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HomeMy WebLinkAbout0110 RIVERVIEW LANE - Health 110 Riverview Lane Centerville A = 228 163 SIII_ I /J �14*tCYCIfpcp. UPC 12534 HASTIN08,UN r Mar 06 2016 22:52 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 Riverview Lane �.. Property Address Robert Najarian Owner Owner's Name / information is ✓ required for every Centerville MA 02632 3-3-16 Qp page. Cityrrown State Zip Code Date of Inspection .R. l:0 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information fin the utf Sri �11�33 `` "��Hunnf�� G' on the computer, �`���y OF use onlythe tab �`� KJ;.• t"" �i 1. Inspector: '- key to move your cursor-do not James D.Sears : JAMES -'N use the return =gm+ key. Name of Inspector ?v; amm a :y Capewide Enterprises, LLC Company Name 153 Commercial Street ��F 6 ►NSi Company Address ' Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification rt �catton 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 m6Iintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-3-16 �ffispector's Signature Dale 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. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page t of 17 V'S D Mar 06 2016 22:52 Jim The Inspector Man 5085349919 ' page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owner's Name information is required for every Centerville MA 02632 3-3-16, page. Cityrrown 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: ® 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: The system is a 1500 Gal.Tank D Box and three 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): 15ins•W 3 - Title 5 Official Inspection Form:Subsurrace Sewage DlsposaI SYStem•Page 2 of 17 Mar 06 2016 22:53 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian_ Owner Owner's Name equir Informatl fo is every required fo Centerville MA 02632 . 3-3-16 page. Cityrrown State Zip Cade 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 ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 l5ins•3113 Title 5 Official Insoection Form:Subsurface Sewage Disposal System•Pape 3 of 17 Mar 06 2016 22:53 Jim The Inspector Man 5085349919 page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owners Name information is required for every Centerville MA 02632 3-3-16 page. City/Town State Zip Code Date of Inspection B. Certification (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'systern has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet,but 50 feet or more from a private water supply well`*. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must. be attached to this form. 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 ammopM is less than 6" below invert or available volume is less than %day flow/ UO, jet t5ins•3113 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 Mar 06 2016 22:53 Jim The Inspector Man 5085349919 page .19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 110 Riverview Lane i • Property Address 4 Robert Najarian Owner Owner's Name information is required for every Centerville MA 02632 3-3-16 page. CirylTown 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 groundwater 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 from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria Indicates absent.and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.]. ❑ ® The system is a cesspool serving a facility with a design flow of 20009pd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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 15,000 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 drinkingwater supply pp Y ❑ ❑ 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•3113 - Tide 5 Official Inspeclion Form:Subsurface Sewage Oisposal System Page 5 of 17 Mar 06 2016 22:53 Jim The Inspector Man 5085349919 page 20 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owners Name information is required for every Centerville MA 02632 3-3-16 page. Cilyrrown 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 breakout? ® ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x#of bedrooms): 440 151ns•3113TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Mar 06 2016 22:53 Jim The Inspector Man 5085349919 page 21 Commonwealth of Massachusetts = Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owners Name information is required for every Centerville MA 02632 3-3-16 page. City/rows State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal Tank D Box and three chambers. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2014-277,000Gal 2015-91,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present 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? El 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: l6ins-3113 Title 6 Official Inspeclion Forth:Subsurface Sewage Disposal System•Page 7 of 17 Mar 06 2016 22:54 Jim The Inspector Man 5085349919 page 22 . Commonwealth of Massachusetts Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 110 Riverview Lane _ Property Address Robert Najarian Owner Owner's Name Information Is required for every Centerville MA 02632 3-3-16 page. CityrTown 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3I13 Title 5 Oftial Inspection Farm:Subsurface Sewage Disposal System•Pape 8 of 17 Mar 06 2016 22:54 Jim The Inspector Man 5085349919 page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owner's Name information is required for every Centerville MA 02632 3-3-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed,(if known) and source of information: 2002 Permit # 2002 - 248. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 38"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction 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: 28"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal.Precast H-10 Sludge depth: 8" 15ins•3113 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Mar 06 2016 22:54 Jim .The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owner's Name information is required for every Centerville MA 02632 3-3-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 2' Distance from top'Of scum to top of outlet tee or baffle 81, Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Tape 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 outlet cover at 28" below grade w/inlet cover at 2". In and outlet tee's. No sign of leakage or over loading. Note:Tank should be pumped 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-3/13 TiQe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Mar 06 2016 22:54 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments " 110 Riverview Lane Property Address Robert Najarian Owner Owner's Name information Is required for every Centerville MA , 02632 3-3-16 page. CityrFown 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Mar 06 .2016 22:54 Jim The Inspector Man 5085349919 page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owners Name information fn is every Centerville required for eve MA 02632 3-3-16 page. Cityrrown State Zip Code Date of Inspection 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 16"x16"-54" below grade w/one line out. Box is clean and solid. No sign of over loading or solid carryover. 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: ISins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 12 of 17. Mar 06 2016 22:54 Jim The Inspector Man 5085349919 page 27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 110 Riverview Lane Property Address Robert Najarian Owner Owner's Name information is required for every Centerville MA 02632 3-3-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: 0 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 is three 500 Gal.dry well chambers w/3' stone. Chambers are 5'+below grade. Ck 0 Box and camera.out to leaching. 6"water w/clean wall's. No sign of over loading or solid carry over. No high stain line. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No thins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Mar 06 2016 22:54 Jim The Inspector Man 5085349919 page 28 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 Riverview Lane Property Address _Robert Najarian Owner Owner's Name information is required for every Centerville MA 02632 3-3-16 page. Cltyrrown 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, etc.): l5ina•3/13 rfle 5 Official inspection Form:Subsurface Sewage Disposal Sys-.am-Pago 14 of 17 Mar 06 2016 22:54 Jim The Inspector Man 5085349919 page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner. Owner's Name information is Centerville MA 02632 3-3-16' 1 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately GA 1 f ' 1 1 f3 eR �Oo ail � f,4 A a'( p C 3- ,D , 3 fa o a r C - � 37 „ 15in6.3113 Tltfo 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Mar 06 2016 22:55 Jim The Inspector Man 5085349919 page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 110 Riverview Lane Property Address Robert Najarian Owner Owners Name information Is required for every Centerville MA 02632 3-3-16 page. City/Town State Zip Code Date.of Inspection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N Estimated depth to high ground water: 11 + 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: 6-7-02 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 6-7-02 no G.W. at 114. Bottom of chambers at T below grade. Bottom of chambers at 4'+above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page, i 15ins•V13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal sys:em•Page 16 of 17 Mar 08 2016 12:08 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Riverview Lane Property Address Robert Najarian Owner Owner's Name information is required for every Centerville MA 02632 3-3-16 page. Cityrrown State Zip Code Date of Inspectlon E. Report Completeness Checklist j ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria 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 ' I 15ins•3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 17 of 17 TOWN OF BARNSTABLE LOCATION //a A vO^yr C<u/ 'IE SEWAGE # 0 j - vi1.LAGE C,&,a- /erv, Ap ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. WDd ✓ �- �� ��'J SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS.__ BUILDER OR OWNER D- PERMIT DATE: L� 6 - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by .. 4T 4 f 1 {v C 6� S V 0 �Jcoa. ) No. � Fe��� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migomf *pgtem Cow5truction 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. 11� Riverview Ln. , . Centervill Donna Hume Assessor's Map arce P Installer's Name,Address,and Tel.No. (p Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Servic Dan Johnson P O Box 1089, Centerville �804 Main St, 0stervilie Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow n gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank J " o Type of S.A. III@V& Description of Soil medium s a n d Nature of Re airs or Alterations(Answer when applicable) Replace c P s G nnn 1 s�i t h a 1 , 900 gal, tank and 3 drywells (32 'L X13 'W X2 'H) 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 Bo d 5PHealth. Signed l Ll v Date' - Application Approved by Date v"X. Application Disapproved for ge following reasons Permit No. 2d0.2—�� Date Issued l �� ----------- --------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Hume (Certificate of (Compliance 'PHIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded(Abando dib j ) y Wm. E. Robinson Septic Service ierview n. , Centerville a has been construe;Fm constructed 'm accordance at ^�. with the provisions of Title 5 and the for Disposal System Construction Permit No. -12 �_dated 1 � a Installer Wm. E. Robinson Sr. Designer Dan Johnson The issuance°�f thii ermit shall not be construed as a guarantee that the sy t - will function as es' ed. Date�p 1 I11h Inspector IIV No. e4���' 11� Fee$50 THE COMMONWEALTH OF MASSACHUSETTS Hume PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Digpogal *p!5tem con,5truction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 1 1 0 Riverview Ln. , Centerville 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:Co sttru ion must be completed within three years of the date of th' ermit. Date: 1 Approved by No. — 1� w � , Fe.5 0 a / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L00101,V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS Zipprication for Mi!5pooal 6pelem Cottgtrurtton Fermat 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. 110 Riverview Ln. , Centerville Donna Hume Assessor's Map/Parcel 2 r 63 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ' Wm. E. Robinson Septic Servic Dan Johnson P O Box 1089, Centerville �804 Main St. , Os _ v A Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building,Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow d d Q gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank l'_00 Type of S.A. UU 6 C�w,Mbvrl Description of Soil medium sane] Nature of Re airs or Alterations(Answer when applicable) Replace cesspools wit-h a if�00 gal. tank and 3 drywells (32 'L X13 'Ili X2 'H) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system w 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 realth. Signed I , / T Date Application Approved by 44. Date v�. Application Disapproved for E e following reasons Permit No. Date Issued �z �� NOTICE: This Forii Is To Be Used'For the Repair Of Failed Septic Systems OWy. Ft °PERC OLA TION TEST AND SOIL EVALUATION EXEMPTION ` FORM 'y.. I,-1) r�� B . f�hF-�a^J hereby certify that the engineered plan-signed by me ` dated (o(l3/ed concerning the property located at. //o / VC- */[g-•✓ . 64-1Ve ~C.4--AJ7Zr•LV<« meets all of the following criteria:' - • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation iaie is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent.present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable]' Please complete the following: A) Top of Ground Surface Tlevation (using GIS information) 36 B) G.W. Elevation 10. +adjustment for high G.W. D¢FERENCE BETWEEN-A and B _ M 1 p fr r2�,•�-ems SIGNED A. DATE: 6 1010 1 NOTICE Based upon the above in ormation, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future-without engineered septic system plans. - a q:heilth folder:perceunp TOWN OF BARNSTABLE LOCATION /�d �, v.' ys Cu/ SEWAGE # ©1— ;-113, VILLAGE_-e� ev?Ap ASSESSOR'S MAP & LOT oZ - 163 INSTALLER'S NAME&PHONE NO.1S SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3' li G (size) NO.OF BEDROOMS BUILDER OR OWNER 17• �� �� A PERMITDATE: L'— % �-- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by :4 L s �' iKas. j Q�Lerv!'evd �tnrlL R - ----------- j 14 1 1 A VT - I A A 4 -1 vq- 1 -1 -0 P f:!U I L: 10 TE-71 I JA NOW L : I - .1 1. 1 . 1 1 ! - - - - .1 PIA !-- ! - - 1- ;- -1 T-1 - I --y , 1 F -I J A I A K 1 [ I I ­.'�I _-__ .. 1 -- -1 - n , i , - - - -- 4. -1 . . v 4-4 + +-�-q- q V L A. f I hT i T-I - 1 -1 A i 11 T 7 JJ- -1 1-4--4--+ --�..;-v r 4 [v A-4r. T 1 lit L sw J T T T -1 Q. t 1 1 LA J1.11 AAA- J T_ ow r 7 A A- I .......... 4-11 -T T T T- A A-4- j I --T I 1 A 14 1 1 AJ 11 i A i q J a�U,n L r[ 11 t v+T; y ......------ Jz) 1-7 T YT 7 171 tl A! 7 "A lit 1A AAA . i (X A + 4- ;--1 QQ:rr-�h 0- VA- ii J - n 4-7- t 4-A 4+0- I - ;+ T Jf i L IL lv � LIN 4-4_44­+.�­ IT A-4-d-4 V1 0� 0-11 i A .- K! T . 1 I J 71 41 A Al FT A fly? d T A IT !71 - ­r I -- ­ --­­-I [ 11:1 F Y- , - 1 111 n. I[It -7 r T I. i J UT A F i 4 i A Q- 7-T 1-q, 1 4- 1 0 t 1 -4-110 1 VA—1- k 1 -1-4-1 i I th 1 4 1 1 -1 70 1:701 24"DIA.RISERS AND 1500 GALLON SEPTIC TANK COVERS OVER INLET MODEL:TK•15M(SHEA CONCRETE) (OR EQUIVALENT) p AND OUTLET o F $E( ��C �Y S 7-C� TEST FIT DATA MANHOLES SHALL BE FINISHED GRADE CONSTRUCTED WITHIN 5(_,4LF: t =tea r Performed B Daniel B. Johnson G'OF FINISHED GRADE - Y (TO BE SEALED 24"DIA 24"DIA 9"jMIN) 24"DIA WATERTIGHT) Date: June 7, 2002 3"' 3' - H-10 TF-1 (EL. = 100.0) 4„SCH 40 FLOW LINE „ ZABEL FILTER A-100 v�,`h» V/FL�4' 6„ A, 10YR4/3 sandy loam 4 SCH�0 10' 14 fN4 33.0 4 I-ANC /:or,2 6" - 3011 Bw, 5R5 Lam sand 4"SCH 40 TEE SEPTIC TANK TO MEET r / Loamy 4 LIQUID LEVEL REQUIREMENTS OF -132'° C1, 2.5Y$/2 Medium sand GAS BAFFLE 310CMR15.226FOR CFrro� No Observed ESHWT V'SCH 40 WATER TIGHTNESS. TEE ETC, No Observed Groundwater ALL WALL SLEEVES/GASKETSSHALL O o o MECHANICALLY PERCOLATION TEST DATA INSERT E CAST IN PLACE OR o s„ (MIN.) Q a COMPACTED INSERTED AT FACTORY. Date,: June 7, 2002 STABLE LEVEL SASE CRUSHED STONE Soil Class: Class I (0.74 G/SF) SEPTIC TANK DIMENSIONS: 1 V 6"L X 5' S"W X FErli A ►d �,,,gy .^�. Perc Rate: < 2 MPI (TP-1) G ^�•- �Pf���� DISTRIBUTION BOX H•10 Depth of Perc Test: 30" - 48" p I� rLD SCHEDULE OF ELEVATIONS REMOVABLE COVER d"5CH 0 OUTLET LATERALS REQUIREMENTS OF 3�Q CMR SHALL BE SET LEVEL FOR A S�- ^ REQUIREMENTS (WATERTIGHTNESS. MINIMUM OF THE FIRST TWO Inv. Out Foundation (existing) 96.2 CONSTRUCTION,ETCj ' FEET AND CONNECTED TO ON LINE Inv. In Septic Tank 95.85 z WITH SOLIDEACH ISCHI40PVCPIPE IZ�LoL rEb Inv. Out Septic Tank 95.60 NO.OF OUTLETS:3 4"SCH40 6" B�oG° 3g Inv. , In Distribution Box 94.95 99 F--13+ e I��Ni>AV Ph4 Illy. Out Distribution Box 94 .78 �Q° :: p 6"(MIN) o Q o STONE( =3X' IA.)CRUSHED STONE(<-3/4"DIA.) �S eXlsrl,4 140ow Inv. In Dry Wells 94 .70 STABLE LEVEL BASE, ,ar fFE= rna.�t Bottom of Dry Wells 92.70 9•�•4 f --•�'"� Bottom(TP-1) NO Obs. GW/ESHWT 89.0 " LESS 0,10L VENT �., LEACHING DRY WELLS.500 GALLONS LAPPR oft•) ti LEGEND lop q)f9 ypf "END"CROSS SECTION D-Box 99f q9+o , Existing Contour , - - - 98 - - - MODEL:SHOREY PRECAST CONCRETE io td 4 S CO 4 0 FINAL GRADE TO BE STABILIZED l ,S�,oA Mr,v.1 t Proposed Contour « 98 FINISHED GRADE(SLOPE=.02) 103 �. o' \ .� , ,00 �; rso o G. c4cnr Test Pit 12"(MIN) l l l 9 9 SC pTr t. r�4•N/c � H•10 � AJtN•?o 9 0+`" 9 , A 99 Finished Floor Elevation FIFE LEACHINGORYWELLS:3 ° ° tl° CFNd) "'°"'�•" ® �0 9G"LX4'10"WXr1"H 325 WASH PEA STONE 1/d"-1/2"DOUBLE d >� d o 3.25' .� roo,t6 Basement Floor Elevation BFE OVERALL LEACHING AREA: 3/4°'-1 1/2"DOUBLE 3 -oey w>ru,S a, /ao Ir3r„7o�• ". tqq,93 / Water Line W 37LXIZWXZH o 0 2'1" c� WASHED STONE. o c c� G o Ej 3z t- 1-11 -X i 3`YW x A`F� 6ess POOL Gas Line �---�---•G ------� LEACHING DRYWELLS TO COMPLY WITH THE Elec. Line ---E ---�-- -j REQUIREMENTS OF 310 CMR 15.252 Cable Line "�-- C ~,- -- , camom we AAIE c cirre� 1.yP t� x • 4�� �� ° NCTES ES MARS„ t y�T�A� 2 3 a &°"kNs " ' D l. All construction methods shall conform to the Title V (310 � fARMou* CMR 15) .and the Barnstable Board of Health Regulations. cP p,ARArCK °Gy 4c aRE2NER 4," tie 4� L It 28 2. There are no known private or public wells within 150 ccm It- F.r o 1 6LYE8E/CatY HILL Rt P P Pas 6,NA Z �� 4°� , ° ` feet/400 feet, respectively, from the proposed leaching ofFICE O CT a ( f e4 �gR6u area. scorrrs,.r ►yESr '�}� 4�? `�� �� N � Lr ��t{ r� r9R�5oN bAAD 3, Existing .cesspools to be pumped and removed prior to Ph of�Lr: o� Ef'716 .SYSTEM P P P C , C �' POND ,. , installing the new septic tank. ,7t.,qL6': Al SHowP+ 4v j 4. No changes are to be made in the field without the approval of the Board of Health and the design engineer. Oa o o •. a Iw 0¢ r'- ,� ` •: coo e ° : LIN 5. Proposed leaching area is not designed for use with $T BEt� -� a A,pERrr CjRLA p o'�P o f,. I'VE �� WA garbage disposal. '1 SK'i d s- :�•w'P �� ep'�" > 'l` t„r) uS I LA ti 2 > > �CtA � 4q f L°o�"�. Fa w Y ` R4orTg 6. Contractor to notify Dig Safe 72 hours prior to AP. 4 '`+""'`� ,�; o cQgR LA o construction. (800) 344-7233. 1 5 �, Q °J y iARfRt06£ � � w yd .''�,w„ V 4; y cp Ka7HE><'� "' y� �"" I 7 . Property line information taken from Deed, Book 7908, Page s'«I 305. Septic Plan not to be used as a p property line survey. E*rS�rtAt(r (•ODE ' 8 . Remove existing cesspool and any leachate impacted soil and 1q07 , .-�'"' replace with Title V fill [Reference 310 CMR 15.255 for specifications of fill (sand) ] . The total amount of fill r___�__w._ _-______.. ____--w__ - z4+D,a• .erSE required is approximately 5 cubic yards. ,qnl D t o.t gltl q`prA �5 ►zS gyw�rr �nt b" CALCULATIONS 9 4 Bedrooms (Existing) 110 GPD/Bedroom X 4 Bedrooms = 440 GPD Percolation Rate - < 2 MPI (TP-1) Soil Class: Class I (0.74 G/SF) ro' 1 PROPOSED LEACHING AREA: n _ x� ` Dry Wells: 3' at 32'L x 13'W x 2' H Side .Area: 180 SF X 0.74 G/SF - 133.2 GPD Bottom Area: 416 SF X 0.74 G/SF = 307.8 GPD Total Leaching Capacity: 441 .0 GPD 94 lJt5T11.7$�T/6M/ jlpT�y r.+�E4LS > i 9Z 3Z � >t 13'W 0.cc 6-0 r� +c.�.Dw pri r. rA49 0. Z 0 w a 6arT•OM rP•t CAL. •0) ° /4 0 a Jt f 6.,,�r SUBSURFACE SEW-AGE DISPOSAL SYSTEM vg1 �cJt�wT 110 Riverview Road, Centerville Q JK� :q ' SCALE: 7►s Shown APPROVED BY DRAWN BY g - ... .� -.�- . k 6/19/02 Daniel B Johnson D.B. Johnson �0.1 f3�7 DATE: D_ 0-too 0+40 01P.1a Qf30 o+4a f7+ra Qfbd d¢�d {?# �� s�t.�a /�� (tio It.)a l�Zo 1+Qo �°? Cy AF, Prepared Donna Hwaa w 7 m tS �1e-rya ,� � Fos: 110 Rivervier Road, Centerville, DX /'P1 AIi Ir Prepared DCMSTIC SFXTIC DESIGN, DRAWING NUMBER tt By: 804 Xain Street, Suite B, Ostery Ile, bM 02655 J-786