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0188 CASTLEWOOD CIRCLE - Health
180 'Castlewood Circle Hyannis ;P A = 272 ,036 II I! TOWN OF B/ARNSTABLE LOCATION'W CST Iet-000L. SEWAGE # VII,LA-GE 4A ASSESSOR'S MAP & LOT 7Z- D3� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 00 -cjSa� ,.LEACHING FACM=: (type) (size) 1 - �,:NO. OF BEDROOMS 11HUILDER OR OWNER PERMIT DATE: COMPLIANCE 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _� �`Y ..� ram. .�.�, r„`''f' � s �r�` S \y •! � � t � . �'� � .�•�:.''`-•�. fit, '� ;. `���;�---�_ i ... :. � ' •r �� .,,r f� <S t����,,, 1 2� (� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION —F02) . 80 MAR 0 3 2005 TITLE OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 180 Castlewood Circle Hyannis Owner's Name: Gary Schwager Owner's Address: Date of Inspection: Name of Inspector:(please print) W i 1 1 i am E_ • Robinson Sr. - CompanyName: William E. Robinson Septic Service Mailing Address: P O Box 1089 _Centerville, MA Telephone Number: (5081 775-8776- CERTIFICATION STATEMENT 1 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 Sec ion 15340 of Title 5(310 CMR 15.000). The system: Passes - Conditionally Passes Needs Further Evaluation by the Local Approving Authority 'Fails Inspector's Signature: t4, ,,�! �., _ Date: — The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heanh or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater;the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies'Sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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 page 1 . Page 2 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 180 Castlewood Circle Hyannis Owner: Gary Schwager Date of lospectlon; Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D V33 Passes: e not found any information which indicates that any of the failure criteria described in 310 CMR 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. Syster�Conditionally Passes: One o more system components as described in the"Conditional Pass"section need to be replaced or repaired.The s stem,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no r 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 re laced with a complying septic tank as approved by the Board of Health. •A metal septic will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that th tank is less than 20 years old is available. ND explain: Observat on of sewage backup or break out or high static water level in the distribution box due to-broken or _ obstru/fpB )or due to a broken,settled or uneven distribution box.System will pass inspection if(with approd of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND ex m required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will passinf(with approval of the Board of Health): broken pipes)are replaced obstruction is xcwvod ND explai Page 3 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 180 Castlewood Circle Hyannis Owner: 6ary SChwa er Date of Inspection: ." G Further Eve]nation is Required by the Board of Health: Condition exist which require further evaluation by the Board of Health in order to determine if the system is failing to protec public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance witb 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 fun Boning in a manner that protects the public health,safety and environment: _ Th system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surface ater supply or tributary to a surface water supply. e system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front 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 S ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 180 Castlewood Circle yannis Owner: Gary c wager Date of Inspection: " I^ "6 D. Syste Failure Criteria applicable to all systems: You mustdicate"Yes"or"no"to each of the following for all inspections: Yes No B ickup of sewage into facility or system component due to overloaded or clogged SAS or cesspool D charge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or cl gged'SAS or cesspool _ S tic liquid level in the distribution box above.outlet invert flue to an overloaded or clogged SAS or ces pool Ligiid depth in cesspool is less than 6"below invert or available volume is less than day flow Requv w ed pumping more than 4 times in the last year NOT due to clogged or obscted 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 Seet of a surface water supply or tributary to a surface wat r supply. Any portion of a cesspool or privy is within a Zone 1 of a.public well. _ .Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 f et from a private xater supply well with no acceptable water quality analysis. (This system passes if the well water analysis, pe formed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds in icates that the well is free.(rom pollution from that facility and the presence of ammonia of rogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria a e triggered.A copy of the analysis must be attached to this form.] (Y /No)The system fails.I have determined that one or more ofthe 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. arge Systems:To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You m st indicate either"yes"or"no"to each of the following: (The fo lowing 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 smface drinking water supply _ he system is located in a nitrogen sensitive area(Interim We Protection Area—1WPA)or a mapped Zone 11 of a public water supply well if you haN a answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in ection D above the large system has failed.The u%mer air operator of any large system considered a significa t threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304 he system o%%-ner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECKLIST Property Address: 180 .Castlewood Circle Hyannis Owner: Gary Schwager Date of Inspection: 3k= —p Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No / _ :7- Wcre mping information was provided by the owner,occupant,or Board of Health any of he system components pumped out in the previous two week s Has the system received normal flows in'the previous two week period? Z/ Have large volumes of water been introduced to the system recently or as part of this inspection?,. V _ Were as built plans of the system obtained and examined?(if they were not-available note as N/A) C/ Was the facility or dwelling inspected for signs of sewage back up? mot/ — 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 ortees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ as he 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: .Yes no _ Existing information.For example,a plan at the Board of Health. -✓ — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CZAR 15.302(3)(b)) 5 Page 6 of I OFFICIAL INSPECTION FORM—' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 180 Castlewood Circle yannis Owner: Gary Schwager Date of Inspection: FLOW CONDITIONS RESIDENTIAI. _ Number of bedrooms(design):. Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):.; Number of current residents: Does residence have a garbage grinder(yes or no):_ Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no):_ Water meter readings,if available(last 2 years usage(gpd)): 0 4/0 5 — 6 3, 0 0 0 Sump pump(yes or no):.— 03104 Last date of occupancy: i COMME CIALRNDUSTRIAL Type of tablishment: Design ow(based on 310 CMR 15.203): gpd Basis o design flow(seats/persons/sgft,etc.): Grease rap present(yes or no):_ Industr al waste holding tank present(yes or no):_ Non-s itary waste discharged to the Title 5 system(yes or no):_ Water eter readings,if available: Last to of occupancy/use: j OT ER(describe): i o GENERAL INFORMATION Pumping ecords Source o�formation: Was sys em pumped as part of the inspection(yes or no):— If yes, olume pumped:_gallons--How was quantity pumped determined? Reas for pumping: _ TYP 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: Were sewage odors detected when arriving at the site(yes or no): A/U 6 I'a6c 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:l 80 Castlewood Circle Hyannis Owncr Gary- S hula ers Dote of lnspccllon: 0 BUILDING S WER(locale on site plan) Dcpth belo grade: Materials f construction:_cast iron _40 PVC_other(explain): Distance om private realer supply well or suction lute: Comore is(oil condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:`(locate on site plan) ) Depth below grade: it Material of construction:concrete metal fiberglass_polyco,ylene _otlncr(cxplain) — If tank is metal list age:_ Is age confnnnfd•by a Certificate of Cul,ipliar,ce oyes or no):_(attach a copy of ccrtifncatc) Dimensions: Sludge depth: Distance from top of sludge to buttons of outlet ice or baffle: Scum thickness: Distance from top of stun,to lop of outlet Ice or ba(Tl Distance from bottom of scull,to.botion,of outlet tee CO"r battle: 1 I low were dimensions determined:__BOfN lc�c: Cumments(on pumping recommendations, inlet and outlet tee or battle conditicn,structwal imegrity,liquid Icvcls as related to outlet invcri,evidence of leakage,c t� "b f 2 GREASE TRAP: (locate on site plan) — Dcpth below grade_ Material of cons clion:_concrete_metal fiberglass�pol)-elhylene—other (explain): Dimensions: / Scuntlhickncss. Distance from op of scum to top of outlet Ice or baffle: Distance froi bottom of scum to bultum of outict Ice or baffle: Date of last umping: Conunent on pumping reconintendatiuns,inlet and outlet ice or ban1c cunditiu:t,structural integrity,liquid levels as iclalc Io oullcl invert,evidence of leakage,cic.): 7 ,age 8 of l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 1NFORII-IATION(continued) Property Address: 180 Castlewood Circle Hyannis Owner: Gary Schwager Dale or Inspcctlon: T1G11T or 1lOLD G TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grad . Material of eonst ctiow—concrete_metal_fiberglass_polyethylene other(explaut): Dinunsions: Capacity: _gallons Design Flow: gallons/day Alarm presen (yes or no): Alarm level: Alann in working order(yes or no): Date of last umping: Comment (condition of alarm and float switches,etc.): D15TIaJllUTION BOX: of present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Conunents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,ctc.): PUMP CHAMBER: rotate on site plan) Pumps in working order cs or no):_ _ Alamis in working ord (ycs or no):— Continents(note con tion of pump chamber,cundition of pumps and appurtenances,etc.): i 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: 180 Castlewood Circle Hyannis Owner: Gary Schwaqer Date of Inspection:_ ,��-l�6 SOIL ABSORPTION SYSTEM(SAS):Zoocate on site plan,excavation not required) If SAS not located explain why: .type d . .. . aching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc. : CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: _ Depth—top o liquid to inlet invert: Depth o/nof " slayer: Depth om layer: / Dimensof cesspool: Materiaconstruction: Indicati groundwater inflow(yes or no): Co nts(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): _ PRIVY: (locate on site plan) Materials f construction: Dimensi s: Depth 99 solids: Com�fents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 Castlewood Circle Hyannis Owner: Gary Schwager Date of Inspection: G J . P 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. L I I 10 Page l l of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 Castlewood Circle Hyannis Owner. Gary Schwager Date,of Inspection: �L1-17 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within ISO feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: ' You must des be how you es blish�d the high ground water elevation: 'C-5� -Va i 11 A =. = C0:�I'MONWEALTH OF MASSACHUSETTS i_— _ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ON TER STREET, BOSTON Kk 02106 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STR HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:18 0 Castlewood. Circle Name of Owner Eric H ub le r Hvann i s , MA Address of Owner: g a nn p Date of Inspection: /ILI—SCE_9 rj Name of Inspector:(Please Print)Wm. E . Robinson S r . I am a DEP approved system inspector pursuant to Section 15.340 of Trde 5(310 CMR 15.000) Compa„yNarrm: Wm. E . Robinson Septic Service MaaingAddress: P 0-BOX 1089, Centerville , MA 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 Inspector's Signature: 4z i Date: 9 7 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 9 g 10 is �► �r m ;A AY 1 2 1999 VNI OF BMflSTME HEALTH DEFT. 6 ILI revised 9/2/98 Page Iof11 %0 Primed on Recycled Paper ' � 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) "roperty Address:18O Castlewood. Circle , Hyannis , MA Jwner: Eric Hubler Date of Inspection:3 i9—g INSPECTION SUMMARY: Check C, of D: A. SYS PASSES: 7I 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. STEM 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 s, 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(with 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 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 i revised 9/2/98 Page 2of11 •' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION (continued) Property Address: 180 Castlewood. Circle , Hyannis , MA Owner: Eric Hubler 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 NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) 0 HER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART A CERTIFICATION (contirwed) Property Address: 180 Castlewood. Circle , Hyannis , MA Ownw: Eric Hubler Date of Inspection: D. SYSTEM FAILS: You m st 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 etermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes N 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. 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. I E. 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: he 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 ealth and safety and the environment because one or more of the following conditions exist: Yes o 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 ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office f the Department for further information. revised 9/2/98 Page 4of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .:' PART B CHECKLIST Property Address: 180 Castlewood. Circle , Hyannis , MA Owner: Eric Hubler Date of Inspection: 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 land occupants,if different from owner) were provided with information on the proper.maintenan".of SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Prop"Address: 180 Castlewood. Circle , Hyannis , MA Owner: Eric Hubler r Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 3 C Og.p.d./bedroom.Number of bedrooms(design): Number of bedrooms (actual):— Total DESIGN flow 3-j� p Number of current residents:_ Garbage grinder(yes or no):_,d,0 Laundry(separate system) (yes or no):k 0; If yes, separate.inspection required Laundry system inspected (yes or no) Seasonal use(yes or no): A-0 a Water meter►eadings, if available (last two year's usage(gpd): 1998 154��30 gal . Sump Pump(yes or no):-&.!5 1997 154, 500 gal. Last date of occupancy: 3-/ `c'j 1 COM ERCIAL/INDUSTRIAL: Type o establishment: Design flow: qpd ( Based on 15.203) Basis o design flow Grease rap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non-s itary waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: Last ate of occupancy: O R:(D cribe) Last ate of occupancy: GENERAL INFORMATION PUMPING RECOR S nd source of infor ation: System pumped as part of inspection: (yes or no)X 0 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 lif known) and.source of information: Sewage odors detected when arriving at the site: (yes or no)L-0 revised 9/2/96 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontinued) 'ropertyAddress: 180 Castlewood. Circle., Hyannis, NIA Owner: Eric Hubler Date of Inspection: g B DING SEWER: (I to on site plan) Dept below grade:_ Mat ial of construction:_cast iron_40 PVC_other(explain) Dist nce from private water supply well or suction line Dia eter Co ments: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: / Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain). If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: (� C` 0. Sludge depth:�'3 Distance from top of sludge to bottom of outlet tee or.baffle: Scum thickness:/-a , , . Distance from top of scum to top of outlet tee or baffle:_ , Distance from bottom of scum to bottom of outlet tee or baffler How dimensions were determined: ® '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.) b a -?J / y" D h— GR SE TRAP: (locat on site plan) Depth elow grade:_ Materi I of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimen ons: Scum t ickness: Distan a from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Com ents: Ire mmendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evid nce of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ►rop"Address: 180 Castlewood. Circle,, Hyannis., MA Owner: Eric Hubl Date of Inspection:y_/9—V� TI T OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (Ioc a on site plan) Depth below grade:_ Materi I of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimens ons: Capacit gallons Design ow: gallons/day Alarm resent Alarm vel: Alarm in working order: Yes_ No Date previous pumping: Com ents: (co 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, evide of solids carryover, evidence of leakage into or out of box, etc.) - Al PUM)on MBER:_ (locaite plan) Pumporking order: (Yes or No) Alarmorking order(Yes or No)Com(notetion of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM d PART C SYSTEM INFORMATION(contirwed) 'roperty Address: 180 Castlewood. Circle , Hyannis , MA Owner. Eric Hubler Date of Inspection: 3 SOIL ABSORPTION SYSTEM(SAS):jZ (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:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) D C POOLS:_ (local on site plan) Number nd configuration: Depth-to of liquid to inlet invert: Depth of lids layer: )epth of s um layer: Dimensions f cesspool: Materials of onstruction: Indication of F undwater:infl (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:_ 4 (locate on to plan) Materials o construction: Dimensions: Depth of s ids: Comments- (note cond tion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) NopertyAddress: 180 Castlewood. Circle , - Hyannis , MA Jwner: Eric Hubler ,)ate of Inspection: "3—1 g—(� e' 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) I I � . 3 I revised 9/2/98 Page 10ofII i • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) r,penyAddress: 180 Castlewood. Circle , Hyannis , MA Owner: Eric Hubler Date of Inspection: —101-5 Cj NRCS/undwater th to groundwater USGSe visited Wells checked r depth: Shallow Moderate Deep SITE Eope 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 V Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records b Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 116& l 130, 9S/ S -,7 revised 9/2/98 Page 11of11 i TOWN OF BARNSTABLE `.'LOCATION /7-0 C G S le C' Z SEWAGE # < .s` /'<2 VILLAGE ASSESSOR'S MAP & LOT ��j�� !� IJ INSTALLER'S NAME & PHONE NO S'7 7 Z SEPTIC TANK CAPACITY ld-6"6 LEACHING FACILITY:(type) G ®-'Q (size) Cy I, NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER r. DATE PERMIT ISSUED: �2 DATE COMPLIANCE ISSUED: 31`f— VARIANCE GRANTED: Yes I---No '� i ' 4 " f �- TOWN OF BARNSTABLE 1 ,'.LOCATION 10 CASTLE ©Q3D SEWAGE # y �.� VILE AGE 1�YANNIS ASSESSOR'S MAP & LOT JAlT;LP36__l •INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_ _(size) NO. OF BEDROOMS 2 PRIVATE WELL OR PUBLIC WATER PV6UC BUILDER OR OWNER DK F 4 4Y\ARY L. tjt)&ER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTT-*,D: k'es No 1 140.00, 28.2' f 4' N M W b� N to 0 m Q1 T n cn m o ° O 13:0' _ co u a -pFA 15.0' ° � � N . Q1 m i 8.0' o 22.2' 14 136.59' Ae p• o ASSESSORS MApNo. a 7 PARCEL NO No._? Fs$..3�. �.�........ . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE , pplirativit for Bi!ipniial 10ork.6 Cnongtrurtion Ilermit Application is hereby inade for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: ...1$Q-...Q.a.9tl.ewood..-Ci.rc- e---•••Hyannis ----------------------•-----•-------------------------....----•--•----•--•-----------....---••---- Eric Hubler Location-Addrrss or Lot No. W W.E. Robinson SeopUic Service P.O. Box 1089 Centerville Installer Address UType of Building 3 Size Lot............................Sq. feet �. Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Rr Septic Tank—Liquid'capacity............gallons Length---------------- Width..:-..-.-------- Diameter--.------------- Depth---------------- W Disposal Trench—No. .................... Width.................... Total Length--....------....---- Total leaching area....................sq. ft. x Seepage Pit No...................... Diameter..-.........-.--..-. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box'( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ a Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.--.-..---..-.........--. Test Pit No. 2................minutes per inch Depth of Test Pit...--.-.-.....------ Depth to ground water........................ -----------------------------------•-••---.....-....--..-.-.....-.--.-....•-•--••---......•..--••............................................................ 0 Description of Soil-.......sand..................................................................................................................................................... U --...-•--••••-••-•••------••-----•--•-•--•-----•----•--••-•-••-------•--••-••-•••---------------------•-----------------•-••--•-•---•---•------•----..•---•----•-•-•-----------••-•-•------•--•------•-- W ----------- -----------------------------•....---------------••--•----•------.....••-----••-••...-....•-•-•-••----•-•-----•-••-------•---•-•---.....-...--•-•---••-••---•-•-•-••--••••••-••----------- UNature of Repairs or Alterations Answer when applicable.-..insta l:--2.nd,•-•p-X.ec,fat,---1-eacbpit--------•--- "`� c• ---------2--- -.....0.4...---S�f?� ------------------------------------------ ...................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n i sued by the board of health. 99 rI Signed ... ........ ... ..... f1` �" ,y. ` Dare Application.Approved By .................................. .... ..... ................ ..............................l.-.................................. ....�. -.. ea.-.y Application Disapproved for the following reasons. ..........................................................::..................................... ............................. ............................................................................................................................... .-.......---........Dare.................. PermitNo. '-S'...... .................................. Issued ........-......-.....-............... -S Dare No..............� � D3�, FE$..30.�.0.�...�y.... t THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE_,Z ApplirFativaa for Diinpwml Workri ( omitraartioaa rantit Application is hereby made for a Permit to Construct .( ) or Repair ( x) an Individual Sewage Disposal System at: Casteweod._C , 1Q______Hyannis " .................. .........••-•-•-------=•--.....--•---.......--•---••-•........•••••••••••.....................•... ' Eric Huber Location-:\dd.... or Lot No. ......................-.......................................................................... --•-----•--••-•--------••----------•--...-------•••--...-•------•..............................--- o„ cr. Addr ss W W.E. Robinson SepVic Service P.O. Box 1089 Cen>rerville Installer Address UType'-of Building 3 Size Lot............................Sq. feet .a Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, ' Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.---;......gallons Length................ Width.........----... Diameter...........-�__ Depth................ r' x Disposal Trench—No. ..............:...... Width` ..................e.Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.-`................: Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.........................••• ......-•---•---•-----•------•-............-- Date...................-<....... ........ 3 Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground-water......................... (i Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water.....-�................. x --------------------------------------------------------•-•---------------------•----------------•--_----------...---------------------••r.----••......•..... Descriptionof Soil........Sand--------------------------•-------.........----•---------......................-•-••------ ••-••••••---•---------•----••-------# '. U ...................................................................................................................................... UW :---•••••-••----------------••---•••-----------•-••-----------------------------•--...••••••-----------•-----•••--------•-------....•-----....-••...•----------•--••-••••-•-••-••-•------•-------------- Nature of Repairs or Alterations—Answer when applicable...instal_l___2n'd_-_precast•_-leachpit__________• ,.. !`J�'N!R fir. ------o- ......X4?Ke..---------•------------------- -------- --------.------------. -------- ------... ....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in 1 operation until a Certificate of Compliance has b n issued by the board of health. ry `Signed ... r �` -� J . G ..l... ....... .... ...... .. � e Application,Approved B �.......................... r! Mte Application Disapproved for the following reasons: ..................................................................................................-....-.............................. t. ! 8 Dace Permit No. .......................... Issued ............................ s- s� - a - ;s ................. 6 ace THE COMMONWEALTH OF MASSACHUSETTS 1 0 1 BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifirat e of C araylianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x ) bW.nE—...Robinson...Septic----Service............:iall.:............................................................................................................................. 180 Castlewood Circle Hyannis ................................................................................................................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. 9...... . ................... dated ..,Z..-...a..Z...-....�� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONS TISFA>TORY. 0 0 k� , DATE......................................... .....��v.. .. ................... Inspector .... - 0 r.,�...... ................................. .®.........�......I................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 30-00 No......... FEE........................ �i nsttl orb Tomitrudilan "rrmit W.E. Robinson Septic-.Berg .cP. ...............•..•••-- Permus>on is hereby granted................................... to Construct ( ) or Repair (X ) an Individual Sewage Disposal System atNo....1 80 .s---•-•--.---------------------------------------------------- ----------------------------------------- Street 9l-��� ,� —a - 9S as shown on the application for Disposal Works Construction Permit No .............. ated___------------------------............. .................•----•••--•-• j -------•-------------- �� .................................... Board of Health DATE --- -- ----------- ----- FORM 36506 HOBBS♦L WARREN.INC..PUBLISHERS