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HomeMy WebLinkAbout0209 CASTLEWOOD CIRCLE - Health 209 Castlewood Circle rvaltr Hyannis j 272 044 " � v D 0 tl 0 0 ° ❑ u o q D N D 0 , r X tL D � � 0 y n �� u i a�-a-oqq Commonwealth of Massachusetts C Title 5 Official Inspection Form ®p 14), ° Ia Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y rY r. 209 Castlewood Circle v Property Addressa 4 Jeane Butler m Owner Owner's Name information is required for every Hyannis t/ MA 02601 Jul f�27, 2018 Y+� page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not _Patrick T Sullivan _ use the return Name of Inspector -- key. Ready Rooter Excavting Company Name PO Box 89 Company Address Forestdale _ MA 02644 _ City/Town State Zip Code 508-888-6055 Sl 12843 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage,disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15'.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Au us9 t 1' 2018 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 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page.1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Isl Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name information is required for every Hyannis MA 02601 July 27, 2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: 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 ompletion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not de rmined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infi ration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is eplaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pa s inspection if it is,structurally sound, not leaking and if a Certificate of Compliance indicating tha he tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts -_ _ = Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler _ Owner Owner's Name information is required for every �H annis MA 02601 July 27, 2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup orlareak 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 approva'I of Board of Health): ❑ broken pipe(s) ar replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is Zx moved ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution bis 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 R/edhe Board of Health: ❑ Conditions exist which re evaluation by the Board of Health in order to determine if the system is failing to prhealth, safety or the environment. 1. System will pass unof Health determines in accordance with 310 CMR 15.303(1)(b)that the syunctioning 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.doc.rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name information is required for every Hyannis MA 02601 July 27, 2018 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SASiand 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 a 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 nalysis: performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent an the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that o other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow 15ins.doc•rev.6/113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name information is y required for every Hyannis MA 02601 Jul 27, 2018 _ _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No / ❑ ❑ the system is witl}in 400 feet of a surface drinking water supply ❑ ❑ the system is thin 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system i located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWP ) or a mapped Zone II of a public water supply well If you have answered "yes" t any question in Section E the system is considered a significant threat, or answered "yes" in Secti 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name information is Hyannis MA 02601 Jul 27, 2018 required for every � 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? El ® 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 linspected 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(andioccupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on:: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 3 2 Number of bedrooms (design). Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name information is required for every Hyannis MA 02601 July 27, 2018 page. Cityr own State Zip Code Date of Inspection D. System Information Description: 2 . Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No i Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 earsiusa e d 2016= 270 GPD g ( y g (gp )) 2017= 176 GPD Detail: I I i Sump pump? ❑ Yes ® No Current Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: i, Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq. ., etc.)' Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pr ent? ❑ Yes ❑ No Non-sanitary waste discharg d to the Title 5 system? ❑ Yes ❑ No Water meter readings, if vailable: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M •'' 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name information is required for every Hyannis _ _MA 02601 July 27, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i General;Information Pumping Records: Source of information: ;Ready Rooter records: Pumped July, 11 2018 Was system pumped as part of the inspection?I ❑ 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 i ❑ Overflow cesspool i 1 ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by:system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name information is Hyannis MA 02601 Jul 27, 2018 required for every y — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank 30+. D-box and leach chambers installed 07/27/2004. Certificates of Compliance on file at Health Dept. _ Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1.6 Depth belowgrade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line. N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): I Septic Tank (locate on site plan): i Depth below grade: 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: 8.6' x 5' x 4.5' 1000 gallons <1" Sludge depth: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts -�; Title 5 Official Inspection Form _ _ r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i .� 209 Castlewood Circle i Property Address Jeane Butler ' Owner Owner's Name i information is Hyannis MA_ 02601 Jul 27, 2018 required for every —� _ Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness ' 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" I How were dimensions determined? Dip tube and tape measure. i Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidenceiof leakage, etc.): Inlet concrete baffle and outlet tee in place. Liquid level at outlet invert. Tank pumped anc cleaned 2+ weeks prior to inspection for maintenance. System at operating level.. I I 1 i I I Grease Trap (locate on site plan): I Depth below grade: j feet Material of construction: I Elconcrete Elmetal ❑ fiberglass ❑ polyethylene ❑ other(explain): I Dimensions: i Scum thickness Distance from top of scum S top of outlet tee orbaffle - Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address i f Jeane Butler Owner Owner's Name information is Hyannis MA 02601 July 27, 2018 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidencelof leakage, etc.): i ! i I I Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: I " I Material of construction: ❑ concrete ❑ metal /El fiberglass ❑ polyethylene ❑ other(explain): I Dimensions: ! i Capacity: gallons Design Flow. j gallons per day Alarm present: j ❑ Yes ❑ No Alarm level: Alarm in working order: [] Yes ❑ No I Date of last pumping,7Date Comments (condition of alarm and float switches, etc.): { - I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i i I t 15ins.doc•rev.6116 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler Owner Owner's Name j information is Hyannis MA 02601 Jul 27, 2018 required for every y — page. CitylTown 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 0 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.): One inlet, two outlets. Equal flow. No solids ca jryover. No high water staining over outlet invert. Riser brings cover within 6" of grade. i l - i I Pump Chamber(locate on site plan): I Pumps in working order: ❑ Yes ❑ No' i Alarms in working order: ❑ Yes ❑ No` Comments (note condition of pum chamber, condition of pumps and appurtenances, etc.): t i i i i f * 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): I If SAS not located, explain why: j t5ins.doc•rev.6116 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Pane 12 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i �,. 209 Castlewood Circle � Property Address I Jeane Butler Owner Owner's Name information is required for every H annis MA 02601 Jul 27, 2018 _� —Y_ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: i ❑ leaching pits number: ' 2-500 gal ea. w/ ® leaching chambers number: 4' stone. I j ❑ leaching galleries I number: I ❑ leaching trenches number, length: ❑ leaching fields j number, dimensions: I ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers inspected and located with camera. Liquid level 1.5' below invert at time of inspection. High water staining 1" above current level. No sign of past hydralic failure. Clean stone is visible in sidewall. i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration i Depth —top of liquid to inlet invert I Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater nflow ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i I t Commonwealth of Massachusetts Title 5 Official Inspection Form al Subsurface Sewage Disposal System Form - Notlfor Voluntary Assessments — 209 Castlewood Circle Property Address Jeane Butler i Owner Owner's Name information is required for every Hyannis annis MA_ 02601 Jul 27, 2018 _ • - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I i j I / Privy (locate on site plan): 1 Materials of construction: Dimensions ` — — i Depth of solids Comments (note condition of soil, s gns of hydraulic failure, level of ponding, condition of vegetation; etc.): i i i I i l I i j I t5ins,doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts - — Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 209 Castlewood Circle Property Address Jeane Butler ' Owner Owner's Name information is required for every Hyannis MA 02601 Jul 27, 2018 _y . page. Cityrrown State Zip Code Date 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 orj benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: i ® hand-sketch in the area below ❑ drawing attached separately I i I I U l A `\ Q r�• ii t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 209 Castlewood Circle I Property Address 'Jeane Butler Owner Owner's Name E information is Hyannis _MA 02601 Jul 27, 2018 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) i Site Exam: ❑ Check Slope ❑ Surface water j I ❑ Check cellar f ❑ Shallow wells i Estimated depth to high ground water: >5feet Please indicate all methods used to determine the high ground water elevation: i ® Obtained from system design plan oon record If.checked, date of design plan reviewed: 07/19/2004 Date I ❑ Observed site (abutting property/observation hole within 150 feet of SAS) i ❑ Checked with local Board of Health -explain: 1 ❑ Checked with local excavators, installers - (attach documentation) i ® Accessed USGS database -explai''n: i _maps.massgis.state.ma.us/oliver.ph�_ You must describe how you established the high 9 I h round water elevation: Y Test hole in 2004 found adjusted seasonal ground water at elv= 39.3. Base of leach chambers at elv= 59.25 per engineered plans. i _ i I I I i I Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins.doc•rev.6h6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 209 Castlewood Circle f Property Address Jeane Butler Owner Owner's Name information is required for every —�ann H is MA 02601 July 27 2018 — page. Cityrrown State Zip Code Date of Inspection E. Report Completeness CheckliS1t i ® Inspection Summary: A, B, C, D, or E checked i ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater I ® Sketch of Sewage Disposal System eitherldrawn on page 15 or attached in separate file . I I 4 F 1 I V 1 I f i f 1 l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OFBARNSTABLE l LOCATION d l 4I E WCC�—'( � t � c SEWAGE #d VILLAGE_ \> t4 YU !V 1 C ASSESSOR'S MAP & LOTt):?a_ I /K INSTALLER'S NAME&PHONE NO. �Z d � t UO Sn SEPTIC TANK CAPACITY. LEACHING FACILITY: (type) 02 X (size) NO.OF BEDROOMS a 3 _ f BUILDER O OWNER d PERMIT DATE: `02 a—O�/ COMPLIANCE DATE: - "o �.' Y Separation Distance Between the: r Maximum Adjusted Groundwater Tablet the Bottom of Leaching Facility Feet Private Water Supply Well and,Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands_exist within,300 feet of leaching facility) Feet Furnished by A � p� . "VV od Y Y I', i rt _Z7 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for'Miopaal �&pgtem Conotruction Permit Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) O Complete System 0 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 71 —0 7 9 0 mjjgg ,'slsrapa�cjewood Cir, H .nnis Tom Davies 272-109 65 Buckskin Path, Centerville Installer's Name,Address,and Tel.No. 7 7 5—' 7 6 Designer's Name,Address and Tel.No.3 6 4—0 8 9 4 Wm E Robinson Sr Septic Service Eco—Tech PO Box 1089., Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 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 J w n Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) we w i 11 i n s t a 11 a new T i t l e 5 leach system to plans of Eco—Tech, # ETE-1726_ 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 by 's oard of Health. Signed O Date Application Approved by ® , Date Application Disapproved f6i the following reas s s lv PY Permit No. r Date Issued I -C�. .-.. � -.- .r., ► .. _...-.__._..'-Uwe- •..a..�* _� r- ,- Fe6 1 0 0_(10 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION'-TOWN OF BARNSTABLE., MASSACHUSETTS Zfpprication for MigpogAY *pgtem Congtruction Permit Application for a Permit to Construct( , )Repair(X)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 71 —0 7 9 0 Asj,909's1Sra a tewood Cir, Hy nnis Tom Davies . 272_ 65 Buckskin Path, Centerville Installer's Name,Address,and Tel.No. 7 7 5— 76 Designer's Name,Address and Tel.No-3 6 4—0 8 9 4 Wm E Robinson `Sr Septic Service Eco—Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures c Design Flow gallons per day. Calculated daily flow gallons.f Plan Date Number of sheets Revision Date Title Size of Septic Tank r✓ .M Type of S.A.S. Description of Soil � r w Nature of Repairs or Alterations(Answer when applicable) we will install a new Title 5 leach system to plans of Eco—Tech. #! ETE-1726- •}F Date last inspected: 1' X' 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 by this •oard of Health. r Signed © Date Application Approved by r7W.,1114 Oy � �. _ > Date Application Disapproved for the following ns yeas Permit No. Date Issued Davies THE COMMONWEALTH OF;MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( ) Abandoned( )by Wm E Robinson Sr Send S _rvi c-P at 209 Castlewood Circle Hyannis- In as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. — ted Installer Designer The issuance of this permits all not b construed as a guarantee that the systp n"ctaa 1 designed. Date , _) Insp or ----------------------- -��7Davies THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSE . S lwig opal stem �Congtruction Permit � p � Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 209 Castlewood Circle, Hyannis 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 Y completo within three years of the date of ape Date: Approved by r Town of Barnstable Regulatory Services . . Thomas F. Geiler,Director • seRtesreeM • 1639. ► � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Designer: Eco-Tech Installer: Wm E Robinson Sr Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On as -6X Wm Robinson Septic was issued a permit to install a (date) (installer) septic system at 209 Castlewood Cir, Hyannis based on a design drawn by• (address) Eco-Tech dated 07-20-04 (designer) I certify that the septic'system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral.relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. . ill it 04VAD Cf`. � D (Installer's Sign '. 9 V 9� 109.3 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED .UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF/BARNS.TABLE LOCATION ate? d d6{1 SEWAGE #r -B®ly' 3�q� i VILLAGE �A /� °YV !V 1 S ASSESSOR'S MAP & LOT L - I / INSTALLER'S NAME&PHONE NO. ©� t mi Sn•ti� SEPTIC TANK CAPACITY LEACHING FACILITY: (typ ) oL X Sop (size) 1 t x NO.OF BEDROOMS off' 3 BUILDER 0 OWNER PERvITTDATE: `oZ a—O COMPLIANCE DATE:: 7 -0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet with in 300 feet of leaching facility) Furnished by c �i /-7 l j FLOW PROFILE j TOP OF FOUNDATION RAISE COVERS TO WITHIN E _ 66.50 . 6 in OF FINAL GRADE 2- LAYER OF 1/8' ,D-BOX 1/2' STONE 3' DROP e� FLOW LINE �° _ PRECAST i-- STONE 48" GASH DRYWELL I- i BAFFLE BOTTOM OF 62.00 6 in SOIL ABSORPTION L,54 STONE si.3s LEACHING SYSTEM ExI TING BASE 6.in STONE BASE 6L5s GALLERY g 61.25 5.00 f t + ISOO GALLON (END VIEW) sU.2s 33 fr SEPTIC TANK 22 /r S fr 12.5 fr / b) 12 /r V ADJUSTED SEASONAL HIGH GROUNDWATER T CA T ED `MENr O OD CIR C) � a M� //23s ft t � _Uin r T D v v / d N y177. a s �` �X/S�-jNG B �Z Z 2 00 33a.lr D BEDpOO �O �.. MN ',-,�, roP LL//�/G w o D° TI to E� OF FNp V m !r 66 �N 50 . W 70-,j4G m ►1 b0l cm� . rnNm Z . 00 ° () o �. . �m m ° m ZZ / DDo n I r 3Z� '' 3 =•I 3m o X , o Q ni Vl z Ui ! w a 3 'D X cZi .� rN > ..P � T 22 r z M A m ^� --I c� c o` � n X m m _ O zy� m w coo _ rri �10m �� y y o _� � v o 0 pp 3r-m �Z k n� m0 Mr N IJ N G7 r�l O O y 0 rP�- >c °' m T A,_ m CA 00 sa Z 4�°n � fT1 Z c� � v5- � m O �cm� 0 D C n > Z r 101 OZ O >l*" I, oZ � m � N -� n3 b> 4 S Oo o f l o o C CASTLEWOOD j CA r-fT1• 0 n Z = `� —� 3AI80 -�c .i, = 3 m rn 3 r Z r 3 Y 400M NJnB CIRCLE m W Z > Z z > z -o r- 3 �0 yla N r- rn > solL TEST LOG . DESIGN CALCULATIONS DATE OF TEST: JULY 19. 2004 DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD SOIL EVALUATOR: DAVID D. COUGHANOWR, RS WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONSNO GROUNDWATER , E ROGLACIALDOUTWASH INSTALL I500 GALLON SEPTIC TANK (MINIMUM ALLOWED) TEST PIT I PARENT MATERIAL: ELEVATION - 65.15 •- PERC AT 62 in - 2 MIN/INCH IN C2 SOILS DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 24 ft "x 12.5 fi x 2 ft LEACHING GALLERY CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Abot - ( 24 ' x 12.5 ) - 300' sf 0-7 A LOAMY SAND 10 YR 2/2 NONE FRIABLE Asow - ( 24 24 12.5 12.5; ) x 2 - 146 sf P Atot - 446 sf 7-26 B LOAMY SAND 10 YR 4/4 NONE FRIABLE Vi 0.74 x 446 - 330.04 GPD 26-44 Cl LOAMY SAND 10 YR 4/6 NONE FRIABLE USE A 24 ft x 12.5 fi x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REOUIRED 44-144 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE GROUNDWATER ADJUSTMENT LEACHING GALLERY EXISTING GROUNDWATER LEVEL BASED ON BARNSTABLE GIs CONSTRUCTION DETAIL DEPARTMENT RECORDS DRYWELL UNIT INDICATED GW: 35.0 8'-O'x 4•-1O'x 2'-9' STONE INDEX WELL: AIW-247 2 N EFF. DEPTH _. ZONE: C 24.0 ft READING: JUNE 2004 LEVEL: 23:9, ADJUSTMENT: 4.3 ft M ADJUSTED GW: 39.3 4 N NOTESN � r� I) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN ;.� 8.5' 8.5'- 3.5' 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. NOT TO 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 24,0 ft SCALE OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED. AND FILLED, OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF .IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN - 8) ECO-TECH ENVIRONMENTAL RECOMMENDS TNISTALLATION OF LOW FLOW FIXTURES SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMLP�) "A 'H, SEPTIC TANK �.� - -TO SERVE EXISTING DWELLING 9) SYSTEM IS NOT DESIGNED TO WITHSTA?7R-' V:EHI'CUti�ARq LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPItGC' SYSTEM THOMAS & GRACE DAVIES 1 i • • _ 10) INSTALLER TO OBTAIN DISPOSAL WORKS RMf�$l �--F STARTING WORK. i r: iz. r:, 209 CASTLEWOOD 'CIRCLE HYANNIS. MA 1 1) SEPTIC TANKS SHALL BE INSTALLED LtEVE120a TRUE TO GRADE ON A LEVEL l STABLE BASE THAT HAS BEEN MECHANICALLY?:'-- PACTED AND ON TO WHICH SIX INCHES OF 'CRUSHED STONE HAS BEEN- Kf C,ED ;TO MINIMIZE UNEVEN SETTLING ECO-TECH ENVIRONMENTAL- -BEEN 43 TRIANGLE CIRCLE SANDWICH MA 02563 �,_ ETE-1726 JULY 20. 2004 2/2