Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0128 CASTLEWOOD CIRCLE - Health
128 C:astlewo'od`'Circle—272 Hyann?is' . .P � i TOWN OF BARNSTABLE LOCATION �S f LQ u�J SEWAGE# 0-2 — U VILLAGE . I�`�, h n e S ASSESSOR'S MAP&PARCEL 6 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY J60p 414.) LEACHING FACILITY:(type) ( > 3�S�ti (size) 1 O.S 7l AS NO.OF BEDROOMS ,3 OWNER 0�JC3 PERMIT DATE: ZP-I ell COMPLIANCE DATE: d- /'5 'I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility AX)A(( 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 Vk - `J w I Vv -rl01.1 � 7 W � E3 V,�, sui I), � i r �, TOWN OF BARNSTABLE LOCATION t�a d,4 UJV-6 CP 64 t4 SEWAGE # VILLAGE ASSE SOR'S MAP & LOT 2 0M SEPTIC TANK CAPACITY ' LEACHING FACILITY: (type) `(size NO. OF BEDROOMS .a,coo \\a' BUILDER-OR OWNER .96o2 �d PERMTTDATE: COMPLIANCE DATE: 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 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 SEWAGE INSPECTIONS � LOCATION 19�t f4bA k'XXXI Ce X DATE VILLAGE ASSESSOR'S MAP & LOT :INSPECTOR SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) L.� (size) 1.00 O j NO.OF BEDROOMS i BMDER OR OWNER T)� I I�z Q . i i OWNER MAILING ADDRESS IIi r � 1 /�� �. '�� ,, i� "�, ��® � �� . , o ``�� \\J � \ �� . � � � N � \ r �\� I 4 ... a No... /V/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppYication for Migonl *petem Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade ] Abandon( ) ❑Complete System ❑Individual Components . Location Address or Lot No. l2$ C4S_r1 twoocA C%rGiQ Owner's Name,Address,and Tel.No.-7—oM DAye 30 uy�►Y►rnj5 MIq oZ(ool /lj' CH5T1ew.-,ojCi2t1� Assessor'sMap/parcel "�Q'a-7rf10 bs'Zp !r'.i�gvtNi3 � Installer's Name,Address,and Tel.No.C-APewicl C 6_nTZ� Designer's Name,Address and Tel.No. t t S°4 C yd"t s S f? cS. c3 a yc T(.-3 - n.3 rerZ\j (,A508 -7io �rZ�o Type of Building: Dwelling No.of Bedrooms Lot Size �+ sq. ft. Garbage Grinder ( ) Other Type of Building 5t!!� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided 3 3 (o• %�4 gpd Plan Date I - Z 3- --Go1 Number of sheets Revision Date Title 12 iie v�u, Size of Septic Tank 1000 i t Type of S.A.S. 3 3 0 S 0 s Description of Soil se-0- O( n Nature of Repairs or Alterations(Answer when applicable) A iS��,'b�,3'�y�. 3ox — �cL, l (Cen"n Date last inspected: ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Complianwhas been issued by this Board of Health. Signed Date z— g Z c, Application Approved by d n Date (/ Application Disapproved by: Date for the following reasons Permit No. Date Issued No. C20 Fee 7HIE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes , rfcation for`:0igpoga16pgtem Congtruction ermit, Application for a Permit to Construct( ) Repair( ) 'Upgrade( ' Abandon( ) ❑Complete System ❑Individual Components r I• Location Address or Lot No. IZ CASTie wood Gi cCl-e Owner's Name;Address,and Tel.No. u �Anr,;S MK\ 0 2da 1 ` /z 9 �[9sT1e4iaoJ Ciac►� Assessor's Map/Parcel a1.� �` 6 657 ZO . �T 44 Ni•S ,^ J Installer's Name,Address,and Tel.No. q peW�d f ��Tc z�f'SPS Designer's Name,Address and Tel.No. USA S A iL�/o,4 5(. J�S P. -c , 3 K -x 3 l h.3 C�TE Jr0B ?70 11270 Type of Building: Dwelling No.of Bedrooms Lot Size �$'��' sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) 1 Other Fixtures Design Flow(min.required) Z 2.0 gpd Design flow provided 3 3 (o• %y gpd Plan Date ( - Z 3 - 2 co-1 Number of sheets Revision Date Title 12� Lw�tltv��, Size of Septic Tank 1000 St1 in Type of S.A.S. Description of Soil Se-CL O(q✓� Nature of Repairs or Alterations(Answer when applicable) e&,J t 2en'C—(I f" Date last inspected: Agreement• ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. �y Signed Date Z Application Approved by A L Date Application Disapproved by: Date for the following reasons ' Permit No. f Date Issued -T— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( x) Abandoned( )by C rc a`er Q�I"> at ('71 Cj o t k•_l.d� L. , oto h i S has been cons ct/ed�in accordance ( with the provisions of Title 5 anj the for Disposal System Construction Permit No. (/ dated Installer CA( +^� W P' Se S Designer L i S A 1.%ita ri) #bedrooms Approved design flow gpd The issuance of this permit shall bt be co 'strued as a guarantee that the system will fun 'on as d si ed. Date �T Inspector r �� —_— ——— — ———————————-——— i .. No. ,O _ _ Fee y THE COMMONWEALTH OF MASSACHUSE TS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migpogar:i�pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Re tr ( ) . Upgrade ( Abandon ( ) System located at t 2 i CA S i be LA>%odCl A-1"v,, S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Cons cti.n m be completed within three years of the date of this t. _. Date Approved by r < f i Town of Barnstable J {NE T Regulatory Services /r "V. Thomas F.Geiler,Director i:i _� Ill �' "R� 4B`� Public Health Division G lk39• �� °'°�Fa MPya Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: i Sewage Permit# Assessor's Map\Parcel 2'l 2 50 Designer: LKA Installer: GA?Z� W11::�, Address: (S92 W 1'l yA-tjv t1SC-be-T a- .Address: Ny&,T t,)I s D210 01 On �awc� �Kfi� S� was issued a permit to install a (date) (installer) septic system at I,Z.�b G�ISTI.�w� G based on a design drawn by (address) LA 5A dated (designer) V1 I certify that the septic system referenced above was installed substantiafiy 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. A11 of tiijjsrl,�� LISA C. • �,� LYONS ' �= (Installers Signature) 's L I C. 11.14 3 �Z ��FRE D S AN,����%� esign 's gn re) (Affix signer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUIELT CARD .ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Town of Barnstable Regulatory Services Thomas F. Geiler,Director • BAMSTABIE. • MAC $ Public Health Division 039. �0 A'�► " Thomas McKean;Director 2,00 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: orz--10--0 Sewage Permit# _Z ��v-�.(,� Assessor's Map\Parcel ;0,9 -t62 Designer: STEPHEN J.DOME AND ASSOCL�tTftstaller: �N e.>► /��,L.� 42 CANTERBURY LANE Address' EAST FALMOUTH;MASSACHUSETTS 02536Address'' On o Z �►�L�v was issued a permit to install a (date) (installer) septic system at __z7A I'jNkSTTL- based on a design drawn by (address) J •��, tir J�s y;�c dated Oil-- o i-v� (ddsigner) _ZI certify that the septic system referenced above was installed substantially.accordingto the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow.. Stripout (if required) was inspected and the soils were found satisfactory. ►XAAAma® �CC�C ♦DD��j�0 1.1"sS4 a®® i _- crik13t5fut� v° �° G AS'Eq 0, v o P� FO Gs ( staller's Sign /e) F�Eriifa �Y I �� sTEPHEN b4p9f86 y: ® J. DOYLE 1 �Ag7V0 SUF" (Designer's Si ature (Affix Designer's Stamp Here vie®® 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:\Septic\Designer Certification Form Rev 03-09-06.doc Town of Barnstable FtME 1p� ° o Regulatory Services Thomas F. Geiler,Director • BMWSTABLE, _�. •0� Public Health Division �f0 MAC A ' Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 10 2007 Ms Dorothy Cameron 128 Castlewood Circle Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located at 128 Castle wood Circle, Hyannis MA was last inspected November 11th 2006 by Mark-Polselli, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System is in hydraulic failure You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. MgILEjHETH DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health — COlI1-IONMTALTH OF'1 A6SACHL SE IT' S �? EkECU-I<IT OFFICE OF E_ �-- c= ti DEP:4RTME�TT -T' OF EIRONT IEl P P OTECTIO 16 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOL U.NTARY ASSESS:IENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: /0 x Ile- Won J 6,,,. tiv'r''is Owner's Name: r o 7' `-le-v Ll Owner's Address: / f �C�✓oor7 G/v+ Date of Inspection: O6 Name of Inspector lease print) 7)12a /m00%je /zi Company-Name: iYliio Mailing Address: o so>4 /d* 1 Telephone Number (_;-of) �j — �� Cj CERTIFICATION STATEMENT f- n I certify that I have personally inspected the sewage disposals stem at this address and - � � i= Y d tha: h- -_rc: iancr_ ��c-e .r below is true; accurate and complete as of the time ofthe inspection.TlZe inspection w,-as ner`c e igased or-,:. v Training and etperience'in the proper function and maintenance of on site sewage disposal s:step s T am a DEEP approved system inspector pursuant to Section 15.340 of Title 5(310 C�_;WR 15.000). c-z r Passes �,� M Conditionally Passes feds Further EN aluation by the Local Appro-,gin.,_hut?er-: Fails - Inspector's Signature: `-", &I Date: The system inspector shall submit a copy of this inspection report to the Ap ro:"_g author . !BearL cf�e_1 or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design'ow o` {�. nn Dgpd or greater; the inspector and the system owner shall submit the report to the approprare regional of=ce o_ EP.The original should be sent to the system owner and copies sent to the bu-,°er; i`applicable. and-he a_ rcr authority-. _ Notes and Comments "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 sl-stem tsiil perform in the future under the same or different conditions of use. . _Title_Inspection Form 6115i2000 page 1 i Page 2 of i l OFFICIAL INSPECTION FORM—NOT.FOR VOLL--�-\-TARY--:5�SSESSMENTS SUBSURFACE SE«'AGE DISPOSAL SYSTEM I\'SPECTION FORM PART A CERTIFICATION(continued) Property Address: Pi✓omC/ O«•ner: CG ✓fro' Date of Inspection: a2 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 am,of the failure criteria de_c bed it=10 CySR 15.303 or in 310 CNIR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or mote system components as described in the"Conditional-Pass'section r-ee1-o be rep paced or repaired. The system, upon completion of the replacement or repair; as approved by the Board of Health. ,.v ill r;ass. Answer yes; no or not determined(Y,\,\TD)-in the for the following statements. ?_'"not dete--fined' ,ica_e explain. The septic tank is metal and over 20 years old-,or the septic tank(whether metal or rot) is s;=c- ral1 unsound, exhibits substantial infiltration or exfiltration or tank failure is irrun rent. Sy-stem ;:=31 pass irsn c~ea if=-e 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 i f a Ce ircate of Co-�l arce indicating that the tank is less than 20 years old is available. V \M explain: Observation of sewage backup or break out or high static'eater level in the disc button box due to bro en or obstructed pipe(s) or due to.a broken,settled or uneven distribution box. Svstem wil pass inspec-tor, approval of Board of health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced N'D expiain: The system required pumping more than 4 times a year due to broken or obs acted sCt. T pass inspection if(xvith approval of the Board of Health): broken pipe(s)are replaced obstruction is removed \M explain: T;rlo Tncncrfinn T prim ,!1 L!)nnn l Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLLI_T_A.RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORV; PART A O CERTIFICAT'ION(contil-,rued) Property Address: /d 7I �AJ��Q lioo raj,� Owner• GG ►-w,•O Date of Inspection: / a2t66 C.�F/urther Evaluation is Required by the Board of Health: /�' Conditions exist which require further evaluation by the Board of Health in order-.o ceter_ ne if the s-:_:ern is failing to protect public health,safehy or the environment. 1. System will pass unless Board of Health determines in accordance with 310 C:%IR 15.303(1)(b) that the shstem is not functioning in a manner which protect public health. safety- and the environment: Cesspool or privy is w-Rhin 50 feet of a surface Rater Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Z. 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 v ithin 100 et cf 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 public v.-ater _ The system has a septic tank and SAS and the SAS is within 0 feet of a private v.,ater su^_r ;;ell. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or:no-e `otn a private;eater supply well . Method used to determine distance "This system passes if the well water analysis,performed at a DER cerr'�ied 7_aborato:, fo=col `=.., bacteria and volatile.organic compounds indicates that the well is free from pollu:on tee~ that fac it :a-.i the resence of ammonia nitrogen and nitrate nitrog l ; -P en is equa.'o or less t�p..an__ nn~= n-e�._ec: _._ _ _ e•t�e failure criteria are triggered.A copy of the analysis must be attached to this o= 3. Other: T;tlo Tncnortinn t G!1:!lnnn Page 4 of l l OFFICIAL INSPECTION FORI7—-NOT FOR VOLU TA—RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR1t PART A CERTIFICATION(coutir ued) Property Address: /d CA,r74let- vo� �X Date of Inspection: // 02 ,( D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the foliowing for all inspections: Yes o Backup of sewage into facility or system component due to overloaded or clostred S.-kS or ce:_noo_ ✓Discharge or ponding of effluent to the surface of the groun or surface;eater_ due t0 a C..o c, ed SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or cloeRed S- - 0- LIquid depth in cesspool is less than 6"below invert or available volume is less tan _ da-.- o: Required pumping more than 4 times in the last year NOT due tc clog zed -,i. e \:I-,�2- d or obsrructec L �_,_� �'- �af times purriped - _ Any portion of the SAS,cesspool or prig y is below high ground water eievarion. Any portion of cesspool or privy is within 100 feet of a surface water sup IV or t-burar�'-o a s r.--ac= }eater supply. _ Anv portion of a cesspool or privy is within a Zone 1 of a public well. An portion of a cesspool or privy is within 50 feet of a priv are water supply Any portion of a cesspool or privy is less than 100 feet but greater than-4,0 feet frrom a private supply well with no acceptable water quality analysis. [This system passes if the well water anal zis. 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-ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] 9�Y"es, o) The system fails.I have determined that one or more of the above dillure criteria exit:__ described m 310 C IR 1-5303.therefore the.system fails. The system ovvrer_1?0u; contact th,=Board o' 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 1-.000 bPd• You must indicate either"yes"or"no"to each of the follovvino: (The following criteria apply to large systems in addition to the criteria above' Xyeshe system is within 400 feet of a surface drinkingwater supply l;;n ee system is within 200 feet of a tributary to a surface d-ina ater s:.m--1e system is located in a nitrogen sensitive area Cnterim Wellhead Protection.area—i.v�one II of a public water suppiv well - "fie` if you have answered''yes"to any question in Section E the system is considered a sigh�fican; - "yes"in Section D above the large system has failed.The owner or operator of aye large _v se '- l._L_i"_•_ _ significant threat under Section E or failed under Section D shall upgrade the sysre u n accrrdaE _ ..1�.304. The system owner should contact the appropriate re2icnal office of the Denartn ea. Tiro � Tncnortinn T-nr.r �;1f!'1l�nn . Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLLIT.,k--RY"ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE-1I INSPECTIO\ FORM PART B CHECKLIST Property-Address: CQ r7��2o✓oc7C �� ,• O«'ner• CG v-2, Date of Inspection: Check if the followine have been done. You must indicate"yes"or`no"as to each of the foilov,- Yes : o Pumping information was provided by the owner,occupant, or Board of Heal-_ ��%ere any of the system components pumped out in the previous t-wo weeks ? Has the system received normal flows in the previous rvo week period? Have large volumes of water been introduced to the system recently or as pa_t of- is nsoec=on �V'vere as built plans of the system obtained and examined?(I-IF-hey were not available nosy_ 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 'The tart{;;iMected for�Le oc;_io^ of the baffles or tees; material of construction;dimensions;depth of liquid; depth of sludge and depth of scar: Was the facility owner(and occupants if different from owner)provided-it:•inforration on:~e groper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has beer Y es no Misting 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-'SzEuili, is unacceptable) [310 CMR 15.302(3)(b)) Ti+lc � Tncnontinn in.-.n (�/1:17nnn . Page 6 of 11 OFFICIAL INSPECTION FORM—SOT FOR VOLUNTARY ASSESS- TS SUBSURFACE SE«'AGE DISPOSAL SYSTEM TNSPECTION FORM PART C SYSTENM INFORNTATION Property Address: lo2e 6 s fle wood (f f v Owner- Date of Inspection: FLOW CO\TIT"tOS RESIDENTIAL TIAL. Number of bedrooms(design):-d--- Number of bedrooms(actual): vZ DESIGN floe-based on 310 CMR 15.203(for example: 110 gpd x...of bedrooms): ola—b \umber of current residents: Does residence have a garbage grinder(yes or no):AV Is laundry on a separate sewage system(yes or no): /!�V`if yes separate inspection requ ed i Laundn-system inspected(yes or no):kV Seasonal use: (yes or no): /fed Water meter readings; if available(last 2 years usage(o-pd)): Sump pump(yes or no): /1-V Last date ofoccupancy: CON- TERCIAL/iND STRIAL Type of establishment: Design flow(based on 310 CvIR 15.203): apd Basis of design flow(sea ts/persons/sgft,etc.): Grease rap present(yes or no): Lndustrial waste holding tank present(yes or no):_ Non-sanitary-waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENE -AL INFORMATION' Pumping Records Source of information: Was system pumped as part of the inspection(ves or no): If ves,volume pumped: gallons--How was qua-itiry pumped determined'.' Reason for pumping: TI'PE SYSTENT — eptic 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 c=ur�nt operation obtained from system owner) _Tight tank —Attach-a copv of the DEP approval Other(describe): Approximate age of all components; date installed(if known)and source of infotnadon: Were sewage odors detected when arriving at the site(yes or no):6�4 T rig G to cnortinn t n ., Gh cf�^— Page 7 of 1 1 OFFICIAL I\'SPECTIO\FORM—NOT FOR VOLI.TN_ T--A-RY ASSESS-AIENTS SUBSURFACE SENVAGE ]DISPOSAL SYSTEM I-SPFCTI O\ FORM PART SYSTEM I\TORNIA T ION(continued) Property Address: /02 (moo► (Q c,i�, C/,� Owner: Bate of Inspection: BUILDING SEVER(locate on site plan) l/ Depth below grade: /O Materials of construction:_ .al�c�st iron _^—.0 PVC_other(explain): DQc,� Distance from private water supply well or suction line: —� Comments(on condition of joints,venting,evidence of leakage;etc.): SEPTIC TANK:_(locate on site plan) l� Depth below grade: �3 Material of constriction:_concrete metal_fiberglass_polvethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(ves or no): (a_a_h a copy o' cerrificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: e S io lj Comments.(on pumping recommendations.inlet and outlet tee or baffle condition, structural .te=-- :. licui 1: e ; as related t9 outlet invert,.evidence of leakage etc.)- / q v. h/ /✓� D O C O✓, -Z AO N . �(7 /4LI . r l -17 40 B ��t/ J��•S G h Y J Oti "Y".9 IL GREASE TRAP:_(locate on site plan) Depth below grade:_ vlateriai of construction:_concrete_metal_`ben_lass_polvethvie-e p tier (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botfom of outlet tee or ba T.e: Date of last pumping: Comments(on pumping recommendations; inlet and outlet tee or baffle condition- as related to outlet invert; evidence of leakage: etc.): ` I T;rle ,/,)nnn Pate 8 of i 1 OFFICIAL INSPECTION FOR1yI—NOT FOR VOLUNTARY ASSESS--kIETS SUBSURFACE SEWAGE DISPOSAL SYSTEM I\SPECT_ON FORM 14.RT C SYSTEM INTO NIATION(coni.rued) Property Address: /029 ( oiS- ftc,pocl Owner: vri Date of Insnection: 02 Q TIGHT or HOLDING TANK: (tank must be pumped at time of inspecrion)(locete or site plan; Depth below grade: \,faterial of construction: concrete metal fiberglass poly thylene other(exraai_.1: Dimensions: Capacity: gallons Design:i=low: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Corm rnents (condition of alarm and float snritches,etc.): DISTRIBUTION BOX: ' (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note ifbox is level and distribution to outlets equal,any evidence of sol;ds cat:vover. any:e c` leakage into or out of box, etc.): PUMP CHAMBER: " (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments (note condition of pump chamber,condition of pumps and appurtenance, etc.): Paee 9 of i i OFFICIAL INSPECTION FORM—NOT FOR VOLL-NT_A.R' --ASSESS'IENTS SUBSURFACE SE«'AGE DISPOSAL SYSTEM INSPECTION FORT -P-kRT C Q SYSTEM INFOWNIATION(continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: T� e p ic/ eachina pits, number: ��` — ��,1/-- leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/'name of technology: Comments (note condition of soil, signs of hydraulic failure,level ofponding,damp soil, condi�on of�-.geta'n etc.): 0 Ji /3 e to i -7 v�.� �7�s ,�,Q CJ- e O C��� ltirP— CESSPOOLS: /// (cesspool must be pumped as part of inspection)(locate on site plan_) Number and configuration: Depth—top ofliquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure.level of ponding, condition e= .-ep—a=on. ::c.?: PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure,level ofponding, condit•on cf v Titlo G i cr,crt:nT 'c- 4!1 c �nnn O Page 10 of 11 OFFICIAL INSPECTIO\FORM—NOT FOR V"OLLT-TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE!I I\SPECTION FORI PART C SYSTEM I1FOR- ATION(continued) Property Address: WC� s#e c,,.00 cJ Owner: CG vyt." Date of Inspection: SKETCH OF SENVAGE DISPOSAL SYSTE'-NZ Provide a sketch of the se«-a&e disposal system including ties to at least m.o permanent re f-�rence landma-ks or benchmarks. Locate all, Neils %within 100 feet.Locate Nv ere public water supply enters the b- _'.din_. Al ao /7 35 T rlo C Tncn,;, T, 41, •� Page 11 of 11 .OFFICIAL. INSPECTION FOIZ'�T-NOT FOR vOLUNT_kRY ASSESSMENTS SUBSURFACE SE.«'AGE DISPOSAL SYSTUNI I\SPECTIO! FORNT PART C SYSTEM FINTORINTATION(continued"Property Address: 1,2 e 61lT MJ12cvonC r �f 0--irner• Date of Inspection: SITE EYAD1 Slope Surface water Check cellar Shallow wells Estimated depth to ground water a*0 feet Please indicate(check)all methods used to determine the high around Rater elevation: Obtained from system design plans on record-If checked;date of design plan reviev,ed: Obse d site(abutting property/observation hole within 150 feet of SAS) ecked with local Board of Health-explain: P 1 G�f Checked\izth local excavators; installers-(attack:documentaron) Accessed USGS database-explain: You must des b how you established th hi h ground Rader elevation: 2? �/ �� �/ I T41. G T,o,.rir.*, ['n— 411:t�nnn t I . RECEIVED ARCEL. O S DEC 2 3 2004 LOT o TOWN OF BARNSTABLE HEALTH DEPT. DATE 2/227-04 PROPERTY ADQRESS 128 Cahtiewood Ciz., Kuann.th Na-, 02601 ptic system at the address above was On the above date, the:aoe Inspected. .. This system consists of the following:. 1., !-1000 ga.R.Pon he/lt.ic tank.-. 2.4-1000 gaUon eeach.ing pit-, Based on Inspection, I certify the following conditions: 3..7h.ih .ih a t.itie' dive helzt.ic 6yhtem.- (78c0de) 4.,7he heptic hyhtem .ih .in /zAapea woak.ing o2de2 at the /zaehent time. SIGNATURE ti Name: Robert A. Paolini Company: Joseph P. MacomW &Eon Inc . Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775.3338 or 508-776-6412 ;lOSEPH P. MACOMBER & SONF. INC� Tanks-cesspooladeachfields ' Pumpa� .&'.Installed Town sewer-connections P.O. Box 66 Centerville, MA 026 32-0066 775iH33a 77.5.6412' �•\ COMMONWEALTH OF MASSACHUSETTS . E+XEm-m. -OPPICK OF E+N-V1R4'NMSN'TAL AFFAIRS DEPARTMENT'OF E+NVIRONTAL PROTICTION TITLE 5 OFFICIAL INSPECTION FORUM—.NOT—,.F0RVOLI3NT.AAY ASSESSMENTS SUBSURFACE SEWAGE DISPOSALS UM[FORM PART•A CERTIFICA'TIIJN. Property Address: .12 8 C a s.t i e w d'o d U It. " Kuann �s: Na., - Owner'sName: Do.,zo.thu Came2•on Ownef'sAddress: Same Date of Inspection: 12/2210.4 Name of Inspector: (Please rint) 2 o Pl e a t P a o i c n i - ....4. Company Name: �: P.Aacomi'e't• & .Son 11%0. Mailing-Address: n ezv c e, cz s a. 026 32 . Telephone Number: 5 0-8—7 7 5.,3 3 CERTIFICATION STATEMENT . ' I ceitify that I have personally inspected the sewage disposal,systefn,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 fitnetion and maintenance of on Bite sewage disposal systems.I am a DEP approved system inspector pursuant ftrSaection:15:340.01;itle 5(31A CNM,15:800). Tire system: xx' Passes -Conditionally Passes Needs Further Evaluation.by the Local Approving Authority FaUs Inspector's Signaxare: Dater 'a/90 The system inspector shall submit a copy of this inspection reop.ato the.Approving Authority.(Board of Health or DEP)within 30 days of co,mpletipg this inspection.If the systeln'is.a.$ha�ted sy*m 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 torft.system mmu=dcopios sontto dp buyer,if applicable,and the approving authority. Notes and Comments ""'this'report only describes conditions at the time of inspectla-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. Page 2 of I 1 OFFICIAL INSPECTIONYORM—.NOT:FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAtGE.IIISPOSAI�.SYSTEM INSPECTION.FO � PART�A CERTIFICATION(continued) Property Address: 12.8 Caztiewood Ci/t., lluanniz, Na" Owner: Do)zothu Came2on Date of Inspection: 12122104 Inspection Sk0 many: Cheek A;R;C-,D or.E./ LA.WAYS:°compCleW.alI of Section;D A. System Passes: n o I have not found any information which-indibates-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: n° One or more system components.as described in.the"Conditional�Pass"1section need to be,replaced.or T 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 o• The septic tank is.metal:and.over 20 years old*or the septic tank(w:hether-metal.or not).is structurally unsound,exhibits substantial:infiltratian or exfiltration.or-tank failure-.is:imrpineni:System will pass inspection ifihe existing tank is replaced with'a complying septic taiik.as-. royed by the:Bosrd 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 o 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 inspectinn•.if(with approval of Board of Health)` broken.pipe(s).are replaced. . obstrddti0h is removed distribiitioribox isleveled or.t6place'd ND explain: v n o The system required pumping-more than 4 times a year due to broken or obstructed pipe(s):The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 O , ,.ICIAL,INW-ECT.ION FORM.NOT j'OR VOLUNTARY T,©NSS R� Thu ES SUBlfiStWACE S�EWWA.�CE DISROSAL SYSTEM. PART:A.. . 'CERT-MCAIRON'(6ontinued)' : Property Address: 128 Ca,3teeu)ood.•C '2.j Xua Owneri./�oitoth ameiton Date of Inspection: Z 2 C. Further Evaluation•is.Required by the Board of Health: no ' Conditions.exist which regpire,further..evaluation•by.the.Berard:of�Heaith;in order,to:detetYriine ifthesystem is failing to protect public,health,.safety or the environment, that the 1. System will grass unless Board•of.Hoaltb determines�in accord&nee with 310.CM1<t 15:303(I).(b) system is•not fuvetionibg it<.a•manperfivhich w91•protect public health,safety.ano the--en-Virg anent: no Cesspool or privy is•within,50 feet of asurface water n o Cesspool or privy is within 50.feet of•a bordering vagetated wetland or a salt marsh. 2. System will fail unless the Board-of Health(and Public Water Supplier;-if any),dgtetmines:thatthe system is functioning in a mafiner that proteets the-public Health,safety and environment: no The system has aseptic tank and soil absorption'system•(SA•S).:and the$AS is within 100 feetofa urface-water supply or... tributary to a surface water supply. n° The system-has•a.septic lank and SAS and the,,SAS is 1w•ithin a Zone 1 of a••public waterfsupply. n o 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.bitt 50 feet or.1hore front a private water supply well"*.Method used to determine distance• **This system passes if the well water analysis,performed at a DEP certified laboratory,,for coliform in bacteria and volatile organic compounds indicates that the�vellss.free from pollution fr om deb thatno other the presence of ammonia nitrogen and nitrate nitrogen is equal to or.1,ess than 5.ppm,.pr failure'.criteiia are triggered.A copy of the analysis must be attached to this$ortn. 3. Other: Page 4 of 11 OFFICIAL-INSPECTION FORM-NOT-FORVOLUNTARY AASS•ESSMENTS -SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSFECTION•FORM PART'A CERTIFICATION, (continued) Property Address: 1 28 Cast eewo6d C.ia.- ' f ,uann ie, Na., Owner: t)ee1 of U Cniga' an ' Date of Inspection: 9 /27>I°n A— D. System Failure Criteria applicable to all systems:. You must indicate."yes".or"no"to.eacb.ofthe:following,for ill inspections: Yes No ' _ . x Back-up of sewage•:intc)-.Pd Ji't-y,or-system-component.duedoaoverloaded:or clogged,SAS,pr.cesspool _ x Discharge:or-ponding of effluent to the,surface.of the-.,ground im.surface:waters due to:an overloaded or clogged SAS ar cesspool _ x Static liquid level in the distribution box above•outlet invert due to an overlbaded or elogged SAS or cesspool ' x Liquid depth in-cesspool is less than.6"below invert or.available�volume is less than'%day flow x Required pumping more•than-4 times in the last year NOT due to clogged of obstructed pipe(s).Number of times pumped x Any portion of.the SAS;cessp©ol-or privy is below High ground water elevation. x Atiy.portion of cesspool or privy is within 100 feet of a surface water supply or tribunary to a surface water-supply, x Any portion,ofacesspool•or.privyisvithin•a:Zone!1,ofa-public.well.. x Any portion of a cesspool-or privy is within 50-feet of a private water supply well. x Any portion ofa•cesspool-or-privy is less•than 100 feet butgreater•.than 510 feet from a-private.water supply well with no acceptable water quality.analysis..[T,his.system.passes if the well watenanalysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compounds Indicates:that the well is free from pollutiog:from:tfi*t.faci ity and thg presence of aanmonia 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 forge.] no •(Yes/No)The system fa_lls,I•have det6rinined that.one ormore-of.the:above.failurelcriteria exist as described in 310 CMR 15.303,therefore the.systern••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>faeilit'y with-a•design flow-of 101000 gpd-to 15,Q00. gpd• A. 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 11 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. 4 Page 5 of 11 OFFICIAL INSPECTION-FOR-M--NOT FOR VOLUNTARY ASSESSMENTS WBSURFACE-SEWAGE DISPOSAL',SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 128 .Ca.31-eewood C.i./t. /Z�Uaaai,6, Mao Owner: Doao.thu Campaon Date of Inspection: 121,220 4 Check if the following have been done You must indicate-"yes"or"no"alto each.of the following: _ Yes No x — Pumping information was Provided by the 4wner,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 Dave large volumes of water been introduced to the system recently or as-part of t1 jinspection? x Were as built plans of the system'obtained and examined?(If they were not available'hote 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? z 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 7 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 LAS).on'the site.iias 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 approxin%tionof distance is unacceptable),[3 10 CNM 15.302(3)(b)] . 5 _ Page 6 of 11 OFFMaAL-iNSPEC'�IO T::1�` }1 M'-1�iOT FOR V4EifN'FARY ASSESSNIEN 'S SUBS ACE Sff ACE DISPOSAL--SYST9 .INSPECT14QN:PORM � PART-C -SYSTEM'INFORK-ATION Property Address: 728 Caz.t ie_wo ocl C i z., Kyanhi.6, Na., Owner: Doaothy Comeao.n Date of Inspection: 1 2/22,10 4 , FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 .. Number of bedrooms(actual): 2. DIrSIGN`tow.based on 110 CNM 15.20'--(for ekaiiiple:'I I0'gpd ii#-ofbedrooriis):T/D x 3=3 3 O gl2 d Number of current residents: .: 1 Doestesidence have a garbage grinder(yes br no)_ no Is laundry on a separate sewage.system.(yes--or-no):.n o [if yes separate inspeption required] Laundry system inspected(yes or no): rye,5 Seasonal use:(yes or no):n.o Water meter readings,if available(last 2 years usage(gpd)):�t,OO5'•1��50 S o)���► g�� `.. Sump pum�(yes or no): n 0o Last date o occupancy: /22 e 3 e rz t COMMERCIfli USTRIAL Type of estab nt' na. . . Design flgw on 310 CMR 1.5.Z03)t. I as gpd. Basis.ofd4iguflow(seats/persons/sgft,etc.):, na Grease trajpresent(yes or no):.`n a Industrial waste holding tank present.(yes or no): na Non-sanitary waste discharged to the Title 5 system•(yes pr no): na Water..meter readings,if available: na Last date of occupancy/use: !z a OTKR(describ.e):. GENERAL INFQRjVJ(ATION Pumping Recprds Source of information: . Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped: gallons--How was quantity pumped determined? Reason for.pumping: ; 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.cvpy•of the DEP.approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: 30yea2.6 Were sewage odors detected when arriving at'.the site(yes or no): no Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 128 Ca yt eewood C.i2.. Ruann.i s, 17a.- Owner:!)o o h y Camelion Date of Inspection: 12122104 BUILDING SEWER(locate on site plan) Depth below grade: 1 7" Materials of construction: xxcast iron _40 PVC_other(explain): Distance from private water supply well or suction line: 10' f Comments(on condition of joints;venting;evidence of leakage etc.): 2olnt R 2 t. � aReaight .r? .•No evidence o� eakage.,Syster vented thliough houze yenta. \ SEPTIC TANK:ys(locate on site plan) Depth below grade: 20" Material of construction:xx concrete_metal fiberglass_polyethylene _other(expIain) If tank is metal list age: no Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) -- Dimensions: 4' 10"wide/5 ' 8'h i.gh/8' 6".bong Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle: 2" Scum thickness: i�g6 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: 12" ` How we're dimensions determined; Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural irate as related to outlet invert,evidence of leakage,etc.): l ty,liquid levels - nk a1212eqltz at2uctu2a22y .sound., and out let teen ate .cn R ace., GREASE TRAP:n o (locate on site plan) Depth below.grade:a a Material of construction:_concrete_metal fiberglass__polyethylene_other (explain): n a — Dimensions: n ri Scum thickness: a a Distance from top of scum to top of outlet tee or baffle: n a Distance from bottom of scum to bottom of outlet tee or-baffle: ad 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.): eaent.• ' Title S Tnerv+rtinn Fnrm 4/1;hnnn 7 Page 8 of I I OFPICIAE IN-S•PEC)t•'ION FORM-NOT FOR VOLUNTARY ASSESSMENTS : ,ft,"W.ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• ' SYSTEM INFORMATION(continu•ecl) Property Address: 128 Cazi.eewood Ult., � Unnniti, Ma Owner,.. Dhnnfh� r((�onnn ' Date of I•ispection: '2/»/'n 4 TIGHT or MOLDING TANK: n° (tank must be pumped at time of inspection)(locate on site plan) Depth below.grade: na Material of construction: concrete. metal 'fiberglass___polyethylene other(explain). .. Dimensions: na• Capacity: na gallons Design Flow: na gallons/day Alarm present(yes or no): na A-larm level; na AIarm'in working.order(ybs or no): Date of last pumping: na Comments(condition of aa.arm and float.switches,etc,); ' 7.ight oa hoid.ing tanks not /22eZento i DISTRIBUTION BOX: 40 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: na 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.):. Diztai&u.t.ion not /22e3en.t: PUMP CHAMBER:no (locate-on sife.plan) Pumps in working order(yes or.no): iza Alarms in working order(yes or no): na Comments(note condition of pump chamber*condition of pumps and appurtenances, ett.): Pump chamgea not �2e�ent. v 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS y. SUBSURFA•CE-SEWAGE.DISPOSAL.SYSTEM INSPECTION-FORM PART=C SYSTEM INFORMATION(continued). Property Address: 128 2a.st.2ewood Cca. Owner:. 7 n n n f h b �n n a Date of Inspection: /1 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation.not.required) If SAS not-located explain why: Located bee page 10 y ep-s leaching pits,number: 1 '\ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: _innovative/altemgtive*system Type/name of technology: damp soil,condition of vegetation, Comments(note condition of soil, signs of hydraulic failure,level ofponding, etc.): Sandi/ Aoii No evidence o� h•ydzauiie �ai.2uae., a 16 no2ma.2.,ldazt e wat e2 wah 5, 2" to znveat CESSPOOLS: n 0 (cesspool must be pumped as part of i nspection)(locate on site plan) Number and conftguration: na Depth—top of liquid to inlet invert; na Depth of solids layer: na Depth of scum layer: na Dimensions of cesspool: . na Materials of construction: na In of groundwater.inflow(yes or no): na Comments(note condition of soil,signs of hydraulic failure,level ofponding,condition of vegetation,etc.): Ce.6,6 Ro0iz not aezeat.- PRIVY: no (locate on site plan) Materials of construction: na Dimensions.na m Depth of solids: na Comments(note condition of soil, signs of hydraulic failure,level ofponding,condition of vegetation,etc.); :9 Page 10 of 11 OFF11Ci4,1.YNSPE r'•TQN'.IFO -,: NOT TOR-VADL NTARY-:ASSESS.M ENTS SISSI�REACE•'SEWAGEMIS�P.OSAL SYSTEA�INSPEC-TION:FORM' PART C SYSTEM P-MORAATION(Gbntit►ued)' -Property Address: 128 Ca.3t.Pewoo.d Cia.- G/CL2ni.3, Na.' Owner: Doao.thu Cameaon Date of Inspection: SKETCH OF SEWAGg-DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two perinanept reference landmarks or benchmarks.Locate all wells.w}thin 100 feet.Locate where public•water supply enters.the building. Y' 10 Page 11 of 1 I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 128 GL.+.t_Pn-mnad r>2.,, Hi n�,n n A I�GY Owner: i�nn� r4n Date of Inspection: Z 2/221.Q,¢, . SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water- feet Please indicate-(check)al]methods used to determine the high ground water elevation: \ n o Obtained from system design plans on record-If checked,date of design plan rgviewed: r3 Observed site(abutting property/observation hole within 150 feet of.SAS) y24 Checked with local'Board of Health-explain: r n 4 d ue Checked:with local excavators,installers-(attach documentation) „�Accessed USGS database:explain:h t - •t n o ry n nA4a Ce e m a u.6 �—� You must describe how you established the high ground water elevation: used;Gaherty & Miller model 1 2/1 6/94 ground water elevations_ used;USGS observation well data June 1992 -- used- 'Technical bul — — wa ere eva ions. • Leaching Pit : ;eet Groundwater: Feet Below Bottom-of Pit High Groundwater Adjustment 1.8 ft per F�Lirnptej.Method Therefore,the.vertical•separation distance between the bottom of the leact ing pit and the adjusted groundwater table is 9 feet: • tt - .n:Tr'n.mrs„�^.rrnnrn.+�+r*•• T"�*^y R� IlOARU OF 11EA.LTII .� OF Barnstable SI1113 11FACR 9FNAGF I)Jgl'USAL 5Y T M III ��TION FORM - PART D - CERTIFICATION v 7• ry•:ET'AM�•" �T r „��� '.p6 OR p.AIN•T GLEI+R L1'- pl?OPERTY INSpEC7'CD STREET ADDRESS �ZS Ca.St�ewood C ` ASSESSORS MAP , DjjQCK AND PARCEL # 272-050 OWNER•' s NAME Do2othy• Cameaon .A,.•� PART D - CEflTI'FX0AT10N NAME OF INSPECTOR COMPANY NAh1E Joseph P. Macomber • &' `Son Inc Box 66 Centerville- Mass 02632 st.t• LIP COMPANY ADDRESS --- 7o►m or G ZY strvot FAX ( 508 ) 790-1.578 COMPANY TELEpliONE ( 508 ) 775-3338 CERTI CICATI0R STATEMENT I certify that z ,. hRve personally inspected the sewa�Ccurate9aandystem nt :this nddr.ess and that the �iner�o�io��rTherinspectionis eWas performed and any omplete as of the time of • P ndations regarding Updrade-1• maintenne�ef.tlnctionpand maintenance on• .'recomine erience in. the prop w.-itll my' training and exp site selvage disposal . Gheck one : ' xx Syste6 .PASSED \ The inspection which I have cond fails tosadequatel not y protect any public which indicates that th.e system f health or the environment as defined in the FAILURE 3CRITERIA fsection of criteria not evaluAted are as sta ' this form . y _ System FAILEll* s ection which I have cona•C1eted. h.as foundnthatordancethe s with tem f Title ails t The in p protect the jitlblic health and the environment'noted 310 Chin 15 . 3Q3 , and as specifically noted on PART C - FAILURE if CRITERIA of this inspection - %- Y Inspector Signature . a % = *___ ctfication Mat be provided to the OWNER, the BUYER ynd COPY of this c,•,P ( Nh.ere applicable') and the p0l�RQ QN gpla 1i 'I'It, rado ' the eyetem- * .If the inspection FAILED , th`e• ow-nor or �op.erator. eha11 10 wired within one year of the do310or. the inspection, unless allowed or reQpQrtd . d otherwise as provided in , x K �y � a F _ 1 9 r� _- 4t L �-� �� .•.5"�Y�1�r� ','may � r - � I EXISTING 1000 GAL TANK DISTRIBUTION BOX INFILTRATOR 3050 CHAMBERS CROSS SECTION LOCUS PLAN ADD GAS BAFFLE NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE 98.5 COVER TO BE WTrHIN 6"OF GRADS INSPECTION PORT TO BE WITHIN 6" OF GRADE o 4"SCIL 40 P.V.C. 3"MtNnKvtrt N.9"COVER /4"-1 1/2"DOUBLE WASHED STONE a �\ 4" 001i� MI " 1/8"-1/2" WASHED STONE W n x existing 13" 4„ ,�1 0.01MIN. 96.55/. 96-3 b 4.0' 95.0 95,2 / / 2.0' / 1 \ 10. ' 95.8 93.2 NIIN �- LJ 6:O$STial�lEilf+tlOERT?+NKi::c:::::: 22.G I2.95' �� � 1 ROUTE 28 10.5'- 2.9" 3.1 4.25 --3.1 28.5' ADJ [NDWATER 87.54' 10.5' SITE SPECIFIC NOTES DESIGN CALCULATIONS GENERAL NOTES ADD GAS BAFFLE ALL PIPING TO BE SCHEDULE 40 P.V.C. EXISTING BEDROOMS 2 ® 110 G.P.O.= ALL LOCATIONS OF UTILITIES SHOWN ARE AS FLOOR PLAN 220 G.P.D. MARKED BY DIG-SAFE AND ARE TO BE PIT TO BE PUMPED AND FILLED M272 P50 NOT TO SCALE VERIFIED BY INSTALLER PRIOR TO NO. OF UNITS 3 CONSTRUCTION 0.17± acres DEPTH BELOW INV. 2' THERE ARE NO KNOWN WETLANDS WITHIN WIDTH 10.5' 150' OF THE PROPOSED LEACHING FACILITY INSTALLER TO NOTIFY DESIGNER 24 HOURS PRIOR TO LENGTH 28.5' UNLESS SHOWN. SIDEWALL AREA 156.0 SF THERE ARE NO KNOWN POTABLE WELLS WITHI BEGINNING OF JOB TO COORDINATE INSPECTIONS BOTTOM AREA 299.25 5F 150' OF THE PROPOSED LEACHING FACILITY. FIRST FLOOR TOTAL SQUARE FEET 455.25 SF THERE ARE NO KNOWN IRRIGATION WELLS WITHIN 50 OF THE PROPOSED LEACHING CAPACITY SIDEWALL 00.74 115.44 G.P.D. FACILITY CAPACITY BOTTOM 0 0.74 221A G.P.D. THIS PROPERTY DOES NOT FALL WITHIN A CAPACITY TOTAL 336.84 G.P.D. FLOOD ZONE AS SHOWN ON FIRM MAP THIS DESIGN(( DOES REQUIRE VARIANCES _ Y - BEDROOM HASHK=H `' THIS SYSTEM NOT DESIGNED TO SUPPLEM TO ENT3AL REGULATIONS OR BARNSTABLE _.._,_._._._.. X. : _. ._._�._._..... ____ ..._._. _..___._...v.....�< .m . .__._ __..' ACCOMODATE A GARBAGE ALL SHALL BE WITHCTIITLE 5 ANDNBARNSTABLENSUPPLLEMENTAE DISPOSAL REGULATIONS. IN-LINE ELEVATIONS PROPOSED AS-BUILT SURVEY INFORMATION BEDROOM LIV1Zi0 BAaM INV. ® HOUSE EXISTING INV INTO TANK 96.55 PLAN TO BE USED FOR INSTALLATION ``•, \ INV OUT OF TANK 96.3 OF SEPTIC SYSTEM ONLY i INV INTO D-BOX 96.0 NOT FOR DETERMINING PROPERTY LINES i NV OUT Of D-BOX 95.8 i INV INTO INFILTRATOR 95.2 BOTTOM OF INFILTRATOR 91.2 BENCH MARK - 3UVHvM UF OBS hULE 67.54 CORN OF TOP STEP IOC 0 (AS'SUMED) WATER TABLE NGWE #128 PIT TO BE PUMPED AND /1 jO DATE; OBSERVED BY: WITNESSED BY: �.J .... :' E SOIL LOGS a FILLED BAN 19, 2007 LISSOILAEVALUA C. ONS DON TOR BOARD OF HARAIS EALTH 1 j OBS. HOLE #1 OBS. HOLE #2 t ELEV. DEPTH ELEV. DEPTH I 98.2 0" 98.5 0" FILL FILL T�H 96.54 20" 96.84 20" I A LOAMY SAND A LOAMY SAND ....................................C _ 10YR 3/2 10YR 3/2 % r 96.37 22" 96.5 24" SAS DIMENSIONS $ LOAMY SAND a LOAMY SAND ( O / i` i 1 OYR 4/4 10YR 4/6 r` She 3 3050 CHAMBERS WITH END CAPS 95.29 C 35" 95.25 C 39" j MEDIUM SAND 58" MEDIUM SAND 1- 2.5Y 6/6 2.5Y 6/6 3Y STONE ON SIDES; 2.95' STONE ON 87.5 - 128 88.5 1 120' ENDS PERC RATE<2 NUNS. INCH E NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED ' OVERALL DIMENSIONS 28.5' X 1 0.5' I � ; paved drive and walkway oncrete m ,rr patio `�N SEPTIC DESIGN PLAN elev g7.7 ��� tiny, ..._...._.. __ .._. . .. .... .. . _ ... ... .._ . ._... . _. _ _ . ... .... ...... •. s,. __......, _ ._ ....._ .... ... O • • �+i PLAN SHOWING: g LISA C. �� PROPOSED SEPTIC SYSTEM REPAIR IN BARNSTABLE 3V 1 ;► �� -ysH-��� FOR: DRAWN BY: LISA C. LYONS BENCHMARK SET ; L I C. #1143•.' : v / ' DAHLBU DESIGNED & CHECK ELID BY. SA C. LYONS •i• 0 ��� Z`� LOCATION: REVI t C O : DATE: Right cor, steps ��i`°G•.; r 1, •• Q���� c 128 CASTLEWOOD CI ,HYANNIS El,=100.0 (Assumed) �'�+�TFRED S►+���>•��� LOT#: DATE: � M272 P50 JANUARY 23 2007 LISA O R.S. SCALE 1 . 10 1 CERTIFY THAT THIS PLAN CCNFORMS TO LISA C . LYONS, R . S. (508) 790-9270 TITLE 5 AND BARNSTABLE B.0,H. REGULATIONS (774)487-i638 (EXCLUDING WAIVERS SPECIFIED) HYANNIS, MASSACHUSETTS 33