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Home My WebLink About0050 CASTLEWOOD CIRCLE - Health 50 ..Castlewood C t i e � o I I TOWN OFBARNSTABLE LOCATION .S-D eA5l—ze latr)d SEWAGE # VILLAGE ASSESSOR'S MAP & LOT - INSTALLER'S NAME&PHONE NO. �� Cl�?��- �I - SEPTIC TANK CAPACITY LEACHING FACIL=: (type) nv -04LtAL-r- (size) NO.OF BEDROOMS . BUILDER OR OWNER PERMITDATE:T �(�'g -7 COMPLIANCE DATE: Z -7 Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 i � `, S �. I e �vW `- • vV �_ .l .... �r , � ' �\ \� i \ 7 �� ` No. _.'.: Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z[pplication for Zi$pool &p.5tem Cot%trurtton 3pCrmit Application for a Permit to Construct( )Repair(1,Kpgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. �Q G K 5TLl=w000 4'_/ Owner's Name,Address and Tel.No. htYu ri-k--U ; Assessor's Map/Parcel � 3 ®�� Installer's Name,Address,and Tel.No;, / Designer's Name,Address and Tel.No. iZ� 00 6 �- A" Type of Building: Dwelling No.of Bedrooms � Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) . Other Fixtures Design Flow 3 3 O gallons per day. Calculated daily flow 33 C7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank der 5TDr- 106-e `l Type of S.A.S. wry�L7'r'�TUIZS Description of Soil h, �- , L�L•S S're N--, Nature of Repairs or Alterations(Answer when applicable) 5170- 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 place the system in operation until a Certifi- cate of Compliance has beep.issde o of He Ith Signed Date Application Approved by Date Application Disapproved for the following reaso Permit No. Date Issued fi No. 10� � �• .�.�.�.. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: A Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpprication for Mioogal *proem Construction Permit Application for aNPeermit to Construct( )Repair(1 [Jpgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. SQ G KI STLE Owner's Name,Address and Tel.No. Assessor's Map/Parcel -2n-3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1�o��e� jber�5 006*- kr'1 Type of Building: Dwelling No.of Bedrooms CP_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow 33 Z:) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ��r 5T.�i /CND ��J- , Type of S.A.S. I Description of Soil Km 5i4 - .�'�, { Nature of Repairs or Alterations(Answer when applicable) �— T 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 place,the system in operation until a Certifi- cate of Compliance has beeA isstte o of Heal`o of He t Signed I , Date Application Approved by '` Date t r Application Disapproved for the following reasons/j Permit No. Date Issued ———————————————------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE th jthe On si e Di s osal System Constructed ( )Repaired (LI) Upgraded( ) Abandoned( )by D dA .e at G STLrr_ bL.V4 0 h s been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -- dated Installer Designer. The issuance of this permit shall not be construed as a guarantee that the system wil`lfunction_as,designed. Date 1 — 1:7 Inspector ——————————————————————————————————Fee N. 67a---- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Digogal 6potem�TT ongtruction Permit Permission is hereby g ranted to Construct Repair ✓ rade( ) P ( )Upgrade( )Abandon( ) System located at 1 i S/LC G�-07i� L re . and as described in the above Application for Disposal System Construction Permit. The applicant recognizes °s/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mu be let within three years of the date of h""'p% t. Q Date: co Approved by 6/ NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated �—/��l , concerning the property located at S L 11�"D Ca rc�- meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There-is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j:cert L�f �: 1 ... .� 1 e � � 0 TOWN OF BARNSTABLE LOCATION SO C,0,bZ :l f SEWAGE # - VILLAGE ASSESSOR'S MAP & LOTS INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE:_I -- Iq : -7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 . 3 .s ,per \ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION " V TITLE 5: OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:.J?- Owner's Name: Owner's Address: c�a Date of Inspection:—T y/U / Name of Inspector: please rint) O beef �• 3r�r��a�+� ' RECEIVED.. Company.Name Mailing Address:�0-g' Dy A �i APR -3 2001 Telephone Number: 7 /- TOWN OF BARNSTABLE HEALTH DEPT. CERTIFICATION STATEMENT , I certify that I have personally inspected the sewage disposal system at this address and that the infonnation.reported: below is true,accurate and complete' as of.the time of.the'inspection.The inspection.was performed based on my training site sewage disposal systems.I am a DEP and experience in the proper function and maintenance of on ' approved system inspector pursuant-to Section 15,340 of Title-5(310 CMR 15.00.0). The system: V ' Passes Conditionally Passes Needs.Further Evaluation by the Local Approving Authority.: Is Inspector's Signature: Date:, /00�. The system P stem inspector shal�mit`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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system:owner.shaII submit the report to the appropriate regional office.of the. DEP.The original should be sent to the system owner and copies sent-to the buyer,.if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will.perform in the future under the same or different conditions of use: Title 5 Inspection Form 6/15/200.0 page 1 Page 2 bf 11 OFFICIAL INSPECTION FORM.-. NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE:DISPOSAL; SYSTEM'INSPECTIONYORM. PART A CERTIFICATION (continued) Property Address:s . OA,�a&�� Owner• ' Date ofInspection: y / Inspection Summary: Check A;B,C,D3'or E/.ALWAYS complete all of Section D A.lystem Passes: I,have not found any.information which.indieates that any o.f.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"sectiowneed to be replaced or repaired.The system,upon completion of the replacement or repair,-as approved by the Board-of Health,will pass. Answer yes,no or not determined(Y,N,ND).in the for the following statements. If"not determined".please explain. The septic tank is metal and`over 20 years old*'or.the septic tank(whether metal or not)is structurally unsound;exhibits substantial infltratibn or exfiltration or tank°failure is imminent. System will pass•inspection if the existing'tank is replaced with'a:comp lying.septic'iank as approved by the Board of Health. *A metal septic tank will pass inspection.if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20.years old.is available. ND explain: ``.Observation of'se.wage 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 uneVendistribution:boxs System:wiI]pass inspection if(with approval of Board of Health): broken pipe(s)are replaced :�obstruccion.is removed °distfibution box�is leveled or.replaced .,. ND explain: 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: ' 2 ' Page 3 of 1.1 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'A CERTIFICATION(continued) Property Address: �J ` A Owner: Date of Inspection: V, y/6 j C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health,in order to determine if the system' is failing to protect public health, safety or the environment. 1. System will pass unless'BoardofHealth determines in accordance with310.CMR 15.303(1)(b).that the system,is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a borderincr.vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system-is functioning in a.manner that protects the,.public health,safety and environment:. _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 10.0 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;4.eet 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other . failure criteria are triggered.A-copy of the analysis must be,attached.to this form. ... 3. Other: 3. l Page 4 of 11 OFFICIAL:INSPECTION FORM=N.OTFOR: '0'tl ARY ASSESSMENTS SUBSURFACIJ=SEWAGE DISPOSAL SYSTEM INSPECTIONTOPM PART A CERTIFICATION(continued) .Property Address: Y1 " Owner' Date of Inspection: D. System"Failure"Ceiteria applicable to all systems: You mutt Indicate"yes"or"no"to each of the following for all inspections: Yes N >� Backup of sewage into facility or system coinponent.due to overloaded or-cloged"SAS orcesspool 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•aboveioutlet 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 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 groundwater 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,] 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 coliform bacteria and volatile organic compounds ..indicates that the well is free from pollution'from.that facility-and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or-less than 5 ppm,,provided that no other failure criteria are triggered.A copy of the"analysis must be attached to this form.i ./ o (Yes/No)Th'e"system.fails l'have determined`that one or:moreof the above-failure criteria exist as described in 310 CMR 15.303,the'reforethe system fails.The system owner should contactthe Board of Health to determine what-will be necessary to correct'the failure. E. Large'Sys'tems:. To be considered aaarge.systemahe,sysf"em.imust serve a facility vith a•design flow of10;000'gpd to*.15,000 gpd. You must'"indicate eithef"yes"or"no"to each of the following: (The following criteria apply-to large systems in addition to the criteria above) 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 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 FORM—:NOT FOR VOLUNTARY ASSESSMENTS SUBSUR E FAC .SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST. . Property Address: ; v Owner: Date of Inspection: C/ D 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. ✓Vdere,any of the system.components pumped out.in the previous two.weeks? Has the system received normal flows in the previous two week period? . "Have large.volumes of water been introduced..to the system recently or as part of this inspection? ✓_ Were as built-plans of the system obtained and examined?(If they were not available note as N/A) ✓' Was the facility or dwelling inspected for signs of sewage back up:?. Was the site inspected for signs of break.out? Were all system components,excluding the SAS,located on site.? . Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of..liquid,depth:of sludge and depth.of scum? Was the facility owner(and occupants if different from owner)provided 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'beer).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 15302(3)(b)] 5 Page 6 of 11 `QFFI:CIAL INSPECTION.:'FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFAkCE SEWAGE`•DISPOSAL: SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: IVA Owner: T Date of Inspection: V /y O FLOW CONDITIONS RESIDENTIAL Number of bedroom's.(design)::' ... Number of.bedroo'ms;(actual)` :..3.,. DESIGN flow based on 3:10:C'MR 15.203 (for example: 11.0 gpd x#of bedrooms): Number of current residents: Does residence have.a garbage grinder(yes orno):,; L( r. is laundry on a separate.sewage'system" (yes'or no):/2kyfif yes separate inspection required] Laundry system inspected(yes or no):,Ow— Seasonal use: (yes or no):, Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or>no)/. 7 Last date of occupancy: p�� LoffX6t..A4 COMMERCIAL/INDUSTRIAL,,,� Type of establishment: Design'flow(based on 310 CMR 15.203): gpd ,Basis of design flow(seats/persons/sgft;etc.): Grease trap present(yes.or°no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to'the Title 5'system(yes or no): Water meter readings, if available: Last date of occupancy/use:. OTHER(describe): .: GENERAL INFORMATION Pumping Records (� Source of information: Y Was system pumped as.part—of the inspection.(ye's or no): If yes,volume pumped: gallons.--How was qua City pumped determined? R'easori for pumping-. TYP 'F SYSTEM 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 current operation and maintenance contract(to be obtained frorh system"owner) —Tight tank _Attach a copyof the DEP approval _.Othei (describe): Mr oximate'a e o all components,date installed if own)and source of information': Were.uwage odors-detected when arriving at the site(yes or no) 6 i Page 7 of 11. OFFICIAL INSPECTION FORM-NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:.0 SYSTEM INFORMATION'(continued) Property Address: A Owner Date of Inspection: C//( /C) BUILDING SEWER(locate.on site plan Depth.below grade: Materials of construction:_cast iron _40 PVC other(explain):- 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) Depth below grade: l 2 Material of construction:—concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a.copy of certificate) Dimensions: P S X&`X-S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 3 L Scum thickness: \-3 - ��)/. -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, Comments(on pumping recommen ata ion�,tlinland outlet tee or baffle condition,structural integrity,liquid levels related to outlet invert,evidence of leakage,etc.): • Q. Ov i, t �. . , GREASE TRAP 91&41.ocate on.site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 , Page 8 of 11 OFFICIAL:INSPECTION FORM-NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. Date of Inspection: S/ /),f TIGHT or HOLDING TANK ank must be pumped at time-of inspection)(locate on-site plan) Depth below grade: Material of construction: concrete metal fiberglass ' polyethylene . other(ex 'lain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or'no): Alarm level: . Alarm in working order(yes or no): Date of last'pumping: Comments(condition of alarm and:float.switches, etc.): DISTRIBUTION BOX%�f present must be opened)(locate on site.plan) 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.): PUMP CHAMBER/.,&(Ocate on site,plan) Pumps in working order(yes or no): . Alarms in working order(yes orno):. Comments(note condition of pump chamber,condition of pumps and appurtenances,:etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: A Owner: Date of Inspection: SOIL ABSORPTION-SYSTEM (SAS):.__Lz�f_ocate on site plan,excavation not required) if SAS.not located explain why: Type leaching.pits,number:_ �,�eaching chambers,number: c/ 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 of ponding,damp soil;condition of vegetation, 24M CESSPOOLS,i�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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)!,- PRIVY pcate,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.): 9 r Page ]0 of l I OFFI,CIA.L IN. SPECTION.FORM=NOT FOR VOLUNTARY•ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL-SYSTEM INSPECTION:FORM PART C SYSTEM INFORMATION(continued) Property.Address: OC � 'Owner: Date of Inspection:_IIL/�p/ .SKETCH"OFSEWAGEDISPOSAL:SYSTEM ' . Provide a sketch of the sewage disposal system including ties to at least-two permanent referencelandmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C . SYSTEM INFORMATION (continued) Property Address: pOL�J2C ' Owner: Date of Inspection: SITE EXAM. Slope .'Surface water Check cellar. Shallow wells Estimated depth to ground water /Z feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked.with local Board of Health-explain: �LChecked with local excavators, installers-(attach documentation) ✓ Accessed USGS database=explain: You must describe how you established the high.ground water elevation: Xepl d1 D7 Xe larmi, aejg, 11