HomeMy WebLinkAbout0128 GLENEAGLE DRIVE - Health 128 Gleneagle Drive
Centerville
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HASTINGS, LIN
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
J
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 128 Glen Eagle Drive i
Centerville
Owner's Name: Estate of Nieki Tavaho
Owner's Address:
Date of Inspection: 0 i
Name of Inspector:(please print) W i I 1 i am E_ . Rob i nson Sr.
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1089
Centerville, MA
Telephone Number: (508) 775-8776.
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Sec ton 15340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
i
Inspector's Signature: , / Date: -6
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health w
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 seat to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
"This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15f2000 page 1
1
Page 2 of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 128 Glen Eagle Drive
Centerville
Owner: Fstat_P_. of Vicki Tavano
Dale of inspection: —6-5
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all onsection D
A. Sy/ Passes:
t 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. Sys m Conditionally Passes:
On or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.Th system,upon completion of the replacement or repair,as approved by the Board of Health,will pass..
Answer yes,n or not determined(Y,N,ND)in the for the following statements.if'%at determined"please
explain.
The Sept c tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally
unsound,exhib substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
existing tank is eplaced with a complying septic tank as approved by the Board of Health.
•A metal septi tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that a tank is less than 20 years old is available.
ND explain:
Ob rvation of sewage backup or break out or Idgh static water level in the distribution box due to-broken or
obstruct ipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
approval o oard of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The syste required pumping more than 4 times a year due to broken or obSt Ailed pipe(s).The system will
pass inspection i (with approval of the Doard of Health):
broken pipe(s)are replaced
obstruction is rcraovod
ND explain:
Page 3 of I I
OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 128 Glen Eagle Drive
Centerville
Owner: Estate. of Nicki Tavano
Date of Inspection:�_�
C urther Evaluation is Required by the Board of Health:
onditions exist which require further evaluation by the Board of Health in order to determine if the system
is failin to protect public health,safety or the environment.
J. S Urn will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the
sys em 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
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:
_ e system has a septic tank and soil absorption system(SAS)and the SAS is Within.100.feet of a. .
surfa a 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 front a
priv a water supply well" Method used to determine distance
••Thi system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteri and volatile organic compounds indicates that the well is free from pollution from that facility and,
the pres nce.of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure c iteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 128 Glen Eagle Drive
Centerville _
Owner: Estate of Nicki Tavano
Date of inspection: /f 7— 0`7
D. System Failure Criteria applicable to all systems:
You must indicate des"or"no"to each of the following for all inspections:
Yes � D!tsc
pof sewage into facility or system component due to overloaded or clogged SAS or cesspoolcharge or ponding of efuentto the surface of the ground or surface waters due to an overloaded or
'ogged�SAS or cesspool
Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or
-�esspool
iquid depth in cesspool is less than 6"below invert or available volume is less.than day flow
. t/Requived pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s).Numbcr
/of times pumped
'/_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
Z/_ Any portion of cesspool or privy is within 100-feet of a surface water supply or tributary to a surface
water supply.
1ny portion of,a cesspool oeprivy is within a Zone 1 of a.public well.
y 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'organir 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.]
( es/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
ealth to determine what will be necessary to correct the failure.
E. Large Sys ins
To be consider a large system the system must serve a.faci!ity with'a`desi it=flow of 10 000 gpd to 15,000
gpd•
You must indicat either"yes"or"no"to each of the following:
(The following cr eria apply to large.systems in addition to the criteria above)
yes no
the syste is within 400 feet of a surface drinking water supply
_ the systc is within 200(eel of a tributary to a surface drinking water
the syst m is located in an ittogen sensitive area(Interim Wellhead Protection Area-1WPA)or a mapped
Zone I of a public water supply well
If you have were,d"yes"to any question in Section E the system is considered a significant threat,or answered .
yes"in Se on D above the large system has failed.The owner or operator of any large system considered a
significant t eat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The
ystem owner should contact the appropriate regional office of the Department.
9 �V
4
Pages of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAG
E DISPOSAL SYSTEM INSPECTIO
N FORM
PART B
CHECKLIST
Property Address: 128 Glen Eagle Drive
Cen ervi e
Owner: Estate of Nic i avano
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?
�as the system received normal flows in'the previous two week period?
i/ 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:
Yes no
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)13 10 CIAR 15.302(3)(b)j
5
Page 6 of 11 .'
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 128G1en Eagle Drive
Centerville
Owner: Estate of Nicki Tavano
Date of Inspection: % Q — n 7
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_-/ Number of bedrooms(actual): L/
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): /�S 7
Number of current residents:_ram
Does residence have a garbage grinder(yes or no):,,d,6
Is laundry on a separate sewage system(yes or no):& [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no):li, o
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no): A., a r"s L _ ��
Last date of occupancy: GZ5 e3
COMMERC L/INDUSTRIAL
Type of esta ishment:
Design flow(based on 310 CMR 15.203): Qpd
Basis of d ign flow(seats/persons/sgft,etc.):
Grease tr9p present(yes or no):_
Industri waste holding tank present(yes or no):Non-s itary waste discharged to the Title 5 system—
(yes or no):_
Water eter readings,if available:
Last to of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: e, �-I
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped: ._gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
_AZSeptic 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:
Were sewage odors detected when arriving at the site(yes or no):,�L-_o
6
Viv 7 of I I
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1 28 Glen Eagle_ Drive
Centerville
Owner: Estate of Nicki Tavano
Dalt of lnsptcllon:_/>I_C r)
BUILDING SEl Lit(locale on silt plan)
DepUl below gr dc:
Materials of a nstruclion:_cast'irun _40 1'VC_udlcr(explain):
Distance frol private water supply well or suction line:_
Conunents un condition of juutts,venting,evidence of Icakagc,Etc.):
SEPTIC TANK:Zoocalt
on site pla►►)
Depth below Bradt:
O �
Material of eonstruciivn:
_olhcr(explain) —
_/concrete metal fiberglass J,ul}eU►ylene
If tank is metal list age:_ Is age confirmed-by a Certificate
certificate) v 11 of Compliance(ycs or nu):_(altach a cup}!of
Dintensions: L 'k L -4 15
Sludgt dcplll:_ Ll
Distance from lop of sludge tv bununl of uullcl Ice or bafllc:
Scttru thickness:_;r�t� � '
Distance from lull of scum to lull of oullct ice or bafllc: Y- +
Distance born bottom of scum to bottortt of outlet Ice or battle: 1 '
I low were dintcnsiuns determined:
Cumntenls(on pumping recunvmendatiwrs,inlet and outlet Ice or bafllc eunditicn, strucW►al iulcg►i1y,liquid levels
as related to owlet utvcrt,cvidcrtcc of leakage,etc.):
v — e
GREASE Tl ':_(lo.calc on site plan)
Dcld below ade:_
Material of onslruelion:__ toncrcle metal fiberglass_pvlycllq Icne _other
(Explain): — _
Dimcnsio s:
Scum Ihi kness.
bistanc front Ivy of scum lv lop of uullcl Icc or bafllc:_
Dislanc Gom botlunn of`scun►lv bultunt of oullct lcc or bafllc:
Dalc o l is.pumping: -
Conti ents(on pumping IC ullumlidaliuns,inlet and uullcl ICE or bafllc cunditiu:t,situottlal 1111e6rily,liquid It:s•cls
as rc alcd to oullct im'crt,ccidcncc of Icakagc,cic):
7
Page 8 of I I
OFFICIAL INSPECTION 1 olm -NOT FOR V0LUNTA11Y ASSL;SSI11l;NTS
SUUSUIU-'ACL•; SLIVAU DISPOSAL SYSTEM INSPECTION F01(N1
PAIIT C
SYSTEM INFORMATION(cominued)
Properly Addresi: 1 28 Glen Ea le Drive
Owner:
_Cen_terville Dale Tavano
of lospcctloo: I—�—® �
TIG11T or 110L ING TANK:_(tartk must be pumped at lime of inspection)(lucale on site plan)
Depth below gr de:
hl3terial of co struction:__concrete_rnelal_fiberglass_lrulyetliylene odter(explain):
Uimcnsions:
Capacity: alluns
Design Flo : gaHunslday
Alarm pies nt(ycs or no):
Alarm Icv I: Alarm in wurkin urdcr
Dale of la t pumping: g V'cs or nu):
Comment (condition of alarm and nua(swilclics,ctc.):
UISTIUUUTION BOX: (if present must be opcmcd)(loca(c on site plan)
Dcplh of liquid level above outicl iuvcrt: C/
Conuncnts(Hole if box is level and distributive tv outicls equal,any cvideiicc of solids carryover,any evidcncruf
leakage into or out of box,ctc.): /�
I'UMI'CIIA�IUCII (locate on site plan)
hillps in working rder(yes or no):
Alanns in workir order(ycs or mo): _
Conuncnls(nul condition of lump t hamtbcf,cundiliun of pumps and appurlcnall(cs,ctc.):,
Page 9 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 128 Glen Eagle Drive
Centerville
Owner: Estate of Nicki Tavano evic
Date of Inspection: f —j --o `
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation"not required)
If SAS not located explain why:
Type
leaching pits,number:_ t,
leaching chambers,number:
leaching galleries,number:
leaching 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.):
t -J v —3 z
CESSPOOLS: /r.tolinlet
ool must be pumped as part of inspection)(locate on site plan)
Number and confi
Depth—top of liq invert:
Depth of solids la
Depth of s/onstiruction:
er:
Dimensionspool:
Materials o
Indicationndwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: flocatf on site plan)
Materials of con coon:
Dimensions:
Depth of soi' s:
Comments note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 1 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 128 Glen Eagle DAr e
Centerville
owner: Estate of Nicki Tavano
Date of Inspec(ion: Z p o"7
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.
1 )LS
3 �
A �
l � �
10
`Page-11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 128 Glen Eagle Drive
Centervii1e
Owner. Estate ot Nic i Tavano
Date:of Inspection: — 9—v-7
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water�2 0 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-if checked;date of design plan reviewed:
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:
11
l0'C KT ION SEWAGE PERMIT NO.
_ (,6-,Al p
VILLAGE
I N S T A LLER'S NAME i ADDRESS F'
BUILDER OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
�I_ N
o j
Lon
.ti
ry
10
f ��
No. —470 a Al00 .00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Z[ppYtcatton for Mf 6 pooal bpotem Cori.5tructfon Permit
Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. 7 9 0—9 5 6 8
128 Gleneagle Rd Centerville Nikki Tavano
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Septic Service Eco—Tech
PO Box 1089, Centerville 43 Triangle Circle Sandwich
Type of Building:
Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(no)
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 Soil
Nature of Repairs or Alterations(Answer when applicable) Ins to 1 1 a n aw Tit 1 e 5
leach system to plans of Eco—Tech #ETE-1757
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 b ued by "barHealth
n ..�
Si ed Date ! ®/
Application Approved by Date
Application Disapproved for the following reasons
' Permit No. Date Issued
7l7 , 100. Ve,
No.� wit/ ..:A�x Fe$
HE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN Of BARNSTABLES MASSACHUSETTS
01ppfication for 3i5po5al *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. 7 9 0—9 5 6 8
128 Gleneagle Rd Centerville Nikki Tavano
Assessor's Map/Parcel
InstalPer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Septic . Service Eco—Tech
PO Box 1089, Centerville 43 Triangle Circle Sandwich
Type of Building:
Dwelling No.of Bedrooms 4 Lot Size ✓�\sq.ft. Garbage Grinder(no)
Other Type of Building No.of Persons �� Showers( ) Cafeteria( )
Other Fixtures �-
Design Flow gallons per y y)Cal' cu}a"d ily flow . gallons.
Plan Date Number of sheets R e sion ate.
Title f
Size of Septic Tank t A T,re of S.A '\, 1
1
Description of Soil
� '7
Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5
leach system to plans of Eco-Tech #ETE-1757
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 b'- '. ued by is$r-oar Health.
Sig ed Date q
Application Approved by Date / ,
Application Disapproved for the following�reasons
1
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
f,.
Tavano BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed ( ) Repaired ( X)Upgraded ( )
Abandoned( )by Wm t Robinson Septic Service
at 128 Gleneagle Road,Centerville has been constructedin accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer _
The issuance of this perift�s �l of be construed as a guarantee that the stem wr function as designed.
Date Inspector
No. 0'w L/70 Fe$1()o 00
Tavano THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Digpogat *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at 128 Gleneagle Road, Caritervi I 1
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 condK
Provided: Constru tion must be completed within three years of the dthis pe
Date:_ `�' �`� Approve
Town of Barnstable "
Regulatory Services
Thomas F. Geiler,Director
• BAmffrest.s.
9� M6 S. ,0� Public Health Division
P�FO reps Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: — `(
Designer: Eco-Tech Installer: Wm E Robinson Sr
Address: 43 Triangle Circle Address: PO Box 1089
Sandwich Centerville
On Wm E Robinson Sr Sept igvas issued a permit to install a
(date) (installer)
septic system at 128 Glen Eagle Dr, Centervillbased on a design drawn by
(address)
E c ZTee c h dated
(designer)
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.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
0avt0D CA
In a er's Si a cu�t`oWp �
( . ) y #1093 0 .-I
TA�,P�
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLICHEALTH 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 YO.U..
Q:Health/Sbptic/Designer Certification Form
TOWN OF BARNSTAB E ��
LOCATION A" SEWAGE # dt
VILLAGE %/"� ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. B J
17
SEPTIC TANK CAPACITY
• h;
LEACHING FACILITY: (type) - G (size)
NO.OF BEDROOMS J� `
BUILDER OR OWNER.
PERMPTDATE: /`� '� �i COMPLIANCE DATE:-9— ��—
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bo of Leaching Facility
Feet
Private Water Supply Well and Leaching Faci • (If any wells,exist Feet
on site or within 200 feet of leaching fac' ty)
Edge of Wetland and Leaching Facility.( any wetlands exist
Feet
within 300 feet of leaching facility)
Furnished by
T
s t
0 �
TOWN OF BARNSTABL'Eoc{
OCATION LO i Ail aSEWAGE # `
LADE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. ,p�
S
SEPTIC TANK CAPACITY p
LEACHING FACILITY: (type) 33, (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE:_ COMPLIANCE DATE:
Separation Distance Between the:
Maximum-Adjusted Groundwater Table to the Bottom of Leaching Facility 1MA> Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) e%__p Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 fe ., I ping faci Feet
Furnished by
0 0
CD
oo
0150 ��
FLOW PROFILE
o VENT
PIPE
RAISE COVERS TO WITHIN
TOP OF FOUNDATION 6 in OF FINAL GRADE
_
EL • 63.00 + ONE INSPECTION RISER FOR
.t
LEACHING GALLERY
-` lee, 2- LAYER OF 1/8'
' D-BOX 1/2- STONE
3' DROP H-20
FLOW LINEIT
TEE
10. H-20
'. 48- GAS--}". BOTTOM OF
PRECAST 3/4'-I 1/4'
RAFFLE '' ' ' DRYWELL STONE
58.60+- 6 in SOIL ABSORPTION
EMMW STONE 58 26 LEACHING SYSTEM
BASE
EXISTING 58.45 5810 _' GALLERY
ocIsnao 5.00 f1
1000 'GALLON (END VIEW) 5e.10
wasnNo SEPTIC TANK 6 rt 0) 5 Ft 12.5 1 t
b) 13fr
ESTIMATED V 37.00
SEASONAL HIGH
GROUNDWATER
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LAG IGN
s0 1 LTEST DESCALCULATIONS Xti .
DATE OF TEST: AUGUST 13, 2004 `
SOIL EVALUATOR: DAVID D. COUGHANOWR, RS DESIGN ''FLOW: 4 BEDROOMS X 110 GPD - 440 GPD -
WITNESS REQUIREMENT - WAIVED - NO VARIANCES .SOUGHT
SEPTIC TANK: 440 GPD X 2 DAYS - 880 GALLONS
NO GROUNDWATER
TEST PIT I PARENT MATERIAL: E ROGLACIALDOUTWASH _
PERC AT 52 in 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL .
ELEVATION - 62.36 •- CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
DEPTH SOIL USDA SOIL SOL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 33.5 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH
0-16 FILL A b o t - (33.5 x 12.5 ) - .418.75 sf
AaJw - ( 33.5 + 33.5 + 12.5 + 12.5 ) x 2 - 184.0 of
16-22 A LOAMY SAND 10 YR 3/2 NONE FRIABLE Atot - 602.75 sf
Vt 0.74 x 602.75 - 446.03 GPD
22-44 B LOAMY SAND 10 YR 4/6 NONE FRIABLE USE A 33.5 f t x 12.5 ft x 2 f t GALLERY. Vt - 446.03 GPD > 440 GPD REQUIRED
44-146 C MEDIUM SAND 10 YR 6/3 NONE LOOSE
GROIA�iDWATER ADJUSTMENT LEACHING GALLERY CONSTRUCTION
DETAIL
EXISTING GROUNDWATER LEVEL GALLION NS PRECASTEDRYO
WELL
BASED ON TOWN OF BARBSTABLE LEACHING UNIT OR
GIS DEPARTMENT RECORDS. \ EQUIVALENT. USE H-20 UNITS
`'� STONE
8"
INDICATED GW 33.00 2 ft EFF. DEPTH 33.5 f t
INDEX WELL SDW-252
ZONE D _
READING 47.5
ADJUSTMENT 4.0 In O O O
ADJUSTED GW 37.00
NOTESM
4.p 8.5' 8.5- 8.5' G'
I) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 33.5 f t
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM.
3) ALL COMPONENTS INSTALLED SHALL. MEET THE MINIMUM REQUIREMENTS
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15)
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES
BEFORE EXCAVATING FOR SYSTEM.
5) EXISTING LEACH PITS TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED
6) A61 STONE TO BE DOUBLE WASHED AND .FREE OF IRON, FINES .AND DUST IN PLACE
7) LINES EXITING D-BOX,70 RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN SEWAGE DISPOSAL SYSTEM PLAN q }
L( s.
8) ECO-TECH ENVIRONMENT AL ,RECOMMENDS THE--INSTALLATION OF LOW FLOW FIXTURES -TO SERVE EXISTING DWELLING
AND APPLIANCES. AND BIANNUAL PUMPING'.'OF,T;HE;SEPTIC TANK
9) SYSTEM IS NOT DESIGNED TO--WITHSTAND_VEHIC`ULAR LOADING. DO NOT »-
; 0 ; �;
- PARK OR DRIVE VEHICLES ,OVER SEPTIC" SYSTEM. NIKKI -TAVAN
�� ><
f . .
10) INSTALLER TO OBTAIN DISPOSAL WORKSI,PERHit-BEFORE STARTING WORK. 128 GLENEAGLE DRIVE CENTERVILLE ;1MA�`
q _SEPTIC TANKS SHALL BE`'INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL L �`
STABLE' BASE THATs�HAS BEEN MECHANICALLY COMPACTED :AND. ON .,TO WHICH ECO ,.TECH xENVIRONMENTAL '
r"a)!;.,-INCHES �OF CRUSHED STONE HAS BEEN``P.LACED,;TO. MINIMIZE :UNEVEN SETTLING -'
i. .. ,. ,.g;,.aYr:Fi!> ;b,.:9- e y-.uan.. ,kns....... _,...•.rt t_w.. . .. .. . y .�.w .:e - _
` = ..43`-TRIANGLE CIRCLE ,SANDWICH�:M�A:02563=
PTI ;TANK :TO BE PUMPED`DRY.:AT ;TIME 40F�SYSTEM REPAIR SAND=CHECKED
T RAL> INTEGRITY.' INSTALL `P.VC'.'OUTLET,'TEE"FITTED WITH 'GAS BAFFLE.
FOR STRUC U - a �ttx ,. Y
. �.h-�. � , . ._ . - ._ _ . a . _ '.ETE-1z57. SEP.T
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