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HomeMy WebLinkAbout0351 CASTLEWOOD CIRCLE - Health L27;3 lewood Circlj -- P r tl �i Ig i I I I 1 yl I o y! I gay 22 15 04:52p � �73 n7� p,1 P Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner ner's Name information is required forevery Hyannis MA 02601 5-11-15 page. City/Town Stale Zip Code Date of Inspection i 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. General information filling outfofms ��I,tnulup�� on the computer, D [2 \\\��` `,tH OFs4i�i use only the tab 5 I l o9 (J ;r9 key to move your 1. Inspector:. c= may% p: G cursor-do not James D.Sears = ; JA M E S rn use the return Name of Inspector r_ key. :v�r CapewideEnterprises,LLC , �,�.,r, o::� Q Company Name #T I IF 153 Commercial Street Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number license Number S. Certification certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-22-15 L nspectors Signature Date 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 el 1igT6-lie"Rystem 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. """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. W t5ins•3f13 Title 5 Official Inspection Form:Subsea Ce Sewage Disposal System-Page 1 or 17 May 22 15 04:53p p.2 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information required for every Hyannis MA 02601 5-11-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) 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 3.10 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 GaL Tank and two over flows. 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. Q Y ❑ N Q ND(Explain below): t5irls-3113 T1119 50111da1 Irspedlon Form:Subsurface Sewage Disposal System Page 2 of 17 r May 22 15 04:53p p.3 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner owners Name information required for every Hyannis MA 02601 5-11-15 page. Cityrrown 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 OBlclal Inspection Farm:Subsurface Sewage Disposal System-page 3 of 17 May 22 15 04:53p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information is required for every Hyannis MA 02601 3-14-45 page. Citylrown state Zip Code Date of Inspection B. Certification (cunt.) 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 Tess 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 Al Q Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in seoepsel is less than 6"below invert or available volume is less than%day flow AiT' t5ins.3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Pape 4 of 17 May 22 15 04:54p p.5 Commonwealth of Massachusetts Res rj Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information required for every Hyannis MA 02601 5-11-15 page. CityRown 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. ❑ Z 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 coliforrn 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.] a ® 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 El 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. t5ins•3113 Title 5 Official Lispedion Form:Subsurface Sewage Disposal System.Pape 5 of 17 May 22 15 04:54p p,6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information is req u ired for every Hyannis MA 02601 5-11-15 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? t ❑ ® 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? ❑ 0 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)1310 CMR 15.302(5)) D. System Information Residential flow Conditions: Number of bedrooms (design): NA Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 l5ins-3i1 3 TAle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 May 22 15 04:54p p.7 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information is Hyannis MA 02501 3-11-15 required for every � page. CityyrTown State Zip Code Date of Inspection D. System Information Description The system is a 1000 Gal. Tank and two over flows. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes 0 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)): NA Detail: Sump pump? ❑ Yes ® No Last date of occupancy-. NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day tgpd> 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•3113 Title 5 Official Inspection Form:SUbsuface Sewage Disposal System•Page 7 of 17 May 22 15 04:55p p.8 Commonwealth of Massachusetts Tit-le 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information required for every Hyannis MA 02601 5-11-15 page. City/Town Slate 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: 2008-2011-2014 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/Altemative 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 ❑ fight 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 May 22 15 04:55p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form UIVSubsurface Sewage Disposal System Fo►m-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information required for every Hyannis MA 02601 5-11-15 page. CityTrown State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed(if known)and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"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.): Pipeing is 4"PVC SCH 40 and orange burge. Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: 0 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 Gal. Precast H-10 Sludge depth: 1" Mna•3113 - Title 5 Otficlal►tspection Fomt:Subsutface Sewage Disposal System•Page 9 of 17 r May 22 15 04:55p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information is required for every Hyannis MA 02601 5-11-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt,) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle B" 18 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Asbuilt-Tape 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.): Tank at working level.Tank and covers at 6"below grade. Inlet baffie,outlet tee. No sign of leakage or over loading. Note: Inlet cover under step to deck tignt but can open cover. Tank to be maint. pumped after inspection. 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-3113 Title 5 Official Inspection Fcnn:SubsuAaoo Sewage Disposal System•Pege 10 of 17 t May 22 15 04:56p p.11 Commonwealth of Massachusetts l Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information required for every Hyannis MA 02601 5-1 1-15 page. Cily/Town 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.): 4 Attach copy of current pumping contract(required)_ Is copy attached? ❑ Yes ❑ No t i5ins-3113 TIM 5 official Inspection Form Subsurface Sawage Disposal Syslem•Page 11 of 17 May 22 15 0456p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 351 Castlewood Circle ,p - Property Address Loretta Gentile Owner Owner's Name information required for every Hyannis AAA 02601 3-1 f-15 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 No Box 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: 15ins•3/13 Me 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 12 of 17 May 22 15 04:56p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information is required for every Hyannis MA 02601 5-11-15 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length. ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): Leaching is a Block C. Pool and 1000 Gal. Precast Pit. Piped in line. The c pool is 7'deep 26" below grade w/cover at 10" below grade. 1'water in pool,which is the first over flow. The pit is a 1000 Gal. precast at 4'below grade wlcover at 30". Pit is clean and dry,w/wall's like new. 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 151ns-3113 _ Title 5 OlBbor hapection Form:Subsurface Sewage Disposal Syatem-Page 13 or 17 May 22 15 04:57p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information required for every Hyammrs MA 02601 5-1 f-15 page. Cityfrown 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.): t51ns•3114 Title 5 Official I specflon Form:Subsurface Sewage Disposal System•Page 14 of 17 May 22 15 04:57p p.15 Commonwealth of Massachusetts Titre 5 Officials inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile OwnBr Owner's Name information a �lyarmrs MA 02601 5-11-15 required for every Cityrrown page. State Zip Code Dale of Inspection D. System Information (cont_) 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 0� Lj GK o 0 o c P0e t5ins•3113 Title 5 Official Irtspection Fctm:Subwolaoe Seurat Disposal System•Page 15 of 17 May 22 15 04:57p p.16 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owner's Name information required for every HyarnRis MA 02601 5-11-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 14' Estimated depth t high ground water: 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'. Hand auger T.H. at 14'no G.W. Bottom of pit at 10' below grade T.H. at 4'below bottom of pit Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins.W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 . May 22 15 04:58p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 351 Castlewood Circle Property Address Loretta Gentile Owner Owners Name information is Hyannis MA 02601 5-11-15 required for every ---� page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 2 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-3113 T le S official Inspection Form:Subsurface Sewage Disposal A g System-Page 17 or 17 Z3zz COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' m � DEPARTMENT OF ENVIRONMENTAL PROTECTION s' u AAF PARCEL 7 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ' �' C' Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601Cn '� Owner's Name: JOHN STAGNARO ' Cn i w Owner's Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 � > Date of Inspection: 7/28/04 e Name of Inspector: (please print) JOHN GRACI,INC. M m Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of itle 5(310 CMR 15.000). The system: X Passes _ Condition I Passes _ Needs F r Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 7/28/04 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspec on. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owners all submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Tnanertinn Fnrm 611 SM100 h Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which,indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year dueito broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a i 0 Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and.environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a i I� Pagq 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: 3 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 '/2 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 nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone I1 of a public water supply well r 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. a Page S of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection?. X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface,sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ 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(3)(b)] 5 Pagq 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):220 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): x1a— 03— 12gD 0 Sump pump(yes or no):NO (�/j 0 Last date of occupancy: n/a U Zs v�� COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no):NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: ORIGINAL WAS 1979 PER OWNER/ASBUILT Were sewage odors detected when arriving at the site(yes or no):NO F Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 BUILDING SEWER(locate on site plan) Depth below grade: 9" Materials of construction:_cast iron =40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:3" Material of construction:Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a l Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Pagp 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: _JOHN STAGNARO Date of Inspection: 7/28/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): NONE LOCATED i PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no):NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a I R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' (NEWER) leaching pits, number: 1 n/a leaching chambers, number: n/a _ n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a 6'X 6' BLOCK CESSPOOL overflow cesspool, number: 1 n/a innovative/alternative system Type/name of technology: n/a C Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT AND OVERFLOW ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.DID NOT EXPOSE NEW PIT.OVERFLOW WAS EMPTY AT TIME OF INSPECTION AND HAS NEVER HAD MORE THAN T OF LIQUID IN IT.BOTTOM IS AT 10'. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a 9 Page-10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. yV C R 9 p rc� o A $ G P a1G 0< as �D I6 I ' i in Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 351 CASTLEWOOD ROAD HYANNIS,MA 02601 Owner: JOHN STAGNARO Date of Inspection: 7/28/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. tt r � 4wz/ No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Apphration for Mopogar *pgtem Construction Permit Application for a Permit to Co st t( . )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q5 ��pp� 6C, Owner's Name,Address and Tel.No. at�aXLt11 ' (11sa, , John 5+%Yu9 Assessor's Map/Parcel — /n/�� 315 CL141f;Wc)C)d Cam• O t un iC) Installer's Name,Address,and Tel.,No. Designer's Name,Address and Tel.No. "d 'Son Z'Qx 6(o (-4V)iv-m(9, ,ou C)0.1,3a 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or lterat*ons(Answer when applicable) 'Zt 4xt t +U_ oyl coo+"10 en d 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 Certifi- cate of Compliance has been issue t i�BVdqf-H Signed i Date .7 /- lc`71� Application Approved by Date Application Disapproved f r e following reaso - Permit No. Date Issued .. ......A........... A/ / . Fee (/ THE COMMONWEALTH OF MASSACHUSETTS Enteredin computer: Yes PUBLIC HEALTH DIVISION --TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for �Di5pogar 6potem Conotructiou Permit Application for a Permit to Co t( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. - �jW (,�(, Owner's Name,Address and Tel.No. gywnrl I' 171a, . 5ohn Stc MAD Assessor's Map/Parcel Installer's Name,Add ss,and W.No. ��(7/T S'J'�P�I Designer's Name,Address and Tel.No. . 7 P,t1laGOMIT Son . a`�x !a(o C4alt�ut!(Q„ flL9�. O9.t'o3, Type of Building: Dwelling No.of Bedrooms - Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures h, Design Flow gallons per day. Calculated daily flow ` gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repati_rs or Alterat'ons(Answer when applicable) Zn5�ao� 5a itt f i 4yz Ofl nol ta. e fA �JC'ITT i C j� l 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 Certifi- cate of Compliance has been issued y,d iis•Bo �ffl th.Signed i Date /cg,( /,`�1/ Application Approved by. ' v l��i _L\ Date Application Disapproved for the following reasons Permit No. Date Issued r �� THE COMMONWEALTH OF MASSACHUSETTS r� 0�V n BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewag Disposal System Constructed ) Repaited( A)Upgraded( ) Abandoned( )by S Y , 1`�1 UCO K 7 Q! �1� at 34rI�+Lu000d Ox ftqqy1pt6 O LD\ had b e, constructed in jaccordance with the pr is ons of Title 5 and the forisp Dosal System Construction Permit No ldated �/o?I/ t/ Installer Designer The issuance of this permit shall not be construed as a guarantee that the e Will fun tion as designed. Date �.2/U l� Inspector , v j( r No. tl: ---------------------Fee / / '✓�_- THE COMMONWEALTH OF MASSACHUSETTS -�� 44-PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS lwig oal stem (fOu5truction permit � p Permission is hereby granted to C struct( Re air(� ),Upgrade( )Abandon( ) System located ats and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu (be completed within three years of the date of thisei Date:_. i -1 l/� Approved by r � , r a ' 2— f7 d LOCATION �j -SSWAGE PERMIT NO. V4,LLAGE INSTALLER NAME i ADDRESS 4-! BUILDER OR OWNER _ DATE PERMIT ISSUED - � b ,,7C� DAT E COMPLIANCE ISSUED N No.__79-..` 7 F�$.. 5. 00.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR[ OF HEALTH ................ . . .Town. --... .OF...............Barest.able--------------••-------------•-----............. Appliratiou for Uinpogal Workii Toutitrurtion rantit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: 51 Castlewood ,.. a ......... --•-•-----••. .............. . ......-. r Location-Address or Lot No. Sidney.Rakatanaky_, 3 1 Qastle�tflod..air,rla,...Hyannisy---02601.---------- Owner Add,es. a A_-L.B Cesspool Service ............................. 1.28__�a.s}aQp __Torrace,-Eyanna.s.....02601............... Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...............3_..........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.......a.................. Showers ( ) — Cafeteria ( ) Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width_-----.------- Diameter-_.-____-__..._- Depth................. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date...................................... aTest 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........................ Ra ----------------------------------------------•----•-----------------------------------......_-----•......................................................... 0 Description of Soil S..rxi••--•--•------•••-•...-•--•---------•--•-••-•••---••------------•------•--•---•---•-----•--•----------••--••-------•-----------------•- x W •---••-----------------------------•------------•-•-•-••------.....•----•--------------•••--•---•-------•-••---••--------------....-••--•...-•-----•-----••--••••--•----------•-••--••--•--•......------ UNature of Repairs or Alterations—Answer when applicable._.InstallatioZ1--of--a._1,QOQ__ga loe..atone...___. packed, pre-cast leach pit overflow • ....-•--------------•-......-- ..•-----------------------------------------------------......._.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I i p 5 of the State Sanitary Code— The undersigned further agrees not to place;fhe system in operation until a Certificate of Compliance has been issued by the board of 1 alth. s Signed... ---8/30/79-._-----_ -- Dat Application Approved BY -------------------------------------•------- ------------ � 0/79......... Date Application Disapproved for the following reasons-------------------------- ----------------------------------•---------------------------------------••--_..... ---------------------------------•-•----------------------------------•--•-----------...---•---------••...------------------------------------------------------------------------•--•--•-•------------- Date Permit No.---79 -----------------------------•------•------_. Issued---8� C, 9 ---------------- Date No....79-.. FEa... 5.00............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------ T own.........OF................Barnstable.._............................................ Appliration for Dhiposal Works C ontitrurtiou Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: w ..31 Castlewood ....... •••-•--•••----••-•.............................•-------.......•----•---•-----•-•-•---•--•••---.... Location-Address or Lot No. Sidney I�aIiatanaky ••-•----------•---....--•-•-•----•-------• 351..Cast.]exaona..•C�.x�I P sis ©2bE ---------- Owner Address Y 7 W A &B Cesspool Service 12 ..Bishops-Te=c�,•••I:I3cammis-,-••©2SQI-.......--••-- ►-a Installer Address 1PQ Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...............3..........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons........2----------------- Showers ( ) — Cafeteria ( ) 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.............�q. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................... aTest Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water----------- ....... Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------'__---_--_-.. -----------•----------------------------------•---------•--..._.._..-----•-----..................------------------------.................................. Descriptionof Soil Sa27d------•-------------------------------•--••----------------------------------------------------------------------------•--• --•------- x V ---------------------------------------------------------------•-----------------••------.....--------------------------------------------------•-•-----•--•-•----------------------•-••-•---•--•••---- UNature,of Repairs or Alterations—Answer when applicable_._ ------ packed, pre—cast leach pit (overflow)' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE,:LE. p of the State Sanitary 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. _ % .r' Siged .....--r.ri ....._..---`"-----f-------------------'---= ; �f 34te {✓/�/� Date Application Approved BY G ! ✓� L� - --•---------- 99 Date Application Disapproved for the following reasons------- ---------------------------------•------•------------------------------------------•---••-...._-•---- ..-•---------------------•-•---------•---•-••-------------------------------------------••----------••-...--••••--------------•--......................................................... ------------- Date PermitNo..-7g --••-----------------------------------•-•--- Issued....8130179................................... Date THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................T own...............O F.............%rnsta ble..........................::..._.............. UTYrrtifiratr of Tompliattrr THIIS�jjS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x) byA & B Cesspool Service, 128 Bishops Terrace, Hyannis,•-- 7A.....QCQI............................................. 351 Castlewood Circle H In alter at ----••--��is-'---�--•-OZ--Ol ------Sidney-Rakatan Y-----------•-•--•----.....--•--------------- has been installed in accordance with the provisions of TITLE of he State Sanitary Code as described in the application for Disposal:Works Construction Permit No.__79-- i -_> 77y.......... dated V309............................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... � ----'•--•..................... Inspector------ ---- ---• ----4�-D-----�'r! . ---- ........ THE COMMONWEALTH OF MASSACHUSETTS,: BOARD OF HEALTH ,., Town......... ....OF..............&'lY7lSt4hle.........................---............ No.....79.............E -r FEE---.$S.9Q-....... Permission is hereby granted A__& B Cesspool Se1^y Ce-,.--128.•B�110ps_Tex....iiye.nnis,:..a26nl.....•••-- to Co t ct ( or Repair (X ) an Individual Sewage Disposal System Cast ewo Circle, Hyannis, MA .02601 --..Sidney..y..Rakatansky Cast� at N -----•- Street as shown on the application for Disposal Works Construction P. it N 79'__.: ...... Dated_____—/3__�79.................... r/44 _s+'iy, ................................... r.. DATE............V31/7-9..---= . •-------------------• Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS