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HomeMy WebLinkAbout0219 CASTLEWOOD CIRCLE - Health f' 219',Castlewood Lircie Hvannis ; . P 'h1 i i I E' .'I h - - DATE: 2/.5/02 PROPERTY ADDRESS: 219 Castlewood Circle ----------------------- Hyannis,Mass. 02601 ------------------------ On the above date, I Inspected the septic system at the This system consists of the following: 1 . 1 -1000 gallon septic tank. 2 . 2-1000 gallon precast leaching pits. MAR 0 7 2002 TOWN OF BARNSTABLE HEALTH DEPT. Based on my Inspection, I certify the following condition .- 3 . .This is a title five septic system/ ( 78 Code ) , 4 . The septic system is in proper working order at the present time. 5. The second leaching pit is dry.Pits are inseries. No distribution box. 6 . Pumped the septic tank at time of inspection. SIGNATURE:-I,;' J. Name:_J_p _ Macomber Company: Josej)h_P_ Macomber-& Son , Inc . Address: Box 66 -------------------- Centerville , Ma . 02632-0066 -------------------- Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY rel 71,V� JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 • I� f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL, PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 219 Castlewood Circle yannis,Mass. Owner's Name: Ce is Bill Owner's Address: Same Date of inspection:2/5/02 Name of Inspector: (please print) Joseph P.Maeomber Jr. Company Name: J.P.Macomber & Son Inc. Mailing Address:Box FF 02632 Telephone Number: 508-775-3 38 CERTIFICATION STATEMENT 1 certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: lL Passes _ Conditionally Passes — Needs Further Evaluation by the local Approving Authoriry Fails Inspector's Signature; Date; �—�=4>. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design now 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 authorir),. 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 l conditions of use. I Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VO LUNTARY OLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address, 19 Castlewood Circle yannis,Mass. Owner: Celia Bill Date of Inspection: 5 0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found an inform )which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: .The septic- system i -q i ri roppr working nrrjAr at the present- time B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. 0 The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: s',Al4tI� Observation of sewage backup or break out or high static water level in th distribution box ue to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System wi pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: ti)D The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 219 Castlewood: Circle Hyannis,Mass. Owner: Celia Bill Date of Inspection: 2/5/0 2 C. Further Evaluation is Required by the Board of Health: A0 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: AW Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: UO The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 10 feet but 5 feet or more fro ma private water supply well". Method used to determine distance j�,(%LL m "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform , bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and . the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 219 Castlewood Circle Hyannis,Mass. Owner: Celia Bill Date of Inspection: 2/5/0 2 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool �/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool �_tlQ Static liquid level in the distribution box bove outlet invert due to an overloaded or clogged SAS or cesspool fl!dam r $ ,w �pt•i� _ �equired squid depth.in scsspeol is less than 6"below invert or available volume is less than %day flow _ pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped / . Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — �water supply. y 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] VO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no he system is within 400 feet of a surface drinking water supply _� 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 219 Castlewood Circle Hyannis,Mass, Owner: Celia Bill Date of Inspection: 2/5/02 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks ? Has the system received normal flows in the previous two week period? ZHave large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) v _ Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out ? _ Were all system components,.e4 tiding the SAS, located on site? _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition Of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: 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 Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 f Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:21 9 Castlewood Circle Hyannis,Mass. Owner: Celia Bill Date of Inspection: 2/5/0 2 FLOW CONDITIONS RESIDENTIAL 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: I Does residence have a garbage grinder(yes or no): S Is laundry on a separate sewage syste yes or no): [if yes separate inspection required] Laundry system inspected(yes or no) j Seasonal use: (yes or no): A Water meter readings, if available(last 2 years usage(gpd)) -� S Sump pump(yes or no): .(IO Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: 14 Design flow(based on 310 CMR 15.203) d Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):I& Water meter readings, if available: 1(J Last date of occupancy/use: OTHER(describe): -t4 GENERAL INFORMATION Pumping Records p Source of information: Was system pumped as part of the inspection `�(yes or no): If yes, volume pumped:��allons-- I�cK/ s quantity umpedetermined'.)1��i9�GJ determined'.) Reason for pumping: Ivy b IV4 TYP OF SYSTEM Septic tank,"tFibu;iOR b , soil absorption system Al� Single cesspool Overflow cesspool _Privy d,h Shared system(yes or no)(if yes, attach previous inspection records, if any) ,dk Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank xX) Attach a copy of the DEP approval Other(describe): 4)t ,4,ppr imate aee of all components,date installed f if known d sou ce f information --q. � Were sewage odors detected when arriving at the site(yes or no):_ 6 E Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 219 Castlewood Circle Hyannis,Mass. Owner: Celia Bill Date of Inspection: 2/5/02 BUILDING SEWER (locate on site plan) Depth below glade: tol .'Materials of construction. cast iron �0PVC&othej(explain): Distance 6om private water supply well or suction line: 4 7f— Corrmenis (on condition ofjounu, venting, evidence of leakage, etc.): Joints appear i ght _No Pvi r3PnrP rsf 1 eakage_ThP system is vented through the house vents. SEPTIC TANK: zoocate on site plan) '4<0 I$/u6t!c Depth below grade: _T 'material of construction: concrete&LmeLaWe fiberglass polyethylene A20 other(explain) ko If tank is metal list age:,�[j Is age confirmed by a Certificate of Compliance (yes or no):40 (attach a copy of certificate) � r 1 Dimensions: �6�SUG ��L"U)dP� C 7��Ie Sludge depth: Distance from top of sluege to bottom of outlet tee or baffle: Scum thickness: 0 _ Distance 6om top of scum to too of outlet tee or baffle: _� Distance [Tom bonom of scu.^t to bosom of outlet tic or baffle: C� How were dimensions determi—rted: M gsfJy� Comments (on pumping reco:meridations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to ouilet.invert; ev:Jence oNeakage, etc.): !Pump the septic tank annually.Garbage disposal is present. I"nlet & outlet tees are in place.The tank is structurally sound and shows no evidence of leakage. GREASE TRAP (locat: on site plan) Dcpth below grade: i Material of construction: 947oncretelflmetal.�LAfiberglassiL�olyethylene,4V other (explain): Dunensions: Scum thickness Distance (Tom to of scum to top ofou(le( tee or baffle: .4)X Distance from bonom of scut^ :o bo^om of outlet tee or baffle: 4,)4 Date of last pumping: A1� . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integiiry, liquid levels as related to outlet invert, cvi'rnce of leakage, etc.): Grease trap is not present. 7 Page 8 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:21 9 Castlewood Circle Hyannis,Mass Owner: Celia Bill Date of Inspection: 2 f 5 f 0 9 TIGHT or HOLDING TANK4)g&'a(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: WA Material of construction: concrete AZA—metald22 fiberglass,yA polyethylene other(explain): �fA Dimensions: /UjQ Capaciry: AA gallons Design Flow: M gallons/day .Alarm present (yes or no): AtI Alarm level: 414 Alarm in working order(yes or no): Date of last pumping: A Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present DISTRIBUTION BOX (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: CW Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box is not present PUMP CHAMBER44�y&(locate on site plan) Pumps in working order(yes or no): .Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present i 8 Pa°e 9 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:219 Castlewood Circle Hyannis,Mass. Owner: Celia Bill Date of Inspection: 2/5/0 2 j SOIL ABSORPTION SYSTEM (SAS): 1� (locate on site plan,excavation not required) 2-1000 gallon precast leaching pits. ( in Series ) If SAS not located explain why: Located; See page 10 Type�le T/ aching pits,number: _d& leaching chambers, number: d _dA leaching galleries,number:0 leaching trenches,number, length: (� leaching fields,number, dimensions: 0 overflow cesspool, number: 0 � / innovative/alternative system Type/name of technology:�y�ry rxe, C.?�� �• Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to boney fine sand-No signs of hydraulic failir or ponding_ Second pit is dry At this time Sails are dry Vegetation is normal. CESSPOOLSQ, 4 ° (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: ,tM Depth of solids layer: '(/� Depth of scum laver: Dimensions of cesspool: A Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present. PRIVW�(locate on site plan) Materials of construction: Dimensions: X Depth of solids: IfW Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present- / i 9 Page IO or a I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 219 Castlewood Circle Hyannis,Mass. Owoer: _Celia Bill Date or Inspectioo: 2/5/_02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reverence landmarks or benehmafks. Locate all wells within loo reel. Locate where public water supply enters the building. / 1 21 q Ca s4Ire 004 Cc. -���v,�, S i y3 I'L 10 Page 1 1 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 219 Castlewood Circle Hyannis,Mass. Owner: Celia Bill Date of Inspection: 2/5/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells r- Estimated depth to ground water '7f 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 150 feet of SAS) _Checked with local Board of Health-explain: _Checked with local excavators, installers- (anach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used;Gahrety & Miller Model. 12/16/94 Groundwaterabove sea level . USGS•Observation Well Data. June 1992 USGS;Annual ranges of ground water-January 1992 92-000-1 Tup of Cround P1ate#2 Leaching Pit q%jf'J'cet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Fhmpter Method Therefore, the vertical separation distance between the bottom ,� Of the leaching pit and the,adjusted groundwater table is feet. 11 I I >•nrnrn+—n.•rrr-..-rr-zrnrmr•nmrrsn•rrt asn.rrrm-•.+-Tvrr1�+�*�rnn�mrn-ra Ts�rrms.•a� Tn-t�-r-�r+nr—:,.....r—... TOWN OF Barnstable HOARD OF HEALTH j SUUSURFACF SEWAGE DISPOSAL ,SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I ^•Tri�T••.'::T�T.t11^T:TTJ.1T.Tn•.f.•11n TRTriRTTTf1►'.7tr1'T�{•IT•11TR�f.1R1.T^TITRRVOr�1.�.�1�'1R7 sri •.+9rrr•tr••1. �..II -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 219 Castlewood Circle Hyannis,Mass. ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Celia Bill- PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son InC'`. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City state LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 790 _ 1578 !T CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . <Chhec1k,,nem PASSED inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* \ The inspection which I have con acted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . r , Inspector Signatur "V6 Date copy of this rtification must be provided to the OWNER, the BUYER One where applicable ) and the BOARD OF HEAL'I'tI. * If the inspection FAILED, the owner or01.operator shall u pgrade ' the system within one year of' the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 15'. 305 . partd .doc TOW-24 OF BARNSTABLE L'0--ATION /� Z� SEWAGE # VILLA ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO..� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� , (size) NO. OF BEDROOMS 02 BUILDER OR OWNER Ltd PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and��j�jaching Facility(If any wetlands exist within 300 fee of/lea h: 'g faci '.y) Feet 0 Furnishe r Ott J i ww- Iv 9 A /I i N1 ! s V $ 5 rn `A � A . TOWN OF BAR/NSTABLE LOCATION 2� �'� S/1c cr c (f4' SEWAGE # 10 - 579 VILLAGE 1���ah�iJ ASSESSOR'S MAP 6z LOT INSTALLER'S NAME PHONE NO.J SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ILL (size) GG' NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: ii f DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No '� -s \ 1 q, �i°1- .. � + ��� r ,� �S �� ,. �� .�. r '� ' © „„� � r >r.r � �. ��� l No --:.5-2Y._ F�$.......r�.... r�...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AppltrFanon for Dh4poti al lVarkii Tomitrnrttnn 1hrutit Application is hereby made for a-Permit to Construct ( ) or Repair �XX) an Individual Sewage Disposal System at: 219 Castlewood Circle Hyannis ...............- ...- - • ... - --------.... • ......_........_. Location-Address or Lot No. Ed Bill W J.P.Macomber Jr. Owner Address Installer Address Type of Building Size Lot............................Sq. feet a Dwelling_No. of Bedrooms_______________2 ..........................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ' ) — Cafeteria ( ) G4 Other fixtures -----------•-------_--............................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity____________gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 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 ,4 Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------••--•--------------•----------•----------•-------------------•----------...--•-••••-•--•••---......................................................... 0 Description of Soil............................................................................................................................=.......................................... x Sand & Gravel v -••--------------------•------ ---------------••--•-•----•--•----••---••-------------------------------------------•-------------------•------------........._...........-•-----•..._.. W --------------------------------------------------------------------- ----------------••--------•------•-•--•----------------------------------•---•••---•----------................................. U Nature of Repairs or Alterations—Answer when a licable_______________________------------------------------------------------------------------------ 1-1000a..l_on leach pig Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System iii 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 'ssu by the health. 12. 1Da1te.90Siged -------------------------- . Application Approved By ............ . . .. ...... d,e.u,, — ....................------------------------------------- t��" Ca... Application Disapproved for the following reasons- ........................................----------------------.......................................-------------------------------- -----------------------------........------------------------------------------------ ------ ------- ------- ----------------------------------------------------------------------------------- -- ------ -------------------------------- � Permit No. .......... ,,.o.-'----�7----2-8.------------------ Issued ----------._ ------...-------------------------------D-.ace....... Date 7, :7 Fss ..30.CC...._ THE COMMONWEALTH OF MASSACHlSSETTS BOARD OF HEALTH a_ TOWN OF BARNSTABLE J Apptiration for Uiipuial Works,Tomitrnrtiun Fermi# Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: 219,,Castlewood Circle Hyannis ..... • _»».• ................. ......................... ................------•-----------•--•-.......----•-----••....................................---- r Location-Address or Lot No. »I+;d BJ -----------------------------------•--•- Owner Address a ALP.Macomber Jr. Installer Address d Type of Building Size Lot.............................Sq. feet U 1 k: Dwelling XL No. of Bedrooms----••......... ---•---•- -•-----••-•--Expia-sion Attic() Garbage Grinder ( ) Other—Type of Building ......... ................ No. of persons............................ Showers .( ) — Cafeteria ( ) a' Other fixtures = W Design Flow...........::.............................ngallons per person per day. Total-&ily flow............................................gallons. . ' WSeptic Tank—Liquid capacity_..____...g . Wiallons Length.............. dth..............._ Diameter................ Depth................ x Seepage P>t No ............. Diameter.................... De tl�tal Length..______.._.___.....Total leaching area.................... ft. Disposal Trench—No.____.•......... ._ ...................., Widt pT below inlet.................... Total,,leaching area..................sq. ft. b Z Other Distribution/box ( ) Dosing tank ( ) Percolation Test/Results Performed by--•-• t# Date --••••-•---••------------- �( ----- Test Pit,No. 1................minutes per inch Depth-of,:Lo st . De Test group water........................ f=t Test Pit_No. 2................minutes per inch Depth of Test Pit_S�-:-._il - Depth.to,ground water..._._____..........__.. a, ii 10 Descript Of Soil------..... ----------------------- -------------- ---------------------- •---------------------------- •----------------------------------- •••-••.................... .._.. vd..Vic•-arga�al.............................................................. -----•--------------=:`=:---•----------•------------------------------- W U Nature of Repairs or Alterations—Answer when applicable.............................................�•�_................................................ ----------------------------------------------•--•--•---....----).-laQQ---P-al l&...1e a ch__�it. Agreement: The undersigned agrees to install the aforedesc"ribed Individual Swage Dis �. l 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 en 'ssued4by Che bgard of health. .11.9JSigned....... -- --------�........................... ......... - - ------- Date Application Approved By ---------- J.......��-,�e..�^��,�--c� .....�..----- ....D� 17a[e Application Disapproved for the ollowing reasons -------- - ------ ---------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- ........................................ Date PermitNo. ..........9/�.. ..... ..5 Issued ................................................................... Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifira e of C antlaIianr.e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedY((XV) by......J.,P-.Ma c.amb e r---J_r. .......................................................................................................I.--.....------...........------........----- ............------. lnmlle, at ....... 1.9---.Cas t&.&w.00d----C ircle...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. ........c�, ---:7.57 76....... dated ../1.......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.n.......... - .............. ----- Inspector .......rdfADATE................ ... ... ...�..`?..... . •-------.....---....--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J TOWN OF BARNSTABLE —)No...... �� FEE...32.CC... 14sposal Works Tuns#rurtiun "rrmi# Permission is hereby granted--. -=--•-......-•----•---•----------------------------•--- to Construct ( ) or Repair (}CX) an Individual Sewage Disposal System atNo.._21:9..Caatle gn a(.-Ci:xcl:e._Hnnni .....-------------•--------•-•--.........-•---•----••--••---------------•-•-•----•-----........-•---.... Street 7 as shown on the application for Disposal Works Construction Permit No.._259.ir-eDated.......................................... ....................................................................-.............................. Board of Health DATE........................................................................... FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS