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0212 BUCKSKIN PATH - Health
212 Buckskin Path Centerville P A _ 171 030 j i llll UPC'12534 No.2153LOR HA871N086 UN i 2 ��� _ APR-i 2 2005 l TO,,"vN STABLE HEALTH DEPT. DATE 3123105 PROPERTY ADDRESS 212 Buckzk.in P a.th 41 Cent eay.i.2..�e �la�s.s 02632 On the above daft, theaieptic system at the address above was inspected. This system consists of the following:. 1 1-1500 ga e.eon zept.ic .tank.- 2., 1-Di�3t zigu.t.ion Box. `. i_L 3., 3- 330 Reehageaz 28'X11 'X2' Based on inspection, I certify the following conditions: 4., 7h.i�3 1,3. a 7.i.t ee T.ive Se/2t-ic Zy,3.tem.l 5., The .6epiic zy�5.tem .iz .in paopea woak.ing o/Edea a.t .the pne,3en.t, .t.ime., . SIGNATURE -�k Name: Robert A. Paolini Company: Joseph P. Macomber &Son Inc, Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508 775.3338 or 508-775-6412 Wig -joSEPH P. MACOMBER & SON;. NCO Tanks-Cesspooisd.eachfields ' -Pumped *Installed Tdwn fewer-Conneotlons P.O, Box 66 Centerville, MA,02632-0066 -775188$0 . 7.5.6412 ' f COMMONWEALTH OF MAMACHUSETTS EXECUTE'OPPI.M OF 21,M- RO NN +'N'TAL AFFAIRS ' 1�EPARTMENT'OF +'NVIROI�'ON'TAL PRO720TION ' . A A = 'Y'ITLE 5 OFFICIAL INSPEG•TION FORM—.NQTWOR VOLUNTAtRY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART•A CERTIFICATION. Property Address:212 Ba c k s k.in-' a.t Iz n' Owner'sName;Sa eon [doe,&:ie Ownef's Address: -3 a m e Date of Inspection: 3123105 . � Name of Inspector; (please print) i2 0 e 2 t P a o e:i n t.. Company Name: „1: P.:Aldcom.�.e�t• & .SO Irtc. Mailing-Address: ---� Telephone Number—7 5 3 CERTIFICATION STATEMENT I ceitify that I have personally inspected the sewage disposal.systein,at this address and that'the.information reported below is true•,accurate and complete as of the time of the inspection.T.he inspection-was performed based on my training and experience in-the proper fiinetion and maintenance of on bite sewage disposal systems.I am a DEP approved system inspector pursuant to�aection.16 340.of•Tltle 5(31.0 CMR•45,.000). Tile system: XX'X Passes Conditionally Passes Needs Further Evaluation,by the Local Approvin&Authority ail O Inspector's 8ignatUre: The system inspector shall submit a copy of this inspection re'010 the-Approving Authority-(Board of Health or DEP)within 30 days of completing-this inspection.Ifthe systepi is a.sh 4'sy m or has a design flow of 10,000 gpd or.grester,the inspector and the system'owaer.sli f submit the ieport to the apppropriat Tegional•office of the DEP.The original should be sent tom sysmm mmm and cop' sort cv ttje buyer,if applicable,and the eppmving authority. Dotes and Comments ****This'report only describes conditions at the time of inspectiolrand under the conditions of use at-that tube.This inspection does not address how the system will perform in the future under the same or.different conditions of use. f Page 2 of 11 OFFICIAL INSP&CT1.ON,F09— i—NOTTORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.IIISPOSAI:SYSTEM iNSl{'ECTYON.FflRIt . A : PARTA CERTIFICATION(continued) Property Address:212 u c k kin P en esay.c e a Owner: Sahaon o "ee Date of.Inspection: Inspection Sammary: Ch�e& AA—,D or E-/ALWA mplet all of Section,D A. System Passes: N U 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: NU One or more system components.as described in the"Conditional:Pass"�section.need t0 be replaced:cr 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 U• The septic tank is metal.and over 20 years old*or the septic-tank(whether-metal.or not).is structurally unsound,exhibits substantialIinfiltratipn or exfiltration.or tank failure.is imminent:System will pass inspection if:the existing tank is replaced with'a complying septic tank as appr yed by the:Boasd of Health. •A metal septic tank will pas§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: ' NO 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 broker;settled-or uneven distribution box.System will pass inspgctign•.if(with approval of Board of Health)` broken.pipe(s)are replaced. , obstruction is removed distrilitition box is leveled or replaced ND explain: v N U 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 pipes)are replaced obstruction is removed ND explain: f Page 3 of 11 9 0.VF'ICIAL P4&MCTION FORM•N©T.JFGR iVOL''UNTARY ASSES'3MENTS SiTggtlRF CE $,WAGrE DISROStAL SYSTEM MSPtCTI&FORM PART A.. . CIERTIFICAMON(eoi inued) : Property Address: C2122 Buckekirt 1 a h Owner:.. Shaaon-739979 Date of Inspection: C. Further Evaluation-is Requi•red by the Board of Health: NO Conditions.exist whichregpirefurther...e.valuatiqn•by.the•Board:of-Healthin•orderto;detertaineifthesystem- is failing to protect public,health,safety or thb environment. 1. System will pass unless Board-of Health deteraiines4h aocord" a with 314.CMR 15:303(l)(b)that the system is.not f7uactioning i!h.a•marioertwhicb m9l•protect public health,safety•ano•the;e"ir obment: a o Cesspool or privy is-within,50 feet of asurface water 70 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 any),determines:that the system is functioning in a mariner that proteets thepttblic health,safety and environment: rho The system has a septic tahk and soil absorp#on'system•(SA•S):.and the SAS is within 100 feetofa surface.water supply or.-tributary.to a surface water.supply. no The system-has•a.septic tank and SAS and the,,SAS is:within a Zone 1 of a--public,water.supply. 11.0 The system has a septic tank and.W:and-the SAS is within350 feet of a private water.supply well. \ no The system has aseptic tank and SAS and the7SAS is less than 100 feet..bi t.50 feet or;triore from a private water supply well".Method-used to determine distance vzzua.e **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the WelUs.free frorn•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. • Y 3. Other: Page 4 of 11 OFFICIAL•INSPECTION-FORM--NOT•FOR;YOLUNTARY ASSESSMENTS' •SUBSURFACE SEWAGE DISPOSAL SYSTEIVI tSFECTIO]!�1•FORM PART:A CERTIFICATIGN(continiaecl) Property Address: 212 Buckzk.in ll aj-'h Owner: Shaizoh Do e,.ie Date of Inspection: 31211 Of D. System Failure Criteria applicable to all systems:. You must.indicate."yes"-or"no"to,vacb.ofthe:followingIor 11ji mpections, Yes No _ . X Backup.ofsewAge,:into-faiAaty..,w system.component•due•:to overloaded:orclogged•SAS,:nr.cesspool _ .X ' Discharge:or•-ponding of effluent.to the.sdrface,of theigrpund gr..surface;waters due to:an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above•outlet invert due to an overloaded or clogged SAS or cesspool ' _ X Liquid depth in-cesspool is less than.6"below invert or.available volume is less than IA day flow X Required pumping more•than•4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS;cessp©ol•or privy is below High ground water elevation. _ X Aiiy.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion_ofa-cesspool•or•privy bwithin,a:Zone!].•ofa•public.well.. X Any portion of a cesspool-or privy is within 50-feet of a private water supply well. X Any portion o€a•cesspool-or-privy is less-than 100 feet but greater-than 5,0 feet from a.private.water supply well with no acceptable water quality.analysis..[This•system.passei if the well water'analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compounds indicates:that the"well is fret from pollutlon;:from::tbot•facility and:thg presence of aahmonta .nitrogen and nitrate nitrogen is equal to or less thaa.5•ppm,provided that no other failure criteria •are•triggere&A copy of the analysis•niust be attaehed•.to this forgt.] NO -(Yes/N-o)The system alls..hhave determined that one or.more:of:the:above.failure criteria exist as described in 310 CMR 15.303,therefore the.system•fails.The-system owner.should contact the Board of Health-to determine what will be-necessary to correct the failure. E. Large-Systems: _To be considered a large system 4he:systtm must.serve.adaeihtty with a design flow of 10s000 gpd to 15i000. gpd• .. You must indicate either"yes"or"no"to each of tho following: (The following criteria apply to large systems in addition to-the criteria-above). yes no — X the-system is wiWu-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 j IWPA)or a mapped Zone H 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'shill upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office.of the Department. i Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 9-1 BNURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART IR CHECKLIST Property Address:212 Buckhk.in Path en e2v.c e Na Owner: Sha2on Do 4� Date of Inspection: 3/2,3/M 5 Check if the following have been done You must indicate"yes"or"no"as to each of the(oilow.ing: Yes No X Pumping information was provided by the owner,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 Have large volumes of water been introduced to the system recently or as-part of thIanspection? X Were as built plans of-he system'obtained and examined?(If they were not available�bote is 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? Y • _ 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? X _ Was:the facility owner(and occupants if diffftnt from owner)provided with information on the proper \ maintenance of subsurface sewage disposal systems? The size and locatiod of the Soil Absorption System(A$).on the stte.bas been deter mmd 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 approximation-of distance . is unacceptable)[310 CMR 15.302(3)(b)] . 5 _ Page 6 of 11 OFFMAL-INSPTC.TION:-1FQFM-NOT•FOR VOLUNTARY ASSESSMENTS � SUBSU9'ACE SEWAGE DI$POSA�,SYSTPM.,INSPEMON:FORM PART.. .0 SYSTEM MORMATION Property Address: 212 Backzkin Path Een.te2vii e lea Owner: S a ha o n D o Mi e Date of Inspection: FLOW CONDITIONS ` RESIDENTIAL 3, Number of bedrooms(actual): 3 Number of bedrooms(design): 3 X y 0=3 3 O Gi D1rSIGN'flow-based on110 C1Vfi� I03'(for eiaiiiple:'ITO gpd z ofbedrooins� `. Number of current residents: 2 es Doesresidence have a garbage grin der{y br no�n°O Is laundry on a separate sew e.system.(yes or.no):n o cif yes separate inspa ption required] Laundry system inspected(yes or no): 2 00 2 0 0 3= 55, 000 ga.e e o n s Cq l D= 15 0., 6 8 Seasonal use?(yes orno): .no. 2004= 49, OOOya��on� G%D=134•'24 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(Yes or no):n o Last date of occupancy:�_3 e n t COMM Wu-btjnM. -L NA Type of estab.4' Design flgw.(�' $d on 310 CMR 15.203):. mod. Basis.of aj�tjj i'`flow(seats/.persons/sgftMC-):, Grease trap resent(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(descril2.e):. • •, .. ' ' T,NERA,L INFARMATION Pumping Records % M a c o m g e a & Son Z n c Source of information: a Was system pumped as part of the inspection(yes or no): y e If yes,volume pumped: 1�'0 00 allons--How was quantity pumped determined? Reason for.pumping: "u i n•t Q n c e' 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 curre operation and maintenance contract(to be nt obtained from system owner) a" _Tight _Attach a.copy-of the DEP:approval Other(describe): Ap roximate a e of al components date installed(`ckno�)a2nd-------------- source of Zfnrntation: In s.taiwed �121197 by a• n o Were sewage odors detected when arriving at the site(yes or no): 6 - Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:212 Bu c k z k i n 10 a t h Centezvifee Na Owner: Shaaon Doggie Date of Inspection: 3/Z 3/0.5 A BUILDING SEWER(locate on site plan) Depth below grade: 18 Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: 0 f Comments(on condition ofjoints,venting,evidence of leakage,etc.): o.intz' a22ea2 Light , no evidence oie .Reakaae , Vented Vz2ough house vent.. \ SEPTIC TANK: - ,(locate on site plan)15 0 0 Depth below.grade: 18 Material.of construction:X_concrete,_metal fiberglass_polyethylene other(explain) If tank is-metal list age:_ Is age confirmed by a Certificate of Compliance certificate (yes or no):_(attach a copy of �.' Dimensions: 10' 6"LX5 ' 8"GIX5' 7"K Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 6" Scum thickness: 4 Distance from top of scum to top of outlet tee or.baffle: 6" Distance from bottom of scum to Bottom of outlet tee or baffi�" How were dimensions determined: ra e a z u 2 e d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural irate as related to outlet invert,evidence of leakage,etc.): sty,liquid levels lank 'zhoued lea 12um ed evg�zu 2 eaaz.� Iaie-.t X ou.tte.t -teens ate .in .eace.,L.i u.id fevetz ate no2ma an 4-13 auc u2a y ound GREASE TRAP:—Ulocate on site plan) Depth below grade: • Material of construction:_concrete metal fiberglass_,_polyethylene_other (explain): Dimensions: Scum thickness: N 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.): apse .t .is not 22e-sen.t , Title S Tnanarlinn T7nrm xn cionnn 7 Page 8 of 1 I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS 9,"' '.9WAFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continues{) Property Address; 292 .Buck ki the Owner:•Shaaori DO Date of I•bspection; /2 D_ 5 r TIGHT or HOLDING TANK: NO (tank must be pumped at time of inspe'ction)(locate on site plan) Depth below.grade: Material of construction: concrete. metal fiberglass polyethylene other(explain): Dimensions: - Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: _ Alarm:m working.order(yes or no). Date of last pumping: Comments(condition of ai.arm and float.switches,etc.): i ht o2 ho �d in ank.s ate not aez DISTRIBUTION BOX;ye-3 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: O 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.) Box i-6 .eeve.e.' Box ha.6 9 eatelta e., Wo .6o e.4d ca22y ovea., No eeaka .in oa PUMP CHAMBER; NO (locate on sife.plan) Pomps in working order(yes or.no): Alarms in working order(yes or-no): Comments(note condition of pump chamber*condition of pumps and appurtenances,etc.): l um cham�e2 �� no.t /Le.6en-t.� v r 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOTTOR VOLUNTARY ASSESSMENTS SUBSURF.A'CE•SEW AGE.IIISPOSAL.SYSTEM INSPECTION,FOR.M PART-C SYSTEM INFORMATION(continued) Property Address: 2/2 Back.3kin Path Cent e2v c e ee. Na Owner:Sha2on o ce Date of Inspection: 3 0 5 SOIL ABSORPTION SYSTEM(SAS): (locate on'site plan,excavation-not-required) If SAS not located explain why: Located zee a e 9 0., Type ` leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: X leaching fields,number,dimensions: 3-3 3 0 2 e c h a 2 a e 3 2 8'X I I 'X 2' overflow cesspool,number: innovative/altemative'system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level ofponding,damp soil,condition of vegetation, etc.): Loam4i to merliam ad., ,837 .6 ate ctlty., vege-7-at-torz 4_3 noltma CESSPOOLS: n o (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: In of groundwater inflow(yes or no): Cgjq�nmments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): ce6,3126o.ez aae not /22eZen.t.1 PRIVY:NO (locate on site plan) y- N' Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of'ponding,condition of vegetation,etc.): l2ivu tz not aezent., f Page 10 of 11 OF IOC•IINSPEC7'`TVN•I`O�-NOT FOIE•'�O L;JNTA3t'S�:ASSESSIVIENTS / SUBSURFACE•'SEWAGE:��S MAL S' STEM-INSL'EG�'i'30�i FUR1V'I PART C' 5YS'F M FNF=ORAATLON ©nt nued)' Property Address: 212 Buckzk.in Path Centeay.i ie . Shazon 70 e Owner. 3 i c�i v„5�,. • �� Date of Inspection: „ SKETCH OF SE'WAG)E•DISPOSAL SYSTEM vide a sketch of the sewage disposal system inc ties to at Iwgter supply p ly ee the building. or bent ' ks.Locate all wells within }00 feet.Locate where public PP.Y Cr A3, / 10 r Page 11 of 11 PECTION FORM=NOT FOR VOLU OFFICIAL INS NrpECTION FORM ASSEsSMENTS SUBSURFACE SEWAGE DISI?S-PARTSYSTEM SYSTEM INFORMATION(continued) Property Address: 212 •Buck,6kia Path cn e2vt e a Sh¢2on o 4-e Owner. r Date of Inspection. a SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water feet dicate•(check)all methods used to determine the high ground water elevation: Please in lens on record-If checked,date Qf desig>plan rgviewedt f� obtained from system design p L IV Ohserved site(abutting propeAY/observation ole within 5 o feet 9f.SAS) Checked with local-Board of Health-explain: .�„ h Checked with local excavators,installers (atta�c9hndo »entat�o}t t Accessed USGS,database=explain: You must describe how you established the high ground water elevation: used;Gahert .. & Miller model 12 used•USGS observation w June— used• Technical bu wa er a eve ions. Leaching _ Pit ::eet Groundwater: Feet B Blow Bottom Pit High Groundwater Adjustment 1.8 ft per Zirn¢te�Mcth4d Vr Therefore,the vertical•separation distance between the bottom of the leact ing pit and the adjusted groundwater table is feet: tt f . t :r•rrnrn.-+srar•+r•r++fie-a++r:neenrs-YsrrS�+rr.-.r.::yrT-rarn'rrrrerm.trrs*+Pase�ar•Gean:aen . �• Tirrrr�rG—r:S:t.-.r'•� TOWN OF BARNSTABLE BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -. PART D '- CERTIFICATION r �r-m-r:K.-nrs+rv.enmr-T *R+• �WM ===sonr mn .:r:e-a-r+••r.--er•—••� TlM�T•YS:t��.Sf�-l..T TtT..if'RRTtTR1PSSG7t- . -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED . STREET ADDRESS 212 Back,3k.in Pa.th Cen.te2v.ixie ASSESSORS MAP, BLOCK AND PARCEL. * 171-030 Shaaoa Doggie OWNER' s NAME Y PART D - CERTIFICATION NAME OF INSPECTOR Ro gel&t Pa.oi-:in i _ J � l COMPANY NAME aoseph, P.' Nacomle2�` Son Inc COMPANY ADDRESS i3ox 66 Cen�eay.iege Nas.s 02632 Street Town or City. State LIP COMPANY TELEPHONE ( 508 ) �7.5 - 3338 FAX ( 508 )790 , 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true ,. accGrate, and omplete as of the time o.f inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my trainii,�g and experience in the proper function and maintenance of on- site sewage disposal systems . Check one XXX System PASSED ' The inspection i4hich 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 con treted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this in ' ection for Inspector Signature , Date One copy of t)ris certifi.cat_ion must be provided 'to the OWNER, the. BUYER where applicable) and the BOARD OF HEALTH. , * If the inspection FAILED, the .owner .or operator shall upgrade ' the system. within ohe year of the date of the inspection, unless. allow.ed or required otherwise as provided in 3;10 Ch1R 15 , 306 . iDar.td.don 1 DATE:_1 0%11 /00--- PROPERTY ..,..----- 212 Buckskin Path ___ CentervilleL_Ma_02632___ On the above date, I Inspected the septlo system at the above address. This system conslsta of the following; 1 . 1 -1500 gallon septic tank e� ` 0 ' 2. 3-300 rechargers 3. 1 -Distribution box Sased on my Inapectlon, I certlty the following conditions: 4 . This is a Title Five Septic System. ( 95 Code ) 5 . The Septic system is in proper working order at the present time. SIGNATURE:,/ Name:_,�,_P.• ..1{,9 S 4 to 1Z¢,L.�LT�......__.. Company: -0-3- _?;. Xacomber-& Son , Inc . Address:_ Box-66- ---------- THIS CERTIFICATION GOES NOT CONSTITUTE A OUARANTY OR WARRANTY r JOSEPH P. MACOMBER & SON, INC, Tinks•C9sspooli-Lsachflolds Pumpsd 1, Instsllsd Town 3#wof Connootlons . P.O. Box 66 Csntervllle, hl�l 026J2.0066 � + t 9 P al© 775.3J38 776.641Z A. g i 19jCOMMONWEALTH OF MASSACHUSETTS s EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDY COXE Secr+ta ry ARGEO PAUL CELLUCCI DAVID B. STRUMS CommissioDer Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERnFICAT10N Property Addrw: 212 Buckskin Path Name of Owrw Kenneth Stuart Centerville AddeeasofOwnir: -Same Data of hap.cdm: P. Macomber Jr. 1 am a DES approved sysrtwn 4upector pursuant to Section 16.340 of Thie 6(310 CUR 15.000) Cor,,.r,yNar,,., Joseph P. Macomber & Son Inc. ile'n Addr.,ys; x en ervl e Ma . 02632-0066 Telaphom Nunbar — — Ce;iT1A4r,ATl0N STATEMENT certify that I have personally Inspected the sewage dlsposal system at this address and that the Information reported below Is true. accurate and complete as of the dme of Inspection. The Inspection was performed based on my training and experience In the proper function and maintenance of on. It age disposal systems. The system: Y Passes —Condltlonally Passes _ Needs Further Evaluation By the Local Approving Authority Fs Is Si l Vupacta's grvtun: '• I i Dieu: The System Inspector 11 submit a copy of this Inspection report to the Approving Authority (Board of Healih or DEP)whhin 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 snail submit the report to the appropriate regional office of the Department of►£rtv(ronmentd 4Totection. The original shouid,be sent tovw system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page IofII (�� primed on g"4d Pipet flI A X +� J SUMURFACL SrWAGI ctsr03u :YSTVA IMSf=WH FOftf.t • PART A CYRTU%CATION (oondr"010 ftopeMA"a": 212 Buckskin Path, Centerville Owrar. Kenneth Stuart D.Wo+ 1 0/11 /00 sa3pECr.0N 5VLAMAAYt Ch cit A. B, C, a Dt A. YSTE3d rASSE3• I haw not found any Inforrnadon which IAdlcat## that any of the fsllurs oorld)dona d#acr(bsd In 310 CMR 14.303 sxlat My fat cif aria not ovwwed we ind)cated below. t✓p Ll.L1FNT5: S. SySTDj C0w0M0NkLjY PASSES: IVOOne or more system sompononu as described In the 'Condldonal►sa#e soodon nood to bo ropl000d or repalred. The #ystam, v compJedon of the replacement w repa)r, sa approvod by the Iloawd of Health, wW peas. 6n4cate yes, no, or not deternJnad(Y, N, w ND). D*scrtbo baalo of detwmlrtadon to W Inwta,ncos, If•not deternLrwd', sxpldn why not_ 4/6 The septic tank Is metal, urJeas tho ownw w opwotw haw provided tho systom I nspootw whh c copy of a C+rvttute Compusnce (snachad)Indfcatinp that the tank waa{rwugod wlthln twonty 120)years prior to the d+u of Vw Inap*cvc the sepdc tank, whether or not meld, Is stocked, svv~auy unwound, shows subot—t1aJ InW411901 Of 0xIuvedon. w failure Is Imminent. The system wW pass Inapoodon If the #xl*dnp s*pds tank 1# replaced whh o swntpfYtAQ #eptic ta% approved by the $card of Hs& h. breakout$swags backup or bserved In the 'Jon box e to tWOkGA of QbrrV4Ud or due to a broken, eecd d or level uneven dlsvlWOonbox,o u a Th�ystom wW pa+sktaDeoUonll lwtdt spprovwJ of VW $oaropc HI&JW. broken plps(s) we replaced obswcdon Is(*moved d)svibudon box is IevoUed w replaced The eynsm required pkwyt*t7'*nms yt�your dunes�'yearduc W broYvnw vbtrtsvoted plpe(s). Them Insp#cUon If(with approved of the good of Hoafth)t broken plpo(s) sus(#plwcid obswcdon la (#moved Pate 1 of It revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �. PART A CEATIACATION (ca* a-wd) iroq*M Ad&@,: 212 Buckskin Path, Centerville owrw: Kenneth Stuart D.a of tnap.ction: 1 0/1 1 /0 0 C. FIIRTHEA EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: y� Condhions exist which require further evaluation by the Board of Health In order to determine If the System Is t&Mn9 to protect VW public health, safety and the environment. 11 SYSTEM YAU PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WRH 310 CLIR IS.=(1)(b)THAT THE SYSTEW IS NOT FUNCTIONING IN A W-kNNEA WHJC)i WILL PRQjECT THE PUBLIC liMTIiAND SAFCTY L140 THE BC480kMWL dr� Cesspool or privy is wl%Nn 60 feet of surface water Ces+pool or prlvy It within 60 lest of a bordering vegetated wetland or a salt marsh. 21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANTI DETER ADUM THAT THE SYSTEM CS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND 9AFETY AND THE ENV1ROUL DDff: ip The system has a septic tank and soil absorption system (SA31 and the $A$ Is wlWn 100 feat of a wrfecs water wpply or tributary to tt surface water supply The system has a septic tank and toll absorption system and the SAS Is wlWn a Zone I of a Dubuc water wpply well.. The system Ms a septic tank end soli obsorptJon system and the 3A3 Is within 60 feet of a private wetar supply werl. ��Jvn The system has a septic tank and soil absorption system and the SAS la less then 100 feet but 60 feet a mue hen o private water supply well, unless a well water analysis for collform bacteria end volatile org"c compounds lydicatas tint trw well Is free hom pollution from that facility and the presence o`aammoJmsdonoge v nd)rJusts nJVogo-n is equal to a less than 6 ppm. Method used to determine distance 71 OTHER Page of ll revised 9/2/98 SUSURFACE SEWAGE DISPOSAL SYSTEM WSPECTIDN FORM ' B . PART A CER,nMAT10N (can*wed) Prop*MAddrea.s: 212 Buckskin Path, Centerville Owner: Kenneth Stuart °'ts of 4OP"d"^' 1 0/1 1 /0 0 D. SYSTEM FAILS: you must Indicate either 'Yes' or 'No' to each of the following: �aI have determined that one or more of the following tallurs condldons exist as described In S10 CMR 16.�OS. The basis s determination Is IdentlRed below. The Board of Health should be contacted to determine what will be necessary to cortact VW la+! yes No oomponent'doeto art overloaded orvWggad BASo('cassPool• .�..-• - - Backup o+r++W+ge In1O4*cIWmor•.*'01*1 od SAS or Discharge or ponding of stfluent to the surface of the ground or surface waters due to an overloaded or dogg cesspool. Static liquid level In theldlstributiop)bo above outlet InnverJ,`du•to Kev an overloaded or clogged SAS or eeeapod• Liquid depth In ca.as;►eei Is less than 6' belo Invert or available volume la less then 1/2 day Row. Required pumping more the54 times In the last Yost tM due to clogged or obstruete0 pipelsl. '— Number of time- pumped G/' Any portion of the Soll Absorption System, cesspool or privy Is below the high groundwater devsdon. rface water supply. Any portion of a cesspool of privy Is within 100 feet of a surface water supply or tributary to a su J Any portion of a cesspool or privy Is-within a Zone I of a public wall. rivals water wpaY wall. Any portion of a cesspool or privy Is within 60 feet of a p Wep wit% / or privy Is less than 100 test but greater then 60 feet hom a private w Any portion of + cesspool ater supply - j� lyzed acceptable ec eerie, vol+itllswaist qu<Yanalysis. it the well hammonia nlu 9snt+ndenluate nitrogen.aeh copy of well water a++vrs�s ' as been ana, -colltorm b E. LARGE SySTDA FAILS: you must Indicate either 'Yee' or SN large ashstem of elnoiddldon to the criteria above: The following cfiterls apDI Y to ge Y The system ssrve: f the ty with a do sign flow of b cause one or0more00 pol the lollowlnpd of greater roondltionsge lex'and the system If • algrJfkartt ttveat t (� health end safety and yes N,/ f` the system Is within 400 feet of a surface drinking water Supply ar -te�wrfeaa�s♦r>�4'w'aNrru►►IY..., ' the eystem•I6-wlti-in 200 toot of-e-M ►t Y IWPA)or a rr+apPed Zono It of a the system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 16.304121. Pia+aa consult fleecar lo r otAce of the Department for further Infognatlon. Ps�r 4 of 11 revised 9/2/98 I t t 1 , SUBSURFACE SEWAGE DISPOSAL SYSTDA INSPECTION FORIA, PART B 1-701 CHECKLI3T Propw,yAddra": 212 Buckskin Path, Centerville Ownw: Kenneth Stuart O.0 of Inap.acdon. 1 0/1 1 /0 0 Check If the following have boon done: You must Indicate either 'Yes' or 'No' so to each of the following: Yes No Pumping Information was provided by the owner, occupant, or Board of Health. -Nona of the systsmcon4 o+er>rs 6&k% ..&m powyed►boa J"&Vtwo�wwfse sa646e-vystam haabaeowceiz+iragIMa..ol A rates during that period. Largo volumes of water have not been Intrdduood.Into the system recently or sa pen of trvs /mot Inspection. Y _ As built plans have boon obtained and examinod. 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. The ake was Inspected four signs of breakout. _ All system components,`.Nluding the Soll Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition of oar or toss, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size end location of the 3oll Absorption System onthe ilia has been determined based on:- _ Ealsdng Information. For example, Plan at B.O.H. _ Doterminod In the field(If any of the failure criteria related to Part C Is at Issue,approximation of distance Is unaccoptao — 116.7021711b11 The fa.clUty owner tand.et_p•^••.Jf dtfarent froaw,ioa ),wsr- ;wnWdaeI with fMmr—artoc on th-Ate-•--f—• SubSurfaco Disposal Systems. revised 9/2/98 Page 5Of11 I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA PART C SYSTEM INFORMATION Propw yAddre": 212 Buckskin Path, Centerville Owns: Kenneth Stuart Data of lnapoctlon: 1 0/1 1 /0 0 FLOW CONDITIONS RES WFTITIAL: Design flow:__,Q�2_g•p•d•1bsdro m. Number of bedroom$ do I Number of bedrooms(actual):.3 Total DESIGN flow Number of currant residents: Garbage grinder(yes or no): Laundry(separate system) Is or�o I}y/+, sepacataJnsp+ction required —• Laundry system Inspected yes or no) Seasonal use(yes or no): �f�� water meter rladings,it available (lost two year's usage(9pd): J D� 44 Sump Pump(yes or no): �a� ('$ Last date of occupancy: tv�'�v (p�✓ 'N1 �f�"'���OG� �,�j COMMET1C%AI.ANDUSTR(AI: Type of establishment: �. Design flow: d I Based on 16.2031 Beals of design flow Gress*trap present: (Yes or no) Industrial Wast* Molding Tank present:(yes or no)" Non•ssnitsry waste discharged to the Title 6 system: (yes or no),Jy Wet*r meter readings,If available: Last date of occupancy: 104 OTHER:(Describe) Last date of occupancy: • GENERAL INFORMATION PUMPING RECORDS and source of Information: System pumped as part of Inspection: (yes or no)A?), If yes, volume pumped: gallons Reason for pumping: T1fP€OF SYSTEM S Septic tank/distribution box/soli absorption system Single cesspool Overflow cesspool Privy Shared system(Yes or no) (if yes, attach previous Inspection records,If any) I/A Technology.oil. Attach copy of up to date operation and maintenance contract Tight Tank V17 Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installe(W known)-end soured of,larformadon: Sewapl odors detected when•orrlving at the site: (yes or no) revised 9/2/98 Paes6orii r SUBSURFACE SEWAGE DISPOSACSYSTEM WSPEcnoN FORM :ems PART C SYSTEM INFORMATION(contlrwW) PropertyAd&*": 212 Buckskin Path, Centerville Owtw: Kenneth Stuart Date of bupecdon: 1 0/1 1 /0 0 BUILDING SEWER: (locate on site plan) I/ Depth below grade: Material of construction:_cut Iron 0 PVC "other(explain) Distance ho jrivats water supply well or suction line Diameter Comments: (condition of Joints, venbng, evidence of leakage,-etc.) Joints appear tight Nn PiriHonGo nf leakage SEPTIC TANK:_ O (locate on she plan) Depth below grade: Material of construction: concrstelometal 4F)bergiassAd Polyethylene thsr(sxpI&In) laf If tank Is fnetal. list ape dff Js.age.conflrmed by Certiftcats of Compliance AlooT(Yes/No) ( r� �+ Dimensions: a "f ',,i sf Sludge dept _ Distance fro top�f sludge to bottom of outlet tee ort*Ms: , " Scum thkknsss:_Z&=9-:!__ Distance hom top of scum to top of outlet tee or baffle:/ Distance hom bottom of scum to bottom of ouU t t or bstfle: Mow dimensions were determined: Comments: Irecommendation for pumping condition of Inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structura"ntegrity, evid nce of leakage, etc.) pump septic tank ann Inlet & Outlet tees are Li ui level ilive.ct is i one inc es. a an is structurally e of jeaRage. GREASE TRAP: Ilocate on site plan) Depth below grade:./9 Material of construction;concrete4 nstaIAOFlbsrglasa, 4PolyethylendL�other(sxplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baMs:_d1A Distance from bottom of s yrn to bottom of outlet tee or baffler Oats of last pumping: _ / Comments: Irecommendation for pumping, condition of inlet and outlet tees or baffles, depth of Uquld level In relation to outlet Invert, structural IntegrhY. evidence of leakage, etc.) Grease revised 9/2/98 Nge7orll SUMURFAU SEWAGE DU UL SYST M WMCMN FOiW /AIIT C SYSToA wr-oF Amw (aunt -ed) 212 Buckskin Path, Centerville o.R•.r; Kenneth Stuart T10MT 011 HOLDWO TANK-a") (Tank mint be pump►d prior to, or of tlmo ol, In►p►cdon) (104e1e on site plan) Depth below Onde: M nrt�concretemetaJ.f�4Flb#rplcevl ,►drell►ylencoth$r(cxpl►!n) M019AIJ of consw ruo Olmen+lour: Capacity: gallons 0909A flow: Oallonalday Alorm present Alarm level; Alorm in worklnp order:Yes /% No,4W Gate 91 previous pumpinO1 AV Comments: lcondroon of Wet tee, oondltlon of ►)arm and flool ewlichee, eto.) nl rii nn a- not PresP OtSnisvT10N IOX:U---' uocete on Nts plan) Depth of ligvld level above outlet Inven:to Comments: Inge 11 level and dletrlbutlon I$ eau►J, evldenw of sonde carryover, evldenoe of leakage Into of out of box, etc. 15 u t i evi ence No evidence of leakage into or out of the box. PVM►CMM5Ex:�-.cy' II94610 on ►Its plan) lumps In workln0 order:(Yea of No) v"- Alorms In workln0 order (Yea or Nol V'141 Comments: mote condltlon of pump chamber, condltlon of pumps and eppurtononcee, etc. Polslofll revised 9/2/98 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � PART C SYSTEM INFORMATION(wntirxj4d) PropertyAd&*": 212 Buckskin Path, Centerville Owe: Kenneth Stuart Darts 04 Inspection: 1 0/1 1 0 SOIL ABSORPTION SYSTEM(SAS): (locate on stir plan, If possible; •:c-v don not required,locadon may be approximated by nondntruslve methods) If not located, explain: Type: C/1V"y"" leeching pits, rwmber: C� �� leaching chambers, number:G� mA/' leaching galleries, number:_ leaching trenches, number, length: —77 leaching fields, number, dlmenslons: overflow cesspool, number: Alternative system: 01 Name o1 Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) o rate is �� 5 _NU bjL9115 of s are dry eqe a ion is norms CESSPOOLS: (locate on site pisn Number and configuration: Depth top of liquid to Inlst Invert: WIN Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as pan of Inspection) sspoo s are not prespnt _ Comments: (note condition of soil, signs of hydraulic failure, level of ponding,eondition of.vegetation, etc.) esspo0l� are not nrocenee PRIVY:�,1o�ve (locate on site plan) Materials of construction: on: Dlrr►ertalona: i1/!Y� Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) revised 9/2/98 Psgt9orII 3U&3URfAC9 5EWACI Dt$POSAL iy$TGA tNSPCCTiON FOFUA , PART C '. SYSTDA WFOrt7dATION(oon*w*d) P►oq.m Addro": 212 Buckskin Path, Centerville °`"""" Kenneth Stuart 10/11 /00 su7c i Of SEWAGE DISPOSAL SYSTEM: Indudi de+ to •t Ies11 two permariont re(orence landmarks or benchmarks I0C&t4 NI wollr wlthln 100' ILoc+te wham public water supply comas Into house) 4 �1r I 4, revised 9/2/98 P.<<toortt r SU93URFACE SEWAGE 0131`93AL SY3104 WS►EC71OW FORM PART C SYSTEM WFORI.AMW(oondrwd) hop«rtY Addraa+: 212 Buckskin Path, Centerville Owrw:. Kenneth Stuart Dau of 1n4pocdon: 1 0/1 1 /0 0 MRCS Ropon name 30 Type_ TyplcsJ depth to groundwater USOS Date webslte visited Observation Walls chocked Orovndweler depth: Shallow Moderate Deep SITE EXAM Slope Surfacs Wolof Check Callan Shallow wells fir! Estimsiod Depth to Oroundwater—v' Feet ►jests Indicate all the methods used to detormine High Groundwater Elevotlon: _Ootalned from Design Plans on record baerved Slte (Abvtdng proportY. boorvstlon hole,bosomoot sump eto.) �elermined from local condltlons _ Chatted with local bard of health _Checked FEMA Maps Checked pvmping records �hecked local eacaystors. Installers Used USGS Dote Describe how you establlshod the High Oroundwater Elevation. (MLVd be aomplelocil Used; Water Contours Map. Gahrety & Millet Model 12/16/94 revised 9/2/98 hill llofll + .wn..•-ww��r•.n.�A•n+Rr-�+.n�n.�.wnw+ww.i+.�.+w�nv+�v rww.•.n�vw �-.-�+v-' .. ,-. . TQWN OF BAR12START-P 13OARD OF HEALTH SUI)SUIIFACF SEWAU. D1SI'O8AL SYSTEM INSPECTION FORM -' PART D •- CERTIFICATION -TYPE OR PAINT CI.EAAI.Y- P/YOPERT Y INSPECTED 212 Buckskin Path, Centerville STREET ADDRESS - ASSESSORS HAP , DLOCK AND PARCEL ;r OWNER' s NAME Kenneth'Stuart PART D - CE17TIFICATXOH NAME OF INSPECTOR Joseph P. Macomber Jr, COMPANY NAHE Joseph P. Macomber & '`Son, Inc. COMPANY ADDRESS Box 66 _ Centerville MA. 02632-0066 31r..t TOvn or C ty state tip- COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( ) CER'IFICATION STATEMENT I certify that I have personally inspected the sewage disposEi`l system at this address and that the information reported is true , accurate , and omplete ns 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 . Chone : Le�Psystem: 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 16 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED# The inspection which I have con acted has found that the system fails to protect the E)tiblic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this Inspection form . Y , Inspector Signature Date a( neherecopy of thi rt.ification must be p ovided to the OWNER, the BUYER &ppl losble ) and ch. BOARD OF'Copy • If the inspection FAILED , the owner or operator shall upgrade ' the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 306 . partd .doc TOWN OF BARNSTABLE LOCATION'7-17 C>UCYL)�In P('1 +Y) SEWAGE # VIILLAG ASSESSOR'S MAP & LOT��✓� G INSTALLER'S NAME&PHONE NO.J 1'n f UU rnV-,XX s�k 275-, SEPTIC TANK CAPACITY 1 m FU Din kt LEACHING FACIL=: (type)„ (size) NO. OF BEDROOMS BUILDER OR OWNER �11� r�, S`►C-UI�W� PERMITDATE: COMPLIANCE DATE: 0 1 o 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 v 21 2 B _ '� sh:inpath- J�jIJC�s� N t1 s Centerville,Mass. Kenneth .Stua'rt. 1 -1500 tank 1 -Distribution box. 3=330 cultec re'chargers. 4 - o .. ,� No. Fee $ 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS ZippYication for Mioonl *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade ZXTAbandon( mfRComplete System ❑Individual Components Location Address or Lot No. 212 Buckskin Pathg Owner's Name,Address and Tel.No. 775-9092 Centerville,Mass . 02632 Kenneth L Stuart Sr. Assessor'sMap/Parcel- 212 Buckskinpath Centerviille,Mass . Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 508—�ZX—gg38 Box 66 Centerville,Mass . 02632 J,P.Macomber & Son Inc. J.P.Macomber & Son Inc. ICenterville,Mass . 02632 Type of Building: Dwelling XX No.of Bedrooms Lot Size sq.ft. Garbage Grinder(NO) Other Type of Building RE*__ No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 2x I 1 n=22 n gallons. Plan Date Number.of sheets Revision Date Title Size of Septic Tank 1 500 Type of S.A.S. 3-3 30 Recharges Description of Soil Medium sand to fine sand Nature of Repairs or Alterations(Answer when applicable) omit cesspools. Install 1—1 5 0 0 gallon tank, 1-Distribution box,3-330 Rechargers packed in a minium of 2. 5 ' of stone.± Date last inspected: 11 .120.196 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this Boar A lth i Signed `4 Date 11 / 0/ 6 Application Approved by Date 1� Application Disapproved for the ollowing reasons Permit No. 9 Date Issued No. Fee $ 50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mi5pogal *pgtem Construction Permit ` Application for a Permit to Construct( )Repair( )Upgrade TXYAbandon( )XXXComplette System ®Individual Components Location Address or Lot No. '212Buckskin Pathg Owner's Name,Address and Tel.No. 77 5-9092 Centerville,Mass . 02632 Kenneth L Stuart Sr. Assessor'sMap/Parcel 212 Buckskinpath 'Cents;rg-,illa.,_Mass . Installer's Name,Address,and Tel.No.508-775— Designer's3338 Name,Address and Tel.No. 50$—.gg�—gg3$ t' Box 66 Centerville,Mass . 02632 J,P.Macomber & SaTCInc. J.P.Macomber & Son Inc. Centerville,Mass . 02632 Type of Building: Dwelling XX No.of Bedrooms_Rf9___ Lot Size sq.ft. Garbage Grinder(NO) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 2 x 11 n_2 2 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 500 Type of S.A.S. 3-330 Reehargers Description of Soil Medium sand to fine sand Nature of I Repairs or Alterations Answer when applicable) Omit cesspools. Install 1-1 500 P gallon tank, 1-Distribution box,3-330 Rechargers packed in a minium of 2. 51 of stone. ; Date last inspected: 11 /2 0/96 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this Boar of�H`al Signed (_ /` '� Date 11 /20/96 Application Approved by - Date 6 ►` Application Disapproved for the following reasons ri Permit No. 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 TIXX)X Abandoned( )by J.P.Macomber & Son Inc. at 212 Buckskin Path Centerville,Mass. 02632 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated p Installer J.P_Mar.nmbar F, Son Tnn. Designer J•P.Macomber & Son Inc. The issuance of this permit shall not be construed as a guarantee that the system w 11 function as designed. Date Inspector r 0 ——Q————————————=———/�—————————————————— No. C � y ��� 1� Fee $ 50.00 THE COM ONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migooar *p'!Aem (Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade`{XX)Abandon( ) System located at 212 Buckskin Path Centerville,Mass. 02632 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru �X_, t be completed within three years of the date of this permit. Date: Approved by 4 CERTIFICATION Or SKETCH AND APPLICATION h'OR A DISPG--; 1, WORKS CONSTRUCTION PERM l'I' (WI'I'IIOU1' DESIGNED PLANSI I, 04h P MArnmhAr_ __ ! =��uy c ertiiy that the application for disposal works construction pernut signed by nie dated 11 /20/.96 , concerning the property located at 212 Buckskin Path Centerville,Mass . meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells vvithiii-150 feet of the proposed septic system • The observed groundwater table is .4 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change ill use proposed • There are no variances requested or needed. SIGN DATE: 11 /20/96 SIGNED • � — LICE SEPTIC SYSTEitiI 1NS'fALLER IN'1I E MYN 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). 1 3-330 Rechargers 1-Distribution Box 1-1500 Gallon Tank Bedrooms 212 Buckskin Path Centerville,Mass i TOWN OF BARNSTABLE I�%--;ATION LQ1Q LS'L/0 talk SEWAGE # �7= S VILLAGE C EAJ �Z e Vi Ili ASSESSOR'S MAP & LOT 71- D 3 d INSTALLER'S NAME&PHONE NO. d JQdQ A,61,-f, SEPTIC TANK CAPACITY � G R LEACHING FACILITY: (type) _ s_['12 e� 8� 5 (size) NO.OF BEDROOMS 3 BUILDER OR OWNER � x S yeti PERMPTDATE: E I 2-c? "2162 COMPLIANCE DATE: f I - 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 o -44 f TOWN OF BARNSTABLE LOCATION IQ SEWAGE # VILLAGE C EAU -' Vi IIE- ASSESSOR'S MAP & LOT l 7/- 03 D INSTALLER'S NAME&PHONE NO. ,Q�A�,c�o, 61f, SEPTIC TANK CAPACITY S� C,R LEACHING FACILITY: (type) -+Z—J-J j !JQ t.0 -L 5 (size) 1 NO.OF BEDROOMS .3 BUILDER OR OWNER PERMIT DATE: I a..0 '`��� COMPLIANCE DATE: q : Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (1f 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 teaching facility) Feet Furnished by 7 � FLOORPLAN Borrower.Vincent 8 Theresa Marcantonio File NO.: 1354098.1 PrpoeMi Address:212 Buckskin Path Case No.: City:Centerville State:MA Zip:02632 19' Interlock Patio (A,ea:gas ft=l Sun Room - 26' �- 19 Dining �Bathroom `� S Kitchen Room Bedroom y — Bathroom a 1 Car Attached I _JI IArea:324 ft=l Ca Z Bedroom Living room Bedroom J� 15' 48' (Area: 1356 ft2] all 41�.mr I IM fie FOW Fled z 1.00<f 33S fi ^ 37 12i os< tern t=Lei^M_ 2-4wL 4 Ii ./. 144.-XO .POO 215 R'6 84", S <44 •24x 06D= 312 A- _ _ Ir ADD NEW 6'FRENCH DOOR a, ISULATE WALLS AND INTALL 6l8 GWB WALLS R-20 CEILING R-30 REM Ell 000 HALL TO KITCHEN ONE STEP DOWN o N 3'0" ID / N 13'10" REM VE WINDOW ADD DOOR / ADD NEW SHELFS \ FIREPLACE IN LIVING ROOM FLOOR \� 6 MIL POLY OR DRYLOCK PAINT ON CONCRETE 2 X 8 PT FRAMING 16"OC INSULATE R 30 BATT 314"T&G PLYWOOD UDERLAYMENT �=— 7'8"— ' NEW BOX OUT WINDOWS Print scale: 1/4" = 1' VINCENT MARCANTONIO NEW LAYOUT 212 BUCKSKIN PATH BARNSTABLE, MA