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Home My WebLink About0086 HORSESHOE LANE - Health (2) *Horseshoe Lane Centerville A=207 - 110 Slll llll � UPC 12534 No.2-153LOR YAiTlM�.YM Nov 09 2016 21:18 Jim The Inspector Man 5085349919 page 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c a F-► 86 Horseshoe Lane s�'I Property Address y Mark Hansen CM Owner Owner's Name � information is requlreo,orevery Ccntcrvilic MHO 02632 11-8-16 page. City/Town State Zip Code Date of Inspection 40 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:out forms A. General Information filling out forms / a�V 2 ```�11plllnu111"I on the computer, v ` use only the tab 1. Inspector: .�`y��-°: '' 9 key to move your cursor-do not James D 'gar JA M ES N use the return .Sears _ key. Name of Inspector = --I y yU:• ;co Ca ewide Enterprises, LLC =* ' *; �y Company Name - 153 Commercial Street I Company Address Mashpee MA 02649 Cdy/Town State Zip Code 508-477-8877 S1623 Telephone Number Uoense Number B. Certification 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving AuthorityA'ZZe�t. 11-8-16 1;ZspeotorsSlgnature 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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. i nis 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. 15ins.dec-rev.606 Title 5 official Inspection Form:Subsurface Sewage Disposal system•Page 1 of 17 Nov 09 2016 21:19 Jim The Inspector Man 5085349919 page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is Centerville required for every MA 02632 11-8-16 page. Cdy/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D , A) 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: The system is a 1500 Gal Tank.D Box and 15 Chambers B) 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): 151ns.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Nov 09 2016 21:19 Jim The Inspector Man 5085349919 page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is required for every Centerville MA 02632 11-8-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ NO (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 [:] NO (.Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 III the system is failing to protect public health, safety or the environment. 1, 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: I I-1 (`.accrnnl nr r+rivy is within 60 foot of o ourfaoo vratcr ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins.doc•rev,6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I 1 Nov 09 2016 2120 Jim The Inspector Man 5085349919 page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is required for every Centerville MA 02632 11 page. Citylrown State Zip code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the:public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 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 cystcm roccoc if tho woll water anolyoia, perfonTtcd at a DEP txrUrit:rd faUturatory, Tor Tecal 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. 3. Other: D) System Failure Criteria Applicable to All Systems: 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 ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ ❑ ® Liquid depth in amiligM is less than 6" below invert or available volume is less than Y day flow 4S,4Plii,vE 15ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslerr•Page 4 or 17 I Nov 09 2016 21:21 Jim The Inspector Man 5085349919 page 23 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Horseshoe Lane Property Address Mark Hansen owner Owner's Name information is required for every Centerville MA 02632 11-8-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont) Yes No ® 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 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 i 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 andtnitrate 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 2000gpd- 10,000gpd. ❑ ® 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. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,600 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact-the appropriate regional office of the Department. t5ins.doc•rev."6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 • I i Nov 09 2016 21:21 Jim The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts All Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is required.for every Centerville MA 02632 11-8-16 page. Cityrrown State Zip Code Date of Inspection C. Checklist 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 ❑ ® 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)) D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 i DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ins.doc•rev.6/16 Title 5 Official Inspection Forth:Subsurface SewQge Disposal System-Page a of 17 Nov 09 2016 21:22 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is required for every Centerville MA 02632 11-5-16 page. Cftyffown State Zip Cade Date of Inspection D. System Information Description: The system is a 1500 Gal Tank D Box and 15 chambers Number of current residents: 0 Does residence have a garbage grinder? ❑ rYes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ® No { Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): 2014-55,000Gais _ 2015-63,OOGal's. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: na Date 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 Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6r16 Tille 5 Official Inspemon Form:Subsurface Sewage Disposal System•Page 7 of 17 Nov 09 2016 2122 Jim The Inspector Man 5085349919 page 26 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is required for every Centerville MA 02632 11-8-16 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 11/18/15 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons a How was quantity pumped determined? Reason for pumping: 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 1/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t6ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 17 Nov 09 2016 21:23 Jim The Inspector Man 5085349919 page 27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name inrormauon is required for every Centerville MA 02632 11-8-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2006 Permit # 06 -479. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22" feet M citcriol of wr izU uVlitri r. ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suctiori line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank (locate on site plan): Depth below grade: 1' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El 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: 1500 Gal. Precast H-10 Sludge depth: tsins.doe-rev.sn6 Title 5 Official Inspection Form:Suoawface Sew9ge Disposal System-Page 9 of 17 ' I Nov 09 2016 21:24 Jim The Inspector Man 508534991.9 page 28 Commonwealth of Massachusetts 4 Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Horseshoe vane Property Address Mark Hansen Owner- Owner's Name information is Centerville required for every MA 02632 11-8-16 page. C1tyT0w11 State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape- Plan 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.): Tank at working level. Tank and covers at 1'below grade. In and outlet tce's. No sign of leakage or over loading. 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 t5ins.doc•rev.6116 a Title 5 Official Inspection Forth;Subsurface Savage Disposal System•Page 10 of 17 Nov 09 2016 21:24 Jim The Inspector Man 5085349919 page 29 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is required for every Centerville MA 02632 11-8-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 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 l5ins.doc•rev.6t16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Nov 09 2016 21:25 Jim The Inspector Man 5085349919 page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Horseshoe Lane Properly Address Mark Hansen Owner- Owner's Name information is required for every Centerville MA 02632 11-8-16 nacre. Citv/Town 4rarp Tin r'n 4. D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): D Box is 18"x 18"-18" below grade. Box is clean and sold. No sign of over loading or solid carry over. 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. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: i .. 15ins.doc•rev 6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 al 17 Nov 09 2016 2125 Jim The Inspector Man 5085349919 page 31 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Horseshoe Lane Property Address - Mark Hansen Owner Owners Name f isrequired or every very Centerville MA 02632 11-8-16 page. CityrT'own State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 15 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions.- 0 overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 15 cultic(10'6x37'6")Ck D Box and camera out to leaching. No sign of over loading or solid carry over. No sign of holding water. 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 I Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 13 of 17 Nov 09 2016 2126 Jim The Inspector Man 5085349919 page 32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments P 86 Horseshoe Lane Property Address Mark Hansen Owner Owners Name informalion is required for every Centerville MA 02632 11-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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, t5ins.doc-rev.6116 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 Nov 09 2016 21:26 Jim The Inspector Man 5085349919 page 33 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti r 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is required for every Centerville MA 02632 11-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 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 whoro public wator oupply cntera the building. Chcak one of the boxca Uclovy. ® hand-sketch in the area below ❑ drawing attached separately 9-9 I=RANT C 15 -y- 3 /- 9 wry`( 15insAoc•rev.6/16. Title 5 Official Inspection Form:Subsurface sewage Disposal System Page 15 of 17 Nov 09 2016 21:27 Jim The Inspector Man 5085349919 page 34 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurfaco Sowage Disposal eystcm r'orm - Not for Voluntary Asxam irerib, r 86 Horseshoe Lane Property Address. Mark Hansen Owner Owner's Name information is required for every Centerville MA 02632 11-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to to ground water: 10, feet 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: 5-4-06 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: T.H. on Design plan 10' G.W.. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins.doc•rev.5116 Title 5Official Inspedion Form:Subsurface Sewage Disposal System•Page 16 of 17 Nov 09 2016 21:27 Jim The Inspector Man 5085349919 page 35 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Horseshoe Lane Property Address Mark Hansen Owner Owner's Name information is MA 02632 11-8-16 Centerville required For every _ page. Cityrrown State Zip Code Date of Inspection„ E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteda.Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i Town of. Barnstable VASA rt�r�►1t�.�, Board of. Health. ' 200 Main Street Hyannis annis MA 02601 Y Office: 508-862-4644 Wayne.Miller,M.D.. FAX:...508-790-6304. Paul J.Canniff,D.M.D.. September 29, 2006 Robert A. Drake, P.E. 66 Greenville Drive Forestdale, MA 02644 .., "� �$6NIo�i sesho ; 1 e , (}� �'. Dear Mr. Drake, You are granted multiple conditional variances on behalf of your client, Jeanne Stevens Newman, to construct a replacement sewage disposal system at 86 Horseshoe Lane, Centerville, Massachusetts. The variances granted are as follows: Section. 360-1: The leaching facility will be located 65.3 feet away from a salt marsh, in lieu of the minimum 100 feet setback separation distance required. Section. 360-1: The leaching facility will be located 16.3 feet away from a ^ coastal bank, in lieu of the minimum 100 feet setback separation V distance required. Section. 360-1: The septic tank will be located 70.7 feet away from a salt marsh, in lieu of the 100 feet setback separation distance required. Section.360-1: The septic tank will be located 23.4 feet away from a coastal bank, in lieu of the 100 feet setback separation distance required. 310. CMR 15.211: The soil absorption system will be located three and eight- tenths (3.8) feet away from the front property line in lieu of the minimum ten (10) feet separation distance required. 310. CMR 15.211: The soil absorption system will be located five and nine- tenths (5.92) feet away from the foundation in lieu of the minimum twenty (20) feet separation distance required. Q:WP/Drake Stevens Newton 2006 1 of 3 310. CMR 15.211: The soil absorption system will be located five (5) eet aw from the water service, in lieu of the minimum ten (10)feet separation distance required. 310 CMR 15.211: The septic tank will be located seven (7) feet away from the front property line in lieu of the minimum ten (10)feet separation distance required. 310. CMR 15.211: The septic tank will be located five (5) feet away from the side property line in lieu of the minimum ten (10)feet separation distance required. 310. CMR 15.211: The septic tank will be located five and nine-tenths (5.9)feet away from the foundation wall in lieu of the minimum ten (10) feet separation distance required. These variances are granted with the following conditions: (1) 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. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three (3) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The waterline shall be sleeved. (4) The septic system shall be replaced within 3 months. However, if the property goes under contract for sale, evidence must be provided to the Board of Health that there are sufficient funds set aside in escrow for the replacement for the septic system. (5) The septic system shall be installed in substantial compliance with the engineered plans dated May 24, 2006. (6) The professional 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 engineered plans dated May 24, 2006. Q:WP/Drake Stevens Newton 2006 2 of 3 1 These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to its close proximity to wetlands and due to the small size of this parcel. The proposed plan appears to meet the maximum feasible compliance standards contained within the State Environmental Code, Title 5. Since ly yours, fine M' ler, M.D. C airman k Q:WP/Drake Stevens Newton 2006 3 of 3 I I I I vlll� J lA.-VJ� + I r y �F1HE�aY,� DATE: sAsxsrnsLs, t FEE: AlFO MAC A REC. BY C�= Town of Barnstable $CHED. DATE: !3 Board of Health Re- �. 200 Main Street, Hyannis MA 02601 -7//ff 'CM Office: 508-862-4644 FAX: 508-790-6304 Wayne A.Miller,M.D. Sumner Kaufman,M.S.P.H. Paul Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: \A o r_S e:S k 0 2. LAN 2 — Assessor's Map and Parcel Number: 0. t7. l i 1 o Size of Lot: O. 1—► Wetlands Within 300 Ft. Yes X Business Name: No Subdivision Name: T' l cs, c APPLICANT'S NAME: 7'ewn,rj 9_ Sieve fr\S �e W i�t A rJ Phone 181� Did the owner of the property authorize you to represent him or her? Yes X No - �a PROPERTY OWNER'S NAME M CONTACT PERSON ,.— Name: tis N e W MAN Name: 17 �e.h.-' A- �I i2A �9_ dP Lc ��3o Sov�l leas PI NP, 4G 6fep_ovt LLe- -bkiVq—. Address: R A C A-D/A E L 5 4 2 6 G Address:__ Fo r esi d1 A l e Vn A o 2 6 4L/ Phone: ( T a 1) Lf Z o— Phone: S 0 S 1 t(-7' — S 0 Lf g VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) SEE PrT7AcROZ SN6E7 ��'E 0}T7�gCNr✓TJ SNEET NATURE OF WORK: House Addition ❑00000 House Renovation ❑ Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four.(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) , Signed letter stating that the property 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 submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals[same owner/leasee 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 Wayne Miller,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. �, REASON FOR DISAPPROVAL •Paul Canniff,D.M.D. /j� ` Q:\Application Forms\VARIREQ.DOC { Jeanne'Stevens Newman 86.Horseshoe Lane Centerville, MA 02632 VARIANCE FROM REGULATION REASON FOR VARIANCE 1.) 310 CMR 15.405(1)(a) A 6.20' Variance, S.A.S. to Property Line, 3.80' Setback. 2.) 310 CMR 15.405(1)(b) A 14.08' Variance, S.A.S. to Cellar Wall, 5.92' Setback.- 3.) 310 CMR 15.405(1)(h) A 5.00' Variance, S.A.S. to Water Service, 5.00' Setback. 4.) 310 CMR 15.405(1)(a) A 2.96' Variance, Septic Tank to Property Line, 7.04' Setback. 5.) 310 CMR 15.405(1)(a) A 4.96' Variance, Septic Tank to Property Line, 5.04' Setback. 6.) 310 CMR 15.405(1)(b) A 4.07' Variance, Septic Tank to Cellar Wall, 5.93' Setback. VARIANCE FROM LOCAL REGULATf0N REASON FOR VARIANCE 1.) 310 C R 15. 5(1)(g) A34.7' Variance, S.A.S. to Salt Marsh, 65.3' Setback. 2.) 310 CM 15 405(1)(9) A 83.7' Variance, S.A.S. to Coastal Bank, 16.3' Setback. 3.) 310 CMR 405(1)(9) A 29.3' Variance, Septic Tank to Salt Marsh, 70.7' Setback. 4.) 310 CMR 5. (1)(g) A 76.6' Variance, Septic Tank to Coastal Bank, 23.4',Setback. 'eA � CERTIFIEDMAILTMRECEIPT - " -n m D• • m e mru m (Domestic LLQ1WUMZftl u�i S OflG •# Fordelivery information visit our website at www.usps.conis) o Ln CE L U S P age $ _'. 0119 m Postage 8 Ui13 ,j 0119 a Ce ied Fee •4Q 1 f� �� Postmark Q Certified ee $2• p Return R slept Fee (Endorsement squired) O$. Here Return Reci t Fee Postmark Restricted De very F (Endorsement R uired) 1• Here rl (Endorsement gwr0.00 O Restricted Del' ryFee (� 1 r 9 (Endorsement cared) JUN O�t)10 00 r� $4•' '01/20Ob o Total Postage ees �•� ��/0 �'0OC; m Total Postage Fees $ p Sent Io o M�. 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C3Return Re-!a t Fee Postmark (Endorsement Re uired) 1 ] Here O Restricted Deliv Fee , 0.00ILUu r-9 (Endorsement R uired) O r� Total Postage& as. $4•n4 Of�/0 12006 m O Sent To r Street,Apt IVo.; _ or PO Box No. (oS kKSC5Nd 6 LANG --------------------------------------------------------------------------------------- City,State,ZIP+4 CENTGkvI11Er P74 02652 �--- 14' �� 12' cu WOODEN DECK cU . LIVING ROOM 14' X 12' BATH ROOM 5' x 8' BEDROOM 10' x 8' 00 cu BEDROOM DINING ROOM BEDROOM 8' x 1 6' 14' . x 1 6' z 10, x 14' w r U x Y o0 4 0' JEANNE STEVENS NEWMAN � ` 1 `1} c' #86 HORSESHOE LANE, CENTERVILLE � ,._; SCALE: 1 " = 10' May 11, 2006 Town of Barnstable Board of Health Department 200 Main Street Hyannis, MA 02601 Re: #86.Horseshoe Lane Centerville, Ma. 02636 Dear Commissioners: I,Jeanne Stevens Newman (Applicant), hereby designate Robert A. Drak e, P.E. as my/our representative for all information, on-site reviews, public hearings, and correspondence with the Commission relative to the Town of Barnstable Board of Health Variance Request for work proposed at#86 Horseshoe Lane, Centerville (address). Submitted(date) J 'C 4 D 2006. Please keep the representative informed of the status of any changes in procedures specifically affecting my/our application(s). I will raise any questions regarding this project through our representative. All correspondence shall be sent to: Name: Robert A. Drake, P.E. Addresses: 66 Greenville Drive Forestdale, MA 02644 Telephone: 508-477-5048 N (A plicant's Signature) (Date) ._!ta,tV V e. s+evens fve by m A d (Applicant's Name-Print) 1 TOWN OF BARNSTABLE LIST OF ABUTTERS SUBJECT MAP: 207 PARCEL: 110 86 HORSESHOE LANE PROPERTY Jeanne Stevens Newman 2230 Southeast Piper Arcadia, FL 34266 ABUTTERS: MAP: 207 PARCEL: 076 Michael + Debra Dangelo 100 105 Horseshoe Lane 103 Centerville, MA 02632 MAP: 207 PARCEL: 077 Paul F. Ignaszak, ET ALS P.O. Box 6934 Scarborough, ME 04070-6934 MAP: 207 PARCEL: 101 Thomas + Cheryl Kenney 17 Harmony Drive Millville, MA 01529 MAP: 207 PARCEL: 102 Angelina Francescone ET AL 21 Russell Street - Apt #2 Brookline, MA 02446-2431 MAP: 207 PARCEL: 142 Robert + Barbara Kinsella 94 Horseshoe Lane Centerville, MA 02632 � .-.:. - z' t � `t .x"'s,.f e u``-ry i gd-:..h ree,�z.d.�",%�a a'r�� :,� ySke�.e 6a✓c k. ;,e : `s y �.,� "`�'+`✓�(1,";..;�1"i ati`._ S :�:fix% J',!� € -si !:g'' .r` °-I "} l i F .� `s, ✓. �. y._ < ..:J, \ r".a}t`,P`.d+' # � 3 .,�,+' '\fs'�•"✓ 4 . 4. �•✓ a,3d°° d `'w°¢°` +'" �' •'`� ,,r k ✓'° a. `"4 t` a x: E J s r `!� #.r! ,f' '.'�- °✓- ✓x ./ '`, +�'s",x �ROB��T. A°�.Q. ��,�hr3*'\`` r, .�."r`.,# y.w. ,v✓' fir'" \ ,° ' ,,` \,:a `�..r" g:z'` �q' 'av,.:a° '\ `w:t \. �' \, !; I l`,,,,% ;2 ? 3 1. ` �• 1 rFs� c { x ''w°. .v.`^' wy<\ � y,,. 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A - r jow- • 12 5:51PM • P No: u Fee s� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Zigpoaf *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(t4upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel /t,e] ` 0 Installer's Name,Address,,and Tel.No. Designer's Name,Address and Tel No. �obr--r 3 Uv✓` j:;1 KGB ti�i,.✓��t�� uS��9. ,�c of y �e�4;e✓rs fr-✓ .� �/ r.es ��erev�>d -f ®,2 t�<�� v y ,sue-Esau �6 � .m e- �- 7• .rs..� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of SoilP� ePl��✓ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 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 by this Board of Health. Signe $ Date Application Approved by Date Application Disapproved the following reas s Permit No. Date Issued ( x ? Fee (/- l�o: DD � ' d.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS' Zipp ication for Miopo0ar *potem Construction pernftC grade ( ) ❑Complete System ❑Individual Components Application for a Permit to Construct(, )Repair(.;1/S,Upg de( , )Abandon p y a„ Location Address or Lot No. Owner's Name,Address and Tel.No. Ass C.sf w s �t ti,- 7 .�.- _- Assessor'sMap/Parcel «�I�C/NO%' i Ins ler's Name,Address,and Tel.No. Designer's Name,Address and Tel.'^No. ob-f.-r 6- Ur Kca, �,yn�P f, .j; u.��t, . ,�/z• �� o?y !K4 U/�ef -✓ �✓� 3zd- 'h Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 6 .. Plan Date Number of sheets Revision Date Title v f" - Size of Septic Tank Type of S.A.S. Description of Soil 'S�� d'fG'� ` Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 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 by this Board of Health. ,y Si gne //J{'1/ l o Date ✓ -l,- o6 Application Aproved by Date Application Disapproved or the following reasons f Pi Permit No. Date Issued '. --------------------------- ----------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERM,thatthe - •te S Dispo�al Sys tem C s c air d )Upgraded( ) Abandoned( )by!a(/� `7� at has constructed fil acc lance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer Designer The issuance of this permit ha l no be construed as a guarantee that the s stem w f .c n s designed. Date �� 1 ) �l Inspector ———————————————————————— A No. Fee v'�/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE,, MASSACHUSETTS Miopooal *pg;tem Construction Permit Permission is hereby gr, ted to ,onstru t Repair Up rade j and :! �_--System located at /> T7( a _ 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 tnust a co pleted within three years of the date of this , rcrtit. Date: / Approved by_ l_. i� 0 a v Z o G (D 4— 14 — 1 Z' N 0 o rn w N i CD WOODEN DECK "J uviNc Rao 14' X Z' BATH ROOM 0 BEDROOM I — 10' xCD B' v C c, — o co cu V (31 BEDROOM DINING ROOM BEDROOM 8' x 16' 14' x 16' z in 10' x 14' w i CJ x i 1 Y 00 r � i 4 0' JEANNE STEVENS NEWMAN #86 HORSESHOE LANE, CENTERVILLE SCALE: 1 " = 1 0' 0 N Town of Barnstable °FtHE r�� Regulatory Services Thomas F. Geiler, Director " > ` Public Health Division 9 MASS. g' ArEDN►A'�A Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit# oG - q- j Assessor's Map/Parcel 2G1 tt� Installer& Designer Certification Form Designer: -bFA C2 Installer: 1Zo 4?c 8 bV K, Com po Address: -Ir iye- Address: Zy Cttg0 t,. uh-&J FowrsldA�r. Vw/J . 4A'W u. On i 1 - t y-a G -a I vt� Q\JK CoG-f�was issued a permit to install a (date) (installer) septic system at ,(p "3K.)e `►A�z based on a design drawn by (address) kC7 G�Gl�eei�tNG dated s- - zq--G( (designer) _ CW I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of th septic system) but in ccordance with State & Local Regulations. Plan revision or ce ed as built by desi to'follow. Stripout (if required) was inspected and the soils er fo satisfactory. OF A448 1V o�� RCSERT A. cyG 'sta er s ign ure z DRAKE o CIVIL v No.41642 Q v' —RI 9 A9oF S�t (Designer's Signature) (Affix Des h- ' p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc ® TOWN OFBARNSTABLE SEWAGE # LOCATION �7� VILLAGE P00'1& y� ASSESSOR'S MAP & LOT KA-//0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACTTY � LEACHING FACILITY: (type) �®ze) Jo NO. OF BEDROOMS BUMDER OR OWNER ��er,��✓Q_ ��'� l/��✓� �.�1�/,�1?l.r/ PERMITDATE: //"9"®4 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 leachin&facility) Feet Furnished by 0 TOWN OF BARNSTABLE LOCATION 1 ' 86) /41D UC XWQG MAN L SEWAGE# VILLAGE CE 10-167it"I P— ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 1,00o G A(i o,) ��!T\4 LEACHING FACILITY: (type) ( A � (size) I,104"a NO. OF BEDROOMS OWNER -7@ANN� s7ev�,�s rve PERMIT DATE: 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) 60 Feet FURNISHED BY r ; _y 6 3 3 121 Z4 �. � , P� fa m,, rea6Nbaws �'�a�PtiZy Nr�G►�1 INF° r •. • rl Ln IJ" rl M Postage $ .3 �, \\ C3 Certified Fee \ 1( o .8S N 1. Retum Receipt Fee P H (EndorsemeM Required) O Restricted Delivery Fee g ®� (Endorsement Required) / \� rq rR Total Postage&Fees rs • (� �~ tt7 � Se To �. oL/,�_ eah� -_ P✓poser mG - P mer,nPr. o.; � c or PO Box No. F _:SN_ee--t -- - Crty,State,2/10r4 Gj,/a.L derJ W/W oa.1 9 Certified Mail Provides: ■ A mailing receipt (es—ea)aooa eunr'oose u„od Sd e A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years, Important Reminders. ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS. PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". . o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. . I 1 .. ses. ."JT P� °r Town of Barnstable 0 - - �F Public Health Division s 200 Main Street % PITNEY BOWES Hyannis, MA 02601 _ 02 1 A $ 04.640 7005 1160 0000 0191 1574 0004606238 APR20 2006 MAI LED FROM ZIP CODE 02601 f'y�F COMPLETESENDER: COMPLETE THIS SECTION / ON DELIVERY ■'Complete items 1,2,and 3.Also complete A. Signature i item 4 if Restricted Delivery is desired. ❑Agent I j X 0 Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I E Attach this card to the back of the mailpiece; or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No i i Ms. Jeanne Stevens Newman 53 Cliff Street 3. Service Type Malden, MA 02148 ❑Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑ es 2. Article Number 7005 1160 0000 0191 15, (rransfer from service la :: "PFornt , e r - o eturn Receipt 1 95-02-M-1540 Town of Barnstable �F tNE 1p� do Regulatory Services swxrvsrng� Thomas F. Geiler,Director 9� b9. •�� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 20, 2006 Ms Jeanne Stevens Newman 53 Cliff Street Malden, MA 02148 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 86 Horseshoe Lane, Centerville,MA,was last inspected on March 18th, 2006 by, Robert A. Drake, a certified septic inspector for the State of Massachusetts. i The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Septic system is in failure, sewage observed overflowing onto top of ground. You have 60 Days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable • Health Department. 4BARNSTABLE HE TH DEPARTMENT McKean, R.S , Agent of the Board of Health w Town of Barnstable �OF ZHE taY do Regulatory Services anxivsrns Thomas F. Geiler,Director 9�A MASS. ••�a Public Health Division tE0 MA'S Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 20, 2006 Ms Jeanne Stevens Newman 53 Cliff Street Malden, MA 02148 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 86 Horseshoe Lane, Centerville, MA,was last inspected on March 18th, 2006 by, Robert A. Drake, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Septic system is in failure, sewage observed overflowing onto top of ground. You have 60 Days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. .1 BARNSTABLE HEALTH DEPARTMENT _ .. 0 s McKean, R.S., . . Agent of the Board of Health Town of Barnstable FTME�� Regulatory Services sszn6LE Thomas F. Geiler,Director 9�A 6 •�� Public Health Division rEDMA�p Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 31, 2006 Ms Jeanne Stevens Newman 53 Cliff Street Malden, MA 02148 SECOND NOTICE ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 86 Horseshoe Lane, Centerville, MA,was last inspected on March 18th 2006 by, Robert A. Drake, a certified septic inspector for the State of Massachusetts. The,inspection of your septic system showed that your system had"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Septic system is in failure, sewage observed overflowing onto top of ground. You were given 60 days from the date of the of the system failure to bring the system into compliance. As of this date (7/31/06 )we have not been informed of any repairs done to this system in order to bring it into compliance If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEAL H DEPARTMENT o as A. McKean, R.S., C.H.O. i Agent of the Board of Health Ian - Y rl OFFICIAL USE I r-q Im Postage $ p26 Certified Fee 0 Retum Receipt Fee ! Postmad� � (EndorsemerdRequired) �`y0 Here �p Fee (Endorrse ent Required) Total Postage&Fees G �� Ln Sentfrq I— ------------------• .._.... Apt.No.; ,- or PO Box No.�: /�� „„�- City Stete,ZlP+ S/ ...__ .-✓--�.-.4-.�____________ ______ Certified Mail Provides: A mailing receipt asianay)ZOOZeunf'ooaewjoisd ■ ■ A unique identifier for your mailpiece �? ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Huila. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified.Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access td delivery information is not available on mail addressed to APOs and FPOs. Town of Barnstable GF THE 1p� Regulatory Services snaxsras Thomas F. Geiler,Director 9� '0390. •� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 31, 2006 Ms Jeanne Stevens Newman 53 Cliff Street Malden, MA 02148 SECOND NOTICE ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 86 Horseshoe Lane, Centerville,MA,was last inspected on March 18th 2006 by, Robert A. Drake, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system had"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Septic system is in failure, sewage observed overflowing onto top of ground. You were given 60 days from the date of the of the system failure to bring the system into compliance. As of this date (7/31/06 )we have not been informed of any repairs done to this system in order to bring it into compliance If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. 4BARNSTABLE HEAL H DEPARTMENT 11 o as A. McKean, R.S., C.H.O. Agent of the Board of Health Xi' `"E'Q'►� Town of Barnstable sesPo61;1 Public Health Division 200 Main Street Z Hyannis, MA 02601 PITNEV BOWES 02 1A $ 04.640 a �•., ,.;•., � .. __._ ! � �70056 1160 00000191 ;765 MAILED FROM ZIP CODE 026011 t Ms Jeanne Stevens Newman U`CLAIMO RETURN RECEIPT 11EQUEST_ED_ airs: 11 w - I COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,"2,and 3.Also complete A. Signature -� item 4 if Restricted Delivery is desired. X ❑Agent N Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, I or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: I If YES,enter delivery address below: ❑No I I I 1 I I Mr Jeanne Stevens Newman I 53 Cliff Street 3. Service Type 1 / I Walden MLA'02148 ❑Certified Mail ❑Express Mail , { I ❑Registered ❑Return Receipt for Merchandise i ❑Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes I \N 2. Article Number N (transfer from service label) 7 0 0 5 1160 0 0 0 0 0191 17 6 5 I �� i- ... PS Form 3$11,February 2004 Domestic Return Receipt _ 102595-02-M-1540 .. : 4W ca—j / Commonwealth of Massachusetts y��`� W Title 5 Official Inspection Form `4 Not for Voluntary Assessments ,M y."R Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: 0 When filling out 1. Property Information: forms on the computer,use 86 HORSESHOE LANE, CENTERVILLE, MA 02636 only the tab key Property Address to move your JEANNE STEVENS NEWMAN cursor-do not use the return Owner's Name key. 53 CLIFF STREET Owner's Address MALDEN MA 02148 City/Town State Zip Code Date of Inspection: oat8-06 3 a T 2. Inspector: C MR. ROBERT A. DRAKE, P.E. j - Name of Inspector - KCJ ENGINEERING Company Name 66 GREENVILLE DRIVE j Company Address .:1 FORESTDALE MA 02644 t r City/Town State sip Code 508-477-5048 Telephone Number i Certification Statement: 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. I am a DEP approved system inspector pursuant to Sec ' f Title 5(310 CMR 15.000). The system: ��H OF Miss ❑ Passes ❑ Conditionally Passes ® Fa' ROBERTq, q�c DRAKE u, CIVIL rn y ❑ Needs Further Evaluation Evaluation by the Local Approving Authority �, NO.4164 T,r� A ° yJ 4-12-06 r g� Inspector's Signature Date AL, 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 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. ""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. HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 v Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I 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: B) 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. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial 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. ND Explain: HORSESHOE-CENTERVILLE-NEWMAN-T5lN8P.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 1.6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments M Subsurface Sewage Disposal System Form A. Certification (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ 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 . i ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced F ❑ obstruction is removed ND Explain: L 1 C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless 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: ❑ 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 'HORSESHOE-CENTERVILLE-NEWMAN-T5INSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification. (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA . 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State ZipCode JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: 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 ❑ ® 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 %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. ❑ Z 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No ® ❑ 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. HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y` Subsurface Sewage Disposal System Form M A. Certification (cont.) .86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection E) 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 D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D.above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. HORSESHOE-CENTERVILLE-NEWMAN-T5lNSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Checklist 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection 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 ❑ ® 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(3)(b)] HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 Cityrrown State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection 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): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ® Yes ® No Last date of occupancy: 8-MONTHS AGO Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A 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 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): HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System Page 8 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? Reason for pumping: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: HOUSE BUILT IN 1954, ADDITION ADDED AT LATER UNKNOWN DATE. Were sewage odors detected when arriving at the site? ❑ Yes .® No HORS ESHOE-CENTERVI LLE-N EWMAN-T51 NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2.50 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): SEWER PIPE APPEARS TO BE IN GOOD CONDITION, NO SIGNS OF LEAKAGE, TEES ARE IN PLACE. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1,000 GALLON TANK INSTALLED IN 1974, ALL COMPONENTS IN GOOD WORKING CONDITION.. If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: 1,000 GALLON Sludge depth: LESS THAN 1" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness LESS THAN 1" Distance from top of scum to top of outlet tee or baffle APPROX. 3" Distance from bottom of scum to bottom of outlet tee or baffle APPROX. 16" How were dimensions determined? MEASURED IN FIELD HORSESHOE-CENTERVILLE-NEWMAN-T5INSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form WM C. System Information (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN . 3-18-06 Owner's Name Date of Inspection. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ALL COMPONENTS OF THE TANK APPEAR TO BE WORKING PROPERLY. WATER LEVEL IN TANK APPROXIMATELY 1"ABOVE OUTLET INVERT. TANK IS LOCATED APPROXIMATELY 3' FROM FOUNDATION. Grease Trap(locate on site plan): N/A' 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts u Title 5 Official Inspection Form Not for Voluntary Assessments 4Uy Vo Subsurface Sewage Disposal System Form C. System Information (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A Capacity: gallons Design Flow: gallons per day 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.): Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(location site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: ACCORDING TO AS-BUILT DRAWING, THE LEACHING PIT IS LOCATED ON NEIGHBOR'S PROPERTY. NEIGHBOR WOULD NOT ALLOW EXCAVATION ON HIS PROPERTY. Type: ® leaching pits number: 1-1,000 GALLON ❑ leaching chambers number: ❑ leaching galleries number: ❑ leach.ing trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACHING PIT IS LOCATED ON NEIGHBOR'S PROPERTY AND WAS NOT LOCATED OR OPENED. NEIGHBOR WOULD NOT ALLOW ACCESS TO LEACHING PIT. HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments �.9_ _'9"0 Subsurface Sewage Disposal System Form C. System Information (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code. JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A -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.): Privy(locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 86 HORSESHOE LANE Property Address CENTERVILLE MA 02636 City/Town State Zip Code JEANNE STEVENS NEWMAN 3-18-06 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch 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. t✓-T G r 4 r r°`Ra N-1 �,e• Z fiaa ��o a � r 22. r r $-` Ir A �e, s if- LeAc�r�� Pr"-I' s{,®wt�� Ar-caq-niN�, 46 As c, 1+ c�,cAt,c,��• wAs N'4+ Coc&-'#.v�. HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2604 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 e i a ♦4 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form 41M 5yey`�v - C. System Information (cont.) 86 HORSHOE LANE Property Address CENTERVILLE MA 02636 Cityrrown State Zip Code JEANNE STEVENS NEWMAN 3-18=06 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked With local Board of Health-explain: ❑ Checked with local excavators, installers -(attach documentation) ® Accessed USGS database-explain: ACCESSED 1992 GW CONTOUR MAPS 4 —)044 GZS t,.89s You must describe how you established the high ground water elevation: 1992 GW CONTOUR MAPS: GROUNDWATER ELEV. IS LESS THAN ELEVATION. 5'HG Nh �04 615 h1AP$ 1. JbICAAC3 GtA CIMM14 p t. ['P. is Aw°PI�aX. l2' NG VD HORSESHOE-CENTERVILLE-NEWMAN-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 ' e TOWN OF BARNSTA13LE LOCATION # S(o NotsCsNoC (Ato VILLAGE CENT l;1t v i l I? SEWAGE# ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY I,oca G C 4 a,J a LEACHING FACILITY: (type) L.A (size) 1,o qo NO. OF BEDROOMS OWNER 7t'Awwp- S7eve rvi' PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 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 Feet within 300 feet of leaching facility) FURNISHED BY� -- , � j � A� 60 beet A `0 �r ..R No. ��x i�t.ss c tg ..U`........•-- ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH J.4---ter _ ..-.......OF...... .... .... 11!1 _..._.------ .... . .......... Appliration -for Diapuiittl Morkii Tomitrurtioaa Vrrufit Application is hereby made for a Permit to Construct ( ) or Repair ( n al Sewage Disposal yst at: -- ------ . ---- ... ....... .... � -------------------------------------------- Location- r s p� �� or Lot No. !_4. ................ -----•-•-•--------•---•---...........---- O ner Address W j----- ..................................................-•.--•----------••-•-•-----.........-------•--- aher Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow.....................................:......gallons per person per day. Total daily flow--_--_______--__--__-.-_--._................gallons. WSeptic Tank—Liquid capacity------------gallons Length_____-____--_- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No- ____________________ Width-------------------- Total Length-------------------. Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter-_-____-_____---_- Depth below inlet.................... Total leaching area.-__-___-_.-.-_-_ST It. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.----:-_.-_-----.-.___- fX, Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water--.-_-_-_-_.-.___-..._. P4 -------- ---• ------- o Description of Soil----- I-• --•f}"1•� � �"- _ � ..I ----------•=--............. x U W --------------------------------------------------------- "_____________________________________________________________ __----.-_____-..-__-----.._._.-----____.. _ ----------------------- _pp V Nature of or. 1 atto s—An wer hen alica eJ- r-t-'a �'�C1 P.�..�A ree ent:gLqjp //- The undersigned agrees to install the aforedescribed Individual Sewe Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees.not to place the system in operation until a Certificate of Compliance has b issued the/board of h a th. J / Signe .......... Date ApplicationApproved By.............................................................--------------------------•-------- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ------•-----•------•--------•---•--••-------••---•-•-•--------------•......------•------•---••-------•--••---------------------------------------------------...---------------------------------------- Date PermitNo......................................................... Issued........................................................ Date -----' A. OP JfJ,��j'� No.... F�$.. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD gF HEALTH p Appliration. -for 'R_qpAsttl Works:Tontitrurtinn Vrrmit Application is hereby made for a Petfnit tp,.Construct ( ) 'or Repair ( M"T'tTMiY Ual Sewage Disposal System at- -- ------------ Location- r s or Lot No. ....--•--- = --•--•---••-••- ------------------•-•--------•--------•...._._..---- ssj ner Address a er Address U e of Building g -' r.-Size Lot-------------------- ________Sq. feet .-, Dwelling=No. of Bedrooms--------------------------------------------Expansion Attic ( ) G:i'rbage Grinder ( ) per., Other—Type of Building _-_________________________ No. of persons............................ Showers ( ) — Cafeteria ( �) Q'' Other fixtures .__._'___________________ _ Q --------------------------.......................................... ..................................................... Design Flow__________________________________S__.......gallons per person per day. Total daily flow____-______ "t______.._...._._.,__.__._..gallons. WSeptic Tank—Liquid capacity AL gallons' Length _______________Width• .. Diameter_"_: _ Deptll................ x Disposal Trench—No._.._.._._....... Width__ Total Length-------_ _________ Total leaching -----------------sq. tt. Seepage Pit No-----_------------- Diameter.................... Depth,;below inlet*.-.,..................Total leaching area------------.___..Sq. ft. z Other Distribution box ( ) Dosing,tank ( ) Percolation Test Results Performed bY------- ------•-- -------------__:.._-:--------------•------•••-•----- Date--------------- Test Pit No. l................minutes per inch Depth of:--I'esf,.Pit.._ `..._.:______... Depth to ground water.-: ..._._-_--_-_---- • , . ter.,..-..,:�-�. Iz, Test Pit No. 2................minutes per inch Depth of Test P•it.___._.....____.____-•D'epfh"to ground water........---------------- ----------------- - --------- -- D Description of Soil '" "�"--•-yiCl._ .c = Xr - _�t'��"�1. `"` .1_..�Y-1..1-p ""~ x .; Nat re of o ati s—An wer hen a lira e...___ + --•-•- -- -------------- --------------------------------- ------ - .... U 4�Q t •----- ------- * Agree ent: The undersigned agrees to install the aforedescribed Individual Sew e Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued the board of h ..' Si Date f APPlication.,Approved By--------------- --------------------- -------------- Date Application Disapproved for the following reasons____________________________ ___ __________________________________________________.. _...,_'__._______._.____.__ ..........._az'__,---____.__.____._. ___...._..__.__._ ... r.; '..t Date';.. Permit No. = Issued-------------------- = . - ...._ Date's " THE COMMONWEAti?rHw.OP"M'A'SSACHUSETTS BOARD OF HEALTH Tntifiratle of f11-nrmPlianrr T S IS T CE FY, That the div al Sewage Disposal System constructed ( ) orh,Repaired (� / Installer � has been installed in accordance with the provisions of Article Xj of The State-Sanitary Code as described in the application for Disposal Works Construction Permit No....... ___ _ ............ dated.... ,%:�_____________ 00 THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - L ..__ Inspector___________-.:---: DATE l. ----•----------------- THE COMMONVU.EALTH OF M`i4SSACHUSETT$' BOARD`� F HEALT , d {d NO. c.: wwr nn s nw: 3w�,a xs` 4 FEE ispotial.. or C i rurtiOtt Permission is.hereby grant ed_....... .:.... ... - , to Construe ) ori Repair ( "S an Indiv' ual Se a Disposal s m k' at N„o--"----- .1 '� �'1 .,.. �1 .... 0P �'!tr __:`. �` _ l'P�.. _..� - Street -. e'6s shown on the application.for Disposal Works,Construction ermit o° ________ ______ Dated___ 1 "_'_/___"�.�__'_�t,._._.. i , . I .Board of Health DTE...... ` FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i R' LOC TION : - SEWIJ.C,E PERMIT UO. 14 VILLAGE WSTALLER5 U&& AE ADDRffESS BUILDER 5 tJ & A ADDR SS DLlkTE PERMIT ISSUED DATE COMPLI W ICE �, _ �,.. r� �.� 9�o F . r�� ,S � .�� °�'� ��: � �` � _ a,�- µ_ t r0A,424 47,__ J)q _V__i 771111,10111- TOP OF rn FOUND4A ION (TYPICAL OF 3)ACCESS COVER STANDARD INFILTRAT❑R TRENCH �'e$h'ay FINISHED GRADE FINISHED GRADE OVER GROUND ELEVATION = 13.25't DETAIL �e� VER TANK EL. = 14.0' t DISTRIBUTION BOX = 13.75' t (NOT TO SCALE) �a FalmouthRdS PROPOSED 4" PIPE 0 `7 � ' c SCHEDULE 40 PVC REMOVABLE COVER 5" DIA. OUTLET(S) -TOP ❑F SAS = 11,39' :i dP $vr"aL�, 0 � �� GENERAL NOTES MIN. SLOPE ® 2% -9"MIN., 36"MAX. �36"MAX. NO FOR PROPER DRAINAGE ESTABLISH VEGETATIVE COVER Ef 1 ' If 4" PVC IN FROM 4" PVC OUT FROM INVERT (IN) = 10.93' 1 '`= �'} pie 91 32 �'� SEPTIC TANK LEACHING FACILITY. INV. END = 10,74'� /\, , , ,,; _ -- 0 1.) UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND 12" ° -� 1� c a ¢ a Get1a 1td - MINIMUM SLOPE 1% o � �� ¢ CONSTRUCTION METHODS SHALL BE IN ACCORDANCE 13' TRENCH B❑T. = 10.20'- TRENCH B❑T. = 10.39' //� NATIVE 12- MIN., H-10 LOAD AREAS .F $ Rd WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY ChH 11.75't 3" 19" �� .j,`. BACKED L 6" MIN., NON-TRAFFIC AREAS v \-I2.00'± 11.50'f 11.40't n- 11.23't �- 37.5' 4s 8 N APPLICABLE LOCAL RULES. 4'0" LIQUID LEVEL OUTLET TEE 5.19' SEPARATION y (EFFECTIVE p.S e 10'-0" K_. 04 LENGTH) '. $ MINIMUM TO BE RESET ON A LEVEL STABLE ADJ. GW = 5,20' ,, - 5� 2.) ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD BASE. FIRST TWO FEET OF OUTLET PIPES ,� 12• qua & OF HEALTH AND THE DESIGN ENGINEER. TO 8E LAID LEVEL. 2-15W EL. = 3.50 - ! / 6. �a 9 ri - - - 0 ` � '"' "�'""" '�; "{'p'°" 3.) 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL CROSS SECTION VIEW 36' GnaerLn N 'S` '"` BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. SEPTIC SYSTEM PROFILE LEACHING FIELD PROFILE LEACHING FIELD END 4.) 4" SCHEDULE 40 PVC PERFORATED PVC PIPE SHALL BE USED rbo N.T.S. N.T.S. N.T.S. �~ c�.r„�alr�xar INSIDE LEACHING TRENCHES OR LEACHING FIELDS. �$ ea. 5.) SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. INLET + OUTLET ACCESS COVER TO BE a� � xaatwckseSm,nd BROUGHT WITHIN 6" OF FINISHED GRADE 0 2006 MapOueA,lmc 02006NAVMQ 6.) THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. FINISHED GRADE OVER DISTRIBUTION BOX = 13.75' ± LOCUS MAP 7.) LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED 4" s„MIN., 36"MAX. - - 10'-6„ PRIOR TO BACKFILLING WHEN SYSTEM IS NEARLY COMPLETE AND I 'r 10'-O„ _ I REMOVABLE COVER 5" DIA. OUTLET(S) (Assessors Map #207, Parcel #110) - 36"MAx. READY FOR INSPECTION. SYSTEM IS NOT TO BE BACKFILLED 13" 24" DIA. MANHOLE 6" MIN, WITHOUT FIRST OBTAINING APPROVAL FROM THE BOARD OF HEALTH 21 3„ COVERS AND DESIGN ENGINEER. PROVIDE WATERTIGHT JOINTS(TYP.) 0o a ca 4 PVC IN FROM I I I SEPTIC TANK 4" PVC OUT FROM LEACHING 8.) BASE PLAN, ELEVATIONS AND CONTOURS ARE BASED FROM A a'o" uQulo LEVEL 'O in to FACILITY. MINIMUM SLOPE 0 1% z SURVEY PERFORMED BY STEPHEN J. DOYLE AND ASSOCIATES, PLAN OUTLET TEE 11.40'± 12 �11.23'± 34° 10,5/ DATED APRIL 4, 2006. THE CONTRACTOR SHALL BE REQUIRED TO 1 3" 6" CRUSHED STONE ZONING SUMMARY: VERIFY ALL EXISTING ELEVATIONS PRIOR TO COMMENCEMENT OF WORK. -- � OVER MECHANICALLY COMPACTED BASEL..� 9.) WETLAND DELINEATION PERFORMED BY DON SCHALL, ENSR, ON 4-3-06 LEVEL BASE 5 OUTLET DISTRIBUTION BOX (H-10) ZONING DISTRICT: RC 6" CRUSHED STONE PLAN VIEW TO BE RESET ON A LEVEL STABLE cRoss SECTION VIEW OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET PIPES , SITE IS LOCATED IN RPOD 10.) CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO COMPACTED BASE TO BE LAID LEVEL. 37,5 CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY PROPOSED 1,500 GALLON CONCRETE SEPTIC TANK (H-10) OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO LENGTH 10'6" WIDTH 5'8" DEPTH 5'8" CROSS SECTION VIEW THE DESIGN ENGINEER. SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL LEACHING FIELD PLAN VIEW TEST PIT DATA 11.) NON-SHRINK GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES IN ORDER TO PROVIDE N.T.S. N.T.S. N.T.S. PERC. NO.: TP #1 + TP #2 WATER TIGHT SEALS. 12.) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED �� 1 , v�- / WITNESSED BY: DON DESMARAIS, R.S. OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH PERFORMED BY: DAVID MASON, C.S.E. DETERMINATION FROM APPROPRIATE AUTHORITY. '0DATE: MAY 4. 2006 13.) ALL SEPTIC SYSTEM COMPONENTS ARE BEING INSTALLED TO � WITHSTAND H-10 LOADING. GROUND ELEV.: 13.00' t 13.) DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, ELEV. WATER: GW OBSERVED AT 120" DUST AND FINES. t : 15.92 PERC. RATE: < 5 MIN./IN. 15.) WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL BELOW AND FOR AN AREA 5 FT. ON ALL --� DEPTH OF PERC: TP#1 @ 28", TP#2 @ 34" SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER 111 10• _ 7.047f \ MOTTLES: N/A UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). P 4. 7. 18 16.) CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES »E �rT FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO 1'�V 9°Q1 '1Q �° TEST PIT #1 TEST PIT #2 CONTINUATION OF WORK. " 17. PROPOSED PROJECT IS LOCATED WITHIN: 0" 13.50' 0 13.50' ) A: SANDY LOAM A: SANDY LOAM ASSESSORS MAP: #207 PARCEL: #110 11te _ rl. 2 o 10YR 2/2 10YR 2/2 11 R loll- 12.67' 11" 12.58' 18_) THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. Remains of - KCJ ENGINEERING WILL NOT ASSUME ANY LIABILITY FOR THE Cedar Tree pnVE B: LOAMY SAND B: LOAMY SAND USE OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. . JIL B W6� 1 12 10YR 5/8 10YR 5/8 � ''L SALT MARSH stl�. WETLANDS O 28" 11.17' 28" 11.17' REVISIONS 1.11. \ � 6 DGE C: MED. SAND C: MED. SAND 2.5YR 7/3 2.5YR 7/3 INSERT "A" - S.A.S. DETAIL ,IL - AL � �` LOT # 207-142 (NOT TO SCALE) -- EXIST. 1,000 GALLON GROUNDWATER , „ GROUNDWATER , ` � BVWS � 120 3.50 120 3.50 - OBSERVED OBSERVED BVWI - - SEPTIC TANK AT 120" AT 120" ~ J B 4 TO BE REMOVED 6 vw2 BV_W3 GENERAL NOTES: EXIST. LEACHING PIT FEMA LINE_ --- / -/ '/ Cs, 1�,.. AND TOP OF TO BE REMOVED 1_) THE PROPOSED LEACHING FIELD SHALL CONSIST OF 18 -STANDARD -, COASTAL BANK LOCATED FROM RECORD AS-BUILT INFILTRATOR CHAMBERS AS SHOWN ON THE DETAIL SECTIONS ON THIS PLAN. DESIGN DATA: PROPOSED SEPTIC SYSTEM UPGRADE o Cedar Tree ( ) THE LEACHING FIELD SIZE IS APPROXIMATELY 10.5' x 37.5'. THE SYSTEM IS 3 BEDROOM DWELLING B Deck r - "� 1� FOR AN AGGREGATE-FREE BED SYSTEM. PREPARED FOR: DESIGN FLOW: 110 GPD PER BEDROOM UPLAND ^1 2.) THE GROUND ELEVATION AT THE LEACHING FIELD IS AT EL. = 13.25' f TING THE ELEV. AT THE TOP OF THE LEACHING FIELD IS AT EL. = 10.93' t 110 x 3.0 = 330 GPD JEANNE STEVENS NEWMAN PROPOSED - EXIS Gj'66 N 13 THE ELEV. OF THE 4' PVC SERVICE PIPES ARE AT EL. = 10.74 f 40 MIL POLY LINER �� _- DWE g,,E14.35 14 THE ELEV. AT THE BOTTOM OF THE LEACHING FIELD IS AT EL. = 10.20' f SEPTIC TANK: H Chr E ,G, ADJUSTED GROUNDWATER EL. = 5.20'f, LEACHING FIELD PROVIDES A 5' SEPARATION. ►r►� � "1'�� 330 GAL X 200% = 660 GALS. DESIGN CAPACITY Tp 3.) ALL SEPTIC COMPONENTS BEING INSTALLED TO WITHSTAND H-10 LOADING. USE PROPOSED 1.500 GALLON SEPTIC TANK q Qw�" `"Fv hs�: LOCATED AT: TEPHEN LOT # 207-77 S AND TOP OFLam;' �' '� COASTAL BNK __ - _ ,� oaY�t #86 HORSESHOE LANE 16. 4 VARIANCES: REQUIRED LEACHING AREA: � 14 e _ 0 a. - �'TP #2 310 CMR 15.405(1�(a)(b)(a)&(h): (330 GAL/DAY) / (0.74) = 446 SQ. FT. n►� �� e 471 1.) A 6.20 VARIANCE, S.A.S. TO FRONT PROPERTY LINE, FOR A 3.80' SETBACK. ° sv F� ®�� CENTERVILLE, MA. 50 BUFFER LIMIT �. � 0 E FROM SALT MARSH C, `} L `26-yu N7 °Ol 1 3 2.) A 14.08 VARIANCE, S.A.S. TO CELLAR WALL, FOR A 5.92' SETBACK. 2 r 3.) A 5.00', VARIANCE, S.A.S. TO WATER SERVICE, FOR A 5.00' SETBACK. REQUIRED # OF INFILTRATOR CHAMBERS: 8 7' � K7 �. 4.) A 2.96' VARIANCE, SEPTIC TANK TO FRONT PROPERTY LINE, FOR A 7.04' SETBACK. 1 3 3 pA , SCALE: AS SHOWN DATE: 5-24-06 WATER SERVICE TO BE SLEEVED 12 5.) A 4.96 VARIANCE, SEPTIC TANK TO SIDE PROPERTY LINE, FOR A 5.04' SETBACK. TYPE OF INFILTRATOR CHAMBER: STANDARD SC CHAMBER AND RELOCATED AROUND SAS FIELD OF LOT # 207-101 6.) A 4.07' VARIANCE, SEPTIC TANK TO CELLAR WALL, FOR A 5.93 STBACK. 0 20 40 80 FEET < �- N0. OF CHAMBERS REQUIRED = SAS AREA REQUIRED PER WATER DEPARTMENT REQUIREMENTS. EDGE LOCAL REGULATION (100 FOOT SETBACK REQUIREMENT S.A.S. AND SEPTIC TANK (EFFECTIVE LEACHING AREA) x (LENGTH) TO SALT MARSH AND COASTAL BANK): 1.) A 34.7' VARIANCE, S.A.S. TO SALT MARSH, FOR A 65.3' SETBACK. _ (446 SQ.FT.) , OF �qS 0 2.) A 83.7' VARIANCE S.A.S. TO COASTAL BANK FOR A 16.3' SETBACK. (4.72 SF/LF) (6.25 LF) aP `9c PREPARED BY: > x �� ROBERT s 3.) A 29.3' VARIANCE, SEPTIC TANK TO SALT MARSH, FOR A 70.7' SETBACK. I DRAKE n KCJ ENGINEERING PROP. 1,500 GALLON SEPTIC TANK f= O�, 4.) A 76.6' VARIANCE, SEPTIC TANK TO COASTAL BANK, FOR A 23.4' SETBACK. = 15.11 CHAMBERS No.41642 - �, � BM.• TOP CB END. �, 100' BUFFER LIMIT ELEV 11.68 PROP. D-BOX ROBERT A. DRAKE O LT MARSH DATUM.•NGVDf y�,�t�lcy 66 GREENVILLE DRIVE FROM SA = 18 CHAMBERS USED IN DESIGN ---- SEE INSERT"A„ PROP. 10.5' x 37.5' LEACHING FIELD �- �2 q S.A.S. DETAIL LOT # 207-102 18- STANDARD INFILTRATOR CHAMBERS FORESTDALE, MA. 026" AS SHOWN IN DETAIL LOT # 207-103 TEL. NO. 508-287-1253 Drawn By. RD Designed By. RD Checked By: JOB No. 0625 TOP OF FOUNDATION 24" MIN. ACCESS COVER At�� rr� EL= 14.35't (TYPICAL OF 3) STANDARD INFILTRATOR TRENCH Way FINISHED GRADE OVER GROUND ELEVATI❑N = 13,25't DETAIL ¢- a FINISHED GRADE C4 �, PROPOSED 4" PIPE OVER TANK EL. = 14.0' t DISTRIBUTION BOX = 13.75' t (NOT TO SCALE) �� FalmotdhRdS SCHEDULE 40 PVC REMOVABLE COVER 5" DIA. OUTLET(S) �T❑P ❑F SAS = 11.39' F ,o� `Ra 0 $ GENERAL NOTES MIN. SLOPE 0 2% 9"MIN., 36"MAX. 36"MAX. ND FOR PROPER DRAINAGE ESTABLISH VEGETATIVE COVER o c 4" PVC IN FROM 4" PVC OUT FROM . �,, �� Pine St __ SEPTIC TANK LEACHING FACILITY. INV. END = 10.74'-- o INVERT (IN) = 10.93' , - , ,.;;", •_ �; , b �' 1.) UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND 12„ MINIMUM SLOPE ,% o �� J �y r �a �°`�Rd CONSTRUCTION METHODS SHALL BE IN ACCORDANCE 13" /// \\�\ ' '"_.;"`: ;: .: . ;' ;; .. ;.: ..: z w Centerville = 11.�s't 3" ty„ O TRENCH BOT, = 10.20'-� TRENCH B❑T. = 10.39' \\ _ "_ NAT[Vr 12' MIN., H-10 LOAD AREAS �` Rd 12.00't 11.so't 11.4o't ,�. 11.z3't ;- 37 5' I BACKFILL ` .' 6' MIN., NON-TRAFFIC AREAS - �� ENVIRONMENTAL CODE AND ANY WITH TITLE 5 OF THE STATE OUTLET TEE - 5.19' SEPARATION s~ APPLICABLE LOCAL RULES. 4'0" uoulD LEVEL (EFFECTIVE N 10'-0" LENGTH) MINIMUM TO BE PRESET ON A LEVEL STABLE ADJ. GW = 5.20' :: ::.:` c1 o 2.) ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD BASE. FIRST TWO FEET OF OUTLET PIPES , To BE LAID LEVEL. \i 12' ¢ s 5 OF HEALTH AND THE DESIGN ENGINEER. n xR �GW EL. = 3.50' 6 a $� t dRd craiprMleBaach 3.) 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL CROSS SECTION VIEW --36' 51 idb G„V„L„ M ,� BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. SEPTIC SYSTEM PROFILE LEACHING FIELD PROFILE LEACHING FIELD END 4.) 4" SCHEDULE 40 PVC PERFORATED PVC PIPE SHALL BE USED N.T.S. N.T.S. N.T.S. Ccntsrvit[eNartror INSIDE LEACHING TRENCHES OR LEACHING FIELDS. 5.) SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. �� .nd INLET + OUTLET ACCESS COVER To BE Nantucket 3o. 6.) THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. BROUGHT WITHIN 6" OF FINISHED GRADE FINISHED GRADE OVER G2006MppQuast,Inc, ®QppONAVI[-Q 4' - 9"MIN., 36"MAX. 10'-6" �- DISTRIBUTION BOX = 13.75' t LOCUS MAP 7.) LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED _ r _10'-0"_ I REMOVABLE COVER 1 5" DIA, OUTLET(S) (Assessors Map #207, Parcel #110) PRIOR TO BACKFILLING WHEN SYSTEM IS NEARLY COMPLETE AND 36"MAX. READY FOR INSPECTION. SYSTEM IS NOT TO BE BACKFILLED 13" 24" DIA. MANHOLE 6// MIN. WITHOUT FIRST OBTAINING APPROVAL FROM THE BOARD OF HEALTH 3„ COVERS AND DESIGN ENGINEER_ 3" 19" m a m a" PVC IN FROM PROVIDE WATERTIGHT : 9 JOINTS(TYP.) J0 SEPTIC TANK _ .__ 4" PVC OUT FROM LEACHING 8.) BASE PLAN, ELEVATIONS AND CONTOURS ARE BASED FROM A 4'0" LIQUID LEVEL / 'n 'n'n FACILITY. MINIMUM SLOPE 4 1% SURVEY PERFORMED BY STEPHEN J. DOYLE AND ASSOCIATES, PLAN OUTLET TEE---JJJ _ i1.4o't 12 �11.2 34" 10,5' DATED APRIL 4, 2006. THE CONTRACTOR SHALL BE REQUIRED TO 3" 6" CRUSHED STONE ZONING SUMMARY: VERIFY ALL EXISTING ELEVATIONS PRIOR TO COMMENCEMENT OF WORK. - -- -- - OVER MECHANICALLY COMPACTED BASE LEVEL BASE 5 OUTLET DISTRIBUTION BOX (H-10) 9.) WETLAND DELINEATION PERFORMED BY DON SCHALL, ENSR, ON 4-3-06 ZONING DISTRICT: RC 6" CRUSHED STONE PLAN VIEW TO BE RESET ON A LEVEL STABLE cRoss SECTION VIEW - OVER MECHANICALLY 10. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO BASE. FIRST TWO FEET OF OUTLET PIPE � SITE IS LOCATED IN RPOD ) COMPACTED BASE TO BE LAID LEVEL. 37,5 CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY PROPOSED 1,500 GALLON CONCRETE SEPTIC TANK (H-10) OTHER APPLICABLE AGENCIES_ REPORT ANY DISCREPANCIES TO LENGTH 10'6" WIDTH 5'8" DEPTH 5'8" CROSS SECTION VIEW THE DESIGN ENGINEER. SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL LEACHING FIELD PLAN VIEW TEST IPIT DATA 11.) NON-SHRINK GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES IN ORDER TO PROVIDE N.T.S. N.T.S. N.T.S. PER(. NO.: TP #1 + TP #2 WATER TIGHT SEALS. 12.) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED //� y �r y- �7 y • v�- / - WITNESSED BY: DON DESMARAIS. R.S. OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH o� PERFORMED BY: DAVID MASON, C.S.E. DETERMINATION FROM APPROPRIATE AUTHORITY. 5.93't s� DATE: MAY 4. 2006 13.) ALL SEPTIC SYSTEM COMPONENTS ARE BEING INSTALLED TO WITHSTAND H-10 LOADING. GROUND ELEV.: 13.00' f 13.) DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, ELEV. WATER: GW OBSERVED AT 120" DUST AND FINES. 5•92t PERC. RATE: < 5 MIN./IN. 15.) WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL BELOW AND FOR AN AREA 5 FT. ON ALL DEPTH OF PERC: TP#1 @ 28", TP#2 @ 34" SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER MOTTLES: N/A UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 47. 18 ,T 16.) CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES O FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO N 79001 1 TEST PIT #1 TEST PIT #2 CONTINUATION OF WORK. - 6 • 9 / 0" 13.50' 0" - 13.50' 17.) PROPOSED PROJECT IS LOCATED WITHIN: IL A: SANDY LOAM A: SANDY LOAM ASSESSORS MAP: #207 PARCEL: #110 111, �I � � �•: 8 � � ° _ _ - _ _.. / 10YR 2/2 10YR 2/2 d 10" 12.67' 11" 12.58' 18.) THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. R Remains of o VE KCJ ENGINEERING WILL NOT ASSUME ANY LIABILITY FOR THE B 6� Cedar Tree P` B: LOAMY SAND B: LOAMY SAND USE OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. �� 10YR 5/8 10YR 5/8 - O F 28" 11.17' 28" 11.17' SALT MARSH 6 � WETLANDS REVISIONS: �- \Q _AL '5 L n GE \ 1 C: MED. SAND C: MED. SAND 2.5YR 7/3 2.5YR 7/3 LOT ,# 207-142 INSERT "A" - S.A.S. DETAIL (NOT TO SCALE) EXIST. 1,000 GALLON " GROUNDWATER , » GROUNDWATER , �� 120 3.50 120 3.50 0 SEPTIC TANK OBSERVED OBSERVED BVWI --_ TO BE REMOVED AT 120" AT 120" 6 B 4 o vw2 ""' BVW3 �' 9 GENERAL NOTES: EXIST. LEACHING PIT �, AND TOP OF TO BE REMOVED 1.) THE PROPOSED LEACHING FIELD SHALL CONSIST OF 18 -STANDARD - -, COASTAL BANK INFILTRATOR CHAMBERS AS SHOWN ON THE DETAIL SECTIONS ON THIS PLAN. DESIGN DATA: o Cedar Tree W (LOCATED FROM RECORD AS-BUILT) PROPOSED SEPTIC SYSTEM UPGRADE B . Deck - THE LEACHING FIELD SIZE IS APPROXIMATELY 10.5' x 37.5'. THE SYSTEM IS 3 BEDROOM DWELLING 1� \ FOR AN AGGREGATE-FREE BED SYSTEM. UPLAND DESIGN FLOW: 110 GPD PER BEDROOM PREPARED FOR: SOIL PIT `9 2.) THE GROUND ELEVATION AT THE LEACHING FIELD IS AT EL. = 13.25' f - THE ELEV. AT THE TOP OF THE LEACHING FIELD IS AT EL. = 10.93' t 110 x 3.0 = 330 GPD sTrNG -- - - JEANNE STEVENS NEWMAN PROPOSED ------ E THE ELEV. OF THE 4' PVC SERVICE PIPES ARE AT EL. = 10.74' t g6 N 40 MIL POLY LINER �B, -' �.,, NG � 13 DAD.Ej-14-35 14 THE ELEV. AT THE BOTTOM OF THE LEACHING FIELD IS AT EL. = 10.20' t SEPTIC TANK' T rN ' � Oar ADJUSTED GROUNDWATER EL. = 5.20't, LEACHING FIELD PROVIDES A 5' SEPARATION. ,►�"'"'��°' t* N aF,t1 a 310 GAL X 200% = 660 GALS. DESIGN CAPACITY FEMA LINE \' TP �� 3.) ALL SEPTIC COMPONENTS BEING INSTALLED TO WITHSTAND H-10 LOADING. USE PROPOSED 1.500 GALLON SEPTIC TANK _. : s'cRFv c ��IV AT: LOT # 207-77 AND TOP OF I �_% _ o� STEFH-ti COASTAL BANK REQUIRED LEACHING AREA: D0�` TP 14 VARIANCES: \ = 2 #86 HORSESHOE LANE 310 CMR 15.405(1)(a)(b)(g)&(h): (330 GAL/DAY) / (0.74) - 446 SQ. FT. 50' BUFFER LIMIT �b �?� . "E Fa/ 1.) A 6.20' VARIANCE, S.A.S. TO FRONT PROPERTY LINE, FOR A 3.80 SETBACK. �� J �� CENTERVILLE, MA. FROM SALT MARSH `" 26.9Q N79, 01 10 3 2.) A 14.08 VARIANCE, S.A.S. TO CELLAR WALL, FOR A 5.92 SETBACK. _ ` 3.) A 5.00', VARIANCE, S.A.S. TO WATER SERVICE, FOR A 5.00' SETBACK. REQUIRED # OF INFILTRATOR CHAMBERS: 4.) A 2.96 VARIANCE, SEPTIC TANK TO FRONT PROPERTY LINE, FOR A 7.04' SETBACK. WATER SERVICE TO BE SLEEVED 12_ p/ 5.) A 4.96' VARIANCE, SEPTIC TANK TO SIDE PROPERTY LINE, FOR A 5.04' SETBACK. TYPE OF INFILTRATOR CHAMBER: STANDARD SC CHAMBER SCALE. AS SHOWN DATE: 5-24-06 AND RELOCATED AROUND SAS FIELD of LOT # 207-101 6.) A 4.07' VARIANCE, SEPTIC TANK TO CELLAR WALL, FOR A 5.93 STBACK. 0 20 40 80 FEET PER WATER DEPARTMENT REQUIREMENTS. � - NO. OF CHAMBERS REQUIRED = SAS AREA REQUIRE DG D LOCAL REGULATION (100 FOOT SETBACK REQUIREMENT S.A.S. AND SEPTIC TANK (EFFECTIVE LEACHING AREA) x (LENGTH) TO SALT MARSH AND COASTAL BANK): 1.) A 34.7' VARIANCE, S.A.S. TO SALT MARSH, FOR A 65.3' SETBACK. (446 SQ.FT. OF M �tSV 2.) A 83.7' VARIANCE, S.A.S. TO COASTAL BANK, FOR A 16.3' SETBACK. (4.72 SF/LF) x (6.25 LF) a�P� gsS PREPARED BY: 3.) A 29.3' VARIANCE, SEPTIC TANK TO SALT MARSH, FOR A 70.7' SETBACK. o� ROBERTA. Y - PROP. 1,500 GALLON SEPTIC TANK DRAKE KCJ ENGINEERING 4.) A 76.6' VARIANCE, SEPTIC TANK TO COASTAL BANK, FOR A 23.4' SETBACK. = 15.11 CHAMBERS J 9 No CIVIL BM.- TOP CB FND S P, ROBERT A. DRAKE 100' BUFFER LIMIT ELEV 11.68 PROP. D-BOX FROM SALT MARSH DATUM.•NGPV_ = 18 CHAMBERS USED IN DESIGN a' E`� 66 GREENVILLE DRIVE SEE INSERT"A" � - - -_ - PROP. 10.5' x 37.5' LEACHING FIELD _ S.A.S. DETAIL LOT # 207-102 18- STANDARD INFILTRATOR CHAMBERS FORESTDALE, MA. 02644 AS SHOWN IN DETAIL LOT # 207-103 TEL. NO. 508-287-1253 Drawn By. RD Designed By. RD Checked By: JOB No. 0625