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HomeMy WebLinkAbout0251 CASTLEWOOD CIRCLE - Health 251 Castlewood Circle Hyannis A = 273 —049 I k I I � J TOWN OF BARNSTABLE LOCATION ( C�5-�1�w�e�1 c t it e. Ile— SEWAGE# VILLAGE � /� � �$ ASSESSOR'S MAP.&PARCEL' mct INSTALLER'S NAME&PHONE NO. . B,,o,d �; I,l Pam. 0 SEPTIC TANK CAPACITY to 0 0 LEACHING FACILITY:(type) ' s°" q A- (size) ;K NO.OF BEDROOMS c Hj,m�.tq y OWNER PERMIT DATE: lO 1 :3 COMPLIANCE DATE: 0 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 orr � site or within 200 feet of leaching facility) t 1 __Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leach' f cility) /J A Feet FURNISHED BY �'� 0 -C�;? 3 tx a Cb y oy o , d c� A. 2 No. �Of3' �OL' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fipfication for Nsposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a15 e ti S 4-L eW o 0 cA, C V Owner's N�am4AAddres�an Tel.N ' — 11JILL Assessor's Map/Parcel µy off-73 — 0N p r Installer's Name and Tel Designer's Name,Ad ress,and Tel.No. �oy�� Type of Building: Dwelling No.of Bedrooms '2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) off—a"d gpd Design flow provided 3 q gpd Plan Date —Number of sheets Revision Date TitlecX �— Size of Septic Tank Type of S.A.S. C3 sa° Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f ealth. Signed - J Date /U'/— (3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 9-0I 3" 3 Date Issued a �� I ' No. o Fee THE COMMONWEALTH OF MASUCHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ` Rpplication for MispoSal 6 ' trin Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. C 5 (�0 t r Owner's �res a •Tel.N� Q q U f Assessor's Map/Parcel 3 Installer's Name,Addres and TeI NN-ru . Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) U gpd Design flow provided 3�t gpd Plan Date Number of sheets Revision Date Title i 1 -, ,—--.S -- ' Size of Septic Tank X ��� Type of S.A.S. (3) UU C' "`'�✓ Description of Soil Nature__of-Repairs or Alterations(Answer when applicable) 4 Date last inspected: Agreement: E 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 f ealth. 74-Signed �`"' Date Application Approved by � Date Application Disapproved by Date for the following reasons Permit No. a o'3— 3 Date Issued -------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO FY at the On-site Sewage /.sposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by O� v at a 5 ' CAS 4- ,j U U C l lr C 'p- has been constructed in accordance l ? with the provisions of Title 5 and the for Disposal System Construction Permit Noa Ut 5 ' it dated Installer Designer #bedrooms Approved design flow f3iftgpd The issuance I s pe Shall not be construed as a guarantee that the system will nct n desi ed. �' U r � , Date Inspector � zit -------- ------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Con ct( .) Repair( ) pgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction UA be completed within three years of the date of this permit. Date y I 2 Approved by (/`'`� ; i ' i Town of Barnstable Regulatory Services Richard V. Scali,Interim Director i*i 1AItN6fABLE, s ►A. Public Health Division i639- � 039. " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790.6304 Installer&Designer Certification Form Date: 007 212013 Sewage Permit# 2013 J q'4 Assessor's Map\Parcel A) 273 /°, 094Y Designer: �1�Dy�E �S56C/.9TC-S' Installer: 111AZ J/11A4-6/p- Address: /749 C121/6i��4S.4—P y Address: ,6f1)Q41Wv7;W41 -a2.s73,6 In�9 a On OG 1 l 244/3 �`-5 was issued a permit to install a (date) (installer) septic system at C14C L6' based on a design drawn by (address) �•-,�DyZ-6 AT- 'eC`f-72!b dated 9-3,,�=2 a13 (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. �,. :.`.� <. h:. I certify that the system referenced above was constru���G�.:. �.� ith e rm of the IAA approval etters(if applicable) r, .. '' OF `� dOF4N Cy. P. )(Installe r's Signature) No 9 N a "�',e d No..335 93589 ��gs n� NITA: _ esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTrLEPUBLEALTHIC H DIVISION. CERTIF TE OF COMPLIANCE WILL NOT WE ISSUED UNTIL BOTH THIS FORM A AM AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc a �1KE Town of Barnstable regulatory Services Department awxivsrnsc.E, Public Health Division rFD" A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler, FAX: 508-790-6304 Thomas A.McKean, CERTIFIED MAIL# 7012 1010 0000 2851 0756 September 30, 2013 Mr. &Mrs. Michael L Palmer 207 Turner Road East Falmouth, MA 02536 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 251 Castlewood Circle, Hyannis, MA was inspected on 8/129/2013, by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • SAS (Soil Absorption System) must be repaired. You are ordered to repair/replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\251 Castlewood Cir Hy Sept 26 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20922 r�tt1E ,-.�..& .Sd_ & Logged In As: Parcel Detail Thursday, September ParcelParcel Lookup Parcel Info _ ........ Parcel'3-049 � Developer LOT ID E Lot Location 251 C WOOD CIRCLE ' Pei 115 Frontage Sec Sec Road. Frontage Village JHYANNIS ( Fire District District Town sewer exists at this Road address No Index i. Interactive Map Owner Info mm Co- Owner SPA ER, MICHAEL L& LEAH L 4Y- N Owner Streetl 120 TURNER RNER RD Street2 City LEAST FALMOUTH � ____ State FPMA Zip.02536 Country i --1 Land Info m Acres�0.21 Use Single Fame MDL-01 ZoningRC-1 Nghbd0105 Topography Road F Utilities Location Construction Info Building 1 of 1 Year,--------- Roof w,. _,. _.. Ext,�......... ....._ _, Built 11967 Struct lGable/Hip _ � Wall Wood Shingle Living Roof AC Area 912 Cover Asph/F GIs/Cmp Type None a- _� Int _ Bed _,_.___-____—j Style Ranch Drywall2 Bedrooms Ha:2 Wall Rooms Int p -- Bath F— ) I':` Model€Residential Floor Car et Rooms 1 Full �'d--- Heat r ______ __� .. Total Grade sAverage Minus _ Type Hot Air Rooms i4 Rooms J Heat 1 �_, Found- nc Stories[1 Story � Gas 1 Poured Conc. Fuel �-- ation i Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=20922 9/26/2013 f�� �� � �r� ���' ti�� common eal h:of assachusett _ ffi , — = n1 Subsurface.Sewage Disposal.Systern Forrn -Not for Voluntary Assessments 251 Castlewood Circle Property Address Michael Palmer Owner ...:. m.... _n._.. _:.._ ___ w.. _ . ... ...... ....., Owner's htame Information is required for every Hyannis Ma 02M 812912 0 1 3i ...... ........ ., _. pager City/Town State : Zip Code Date of Inspection Inspection results rraust be submitted on this form. Inspection,farms may not be altered ►n any w;�y. Please see corrDpI teness'checklist'at the end of the for' . Important:Whelp ,GeherAl:lnforrhatioh filling:out forms on the computer, j') use only the tab 1 v . Inspector:: . key to move your cursor do not use the return Sean M Jones key. Name of Inspector Ca ewlde_Enterprises P. ..... _. __ ....._ .---- ------- __.. .. .... ..;. .....--- '; ........ . �aa Company Name 15.3 Cornmercial St. r^nan Mash M ap ..... ......... ........ ... City/T.own: 02649 State Zip Code. 508-477-8877 _ SI4522 . - _ ....... .... ---- -- __. Telephone Number License Number.; � rto:It atl 6n fi? c� '-i I certify that I have personally inspected the sewage disposal system at this addres and that'"tote information reported below is true, accurate and complete as of the time of the inspreetlon The' nsp Rion was performed based on my training and experience in the proper function and rnaintenance�9f on site sewage disposal systems. I am a L EI'approved system inspector pursuant to Silecti 6 15 340 Oj Title 5(310 C R 115.000).The'system: ❑ Passes: ❑ :Conditionally Passes ® 'Fails ❑ ,Needs Further Evaluation by the Local Approving Authority 8129iM l 3 Ins ector s Signature -- p Date- The'systerri;inspector shall submit a copy of this inspection report fo the Approving Authorlty,(S:oard of Health or DEA}within 30 days of completing this inspection. if the system is a hared systerrror has a design flow of 10;000 gpd or greater, the inspector aril the system owner shall submit the report to the appropriate.regional office of the DER The original should be sent to the system ovuner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions.off use at flat three.This Inspection does not address howl the systems v ill perforrn0ia.the future under the same or different conditions of use. f5n's•3/13 Title 5 Official Inspection Form.Subsurface Sewage Dis�iosal System•Page 1 of 17' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 215 Castlewood Cir Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank'and a 1000 gallon precast leach pit. The leach pit was found to have only 9" of available leaching at the time of inspection resulting in a failing inspection per Town of Barnstable regulations. Town of Barnstable requires a minimum of 12" available leaching. 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. Cityrrown State Zip Code Date of.Inspection B. Certification (cont.) 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: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody.must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health. ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No. information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2012—3100 Cubic Feet; 2011 —3500 Cubic Feet Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes E No Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks,vented through the roof Septic Tank(locate on site plan): Depth below grade: 10"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 311 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 3" 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 1011 How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. ` Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is Hyannis Ma 02601 8/29/2013 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1x1000 gallons ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leach pit was found to have only 9" of available leaching at the time of inspection resulting in a failing inspection per Town of Barnstable regulations. Town of Barnstable requires a minimum of 12" available leaching. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 0260.1 8/29/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth o assqch se " a : Subsurface Sewage Disposal System Fora - Not for Voluntary Assessments 21 Castlewood Circle ----- Property Address Michaei.Palmer OwnerNam _...... ......... Owner's e ...information is. H annis:' 11�a 02601 8/29/2013 required for every _-Y __.. _.... pager Citytl-owrr State Zip Code Date of 1nspedt(on D. System Information (cunt:) Sketch 0 Sewage Disposal System: Provide a view of the sewage'disposal system", including tires try at least Mo.permanent,reference'landmarks or ber�chmarks.:Locate all wells within 100 feet. Locate where,putal c water`sup.pI enters'>the building.Check one of he boxes beleiw ® hand=sketchAn'the a ea"belaw El drawing attached separately l _ . ..: 4. ej is - ( Z ` �1f ' 3 Z7 .. 7- (Sins-3113 Tide 5 Official inspection Form Subsurface Sewage.R:sposal,System P age'15 of 117' u Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 251 Castlewood Circle Property Address Michael Palmer Owner Owner's Name information is required for every Hyannis Ma 02601 8/29/2013 page. CityTrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town.of Barnstable P# Department of Regulatory Services Public Health Division Date • � ia79 w� 200 Main Street,Hyannis MA 02601 ArFO MA`I�' Date Scheduled— Time Fee Pd. [ . l Sall Suitability Assessment,f or S "Disa Performed By: / . 0 �i AWitnessed By: LOCATION& GENEIIAL EVI+ORIVIA Location Address ( Owner's Name vis Address w (UC'OG,— Ad Assessor's Map/Parcel: 90 3— `f Engineer's Name �ij/1 PD/ (_ NEW CONSTRUCTION REPAIR _ Telephone# A3 0 "SY(k5 . Land Use L�'ES/ �/1/L Slopes('30) _ Surface Stones AQ;% l a.3"E/C�r'/,6-P Distances from: Open Water Body OG ft Possible Wet Area ft Drinking Water Well �ft Drainage Way a ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands(n proximity 1.0 holes) Z- E / 10 N 0 7- No / /a, 33 , lea . I� r � Parent material(geologic)ze ex-fc Depth to ITecb'nclt ,V Depth to Groundwater. Standing Water in Hole:AlO r /QMWJ Weeping from Pit Rce /!/yT Estimated Seasonal High Groundwater 1�5L I_K✓1 3 /-c 19AA _rY IL 6.e4 AY, ,f A DETERMINATION FOR SEASONAL HIGH wA'1TER 11ADL101 Method Used: Depth Observed standing in obs.hole: la. Dep[h to 5011 InUttics;. 1tt. Deptli to weeping from side of obs.hole: _ R_ In, Groundwater Adf ustment ft. Index Well# Reading Date: Index Well level_� Acj,fhaor— AtU.Groundwater Level e i PEI RCOLATION TESL' Date: - 24-1,3 Tltae l�sw Observation Hole# Tittle at 9" Depth of Pere 33 it S 4 _ The at 6" Start Pre-soak Time @ /10l 02 d O e d Time(9"-6") End Pre-soak /�i® !% d y -/2 t��7� ��7LW7C.A Rate Min./lach 2 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***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. q:\.sEPPICNPERCFORM.DOC DEED OBSERVATION MOLE LOG hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Stnucture,Stones;Boulders. O,' p�� onsis[encv 96 t3ravell z Coq�SE ;/,►n/>° �p ,e �c7 DEEP O-13SF-RVATION DOLE LOG hole#I-P" 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. onsisten % ravel oe 7'�=/3�4" DEEP OBSERVATION MOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Con i to c Gravel) ]DEEP OBSERVATION BOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color 5011 Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones.Boulders. Consistency, 6 a x I food Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious titerial exist in all areas observed throughout the area proposed for the soil absorption system? --f If not,what is the depth of naturally occurring pervious material? Certification _ I certify that on � (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 10 CMR 15.017. Signature C/ Date - Q:\ HPTIC\PLaRCPORM.DOC S r. af TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address 251 Castlewood Cir Hyannis,Ma 02601 Owner:Michael Palmer d Owner's Address: 207 Turner Rd Falmouth,Ma 02536 Date of Inspection: 03/14/06 Name of Inspector.(please print) David J.Burnie Company Name: David J Burnie&Sons Septic Services Mailing Address: 307A Commerce Park N South Chatham,Ma 02659 Telephone Number: 508-432-7420 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 fimction 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 15.600).The system: X Passes _Conditionally Passes _Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 03/14/06 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments V W a W Fn ****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. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner:Michael Palmer Date of lospeetion:.03/14/06 Inspection Summary:Check A,B,C,D or E I 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 exists.Any failure criteria not evaluated are indicated below.Comments: sample 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 Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate Of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _broken pipe(s)are replaced _Obstruction is removed _Distribution box is leveled or replaced ND explain: the system required pumping more than 4 times a year due to broken or obstructed pipe(s�The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _Obstruction is removed ND explain: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Palmer Date of Inspection: 03/14/06 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 aseptic tank and SAS and the SAS is within a Zone I ofa public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a Private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3.Other: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Palmer Date of Inspection: 03/14/06 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 Backup of sewage into facility 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 lf2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped . X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 fat 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 fat but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysla, 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 forml No (Yes/No)the system faits. 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 — _ 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 Il 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. /1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Palmer Date of Inspection: 03/14/06 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 Has large volume 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 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,including 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 baBle�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 maintenanceof 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 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is Oacceptable)[310 CMR 15.302(3)(b)l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Palmer Date of Inspection. 03/14/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):Unknown Number of bedrooms(actual)2 per owner_ DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms):unknown Number of current residents:0 Does residence have a garbage grinder(yes or no):No Is laundry on a separate,sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no) Seasonal use(yes or no)No Water meter readings,if available(last 2 years usage(gpd)):2006-2.05 god.2005-24 gpd.2004-27 Sump pump(yes or no).:No Last date of occupancy:Unimown COMMERCIAIANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): %wd 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): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:December 12,2000 per Board of Health Was system pumped as part of the inspection(yes or no):No If yes,volume pumped: gallons-How was quantity pumped determined? Reason.for pumping:. i 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 ITom system owner) Tight tank_Attach a copy:of the DEP approval Other(describe): 1 Approximate age of all components,date installed(if known)and source of information No records available at Board of Healer No distribution boz. Were sewage odors detected when arriving at the site(yes or no):No P OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAI.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Palmer Date of Inspection: 03/14/06 BUILDIN EWER G SEWER on site plan) Depth below grade: 11" Materials of construction: cast iron X 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: Yes (locate on site plan) Depth below grade: :6" Material of construction: X concrete_metal_fiberglass_polyethylene_other(explain) If tank is metal list age,_is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:1000 eallons Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 1" Distance from top of scprn to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:. How were dimensions determined:Estimated Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid.levels as related to oudetL invert..evidence of leakage,eta): Recommend oumom¢every 3 years. GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert evidence of leakage,eta): X-6 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Palmer Date of Inspection: 03/14/06 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:—concrete_metal_Sberglass_polyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no):_ Alarm level:_Alum in working order(yes or no):_ Date of last pumping. Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids canyover,any evidence of leakage into or out of box,etc.): Not Present.Used sewer camera to view line from septic tank on"to leaching alit. PUMP CHAMBERS(locate on site plan) Pumps in working order(yes or no)- AlamMs in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): �J OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Pahner Date of Inspection: 03/14/06 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan,excavation not required) If SAS not located explain why: Type X Leaching pits;number: 1 _Leaching chambers,number:_ _Leaching galleries,number:_ _Leaching trenches,number,length:_ _Leaching fields,number,dimensions:_ Overflow cesspool,number._ _Innovative/altemative system Typelname of technology:_ Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): 2'of water found in nit CESSPOOLS:_(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):- PRIVY:_(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 251 Castlewood Cir Hyannis,Ma 02601 Owner: Michael Palmer Date of Inspection: 03/14/06 SITE EXAM Slope No Surface water No Check cellar Shallow wells No Estimated depth to ground water 35•+/-feet See below 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) X Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: You mast describe how you established the high ground water elevation: See attached.See below. Town of Barnstable GIS may elevation 67.70 Site elevation at 251 Castelwood Cir Barnstable Town Map,Groundwater may elevation 30.00 37.70 Also reference shallow Woad elevation 33.62 Weauaauet Lake elevation 33.41 AIW 247 Level 22.0 Zone D Adj=22• i /y : a f4 o �\ y J',•� `.1 rf�67.9�' f .75. f %; , ti #2KD ,i i / r ." -ran — / /.r��� \'9 66.2 _ I � i � j 67.?3 / 68AP 273 j'�88.5 - - t^\/ t j \ 'r"\, MArPY273 I i MAP;93 . .- �/\ ^ / �- #•25; (l s o _ 1�_Er$S j 65..3 1 •MAP 273 r,. �t MA 273 t; \ ` ! #6 �� J / I 1 J _ _ ,'� 66.1 #1a9 -' '_ _ #'1�04 `2 ! 1 f _ MAP 273 _ L ! �..: MAP�73 `5a �; '�:t 1 1 '�—.....� � }�64.6 e: c s {, s� 4.2i #0 �! # %�6�•� 1 ` �� / y~r��, #79.`i j MAP 273 ) �• v/ 67 1 '�� .8 I~ E I 1 ' MAP 273 �%\ { MAP 2`3 ( _ 'j\�'- MAP 273 .._ 66.2 r MAP 273 _ . #,-2FI - _ i�t MAP 273 r I #82 ..�� #240" ` ;r %\ 6.8 #X I�7:3- r i \/ t #8I 1 MAP 273 %\ 17 '~ /yh �72 '7 y MAP 272 651 MAP 272 0 a' 67 \/ 44 /�\ r #72 ! \/ #r 23( �_ ! 229 MAe?72�2 /\ 112 1 #65 i f 1/ \/67.4 1 _ _ MAP 273 MAP 272 X 65i i "t Ci :11� i 66.5 / faf=�\/ ' MAP 272 V / I _67 f t _ C j. 1 F272 d MAP 2Tz/l 6 8�5 l #0 #22 ,\ _ I MAP 272._ \/ r�, # 136 /53 , % r �� Z�z°3v/66.8 ,•/,93 67 MAP 272 \ 'J r` #2 10" / 6 5.1' \/ _ 144 \. #50 ' 67.6 /. 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