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HomeMy WebLinkAbout0301 CASTLEWOOD CIRCLE - Health 301 Castlewood Circle Hyannis A= 273 — 111 �.....�..-. � o w s a a ol- 3 — 111 Commonwealth of Massachusetts Title 5 Official Inspection Form I I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c. � 301 Castlewood Cir u— Property Address Libero& Nancy Molinari Owner Owner's Name/ information is required for every y H annis 'r/ MA 02601 10/14/2020 i 4, ,..� page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information �- filling out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-.do not Cape Septic Inspections use the return Company Name key. '.. t., 52 Rivers End Road V Company Address Teaticket Ma. 02536 City/Town State Zip Code r 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 'u 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails w . ..-.. ..._.___. ...__..._..._ c� 10/15/2020 Inspector's Signature Date oy� 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 301 Castlewood Cir u Property Address Libero& Nancy Molinari _ Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3;or 5 and all of 4 and 6. 1) System Passes: s ® 1 have not found any information which indicates that any of the failure criteria described ' I, in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 3 bedroom home has an H-10 1000 gallon septic tank feeding two precast leaching pits with stone. At the time of the inspection no visible failure criteria was found. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 301 Castlewood Cir VI Property Address Libero & Nancy Molinari Owner Owner's Name information is Hyannis MA 02601 10/14/2020 required for every y page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) =' 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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)`.-Th-e- 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): rr .. 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts n Title 5 Official Inspection Form cI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t r 301 Castlewood Cir Property Address Libero & Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4), System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No El ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t,— 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name information is Hyannis MA 02601 10/14/2020 required for every y .. �* page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (coil Yes No ❑ ® 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.-R ❑ ® 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 water supply 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 analysas and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. I 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 y..i Commonwealth of Massachusetts �v Title 5 Official Inspection Form - �i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 301 Castlewood Cir u� Property Address Libero & Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed„ under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The systern,owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: 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 w tfi� 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)] 1,tA+ ', t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name information is required for every y H annis MA 02601 10/14/2020 page. City/Town State Zip Code Date of Inspection t D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: p; Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: ifH LL Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) El Yes ®!fi No<- Laundry system inspected? ❑ Yes n No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): town water Detail: In the first part of 2020-47,872 gallons were used and in 2019-32,164 gallons were used. Sump pump? ❑ Yes No Last date of occupancy: occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 k,ka Commonwealth of Massachusetts n Title 5 Official Inspection Form ,f + ' �i' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: _ Type of Establishment: pp ' 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No t'! Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑>, No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 71t 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name t information is Hyannis MA 02601 10/14/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool .. Privy ❑ y r. =" ❑ 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): .Y_ � L I Approximate age of all components, date installed (if known) and source of information: ;;,j = ;,. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 36"feet Material of construction: ®40 PVC❑ cast iron ❑ other(explain): - R r town water Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts �v Title 5 Official Inspection Form lI., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -; ............ 301 Castlewood Cir V� Property Address Libero & Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"feet . .r - 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) El ❑Yes - No"- Dimensions: H-10 1000 gallon Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5„ 13" - - Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? sludge judge ' Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. i t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name information is Hyannis MA 02601 10/14/2020 required for every H y - - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form <' iI; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f' .............. 301 Castlewood Cir u� Property Address Libero& Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) e' 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 9. 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.): I ran a camera down the discharge pipes and did not see a D-Box. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form +, I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name information is required for every Hyannis annis MA 02601 10/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r- - c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) _= Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of, vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): _. U11, 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 4,. Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name information is Hyannis MA 02601 10/14/2020 require d for every - y page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 13. 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, ins.• etc.): i"IIf0 va !e c�. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 i Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 301 Castlewood Cir Property Address Lib_ero& Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately er, Driveway rr:s A B 1 21' 1816" 2 39'6" 24' A B 3 33' 3312" A 00 o,v z 3 `w <!6 t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r Commonwealth of Massachusetts �e _. Title 5 Official Inspection Form +• I1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a� u� 301 Castlewood Cir Property Address Libero& Nancy Molinari Owner Owner's Name f information is required for every Hyannis MA 02601 10/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar Shallow wells i y Estimated depth to high ground water: 14 plus feetfeet 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: v1` i a) ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show four plus feet of seperation. 1 �. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i4i'Z7 1 E. Commonwealth of Massachusetts Title 5 Official Inspection Form iI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 301 Castlewood Cir u Property Address Libero & Nancy Molinari Owner Owner's Name information is required for every Hyannis MA 02601 10/14/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: rY: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached - -; For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I { 5 Certified Mail#7006 0810 0000 3524 8189 �OFj"E Tows Town of Barnstable Regulatory Services + BARN FrABLE, ' 9 MASS. g Thomas F. Geiler, Director �p 16gq. ArfD 39. ek Public Health Division Thomas McKean,Director, 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 30, 2007 Libero Molinari 11 Sheep Pasture Way East Sandwich, MA 02537 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 301 Castlewood Circle, Hyannis was inspected on January 23, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. 07 The following violations of the State Sanitary Code were observed: ^ v 105 CMR 410.351 - Owner's Installation and Maintenance Responsibilities - Observed outlet behind couch not working; observed hot water tank leaking. The following violation(s) of the Town of Barnstable Code were observed: 170-7- Posting of Owner's Installation—Owner's information not posted.* hYou are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by fixing or replacing outlet behind couch; by repairing or replacing hot water heater. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. QAOrder letters\Housing violations\Rental ordinance\301 Castlewood Circle.doc I , Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDWOFE BOARD OF HEALTH s , .S., CH O Director of Public Health Town!of Barnstable Cc: Igor& Gisele Coura, Tenants Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\301 Castlewood Cirele.doc T Certified Mail#0000 0000 0000 0000 0000 t Town of Barnstable Regulatory Services � g Y � �stag. Thomas F. Geiler, Director A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 date ddrgss city,state,zip d;I- 3 7 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 3o I ie was inspected on 1—/23-4 1j ( b _o (Address) Y t ,(date) (Inspector's Health Inspector for the Town of Barnstable, (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-violation descri tion p 105 CMR 410. 3 51 105 CMR 410. 3 51 _ gru.t I j� 105 CMR 410. 105 CMR 410. Q:\Order letters\Housing violations\Rental ordinance\template.doc 105 CMR 410. The following violation(s) of the Town of Barnstable Code were observed: Town code violation number-vio atio des ri tion §170- '� - In. N §170 - You are directed to correct the violations listed above within (3 ) days.. a of your receipt of this written#) (#)©notice by {�-L �Q�, " You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violations\Rental ordinance\template.doc W HOBBS&WARREN THE COMMONWEALTH OF MASSACHUSETTS FORM 30 � BOARD OF HEALTH s CITY/TOW DEPARTMENT D4 G0 4„M see�•�� / y/ 1( TELEPHONE Address 6 O 6260 _Occupant_ �' _ No.of Occupants— No.Floor��Apartment No. _ of Habitable Rooms S_ No.Sleeping Rooms No.dwelling or rooming units_n/_/�_-___No. t_ories._ — Nam e and a dress of owner ------ w4uz �- Remarks Reg. Vio. YARD Out Bld s.: Fences: O Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Al n Hall, Floor,Wall,Ceiling: Ij) _ 3 5 Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 11220 Fusing;Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room F1 Bedroom(1). X_ Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Sta ks, Flues,Vents,Safetie : Kitchen Facilities n Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDE T E PAINS AND PENALTIES OF'PERJURY." INSPECTOR TITLE A. TIME_ DATE ( ,. _ P.M. l A.M. THE NEXT SCHEDULED REINSPECTION 1 P.M. "'` i' .. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. . (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. • Parcel Detail Page 1 of 3 ._w tA' z 9 w Logged in As: Parcel Detail Tuesday, Octob. Parcel Lookup Parcellnfo Parcel ID 1273-111 m Developer SLOT 112 Lot Location 1301 CASTLEWOOD CIRCLE Pri Frontage 1105 _.._.-..------------------ ------ -- ....... _. Sec Road Sec I I Frontage Village IHYANNIS Fire District[HYANNIS Sewer Acct I Road Index ' . 41 Interactive I Map a" 617. _,W Owner Info Owner MOLINARI, LIBERO J & NANCY A - I Co-owner j Streets 311 SHEEP PASTURE WAY I Street2 city "E SANDWICH I State jEA Zip 102537 Country Land Info Acres 10.21 use$Single Fam MDL-01 Zoning RC1` � i Nghbd 10106 Topography iLevel Road Paved 5 ---- -- _..-. _.-. ----- Utilities I Public Water,Gas,Septic I Location - Construction Info Building 1 of 1 Year i 1971 Roof I Gable/Hip �.- � Ext Wood Shingle I Built? Struct Wall Effect'1723 Roof iAsph/F Gls/Cmp AC None I Area l Cover Type Int g Bed Style}Ranch Wall!Drywall I Rooms 3 Bedrooms Model Residential Int, Bath Full+ 1 H Floor! Rooms i Grade Average Minus I Type Hot Water I Rooms ? ROOmS http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=21034 10/31/2006 Parcel Detail Page 2 of 3 Stories 1 Story Heat Gas Found- Poured Conc. FuelWE Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History Date Who Purpose 10/29/2002 12:00:00 AM Paul Talbot Meas/Listed 1/24/2001 12:00:00 AM Paul Talbot Meas/Listed 6/15/1991 12:00:00 AM ML Sales History Line Sale Date Owner Book/Page Sale P 1 5/31/2002 MOLINARI, LIBERO J & NANCY A 1 52 1 7/349 2 8/15/1996 BUZON, STEVEN M 1 0353/1 1 1 3 FISHER, ELINOR M 2195/343 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parce 1 2006 $124,500 $2,600 $0 $142,100 ; 2 2005 $115,300 $2,500 $0 $126,800 3 2004 $93,300 $2,500 $0 $95,100 J 4 2003 $87,500 $2,500 $0 $38,300 ; 5 2002 $87,500 $2,500 $0 $38,300 6 2001 $87,500 $2,500 $0 $38,300 7 2000 $70,100 $2,300 $0 $24,400 8 1999 $70,100 $2,300 $0 $24,400 9 1998 $70,100 $2,300 $0 $24,400 10 1997 $68,100 $0 $0 $24,400 11 1996 $68,100 $0 $0 $24,400 12 1995 $68,100 $0 $0 $24,400 13 1994 $65,500 $0 $0 $27,400 14 1993 $65,500 $0 $0 $27,400 htt ://iss 1/intranet/ ro data/ParcelDetail.as x?ID=21034 10/31/2006 P 9 P P P . Parcel Detail Page 3 of 3 •15 1992 $74,600 $0 $0 $30,500 ; 16 1991 $87,600 $0 $0 $42,600 17 1990 $87,600 $0 $0 $42,600 18 1989 $87,600 $0 $0 $42,600 19 1988 $65,600 $0 $0 $16,800 20 1987 $65,600 $0 $0 $16,800 21 1986 $65,600 $0 $0 $16,800 Photos http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=21034 10/31/2006 �Q Commonwealth of Massachusetts 2 3y Executive of Environmental Affairs I DEP 4 Department of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property AddresY 301-Castlewood-Circle.-Hyannis,_Ma�� Address of Owner: Elinor Fisher (if different) Po Box 413. Hyannis, Ma 02601 Date of Inspection: 07/17/96 Name of Inspector: Michael DeDecko Company Name, 'Address and Telephone number: Atlantic Environmental P.o B ox 2384 - M ashpee M a 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails Inspector 's Signature: Vw � �,� Date: 07/18/96 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer, if applicable and the approving authority. f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) a Property Address: 301 Castlewood Circle. Hyannis, M a. Owners : E. Fisher Date of Inspection : 07/17/96 INSPECTION SUMMARY: Check A, B, C, or D A)SYSTEM PASSES: - I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. An failure criteria not ev aluated valuated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determinate(Y,N, or ND). Describe basis of determination in all instances. If "not determinated",explain why not. - -- The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration , or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). ----- broken pipe(s) are replaced ----- obstruction is removed ---- distribution box is levelled or replaced ---- The system required pumping more than four times ayear 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 301 Castlewood Cir. Hyannis, M a. Owner : E. Fisher. Date of Inspection : 07117196 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING INAMANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a. bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IFAPPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: -- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 301 Castlewood Cir. Hyannis, M a Owner: E. Fisher Date of Inspection : 07/17/96 D) SYSTEM FAILS (continued) -- 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 over- loaded or clogged SAS or cesspool. --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. --- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). number of times pumped --- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a Zone I of a public well. --- Any portion of a cesspool or privy is within 50 feet of a private water supply well --- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality ana- lysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. H SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 301 Castlewood Cir. Hyannis M a. Owner: E. Fisher Date of Inspection : 07/17/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : The design flow of system is 10,000 gpd or greater Large System and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: --- the system is within 400 feet of a surface drinking water supply --- the system is within 200 feet of a tributary to a surface drinking water supply --- the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. . � I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 301 Castlewood Cir. Hyannis M a. Owner: E. Fisher. Date of Inspection: 07/17/96 Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of H ealth. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N/A. -x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components, excluding the Soil Absorption System, have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions, depth of liquid, depth of sludge, depth of scum. --x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 301 Castlewood Cir. Hyannis, Ma. Owner: E. Fisher Date of Inspection: 07/17/96 RESIDENTIAL: Design flow : 330 gallons Number of bedrooms : 03 Number of current residents: Dt Garbage grinder (yes or no) : tzc Laundry connected to system (yes or no): Seasonal use(yes or no) : 00 Water meter readings, if available: _tajA . Last date of occupancy : gr~atit- COMMERCIALIINDUSTRIAL : Type of establishment: Design flow : gallons/day 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 : Other: (Describe) ............................................................................................................ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and sour a of informab'on : in....... ea4&.... Nc t PrT System pumped as part of inspection(yes or no) :......0.......... if yes, volume pomped : .................... gallons Reasonfor pumping :............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 301 Castlewood Cir. Hyannis, M a. Owner: E. Fisher. Date of inspection: 07/17/96 TYPE OF SYSTEM Septic tank/distribution box/soil absorption system --- S Ingle cesspool --- Overflow cesspool --- Privy --- Shared system (yes or no) (if yes, attach previous inspection records,if any) --- Other (explain)........................................................................................... PPR OI MAT E AG E of all components, date installed (if known) and source of information Q. t� ::. �,....... �I'r'an�.4 .. ..c4s� �.......y •'�.. .' ...y ...................................... ................................ Sewage odors detected when arriving at the site : (yes or no).....N U SEPTIC TANK: ..LAB s.... (locate on site plan) n Depth below grade: ..`..... Material of construction: ..K.. concrete ......... metal ........ FR P ........ other(explain) ................................................................................................................................................ Dimensions: 5 w i?.t.L t4 Sludge depth :....D.'....... Distance from top of sludge to bottom of outlet tee or baffle:......tlk................. Scum thickness :..... ............ Distance from top of scum to top of outlet tee or baffle: ............�C?4..................... Distance from bottom of scum to bottom of outlet tee or baffle :....��. ............... Comments : (recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in re ati to outlet invert, structural tegrity, viden a of leakage, etc.)...................... } }l .. ay . Umlk SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property Address: 301 Castlewood Cir. Hyannis, Ma. Owner: E. Fisher. Date of inspection: 07/17/96 GREASE TRAP : ......00)...... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... .......................................................................................................................................... Dimensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle:............................... Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................ . ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:...f� .... (locate on site plan) Depth below grade: Material of construction:........concrete........metal.........FR P..........other (explain).......... ................................................................................................................................................ Dimensions:............................ Capacity:....................gallons Design flow:...............gallons/day Alarm level:.............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 301 Castlewood Cir. Hyannis Ma. Owner: E. Fisher Date of inspection: 07/17/96 DISTRIBUTION BOX:..ges (locate on site plan) Depth of liquid level above outlet invert:......"-? . Comment: (note if level and distribution equal evidence of solids carryovet, evidence of leakage into or out of box,etc.)...... ?. ..e .. r : .. .. ! � .� .. .............. ................................................................................................................................................ ................................................................................................................................................ PUMP CHAMBER:.....NO. (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... . ................................................................................................................................................. ................................................................................................................................................ SOIL ABSORPTION SYSTEM ...... (locate on site plan, if possible; excavation not required, but may be approximated by non- intrusive methods) if not determined to be present, explain: ................................................................................................................................................ ................................................................................................................................................ Type: leaching pits, number: leaching chambers, number:........ leaching galleries,number:........... leaching trenches, number ,length:..................... leaching fields,number,dimensions:................... overflow cesspool, number:.......... Comments: (Hoke c ndi ion of soil ,sicins of hydrayfic failure level ofnding, condition of ve ekakio tc Al... ....:........ .......y....� .............�... ................. tam SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property address: 301 Castlewood Cir. Hyannis, M a. Owner: E. Fisher Date of inspection: 07/17/96 CESSPOOLS:....I�d... (locate on site plan) Number and configuration: .................................... Depth-top of liquid to inlet invert: ........................... Depth of solids layer: ................................................ Depth of scum layer: .....................4......................... Dimensions of cesspool: ...................... Materials of construction: ..................... Indicator of ground water: .................... inflow (cesspool must be pumped as part of inspection) ................................................................................................. ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY : ....00.... (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) . . ................................................................................................................................................ ................................................................................................................................................ l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 301 Castlewood Cir. Hyannis, M a. Owner: E. Fisher. Date of inspection: 07/17/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100' R ® s az Pt?, AS . X A4 e . DEPTH TO GROUNDWATER: Depth to groundwater: t-. S.feet Method of determination or approximative: ......................................... ........................................ ........................................................................................................................ . .................................................................................................... 1 TOWN OF BARNSTABLE LOCATION S/ SEWAGE # — ,:5- j VILLAGE fly' f ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. &may" °j1'/ A �✓/� j SEPTIC TANK CAPACITY 1,000 LEACHING FACILITY:(type) OP/% (size) f co® NO. OF BEDROOMS PRIVATE WEL PUBLIC WATER BUILDER O OWNER DATE PERMIT ISSUED: j — 9 7— DATE COMPLIANCE ISSUED: 3 CRZ, VARIANCE GRANTED: Yes No !. 4,�,1b� . . � �� �..� �� � pt�}1 �, �i� '' ^� ... _, :. No.q THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Barnstwo A'PROV90 o=ValmeeTOWN OF BARNSTABLE 4 ' � pertment ApplirFation far Dispos al orks Toustrurtinu i# u�- Application is hereby made for a Permit to Construct ( ) or Repair (�Q an Individual Sewage Disposal System at: ...._ Location-Address or Lot No. Owner W,a � Address -Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.................: ..._._.....Ex anion Attic a g— •-----•--•---•- p ( ) Garbage Grinder ( ) aOther—Type of Building............................. No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures •---------------•-•----------------------------------......................................................... Design Flow............................................gallons per person per day. Total daily flow---_---_--_-----•__-•-----_.-_............gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...-••--••-•••••-•...............•-----••-----•--••........••--•-•-•_.... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ a .-••-•-•---•-•-•••.....•-••-•--••-•-••••--•••-••-•-•-•••-•-__._••---••....•-•--•--•- --.....---••---•••-•---•...•--•-•-----•---------------••--•---•--•-•-- 0 Description of Soil--•-•••-••0 ---2- .......... ...................�— rA-.----••-`s• x W ---------------------------------------------•-••......-•----......----- ---••-------••••---•-----------••••------•---••-----------•-•••----•--•--•-------•--•-•-----••••-•-----•--•-........._•-••-- U Nature of Repairs or Alterations Answ r when applicable..._ ........Q_1.). .___.._: IXC .Q....... __:4i�c4- v Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed *, - �?y-. VI �'��4Z -- a DareApplication App BY ' �4' �- . �(`7 1 = /t!_ " - ----------------- roved ---....................- Da Application Disapproved for the following reasons- ------------------------------------------------------------' --....--------" -- --- ----...----------------------.-------- ""'.'...'." ....... .. ._k----------- - ........ --�y>-----.-........------------...........-------------------------------------. -------- ---------------Tate----------------- • �,.... 4 may/ Permit No. .'"'"-' �,� -------- Issued " " .... Date No. ........._....... Fizz—, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appl ration for Disposal Works Tonstrnrtinn 1j.ermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - --____---------- -- - - ... - -- --- --------------------------------------- ----- ---- ------...._._-- Z�� O Localises Andress �� Lot of No. --- _—ry—__—. -.....---- per \ `` - -------- --------------------------------------------------------------------------------..-............ Address rQ• ,�'7�(�✓NSs ........... ............ Installer Address UType of Building Size Lot----------------------------Sq. feet .—I Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `k Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures .----•----------------------------------------- •----------------------------------•----------•-------------------•••------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth-__-____-__---_. x Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet-------------------- Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by a ---•---------------------------------•••-•-----------------------------... Date------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-___.-____-______...__. f� Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water------------------------ ----------------------------------------- -----------------------------------------------•--------------------------------------------------------------- O Description of Soil..._.......O 2 S J rS c��,Jss p ................................................--•-----------------------•------------------------------------------------------ V ------------------------------------------ •----------------------------------------------------------- •------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------W U 1V�atu off 1Re�pairs o� Neratio s}-Answer wheypplicable____ --_.__. 0_`--------- t Via?o......- � ��o "j_.. lc;-:-x/ L 7,-A, c- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until;a.Certificate of Co liance has been issued by the board of health. Signed---- - - - 4Z- ---Date Application Approved By ------- ------------------------- ---------------------------------------- Date Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------........... ------------------------------------------ -------- ---------------------------------------------------------------------------------------------- ------------------------------------=-=- r r� Dale PermitNo. --- --------��---/-------------- -------------- Issued -------------------------------------------------------------------- • Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cgertifirate of Tomylian e TH����ERT� �STt the Individual Sewage Disposal System constructed ( ) or Repaired( by----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- Installer has been installed in accordance with the provisions of T-ITL )o a St .�Environmental Code as described in the application for Disposal Works Construction Permit No. - = dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f _ - DATE-----j. - �; ..... Inspeat�-- -.,. ., THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..... ................ FEE........................ Disposal Works QMstrution rrmif Permission is hereby granted_..k��� 4 cz�s ---------------•-----•-- --_ to Const tt&t 'C`oXs� a� Indio Sears pis osal� stem at No........ ( - Ifs �' + �� � yam? l `Street shown on the 7aplicatio for Disposal Works Construction er �1V ............ ...... D�ted _._..............._....._I.•.... --------------------= - - --- ----------•-------------------------- Board ofHealthDATE.....--•//- -------- ------------------------ FORM 36308 HOBBS R WARREN.INC..PUBLISHERS