The URL can be used to link to this page

Home My WebLink About0193 HORSESHOE LANE - Health 1?� O rseshoe Lane Cerville F. == 207 121 I No. 4210 1/3 ORA 30 � � t 0 om 10% U& ® o 0 O 1 No. 00 2 ' e`d f— E Fee s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprfcation for ;Bigool *p9tem Conztruction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel � ! ..5CcY71 4P_ .. Installer's Name,A/°ess,a¢Tell.L � Designer's Name,Address and Tel.No. C mcru M eC �►� 1 I 9 A 31 Type of Building: Dwelling No.of Bedrooms �J 7 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building T_- No. of Persons Showers( ) Cafeteria( ) Other Fixtures ^ Design Flow 3�;() gallons per day. Calculated daily flow .33g gallons. Plan Date 9— I d QL. Number of sheets I Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil--19& a&( rl N ture of Repairs o Alterations(Answer when applicable)i /) ��>Uc S;�/ . /2y V_W 1)_6 oc e -i Date last inspected. DESIGNI;�u ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING Agreement: THE SYSTEM WAS INSTALLED IN STRICT The undersigned agrees to ensure the construction and maintenance of the aACC4R9AWg Lpri3ipLAWage 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 issued this oard of H 1 Signed Date A./o ,.I, Application Approved by Date G Application Disapproved for the fol owing reasons Permit No. ;Z 00 a 2 Date Issued (!fZ No. ' U�� 2k� : " �r ...W Fee ..; THE COMMONWEALTH OFASSACHUSE-T.TS__ Entered in computer: V r -r. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for 30igogar bpgtem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Q r Owner's Name,Address and Tel.No. 111p �} /►�flsbn Assessor's Map/Parcel aa'7 is Installer's Name,Ad0 ress,ano Tel. o. Designer's Name,Address and Tel.No. , M�'d rd qUl - 3/ _ . Type of Building: (� Dwelling No.of Bedrooms ST Lot Size sq.ft. Garbage'Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria(� ) Other Fixtures , a Design Flow =,`) l gallons per day. Calculated daily flow , / gallons. Plan Date 9_. I-O�,... Number of sheets Revision Date Title - Size of Septic Tank Type of S.A.S. Description of Soil N ture of Repairs or Alterations(Answer when applicable) i GC,e S,7- .W f ' ,)I e ` t Date last inspected: J 1 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 issued this P oard of He Signed Date I A/6 Application Approved by t Date 0 . Application Disapproved for the following reasons Permit No. 2 9� Date Issued 1§2 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CT TIFYi that the On it Sewage Disposal System'Constructed( )Repaired( )Upgraded(L__r_ _ Abandoned( )by (.�. at a _ �/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 02 Ua 2-2&2 dated Installer ,(J A Designer The issuance of s ermit shall not be construed as a guarantee that the systkr ill fu ctionn as de sig:e I Date U Inspector 'V ------G--------------------------------- No. .ZUd�' o�t�.Z Fee ��.. THE COMMONWEALTH OF MASSACHUSETTS }PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mig;poal *patent Construct" n Permit Permission is hereby granted to Co struct( )Repair )Upgrade( Aba n( ) stem Gated at T _O 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:Construction must be completed within three years of the date of this t. Date: 69. Approved by i TOWN OF BARNSTABLE LOCATION �� (( CMS- lr� SEWAGE #,r-- VILLAGE_ -&-KA ASSESS S MAP & LOT D - INSTALLER'S NAME&PHONE NO.'- �� SEPTIC TANK CAPACITY i5a 01I4- nJ i3 LEACHING FACILrrY: (type) 5dUG Oqt (size)a,5�6a, 2c- D I ' NO.OF BEDROOMS y BUILDER OR OWNER O� PERMrrDATE: COMPLIANCE DATE: U1. r 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 o 0 ec�, TOWN OF BARNSTABLEL LOCATION SEWAGE # - ' VILLAGE p �Z�-r v�� ASSESS S MAP & LOT U INSTALLER'S NAME&PHONE NO. ✓� SEPTIC TANK CAPACITY 115n �- LEACHING FACILITY: (type) (size) C2 Kl NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: U 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 o o ec�, ` �s 1 erl'�� FAILED INSPECTION DATE/20/0 PROPERTY ADDRESS :193 Horse Shoe Lane ----------------------- - Centerville ,Mass_ 7 �l�.� 02632 ------------------------ On the above date, I Inspected the septic system at the above add ss. This system consists of the following: 1 . 2-6 ' X8 ' block cesspools . Cesspools are in series . �o L Based on my Inspection, I certify the following conditions: 2 . This is not a title five septic system. 3 . This is a sewagesystem. 4 . Both cesspools are in hydraulic failure . F 5 . Pumped both cesspools at time of inspection . 6 . A new title five septic system needs to be installed . SIGNATURE :, Name p m _r _P._ Maco=ber _JrJ_____— Company ; Jose ph_P __Macomber_& Son , Inc , . ^ c�ress :--Box- 66 -- --------------- _-Centerville _ Ma_- 02632-0066 P.none : --- 508- 775- 3338 ------ ------------ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC, Tan ks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 1 • 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 193 Horse Shoe Lane Centerville ,Mass . Owner's Name: David Mason Owner's Address: 193 Horse Shoe Lane CPntPrvj11e ,Mass _ 02632 Date of Inspection: 6 2 fl/n 9 Name of Inspector: (please print) Joseph P .Macomber Jr . Company Name: J. P. Macomber & Son Inc . Mailing Address: Box 66 (7PntesiLl M— . 02632 Telephone Number: — CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Beds Further Evaluation by the Local Approving Authority Y Fails Inspector's Signature: leoll-,61�1-00XDate: The system inspector shall bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments **.**This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 , Page 2 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 193 Horse Shoe Lane entervi e , ass . Owner: David Mason Date of Inspection: 6 20 02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D 't A. System Passes: e5 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: Both cesspools are in hydraulic failure . A new septic system needs to be installaed Both cesspools were pumped at time of inspection . B. System Conditionally Passes: VQ_ 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. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined"please explain. VAf4 -The tic tank 's 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 Cenificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 4,1L!VL,Observation of sewage backup or break out or high static water level in the distribution box ue 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 obstruction is removed distribution box is leveled or replaced ND explain: /LtC� The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propern• Address: 193 Horse Shoe Lane Centerviiie ,Mass . Owner: David Mason Date of Inspectioo: 6 20 02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. S,N'stem 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: �Zj Cesspool or privy is within 50 feet of a surface water 0 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. S*stem 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'with in 100 feet of a surface water supply or Tributary to a surface water supply. f The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple �YD The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. *Qd The system has a septic tank and SAS and the SAS is less than 100 feet but 0 feet or more from a private \pater supple well,' Method used to determine distance L ee Z,1 .11 This s'stem passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facilir) and the presence of ammonia nirrogen and nitrate nit7ogen is equal to or less than 5 ppm, provided that no other failure criteria are rriggered. A copy of the analysis must be artached to this form. 3. Other. / The system consists of two 6 'X8 ' Block cesspools in series . Both cesspoo s are in y Tau is ai ure . A nPw septic system needs to be insta le 3 Page : of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:v 193 Horse Shoe Lane Centerville ,Mass . Owner: David Magnn Date of Inspection: t; /on /no D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Ycy ',o ►/ _ ckvp 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 cesspoo y� ,Swtic liquid level in the distribution box bove outlet invert due to m overloaded or clogged SAS or cesspool squid depth in cesspool is less than 6" below invert or available volume is less than ''A day now cquved pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped j, _ Any ponion of the SAS, cesspool or privy is below high ground water elevation. Any ponion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ y ponion of a cesspool or privy is within a Zone I of a public well. _ is .any ponion of a cesspool or privy is within 50 feet of a private water supply well. Any ponion 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. jTbis system passes If the well water analysis. pert.,rmed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (Yes'No)-The system fails. I have determined that one or more of the above failure criteria exist as described to 310 CMR 15 30). therefore the system fails. The system owner should contact the Soar: : Health to determine what will be necessary to correct the failure E Large Systems: To or considered a large system the system must serve a facility with a design now of 10,000 gpd to 15.000 gpo You must indicate cithe-r'ycs" or"no"to each of the following: (T?tc following criteria apply to large systems in addition to the criteria above) e s n o/ 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 !f you nave answered "yes" to any question in Section E the system is considered a significant threat, or answered es" in Section D above the large system has failed. The owner or operator of any large system considered a s:e.n.:Ficant tfveat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR ;0- The s)•stem pwner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 193 Horse Shoe Lane entervi e , ass . Owner: David Mason Date of Inspection: 6 20 02 Check if the following have been done. You must indicate'yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health Ylkere 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 N/A z_ 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,�eluding the SAS, located on site ? "ALE—r Were the ssptic anholes uncovered,opened, and the interior of the tank inspected for the condition of the ba fles or tees, matena of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? the Was a f cility owner ner(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: Yes no � Existing information. For example, a plan at the Board of Health. d'/dam_ Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 193 Horse Shoe Lane Centerville ,Mass . Owner: David Mason Date of Inspection: 6/20/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):• %:�— Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): : Number of current residents: Does residence have a garbage grinder(yes or no):oP/D' Is laundry on a separate sewage system (yes or no):40 (if yes separate inspection required] Laundry system inspected (yes or no): ' Seasonal use: (yes or no): Water meter readings, if available (last 2 years usage(gpd)): 2000-84 , 000 gal lons=230. 14 GPD Sump pump(yes or no): 2001-92 , 000 gallons=252 . 06 GPD Last date of occupancy COMMERCIAUUYDUSTRIAL Type of establishment: J;q Design flow(based on 310 CMR 15.203): _gpd Basis of design now(seats/persons/sgft,etc.): _1(AjQ Grease rrap present (yes or no):.A/A Industrial waste holding tank present (yes or no):A Non-sanitary waste discharged to the Title 5 syst (yes or no): Water meter readings, if available: /r�/ ' Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records inform Source of information: Was system pumped as part of the inspection (yes or no): If yes, volume pumpedgallons -- How was quantiry pumped determined? �� Reason for pumping: goth cesspools filled to capacity . TYPE OF SYSTEM A16Septic 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) 41OTight tank &Attach a copy of the DEP approval /Q Other(describe): /ele Ap oxi at agq of all componen date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no):'Ch 6 r -Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 193 Horseshoe Lane Centerville ,Mass . Owner: David Mason Date of Inspection: 6/2 0/0 2 BUILDING SEWER(locate on site plan) N Depth below grade:� r Materials of construction: _cast iron &40 PVC_other(explain): Distance from private water supply well or suction line: /D Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight .No evidence of leakage .The system is vented through the house vents . SEPTIC TANKP.(locate on site plan) Depth below grade: Material of construction:AWconcrete,4metal4afiberglass tl�olyethylene 1614 other(explain) .i3O If tank is metal list age: is age confirmed by a Certificate of Compliance(yes or no):�,4 (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Id/14 Distance from top of scum to top of outlet tee or baffle: ,t,1dt Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: AX Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 'Once new system is installed Pump the septic tank every2-3 years . Septic tank is not present . GREASE TRAIX4,gc(locate on site plan) Depth below grade: . Material of construction:,tq concrete meta lWWfiberglass�olyethylene,Cother (explain): 440 Dimensions: _40 Scum thickness: OM Distance from top of scum to top of outlet tee or baffle: ti�9 Distance from bottom of scum to bottom of outlet tee or baffle: o%, Date of last pumping: fp O Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present . 7 Page 8 of I I OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 193 Horseshoe Lane Centerville ,Mass . Owner: David Mason Date of Inspection: 6/20/02 TIGHT or HOLDING TANKzA!&(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:AO, concrete&Ametal tjKfiberglass"polyethylene 40 other(explain): AM Dimensions: AM Capaciry: ,AA gallons Design Floes: JM gallons/day Alarm present (yes or no): _,da, Alarm level: �, Alarm in working order(yes or no): Date of last pumping: —AB Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BOXA�tJ_�,(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: to 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.): Distribution box is not present . PUMP CHAMBEM�WLJ ,(locate on site plan) Pumps in working order(yes or no): W-4 Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present . 8 Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 193 Horseshoe Lane entervi e , ass . Owner:David Mason Date of Inspection: 6 20 02 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) 2-6 X8 block cesspools.-Tn series . If SAS not located explain why: Located : See page 10 Type AJ6 leaching pits, number: d1Q leaching chambers, number: " leaching galleries, number: A2Q leaching trenches, number, length: 4 leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: J Comments(note condition of soil, signs of hydraulic failure, level of damp soil, condition of vegetation, etc.): Lnamv Land to boney fine sand Both cesspools are in hydraulic ter above invert pipes of bot cesspools . Pumped both t time of inspection . Soils are damp . Eegetation is normal . CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: ag Depth-top of liquid to inlet invert: . Depth of solids layer: Depth of scum laver: Dimensions of cesspool: -- ) Materials of construction: .►�t '�'�E �„ ( Indication of groundwater inflow(yes or no):X110 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Same as above PRIVY,-(locate on site plan) Materials of construction: A Dimensions: V09 Depth of solids: _ IVA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): -Pr; vv ; G not oresent 9 Pagc 10 0( 11 OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWACE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continvcd) Properr) A00,c,c: 193 Horseshoe Lane C,entervi e , a s . Owocr: David [� s,07 Dctc of Insp(c 0-0.7VIt7It2 SKETCH Or SEWACE DISPOSAL SYSTEM PTo.ioc c ctctch or the "'Ic 0i,polcl sylccm Inclvdtng tics to 11 Icest two permancm rcrcrcncc Ittn(mark, o, ocncNnuk, lo<,ic cu wctl, within 100 rcm I.Ocm whccc pvblic waccr supply cnlcrs the bviloing. 19'3 oe ls►� lRn-�t�ns�� w P / �� lo. ,Page 11 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 193 Horseshoe Lane Centerville ,Mass . Owner: David Mason Date of Inspection: 6/2 0/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water A0 feet Please indicate (check)all methods used to determine the high groundwater elevation: Obtained from system design plans on record - 1f checked,date of design plan reviewed: _ served site(abutting-prope bservation hole within 150 feet of SAS) Checked local Board of Health-explain: Ali Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain:h t t p : 1 1 Town , b a r n s t a b l e .ma . us . You must describe how you established the high gground water elevation: Used ; Gahrety & Miller Model . 12/16/94 Ground water elevations above sea ievei . Used ; USGS ; Observation Well Data . June 1992 Used ; USGS.; Technic41 up ulAulletin . 92-000-1 Plate #2 Annual ranges of uroun groundwater elev ations . Leaching t Pit L® :ect Groundwater: Feet Below Bottom of Pit A1gh,Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the botto�� v Of the leaching pit and the adjusted groundwater table is pe feet. 11 y,•r'nr+•—nrr*—rr 'r►.—mr•rts+r rarer+n*m.mn:•.�.-*e+vrr:+rrn•rrrn rsr.-btu tiarrm..m� .rrrrrr r—r—..-. 1 TOWN OF Barnstable LVJARU OF HEALTH - r SUBSURFACF SFWA(;F D1Sf'O8AL SY, STF,M INNSPECTION FORM - PART D .- CERTIFICATION -TYPE OR PRINT CI•EARLY- PROPERTY INSPECTED STREET ADDRESS193 Horse Shoe Lane Centerville ,Mass . ' 0 ASSESSORS MAP , DLOCK ANU PARCEL 0 OWNER' s NAMEDavid Masorr PART D - CEIRTIFICATION t NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J.P.Macomber & Son inC'!" COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City Stat• LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage dieposa7 system nt this address and that the information reported is true , accurate ) and omplete as of the time of .-inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; 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 16 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . J_/_ System FAILED* The inspection which I have co Vcted has found that the system fails to Protect the j)ublic health and the environment in accordance with Title 5 , 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date ne copy of this rt.ification must be provided to the OWNER, the BUYER ( Where applicable ) and the D OAR D OF )IHALI'II. * If the inspection FAILED , the owner or"'oporator shall upgrade ' the ayatem within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CFIR 15 . 305 . partd .doc MANHOLE CCVERS TO EXTEND TO y 2S, LUNG MMIN 6- OF FINISH GRADE i ''. 2, DEEP .I S90 BAFFLE REQ'D Z-id . � �f�m EL_(�. O 'S N evj 1 3F - ZZ�O I Z( �5 ( x D B 2' PEASTONE TOPPING GENERAL NOTES: TA�L 15 1 6• n Tom 3 =' -( CAP ENDS `�3[4' DOUBLE WASHED — ELEVATIONS SHOWN BASED ON U.S.G.S. DATUM. tt �, STONE ALL AROUND SYSTEM PIPE SHALL BE EITHER C.I. OR l i SCHEDULE 40 P.V.C. f S'CDt3E ' ' a — THE BOARD OF HEALTH SHALL BE NOTIFIED 20' PAIN. .4 ��` 17 ' ' _ PRIOR TO BACKFILLING OF SEPTIC SYSTEM. USA TWO(Z) 500 vRt.. --SEPTIC SYSTEM STRUCTURAL COMPONENTS SOI /Iv PER C RATE=< 2 MIN/INCH SHALL BE -CAPABLE OF WITHSTANDING A TEST LOG PROPOSED SEPTIC SYSTEM '�-- H-10 LOADING. UNLESS SPECIFIED OTHERWISE PER No SCALE PRECAST CotilC,l2ETE I SEPTIC SYSTEM UNDER DRIVEWAYS SHALL 6 ALL tY'S V j � �� D T COMPLY WITH A H-20 LOADING. DEPTH ELEV.= I V Xb J `�S� — THE DESIGN AND COMPONENTS OF a s 70fJE THE SEPTIC A LOAMY SAND ICYR i _ pp SYSTEM SHALL BE IN COMPLIANCE WITH THE ±= 9 LQWY SAND t0YR AGE J J S! STATE OF MASSACHUSETTS SANITARY CODE U�E.ST N30 E. 7t TA Ta P s j�r TITLE V. AND SHALL BE IN COMPLIANCE'.WITH S S I S� / r v �"j z vo k ,S THE LOCAL BOARD OF HEALTH RULES AND Cl MEDIUM SMD iam �3 REGULATIONS. A c 1 — THE CONTRACTOR SHALL BE RESPONSIBLE FOR �-� i �_ W LOCATION OF ALL UNDERGROUND UTILITIES AND ` ( — SHALL NOTIFY DIG — SAFE PRIOR TO CONSTRUCTION. NO GARBAGE GRINDER Z� � � Zo7 o„ C� I I Z I DESIGN CRITERIA: LEGEND: g/ ,� �C I�.` ';` DESIGN FLOW EXISTING CONTOUR 3 BEDROOMS AT, 110 G.P.B. / DAY 330 G.P.D. WATERHC�SERVICE y� —WTEST — ( 4�* REQUIRED SEPTIC TANK: GAS SERVICE —G—G ZG \ _N .._ 1.; O0 cAl BENCH HARK �gy (• D• = 2� ` SEPTIC TANK PROVIDED 14 DESIGN PERC RATE <2 MIN/INCH 42 SIZE OF REQ'D (SAS) AREA = 330/0.74 = 446 S.F. SIDEWALL 2 2) _?— *L 2 ( - 2�_ JAME8 A. yGm BOTTOM �l14�( 25 .) p p . S.F. I PAVUK a 3 CIVIL co SIZE OF LEACHING FACILITY PROVIDED: CIVIL I `� S.F. + 3O0 S.F. = 44-8 S.F. 1 ,f..►J 5.��-cam 5►c4 A<<,1., �v y1[e.3 T j � � �, G/ST G\ , I �A t'�,I U` ` A EFFECTIVE DEPTH: �� A •2 -(-+ _ EFFECTIVE LENGTH: :-Z S pD / / _ I _/)'7 EFFECTIVE WIDTH: l a si N b . HoR sesHo t I V OUTBACK ENGINEERING 106 WEST GROVE STREET 1 MIDDLEBORO, MA 02346 (508) 946-9231 P�, A PROJECT: SEPTIC SYSTEM REPAIR I \'" DESIGNINGPOR 1NST ENGIN 13 Hop-R t 14 O t / A n1 t r << � I THE SySTT ION AND �E MUST SUPERV � AS SHOWN M� jp I ACco �M Wqs I RTI�•IN /SE Z07/ LOT (.2 I .,,NSTALLED/NWRITING OWNEf2: -r STRICT OAvlI) MI�Sot4 l`� A