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HomeMy WebLinkAbout0190 HORSESHOE LANE - Health 190 HORSESHOE LANE, CENTERVILLE A= a Slll J� llll UPC 12534 No.2_ s HASTINGSo.MN L ao3--13,;L Commonwealth of Massachusetts Title 5 Official Inspection Form - 1; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane v Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 ` page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information Sl# 15gd,D on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Co r� Company Address Teaticket Ma. 02536 _ City/Town State Zip Code ,ems 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 05/27/2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and,6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 3 bedroom home has an H-10 1500 gallon septic tank with an H-20 D-Box feeding (2) 500 gallon leaching chambers with 4' of stone. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)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 infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City(rown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doe-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 c Commonwealth of Massachusetts r� ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I' 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and 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 feet 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4 System Failure Criteria Applicable to All Systems: y pp You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c� Commonwealth of Massachusetts ? . Title 5 Official Inspection Form ±= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane V Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/2 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 ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Horseshoe Lane v� Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® 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 been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /n u— 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 348.7 GPD Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d town water 9 ( Y 9 (gP ))� Detail: In 2020 -77,000 gallons were used and in 2019-44,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane V� Property Address Elizabeth A Brosman Trust Owner Owner's Name information is Centerville MA 02632 05/27/2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form +' i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v � 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy , ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I Approximate age of all components, date installed (if known) and source of information: 2018 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 26"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1500 gallon Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form i} Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane u— Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. CityT town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c � Commonwealth of Massachusetts r- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 � I Commonwealth of Massachusetts Title 5 Official Inspection Form '= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 190 Horseshoe Lane u� Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c� Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Horseshoe Lane Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A 34 G' z. cy'=Zy 3 C t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c Commonwealth of Massachusetts i r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /n 190 Horseshoe Lane V Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: feeetet plus Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Perk Date 7/10/18 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per perk data no water encountered at 138". Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Horseshoe Lane V Property Address Elizabeth A Brosman Trust Owner Owner's Name information is required for every Centerville MA 02632 05/27/2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. ao49 V D0 Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftphCatlon for Misposal *pstrm Construction 3dErmit 7 Application for a Permit to Construct( ) Repair(V�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components 1, Co Location Address or Lot No. 190 i4orSc•Shoc. i-N� +-_ 0wn;tr's Name,Address,and Tel.No.6/,Zer�eJ acoSr►a+� '�` 6-etwv Le Assessor's Map/Parcel Zo"7- 13 Z N Installer's Name,Address,and Tel.No. jl, EXca -A;o h Designer's Name,Address,and Tel.No. EN b W or•R S p4 Ico,Sc.rrc j Lf-3 S0S• y 77-OG53 S08- y )`)-S3 l3 Type of Building: Dwelling No.of Bedrooms `3 Lot Size �D�Sq o sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1330 gpd Design flow provided 3 q$ gpd Plan Date $^ 1" g Number of sheets Z Revision Date 1- 29 ^ 1 8 Title \ Size of Septic Tank B$00 c�a 1 Type of S.A.S. S"DO Description of Soil `eNature of Repairs or Alterations(Answer when applicable) -rA0K - , BQ?t- (.C,�4 -% �4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5.of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 0- / Application Approved by Date l(��� [ Application Disapproved by Date for the following reasons "Jl Permit No. �C�` "'�t� Date Issued 16 M. No. 104_3019 Fee �/001 6)6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for 33isposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(v�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components J.r Location Address or Lot No. 4 190 dor5c Sl,oz. L.►J 4—�10 Name,Address,and Tel.No.�'J�'sa.,a' e•1� ,QsoS�na f\ ', Assessor's Map/Parcel 'Zp .. 13 Z_ �.. Installer's Name,Address,and Tel.No. ,B (3 CxCCLvo-Aia h Designer's Name,Address,and Tel.No. C,i 6 W oH S 1�-9ca�crrc� L►.� S'0F• L477- 0Z,53 �•O�S y77 ' $313 Type of Building: Dwelling No.of Bedrooms 8 Lot Size 10, 5140 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures F Design Flow(min.required) 330 gpd Design flow provided 3 q$ gpd Plan Date $• ) - )$ Number of sheets Revision Date $' Z 9 I B Title Size of Septic Tank / OO q c�,. Type of S.A.S. TOO qqj Ll c �2� Description of Soil ature of Repairs or Alterations(Answer when applicable) TA rJK rJ .BUx• L'co�e h �1 q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of j' Compliance has been issued by this Board of Health. Signed Date (� s• �/ Application Approved by Date j} ! q / F Application Disapproved by �T Date for the following reasons Permit No. ,4lU/g_308 Date Issued �6 1 a1 !� ------------ ------- ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS I Certificate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(./}� Upgraded( ) Abandoned( )by ,[3 13 FX C as v o A t O n at_ 190 }o r5 c S j Or. L-Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.D e.-4`3C87dated lolq Installer 5 s 2 E Xcc,yp.A► O/\ Designer E A)6 &)or R.'s #bedrooms Approved design flow \\ ? and The issuance of this permit shal not beXcnstrued as a guarantee that the syste will func n d 'gn2=d. Date / Inspector i - -- -- -------�----------------------- No. c Ul 3V9 Fee (00.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction permit Permission is hereby granted to Construct( ) Repair( L--yo' Upgrade( ) Abandon( ) System located at 190 d0 r'Sc 5 k O r_ L.." 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. Date 1 �� ,Approved by , ti . ; "Ta�vn of Ba.r>r>< �blc d,THE,�p s.;: Rtehatd V Sea t,1<hledi��JDirtctot ■ IIARNS'S'ATSLII, �- �zAss ,� Public Health ]Div�sron Y63q �� ;. ��MA"° T#io?n�as Yt�tKan Dtre¢ ot. ,200 Ma ii Street,Hyae nas;'Al1 ?2601 Office• �(?C SF;2-4644 1ax,:.at)5-:'��t)-t�3t)t ti i I,t stalle-,&DeAk .r'Ccr"6;' tion'Foi.rrf' Date. 1 I, Cr -)" . Sc�� �I.—- mttt�. OIL' 3O� Asses or s';41apl11 CeI_ . I7iesigtler any`�r�ee�, tea r=1>ts F�? Insta7.er: x °t+i . _____ �_ __� _._;w,..._ Address J2 W:, G ra s .e�� 11 add.re ss: l � t t�1 ri 9 �. -- rl[� 'tt�f>��ras tss��ed 1}?e mit ta't3zstal:I a septic system at gU. G SC'S:�, I`' ,( tlta. �v�t- b<i5c cl an a dcsi_ n drav�z� b tg (a`(id1eSS) -FefiE f i,, t✓l'irj �4L' � .. rten_�r'.� Wt,-lA r /+2 C ; dated �� l ` , �, (dcs� � er) i comfy chat the septic system 7tf€rcncriW above'���as tr stalled`substantiall"y according to file design, wk ich 1'.n include minor api roved:claangcs sue h:as.lat aal xelocatib» ©f'ttle; ,' tistri"bu;tion be t aad,or septic tank: Strip out ( F�ccluired) i�!as in,pcctec:and the �ciils . . trere found satistacttry T,cc,ti:ty tlic�t the septa, a Stern icFerehoel9 abo� was inS�alled t�stir iia��or eilari�e5 (i.c: 9 ..'rLr r . l01 lateral ►elocution of the S.AS or any�ei� al relocatio.n.afai y.coxnp6iient of the sepCte-.system)-9 iri''accordance ��rith St :tc Ccical, R : ulattons P(ctu revision or certif cd as-built by ctcs,. .,to fotlais Strip out(tf recjuired. ���s tiis%....1 l and Cho soih verc.foiutd satitsfactdty T ieitrfv that Clio 5yst:cnt refcrencecl above w as 4i�nsttucic c� I. �v itii the terns; of the.1%:A appr&al letters (it apl�li able) a ► R T Gfi�, , , , , � . "stal1er's Signature ��iq9 j' r ,; s (L7esi;tjei's 5irtature)' ( lr lesil,�et s ,ttin�p Nee) ; tEASG Rii�IUCLy `t U.13 12VS t A 3LE. I'UBI.LC II;CAL' I3IVIS1UN. .ttkl�[FIt��TE OF CU,ViP7 I NCE' �?ti'I.I L NUT BE ;xSSU.ET) 'I:7NTI 0Tt-I `THIS FC)t2-�l A,NMD aS BLJLT L 'A ARE;`RECEIV'ED`..B,Y IHE DARNS 'Ak3LE T'U iGIC II ALT1Fl I7;IVISI.i'.N. IArtI YUv. t��Saptic,l�esignt.r;E cifificij��n f onii-P.��� =l-t I t,��oc''. �. .�. ,..,:� 1 :,,„ E �: ..:..5 d r n '...,.: , x,.�, I TOWN OF BARNSTABLE LOCATION 190 ocScSl,oc LQ SEWAGE# ZOI$ -308 VILLAGE (2c-nAr-r y I I I C. ASSESSOR'S MAP&PARCEL Z011 - 13Z INSTALLER'S NAME&PHONE NO. JG 4,.3 EXCa%jg-A;0A ynl- D1,53 SEPTIC TANK CAPACITY /SOO 9 ci,I \ LEACHING FACILITY.(type) SW gqJ L I��2) (size) 13 x ZS X t- NO.OF BEDROOMS OWNER PERMIT DATE:101 9) 1$ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on' site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al- zs ' $► ZZ AV 314'Z, zO lO ,BZw 19 83.39 ' a 4 cy-zq ' 3 0 BATH DECK FAMILY ROOM �w CL. �Q BH BEDROOM BATH KITCHEN/DINING 120 SF BEDROOM LIVING ROOM BEDROOM 130 SF 140 SF FLOOR PLAN 190 HORSESHOE LANE, CENTERVILLE, MA 0 r Town of Barnstable P�—� ` _ Department of Regulatory services eru3re Public Health Division Date 6 7 �p s6]9. ��� 200 Main Street,Hyannis MA 02601 Date Scheduled l / Tiine l A — L Fee Pd. i 60 S it Suitability Assessment,or St e Disposal Performed By:� if cfFl��� S t=— 1ST 2— Witnessed By; �S LOCATIOtY& GE 11RA:L INFORMATION Location Address l�(D trtthot_ Zd"l a owner's Name F('z L 6e tit �j yrO 5 YY—1 Address 1�(U t_tnn f 2 v-v, Assessor's Map/Par L• �7 3 Z— Engineer's Name Fvt�'vl,.e NEW CONSTRUCTION _II __ REPAIR �'' Telephone# ' O 8— �'77'r <i 1 3 Land Use 5'COX u -Slo es �o 2— �— P f ) Surface Stones i Distances from: Op n Water Body>fw/ ft Possible Wet Area�C�G ft Drinking Water We I �`®ft Dra page Way Z 10U ft Property Line - P�/� ft Other ft 1 i SKETCH:(Stye t name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands fn pro)imity to holes) 1 i i I . I / i H (5-CS kM E �t I I Parent material(geologic) �y�V'"�5 Depth tb.H,edrock. �� Depth to Groundwater. 3tanding Water in Hole: N O+ _: Weeping from Pit Noe Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL kIIGH WATER TABL a Method Used: I I I Depth Obse ed standing in obs.hole: _ In, Depth to sell mottles: Depth to wet pd ing from side of obs.hole: ____-,—..__In,' Groundwater Adjustment Index Well# }i cading Date: _ Index.Well level,— Adl,factor,,,,,,,,, Adj,Clrnund i nte�r hgvel PERCOLATION TE SIT Datea,.._ .m xme Observation Hale# ^� Z Time lit V Depth of Perc J 2 5 A�_ p�i .h �v Time at 6"Start Pre-soak Time O _ _ _ r� t 2(f Time(9 6t) End Pre-soak pl G�I is Rate Mindlnch Site Suitability Assessment: Site Passed Site Failed:_ Additional Testing Needed(I,/N) Original: Public Health Division Observation Bole Data To Be Completed on Back----------- ***.If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Cons rvation Division at least one(1) week prior to beginning. Q:\S EPTICIPERCr-ORM.DOC I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on i te�y.%Gravel). 9� C� i DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ Cons' enc .%Gravel)_ LO CnnU,l Sr�,�j_ to`f t2Y IZ g V � i I _ BEEP OBSERVATION HOLE LOG Bole# Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i e cy,�5 Gravel)-- I — i i r j DEEP OBSERVATION HOLE LOG. Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency 9h Gravel,) I � _mm Flood Insura i ce.Rate.Map;:. Above 500 year flood boundary No— Yes Wiilur.500 year boundary No✓+ Yes,,:,_, Willi, 100 year flood boundary No Yes roll OccurrIn Pervious Material Death of Nato v Q observe Does at least Pout feet of naturally occurringoccurringperviou�s,mater`iafl exist in all areas throughout the t _ � 'L absorption system?e 32.—� area proposed for the sot p y If not,what is the depth of naturally occurring pervious material? Certification CC 1 I certify that cn 1 'k L( L.(date)i have passed[Ile soil evaluator examination approved by the Departmento Environmental Protection and that the above analysis.was performed by me consistent with the required.tia expertise and.experience described in 10 CMR 15.017. Signature �—� —_ Date IO 1 Q\5S131 T[C\P&RCPORM.DOC Town of Barnstable SBA "6 .A L g. Board of Health ArEo► '�' 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Paul J.Canniff,D.M.D. John T.Norman Donald A.Guadagnoli,M.D. September 6, 2018 Mr. Peter McEntee, P.E. Engineering Works 12 West Crossfield Road Forestdale, MA 02644 RE 190 Horseshoe°LaneCenterville 4 k i Dear Mr. McEntee, .You are granted variances on behalf of your client, Elizabeth Brosman, to construct an onsite sewage disposal system at 190 Horseshoe Lane, Centerville. The variances granted are as follows: Section 360-1, Town of Barnstable Code: To construct a soil absorption system 90 feet away from the top of a coastal bank, in lieu of the minimum 100 feet separation distance required. Section 360-1, Town of Barnstable Code: To install a septic tank 33 feet away from the top of a coastal bank, in lieu of the minimum 100 feet separation distance required. 310 CMR 15.405: To construct a soil absorption system 6 feet away from the side property line, in lieu of the ten (10) feet minimum setback required. 310 CMR 15.405: To construct a soil absorption system 6 feet away from the front property line, in lieu of the ten (10) feet minimum setback required. 310 CMR 15.406: To construct a soil absorption system 10 feet away from a foundation wall, in lieu of the twenty (20) feet minimum setback required. 310 CMR 15.405: To allow five feet of soil cover above the system, in lieu of the maximum three feet allowed. Q:\WPFILES\McEnteeBrosman 190 Horseshoe Ln Cent 2018 Variances.docx These variances are granted with the following conditions: (1) The septic tank shall be H10 coated and wrapped. (2) No more than three (3) bedrooms. maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (3) The septic system shall be installed in strict accordance with the engineered plans dated August 11, 2018. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the. submitted plans dated August 11, 2018. Physical constraints at the site severely restrict the location of the septic system due to its proximity to a coastal bank. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. S' erely yours, Paul . C s n i Chairman Q:\WPFILES\McEnteeBrosman 190 Horseshoe Ln Cent 2018 Variances.docx �V Y �cIME Tp� �` ' \Il t,es DATE: ti FEE: BARNSTABLE, 9 MASS. �A 1639• �� REC.BY ' Town of Barnstable SCHED.DATE: 3`~ Board of Health w 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoli,M.D. Alternate:Cecile Sullivan,RN,MSN VARIANCE REQUEST FORM LOCATION Property Address: tS !- t r-s-2, G Z Lv, �-V Assessor's Map and Parcel Number: .2 �� -l�a Size of Lot: t Qe Wetlands Within 300 Ft. Yes i-*" Business Name: No R Subdivision Name: APPLICANT'S NAME: Fe�-e—f :L 17 Phone - �7 `� 7 G Did the owner of the property authorize you to represent him or her? Yes _ No PROPERTY OWNER'S NAME CONTACT PERSON _ f t Name: N� )cZ � �- ` :�S v U�`z\ Name: �':��� h c-'.�.^^.nq Address: /' . �„ , - , , j Address:T�� e- N1 i Ira Phone: 1 ? 7 Z Phone: SCE T 3 1 Al ,5 Cy F - 7`7 6 EMAIL:ape VC c, M C-e C C,d VARIANCE FROM REGULATION(List Reg) REASON FOR VARIANCE(May attach if more space needed) `3` 6 C-\ (- I � , 4 ca-5— eA �, r QA --- C hgn k; '73 6 0 Anr��Lt K�R R-0--c. c.AAk,Cc a - -- NATURE OF WORK: House Addition House Renovation LJ Repair of Failed Septic System Checklist (to be completed by office ce staff-person receiving variance request application) Please submit copies in S separate,collated packets. Five(5)copies of the completed variance request form Five(5)copies of engineered plan submitted(e.g.septic system plans) Five(5)copies of MA DEP approval letter for 1/A septic systems only. Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). $95.00 variance request application fee collected (No fee for lifeguard modification renewals , grease trap variance renewals [same owner/lessee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Paul J.Canniff,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Donald A.Guadagnoli,M.D. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BMQD49H2\VARIREQ Rev APR2017.DOC Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax (508) 477-5313 August 13, 2018 Re: 190 Horseshoe Lane, Centerville, MA (Assessors Map 207, Parcel 132) Construction Title 5 Septic System Dear Sir/Mam: Please be advised that an application for variances from the Massachusetts Department of Environmental Protection, Title 5, and Local Regulations have been submitted to the Barnstable Health Department for approval. The following variances are being requested: • 310 CMR 15.405(a&b) — CONTENTS OF LOCAL UPGRADE APPROVAL 1. A 4' variance, S.A.S. to property line (side), for a 6' setback. 2. A 4' variance, S.A.S. to property line (front), for a 6' setback. 3. A 10' variance, S.A.S. to cellar wall, for a 10' setback. 4. A 2' variance to the maximum depth requirement of 3', for a maximum depth of 5'. • LOCAL REGULATION, Chapter 360, Article 1 — Setback Requirements 5. A 67' variance, septic tank to coastal bank, for a 33' setback. 6. A10' variance, S.A.S. to coastal bank, for a 90' setback. The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. A public hearing will be held, to discuss the proposed work, on Tuesday, August 28, 2018, at 3:00 p.m. The hearing will be held at the following location: Town Hall Hearing Room Second Floor 367 Main Street Hyannis, MA S'.nte, ely, Peter T. McEntee P.E. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA a:- ft �r �.'�-`� _.._ -`�=" _::,. "'_.. -ua�w•-..vim. '.� _�`.;- .mac '. - �-t^^�._Sr w.-..Y.eiA _ �'"�"-fix-' __ -:2'E+4 --- -. - _,_ _ _S.UBSUREACE SEWAGE.DISPOSAL SYSTEM-IN:SPECT,ION FORM -� � -�_ _ _ _ t - �4 pp,yyy -+waVP�1 CiWWJWJ...�- — .-coarrX_�a.erress.....e1-94-Hofseshae Latte_Eerrte:ruffle—= AA&ess_of own,9r Date of Inspection .10/3019e (If different) "v Name of Inspector'John Graci Maria Etchells:43 Shaw Farm Rd Canton 02021 t Company Name Address and Telephone Number CERTIFICATION`STATEMENT I certify that1 have personally inspected the sewage"disposal'system at this address and that the information r ported.below. s true accu`rates, and cflmpl:ete as o(;the tame°:of inspection KT i`e inspection was performed°based on mytrairnng'and experience,ih the proper function and' 'malntenanCe of on-site.sewage,disposal systems: The.System: -` - r . x. Passes _ Conditionally Passes Needs Further aluafion By the Local Approving Authority — Fails Inspector's Signature ,y Date: io13v9s The.System Inspector shall submit a copy of this inspection report to the Approving Authority yJithm thirty(30)days of completing this inspections. If the system is a shared aystem or has'a design flow of 10,000 gpd"or greater,the inspector and the system owner shall submit the report to the appropriafe regional office of thie Department of Environmental Protection. , The original should be.sent to the•system owner and copies sent to the buyer. if_applicabte and the approving authority. INSPECTION SUMMARY: Check A, B, C, or.D: A] SYSTEM PASSES: x I have not found any information'which indicates that the system violates any o.f,the failure criteria defined as 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 not.) _ The septic tank is metal, cracked,structurally unsound, shows:substantial infiltration.or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street .. Boston,(Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 s �-•°�- r — � -fit-_ —_-Y-z-� .�r =- ". - — ram- .^""r""�"`.. --•—+""+'.��''- aT t r� �-�`- ' -,ram,.-_='•*--V'".�'=. stir 'x.-" •-�-;K._ .=_ '„-3i•-,-.,, f »�,4�-- '� m�-4. 2 2,?k.�•s,,, ,t T _ -_„^...,,r- - - _ �ProPertVA` - r ,- ,.,.,•_..���-- ._ _ �j--•s.��ur�=irr�h��c ��i{it�f3� 03z*�!i Q�P� _ - �=Sewage backyl3 or rea ou Y �+P r wttl ass inspectiorr+t fsriitf�aPGro� Lafth Hama- - - - — _ - - e s -The _ _ _The system required pumping more than four.times_a year-due to broken or.obsuucted pip (: - system will pass inspection if(with approval of the Board of Health): - broken pipe(s)are replaced obstruction is removed 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 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 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM EISYSTEMtIS FUNCTIONING IN A MANNER THAT DPROTECT,THE PUBLIC H PUBLIC WATER SUPPLIER ALTH AND SAF TYEAND THE DETERMINES THAT THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is r,ithin a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a 'hwprivate water supply well, unless a well water analysis ror coliform bacteria volatile organic compounds indicates that the +ell is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 opm. 3) OTHER D] SYSTEM FAILS: _ have determined that the system violates one or more of the following failure criteria as should d-i I d 310 CMR 15.303. The basis for this determination is identified below. The Board of Health shoufcf be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool a yDlscharge orontnrtg ptifttrfo ii�e st�,z� -the grouAd�� tirw �x e for'� rloaded or clogged _ -_- - cesspool. -- AS is_in_hyd uN: f�Iur� - Y (revised 11115195) --71 _ er1'�-�:'--�. � _�_.�Z.r..vt r _ �_�• -- •+r T �3�_ ....'sir. �-L -`i 1i ,Y— 4 SC'^-+ - ir_. - �.s N^_'c '-a-.`__ '•-�T -=' ..—`--- '_ �Ma1a E[ctiells43 ShavrFarm�Rd tic=litquid lesieLux3tip distriliuti4[f bo. .. outletirivertdtYe to an_over a o c gge - SRS=o`r._d�s pTiat"` — _ ==C+qutEfidej3tirrsesspoef is�ess tkzan 6—beln>hr_ie�rcLo�ava'iCzb�e uolutneas lass:tFian�172:ctaCow — = - — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(§), Numbers of times pumped Any portion of the SoiLAbsorption System, cesspool or privy is below the high groundwater elevation. - Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to,a surface water.supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of v/ell water analysis for coliform bacteria, volatile organic compounds. ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ 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 environment because one or more of the following conditions exist: 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) 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 5.00 and 6.00. Please consult the local regional office of the Department for further information. ..: _ - �-•--�-sue" — - _ - ti - -� (re vised-Tt115195)�- -� = �' :-�-•=-={ �"_=."__" �� -_ _ -�_ � _ � Y O v —= - y , zr f c ..'--+e--.ram'•-a-� .,. "2:->`� -.=--"" _ ..�_. — - •.-a^�.'r-^.--^- .—ram^e-'• , w'rf3 4�E S i+1FA ERf AE S�EN1 Jl S.'':E-PEgN Q" _ — "•,t= ��-�• L — _Tm3-eAt -Adalress-t9Qitsrrseshottunteerrtervme _ - _ - _ - — — I dWrlef —�ariaEfCTiettS ?t3Sh FanTR(rganthrM02177 - - - - �'�-tea--€_ Check.if the following have 15een one:..: -X-Pumping informafion was requested,"of-the:owner,occuparit,,and Board of Health.. — x None of the system components have been pumped for at least two weeks and the 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. n1aAs built plans have been obtained and examined. Note if they are not available with NIA. x The facility or dwelling was inspected for signs of sewage back-up. x The system does not receive non-sanitary or industrial waste flow. x The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x 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. x The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. x The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. 4 .,m;,.�. _ •� �„� �=�;...,,.,..,..wY.....3G.'._�^".�'7�•.-��"-" T '""ti=���"'.3w+.`��� -sue.-s:=-+:'c.c,...::H--..-..--_- "^"�'.+-- C - t- r -a: .,'�'..v +*..t.,-=-..-• - _r"'r_ 1;0!';".�"'l`'3 .� yam_. �_ a -�• .�.� � __: ��� �.�...,c-x.. _ _�_ .n_ L�..,r—^'- �-��- ,.,T .,�-"'-..,,.�,.•—',�=:M.:e�.a'�'e='�-.s`:'T�� �r..F'H��—*,_-'-'� -�=-<�c.-"`� r�_"L�`-"¢^ .�'-- "`._.z.+T-•--.Ti-�. — — -µ'-yet-�fhedr�orus=3 - - _ ur t ar of current r n s. u — - --_ w iun,�cohne-cted to system{yes 777 Last date of occupancy: summer COMMERCIAL/INDUSTRIAL: Type of establishment: Na ` Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: n1a Last date of occupancy: n<a OTHER: (Describe) rVa Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes.volume pumped: 0 gallons Reason for pumping: n/a TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system X Single cesspool X Overflew cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source information: 1969 -Sewage odors-detected when-arriving at the site (ye7.or no) Na. „_(reytised it115l95)y - 7 3 _ t _ :�o. .....y......-- .. .....—..m.r—�,—. - ZA t -=391 forp loe ene Cwterutlle-- f ><r--- ., a ct�F�F33'ti�K L�262 --_ __=_�u �,�-- =.� —- �'• - ftog-ate-on-site=pfanJ -r _=' ra�'e�f34•� �eate_-rnefal-•ERP->-other{.e�cp4aicl}___ -� - ---- --- - Dimensions-Va: Sludge depth:n1a Distance-from top of sludge to bottom of outlet tee or baffle: n1a Scum thickness'.nfa Distance from top of scum to top of outlet tee or baffle:nfa Distance form bottom of scum to bottom of outlet tee or baffle: n1a 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.) nla GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:nfa Distance from top of scum to top of outlet tee or baffle:nfa Distance from bottom of scum to bottom of outlet tee or baffle: nia 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.) n1a 7revfsed 11/15199%^= ` - _ _ T, �, t L w • _- .- ?'R�-vim'�2.'y_" - " SLIBS11F3EA_CE SEkYA�iEDISPdiA.L.SYS liF-1V SY TEft7fNF6RMkT AD, cVri T 3 - -_._� =twTrra Etctle0s d3Bh3WFarttt Rd Canto 0 0 - '.," dY6�..Ln�e�tacr�49E30196-� -= lid i— Fly ofir te__,metal_FRP�othgr(ex ain) Dimensions: n1a - - - Capacity.: nta gallons - Design flour:: n1a gallons/day Alarm level: rda Comments: (condition of inlet tee, condition of alarm and float switches, etc.) nla DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) nla PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_ Comments: (note condition of pump chamber, condition of pumps and appurtenances. etc.) Na (revised11115195)_= 2]5_ 5 g S R 1 F.. r �� � ..�� -• +---.r '1r• r•"Y, ^"]e.y.,o•...�'z•'c_fit _ - ""�,�-'�' Tv.�,_ ^S� _ �f� S1J$SURE E�E.WASsEA1SP4SF�L SYSTEM tiVSPECTldt�F4RId _ _ -• :'..T •�-ram_,... �- "`'r�i.�','�' 4"``^`"_ _ ___ - _ _ ---T _�'_'�- '4<:. �"+^�T_^l""9'f�^'1 "_ =.a Prop_y AddFesS�97I HoYsitbe 6arieCenteruiHe C3bNRE� f($�1f&Etetlells 43Ti�i9ZffffRt>`£37RbZk420 r-.�*a�{�_��L4lkre>.�f.30/9g" - .,.�` -- - -- — '_ 3•� _ -' _ ,a •.-x��,.�� .- �5�_.- '._ � ^.-o'er '...__ -"'�^'^«� �. _.. �.�`"• x a '..'�^--_-,--_ v. �._y__-. -�soir���c��Tlof�-sYSTEf�-�s�s�-� -_-_ _ - _- __ --�--- �-.---�._ -,�� .f _ -�`, ,.,�-�,=-.�•.•.=�; '" �T9.ca3e`san�ite:Alan,ifpossible;.excavation not required, 6utmay be approxlmated6y nortirt"�rusiveTn"'efio3's`�--` - _ "- '" Na Type:: - leaching pits, number: n1a leaching chambers, number:nla leaching galleries, number: nfa leaching trenches, number, length: Na leaching fields. number, dimensions:nfa . overflow cesspool, number:6'x6' block Comments: (note condition of soil. signs of hydraulic failure, level of,ponding, condition of vegetation, etc.) The leach pit is structurally sound and functioning property.The pit was empty at the time of the inspection. CESSPOOLS: x (locate on site plan) Plumber and configuration: one Depth-top of liquid to inlet invert: empty Depth of solids layer: nfa Depth of scum layer: nfa Dimensions of cesspool: 6'x6, Materials of construction: block Indication of groundwater: none inflow(cesspool must be pymped as part of inspection) Na Comments: (note condition of soil, signs of hydraulic failure. level of ponding, condition of vegetation, etc.) The cesspool is structurally sound.Recommend pumping system every one year for maintenance. PRIVY:_ (locate on site plan) Materials of construction: nfa Dimensions: nfa Depth of solids: Na Comments: (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.) PrivyComments (revised 11115195) -- ------------------ SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM — -- — PART C SYSTEM INFORMATION (continued) roperty Address:_190-Horseshoe Lane Centerville Owner; Marla Etchells:43 Shaw Farm Rd.Canton 02021 -" Date of Inspection:10130196 - L' SKETCH F;SEWAGE DISPOSAL SYSTEM:.: Inclgcfe,ti-es to at ieasYtwo permanent references landmarks—or—benchmarks `l66a't*"I wells within 100' I f DEPTH TO GROUNDWATER Depth to groundwater: 12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 tlar LEGEND b _ WLF-1 ——10—— EXISTING CONTOUR 5.48 N x 11.98 EXISTING SPOT GRADE \ Nay LOCUS W EXISTING WATER SVC. \ Church G EXISTING GAS SERVICE 1) —UGW— ONDERGROUND WIRES eppOn `n o \ WLF-2 �a WETLAND SYMBOL \ II \ �,3S W F-12 12 13 0 WETLAND FLAG MADEP POLICY 92-1 rT�^ TEST PIT Figure 2 \ W L F-3 a BENCHMARK & Barnstable Coastal Bank , \\ \ \ `% 5.10 `° Slope exceeds 187. \ \ IZD 5° 0 O rseyr + 20, o �♦ \\ �\ �� \\ LOCUS MAP NOT TO SCALE + 21.60 `♦ \ \ \ \ \ o BENCHMARK. C:)- o♦U,_ 1\ \\ \\ `y � WLF-4 MAGNETIC NAIL SET �U, ♦ v♦ N q 8.55 \ EL.=21.58 -A U)A♦� 1 17� ` 1 + 5,75 , 5.01 : OF 414s n o /�♦� W♦ x 18, \ \ \ \\ I I i o PETER T. p _ / z ♦o vz♦ ` \ -�\�'p \ C I McENTEE ���♦G♦` +. •N / ♦♦ 19,48 ♦ �+ / j\ \��\ \ F-5 CIVIL -A + ` 1 . 5.15 No. 35109 20111 80'54 00 o\�F \7.86 o I /STE �z♦ 108'f o ♦ m / o \ \ ,`'� \ \ VEGETATED I '\e ♦ I ..••••'" � � g0 0 / � � \ \ \ \ � I WETLAND 21.71 ♦ 20.82 rn +'�(0,15 x TP-9 GARDEN ♦ O �` 10,47 n 3,3j \\ \ \ \ \ \\ ♦ `` 19.11• + \O O PROPOSED 21,58P PTIC TANK \ \ \ \ cJ MAG. NAIL SET 6 ♦ \ \ �`Oq0 9,77 S�RJ F PA 20 9,27�p o <i \ \� \\ \ \\ `\ \\. \\ I WLF-6 ;�• O �'% \' 4.79 FEMA FLOOD DESIGNATION ' `� ♦ W 2 07�' \\ �� \ I MAP NUMBER: 25001 C0564J t 9 .'z. 10 a`n� �► 160ECK ♦ < d? 6.4 3 1� . . •,. �o�F ♦ \ \ , 1 EFFECTIVE DATE: JULY 16, 2014 2010 \ 1 • Zone X and AE (EL12) l 20.57 Z$ / ♦ , 19,'3 6 x EXISTING x ♦ 1 1 1 I \ ` WETLAND CONSULTANT 0 HOUSE(#190) 1 I I SABATIA, INC. <% ♦ 19,87 T.O.F.=19.75t 19,25 I , EX G CESS�GQLS ` 21 Observatory Ln olpp VENT—DISCUSS �18,90 I I ` PUMP,�F�L WITH Pocasset, MA 02 559 NE R SE SAND & AHANDON (508) 563-5349 p WITH LOCATION.' LF-7 0, y�'� • ♦ SHE — I I 4.65 OWNER OF RECORD ♦ 18,93 • a'�n �P� ♦♦ I I ` �\ \ \ ELIZABETH A BROSMAN TRUST \ BROSMAN, ELIZABETH A TR ♦x / 01' ;18:89 GARAGE • ` I \�, \\ 190 HORSESHOE LANE I�' O ♦ vG�N �, ....E�AY, `.,.. is 99 `� I ' I CENTERVILLE, MA 02632 18.57 �1a :QR � LOT 30 I B 2� - ;•. \ 18.91 ____J 10,540 ±SF I PROPOSED SEPTIC SYSTEM UPGRADE PLAN 17,64 190 HORSESHOE LANE, CENTERVILLE, MA A. . . . . . . . X'ta 5a 15.66 • . . . . . • • • • ' ' . . . .. 1 Prepared for: Elizabeth Brosman, 190 Horseshoe Ln, Centerville, MA 02632 ♦ "� E ` Engineering by: SCALE DRAWN JOB. NO. 6.73 N 84'34100 Engineering Works, Inc. 1"=20' P.T.M. 194-18 17,10 ` t PARCEL ID: 207-132 12 West 477 Crossfie 5313id Road, Forestdale, MA 02644 ATE /18 CHECKED E MED 1 H Q NO. r NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=16.0 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=19.75t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=19.1 t F.G. EL.=18.9f F.G. EL.=20.4f F.G. EL.=20.5t VENT MAINTAIN 27 SLOP OVER S.A.S. L = 17' 3'(max.) L = 51' L = 5' GENERAL NOTES: ® S=1% (MIN.) ® S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC 4'SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" DOUBLE WASHED STONE 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 3. �o"I ® aea�iaaa (OR APPROVED FILTER FABRIC) BOARD OF HEALTH AND THE DESIGN ENGINEER. t4' aaa®®aa 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS a®e a ®e® 4 TO 1-1/2" DOUBLE INV.=16.50 48" LIQUID 3/ " / " OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LEVEL ADD PROPOSED 4' 4.8' 4' WASHED STONE GAS BAFFLE INV.=i5.77 _ INV.=15.60 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: INV.=16.25 D BOX EFFECTIVE WIDTH = 12.8' -310 CMR 15.405(1)(a&b): 3 OUTLETS 1) A 4' variance, S.A.S. to property line (side), for a 6' setback. INV.=15.50 2-500 GALLON LEACHING CHAMBERS PROPOSED SEPTIC TANK 2) A 4' variance, S.A.S. to property line (front), fora 6' setback. SURROUNDED WITH STONE AS SHOWN 3) A 10' variance, S.A.S. to cellar wall, for a 10' setback. ICONNECT TO EXISTING SUITABLE SEWER PIPE/S H-20 RATED 3" LAYER OF 1/8" TO 1/2" 4) A 2' variance to the 3' maximum cover requirement, for up to AT HOUSE, AT OR ABOVE, INV.=16.80t(verify) DOUBLE WASHED STONE 5' of max. cover. S.A.S. shall be H-20 and vented. TOP CONC. ELEV.=16.6t (OR APPROVED FILTER FABRIC) -LOCAL REGULATION Chapter 360. Article 1 - Setback Requirements NOTES: BREAKOUT ELEV.=16.00 5) A 67' variance, septic tank to coastal bank, for a 33' setback. INV. ELEV.=15.50 aaa®® 6) A 10' variance, S.A.S. to coastal bank, for a 90' setback. 1 CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & 00006 ®a®®a 00,30 3 aa8aa INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. BOTTOM ELEV.=13.50 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 2 x 8.5' = 17.0' 4' TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE TRUE TO GRADE ON A MECHANICALLY COMPACTED 4. OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' DESIGN ENGINEER. SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=8.50 T 3/4" TO 1-1/2" DOUBLE ENGINEER BEFORE CONSTRUCTION CONTINUES. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE WASHED STONE 5. ALL ELEVATIONS BASED ON BARNSTABLE G.I.S.t. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SEPTIC SYSTEM PROFILE 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. E RESTORED DESIGN CRITERIA SOIL LOG 9 AGREEDALLEUPONEBYEOWNOER ANNDSON CO TRIAACTORAOR LL AS OTHERWISE AS DIRECTED BY THE APPROVING AUTHORITIES. NUMBER OF BEDROOMS: 3 BEDROOMS DATE: JULY 10, 2018 (REF#15,701) 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY SOIL EVALUATOR: PETER McENTEE PE(SE#1542) THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT CONSTRUCTION. DESIGN PERCOLATION RATE: <2 MIN/IN ELEv. TP-1 DEPTH ELEV. TP-2 DEPTH 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS DAILY FLOW: 330 GPD 20.0 A 0" 20.3 q 0" IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND LOAMY SAND LOAMY SAND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). DESIGN FLOW: 330 GPD 19 3 10YR 4/2 8„ 19 6 10YR 4/2 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE GARBAGE GRINDER: NO-not allowed with design B FINE B FINE 8 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAMY SAND I LOAMY SAND 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 10YR 5/4 10YR 5/4 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. .74 GPD/SF 17.7 28" 17.5 34" PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY C C PERC 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED 32"RC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES MED. SAND 4 MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 7/3 2.5Y 7/3 � g0 HORSESHOE LANE, CENTERVILLE, MA 1 SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Prepared for: Elizabeth Brosman, 190 Horseshoe Ln, Centerville, MA 02632 EngineeringEngineering SCALE .TA. B. TOTAL AREA:.............................................................. 471.2 S.F. n S D JO 8.5 t38" $18 t38" N.T.S. P.T:M. 194-18 E i ng Works, Inc. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD PERC RATE <2 MIN/IN. "C" HORIZON 12 West Crossfield Road, Forestdole, MA.02644 DATE CHECKED SHEET NO. NO GROUNDWATER ENCOUNTERED (508) 477-5313 8/11/18 P.T.M. 2 Of 2 ram-•+ r LEGEND q WLF-1 --10-- EXISTING CONTOUR ` ,5.48 N Rood x 11.98 EXISTING SPOT GRADE C \\ \ Church LOCUS yll EXISTING WATER SVC. G EXISTING GAS SERVICE \ , \ ` Lo m Boron -UGW- ONDERGROUND WIRES \ , o^ g WLF-2 � WETLAND SYMBOL \ 5.38 6 WF-12 O WETLAND FLAG MADEP POLICY 92-1 \ �01 & TEST PIT Figure 2 \ \ \ W L F-3 BENCHMARK & Barnstable Coastal Bank \ \ \ `. 5.10 `° Norse � Slope exceeds 189 ` \ ` \\ \ m yo�'l' No \ \ \ a S N 0 18.1� \\ \ \ ,\' \ \\ m o� 7 rseyr LOCUS MAP + 20• 0 1 \ \\ \ \ \ NOT TO SCALE + 21.60 BENCHMARK o'�- �� )N UN_ WLF-4 MAGNE77C NAIL SET to♦ y♦ \ N 8.55 1 + 5,75 5,01 OF EL.=21.58 v � �-� G 1 171 Xf3 \ '�gss9 Q I I 13fc G o /�� `�� \\ \ \\\�?'�\ I I o PETER T. s WORK LIMIT (TYP.)/ �z -� � � ` 18, \ � '"\r'p\ I c I � McENTEE v / \ 19.48 `0 19 � \� \2�\ I 171 ( WLF-5 v CIVIL 81 \o\\ \ I 5.15 No. 35109 20:. + , .N 80.54=00 E� •� o EDGE o+ �Z�p\ \,� \2�\�t�\ \7.86 0 G/STE � � � � � \ \ •�'-\��\ \ � � VEGETATED SI � o - ��� .108 t 9� 'S� �'o \-'\\ \ w I WETLAND �V 21.71 20.82 TP_9 GARDEN.15' �O ♦ 4' 1�•47 3 1 \ \ \ \\ \\ I A � ♦� o \ \ � \ \ I PLAN REVISION 8/29/18 t 19.11 14 O PROPOSEf� \ \� i WATERPROOF AND WRAP SEPTIC TANK 21,58 ilt 1R�' PT IC TAN \ \ \ k MAG• NAIL SET �'� 6`' �♦ \ \ \ \ N\\ \\ �\ .•..�.:,` +' SRO ♦ o \ \ \ \ 9.77 `' PA � .20 <�� \\ \\ W6 ii J� 9. \' \\ \ 4.79 FEMA FLOOD DESIGNATION ems\ ' ��' r ♦ DECK O 2 07�' \ \ \ MAP NUMBER: 25001 C0564J t'� X .1 ♦ \ \ \ &43 I EFFECTIVE DATE: JULY 16, 2014 //� Zone X and AE (EL12) 20.57 ♦ ' 20.20 19•'3 6 EXISTING ♦ 1 1 I WETLAND CONSULTANT Q - " • HOUSE&190) x I i I I SABATIA, INC. 19.87 19.25 EX>S�ING CESS�QOLS 21 Observatory Ln N <�� ♦ T.O.F.=19.75t ` I ` y O VENT-DISCUSS +18,90 PUMP,AFL WITH , Pocasset, MA 02559 (� O ♦ LOCATION. RI SE I ` SAND & A8A\NDON (508) 563-5349 mod, ♦ I I I \ 'p0, ♦ WITH OWNER sy ` I � �� WLF-7 Off, ♦ �'� SHE - - I ` \ � \ 4.65 OWNER OF RECORD tJ� ♦ 18.93 ��n �P� ♦ I I ELIZABETH A BROSMAN TRUST Va \ BROSMAN, ELIZABETH A TR X 01' "18 89 190 HORSESHOE LANE ♦ ` Y< GARAGE x I CENTERVILLE, MA 02632 O ♦ �� i \. ....WA I 18.57 v i1� ..DR LOT 30 ...:E `18 18,99` ,91 I 82� PS\ ---_-�� 10,540 ±SF I �� PROPOSED SEPTIC SYSTEM UPGRADE PLAN ,/ ♦ 17.64 - ` 190 HORSESHOE LANE, CENTERVILLE, MA ` �. x 1 ,5a 15.66 115 f Prepared for: Elizabeth Brosman, 190 Horseshoe Ln, Centerville, MA 02632 ♦ +� SCALE DRAWN JOB. NO. A 4,p0 ,E ` Engineering by: C� 6J3 N 84�, ; Engineering Works, Inc. 1"=20' P.T.M. 194=18 PARCEL ID: 207-132 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 17.10 (508). 477-5313 8/11/18 P.T.M. 1 Of 2 c SEPTIC TANK NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=16.0 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=19.75t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL=19.1t � F.G. EL:=18.� � F.G. EL.=20.4t F.G. EL.=20.5t ? � _ VENT A¢ � MAINTAIN 2% SLOPE OVER S.A.S. L = 17' 3'(max.) t L = 51' ® SCH4 (MIN.) ® S=1% (MIN.) L 1 5' GENERAL NOTES: 4"SCH40 PVC 4"SCH40 PVC ®"SCH 0(P C) 2" LAYER OF 1/8" TO 1/2" DOUBLE WASHED STONE 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 11 �� I ia" } 6 aaaFaaa (OR APPROVED FILTER FABRIC) BOARD OF HEALTH AND THE DESIGN ENGINEER. 1. as®®®a® INV.=16.50 48" LIQUID Baaaaaa ---3/4" TO 1-1/2" DOUBLE 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS LEVEL ADO PROPOSED 4' 4.8' 4' WASHED STONE OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE GAS BAFFLE INV.=15.72 _ INV.=15.55 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: INV.=16.25 EFFECTIVE WIDTH = 12.8' -310 CMR 15.405(1)(a&b): 3 OUTLETS INV.=15.50 1 A 4' variance, S.A.S. to 2-500 GALLON LEACHING CHAMBER ) property line (side), fora 6' setback, .PROPOSED SEPTIC TANK 2) A 4' variance, S.A.S. to property line (front), fora 6' setback. IAT HOUSE,, (verify) SURROUNDED WITH STONE AS SHOWN 3) A 10' variance, S.A.S. to cellar wall, for a 10' setback. CONNECT EXISTING SUITABLE SEWER PIPE/S H-20 RATED 3" LAYER OF 1/8" TO 1/2" 4) A 2' variance to the 3' maximum cover requirement, for up to AT OR ABOVE, INV.=16.80t DOUBLE WASHED STONE 5' of max. cover. S.A.S. shall be H-20 and vented. TOP CONC. ELEV.=16.6f (OR APPROVED FILTER FABRIC) -LOCAL REGULATION Chapter 360. Article 1 - Setback Requirements NOTES: BREAKOUT ELEV.=16.00 5) A 67' variance, septic tank to coastal bank, for a 33' setback. INV. ELEV.=15.50 6 ® 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & a!x8.!5 ! a 6) A 10' variance, S.A.S. to coastal bank, fora 90' setback. INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. aBOTTOM ELEV.=13.50 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4 ' 4' TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE TRUE TO GRADE ON A MECHANICALLY COMPACTED 4 OF NATURALLY OCCURRING 25.0' DESIGN ENGINEER. SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=8.50 - LEACHING SYSTEM SECTION ENGINEER BEFORE CONSTRUCTION CONTINUES. 3/4" TO 1-1/2" DOUBLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. WASHED STONE 5. ALL ELEVATIONS BASED ON BARNSTABLE G.I.S.t. 5) SEPTIC TANK SHALL BE WATERPROOFED & WRAPPED. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SEPTIC SYSTEM PROFILE 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. DESIGN CRITERIA SOIL LOG 9• ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. NUMBER OF BEDROOMS: 3 BEDROOMS DATE: JULY 10, 2018 (REF#15,701) 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY SOIL TEXTURAL CLASS: CLASS { (LOADING RATE=0.74 GPD/SF) SOIL EVALUATOR: PETER McENTEE PE(SE#1542)WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. DESIGN PERCOLATION RATE: <2 MIN/IN ELEy. TP-1 DEPTH ELEv. TP-2 DEPTH 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS DAILY FLOW: 330 GPD 20.0 A 0" 20.3, A 0" IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND DESIGN FLOW: 330 GPD LOAMY SAND LOAMY SAND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 10YR 4/2 10YR 4/2 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE GARBAGE GRINDER: NO-not allowed with design 19.3 B FINE B FINE 8,, 19.6 8" INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAMY SAND LOAMY SAND 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND .74 GPD/SF 17.7 10YR 5/4 10YR 5/4 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY C 28" 17.5 34"C PERC 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED 32"/50" SYSTEM COMPONENTS NOT SHOWN ON THE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES MED. SAND MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN 2.5Y 7/3 2.5Y 7/3 SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. 190 HORSESHOE LANE, CENTERVILLE, MA I BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Prepared for: Elizabeth Brosman, 190 Horseshoe Ln, Centerville, MA 02632 TOTAL AREA:................. .........................................471.2 S.F. Engineering by: SCALE DRAWN JOB. NO. 8.5 1 1 138" 8.81 138° N.T.S. P.T.M. 194-18 Engineering Works, Inc. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD PERC RATE <2 MIN/IN., "C" HORIZON West Crossfield Road, Forestnc MA 02644 DATE CHECKED SHEET N0. NO GROUNDWATER ENCOUNTERED (508) 477-5313 8/11/18 P.T.M. 2 of 2