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0153 CASTLEWOOD CIRCLE - Health
1'53 CASTLEWOOU CIRCLE; HYANNIS Yv I ° Town of Barnstable .�' Board. of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304. Sumner Kaufman,MSP: Wayne Miller,M.D. Mr. Brian Olander May 5,.2003. 153 Castlewood. Circle. Hyannis, MA 02601. RE:. 153 Castlewood. Circle, Hyannis. A=.272-047. Dear Mr.. Olander, You are.granted. a.variances. on behalf of your. client,. Denise Garner, to.construct a garage at 153. Castlewood Circle, Hyannis. only three feet away from, the existing soil absorption.system. These variances. are granted.with.the following.conditions: (1) A driveway shall. not be constructed over the soil absorption. system. (2) No additional. bedrooms shall. be constructed... Dens, study rooms, offices, finished. attics, sleeping, lofts, and. similar-type rooms are considered "bedrooms". according to.the. MA Department of. Environmental Protection.. These variances. are. granted. because the. small size of the lot and physical. constraints at the site.severely restrict the location.of the garage. Sin rely yo s . Fyn Miller, M.D. Chair an Olander SENDER: COMPLETE THIS.SECTION 'COMPLETE THIS SECTION ON-DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the revers ee so that we can return the card to you. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is deliv tiff t from Rem 1? Cl Yes 1. Article Addressed to: If YE r delivery below: ❑ No qPA .o N%6 Q n » 1 / /ti q,5& 3. Service SZD Ified Sid- Express Mail ❑Registered '❑Return Receiptfor Merchandise ❑ Insured Mail ❑C.O.D.,,, 4. Restricted Delivery?(Extra Fee)" ❑Yes 2. Article Number (Transfer from service7abeQ ! ;f i i ;i 7 0 0 2 ; 2 41,0;;0 0 0 2";8'2 9 >' 0`5 9 7 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M?540 I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • I I I 0 a-6- of Hill Il,l,itlil li,:If„lll1114111111IllillifId:iffill ll Ill COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signet e item 4 if Restricted Delivery is desired. n ❑Agent ■ Print your name and address on the reverse ,J•��Addressee so that we can return the card to you. B. Received by(P t r Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery a ft- differe de 1? ❑Yes 1. Article Addressed to: If YES,ente ver9ss belo ❑ No ,/1e1.(t �1t'S 't, � �` Li �Gt�Se '�•1 Ct�c vgQ°' u n r7 iS �. � 3. Service Type O o1 Q / 9 'Mified Mail ❑Express Mail ❑Registered ❑Return.Receiptfor Merchandise ❑ Insured Mail ❑C.O.D.. N'.8V0 4. Restricted Delivery?(Extra Fee) ❑Yes L cleN er Nd m ?002 2410 0002 ' 8290 0580 nsfer ervice lab rm 381 'Domestic Return Receipt � � ��* 102595-02-M-1540 PLACE STICKER AT TOP OF ENVELOPE TO THE RIGHT l UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I I l �S3 C,,S le k--cod arck a n n ks , /41 ass' 0a H11!f11Il13.11111{!!!!!111IJ11!111i!!I!I{!1!'!!i1I11!ilJ!1!11 i COMPLETE •N COMPLETE THIS SECTIONON ■ Complete items 1,2,and 3.Also complete PM N� item 4 if Restricted Delivery is desired. Q`0 0 ❑Aden ■ Print your name and address on the reverse ❑Addressee so that_we can•return the card to you. Receiv (P' `e Name)11 C. Date of Delivery ■ Attach this card to the back of the mailpiece, <JO or on the front if space permits., '~ Is ery add erent from item 1? ❑Yes 1. Article Addressed to: _ S,enter address below: ❑No 7 -A n n LS 3. Service Type 912eRIflBd Mail ❑Express Mail ®A 601 ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) i! ;s=i i i ,7 0 0 2;:2 410; ;0 0 0 2 ;8 2 9 ;; 5 7 3 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 �! t i 4: ::i i.. f i r t t p r r 2 j, r r r - UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • /S-3 ccs-He w®®cr or'de_ SENDER: COMPLETE THIS SECTION' COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X —, y ❑Addressee so that we can return the card to you. eived by(Printed Nam C.pat of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I / 69® e gilt)e,w0 o R n Ly ,/4 coy 3. Service Type M'ft ified Mail ❑Express Mail D'�L 6 0/ ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail. ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes •.Article Number > — - rdnsfer from se el)• 7002 2410 0002 8290 0627 ;� I ggcedl - 'y�" —PS-r-orm 3811,Rkugust 2001 -v Domestic Return Receipt 102595-02-M-1540 rn 0 1 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • VLniS _ GV-Z1tA` I'S 3 C'\'-f)e L;,jG 06( ci rc1� r-I `act 17 n' s /►R�SS' o� Gnj COMPLETE • -COMPLETE • ON-DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature ` item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee, so that we can return the card to you. A MMA 43o Received by(P me Name) C. Date of Delivery ■ Attach this card to the back of the mailpfe a , or on the front if space permits. ,rVIs delivery add ress different from item ? Yes 1. Article Addressed to: ��U1 F'V��v YES,enter delivery address below: ❑ No MIL 0Mai t ®w�*2� 3. Service Type Certified Mail ❑Express Mail ❑Registered ❑Return.Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service labeq 7 0 0 2 2 410 0 0 0 2 -8 2 9 0 0 610 PS Form 3811,ALgusf 2001 C Hill {Domestic Retuin.Receipt i i i i t i t t i !t t i i l 102595-02-M-1540 UNIYED STATES POSTAL SERNI '��i ciP f _ Q Postage&Fees Pajd `e i J, USPS SG + Permit No.G-10'— • Sender: Please print your name, address, and ZIP+4 in this box •y %S,3 - I 0 X IG o/ I I )li!,!�!fiti!i)!t►i!t!!!tii!ti!i!!►ii!tt!1i!i!!!1:)!!!I)!}tllt� I I I DATE: 3 13` Q y�JO . FEE: I I • BARNSPABM MASS. PA_ 1639. `0� REC. BY ��EDMAtp Town of Barnstable , o SCHED. DATE:�3 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: I_.5� �- g'�'1 G �✓G a Gj C 1 (L, f-lVa Assessor's Map and Parcel Number: © Size of Lot: / , / 51 +T- Wetlands Within 300 Ft. Yes Business Name: No_ Subdivision Name: APPLICANT'S NAME: 0 Lei r7 O ie, Phone SO I 7 2C Q 3`01 y Did the owner of the property authorize you to represent him or her? Yes _ No PROPERTY OWNER'S NAME CONTACT PERSON Name: )D f..-1 l,5 t. �'a f2 n e 2 Name: 0 L a r7 Address: I C'3 C V--'OOd Ct PC'e— Address: A 435 . 7 Wh n / e Phone: X O S 7? O -- 0 3 Zk y Phone: �07 —7 O " 6 3 Y VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) .5�—e— ys+ei nC�S J'Lca a fov SEAS NATURE OF WORK: House Addition ❑00000 House Renovation q Repair of Failed Septic System ❑ Ca AbT1°'V Ct i t"ri 0f fk''"'t;e;LJedl !'C1 Checklist(to be completed by office staff-person receiving variance request application) 4F (4)copies of the completed variance request form S;kFi Z(4)copies of engineered plan submitted(e.g.septic system plans) ` Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent hinAer for this request 3� Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) V Full menu submitted(for grease trap variance requests only) V Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\WPFILES\VARIREQ.DOC •A.�pL�cw►��, Oen��e �`�� 0 L-,+7 0�� ay,- -Fo-�- tea►/`t o✓►c )D`emu.c 1, = Ltvi , I/lG6es A d ove- 4yevn D 1, iOrevioLu �����t 0wne0' vtoro% ..� Q cv -t'`c .S v��f e i+•1 q n p i/1 S-4a 1 e- SAS -r-rcl a rct 0 OF: -r A e- C o f W o v I a ALLo w Ai0 va' �oo✓►� -'C O '� P°';� t'�- 5A5 r Orive w wovla �'►�� �� l Eve n eQ-0 e QnSI Dual 1� I I N LOT 105 _ LOT 100 cv 153 2�, LOT 104 cb' �. ' . ' . ' "' BRICK PAD � ,,,,. �• irk '9s . e OT 101 ,c� 0 1 YJ Itr * A Z LOT 103 lY LOT 102 — NOTE- PRE—EXISTING NON—CONFORMING RES. ZONE. 'RC-1" This MORTGAGE INSPECTION Plan is For Bank Use only FLOOD ZONE., "C" HE DISTANCES MEASUREMENTS ON IS LAN SHOULD BE VERIFIED BY N INSTRUMENT SURVEY. D REGISTRY 0 WNER: ADAM L BECKLOLF & TERRY C�TARDO DEED REF: �L6�37�7 _ _ BUYER: -DENI,SEL A_ GAR1NE1� _ _ _ _ _ _ _ _ _ _ DATE: �1��4L;�� _ _ _ _ PLAN REF: 197197 _ _SCALE:1"= 20 FT. I HEREBY CERTIFY TO _�A _� _ — SAVINGS_BANK-- _ _____-_THAT THE BUILDING '3��� OF YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS PAUL CONSULTANTS SHOWN AND THAT ITS POSITION DOES __ -CONFORM A TO THE ZONING LAW SETBACK REQUIREMENTS OF THE AAERITHEW H 40B (SUITE 1) TOWN OF _BARNSTABLE____ <<; _-AND THAT INDUSTRY ROAD IT DOES_NOT- LIE WITHIN THE SPECIAL FLOOD HAZARD , gfg+ Sa MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED_$/1�9,(�5 _ Co u it —Pan 1 ,250001 0005 C P� �Og TEL 428-0055 THIS PLAN NOT MADE FROM AN INSTRUMENT SURVEyFAX 420-5553 PA A. MERITHE ------- NOT TO BE USED FOR FENCES BUILDING PERMITS ETC. '2803.2 JF o a, ,r k o H e« I'I�� o� o o ^4 n J- 14 ASS 2 fiere �� ,�v- 'ariie � 0,Xan ol.anne9- 7o YZe p ese..T �e n -tl, 2 A-rro cck#- I YzecLvesl- a .► GL�.iy2� -D e n S G A t?-A-L% I53 cG.s-He wood Cr,c1e . £L.�vo:�io n F�c�`nc� Street Ll Q ofooSeA Cwraae- Den S.%SQ GaRr1@J' N �gnni.S � McsS e 'A TOWN OF BARNSTABLE LOCATION �� � [ As4,q i„iopo SEWAGE # fl VILLAGE_ ASSESSOR'S MAP & LOT2 79. Q INSTALLER'S NAME &-PHONE NO. j,)I)O SEPTIC TANK CAPACITY' jo O o SAL LEACHING FACILITY:(type) (size) NO. OF BEDROOMS ,5 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER czldd t „_tea DATE PERMIT ISSUED: �-� CI 7 DATE .COMPLIANCE ISSUED: Al / / VARIANCE GRANTED: Yes No ' r ' .. .. l�_ _.. y,•� .O - �. v � `� � � � V � �� .• o � _ . � � � u �� � � -�- .:•v �. .0 �*a TOWN OF BARNSTABLE � J-�� LOCH i ION',z" &?YAS �wal VILLAGE ASSESSOR'S MAP & LOT =-9.II`' Xt-t�NAME&PHONE NO. SEPTIC TANK CAPACITY 046 ,wl r LEACHING FACILITY: (type) / i� t � (size) �G�=lJ NO. OF BEDROOMS BUILDER OR OWNER DATE: 0 7 EOO� k0&X—)r DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) V Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o leachin fa lilt Feet Furnished b t w 00 1� 00.0,p O4 s zz No. Fee 1•s d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Migap/o�gaf *pgtern Construction Permit Application for a Permit to Construct( )Repair(�/)Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. k4VA Cr.G Owner's Name,Address and Tel.No. Assessor's Map/Parcel O�� •ZZ O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank rST Type of S.A.S. -�� �`t-✓eclu,S Description of Soil C7' Nature of Repairs or Alterations(Answer when applicable) .TK-STa-t Ce, gatL,/ 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 Environ ental Code and no lace the system in operation until a Certifi- cate of Compliance has b d of Signed Date Application Approved by Date Application Disapproved for the ollowing reasons Permit No.9 7- O Date Issued -Z, a. ��...+-�x��`a� :� ti.�yL� .t....�^�.� ,ys• � L.•'y'�'.1.^.-:J� J4.ir:. No. �771 Fee I U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for ]Dtgpool bpMem Congtruction Permit Application for a Permit to Construct( )Repair(Apgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �.3 C 145TL C k.C64 Gt•e Owner's Name,Address and Tel.No. Assessor's Map/Parcel �� a v W tl Z O Installer's Name,Address,,and Tel.No. n-.- Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size--sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures 1 Design Flow ��i��/ gallons per day. Calculated daily flow 3`Aci gallons. Plan Date. Number of sheets Revision Date Title Size of Septic Tank !Fer, 1 COO A- 10 1k, Type of S.A.S. stv-G I-T r c�T a f1 s Description of Soil Y Nature of Repairs or Alterations(Answer when applicable) _--pot,s r.a 1 Ca g r�i / A Date last inspected: Agreement: l- w•�*�,_ r.;. x . .. 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 Environ ental Code and not place the system in operation until a Certify- jo cate.of Compliance has be enaesued-by thrs;Be d of th. a Signed Date Application Approved by '� Date L Application Disapproved for.the ollowing reasons Permit No. _/( © Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER that the O - ite Se �Sewage Disposal System Constructed( ) Repaired ( ) Upgraded( t Abandoned( )by o c u wbo at r 3 Ct (^E�-OvV� C�vr `/t4�-f4`f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D dated Installer C Designer The issuance of this permit shall not be c pstrued as a guarantee that the system will 1 function as designed. Date - -) Inspector —___—_—_———Y————————————————————— . N. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wigpogar 6pgtem Construction Permit Permission is hereby granted to Construct( )Repair( ✓jUpgrade( )Abandon( ) System located at / CV1 S`/�V_VzAb G t— 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: Ll -7 a Approved by NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANSI hereby certify that the application for disposal works construction permit signed by me dated 'ci , concerning the property located at 153 meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. jxcrt i i _ Y l fr r TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE_ ;'Ap//!i/ C ASSESSOR'S MAP & LOT Q INSTALLER'S NAME & PHONE NO. L AFC S��ofic 778-Oy' SEPTIC TANK CAPACITY / 0 0 AL LEACHING FACILITY:(type) �{ ►a f►// �s���l� (sue) NO. OF BEDROOMS ,S PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: Ll y 7 DATE COMPLIANCE ISSUED c/ 7 VARIANCE GRANTED: Yes No ' I 1 .t 2 / S-jI i}S-t L c wo o D 1 M D7 Oq -7 DATE: _ 3/.1 0/97 PROPERTY ADDRESS:- 153 Castlewbod Circle Hyannis ,Mass . 02601 On the above date, I Inspected the septic system at the above address.. This system consists of the following:" 1 . . 1 -1000, gallon septic, tank. . 2 . . 1 -61x8 ' block cesspool. Based bn my lnarwctlon, I certify the following conditions: 1 . -This' is a title five septic -sys-:tem ( 78 Code ) 2. The" septic, system is not in.,'proper working . .I`ordei at the• ,present time:.-`°The septic" system--1 V. is--in ,failure..—Must be 'upgraded to a `ti`tl.e five . septic system.--( 95-Code °) SIGNATURE: Flame: J . P .Macomber Jr., i company:_J. P_MacoMber & Son-_Inc , Q_-7_ f 6 Cente�rvil le , Mass__0.2-632 Phone:---SQ8..J7�..3338_____-- - i THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY R fcrJOSEPH P. MACOMBER & SON,. INC. AP 4 1997 Tanks-Cesspools-Leachflelds TOM0F8ARNST4t a Pumped & Installed HEAITHDEPT Town Sewer Connections t P.O. Box 66' Centerville, MA 02632.0066 775-3338 775-6412 ` r . U Commonwealth of Massachusetts Executive Office of Envlronmentol Affairs ' Department 'of Environmental Protection ft"M F.wow Trudy Cox* Arpeo Paul CellucW David B.Struha LL 6oanor ��� e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAddre" 153 Castlewood Circle Hyannis ,Masjiddrees.10waer. Date of Inspection: 3/10/9 7 of different) Naaasoflaspector. Joseph P.Macomber Jr. ' Com Name.Addreas and Telephone Number. I J. I acomber & Son Inc . Box 66 Centerville ,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this addrew and that the information reported below is true,accurate sad Completa as of the time of inspection. The inspection was performed based on my training and experience in the proper function and mamtenaaee of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes Beds Further Evaluation By the Local Approving Authority inspector's Signature: Date: /t-�/ 7 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 end copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A.B, C,or D: A) SYSTE31 PASSES: have sat found a1Y 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. B) SYSTEM CONDITIONALLY PASSES: yIJ One or more system Components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If'not determined',explain why not) Qj� The septic tank is mats), cra:ked, structurally unsound,shows substantial infiltration or enfiltration,-or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Wlnter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292.5500 �� Primed on PAcyckd Papv SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontlnued) PropertyAddre.c 153 Castlewood Circle Hyannis ,Mass . Oar. Cynthia Engle Date of Inspection: 3/1 0/9 7 B)SYSTEM CONDMONALLY PASSES (ooatinuad) ,aA,f— 8swa8e backup or breakout or ho static water level observed in the distrOtttioa boa'is due to broken or obstructed pipow. or due to a broksA settled or uneven distribution boa. The system will pass inppection if(with approval of the Board of Health): broken pipe(&)are replaced obstruction is removed distribution boat is levelled or replaced The system required pumping more than four times a year des to broken or obstructed pipe(s). Tbs systam will pace& inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A- Conditions dst which require Anther evaluation by the Board of Health in order to determine if the system is failing to prof m 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 it within 60 fact of a surface water Cesspool or privy is within 60 fist of a bordering vegetated wetland or a salt marsh 3) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERhUNES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. QED The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to& surface water supply. The system hu a septic tank and&oil.absorption system and is within a Zone I of a public water supply-oil- Leo The system has a septic tank and*oil Absorption system and is within 60 feet of a private water supply well Tha system has a septic tank and*oil absorption system and is Is"than 100 feet but 60 feet or more from a private water supply wall,unless a well water analysis for coliform bacteria and volatile orgaaic oompouads indicates that the wail is &" $om pollution liom that facility and the.presence of ammonia nitrogen and nitrate nitrogen is equal to or lea& than 6 ppm 3) OTHER Y1� . (revised 11/03/95) 2 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddresw 153 Castlewood Circle Hyannis ,Mass . Owner. Cynthia Engle Date of Inspection: 3/10/9 7 D) SYSTEM FAILS: Y`l I have determined that the system violates one or more of the following failure criteria as defined in 310 CI M 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. Backup of sewage into facility or system component due to an 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. J� Static liquid level in the distribution boat above outlet invert due to an overloaded or clogged SAS or cesspool. NO Liquid depth in cesspool is keen than 6"below invert or available volume is Is"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 Soil Absorption System, cesspool or privy is below the high groundwater'elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. . 426 Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water.supply well with no acceptable water quality analysis. If the well has been analysed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 2 jo 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: the system is within 400 feet of a surface drinking water supply 1/¢ the system is within 200 feet of a tributary to a surface drinking water supply W7 the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of arty 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.tt/03/95) �r 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 153 Castlewood Circle Hyannis ,Mass . Owner. Cynthia Engle Date of Inspection: 3/1 0/9 7 • Check if the following have been done: Zpumping information was requested of the owner,occupant,and Board of Health. -/Mons 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. t As built plans haw been obtained and examined. Now if they.are not available with NIA.'_ i The facility or dwelling was inspected for signs of sewage back-up. 4z�.hs system does not receive non-sanitary or industrial waste flow 46u site was inspected for signs of breakout. - All system oompoasats, cludiag the Soil Absorption System, have been located on the site. The septic tank maaboles 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. 2The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. Z�bs facility owner(and oocupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Deposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Cynthia Engles Owner. . 153 Castlewood Circle Hyannis ,Mass . Date of Inspeotiuw3/1 0/97 FLOW CONDITIONS RESIDENTIAL• Derigaflow: n, ,+^01,4Y s Number of bedroom,: 19 Number of wrrent resident,: Garbage grinder(yes or no):d& Laundry connected to system(yes or no):-Y,—S Seasonal use(yes or no):_4& Water meter readings, if available — :z 'O5- F A Last date of occupancy: COMMERCIAL NDUSTRIAL Type of establishment: 4,47 Design ilow: V,�l galloWday Grease trap present: (yes or no),&y Industrial Waste Holding Tank present: (yes or no).&jO Non-sanitary waste discharged to the Title 6 system: (yes or no) / Water meter readings, if available:_ .VA • last date of occupancy:_ OTHER: (Describe) �G;¢ Last date of occupancy: iU GENERAL INFORMATION PUMPING RECOIJDS and source of informatio System pumped as part of inspection: (yes or no).&JO If yes,volume pumped: sallons Reason for pumping: if/ TYPE OF SYSTEM f �/Septie t silt bea/aoil absorption system —wld siagie cesspool 410 Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) „Z)h Other(explain) APPROXIMATE AGE of all components, date inrtalled(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)- (revised 11/03/95) ti i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C- SYSTEM INFORMATION(continued) Property Add►ess:. 153 Castlewood Circle Hyannis ,Mass . Owner: Cynthia Engle Date of Inspection: 3/10/97 SEPTIC TANK:_&W9 >5 , (locate on site plan) Depth below grade:_ Material of construction: concrete _metal _FRP_other(explain) Dimensions: _P�0,' 7 r Ac Sludge-depth: Distance from top of sludge to bottom of outlet tee or baffle:�� Scum thickness: Distance from top of scum to top of outlet tee or baffle: l �— , Distance from bonom of scum to bottom of outlet tee or baffle._: � 411 Comments: _ (recommendation for pumping, condition of inlet and outlet tees or baffle. depth of liquid level.in relation to outlet invert, structural rity, evidence of leakage, etc.) PumZ se tic tank ever 2-3 years : Inlet & outlet _tees- are in lace :Li uilevel at- 011,tlet invert.4s 511" . The ..septiv tall is trilgl1Lo,11y sottnc3'_Nr avidPnrP• nff IszAkA GREASE TRAP. ltlaWf— (locate on site plan) Depth below grade:�lJ/� Material of conslmrii6r7& zoncrete _metal _FRP —other(explain) Dimensions - Scum thickness. Distance from top vt scum to top of outlet tee or baffle:vd ,. Distance from bonom nt -rom In.honnm of outlet IPt• or 6hle' v� „ h Comments: (recommendation for pumping• condi—n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural_ integrity evidence of leakage, ei�_ Grease trap is riot present. tr.vs..a s/ssi9st �•6 , f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propertymdrem 153 Castlewood Circle Hyannis ,Mass . Owner. Cynthia Engle Date of Inspection:3/1 0/9 7 TIGHT OR k30LDING Tmx-Abtle- (locate cn site plan) e Depth below gr*de:-1)-4 Material of const:uctfonooncrete metal . k'RP_other(aplain) . AAA• - !lJ Dimensions: NA Capacity: AM gallons Design mow' na/day Alarm level: Comments: (condition of inlet tee condition of alarm and float switches,etc.) Tight or holing tank not present. DISTRIBUTION BOX:/&nV— (locate on site plan) Depth of liquid level above outlet invert: 4/4 x Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of b=,etc.) Distribution box is not present PUMP CHAMBER. (locate on site plan) Pumps in working orden(yes or no) fw,, Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Piim= (,.hamhPr is not Dl:esent. (revised 11/03/95) 7 �!` . U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oonthnued) PropertyAddr,mw 153 Castlewood Circle Hyannis ,Mass . Ovuer. Cynthia Engle Data of In,Peotloo: 3/1 0/9 7 SOIL ABSORMON SYSTEM (WA zl aoeau on she Plan,if possib3e;a:caval not required,but may be appnid a by wz• methods) . If not determined to be present,cTLin: a Tne; kaclsln l4 number—L 6"hin chambom number: pDaies,numbs 1whin trwxhas,number,kr gth: bac A&Ws, number, as overflow,oeespool,number. Comments:(note condition of soil,signs of hydraulic failure,level of pondin&condition of veSetaiioa,*tc.) Mprli um canri to fi nP Gand -ThPrP arp gi gns of Hydraul i failure ; Waste 4ietAr 46. ;r4t14n (Z" 0€—th-e inv®rt—Pipe• No pogdijag- All upgPt.atA nn i G CESSPOOLS: •V5'•.C o d.e.`_ T-` - (locate on site plan) Number and conliguratioa: A)A• Depth-top of liquid to inlet invert: A>A Depth of solids layer._ u� Depth of scum lyre. Dia�nsioas of a.spool:_ AM . Matareals of contraction: Indention of grrouadw& r:_ Inflow(cesspool must be pumped ar part of inspection) AM Comments (note condition of soft,sips of hydraulic failure,level of pondin&condition of vegetation, etc.) CPSSnccis are not present. PRIW:AE, (locale On sett Plan) . IdatarLl/at -� .dq � DemaIIitOmi'_ 9�1� . Depth of solidsS I./pgi CommaaL (rota condition of&4 signs of hydraulic&Du»,level of pondiaC,condition of vegetation,etc.) Privy is not present (revised 11/03/95)•• g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L'_SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Hyannis Water Company 775-0063 / S3 C RSTL e cuead C/� f DEPTH TO GROUNDWATER 1.6 ' + : depth to groundwater t• r+-thod of determination or approximat�cp: ave ri`sta:i ed ".s ste-mt a:t;:;1 �Ca t• 'eWood Cirit ; 104 CastlewoodCircle ; 1. Castle oo ire 6.' s:s eurt�0 irc .e• a.s e_woo it e ; as e Wood: Circle • as. e .0p ix� .e .._ b :wa er encoun, er.e at 121 K.d , Cr 40 � G THE COMMONWEALTH OF MASSACHUSETTS + DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and- is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section ,13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acung Director of the ion of Water Pollution Control I C011 '£ALTH OF MASSACHliSETTS !; EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS :,= F DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE X% NTER STREE7. BOSTON MA 021OF t617i 292.550V TRUDY CONE Secretan- ARGEO PAtiL CELLtiCCI DAVID B STR-'HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAddress:153 Castlewood. Circle Name of owner Terry Contard.o H anis MA Address of Owner: same Date of Inspection%Tn 9 Name of Inspector:(Please Print)Wm. E . Robinson Sr. I am a DEP approved s eM inspector rsuartt to Section 15.340 of Title 5(310 CMR 15.000) Company Name: WM E . Robinson �eptic Service Marling Address: PO BOX 0 9. Centerville . 1VLA . Telephone Number: 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 Fails Q Inspector's Signature: i Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS FC TOiOFDEP�� revised 9/2/98 page IorIi - i• �rrted on Recvc;rd Panr, - . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontin+ed) "ropeny Address: 153 Castlewood. Circle , Hyannis )wrw: Terry Contard.o Date of Inspection: `//9 13, INSPECTION SUMMARY: Check U B, C, o/ D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. YSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate es, 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 failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. 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 Iwith approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to brokeri or obstructed pipets). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 . Page 2ofII i • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontinued) PropertyAddress: 153 Castlewood. Circle , Hyannis owner: Terry Contard.o Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 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 is equal to or less 'than 5 ppm. Method used to determine distance (approximation not valid). 3 OTHER revised 9/2/98 ItQc3of11 i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (corrdnued) Property Address:153 Castlewood. Circle , Hyannis Owrwr: TQrry Contard.o Date of Inspection: >7 D. SYSTEM FAILS: / You mu t indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes o Backup of sewage into facility-or system component due to an overloaded orclogged 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LA GE SYSTEM FAILS: You mu t indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The wner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional offic of the Department for further information. revised 9/2/58 Page 4ofII r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. - PART B CHECKLIST Propeny Address: 153 Castlewood. Circle , Hyannis Owner: Terry Contard.o Date of Inspection: ��_J�- Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes, No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and•the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,.material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)] _ The facility owner (and occupants,if different from owner) were provided with information on the proper_raintenaarax-0f SubSurface Disposal Systems. rev�ised 9i 2/98 Page sorl1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION tiope.ty Address:153 Castlewood. Circle , Hyannis Owner: Terry Contard.o Da Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: '36 v g.p.d./bedroom. Number of bedrooms (design): Number of bedrooms (actual): Total DESIGN flowi3L O Number of current residents: Garbage grinder(yes or no):_Z Q Laundry(separate system) (yes or no)3' If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):LL Water meter readings, if available (last two year's usage (gpd): 1998 58 , 500 gal Sump Pump(yes or no):AL 0 1997 54, 750 gal. Last date of occupancy:J//-Q7 -7 COMMERC L/INDUSTRIAL: Type of esta ishment: Design flow: d 1 Based on 15.203) Basis of desig flow Grease trap p► sent: (yes or no)_ Industrial Wa to Holding Tank present: (yes or no)_ Non•sanitar waste discharged to the Title 5 system: (yes or no)_ Water me r readings, if available: Last date occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and of of info, o a n: y /9 l / r L � .ems („ f,,0 L System pumped as part of inspection: (yes or no)�f-d If yes, volume pumped: gallons Reason for pumping: TYPE OF STEM Septic tank distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: b Sewage odors detected when arriving at the site: (yes or no) IL v /� revised 9/2/9.c Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'ropenyAdd►ess: 153 Castlewood. Circle , Hyannis Owner: Terry Contard.o Date of Inspection: BUI ING SEWER: (Locat on site plan) Depth below grade:_ Mater I of construction:_cast iron_40 PVC_other(explain) Dista ce from private water supply well or suction line Die eter Cc ments: (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK:_ (locate on site plan) it Depth below grade: Material of construction: n/concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: ` 1 Distance from top of sludge to bottom of outlet tee or baffle:L% Scum thickness: /-3,, Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom,pof outlet tee or baffle: How dimensions were determined: 0 1 %.t T, 'omments: (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.) -T.�y.Y !w n A. L i? GR E TRAP: (locat on site plan) Depth elow grade:_ Materi I of construction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimen ions: Scum hickness: Dista ce from top of scum to top of outlet tee or baffle: Dist nce from bottom of scum to bottom of outlet tee or baffle: Da of last pumping: Co ments: (re ommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, e dence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION IconOrwed) ,Iroperty Add►ess: 153 Castlewood. Circle , Hyannis , Owner: Terry Contard.o Date of Inspection: TI HT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) Iloc to on site plan) Dept below grade:_ Mater I of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dime sions: Capa ity: gallons Desi flow: gallons/day Alar present level: Alarm in working order: Yes_ No Dot of previous pumping: Co ments: Icon ition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:- (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, eviielence of solids carryover, evidence of leakage into or out of box, etc.) ili O 5 PUMP HAMBER:_ (locate on site plan) Pum in working order: (Yes or No) Ala s in working order(Yes or No) Com ents: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8or11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM INFORMATION(continued) 'roperty Address: 153 Castlewood. Circle , Hyannis °iwnef Terry Contardo Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_✓ (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers,number: leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Altemative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, d mp soil, condition of vegetation, etc.) ,A �L'y s C POOLS'_ (Iota on site plan) Numb r and configuration: Depth- op of liquid to inlet invert: Depth f solids layer: r )epth o scum layer: Dimensi ns of cesspool: Material of construction: Indicatio i of groundwater: inflow (cesspool must be pumped as part of inspection) Comm r (note ondition of soil: signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY _ (locat on site plan) Mate ials of construction: Dimensions: Dept of solids: Cc ments: (no a condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,) revi-se S/L/7C Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) NopertyAddress: 153 Castlewood. Circle , Hyannis Jwnef: Terry C�omtard.o Jate of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) l revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION Icontinued) ►openyAd&ess: 153 Castlewood. Circle , Hyannis owner: Terry Contard.o Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow. Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) D termined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) ,j b , revised 9/2/98 Page ofll