.
Method Used: in. Depth to soil lnottlrs*
Depth dbserved standinglin obs.hole: I in, Oroundwnter Adjustment
Depth toiweeping from side of obs.hole: , Adj faCtor,,.�� Adj.C)roundwaterLzV01.,.,e
Index Well# Reading Date Index Well I@V41
PERCOLATION TEST
Observation + Trott:at 9" -------
Hole# '
t' Time at 6"
• Depth of Pere S6• � ��
1`O f' i Time(9"•G')
Start Pre-soak Time.0 Ito,
-- i
End Pre-soak
Rate 1AinJInClt
X Additional Testing Needed(YIN) —
Site Suitability Assessment: Site Passed Site Failed; Be Completed on Back
_—
Original:.Public HeMth Division
Observation Hole Data To --
***If percolafiipn test is to be conducted within 1009 of wetland,you must first notify the
prior to beginning.
Barnstable C4#servation Division at least one(1) wedk
Town of Barnstable Barnstable
Regulatory Services Department AtAnmr9sa 1
AA.RNSPABLE, I
9� b 9 � Public Health Division
200 Main Street,Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 70062150000210418528
4/14/2009
Marchia J. Boucher
Marguerite Eisentraut
112 Castlewood Circle
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 112 Castlewood Circle Hyannis,MA was last inspected on
March 7, 2009,by Darren Meyer, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system"Failed"under the guidelines.
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Backup of sewage into facility or system component due to an overloaded or
clogged SAS.
You are ordered to-repair or replace the septic system within Sixty (60) days 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
p'b
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is
required for Hyannis
every page. City/Town MA 02601 March 7, 2009
State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important:When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key i
to move your
cursor-do not Darren M. Meyer
use the return Name of Inspector
key. n/a
Company Name
P.O. Box 981
Company Address
East Sandwich MA 02537
fftVO City/Town
508-362-2922
State Zip Code
SI 3920
Teleph one Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. 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
❑ N ds Further Evaluation by the Local Approving Authority
ector's Signature -Da
te
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
"""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
� 30?Castlewood Circle,Hyannis,MA-TITLE V INSP•08106 /
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15
Bop Cop .
Y
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
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:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not
determined,"please explain.
❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
112 Castlewood Circle,Hyannis,MA-TITLE V INSP-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
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Commonwealth of Massachusetts
Up
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
every page. Cityrrown 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.
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
112 Castlewood Circle
Property Address
M_archia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is
required for Hyannis MA 02601 March 7, 2009
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:
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 1/2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
112 Castlewood Circle
k19-tj .
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
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.
❑ ® 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 CMR 15.303, therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
112 Castlewood Circle,Hyannis.MA-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
y Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
every page. Cityrrown 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)]
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08/06 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
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 2 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: 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 usage 2007: 242 gpd
9 ( Y 9 (gpd)): 2008: 156 gpd
Sump pump? ❑ Yes ® No
Last date of occupancy: unknown
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):
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08106 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
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Owner/realtor
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:
1999
Were sewage odors detected when arriving at the site? ❑ Yes ® No
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
i
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
every page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 6 inches
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.):
No issues, no signs of leakage
Septic Tank(locate on site plan):
Depth below grade: �Z inches
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: apical 1,000 gallon
Sludge depth: 4 inches
Distance from top of sludge to bottom of outlet tee or baffle 30 inchces
Scum thickness 2 inch
Distance from top of scum to top of outlet tee or baffle 10 inches
Distance from bottom of scum to bottom of outlet tee or baffle 12 inches
How were dimensions determined? tapes and rods
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is
required for Hyannis MA 02601 March 7, 2009
every page. Cityrrown 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.):
PVC Tees were present, vegetation normal, liquid level equal with outlet pipe, signs of hydraulic
failure (staining).
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):
112 Castlewood Cirde,Hyannis,MA-TITLE V INSP•08106 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
�.� 112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owners Name
information is required for Hyannis MA 02601 March 7, 2009
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 previous staining to top of d-box
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.):
D-box is level,flow equal to outlet pipe, approx. 28" below grade, signs of solids carryover, no signs
of leakage, signs of hydraulic failure (staining)
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08/06 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
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is
required for Hyannis MA 02601 March 7, 2009
every page. Cityrrown 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:
Type:
❑ leaching pits number:
® leaching chambers number: 2 -50OG precast
leach chambers
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach Chambers were empty due to vacancy, Chambers did show signs of hydraulic failure (staining
up to top of units including scum on cover). No risers present, no ponding, soil conditions were
normal, vegeation normal.
112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08106' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�. 112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
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.):
112 Castlewood Circle.Hyannis,MA-TITLE V INSP•08/06 Tide 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
112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
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.
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112 Castlewood Circle,Hyannis,MA-TITLE V INSP•08/06 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
t� 112 Castlewood Circle
Property Address
Marchia J. Boucher& Marguerite M. Eisentraut
Owner Owner's Name
information is required for Hyannis MA 02601 March 7, 2009
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 ground water: >11
feet
i
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 files -perc tests on abutting properties show no water to 10 feet below grade.
❑ 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 to 11 revealed no groundwater. Bottom of system is approx. 6 ft. below grade.
112 Castlewood Circle,Hyannis,MA-TITLE V INSP-08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15
' Z°v�t31
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
o DEPARTMENT OF ENVIRONMENTAL PROTECTION
p FAPR
ED
a�
350 MAIN STREETWEST YARMOUTH,MA003
C
508-775-2800 1CO TfrlJ,WN OF BARNSTABLE
HEALTH DEPT,
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
MAP 273 PAR 076
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner's Name: SOUZA,ALAN
Owner's Address: 32 ROYAL CREST DRIVE#9
NORTH ANDOVER,MA 01845
Date of Inspection APRIL I,2003
Name of Inspector:(please print) JAMES D.SEARS
Company Name: A&B Canco
Mailing Address: 350 Main Street
West Yannouth,MA 02673
` Telephone Number: 508-775-2800
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was perfonmed 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
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: Z— 0 3
The system inspector shall subVit copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd
or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.
The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that time.
This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 1
i
Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL 1,2003
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:
B. System Conditionally Passes: N/A
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 complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
_ Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval
of Board of Health):
broken pipe(s)are replaced
obstruction is removed
' distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health)"
broken pipe(s)are replaced
obstruction is removed
ND explain: 1
Title 5 Inspection Form 6/15/2000 2
i
Page 3 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL I,2003
C. Further Evaluation is Required by the Board of Health: N/A
_ Conditions exist which require further evaluation by the Board of Health in order to detennine 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 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 I of 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:
I
Title 5 Inspection Form 6/15/2000 3
i
Page 4 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL I,2003
D. System Failure Criteria applicable to all systems: N/A
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 leaching is less than 6"below invert or available volume is less than %day flow
✓ Required pumping more than 4 tirnes 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
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply
N/A Any portion of a cesspool or privy is within a Zone 1 of a public well
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well
N/A 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 or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.)
NO (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 detennine what will be necessary to correct the failure.
E. Large Systems: N/A
To be considered a large system the system must service a facility with a design flow of 10,000 gpd to
15,000 gpd.
You must indicate either"yes"or"no to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a
mapped Zone II of a public water supply well.
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system is 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.
Title 5 Inspection Form 6/15/2000 4
i
Page 5 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL 1,2003
Check if the following have been done. You must indicate"yes"or"no"as to each of the following
Yes No
✓ Pumping infonmation 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 infonmation on the
proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)has been determined based on:
Yes No
✓ Existing infonmation. For example,a plan at the Board of Health.
✓ Detenmined 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)]
Title 5 Inspection Form 6/15/2000 5
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Page 6 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL 1,2003
FLOW CONDITIONS
RESIDENTIAL
Number of Bedrooms(design): 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 220
Number of current residents: 0
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO (if yes separate inspection required]
Laundry system inspected(yes or no): YES
Seasonal use(yes or no): YES
Water meter readings,if available(last 2 years usage(gpd)): 2001 2,775/2002 3,337
Sump pump(yes or no) NO
Last date of occupancy: UNKNOWN
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CM 15.203):
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: N/A
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: gallons—How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
./ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank Attach copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
NEW LEACHING IN 1999
Were sewage odors detected when arriving at the site(yes or no): NO
Title 5 Inspection Form 6/15/2000 6
i
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL 1,2003
BUILDING SEWER(locate on site plan): ./
Depth below grade: 18" ,
Materials of construction: ✓ Cast iron _ 40 PVC other(explain)
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK(locate onsite plan): ./
Depth below grade: 8"
Material of construction: ✓ concrete metal fiberglass polyethylene
other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1,000 GALLON PRE CAST
Sludge depth: 2"
Distance from top of sludge to the bottom of outlet tee or baffle: 30"
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 16"
How were dimensions detennined: ASBUILT AND TAPE
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
MAIN TANK AT WORKING LEVEL.TANK AND COVERS 8"BELOW GRADE. INLET BAFFLE,OUTLET
TEE.NO SIGN OF OVERLOADING OR LEAKAGE.
GREASE TRAP(located on site plan) N/A
Depth below grade:
Material of construction: concrete metal fiberglass _ polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
Title 5 Inspection Form 6/15/2000 7
i
Page 8 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL 1,2003 '
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain)
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no)
Alarm level: Alarm in working order(yes or no):
Date of last pumping
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ./ (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.,):
DISTRIBUTION BOX IS 16"X16",21"BELOW GRADE. BOX IS CLEAN AND LEVEL.ONE LINE IN,ONE
LINE OUT.NO SIGN OF OVERLOADING OR SOLID CARRYOVER.
PUMP CHAMBER: N/A (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Title 5 Inspection Form 6/15/2000 8
Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL 1,2003
SOIL ABSORPTION SYSTEM(SAS): ./ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers,number: 2
leaching galleries,number
leaching trenches,number,length
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of
vegetation,etc.)
LEACHING IS TWO 500 GALLON PRE CAST CHAMBERS WITH 4' STONE. LEACHING AND COVERS
ARE 38"BELOW GRADE. LEACHING IS DRY,NO HIGH STAIN LINE OR SOLID CARRYOVER.
CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.):
PRIVY: N/A (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.)
4 .
Title 5 Inspection Form 6/15/2000 9
Page 9 of'I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS,MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL I,2003
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
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Title 5 Inspection Form 6/15/2000 10
I
Page I 1 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 112 CASTLEWOOD CIRCLE
HYANNIS, MA 02601
Owner: SOUZA,ALAN
Date of Inspection: APRIL 1,2003
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
i
I
Estimated depth to no groundwater 12 feet
Please indicate(check)all methods used to detennine the high ground water elevation:
Obtained from system design plans on record-If checked,.date of design plan reviewed:
./ Observation 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 DUG TEST HOLE 12' NO WATER. TEST HOLE 5' BELOW LEACHING.
1
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i
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Title 5 Inspection Form 6/15/2000 11
it
f � TOWN OF BARNSTABLE
LOCATION //2- C66 T ZL W OOQ 6196&E SEWAGE#
i VILLAGE ASSESSOR'S MAP&PARCEL
1=igfffth l;NAME&PHONE NO. LDA U45,1 l A40?,16e (7 k1242¢-674-6
lNs��c-•top t
SEPTIC TANK CAPACITY DOO
2 •Slti f?C. CAIMAW (size)LEACHING FACILITY:(type) G•
NO.OF BEDROOMS ?'
OWNER MARr k1,4'
I
PERMIT DATE: 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 leaching facility) 200 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) 3 Feet
FURNISHED BY DA72h� � 12—_
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TOWN OF BARNSTABLE �
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O(ATION cdsi,4 ,�f SEWAGE #
VIL:..AGE Y 'ASSESSOR'S•MAP & LOT
D 'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS t
BUILDER OR OWNER S
PERMITDATE: CODE DATE:
/4.,514f CT/ox,
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
1
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SL
Mb
41.
w
I TOWN OF BARNSTABLE
LOCATION�f� �����-6tb:3 /�'�LP— SEWAGE # -
`VU,_LAGE•� i"'2 f-.S ASSESSOR'S MAP & LOTZ 7ff
IIdSTALLER'S NAME&PHONE'N0. AfA C_A 1UIIQ 7�S �MCD
SEPTIC TANK CAPACITY Ex 2ti I
LEACHING FACILITY: (type) " Cis 4hom (size)
NO.'OF BEDROOMS
' . BUILDEWOR OWNER S I'z
PERMITDATE:/--1- -.5; !2j COMPLIANCE
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
onsite or within 200 feet of leaching facility) Feet
Edge?of Wetland and Leachtrig Facility(If any wetlands exist
within 300 feet of leaching facility) .' _- Feet
Furnished by
!7 + G4
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No. 7� Fee SU
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS V
ZIpprication for Migool *pgtem Construction Permit
Application for a Permit to Construct( )Repair(--I)Upgrade( )Abandon Q ) ❑Complete System ❑Individual Components
Location Address or Lot No. /pZ �,S f 12�d C r!' Rwner's Name,Address and Tel.No.
D Ui A AAL _ �OU a�
0l7
Assessor's Map/Parcel 3
I1 o? (.J;ngso,r Of. rrR►v,,
Installer's Name,Address,*&'SoCANCO Designer's Name,Address and Tel.No.
350 Main Street A lA
W.Yarmouth MA 02673
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 5 4 S gallons per day. Calculated daily flow -3 30 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /O®o �f%s�%�- Type of S.A.S. Ln i/fr yI6r
Description of Soil01
c
Nature of Repairs or Alterations(Answer when applicable) TWWsf -r'(
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore'described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health. /�
Signed J f� ( &AA- __ Date
Application Approved by Date 2 -S''- 97
Application Disapproved for the fmowih reasons
Permit No. / 7- %/ Date Issued r
Y j ,
py.r .'•'` .. '4«art'i ,'�.f tt .'3�. `:•y .%ri, .lr3+:w ,.s ..�.: _,..-Y;..� ti:"r7 :aw'.,7�lfit�tii) +_ram,..-J ,g.. -'.2''$.tr'�i+i.K '+a. � at"iY'+tl� ''.7�w►a
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No. 7' — ... Fee SU /
r �` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
PUBLIC HEA�LTKDIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yev
�r 01pplication for �Digom' [ *pgtem Congtruction permit
Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
j: Location Address or Lot No.//a r4s f(Q��CJ� �' �-;` Owner's Name,Address and Tel.No.
Assessor's Map/Parcel ��A Aetc SOUS c4.
U t .
Installer's Name,Address,an jV"CANCO Designer's Name,Address and Tel.No.
350 Main"Street
W.Yarmouth, MIA 02673 /���
Type of Building:
Dwelling No.of Bedrooms , Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures '
" Vesign Flow 116a !-gallons per day. Calculated daily flow �3 3d gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /Ooo <.' F;_ • Type of S.A.S. 2,-7 i1fr,-g&T
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement: -_
The undersigned agrees,to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health. y
Signed �)1�Q� Date /� �/ - 7
Application Approved by 9 7
Date � � -��'_ _
Application Disapproved for the f owir reasons
Permit No. q� '�/_ Date Issued
THE COMMONWEALTH OF MASSACHUSETTS --
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired (Upgraded( )
Abandoned( ),by r'14.4)l cJ
atC. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construciion Permit NO. _ dated
Installer Designer z .
,The issuance of this,permit shall not—he construed as a guarantee that the s ill function as designed.
Date .• ?41 r' Y Inspector
__ —
Fee
! �' ��J /l/l ---- —------ ------ -- — S -
No.
y
THE COMMONWEALTH OF MASSACHUSETTS
1
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
ga'WigpoOf *pgtem Con u'ction Permit
Permission is hereby granted to Construct( )Repair( / Upgrade;( )Abandon( )
System located at 4Z40126 r','r ,4/-7r,,
V
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date:_�o�_�=9 7 Approved by�� '
SEPTIC SYSTEM - DESIGN
DMO-![ _ GAL/DAB
� BZDJ�AfS AT .. _ GAL/DAY/.3X
SLPTIC TANK:
GAL/DAY x 2 DAYS CAL
LASE IQW GALLON SKPTIC TANK (EXISTING)
LEACHING AREA:
USE 3 INFILTRATORS MAXIMIZER CH"Bf=RJS _
-WITH V Oj' STONE ALL AMUND (W x tf° x Z DEEP)
HR AREA: 30 + ft z x �2 � �164 SF (.7 4) � . GALI DAY
SIDE -- GAL/DAY
CAPAUTY 365 GAD/DAY
• + 10/9/97
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
(�0'btay%' , hereby certify that the application for disposal works
construction permit signed by me dated la- ' 4 , concerning the
property located at le'.� meets all of the
following criteria:
v • There are no wetlands located within 100 feet of the proposed leaching facility
There are no private wells within 150 feet of the proposed septic system
/There is no increase in flow and/or change in use proposed
J• There are no variances requested or needed.
• If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the
proposed leaching facility will be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S.map)
B)Observed Groundwater Table Elevation(according to Health Division well map)
av
SIGNED : DATE: l�• �'
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
q:health folder:cert
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TOWN OF BARNSTABLE
LOCATTONO CfI �2 �'Ze-et SEWAGE
VILLAGE_ ASSESSOR'S MAP & LOT 07
INSTALLER'S NAME&PHONE N0.
SEPTIC TANK CAPACITY Ex rsf j l Ca/
LEACHING FACILITY: (type) '
(size) 0
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE:Zf � '�COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and LeachingFacili
ty (If any wells exist
on-site or within 200 feet of leaching facility) Feet
Edge'bf Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
b�
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FtMElq�O� Town of Barnstable
'1 Department of Health, Safety, and Environmental Services
BnxxsrABM
MASS.: � Public Health Division
P.O. Box 534, Hyannis MA 02601
i
Office: 508-8624644 Thomas A.McKean,RS,CHO
FAX: .508-790-6304 Director of Public Health
2/12/01
Dianne M. Souza
145 Lockland Ave
Framingham, MA 01701
Dear Mrs. Souza,
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE 11, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
The property owned by you-'located at 112 Castlewood Ave, Hyannis, MA was inspected
on January 2, 2001 by Edward Barry, Health Inspector for the Town of Barnstable,
because of a complaint. The following violations of 105 CMR 410.00, State Sanitary
Code II, Minimum Standards of Fitness for Human Habitation were observed:
410-500 - Bathroom shower wall tile loose, floor covering in bathroom and closet are
raised from floor: water stains on floor of bedroom adjacent to bathroom.
Window sills are rutted and water stained. Fireplace does not vent properly.
410-501 - Exterior cracks between storm window and primary window.
410-480 - Lock inoperative on East slider.
410-551 Holes in screen doors of both sliders.
410-481 -No rventy(20) square inch sign posted on front door bearing name, address
and telephone number of owner.
t.
You are directed to correct these violations within twenty-four(24) hours of receipt of
this notice.
You are also directed to correct the above violations within fourteen (14) days of receipt
of this notice:
2
You may request a hearing if written petition requesting same is received by the Board of
Health within seven (7) days after the date order is received. However, these violations
must be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than$500. Each separate day's failure to comply with an order shall constitute a separate
..�..4: -
V 1VIa L1V11.
PER ORDER OF THE BOARD OF HEALTH
o A Mc can
Director of Public Health
-[ 0 _
FORM30 HOBBS&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITYrrOW N
14
o DEPARTMENT
ADDRESS
/// TELEPHONE /�t
Address ���1yR tJ �oes�a W i1P-4;�A4, Occupant -��� �� 9'av 4(
Floor Apartment No. �No.of Occupants
No.of Habitable Rooms -11- No.Sleeping Room
No.dwelling or rooming units No.Stories
Name and address Al"f owner Z > 41412
N L� A r"lam, // 7,07 /�,''�; Remarks Reg. Vlo.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows: 0 G '� ��/ p YQ"� i z4C
hoof, V
Gutters, Drains: o#,<e -K A
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Haft,Stairwa�:r ,A/rM I a In ,4q i�1.`7,
Qbst=.n.:141 S h a W,"- '.,,I
_HallrFteor-Wa1I,-GeiNn :?`!-1' 6/N f !.� c>✓ v yY' /A /JO
Hall Windows-°,".l..a.,7.��1; 1�i/ S-T,��9✓;f 41IV. 4101y-W/ij 1! ow
,HEATING -C11irrrr1b s:l1✓7/ �' r,. 414 y--7-
Central ❑ Y ❑ N E ui . Re air / e) � JIS 44 .1
TYPE: Stacks, Flues,Vents:. -r f . 4¢4
"Pt U'MBTNf. Su I.-NFle:' r A4 s 0 64 ZL V_ > ,a p'p
❑ MS ❑ ST ❑ P -Waste-Line:? x 0-;7` 00'g4 A,'-/V
H:W-Tanks Safe -andiV.e s ! a r,M1 7'limit.R-
ELECTRICAL P-anels;Meters;Cir - ,,je w ,2 �' !�/� p
❑ 110 ❑ 220 Fusin ,.Grnd.:
AMP: Gen.Cond. Distrib. Box: r
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted IV0 �4 0 to � �h/,.�1� W
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY." �,,
INSPECTOR'' "� � TITLE A�_ -P% n
DATE TIME > O P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
1 -
W
410.750; Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises,
shall be deemed conditions which may endanger or impair the health, or safety
and well-being of a person or persons occupying the premises. This listing
is composed of these items which are deemed to always have the potential to
endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499
state minimum requirements of fitness for human habitation, any violation has
the potential to fall within this category in any given situation but may not
do so in every case and therefore cannot be included in this listing. Failure
to include shall in no way be construed as.a determination that other
violations may not be found to fall within this category. Nor shall failure
to include affect the duty of the local health official to order repair or
correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833
nor shall it affect the legal obligation of the person to whom the order is
issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure
and temperature, both hot and cold, to meet the ordinary needs of the occupant
in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or
longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper
venting or use of a space heater or water heater as prohibited by 105 CMR
410.200(B) and 410.202.
(C) Shut-off and/or failure to restore electricity or gas.
(D). Failure to supply the electrical facilities required by 105 CMR 410.250(B);
410.251(A), 410.253(A), 410.253(B) and the lighting in common area required
by 105 CMR 410.254.
'(8) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage system in operable
condition as required by 105 CMR 410.150(A)(1) and 410.300.
'(G) Failure to provide adequate exits, or the obstruction of any exit,
passageway or common area caused by an object, including garbage or trash,
which prevents egress in case of an emergency 105 CMR 410.450 and 410.451.
(H) Failure to comply with the security requirements of 105 CMR 41b.480(D).
'(I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602
' 'which results in any accumulation of garbage, rubbish, filth or other causes
-`of sickness which may provide a food source or harborage for rodents, insects
.or other pests or otherwise contribute to accidents or to the creation or
:.spread of disease.
(J) The presence of lead-based paint on a dwelling or dwelling unit in
.violation of the Massachusetts Department of Public Health Regualtions for
Lead Poisoning Prevention and Control 105 CMR 460.000.
.;([) 'Roof, foundation, or other structural defects that may expose the
occupant or anyone else to fire, burns, shock, accident or other dangers or
I*A1 Cant to health or dafety.
(L) Failure to install electrical, plumbing, heating and gas-burning
facilities in accordance with accepted .plumbing, heating, gas-fitting and
electrical wiring standards or failure to maintain such facilities as
are required by 105 CMR 410.351 and 410.352 so as to expose the occupant
or anyone else to fire, burns, shock, accident or other danger or impairment
'to:health or safety.
(M) Any of the following conditions which remain uncorrected for a period
of five or more days following the notice to or knowledge of the owner
of said condition or conditions:
(i) lack of a kitchen sink of sufficient size and capacity for
washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either operable.
(2) failure to provide a washbasin and a shower or bathtub as required
in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which
renders them inoperable.
(3) any defect in the electrical, plumbing, or heating system which makes
such system or any part thereof in violation of generally accepted
plumbing heating,. gas-fitting, or electrical wiring standards
that do not create an immediate hazard.
.(r)_ failure to maintain a safe handrail or protective railing for every
stairway, porch balcony, roof or similar place as required by
105 CMR 410.503(A) and 410.503(B).
(5) failure to eliminate rodents, cockroaches, insect infestations and
other pests as required by 105 CMR 410.550.
(N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A)
through (M) shall be deemed to be a condition which may endanger or materially
impair the health or safety and well-being of an occupant upon the failure of
the owner to remedy said condition within the time so ordered by the board
of health.
f .
COMMON VEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
�)WzI
DEPARTMENT OF ENVIRONMENTAL P OTECTIO
ONE "'INTER STREET. BOSTON. NIA 02108 61 1.29 '00
�..�° -�76 NOV 1
�J Z7� Tow"0Fe 3 199, Y xE
GovcmufA F.V1 ELD •C yE4[THD6tl Ze DSccretary
350 MAIN STREET
ARGEO PAUL CELLUCCI b WEST YARMOUTH, MA vID B.STRUHS
Lt.Govcmor KO 508-775-2800 Commissioncr
s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
PROPERTY ADDRESS: 112 Castlewood Circle, Hyannis ADDRESS OF OWNER:
DATE OF INSPECTION: November 5, 1997 Dorothy Bourassa
NAME OF INSPECTOR : James D. Sears
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000)
COMPANY NAME: A& B Canco
MAILING ADDRESS: 350 Main Street, West Yarmouth, MA 02673
TELEPHONE NUMBER: (508)775-2800
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,
accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper
function and maintenance of on-site sewage disposal systems. The system:
PASSES
CONDITIONALLY PASSES
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
X FAILS
INSPECTORS SIGNATURE: JDATE: November 5, 1997
The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall
submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
Aj SYSTEM PASSES: N/A .
I have not found any information which indicates that the system violates any of the failure criteria as
defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below..
COMMENTS:
B SYSTEM CONDITIONALLY PASSES: N/A
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 b the Board of Health,
will pass.
Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If"not
determined", explain why not) .
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy
of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20)
years prior to the date of the inspection, or the septic tank, whether or not metal, is cracked,
structurally unsound, shows substantial infiltration or exfiltration, or tank is failure is imminent. The
system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
Page 1 of 10
(revised 04/25/97)
DEP on the World Wide Web:hftp://www.magnet.state.ma.un/d
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (CONTINUED)
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
B]SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to
broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will
pass inspection if(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
I
The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if(with approval of the Board of Health).-
broken pipe(s)are replaced
i obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A
MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet to a surface water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone
1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet
of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100
feet but 50 feet or more from a private water supply well, unless a well water analysis
for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate
nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine
distance (approximation not valid).
3) OTHER
i
(revised 04/25/97)
Page 2 of 10
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
D]SYSTEM FAILS: X
You must indicate either"Yes" or"No" as to each of the following:
X I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should
be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged
SAS or cesspool.
iX Discharge or ponding of effluent to the surface of the ground or surface waters due to an over-
loaded or clogged SAS or cesspool.
N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged
SAS or cesspool.
X Liquid depth in pit is less than 6" below invert or available volume is less than '/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)
Number of times pumped
X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater
elevation.
X Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a
surface water supply.
X Any portion of a cesspool or privy is within a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed to be
acceptable, attach copy of well water analysis for coliform bacteria, volatile organic
compounds, ammonia nitrogen and nitrate nitrogen.
NOTE: Pit structural un-safe, side of pit gone, some sand coming in, plywood over side hole.
E) LARGE SYSTEM FAILS: N/A
You must indicate either"Yes" or"No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a
significant threat to public health and safety and the environment because one or more of the following
conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or
mapped Zone II of a public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of
the Department for further information.
(revised 04/25/97)
Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following:
Yes No
X Pumping information was provided by the owner, occupant, or Board of Health.
X None of the system components have been pumped for at least two weeks and the system
has been receiving normal flow rates during that period. Large volumes of water have not
been introduced into the system recently or as part of this inspection.
N/A As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,including the Soil Absorption System, have been located on the site.
X The septic tank manholes were uncovered, opened, and the interior of the septic tank was
inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid
depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
X The facility owner(and occupants, if different from owner)were provided with information on
the proper maintenance of Sub-Surface Disposal System.
X Existing information. Ex. Plan at B.O.H.
X Determined in the field (if any of the failure criteria related to Part C is at issue, approximation
of distance is unacceptable)[15.302(3)(b)]
(revised 04/25/97)
Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 220 g.p.d./bedroom for S.A.S.
Number of bedrooms: 2
Number of current residents: 1
Garbage grinder(yes or no): NO
Laundry connected to system es or no): YES
Seasonal use(yes or no) NO
Water meter readings, if available(last two(2)year usage(gpd):
Sump Pump(yes or no): NO
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gallons/day
Grease trap present: (yes or no):
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
2 YEARS AGO
System pumped as part of inspection:(yes or no) NO
If yes, volume pumped: gallons
Reason for pumping
TYPE OF SYSTEM
X Septic tank/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous'inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known)and source of information:
AGE UNKNOWN
Sewage odors detected when arriving at the site: (yes or no) NO
(revised 04/25/97)
Paget 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
BUILDING SEWER: N/A
(Locate on site plan)
Depth below grade:
Material of construction _ cast iron _ 40 PVC _ other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK: X
(Locate on site plan)
Depth below grade: 10"
Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain)
If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No)
Dimensions: 1,000 GALLON PRE CAST
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: 1
Distance from top of scum to top of outlet tee or baffle: 11"
Distance from bottom of scum to bottom of outlet tee or baffle: 14"
How dimensions were determined TAPE MEASURE
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet
invert, structural integrity, evidence of leakage, etc.)
TANK AT WORKING LEVEL, OUTLET BAFFLE, COVERS 10" BELOW GRADE.
GREASE TRAP: N/A
(locate on site plan)
Depth below grade:
Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet
invert, structural integrity, evidence of leakage, etc.)
(revised 04/25/97)
Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to, or at time, of inspection)
(Locate on site plan)
Depth below grade:
Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain)
Dimensions:
Capacity:
Design flow: gallons/day
Alarm level: Alarm in working order _ Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: N/A
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,)
PUMP CHAMBER: N/A
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised.09/25/97) '
Page 7 of 10.
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
SOIL ABSORPTION SYSTEM (SAS): X
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: 1
leaching chambers, number:
leaching galleries, number:
leaching trenches, number, length:
leaching fields, number, dimensions.-
overflow cesspool, number,
alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
1,000 GALLON PRE CAST PIT, NO STONE, PIT AND COVER 28" BELOW GRADE
NOTE: PIT STRUCTURAL UN-SAFE, LEACHING SHOULD BE REPLACED.
CESSPOOLS: N/A
(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(cesspool must be pumped as part of inspection)
Comments:.-
(note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.)
PRIVY: N/A
(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.)
(revised 04/25/97)
Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100(locate where public water supply comes into house)
R LAP
1 r
3� 3°
O
(revised 04/25/97)
Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 112 Castlewood Circle, Hyannis
Owner: Bourassa, Dorothy
Date of Inspection: November 5, 1997
Depth to groundwater N/A feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained fro Design Plans on record
Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
(revised 04/25/97)
Page 10 of 10
i
' TOWN OF BARNSTABLE
LOCATION jetomi� CA(ZCLE SEWAGE #
VILLAGE ASSESSOR'S MAP 6z LOT
ID�8�g,L-L'E�t'S � A & B CANCO 775-6264
_SEPTIC TANK CAPACITY .
LEACHING FACILITY:(type)\ (size)
'.,NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER �j( U 1�-��) rW'��SIA
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
i
i
�J 1
rl' I
4 ' ,
FTME Town of Barnstable
LUnsTnst�, II
Department of Health, Safety, and Environmental Services
.
i6 Public Health Division
3 9. ♦0
P.O. Box 534, Hyannis MA 02601
i
Office: 508-8624644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
p June 10, 1998
1
' f
Diane Souza
112 Castlewood Circle
Hyannis, MA 02601
ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE,
TITLE 5.
I
The septic system owned by you located at 112 Castlewood Circle, Hyannis was inspected on
November 5, 1997 by James Sears,a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of
1995 TITLE 5 (310 CMR 15.00)due to the following:
• Pit was structurally unsafe. The side of the leaching pit was "gone". There is some
sand coming in also.
I
You are directed to hire'a licensed Town of Barnstable septic system installer to submit a sketch
diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367
Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00,
The State Environmental Code,Title 5 within(30)thirty days of receipt of this notice.
You are also directed to bring the septic system into compliance within sixty(60) days of receipt
of this order letter.
I
You are further directed to maintain the system by hiring a licensed septage hauler to pump the
septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of
the ground,or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to any
court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF-THE BO OF HEALTH
Thomas A. McKean,R.S.,C.H.O.
Agent of the Board of Health
q\health\dbfiles\title5i.doc i
I
I
j
s
Z 2,03 498 845
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
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Po ce State,&ZIP Codf
Postage
Certified Fee
Special Delivery fee
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Ln
rn Return Receipt Showing to
Whom&Date Delivered
Return Receipt Showing to Wham,
Date,&Addressee's Address
0 TOTAL Postage&Fees
M Postmark or Date
LL
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Stick postage stamps to article to cover First-Class postage,certified mail fee,and
charges for any selected optional services(See tront).
1. If you want this receipt postmarked,stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service
window or hand it to your rural carrier(no extra charge). Ln
a�
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m
return address of the article,date,detach,and retain the receipt,and mail the article.
Lo
3. If you want a return receipt,write the certified mail number and your name and address o' "
on a return receipt card,Form 3811,and attach it to the front of the article by means of the rn
gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article n
RETURN RECEIPT REQUESTED adjacent to the number. Q
4. If you want delivery restricted to the addressee, or to an authorized agent of the
r addressee,endorse RESTRICTED DELIVERY on the front of the article. 000
�M
5. Enter fees for the services requested in the appropriate spaces on the front of this E
receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. er
LL
i 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145" d
i
I
oFo+etq�, Town of Barnstable
• Department of Health, Safety, and Environmental Services
■AMSTABM
3 9 �0r Public Health Division
AIED��a P.O. Box 534, Hyannis MA 02601
I
Office: 508-8624644 ± Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
I
June 10, 1998
Dorothy Bourassa
112 Castlewood Circle
Hyannis,MA 02601 '
i
ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE,
TITLE 5.
i
The septic system owhed by you located at 112 Castlewood Circle, Hyannis was inspected on
November 5, 1997 by James Sears,a Massachusetts licensed septic inspector.
I
The inspection of your septic system showed that your system has failed under the guidelines of
1995 TITLE 5 (310 CMR 15.00)due to the following:
I
• Pit was structurally unsafe. The side of the leaching pit was "gone". There is some
sand coming in also.
You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch
diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367
Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00,
The State Environmental Code,Title 5 within(30)thirty days of receipt of this notice.
You are also directed to bring the septic system into compliance within sixty(60)days of receipt
of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to pump the
septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of
the ground,or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to any
court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE ARD OF HEALTH
T o s A. McKean,R.S.,C.H.O.
Agent of the Board of Health
q\health\dbfi les\title5 i.doc
j
I
[Installer letter]
TO: (Date) � crc� 3, Z928
At
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
The septic system owned by you located at !12 C�okALtJ Ci,cf Ac,4,,S was
inspected on Abv. r5d g97 by & s Sears a Massachusetts lien eseptic
inspector.
The inspection of your septic system showed That your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00 due to-the following: - r
�` vi c s�cYSL, clni+C
f I Ze 'kt' Sores
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within days of
receipt of this notice. k
You are also directed_to bring the septic system into compliance within t ' ) ays of
receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
Town of Barnstable
HM ] 01 H E A L T H M A S T E R ] HELP [ ]
R E C O R D ] ACTION I]
For Parcel Number 2731 0761 ] ] Rental Property(Y/N) [ ]
Owner Name BOURASSA, DOROTHY M ] Zone of Contrib (Y/N) [ ]
Location 112 CASTLEWOOD CIRCLE HY ] Contaminant Rel (Y/N) [ ]
Business Name [ ] Area Number
Contact Person [ ] Phone [000] [ ]
Fuel Storage Tank Permit [ ] Card on File [ ]
Perc Test Well Septic_
File/Permit No. [ ] [ ] [977.6.9.6_ l
Issuance Date [ ] 'J-[120597]
Completion Date [ ]
Last Communications [ ] (MMDDYY)
Comments [EX 1000 ST NEW 3 MAXIM W/4' STONE ]
Cancel [ ]
NEXT SCREEN [HM ] ACTION [
PARCEL NBR [ ] [ ] [ ] TANK NBR [ ] ]
[ ]
r
o SENDER:' I also wish to receive the
■Complete items 1 and/or 2 for additional services.
m ■Complete items 3,4a,and 4b. following services(for an
q ■Print
r toourname and address on the reverse of this form so that we can return this extra fee):
d
you.
■Attach this torn to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
o permit.
■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N
■The Return Receipt will show to whom the article was delivered and the date ..
delivered. Consult postmaster for fee. a
m
v 3.Article Addresse t 4a.Article Number c"►
2-- a3
4b.Service Type «'
0 `�j /1 ❑ Registered IF Certified
(�y�_ Im
W ❑ Express Mail ❑ Insured S
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IX
❑ Return Receipt for Merchandise ❑ COD
7.Date of eli e w
W 5.Received By: (Print Name) `'!r 8.Addressee's Address(Only if requested
w 113 and fee is paid) t
� 6.Sign; dress rAgent)
—i iPS Form'3811,1December 1994 Hi i +i r+ 102595-97-B-0179 Domestic Return Receipt
UNITED STATES POSTAL SERVICE First-class Mall
Postage&Fees Paid
uSPS -
Permit No.G-10
• Print your name, address, and ZIP Code in this box •
Public Health DlviSIOQ
Town of Bamstable
p 0.Box 534
HYannis, Massachusells 02601
` Plaza
SURVEY REFERENCE: LEGEND
PLAN OF LAND BY MERCER ENGINEERING, CORP, SURVEYORS I
DATED: MAY 1965 I PROPOSED CONTOUR
PROPOSED SPOT GRADE
—— 98 —— EXISTING CONTOUR14,
+ 96.52 EXISTING SPOT GRADE
W— EXISTING WATER SERVICE ,� '�? , ?��� •\�'� `• ; r, �_� _
a
TEST PIT �
' , I '..J , c�1
W .� /.�f r t � t l�r 1
Sty
KL1ks�
t_ te II w v --- C``•
LOT 12 98
44 r1 65\ LOCUS MAP N.T.S.
� I AREA = 7671 sf +-
W I �� GENERAL NOTES:
Y I TH-2
�I � 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER.
FORM TO THE REOUIREMENTS
L W I Z 20 ft \ 2. ALL WORK AND MATERIALS OF THE STATE ENVIRONMENTAL CODENTITLE V. AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS, EXCEPT AS REOUESTED BELOW:
I
p I y J LL TH�1 i i rt - 310 CMR 15.405 (1) (8):
O L/ C) 1 oco EXIST, WA TER / LL.? � \ 1) A 4.42 FT.'VARIANCE FROM 310 CMR 15.211 TO ALLOW
0 j n LIN� Q \\ LEACHING TO BE 15.5&�FROM DWELLING VS REO'D 20 FT. (LINER PROVIDED)
O W a GGAS
ATE L�l Q Q II 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
_ DESIGN ENGINEER.
I \ ~W 1SSg \ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
GAS FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
Lu CS O 65 ENGINEER BEFORE CONSTRUCTION CONTINUES.
o� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
—L_ E dOb 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
' PAVED D / ��2167. 3 O N 1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
_ RiVEW/Ay _ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
----____/ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
/ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
/ TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
70 rt ^ 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
Existing Leaching THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
\ V CONSTRUCTION.
66 98 30 tt \\ J\, (See Note 10) 10. EXISTING LEACHING TO BE PUMPED AND REMOVED.
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
66 I 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
i AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
BENCH MARK i 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING.
14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING.
PAINT SPOT ON 15. ALL PIPING TO BE 4" SCH 40 (P-1/8-/FT (UNLESS SPEC(PIED)
CONCRETE STEP 16. PLACE 40 ml POLY BARRIER AS SHOWN FROM EL. 62.50
ELEVATION = 66. 40 TO EL. 59.0 TO PREVENT INFILTRATION. ENG. TO INSPECT AND CERTIFY
OF ,!/qss BARN STABLE CIS DATUM 17. PROPERTY IS LOCATED IN A ZONE II/NITROGEN SENSITIVE AREA.
.18. TWO (2) BEDROOM DEED RESTRICTION REQUIRED.
j \o� DAR ' M. PROPOSED SEPTIC SYSTEM UPGRADE PLAN
N o. 140
�— 112 CASTLEWOOD CIRCLE, HYANNIS, MA
CASTE Prepared for: Boucher
MNITAR�a� s
MAP: 273 Engineering by: Surveying by: SCALE DRAWN JOB. NO.
nr(' LOT.076 DARRENM.MEYER,R.S. gco-Tech dbvlronmentel 1"_20' DMM
V v�� lYl t LCP:C169356 POBOX981 (508) 364-0894 DATE CHECKED SHEET NO.
V E4ST S4VDWICH,MA 02537
509.3s22922 04/06/09 DMM 1 of 2
I
ELEV. TOP BRING ALL COVERS TO WITHIN 6 " OF GRADE
FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS
(Existing)
66.49 F.G.EL: 65.50 F.G.EL: 65.40 F.G. EL: 65.4 FINISH GRADE=65.40
:� MAINTAIN 2% MIN SLOPE OVER LEACHING AREA
u
RISER TO W/IN 3" OF GRADE
0 2" OF 3/8" DOUBLE WASHED j
3/4" - 1-1/2" DOUBLE
A' STONE OR FILTER FABRIC WASHED STONE
6" 4" SCH 40 PVC
- =7
ra 10"1 ®®®®- O ®®®®
TEE'S ARE TO BE 14 e @ S= 1% (MIUF.
®®®®®®®®®®®
INV.63.0 2' DEPTH ®®®®®®®®®®®
4" SCH 40 PVC
-••-��-��� INV.63.57 -
I NV.62.80 4' 2 X 8.5' 4'
GAS PROPOSED DB-3
EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 25'
�•. « H-10 DISTRIBUTION BOX
' INV. ELEV.= 62.0
INV. 63.82 EXISTING 1000 GALLON SEPTIC TANK
BREAKOUT
GAS BAFFLE TO BE INSTALLED ON ELEV.= 62.50
UT
OUTLET TEE AS MANUFACTURED BY TOP CONC. ELEV.= 62.50
TUF-TITE, ZABEL, OR EQUAL
INV. ELEV.= 62.0 •®® O ®®
®®®®®®® .
® a E3 E3
®®®®®®®
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BOTTOM EL.= 60.0 N ®®®®®®®
PIPE INVERTS PRIOR TO CONSTRUCTION 3.75' 5 FT. 3.75'
2) D-BOX SHALL BE SET LEVEL AND TRUE TO
GRADE ON A MECHANICALL COMPACTED SIX EFFECTIVE WIDTH = 12.5'
SEPARATION 7.0 FT.
INCH CRUSHED STONE BASE, AS SPECIFIED IN SEPTIC SYSTEM PROFILE
,
310 CMR 15.221(2) SOIL ABSORPTION SYSTEM (SECTION)
3) REPLACE EXISTING 1,000 GALLON SEPTIC BOTTOM OF TESTHOLE EL: 53.0
TANK WITH 1500 GALLON•SEPTIC TANK (500 GALLON LEACH CHAMBER (H-10) LOADING)
IF FAILED, DAMAGED, OR UNDERSIZED.
4) INSTALL INLET & OUTLET TEES AS REQUIRED SOIL LOGS P#: 12526 DESIGN CRITERIA
DATE: APRIL 3, 2009
NUMBER OF BEDROOMS: 3 BEDROOOM
i SOIL EVALUATOR: DARREN MEYER, R.S., CSE SOIL TEXTURAL CLASS: CLASS I (0.74 GPO/SF)
WITNESS: DONNA MIORANDI, BARNSTABLE B.O.H. DESIGN PERCOLATION RATE: <2 MIN/IN
Elev. - TH-1 Depth Elev. TH-2 Depth DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D.
65.18 LOAMY 0" 65.0 A 0" GARBAGE GRINDER: NO (not designed for garbage grinder)
10YR 3/2
A LOAMY SAND 10YR
/1 SEPTIC TANK: 330 gpd x 2.0 = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK
Of 64.51 B 8" 64.42 B 7" 330 445.94 S.F.
Mqf LOAMY SANG LOAMY SAND LEACHING AREA REQUIRED: ( )
10YR 6/S 10YR 5/8 .74
�N ✓ 62.06 35" USE TWO (2` 500 GALLON PRECAST LEACH CHAMBERS W 4' STONE
V o: 1140 Cn C1 ON SIDES & 3.75 STONE ON SIDES: 25' L x 12.5 • W. x 2 D
MEDIUM BOTTOM AREA: 25 x 12.5= 312.5 SF
C/S1Ea MEDIUM SAND SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF
NITAR�a� PERC ®60.51 SAND 2.5Y 7/4 2.5Y 7/4 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D
b! L) DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.O. req'd
1 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
53.10 145" 53.0 144" 112 CASTLEWOOD CIRCLE, HYANNIS, MA
PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Pinheiro
NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN
DARRENM.MEYER,R.S. Eco-Tech EDI'&- i-J N.T.S. DMM
I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX981 (508) 364-0894 DATE SHEET N0.
to conduct soil evaluations and that the above cnalysis has been performed by me consistent with the EAST SANDWICH•MA 02537 CHECKED I requirements of 310 CMR 15.017. 1 further certify that I hove passed the Soil Evol. Exam in October, 1999. 50"2-2922 04/06/09 DMM �f 2 Of 2
(