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HomeMy WebLinkAbout0190 BUCKSKIN PATH - Health 190 Buckskin Path,Centerville A= UPC 12534 No.2-153LOR � HASTINGS, MN i No: °' - l 9 r 11� Fee THE COMMONWEALTH OF MASSACHUSETTS Enteredincomputer: PUBLIC HEALTH DIVISION.- TOWN OF BARNSTABLE, MASSACHUSETTS YeS ftpliCation for Mispo8al 6pstem Construction Permit t Application for a Permit to Construct( ) Repair X Upkrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. %Qd ,&L *'_Vjje1W *'CAT0 .Owner's Name,Address,and Tel.No. 7741-1-0—Z-<eO IL/ZA$67H r714M1_0eX1 Assessor's Map/Parcel O �,�jy f'�j,f Z1w77&11ak &Ye4, Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. P)�AIAI/I4:�,R41Kb�/AI40,,0,01 9 499-AZ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(AtLO) Other Type of Building 1t�34PSEV7/44 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date /J7��' 04016 Number of sheets Revision Date Title 4von�—I Size of Septic Tank 16061 9�/` . Type of S.A.S. T Description of Soil ��= Si�A/f� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in P accordanccelwith 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 ealth. Signed Date �! Application Approved by Date Application Disapproved by Date for the following reasons 10 Permit No. 0 Date Issued S—� s No. O'" l t V Fee THE COMMONWEALTH OFMASSACHUSETTS Entered in computer: v PUBLIC HEALTH DIVISION - TOWN Of..BARNSTABLE, MASSACHUSETTS Yes pplication for �isp9sal st,In Construction permit .. Application for a Permit to Construct( ) Repair WUpglra5( ) ;Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /fO ©41 *Owner's Name,Address,and Tel.No. 77i�Z0-2-6V4 iag�' Assessor's Map/Parcel 117 74/ i''.¢Th/ "A Installer's Name,Address,and Tel.Nor - Designer's Name,Address,and Tel.No. �7LLC' G /ter, �vsaGs-'�rc'. ,ZbwAl 400p"� ►s v��.r. . Type of Building:. Dwelling No.of Bedrooms 3 Lot Size I'5(47ZZ sq.ft. Garbage Grinder(W) 4. Other Type of Building �F B/��NT/AG No.of Persons Showers( `) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided p gpd Plan Date /4 y 17 9,0 J g Number of sheets Revision Date Title Size of Septic Tank /S6G0 q. x„ Type of S.A.S. 2 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: .P Agreeme : The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordanc ,,,ith 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. Signed Date -(5' Application Approved by .�*�.ts 5. Date Application Disapproved by r Date for the following reasons F Permit No.'' D t I - Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at /J�(7 /jai l� 5'.N%il/ /©j'�i rrAl has been constructed in accordance- witli the provisions of Title 5 and the for Disposal System Construction Permit No. ,2Oj • f qt dated 5— / 5-1 e Installer Designer zuzw ey,4)ad� y Approved-design#bedrooms -- �� gpd The issuance of this permit shallnot be construed as a guarantee that the s stem ns'will fu ionn as designed. Date �I ! Inspector- .Q. _- --. - - ----7 - - _ _-. . _ _ _ . —_ -_ _ - - --- -----_----------------- -.--- . 'No. P 4/b Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. ,�-'-, C � Date Approved by Town ®f Barnstable swer o Regulatory Services Thomas F. Geiler9 Director BARNSTABLX � U% �0g public Health Division 'Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&IDesigger Certification Form Date: Sewage Permit# Assessor's Map\Parcel Designer: W PVM I INCU NOM(96 Installer: CAjTn W RCAU&FI Q Address: _ � ?IN Address: LLIE- %U9C9 A 2 N W On was issued a permit to install a (date) (installer) septic system at Cn .)N l T et SM JU_E based on a design drawn by (dress) N. DJA L& dated ova MW 17 (designer) VI 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. N OF M,q qq� or X0 // DANIELA. o OJALA (I stal er's ignature) U CWIL N No.46502 CD � ` �f 8—16j Sr0NAL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC BEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVE ID BY THE BARNSTABLE PUBLIC HEALTH IDMSION. TIIANK'YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doe TOWN OF BARNSTABLE LOCATION SEWAGE# oVh'- C VILLAGE SSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �G2taG �A/Z' SEPTIC TANK CAPACITY LEACHING FACILITY.(type) I5f�9Z5(size) 12,g b NO.OF BEDROOMS 3 OWNER PERMIT DATE: .`� 9a /S COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) 1Y1,4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYi/���� �.�� t � 0 0 � a 1 /)-7 Town of Barnstable P# �y` o Department of Regulatory Services BARNSTABLE, : Public Health Division Date y MASS. ; Q; 1639. ��� 200 Main Street,Hyannis MA 02601 ArFD MAy A Date Scheduled Time l 4�3 Fee Pd. �49 0 00 Soil (Suitability Assessment for Se e Disposal 1/7 Performed By: 6,lc (,J a`�—t--KCOL\ I Witnessed By: LOCATION & GE,NERAL INFORMATION_ Location Address /ft) ^�6 V-L�� /00-1/ Owner's Name C evii-l7 t ((� Address Assessor's Map/Parcel: / /0 7� Engineer's Nam NEW CONSTRUCTION REPAIR Telephone# eC�0 E 36J Land Use �Il�'icjpil d( ` //�� Slopes(%) U"J b� Surface Stones J� Distances from: Open Water Body ZIoV 0 ft Possible Wet Area IJ ft Drinking Water Well 1,�A ( ft Drainage Way �G� 1< ft Property Line z© ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ? v �c a Parent material(geologic) UJ S Depth to Bedrock ZOO + Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Hole# Time at 9" Ji Depth of Perc �' Time at 6" Start Pre-soak Time @ 1�ir/O Time(9"-6") End Pre-soak Rate Min./Inch N434 /)J, Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N)_ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# - Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole# ri Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency %Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No Yes Within 500 year boundary No!< Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 3E If not,what is the depth of naturally occurring pervious material? Certification /- I certify that on r',5 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. r � Signature ' Date . Q:\SEPTIC\PERCFORM.DOC rZ DATE: _ 5/.2 4 6 RECEIVE® PROPERTY ADDRESS: 190 Buckskin Path J U N 7 1996 nAntarvi 1 l a rMR= � g' i `F'I. 02632 ' , On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 2-51x91 block cesspools. ' r l Based on my Ins:'action, I certify the following conditions: 1 . This 'is not a title five septic system. 2. This is a sewage- system 3. The sewage system is in proper working order at the ;present . ime. SIGNATURFF . Name:_J P Macomber Jr___�____ i Company:_J•P_Macomber_ & Son-_Inc t. Address:--Be.c-6b-----=I------_ __Cente_rvilLe LMass__0.2.632 Phone: ---sas...:z7-5-3338-y--l--- . f i l I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY X. JOSEPH P. MACOMBER & SON, INC. Tanks-Ceupools-Leachfields Pumpsd & Instilled Town Sewer Connections P.O.Nox 66' Centerville, MA 02632-0066 77.5.3338 775-6412 ' U Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection . Trudy Cox* William F.Weld soer +y oowmor David 8.Struhs Argeo Paul Cellucci �oe,ve�selon.r tL aowmor • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION pertyAddrasa; 190 Buckskin Path Centerville ,MasSAddreofOwner. Date of Inspeotion: 5/24/96 (If different) ss erent) Name of Inspector- Joseph P. Macomber Jr. Company Name,Address and Telephone Number. .P.Macomber & Son Inc. Box 66 Centerville,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewageaccurate,posal system at this address and that the information reported below is true,accurate, and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-sit e ewage disposal systems. The system: _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Faus SI ture: a /"`�C�r'uL Date: ✓ Y' �`�� Inspector's gna The System Inspector submit a copy of this inspection report to the Approving Authority within thirty(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 shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be seat to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: r �7ve PASSES: not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y.N,or ND). Describe basis of determination in all instances. If"not determined",explain why sot) /1'(Z& The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or enfiltration,-or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556.1049 • Telephone(617)292.5500 �4)Printed on Recycled Paper `Property Address: Owner. Date of Inspectlow. Bl SYSTEM CONDITIONALLY PASSES(continued) dd1BfQ� Sewage backup or breakout or huh static water level observed in the distribution bout is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution boat. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced - obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: NQ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water ,d Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: &)D The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 60 feet of a private water supply a'elL lI The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well wate .-analysis 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]ass than 5 ppm. 3) OTHER zThe sy.stm has two 51x9 ' block cesspools . The system does not violate any o - (revised 11/03/95) 2 U6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addreaw 190 Buckskin Path Centerville,Mass . 02632 Owner. Chester L. Vogler Date of Inapeoti=5/2 4/9 6 DI SYSTEM FAILS: • Q/2) I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. &() Backup of sewage into facility or system component due to an 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. k�WWf 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. _/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes pumped A Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. tVO Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a.surface water supply. I10 Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. A10 Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the euviroament because one or more of the following conditions exist: G` the system is within 400 feet of a surface drinking water supply 4Y—T the system is within 200 feet of a tributary to a surface drinking water supply A/4 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST pr,cpertyAddr.= 190 Buckskin Path Centerville ,Mass . 02632 Owner. Chester L. Vogler Date of Inspection: 5/2 4/9 6 e. Check if the following have been done: ,Pumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. /yh As built plans have been obtained and examined. Note if they are not available with N/A , The facility or dwelling was inspected for signs of sewage back-up. , The system does not receive non-sanitary or industrial waste flow .J , The site was inspected for signs of breakout. 2AII system components,�Luding the Soil Absorption System,have been located on the site. ,f O* The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. ZT11 size and location of the Soil Absorption System on the sits has been determined based on existing information or apSroximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreaa: 190 Buckskin Path Centerville,Mass . 02632 Owner. Chester L. Vogler Date of Inspection: 5/24/96 FLOW CONDITIONS REBID Design Bow: �lloas • Number of bedrooms:3 Number of current residents: Garbage grinder(yea or no): Laundry connected to system(yea or no):*(, Seasonal use(yea or no):A2i90 /!j . Water meter readings, if available: ... 1�0 _ '2z Last date of occupancy:V6--;14 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow: n11� gallona/day Grease trap present: (yes or no)AZd Industrial Waste Holding Tank present: (yes or no)-.,&—.4 Non-sanitary waste discharged to the Title system: (yea or no)/V' Plater meter readings, if available: Last date of occupancy: u' OTHER (Describe) 1JA Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of' t n: ��r 1t7 Sysu pumped as part of inspection: (yes or no)M If yes,volume pumped: 0 gallons Reason for pumping: TYPE OF SYSTEM A,(,Iv Septic tank/distribution box/soil absorption system _�.. Sings cesspool Overflow cesspool 'V""— Privy k�Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) AI?IPROXIMATE AGE of all components, date installed(if known) and source of information: Sewage odors detected when arriving at the site: (,Yes or no) y� (revised 11/03/95) 6 JOSEPH Pe MACOMBER&SON,INC. P.C.BOX 66 CENTERVILLE,MA 02632-0066 Name: Chester Vogler Customer Code: Address: 190 Buckskin Path cYog Town: Centeryilie state:Ma zip:02632 Mailing address: 190 Buckskin Path Centerville MA 02632 Notes: 80--89 9127190 pump 1 pool 105.00 10112190 9130194 pump 1 pool 145.00 10111194 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: Chester L. Vogler Owner. 190 Buckskin Path Centerville ,Mass . 02632 Date of Inspection: 5/2 4/9 6 SEPTIC TAN& _ e (locate on site plan) Depth below grab-4X Material of construction: concrete_metal_FRP—other(explain) Dimensions: /1JR Sludge depth: ) _ Distance from top of sludge to bottom of outlet tee or baffle: AJ A Scum thiclmesa: AJjQ Distance from top of scum to top of outlet tee or baffle: kA Distance from bottom of scum to bottom of outlet tee or bane: A)fl Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.)' GREASE TRAP: ,u(n_ (locate on site plan) Depth below grade:V,4 Material of constnution:�Gconcrete_metal_FRP_othes(explain) Dimensions: /bA Scum thickness:, Distance from top of scum to top of outlet tee or baffle: l? Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or bathes,depth of liquid level in relation to outlet invert,structural integrity, evidence�of leakage,etc.) • 1 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 190 Buckskin Path Centerville,Mass . 02632 Owner. Chester L. Vogler Date of Inspection: 5/24/96 TIGHT OR HOLDING TANK:�h'Z- (locate on site plan) • Depth below grade: Material of construction:A&ncrete_metal_FRP—other(explain) - Dimensions: Capacity: 64 gallons DesAlarm flowlevel: Comments: Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) 41d If G of fy1C/L'�S DISTRIBUTION BOX-Z (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box,etc.) h/a t^ovyfiNE°,U7'S PUMP CHAMBER rLfY1i 7 (locate on site plan) Pumps in working order:(yes or no) /x Comments: (note c�)4 tion of pump chamber,condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinucd) Property Address: 190 Buckskin Path Centerville,Mass . Owner. Chester L. Vogler. Date of Inspootion: 5/24/96 SOIL ABSORPTION SYSTEM (SAS):-,—,/ (locate on sits,plan, if possible;excavation not required, but uwy be approximated by non-intrusive methods) If not determined to be present, axplain: Type: leaching pits, number:Q leaching chambers, number: leaching galleries, number:= leaching trenches, aumber,length: 0 leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, sigui of hydraulic Caiiurr, Iev�l of ndin�, condition of vegetation,etc.) Loam sand to medium fine sand• to si ns of hydraulic failure or ponding;All vegetation is normal. No repairs needed at the present time. CESSPOOM: (locate on site plan) Number and configuration: _ Depth-top of liquid to inlet invo3t: Depth of solids layer: _ Depth of scum layer: Dimensions of cesspoo X Materials of construction: VCW,7- Indication of groundwater: Q, � ) )inflow pool must be ?umped as of inspection) eyewer 1.ow ae S 5 0eew4l Commeatq (noteynditiongra46'Ve�illm` ine'8ari0.f;lVo J gI�1t8n0I 71yCln' e � failure or LLoam sang T, rau is onding; All veggtation is normal. No rplaairs nePdPd at the present time. PRIVY:A�e (locate on site plan) Materials of construction: Dimensions: &/R Depth of solids:-'.4/ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) property Address: 190 Buckskin,path Centerville,Mass . Owner. Chester L. Vogler Date of Inspection: 5/24/96 t SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Centerville Osterville Marstons Mills Water Company 428-6691 \O .- I DEPTH TO GROUNDWATER Depth to groundwater. _4 t feet method of determination or approximation: Installed systems at .46., 162, 2 5 6,26 6,29 6,297,316, 319, 392 and 406 Bckskinpa ('PntPrvillP No water was encountered at 1 7 t (revised 11/03/95) 9 ���. .�t�y-• S fir - byv 3�7 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. J Has satisfied the Department's qualifications as required-and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter .21A of the General Laws. Issued by The Department of Environmental Protection. ` June 8, 1995 Acting Director of the ion of Water Pollution Control TOWN OF 'Barn s t n hl P BOARD OF HEALTH Y S1))ISUR FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION �/ �•••�••;-r••.^: T—r.::n^.-:•r:.r.—n•r.:tT:—s.-�:r..r..m-rr:r�:.—v:.-zr...r.s-'-*+Harr rxr._'rnr.ea.r — ssm ntmrrrcrsrrrrr�r...•�rrr•r.•�.._..11 -TYPE OR PRINT CI.EARL)•- PROPERTY INSPECTED STREET ADDRESS _190 Buckskin Path Centerville Mass ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME __Chester r, Vogler PART D - CERTIFICATION I NAME OF INSPECTOR -Joseph P. Macomber Jr. . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street. Town or City Stat• LIP COMPANY TELEPHONE ( ��� ) 77� 3��R FAX CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate, and complete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems : Check one: XXXXX= Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the publiIc health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Ile , Inspector Signature Date 5/25/96 One copy of this c t.ification must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF IIEALTH. * If the inspection FAILED, the owner or" 'P' erator shall u d within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 310 CMR 15 , 305 , partd.doe WN OF ARNSTABLE \ LOCATIONJAI- ` SEWAGE# VILLAGE ASSESSOR'S MAP& LOT h 0 ,JN&TO&EE 'S NAME& SEPTIC TANK CAPACITY LEACHING FACILITY: (type) t A d A$ (size) ��Od NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: u 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 f leaching ac' ) Feet Furnished 07 ,9 1 ' AN waSF�es ALL' SYSTE COMPONENTS SHALL BE NOTES SYSTEM PROFILE MARKED WITM H MAGNETIC TAPE OR COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS NAVID 88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE Oo ,� 2" PEASTONE OR GEOTEXTILE TOP FOUND. EL. 56.7' 2. MUNICIPAL WATER IS EXISTING FILTER FABRIC OVER STONE 55. 3. MINIMUM PIPE PITCH TO BE 1/8- PER FOOT. F MINIMUM .7JOF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST MINIMUM 1' OF COVER THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-LQ OVER POLY TANK PRECAST RISERS 4 OSCH40 PVC MORTAR ALL H-10 6" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS S. PIPE JOINTS TO BE MADE WATERTIGHT. 16.1"(1.34') 12" MIN INT. DIM. 4'- (TYP.) INV'S FL. 51.70 4'- 0 ENDS -DES 52.53 I , - ­1 1 1 SIDES 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE us .\*54.0' 1,500 r-T----E. . i � , "I ��, I I ... 11� � 1� 1 . 1 1. �� -,1_._� 52.48' PROPOSED WITH 310 CMR 15.000 (TITLE 5. GALLON POLYETHYLENE 52.23' 0 C MINIMUM IM U M OVER PO' 6, 52.48f PROPOSED PC ED 1 T500 5 r22 3 P LLO S POLYETHYLENE IE:N H LENEJ 0 E� En-1-0 GALLON m�`l EE 000-00 00 01 MM� S P P C TANK OT-00 ,�0-0 00 F rMM�E; SEPTIC TANK 00 8.00 0. 0. MMMMMMMMFc1 M GAS lsfl �0'0'0,0' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 0 oogog000 WATERTEST D'BOX (H-10) L Yoou_�Cu'­�'o,�_o' FOR LEVELNESS C�BAFFLE I - 'o, Im [E-__ � �.,o.o MMMMMMMMF= l5n, F- NOT TO BE USED FOR LOT LINE STAKING OR ANY 0 1 :VA;..r o 0 8g4og`? 51 .97' 51 .80' 49.70' OTHER PURPOSE. 0 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. LH-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. DEPTH OF FLOW 4' 3/4"-1-1/2" DOUBLE AASHED STONE 4' MIN.ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL CONCEALED WITHOUT INSPECTION BY BOARD OF S ViG REQUIRED TEE SIZES: OVERALL DIMENSIONS TO OUTSIDE OF STONE: 2500 X 12.83' Iler Rd.. INLET DEPTH = 10" MIN. BELOW FLOW LINE COMPACTION. (15.221 [2]) HEALTH AND PERMISSION OBTAINED FROM BOARD Route FU OUTLET DEPTH = 14" MIN. BELOW THE FLOW LINE U� OF HEALTH. po NOTE: STANDARD TEES ARE TO BE USED. DO NOT USE MANUFACTURER'S TEES THAT COME WITH THE TANK 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND LOCUS MAP 44.0' BOTTOM TH-1 (_2=5% SLOPE) (--!-% SLOPE) (-!-% SLOPE) NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. SCALE 1"=2000'± FOUNDATION- 16' SEPTIC TANK - 26' - D' BOX 12' LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 170 PARCEL 74 FACILITY BE REMOVED BENEATH AND 5' AROUND THE PROPOSED LEACHING FACILITY. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 12. EXISTING LEACHING FACILITY SHALL BE PUMPED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEN D SAND. 99 EXISTING CONTOUR SYSTEM DESIGN: X 99.1 EXIST. SPOT ELEV. -[99]- PROPOSED CONTOUR GARBAGE DISPOSER IS NOT ALLOWED 198-41 PROPOSED SPOT EL. 4� DESIGN FLOW: 3 BEDROOMS (8 110 GPGPD330 GPD USE A 330 GPD DESIGN FLOW TEST HOLE G PAVED /V SEPTIC TANK: 330 GPD (2) = 660 SLOPE OF GROUND DRIVE 19 7' 181-94 USE A 1500 GAL. SEPTIC TANK UTILITY POLE GARAGE LEACHING: VIC FIRE HYDRANT 'SIDES: 2 (25 + 12.83) 2 (.74) 112-1-GPD NOTE. NOT ALL SYMBOLS MAY APPEAR IN DRAWING COVERED t BOTTOM 25 x 12.83 (.74) 237 GPD PATIO 54 I TOTAL: 472 S.F. 349 GPD # TEST HOLE LOGS USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) ENGINEER: CRAIG J. FERRARI, SE #13871 56 LOT AREA WITH 4' STONE ALL AROUND 18,982 S.F. WITNESS: DONALD DESMARAIS 0 PORCH DATE: 5/2/2018 EXISTING DWELLING PERC. RATE < 2 MIN/INCH TOF = 56.7 0 MA CLASS I SOILS p# 15656 - OHE 10.0, 0 APPROVED DATE BOARD OF HEALTH 0/-/E- ELEV. ELEV. OHE of) 55' Off 55' A A LS LS 0 9„ 10YR 3/2 10YR 3/2- 14" TITLE 5 SITE PLAN B B 9,17" OF LS LS �9s.01, 361f 10YR 5/6 52' 36" 10YR 5/6 52' BENCHMARK: #190 BUCKSKIN PATH COR. BULKHEAD CENTERVILLE, MA =56.8 NAVD88 PREPARED FOR PERC CLIFFORD EXCAVATION \��A OF MS MS �j"OFlsslcy DATE: MAY 7, 2018 DANIEL REV.: MAY 16, 2018 (PLASTIC TANK) DANI L A REV.: MAY 17, 201 ROTATE TANK) A 10YR 7/4 r) 10YR 7/4 OJA .;.JIXI.A (n No.4:111nso off 508-362-4541 CIVIL o.46502 fax 508-362-9880 downcope.com @ '� /ST 0 U R 132" 44' 132" 44' /ON L down cope eft vbleerh7f, inc.. I 1 - - 1 1! ciil engineers NO GROUNDWATER ENCOUNTERED Scale: 1 20' ib land surveyors 939 Main Street ( Rte 6A) B 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT "A 02675BCC' # 18- 127 18-127