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HomeMy WebLinkAbout0220 CASTLEWOOD CIRCLE - Health _220 Castlewood Circle Hyannis P A 272 040 t i TOWN OF BARNSTABLE LOCATION , 'C 4 C(�,� ,QiSEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL 7 -�L�Z INSTALLER'S NAME&PHONE NO. !;\CS Cc-)W SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) :fj NO.OF BEDROOMS v2 OWNER PERMIT DATE: ` " �.(;, COMPLIANCE DATE: i --a� — i ca Separation Distance Between the: foC)to C.L+- P('fC Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) \ Feet FURNISHED BY �'� U rt V7 0 U IN N d' T, OF BARNS LE LOCATIO4N & SEWAGE # VILLAGE ASSESSOR'S MAP & LOTO U INSTALLNE n�N SEPTIC TANK CAPACITY V M—= LEACHING FACILITY: (type) (size) NO. OF BEDROOMS �> BUILDER OR OWNE Y V 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 Leaching Facility(If any wetl exist within 300 feet of leaching facility) Feet Furnished by II A � No. �Dl N Fee THE COMMONWEALTH OF MASSACHUSETTS Entered incomput r: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplitation for Disposal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair(0/upgrade( ) Abandon( ) ElComplete System Individual Components Location Address or Lot No. Q Ct�' f"�C 1,iiCr� Ch/C Owner's N e,Address,and Tel.No. a T CS Assessor's Map/Par��tuvn9� -z-7)-_ol-1 SCiAi Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 'phi�. N� �� n/r,�✓��visu ��JC ' Type of Building: v Dwelling No.of Bedrooms Lot Size C().C(5( sq.ft. Garbage Grinder( ) Other Type of Building �PS� No.of Persons Showers( ) Cafeteria( ) Other Fixtures nn Design Flow(min.required) 4�� gpd Design flow provided '3 L4 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Y.iSJ�; Type of S.A.S. 93 , Gt��Cjc�i Description of Soil Nature of Repairs or Alterations(Answer when applicable) INS4,Gc�k ,'L t�-QCi rrC. CK' tl. ��� eA— Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board—of Health. � Application Approved by Signed Date --�© Date —,�O " ('6 Application Disapproved by Date for the following reasons Permit No. _;016 — 61 FJ Date Issued 3 � `'�•;..;,iz ram, No. L O'(f + 61(0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compuiejftf # PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplicatlon for MIsposal 6pstem Construction i3ermit. Application-for a Permit to Construct( ) Repair((Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ,Z a Q Ca-, --lP c� C>✓�� Owner's N e,Address,and Tel.No. Assessor's Map/Paz eYUN�� SvN Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: r Dwelling No.of Bedrooms ;;Z -j (, Lot Size C().E(C( sq.ft. Garbage Grinder( ) Other Type of Building f FS 1 c, No.of Persons Showers( ) Cafeteria( ) Other Fixtures `� Design Flow(min.required) �d�V f gpd Design flow provided 'fie '7 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank X Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) rrc, N Ck �o(�c��)A, L( Date last inspected: _ A Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in { accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Health. i Signed Date / -.�2 O w Application Approved by Date /—,a f'6 Application Disapproved by Date for the following reasons Permit No. oZ d 6 �1 Date Issued i --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( tl�Upgraded( ) Abandoned( at _ -C!e,4 Pi,J�c�CJ 1 Y C 4Y4,A).Nl S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.o?A`016 dated i �-� i Installer A c\)C Designer #bedrooms Approved design flow gpd The issuance of this pe it shall not be construed as a guarantee that the system will o signed. (� Date i � (G Inspector 1 w J _J ---- --------------------------------------------------------------------------------------------------------------------------- No.� ! oi� Of l� � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION —BARNSTABLE,MASSACHUSETTS Disposal *pstem onstruction Permit i Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abapdon( ) System located at 2.O c S+�Pt,✓OD� ��i C�P and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. 9 Provided:Construction must be completed within three years of the date of this permit. Date D Approved by ! Town of Barnstable �TME T Regulatory Services Richard V. Scali,Interim Director + RABNnABU& Meac Public Health Division a 3% Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: d Z-Z t Sewage Permit# ���� o Assessor's Map\Parcel ��2 Designer: f'��er- �n�� PE Installer: 0 A - 3ra"-4 1 n L Address: b Z W-. Crb c r�7- R-4 Address: x 1�4 S (fevLl-erJ.1LC MRc Q Z.632 On a0 JP,A-'6{a.)e`. 1 n C. was issued a permit to install a (da e) (installer) septic system at Z-Z 0 Cc..s !-e...roac4 based on a design drawn by (address) P,it, dated (designer) _ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co fiance with the terms of the I\A approval letters(if applicable) 44s39 G y PETER T. s r ,s Installer's Signature) nn CIVIL No. 35109 R£GISjE�S� (Designer's Signature) (Affix Desi Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:1Septic0esigner Certification Form Rev 8-14-13.doc I _ I Town of Barnstable P#�-' — �oF1►+e wti e� Department of Regulatory Services / �r y BARNSTABLE, : Public Health Division Date MASS. 200 Main Street,Hyannis MA 02601 w j AIFD MAC A t"''' Date Scheduled I Time Fee Pd. U Soil Suitability Assessment for Sewage Disposal ;; Performed By: �L I � Witnessed By: � ry� LOCATION & GENERAL INFORMATION Location Address e&S4__k yam,( �� Owner's Name r v'S.S i rr 16 N S /a­k'1 AvC,_d4_Lj /24J Address j-.?d S � UN J' T>-0 V CAN �-ei✓�'/Lt ;i'''' y� o z(P 3Z Assessor's Map/Parcel: �J -�'Z Q q a Engineer's Name�Q � `� NEW CONSTRUCTION y REPAIR Telephone# — Land Use � � ,y Slopes(%) ( ' Z ^ Surface Stones AJoAf Distances from: Open Water Body < / ft Possible Wet Area /� ft Drinking Water Welt�ft Drainage Way lipj= ft Property Line ft Other ft t i SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes), i i i ® 1 '2— i r-7 QN i G4s-t�_Cw010�O „ ` Parent material(geologic) y y c' Depth to Bedrock /v d " �� li Depth to Groundwater: Standing Water in Hole: d Weeping from Pit Face /W i Estimated Seasonal High Groundwater ? / 35? I DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: _in. i Depth to weeping from side of obs.hole: in. Groundwater Adjustment _ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date Time Observation Hole tt Time at 9" _ Depth of Pere Time at 6" _ i Start Pre-soak Time @ S Time(9"-6") _ End Pre-soak 1q - 2 Rate Min./inch j Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) ' I Original: Public Health Division Observation Hole Data To Be Completed on Back----------- i ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. i Q:\SEPTIC\PERCFORM.DOC i } DEEP.OBSERVATION HOLE LOG Hole#_L— Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones;Boulders. Consiitericy.%Govl) I I DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil - • Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. I. Cons' en % rave 6 —►3F L N1—C Sa yd ' isSy 1`� Serer Cd bit I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i n istency.96 Oraveli� i i I DEEP OBSERVATION HOLE LOG' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ns' i i a ; i I I j Flood Insurance Rate Klan: k Above 500 year flood boundary No— Yes L)__ I _f Within 500 year boundary No Yes Within 100 year flood boundary No Yes I ' Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 1_3 If not,what is the depth of naturally occurring pervious material? _.._...�,�..� Certification I icertify that on 1A 5_ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature (� �- Date /LC— /�S E 6i :\ Ep'1'1C�PERCPORM-DOC MAP 933 PARCE4 O O LOT \ -� l COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS w DEPARTMENT OF ENVIRONMENTAL PROTECTION .0 > ' 1ij.L APR 7 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 OLD Owner's Name: FORESTER Owner's Address: PO BOX 7 CUMMAQUID,MA 02637 Date of Inspection: 3/15/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was 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: X Passes _ Conditionally sses _ Needs Furt valuation by the Local Approving Authority Fails Inspector's Signature: % Date: 3/15/04 The system inspector shall submit opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti . If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner sh 1 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 SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND GETTING NEW COVER FOR OVERFLOW. ****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 S incnPntinn Fnrm 1,/]V')000 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.RECOMMEND GETTING NEW COVER FOR OVERFLOW. 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. n/a 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: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "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: n/a Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backupof sewag e into facility g cility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Wa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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.] NO (Yes/No)The system fails.1 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 _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. d i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X Has the system received normal flows in the previous two week period`? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out" X _ Were all system components,excluding the SAS, located on site'? X _ 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? X _ 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 X _ Existing information.For example,a plan at the Board of Health. X _ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] S Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):220 Number of current residents: n/a Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): YES Water meter readings, if available(last 2 years usage(gpd)):vjw Sump pump(yes or no):NO Last date of occupancy: n/a C [ COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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): n/a Approximate age of all components,date installed(if known)and source of information: 1960 PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO 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: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron _40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Continents(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): N/A PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R � Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a 5' X 6' BLOCK OVERFLOW overflow cesspool, number: CESSPOOL innovative/alternative system n/a Type/name of technology: n/a Continents(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): OVERFLOW IS FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. RECOMMEND GETTING NEW COVER.OVERFLOW WAS EMPTY AT TIME OF INSPECTION.THERE ARE NO STAIN LINES,INDICATING THERE HAS NEVER BEEN ANY LIQUID IN IT.BOTTOM IS AT 8FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 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. tl�J r-ol. AA Z `j C'o ,zS hr. 31 2i . in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 220 CASTLEWOOD CIRCLE HYANNIS,MA 02601 Owner: FORESTER Date of Inspection: 3/15/04 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation:. HAND AUGER-12+FT. 11 -100——EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE N s —W—EXISTING WATER SERVICE G EXISTING GAS SERVICE N --$H. W.—OVERHEAD WIRES s o TEST PIT LOCUS { BENCHMARK iiiilljjj BENCHMARK LEGEND PB 20g_PG 1p9 OUTSIDE560R./8OTT. STEP t 0 c .y S 12*54'10" W 8 99,7 FENCE LINE CB $ Y C J ' 100,03 1$p-.. m TP-1 _ 97.30 1 e o N �25,� x 99,50 �.--- ---- I LOCUS MAP T PROP. .S.A.S.;:�; 1 ' J ,_\ NOT TO SCALE N Q QL EXISTING S.A.S. 100,68 PUMP, FILL WITH GENERAL NOTES: SAND & ABANDON 99.8� ST MP I 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 100.90 00.80 Q BOARD OF HEALTH AND THE DESIGN ENGINEER. EXISTING SEPTIC TANK 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS STU�� 100.25 PATIO BM Q TOP OF TANK, EL.=99.72 LOCAL ERULES AND STATE VIREEGULATIONS.RONMENTAL ODE, TITLE V, AND ANY APPLICABLE 101.56 0x 99 7 /NV.(OUT)=98.39t(VERIFY) i I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 99.9 / 101.12 100.67 I N TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE / x DESIGN ENGINEER. ^ W i STOMP DE I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING e FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 0 1 i7 :4 01 I ENGINEER BEFORE CONSTRUCTION CONTINUES. 00 0 + 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. I rn GARAGE /EXISTING �'- 0 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 1 HOUSE(#220) i m THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF f T.O.F.=101.91.1 I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 1101.4 101.5 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 100.78 x 99,8 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 0101.15 ` AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ` DIRECTED BY THE APPROVING AUTHORITIES.�- WALK* 'F 14/ z ��� OF M�SS9 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ' SLOT 131 �O =`�P �yG THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING • O''' o PETER T. ✓ 9299 ±SF CONSTRUCTION. McENTEE 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS MBL: 272-04 o CIVIL IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND _. o. 35109 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). () LAMP g 97 30' O 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE opt ECISTER� �`�� INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. N 12-22'00" E �100.47 S 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND — Z 100,94 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. SW 160 SIDEWALK S �Cly 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 99,54 edge of pavement 100,55 )t SYSTEM COMPONENTS NOT SHOWN ON THE PLAN I PROPOSED SEPTIC SYSTEM UPGRADE PLAN CA►STLEWOOD CIRCLE j 220 CASTLEWOOD CIRCLE, HYANNIS_MA OWNER OF RECORD Prepared for: Russell Jacobson, 1645 Falmouth Rd, Centerville, MA 02632 JACOBSON, RUSSELL J Engineering by: SCALE DRAWN JOB. NO. ! 1645 FALMOUTH ROAD Engineering Works, Inc. 1"=20' P.T.M. 266-15 BLDG. F UNIT D4 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 1/14/15 P.T.M. 1 Of 2 1 ^' NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:96.50 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. PROPOSED S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX Z:25 PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" Ti PROP. S.A.S. INSTALL WATERTIGHT RISER & OF FINISH GRADE FOR INSPECTION PURPOSES aO TLF.G. 2.9t COVER SET TO 6" OF GRADE NI .=101.1 t F.G. EL.=100.6t F.G. EL.=100.0f F.G. 'EL.=99.8t i __— MAINTAIN 2% GRADE (MIN.) OVER S.A.S. N h �\ S6 a L = 28' L = 5' �� ��. , 4 8 ® S=1% (MIN.) ® S=1% (MIN.) 2, .3 .9 • ' 4"SCH40 PVC 4"SCH40 PVC 6" 101 11 as 8 ae 14" ) 6" 66Ba69B EXISTING 48" LIQUID aaaaeaa LEVEL ADD 4' 4.8 4' GAS BAFFLE • INV.=96.47 PROPOSED INV.=96.30 / • . INV.=98.39t D-BOX EFFECTIVE WIDTH = 12.8' GARAGE /EXISTING EXISTING SEPTIC TANK EXISTING INV.=96.00 HOUSE 220 2-500 GALLON LEACHING CHAMBERS T.O.USE 9 SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=96.8f BREAKOUT ELEV.=96.50 SEPTIC LAYOUT NOTES: INV. ELEV.=96.00 ease aaaaeAlU.-M.N.A1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE a- Mw aaaese INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=94.00 4' 2 X 8.5'=17.0' 4' 2) D—BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0. ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL ®®U® 0 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION U U U U U U U U U®q 33" 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP, EL.=88.3 — � w U®®®®® U U U U 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON 3/4" TO 1-1/2" DOUBLE C14 > U U®®U®U U U U THE OUTLET TEE. WASHED STONE Z 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE 102" (OR APPROVED FILTER FABRIC) SOIL LOG 4" KNOCKOUT DESIGN CRITERIA 20" DIA. COVER DATE: JANUARY 6, 2016 (REF#14,921) NUMBER OF BEDROOMS: 2 SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 4" KNOCKOUT I--," 4" KNOCKOUT 58" SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVID STANTON R.S. HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH (0.74 GPD/SF LOADING RATE) 99.8 A 0" 99 9 A 0" 4" KNOCKOUT DAILY FLOW: 220 GPD SANDY LOAM SANDY LOAM 10YR 4/2 10YR 4/2 DESIGN FLOW: 330 GPD 99.3 6" 99.4 6" GARBAGE GRINDER: NO SANDY LOAM BSANDY LOAM 500 GALLON CAPACITY, H-10 LOADING LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 1OYR 5/6 10YR 5/6 CHAMBERS 96.1 32" 96.4 30" .74 GPD/SF C1 PERC C1 N.T.S. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 30"/48" PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES M-C SAND M-C SAND 2.5Y 6/6 2.5Y 6/6 220 CASTLEWOOD CIRCLE, HYANNIS, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. SOME COBBLES 1 SOME COBBLES Prepared for: Russell Jacobson, 1645 Falmouth Rd, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:..............................................................471.2 S.F. Engineering Works, Inc. NTS P.T.M. 266-15 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 88.3 138" 88.4 1 138" 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. NO GROUNDWATER, PERC RATE: <2 MIN./IN. (508) 477-5313 1/14/15 P.T.M. 2 of 2