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HomeMy WebLinkAbout0373 CASTLEWOOD CIRCLE - Health ol 373 CASTLEWOOD CIRCLE, HYANNIS A=273-040 o j Commonwealth of Massachusetts OR3- Title 5 Official Inspection Form <1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 373 Castlewood Cir Property Address i.a Scott Estes { Owner Owner's Name information is Hyannis required for every Y MA 02601 10/09/2019 page. City/Town State Zip Code Date of Inspection . r ? 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 filling out forms A. Inspector Information S/#� N 104 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. 52 Rivers End Road Company Address Teaticket Ma. 02536 City/Town State Zip Code 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 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 77 ti. 10-11-2019 Inspector's 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 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.7/26/2018 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 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 — page. City/Town 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: ® 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: This 4 bedroom home has a H-10 1000 gallon septic tank and a D-Box feeding a leaching trench. At the time of the inspection there were no visible failure criteria found. 2) System Conditionally Passes: El 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 FIND (Explain below): I ` 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 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. City/Town 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. f ❑ 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 FIND (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): 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 i, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. City(rown 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 ❑ ® 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 373 Castlewood Cir V Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool q ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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. ❑ ® 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 analysis 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. 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 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 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 system 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® 0 Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on.the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ElDetermined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.3012(5)] t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 r Commonwealth of Massachusetts ,e Title 5 official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 373 Castlewood Cir V� Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 plus GPD Description: 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: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage Town water 9 ( Y 9 (gPd))� Detail: 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 Commonwealth of Massachusetts ,1� Title 5 Official Inspection Form Ala Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No 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): 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 Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 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 ❑ 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): Approximate age of all components, date installed (if known) and source of information: A new leachimg was added to the existing 1000 gallon septic tank. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 21"feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): water was flushed and it came freely. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts �- .. Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1000 gallon Sludge depth: 3 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 5" Distance from bottom of scum to bottom of outlet tee or baffle 1211 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �n Title 5, Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is Hyannis MA 02601 10/09/2019 required for every - 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: El 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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): 0„ Depth of liquid level above outlet invert 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. City/Town 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: ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: One 11 x 50 x2 ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u � 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 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): 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 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 Commonwealth of Massachusetts �n Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 - page. Cityrrown 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, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .� 373 Castlewood Cir t,— Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 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 13,114- OJ I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 TOWN OF BARNSTABLE (; G LOCATION 2 Ce s7/i=w o ae! G--R SEWAGE# 7 3 4 VILLAGE� ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. ;Qi,', e e 7.!r—?'7 l' C SEPTIC TANK CAPACITY/6/ LEACHING FACILITY:(type) J'" (size) NO.OFBEDROOMS BUILDER OR OWNER rg 7A,1 5 PERMTTDATE: oe "'7"l Y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to a Bottom of Leaching Facility Feet Private Water Supply Well and g Facility (If any wells exist on site or within 200 feet eaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by <,� r i 3 f 4 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feet 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: I augered a hole to ten feet. 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 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 373 Castlewood Cir Property Address Scott Estes Owner Owner's Name information is required for every Hyannis MA 02601 10/09/2019 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: 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 All z� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOCATION g s7/=w U a� Ci SEWAGE # t/ VILLAGE 4 1 J ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. / 6i/.e— 7 6 SEPTIC TANK CAPACI TY �"f�•e�0� 3 LEACHING FACILITY: {type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: C' —' COMPLIANCE DATE: 1 Separation Distance Between th/te Maximum Adjusted Groundwatem of Leaching Facility Feet Private Water Supply Well and (If any wells exist on site or within 200 feet Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 00 No. 3 Fee $5 0. 0 0 computer:THE COMMONWEALTH OF MASSACHUSETTS Entered in com p Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migogar *pgtem Con0truction Vermit i Application for a Permit to Construct( )Repair(Kx)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 373 Castlewood C i r c 1 eOwner's Name,Address and Tel.No. Assessor'sMap/Parcel Hyannis, MA James McInnis 807 Turnpike St N Andover, MA 01845 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service PO Box 1089 , Centerville, MA 02632 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(no) 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 sand/gravel Nature of-Repairs or Alterations(_Answer when applicable) Title 5 Leaching consisting of anew D-Box and five maximizers. 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 Envir nmental Code and not to place the system in operation until a Certifi- cate bf Compliance has been issue iby th' o ealth. �" Signed + Date Application Approved by Date L19 Application Disapproved for the following reasons Permit No. 9' �_3 e/Z Date Issued TOWN OF BARNSSTABLE j LOCATION ��►�?/z J o as / G�• SEWAGE # o� jl =�c VILLAGE 1 i ASSESSOR'S MAP& LOT ` INSTAI;I Epp' NAME&PHONE NO. SEPTIC--;TANK CAPACITY (size) LEACHING:FACILFN: (type) NO OF BEDROOMS BUII..DER`GR OWNER 2�.l Ael` � PERMIT DATE: -',` COMPLIANCE DATE: Separation Distance Between the: Maximu►ii,Adjusted Groundwater Table to a Bottom of Leaching Facility Feet private V1!ater Supply Well and Le ng Facility (If any wells exist on site of within 200 feet aching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist wiihin'300 feet of leaching facility) Feet Furnished byb. :5 . . ......... l r ) © s g� © 10 No. Z Fee $5 0.0 0 computer:THE COMMONWEALTH OF MASSACHUSETTS Entered in com p Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS F RpPlicatton for �Dioogaf *proem Con!5truction Permit Application for a Permit to Construct( )Repair�CX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 373 Castlewood Circl Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Hyannis, MA James McInnis 807 Turnpike St i. N Andover, MA 0184 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service PO_, ox 1089, Centerville, MA 02632 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building 1�Td.of Pers�ms Showers( ) Cafeteria( ) Other Fixtures (,,,,o / Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date i Title Size of Septic Tank Type of S.A.S. Description of Soil sand/gravel Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching consisting of a new D-Box and five maximizers. 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 by this 3ged o ealth. / e Signed Date Application Approved by _r r Date , �' Application Disapproved for the following reasons Permit No. 9' F— 3 y Z Date Issued lei ——————— —— ——— — ——--—— —— CO.MONWEAL OF MASSACHUSETTS ASSACHUSETTS McInnis Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired(xx)Upgraded( ) Abandoned( )by at 373 Castlewood Cir, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 6 S r Installer W E Robinson Septic SrV Designer The issuance of this permit shall not be construed as a guarantee that the system will.ft n io a&'designed. Date Inspector ———————————— No. __?y Z Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS McInnis 1=igoar *p6tem Con5tructiott permit Permission is hereby granted to Construct( )Repair:kx)Upgrade( )Abandon( ) System located at 373 Castlewood Circle Hyannis, MA Installer: W E Robinson Septic Service 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 must be completed within three years of the date of this permit. Date: ® — �' g� Approved by NOVICE: This Form Is To Be Used For the Repair Of Failed J Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated 9 ; concerning the property located at 373 Castlewood Circle. Hyannis, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted, groundwater table elevation: Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.•map) B)Observed Groundwater Table Evaluation(according to Health Division well map) O SIGNED: DATE `A LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 i (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). f} _ - �� � G ��> �-� Y . �A' , - r STATEMENT JOSE_P�H P. MACOMBER & SON, INC. Tanks - Cesspools - Leachfields Pumped & Installed Town Sewer Connections T P. 0. Box 66 Centerville, MA 02632-0066 DA ' 775-3338 775.6412 ���. .......... �� .......... As4...11 '1� -......... ........ �/W. ...................... .........._/1�m _�� s�V TERMS: PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ LOCATION .- SEW G„E Pptmril . 7 3 VILLAGE INSTAE S NA E i A DRESS 3UIL0EIII OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED a7c __� } P W ' r A $ DATE INVOICE NUMBER DESCRIPTION CHARGESCREDITS BALAN CE BALANCE FORWARD tva,r 0-...................................................... ........ ........................ .............. ............-............... ........................................... . ............................................................... ............. /7 ................................. ..................... ..................................................................................................................................................................................... ................................. .................................... y . .. ..... ....... ....... ........... ........... ............... .............................. . . .. ........ .............. .............................. .............. -1ii ... ... ......... ........................ .................... ......................................... ....................... ..................... .....................................- ./:�/.. .. ....................................................... ....................... /�/................................. ....................................................... ...........................................- 07, ............. ......... .......... ......................................... ..............-............................... ............... ................ . ...... ........ .................................................. ................. .......... .... .................................................................................................................................................................. ............... ........................................ ............................................................- --------------------- ............. -------------- JOSEPH P. MACOMBER&SON, INC. v w PA-LAST AMOUNT IN THIS COLUMN Human Services Resource Center, 220 MAIN STREET FALMOUTH, MASSACHUSETTS 02540 Inc. Telephone: 617-540-4806, 4808 January 20, 1984 Mr. b hn Kelley Health Inspector Zben of 'Barn stable Barnstable rbwn Hall Hyannis, M- a 02601 Dear 1r, Kelley, As agreed in our iiscussion this morning, 1/20/84, this is to state in writing our intent to have the septic system at 373 Castlewood Circle, uyannis, eta, inspected to determine its suitability in meeting cent health code requir_enents. Trrangements have been made with �b seph P. r4acanber & 9on, Inc, who will .be px efot-nirq this inspection tray, 1/2_0/84. lastly, the requ:ised size of the septic system will be corrected as soon as possible, if this system is not up to the standards for a single fanily, four bedroom system. Thank you .for your cooperation, If further clarification. is required, please do not hesitate to contact me at 7.59-9311. Sincerely, wren �J7, vet Director H.S.P.C. , Inc, NAM DEf VER K,M,/kcs LOCATION SEWAGE PERMIT NO. � � ,��11�,�= ate✓--c,�_.� � r'-�. VILLAGE A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER = . A - ca03 � DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��.--a-�-�- ,�, �� �� 1 i c o! �� _� / r iy�� f � 9�� ,� f �� y ^\'� o^ l � �� _ � /� ���%. LOCATION SEWAGE PERMIT NO. VILLAGE A & B CESSPOOL SERVICE / 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED 1 DATE COMPLIANCE ISSUED �� i '��' qy �` �� �G�- �` '` � � J � i r, ,� i ,, ,.. , . C-1 n No........ -.J.. y FEs.$...15.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T.WA.......OF...Barnstable............................................................ Appliration for Uiipniitti Workii Tomitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal ' System at 373 Castlewood Circle, Hyannis, MA 02601 ................-................................................................................ --------------••------------.......•-----.............-----....---........----•-------•-------•••- oca n Ad ress Lot N Castlewood Circ�e `�rus 807 Turnpike St. , �. Andover, MA ......................----.........---.........................-•------.........--••--...._._.... ................---------•---•-................-•••--....---•-----------------.................... W A & B Cesspool Service 128 Bishops Terrace ddro Hyannis, MA 02601 Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........... ...............................Expansior4Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers Pa YP g ---•------------------------ P ( ) — Cafeteria ( ) a 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........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•-------------------•-----....-•----••-------------..................................---.....---......................................................... 0 Description of Soil.......Sand-....................................................................................................................................................... W -----------------------------------------------------------------------•---------------............_...-•--------------••- W ---------•••-- ..............................................••••••-••.................................................................................................................................. VNature of Repairs or Alterations—Answer when applicable.installation.-of__a-_1,000 gallon, stone...packed leach pit (Overflow Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further rees not to ace the system in operation until a Certificate of Compliance has,been, by the do alt• 84 Signet. ... . . 2/08Z Application Approved By........ .:........ 2/08/ e Date Application Disapproved for the following reasons:__......--•----•---------------------------------------------------------------•---.-•-•-••------.........------ ------------------ -------------- -----------------•---••-•-----•---•--••------•-•-•-•-----.--...................... -------------•----.--------•-----•• --•-•---- -Date - .. ... Permit No....I............................................. Issued 2.�08.. �8�1 ---•---._...... ._......... ...._ Date No........" '� :�' �° Fl�s.. 1 .00 ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ...... `1'.OKA.......OF....Ba.rnBwai t---------------------------------------------------------- Appliration for Ui,gpoii al Works Tomtrnrtion rrntif Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 373 Castlewood Circle, Hyannis, !1,!! 02601 .......................................................................•---•--........-----•------ •----•••---...••.._.........------•--•-----•-......---.......-•--••---•-•-----••-----•--•-........ Castlewood �� ocat' n•Address 1 p , g� L°tAn°dover, i A 'rc�e �Prus 80 Turnpike St., 1` . ......................-.......................................................................... .••-•---.....•-•--•----•-------•---•--•-------•--•--------.......-••-............................. W A & BE Cesspool Sexv°lee 1?8 ;Bishops Terrace;aaMannis, MA 02601 Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......_.._.................................Expansion Attic ( ) Garbage Grinder ( ) p.l Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p'' 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. 4' Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ j (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------- •........ •....... ---------------------------------•---. -----------•-----•----------.----•--------------------------.----. \ 0 Description of Soil.......U44.......... U ........................................................ ............................................................................................................................................. ! - W VNature of Repairs or Alterations—Answer when applicable_installation of a 1 000 gallon, storm pacod leach_Pi _._(Overilot4'. -----------------------------••---........----•--•-•-----------------------------....-•••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiE 5 of the State Sanitary Code— The undersigned furtl r agrees not to ace the system in operation until a Certificate of Compliance h ' sued by the b th. °! Sign -rtc-..: � 2�08�84 ' ..........................•-•-••---• ................................ Application Approved BY 208w / /�� -,�- j'' ----------------- �\ Date S� Application Disapproved for the following reasons:----------------------------------------------------------------------•........................................ ---------------------------•-•---....-------•---------------••---------------------.....---••-------...----•--------------••--•-•••---•-------•----••••-•-••------•-•------•----•-•-•-••-•-------•---•-. Date Permit No...A'::.............................................. Issued..?..��1 .----••----....-•--•-............... Date THE COMMONWEALTH bF MASSACHUSETTS BOARD OF HEALTH ."Own Barnstable OF..................................................................................... Trr#ifiratr of TOmplianrr THLS I's TO CE fiFY That t vitlual Sj? e )ispoW Sgjem cgstr8q 1( ) or Repaired ( X) A ! B SCesspoo er�fice, t�isnops , ya s, P7A U Q by.............................................................................................••----•----•----•--•-•----•--•------•••-•-•-•-••-•----------------------•-••-----•--•--......---- . 373 Castlewood Circle, Hyannis, PA InetftI - Castlewood Circle Trust at.............................................................................................................................................. has been installed.in+accordance with the provisions of TT r of The State Sanitary CVeoas/scribed in the application for Disposal Works Construction Permit No...............01................. dated_-_..__-_ __._-__---............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM VI IJU F NCTION SATISFACTORY. DATE._.../Z!..Y�...................................................... Inspector----. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T own OF Barnstable G� .................................... ...................................................... No. .........,� !• FEE........................r7.�o �io�roo�tl ork,� �ono�ra�.r�ion rrmi� A & E Cesspool Service r' Permission is hereby granted.............................................................................................................................................. to Construo17S Goa°ss�;lReVPood(Ci)rcleT,hyannib, D686q'S-Di Circle-Trust atNo....................................................................------..........---•------.-••-••••--•-------•-•••-•••-•...-•--••----••---•••--•---•--•--•--•••-••----•••----...........•. Street as shown on the application for Disposal Works Construction Permit No 84..... ........... Dated.......................................... •ealth-------------------------••-----•-•--........._ Gard of H DATE/ FORM 1255 A. M. SULKIN, INC., BOSTON