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0171 RIVERVIEW LANE - Health
low 171 Riverview Lane Centerville A=227 —093 — 007 I ' Pona4I " �,�sseet 4210113 ARA 10% P4 a Zi TOWNN OF BARNSTABLE Y;-LOCATION 11 12/V64 V16 `"" L4 I't SEWAGE# VILLAGE CC A-) —ASSESSOR'S MAP&PARCEL 2,2:1 INSTALLER'S NAME&PHONE NO. ioq�-6 SEPTIC TANK CAPACITY Ex1 7-10JCI I6Z-b LEACHING FACILITY:(type) (size) �• •�a'X �!°Z NO.OF BEDROOMS , OWNER PERMIT DATE: COMPLIANCE DATE: 12 2,0 ' f 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 � w A3,e� �,eowr Aqf 3& A 3V,3 N 43= ��- jq� � I VCK -vs L-A P No / J 3 I � 1 •� � Fee '1406 Entered in computer:T THE COMMONWEALTH OF MASSACHUSETTS p . PUBLIC HEALTH DIVISIGN i OWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �Digozal 6p!5teiu Con5tructfou Permit Application for a Permit to Construct( ) Repair(W- Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /7/ /P/✓C rV i eW Owner's Name,Address,and Tel.No. Assessor's MMap/Parcelcel CeJ-f rV;)(e Vila mk<<d , . 11Ana )1,4tj a _ Installer's Nam Address,and Tel.No. Designer's Name,Address and Tel.No. t13 ����P �, 773=o18a?o cyer ell 5d7- 3602 -d4ad XV Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow(min.required) / 3 gpd Design flow provided ?j3y gpd Plan Date / Number of sheets O') Revision Date ,fiJy/A�(- Title S-C a i"L D—r A-C i•(— Size of Septic Tank 1006 Type of S.A.S. t3 i od i o s-e-1— Description of Soil r pkpl 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 Certificate of i Compliance has been issued by this Board of Health. _ I Sign d Date ,/®�� �r Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. E) O1 -� 3 Date Issued ——————————————————————---—————— [� %No. // ( :.V Fee .._ ,. 't Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISIOi OWN OF BARNSTABLE, MASSACHUSETTS Yes S Rpplication for Digo5aY pg u Conztruction Permit Application for a Permit to Construct( ) Repair(W-lupgrade( ) Abandon( )' ❑Complete System ❑Individual Components Location Address or Lot No. /7/ P1✓e rV Owner's Name,Address,and Tel.No. Assessor's Map/parcel da _ 93 Ma f;d y1 11A/1��` � 7 Insta s am ler' Address,and Tel.No. Designer's Name,Address and Tel.No. � �f1 �.4.v�a 174eye r erl i 5 62- 3 .Z) Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) i. Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided ��U gpd Plan Date Number of sheets 07 Revision Date �� Title (— Size of Septic Tank �'X s�. ��C /v oG Type of S.A.S. 13 i od i '�o S-e I— Description of Soil r 4n Nature of Repairs or Alterations(Answer when applicable) / /` 1�)G41 F` Date last inspected: Agreement: _ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a`Certificate of Compliance has been issued by this Board of Health. I Sign d / _ Date 0 Application Approved by DateZQ Application Disapproved by: Date for the following reasons Permit No. o ) -3,3 y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( � Upgraded ( ) Abandoned( by at 1 W J il/ • e 4 1C ry(/ t has been constructed inaccordance with the provisions of Title 5 and the for Disposal _ stem Construction Permit No. �i l 3 3 7 dated Installer ,f l" Designer #bedrooms Approved design flow .'>• 3 C� gpd The issuance.of this permit hall not be construed as a guarantee that the syste wi..fun t on as designed. Date �d�� ' Inspector - ----���^^� --- --------------------------- Fee --;_--- —— No. —33 /dc THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 'igpoar i�p.5tem Construction Permit Permission is hereby granted to ConsLrruct ( ) Repair ( U�grade ( ) Abandon ( ) System located at r/7 r' /C //�C/��i 4J /�4 /�Cf ��yr"�t/y i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special condition . Provided: Construction ust b• completed within three years of the dateof this rmit. Date 77 7/ Approvel`b / . Town of Barnstabl Im e NAP . o� Regulatory Services .0 ", �. ; Thomas F. Geiler,Director ......;e i619. `�� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 ' Fax:.508-790-6304 Installer& Designer Certification Foru Date: I J l Designer: A4 ^P,-1 Installer: Address: Address: bUA \/iJV -I_A_-j-� On (da e) was (installer) issued a permit to install a septic system at 1 -7 I 1 v e r-v i 4I►-J ,4,e (address)� based on a design drawn by dated 7 Y �.®/I ' (designer I certify that the septic'system referenced a ' to the design, which may include minor approved changes such as lateral resubstantialllocation ofgthe distribution box and/or septic tank. Ice . '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 an co of the septic system)but in accordance with State & Local Re y component certified as-built by designer to follow. Regulations. Plan revision or \1\4 OF 4%. �y (Insta.11er' ignature) 0. 1140 �F �o "/STER sq'N1TAR�P� �b�� (Designer's Signature) zOli (Affix Designer's p Here) PLEASE RETURN TO B . STABLE PUBLIC Hl✓AI OF CO ,TH DIVISION. CERTIFICATE MPL IAN CE WILL NOT BE ISSUED UNTIL, BOT THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BAR WABLE P LIC HEALTH DIVISION. Q:Health/Septic/Designer Certification Form Cr •-'yam �2- P� G vl UIC M - R t{yS • ICIOM, F r 7,6 11c, dT i S j, Fr, BA:AAA 4 �� ► lq J� q EXCERPT FROM THE BOH MEETING MINUTES 8/23/11: B. Darren Meyer representing Estate of Marion Hanaghan — 171 Riverview Lane, Centerville, Map/Parcel 190-143, 0.48 acre lot, multiple variances. Darren Meyer was present. The property is a three bedroom dwelling with a failed ed septic. The septic system needs to be placed in the front yard. This creates a situation of needing a few variances. Adjusted ground water is 6.09 feet below the bottom of what they propose for leaching. The staff agrees that this plan was designed for maximum feasible compliance and has no issues with the plan. Dr. Miller asked if the staff was concerned with the integrity of the structural foundation. Darren did look at options but the problem would be that they would then have to get into the stonework of the foundation and did not want to cause an issue with the integrity of the wall. There will be no load up against the wall. Dr. Miller said he would rather have the liner moved closer to the leaching and keep it further from the foundation. Mr. Meyer said he would do that. Upon a motion duly made by Dr. Miller, seconded by Junichi Sawayanagi, the Board votedJo approve with the following conditions 1) due to the environmental variances, a'-fhree bedroom deed restriction will be recorded at the Registry of Deeds, and 2) a proper copy of the deed restriction will be submitted,to the Health Division. (Unanimously, voted in favor.) k. SEP-27-2011 13:16 ATTY ROEERT J,DONAHUE 15083621125 P.03 F11€ 25730 Ps 112 or 49557 10-05i-2001 1 a rig : 09 U NOTICE OF DEED RESTRICTION RESIDENTIAL The"Town of Barnstable Board of Health requires, that based on 310 CM 15.214, 'Title V.Nitrogen. Loading Restrictions, the following restriction: Existing Dwelling Restricted to three (3) bedrooms. Be placed on the property located at 171 Riverview bane, Centerville, MA 02632; Assessors Map: 227 Pare el: 093 As Deed is recorded at the Barnstable County Registry of Deeds, on the Deed Book 2967, Page 123, The land together with buildings thereon, situated in Barnstable (Centerville), Barnstable County, Massachusetts being Lot 7 shown on subdivision plan drawn by Whitney & Bassett—Architects and Engineers, dated December 1964, a copy of which is filed at the Barnstable County Registry of Deeds in Book 190, Page 143. I, Kathleen McGann, Executrix of the Estate of Marion B. Hanagha.n as owner of the property referenced above acknowledge the deed restriction being placed on the property. Witness my hand and seal this `�day of i e v— , 2011, Estate of Marion B. Hanaghan By: Witnesses: !?%�— � Katfile.en McGann J� STATE Or CONNECTICUT Hartford, ss. On this day of 00_;b 2011, before me, the undersigned notary public, personally appeared Kathleen McGann, proved to me through satisfactory evidence of identification, being ❑ other state or federal governmental document bearing a photographic image, ❑ oath or af..#imlation of a credible witness known to me who knows the above signatory, or o my own personal knowledge of the identity of the signatory, to be the person whose name is signed above, and acknowledged to me that she signed the BRIVY J. DONAr,u,; foregoing instrument voluntarily for its stated purpose. ;fTOUNBY AT LAW n WII.:C)W:i7TUi!:T YARMCWNarrr.)le;•, Notary Public csm=1t�2.4ozs Cl°'[�dI'�'I IIA T. HADDEN My commission expires' NOTARY Pi 31RUC MY COMMISSION EXPIRES APR.30,2012 Tnl-Cal P Gl; I Town of Barnstable. P# of � Department of Regulatory Services Public Health Division Bate � 19. tee$ 200 Main Street.Hyannis MA 02601 'j Date Scheduled --/ �/ Time Fee Pd. 1.../ oil Suitability Assessrect for ;fie e Disposal Performed By. 1 ! �" ` Witnessed By: i LOCATION & GENERAL INFORMATION y, Location Address'. LV r��?ytl ( „ylt? Owner's Name. P.MAC') ) Deta Sr !AA I Address Assessor's Map/Parcel: Z��. 3 I Engineer's Name AA A A" 2_1 Z REPAIR X ! Telephone# S-08 5�a2� --1,, NEW CONSIRU-�'i'IONrr � Land Use `� 1 V G � L• Slopes(90) Surface Stones G'" j Distances from: Open Water Body .100 ft Possible Wet Area QQ ft Drinking Water Well ? ') ft i Drainage Way i' ft Property Linc 'r ft Other ft . ��7+ TOP OF BANK-"p—_------—_----- S cr� JL CH:(S / _ A----- $` '_6 -— _ - 4---1s4 \ es) H / / DECK \ Cb ---' \ —�_ j m� rn ccao a ro r z vy\ r Al / O at r Z= ER V I EW Lq N E rn m °_ _Qb � N Z=-- _f zo g r� O< �®_I__----- WATER MAIN T` Q ® q r l`i Depth to Bedrock r Parent material(geologic) l) t-Iru Depth to Groundwater-. Standing Water in Hole:' 3 i Weeping from Pit Pace Estimated Seasonal;IIigh Groundwater i DtTERNIINATIO FOR SEASONAL HIGH WATT''R TA LI Method Used: C .c. M a I N a L 3 4 in. De .v1 to salt rhs,ttles: In. Depth Qbperved standing in obs.hole: __ P {t. it De th toiweeping from sidc of obs.hole: in. OfdUnrilvhter Adjustment index Well#p�q Reading Date: A .f 1etOC �- A��t7roundwaterievel s�7 �05�I fllbl-2 �7UN� Index Welllev�l. �. I T1iH PERCOLATION TEST D$t0 Observation Tiitte at 9" ...------ Bole# I I rl Depth of Perc 9 Time at 6" .-- -- Time(9"-6") --_ Start Pre-soak Time.@ I2 I End Pre-soak I Rate MinAnch L 2 ~ Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original_Public i'e$lth Division Observatioti bole Data To Be Completed on Back - I ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Dj ision at least one (1) week prior to beginning. i i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil I Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel It IFill P A b4M JaAA [0. i'•'rl3 "13- t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil, Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) i 42`'-�-4�" S l ,(L41 &/ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel T7- I i DEEP OBSERVATION HOLE LOG_ Hole# N Depth from Soil Horizon Soil Texture Soil Color foil I Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency. ra I ------------ i F I I i i 1 i Flood Insurance Rate Map: Above 5CO year flood boundary No— Yes Within 500 year boundary No— Yes j Within 100 year flood boundary No %1q Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification i I certify that on 6 O� (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the require I ' in expertise and experience described in all CMR 15.017. Signature ` Date S l 1 i Q:\SEPTIC\PERCFORM.DOC Postal ,n mD. Omy,No Insurance Coverage Provided) For delivery information visit our website at www.usp6.coffkQ,, Ln ru F ?.. u1 M Postage $ 0 M Certified Fee M ��PosUriQr p Retum.Receipt Fee. (Endorsement Required) Here E Ae:%d Delivery-Fee ra (Endorsement Required) CO M Total Postage&Fees $ 00 �ent .Cl�JJ Cs�N eet,Apt No -.�. .. .............. ...= ---'• -^ .........or PO Box A. 441 ` ----- . .a9s. .................................... cry' 0 Ct' 04 119 Certified Mail Provides: ( • A mailing receipt asianea)aooa sunr'oose uuo�sd • A unique identifier for your malipiece r , • A record of delivery kept by the Postal Service for two years Important Reminders: in 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 3911�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 LISPS®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 malting an inquiry. Internet access to delivery information Is not available on mail addressed to APOs and PPOs. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign ure item 4 if Restricted Delivery is desired. j „/, ❑Agent X ■ Print your name and address on the reverse O%Mdrpssee so that we can return the card to you. B RAcelved by(Printed Name) C. a of elivery ■ Attach this card to the back of the maiipiece, ���� rne �n or on the front if space permits. 61 D. Is delivery address different from Rem 1? ❑Pes 1. Article Addressed to: If YES,enter delivery address below: ❑No r — -- r�Mar an B. Seigle --C/o Katherine McGann II 296 Fern Street I West Hardord,,CT 06119 3. Service Type ❑Certified Mail ❑Express Mail _ ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number;r ` r t t9'[�E 5 S 2 S E D 0 D'iD 101 (rransfer from service label) `j PS Form 3$11,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE _ irsE C1ass:AG�iI b • Sender: Please print your name, address;-,.and !Vox �f� s i-s Town of Barnstable a � Public Health Division '' j200 Main Street r Hyannis, MA 02601 ._ ilit3ttfltltilt��lttttitiltitlitlb::tlltt�t:�tlliattiftsEtls�=.i �pF THE Tp� Town of Barnstable Barnstable Regulatory Services Department ;edcaCft BA RNSTABLE, MASS. Q Public Health Division t63q• rfD MAC s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f 'undwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 5316 June 1, 2011 Marian B. Seigle c/o Katherine McGann 296 Fern Street West Hartford, CT 06119 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic 171 Riverview Lane, Centerville, MA was last inspected on 4/27/2011 by Paul C. Martin a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution Box is corroded and needs to be repaired • Portion of SAS is below high groundwater The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action PER ORDER OF THE BARD OF HEALTH cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc �oF sKE raw Town of Barnstable Barnstable Regulatory Services Department w``aC 1 aD * 6ARNS"rABLE. ' "A9- i639. Public Health Division ♦0 prfD MAI A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f )undwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 5316 May 31, 2011 Marian B. Seigle c/o Katherine McGann 296 Fern Street West Hartford, CT 06119 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system 171 Riverview Lane, Centerville,MA was last inspected on 4/27/2011 by Paul C. Martin a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution Box is corroded and needs to be repaired • Leach pit is only 3'4" above water • Portion of SAS is below high groundwater The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc Postal (DomesticOnly, For delivery information visit our website n M Postage $ s tJN 9 S M Certified Fee y _ p. O Return Receipt Fee +qr,3"8(Endorsement'Requi[ed) M Restricted Delivery)=ee r-1 (Endorsement Required) CO M Total Postage&Fees $ S p Sent To o c..r. an ..... a.na 3- - -- r Sheet Apt!fd -•-•- --- or PO Box No. f . .�-1 t/e.lra�/�-----�..n . ... .city State, •- r I.J. PS Form :0r June 2002 Certified Mail Provides:■ A mailing receipt (asanea)zpoaeunr'oose-ozisd ■ A unique identifier for your maiipiece A A record of delivery kept by the Postal Service for two years Important Reminders: is Certified Mail may ONLY be combined with First-Class Mail®or Priority Malls. s Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For aR 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 Fonn 3811�to the article and add applicable postage to cover the fie.E�dorse mailpiece.'Retum Receipt Requested".To receive a fee waiver for a duaiicate return receipt a USPS®postmark on your Certified Mail receipt is regw ■ 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". , is 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 riot needed,,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery int3rmation is not available on mail addressed to APOs and FPOs. U3 OF TME Town of Barnstable w U.S.POSTAGE>)PITNEY BOWES Public Health Division BARN ABLE. ` 200 Main Street MASS. �J '"•FON;••0� Hyannis,MA02601 ZAP 02601 $ 005.540 ' 02 1YV 0001361475 MAY 03 2011. 7006 0810 000.0 3525 5217 RE:T RN - u�F NOT OC _ UNAM v2329441449� mac; 02801400!.-O s 026010401 III)lUi�i l_1I1.I I.I I31I I81IIIIitIII;�,' . . DELIVERY SECTIONSENDER: COMPLETE THIS ■ Complete items 1,2,and 3.Also complete A. Signature ❑Agent I I item 4 if Restricted Delivery is desired. X I ❑Addressee I ■ Print your name and address on the reverse I I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery 1 ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? Oyes � 1. Article Addressed to: If YES,enter delivery address below: ❑ No I I i LRe gan 11 w Lane s. Service Type A 02632 ❑Certified Mail*` ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail [I C.O.D. 4. Restricted Delivery?(Extra Fee) ElYes 2. Article Number 7226 0810 2a2O 3525 5217 � { I label) PS Form 3811 Februa 2004' Domestic Return Receipt 102595-02-M-1540 i r : :�..:r.� ry r --w.�.,.,... ' i- q..,__ --.J_._.....r....._.. � � a i t! €t 1 --,•t.. ---e--z� .�.�_,, :�4-Y-t"t'TTT.�T?`Ti.[.'-�H�I pp THE Tp� Town of Barnstable Barnstable Regulatory Services Department A"medcaC'j • D Dm • BARNSrABLE, 9 MASS. Public Health Division i639• �� ArfO µAI° 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f )undwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 1810 0000 3525 5217 May 2, 2011 Marian Hanagan 171 Riverview Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system 171 Riverview Lane, Centerville, MA,was last inspected on 4/27/2011, by Paul C. Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE'5 (310 CMR 15.00) due to the following: • Distribution Box is corroded and needs to be repaired • Legch pit is only 3' 4 above water • Portion of SAS is below high groundwater , You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification: Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO RD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-I SAMPLE 60 Day Deadline.doc OF tNE Tp� Town of Barnstable Barnstable Regulatory Services Department �' "eiicac BARNSTABLE, • „ 639: Public Health Division ?, MAI s. 200 Main Street, Hyannis MA 02601 2017 Office: 508-862-4644 Thomas F.GeilerLeach)it is only3f wndwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHG. 1 CERTIFIED MAIL# 7006 1810 0000 3525 5217 May 2, 2011 Marian Hanagan 171 Riverview Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system 171 Riverview Lane, Centerville, MA,was last inspected on 4/27/2011, by Paul C. Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution Box is corroded and needs to be repaired Portion of SAS is below high groundwater You are ordered to repair or replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO RD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\L.etters Septic Inspection Failures\1-I SAMPLE 60 Day Deadline.doc Q tiQ ca J �.5 o ur"� %,orT monvveain oT massacnusens Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 171 Riverview Ln. Centerville, MA 02632 Property Address Marian Hanagan Owner Owner's Name information is required for every 171 Riverview Ln. MA 02632 4/27/11 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information p� on the computer, J ► I use only the tab 1. Inspector: U key to move your cursor-do not Paul C. Martin use the return key. Name of Inspector AB CANCO rat Company Name 350 MAIN ST-ROUTE 28 IL 10 Company Address W YARMOUTH MA 02673 City/Town State Zip Code 800-593-6449 5016 Telephone Number License 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 15.000).The system: ❑ Passes 0 Conditionally Passes ❑ Fails PN,\\AOF rl17gss�''4, ' •.qp : ® Needs Further Evaluation by the Local Approving Authority ,' PAUL :yN C): MARTIN �� 4/27/11 -* Inspector's Signature Date zF 5 INSP ���— � tl ► ������ The system inspector shall submit a copy of this inspection report to the Approving A�ii��ft�'H�J' �oard 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. �I G • �U t5ins•09= i. Title 5 Official Inspection Form Subsurface Sewage Di System•Page 1 of 16 � ttommonweanin or massacnuserts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Owner B. Certification (cunt.) information is required for every Inspection Summary: Check A,B,C,D or E/always complete all of Section D Daae. 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: B) System Conditionally Passes: ❑O 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 O N ❑ ND(Explain below): B. Certification (cont.) t5ins-09108 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 2 of 16 tommonwearin or massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments B) System Conditionally Passes(cont.): Owner ❑Observation of sewage backup or break out or high static water level in the distribution box due to information is broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass required for every inspection if(with approval of Board of Health): Dane. ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled or replaced Z Y ❑ N ❑ ND (Explain below): Distribution box is corroded and deteriorated and needs to be replaced. Lines leaving box are not level. ❑ 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): i C) Further Evaluation is Required by the Board of Health: OConditions 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 B. Certification (cunt.) t5ins-09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 16 I- i tommonweaitn or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of Owner 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 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: Leach pits do not meet the minimum groundwater separation. 1 st-Leach pit has a 31"separation. 2nd- Leach pit has 34"separation. It was stated by an agent of the Board of Health to submit this report as further review. 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 B. Certification (cunt.) Yes No ❑ Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: x❑ ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. t5ins•0901 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 4 of 16 %,ommonweam oT massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Owner ❑ R Any portion of a cesspool or privy is within a Zone 1 of a public well. information is required for every ❑ x❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. pace. ❑ 0 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 2000gpd- 10,000gpd. ❑ 0 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.15,000 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. 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 ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ x❑ Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? t5ins•09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 16 uommonweam or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments © ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Owner ❑ Was the facility or dwelling inspected for signs of sewage back up? information is required for every ❑x ❑ Was the site inspected for signs of break out? aaae. p ❑ Were all system components, including the SAS, located on site? p ❑ 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? 0 ❑ 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: Q ❑ 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): Unknown Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Unknown D. System Information Description: 0 Number of current residents: Does residence have a garbage grinder? []Yes © No Is laundry on a separate sewage system?[if yes separate inspection required] ❑Yes B No Laundry system inspected? ❑xYes ❑ No Seasonal use? ❑Yes © No t5ins•09M Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 16 t ommonwemin oT massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °y < Water meter readings, if available last 2 ears usage 2009=54000 9 ( y g (g�))' 2010=28000 Detail: Owner information is required for every Pane. Sump pump? []Yes 0 No Last date of occupancy: Est. 2009 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? []Yes ❑ No Non-sanitary waste discharged to the Title 5 system? []Yes ❑ No Water meter readings, if available: D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? [--]Yes ® No If yes,volume pumped: gallons t5ins•09= Tide 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 16 %,ommonweaun or massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments How was quantity pumped determined? Owner Reason for pumping: information is required for every Type of System: aaae. p 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): D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 1975 Per BOH records on file. Were sewage odors detected when arriving at the site? ❑Yes © No Building Sewer(locate on site plan): Depth below grade: 27" feet Material of construction: Z 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.): Line could not be visually checked due to irrigation controls over Inlet of Septic Tank manhole cover. Used probe to determine depth. t5ins•09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 16 i tommonweaiin or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Septic Tank(locate on site plan): 20" Owner Depth below grade: feet information is required for every Material of construction: Dace. 0 concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) 1000 gal. H-10 precast If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑Yes ❑ No Dimensions: 1000 Gal Sludge depth: 7" D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Sludge Judge/Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Inlet manhole not accessible due to irrigation controls over cover. Property representative stated pumping was done 3 years ago. Outlet tees were in place and tank seems structurally sound. Grease Trap(locate on site plan): t5ins-09108 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 16 toommonweam or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Depth below grade: feet Owner Material of construction: information is required for every ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): cane. 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. D. System Information (cunt.) 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: ElYes ❑ No Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 16 li.,ommonweann or massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Comments (condition of alarm and float switches, etc.): Owner information is required for every page. *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No D. System Information (cunt.) 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.): Box is 21"down. Box is corroded and walls are gone. Box needs to be replaced. 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.): t5ins•09/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 16 Loommonweaiin or massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments pY Soil Absorption System (SAS) (locate on site plan, excavation not required): Owner If SAS not located, explain why: information is required for every paste. D. System Information (cont.) Type: ❑x leaching pits number: 2-6x6 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/aftemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): 2-6x6 Leach pits with 2'of stone around. Leach pits were dry upon inspection. It appears that leach pits were installed at different times. The first leach pit has corrosion and high effluent staining. The second pit was dry with effluent staining minimal. Pipes leaving D-box were not level and causing the first leach pit to take most of the flow. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 16 . t.ommonweaitn or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Depth of solids layer Owner Depth of scum layer information is required for every Dimensions of cesspool Pam. Materials of construction Indication of groundwater inflow ❑Yes ❑ No 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.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 16 %,ommonweattn of massacnuseats Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �s Owner information is required for every imae. D. System Information (cunt.) 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: 19 hand-sketch in the area below C drawing attached separately 1 0 t5ins•09108 Title 5 Official Inspection Fomr.Subsurface Sewage Disposal System•Page 14 of 16 tommonweam or massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments D. System Information (cunt.) Owner Site Exam: information is required for every 0 Check Slope Moderate wane. Surface water Within 80' 0 Check cellar Dry 0 Shallow wells None Estimated depth to high ground water. 11'8" 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: Date 0 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: Auger hole through bottom of dry leach pit. Auger to 11'8"and found water. As stated above 3'4°of separation in 1 pit and 3T separation in second pit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked 0 Inspection Summary D(System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater Cl Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 16 -.0 ".05 1(76 02077 _ LOCATION _ 5EW 0,C,E PERMIT -----1.I�ISTALLE-R S U&NlE .-ADDRESS - - - vf - - - - - - - - - - - - --- ----- --- -- D.ATE-RE.RIA1T__LS5uED__ =3=7 _-_-_-_- D.ATE_COMP_U &KiCE _LSSUEQ__�� /-? _ t r.. '� �1 � � l`. �� i. (` �% s�' , q � \ � � 1 � ® �, `�v / � ��� �. No.... . -••---...... FRic .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA TH OF. . ..... e...:.....--.�. . -_.. .. .................... . pphra#ion -for Uiapwial Workii Tiamitrurtion Vantit Application is hereby made for a Permit to Construct. ( or Repair ( ) an Individual Sewage Disposal System V L ation-Address r Lot o. J i. ••••• i &.�S_�;t r � Owner- Address W Insta er Address Q Type of Building Size Lot_.-.-._--_____ __________Sq. feet U Dwelling K No. of Bedrooms._.---�_______________•________--__-_.--.Expansion Attic ( ) Garbage Grinder ( ) a4 Other—Type of Building ____________________________ No. of persons_-___-_.--_______-_--_----- Showers ( ) — Cafeteria ( ) P' Other fixtures ----- ------------------------ W Design Flow-----------T'®---------------------------gallons per person per day. Total daily flow----- -___--____--..---_-gallons. 1:4 Septic Tank L Liquid capacity_ 9R(__gallons Length................ Width................ Diameter---------.-.---- Depth................ W Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area.-.-.-_..._--___----sq. ft. x Seepage Pit No---- --------------- Diameterlg!QAmR7?_!!g Depth below n ... _........ Total leaching area-.-_------_.-__--sq. it. z Other Distribution box ( ) Dosing tank ( ) 0 8 i- aPercolation Test Results Performed by-------- ----------------•----------•------••---..................--•--_.. Date---------------------------------------- Test Pit No. 1_______________`_minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.-----_-----.-_._-.--_ (Iq Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--.-..---__----.___--_- Q'+ p - ....�-- x ` . ------------ ----- JC. w 6�4...._ --.-.-. ---il O = -escrpton oo ..___ -- 1_.._ a - ---- �- ` _- .'..Y---- =, - W V Nature of Repairs or Alter ions=An er when applicable._................: ............ ... ............. .................... .. .. ....... r -•- --- --I-----------•_.--- --'------...--�-------------- ------------------------ ` _ ?4 ._� - . Agreement: : The undersigned agrees to install the aforedescribe I ividual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— h undersigile4i further agrees not to place the system in operation until a Certificate of Compliance has been issu d b the�o d of h lth.%s :_�� I •e �/ ate Application Approved BY------ -- •-- .............. - ........................ _..... ��........ Dace Application Disapproved forte following reasons--------------•---...--•-•-----•--•---•-•-------•------------------•--•------•-•-............ _-•--•-----•-. ----------------•-••----•---------••--------------------------•---........-------•-...•---••-•--------•-••--•----••----••---------------•-•--•------...---•---------------------•••...--••------•---•-- Date Permit No. Issued -7 ...... ~ Date \ --------------------__-_- --------------------------'-'•` No.... -- F>�s....l..... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEA TH f Apphratinn -for :4 isVnsttl Works Tons#rurtinn Vrruift Application:is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System : ' - o a tion-Address -----------•-------•---------------•---- L ot o. lt----cr!Y n Address a ..--••••-• . ---- .................................... •••------•--......-•••------•----•••••--•................•••-------•......-•-••---.............--- Installer Address UType of Building Size Lot............................Sq. feet Dwelling 411?NO f Bedrooms__..___ ..............................Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of Building ............................ No. of persons---_.._---_____________-_-__ Showers ( ) — Cafeteria ( ) G4 Other fixtures -------------------- d W Design Flow-----------iro--------------------------gallons per person per day. Total daily flow__..._.._.I-0O------_.............gallon,. WSeptic Tank-t Liquid capacity__ *.4-gallons Length----_--------- Width.....'..-_....... Diameter................ Depth-----........... xDisposal Trench—No--------------------- Width-------------------- Total Length.................... Total leaching area...............-----sq. ft. Seepage Pit No..--/--------------- Diameter.l_8.4AXY' 4Depth below)nlet..._..._. ... ... Total leaching area.___-_.----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) - I/O. P� 11 'S"'' aPercolation Test Results Performed by----------------------------------------------------- ................... Date----------------------------------- 0_a Test Pit No. 1-----__________minutes per inch Depth of Test Pit.................... Depth to ground water_..__-___-__-__--_----.- fZq Test Pit No. 2................ininutes per inch Depth of Test Pit.................... De th to ground water_--_::___--__-..____---. ---------••-•--••- Descri Description of Soil---___-Q!..__ ) (( x P D �It� � V j✓"g - - ------- ----------------------- - -----.Z W y - . - ... ..... U Nature of Repairs or Alter ons An er when applicable.................. _..:......... ............... ___...�..-- :.--.�. ----------------------------•- ------------- %------- .... ............ . Al.- Agreement: Iw The undersigned agrees to install the aforedescribe I ividt al Sewage'Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— undersign further agrees not to place the system in operation until a Certificate of Compliance has been issu b the 4oa y of he ltl ¢`,\J Si �,�-. � Date Application Approved By----- % 1 y � ' " -i Date tt- Application Disapproved for the following reasons-------------......................-----:...:-----------•:_-................._........_:____.........I............ ---------------------------------------------------------------------------------------------------------------------------------------------------=---------------------------------------------------- Date PermitNo......................................................... Issued...................... ...................•-----..--•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ILI 5rr ifira#r VA f'untptianrr THIS IS T CLFY, That t Individual Sewage Disposal System constructed ( ) or Repaired ( ) G by �'�1 z ft Iler " -----•- - -.......................... s 'has been installed in ,ccordance with the provisions of Article XI oThe State Sanitary Code as described in the application for Disposal Works Constrruction Permit No---------t__ _______---------------- dated..... «'�. _ `_�. ........... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM'_-WILL FUNCTION SATISFACTORY. -7 DATE----/-- /--/�_zs ------------------•----------•---•------- Inspector - v THE COMMONWEALTH OF MASSACHUSETTS BOARD IF HEALTH .. ..1 .........OF No...... .......... FEE •--•--- Buipjavo, --- n Tnns nr#inn Vrrmit Permission is eby granted.--- - - - ------- .... ......................................... to Constr t or epair ( n Individ ewa Disp a] Says '� tree[ AD_ -/% . as shown on the application for Disposal Works Construction P r 't No... . ---- �- .....------ Ar ted ealth 1. DATE. -------------------- ------------------------- FORM . . 1255 HOBBS & WARREN. INC., LISHERS �. L®i y1. 'va a lot �d • �aa R Nor ra �K�si Say/ i TBM: -CENTERVILLE • COR STEP LOT 6 ` ELEV=16.79 - PARCEL ID: �. I i 4228/178-003 �� PINE STREET AL GUY127'/ UPOLE � -------- ------ LOCUS �o ------ - � VW2/ OE7 /i6 C ME-E EX15T. 1 ,000G rn1 / EMENT ,�� PINE► i ► / w SEPTIC TANK - --- ' ------ III • I I II t E G Y / ;,----'- j Id I , �....:... ...� G / ; LOCUS MAP ( � '' I I 1 ' ' S989' % 0 74 �� %� LOCUS INFORMATION m ,llk I I i 1 ; 6.3 PLAN REF: 190/143 TITLE REF: 3237/77 #171 J; a O f J 1 I PARCEL ID: MAP 227 PAR. 93 �, O f i NOT IN ZONE II LLJI FLOOD ZONE: "C" & "AE" C - -_ COMMUNITY PANEL: 250001-0008—D DATED:07/02/92 r AL N 11 I I 0 i i '— f z 1 II I LLi I 626'2, I ° ° i — I PROPOSED SEPTIC REPAIR 1106' > Q PLAN TO ACCOMPANY T--- ,--- 3 REQUEST FOR DETERMINATION MARSH Y vwl `,1 GAR..; I i IJNDER i OF APPLICABILITY (RDA) _ i I,m j I iiiii;iii 2 N i LOCATED AT: I I I I L� I 171 RIVER VIEW LANE ,� A4TH-2 _ I ;t--`�;� CENTERVILLE, MA. I I TH-1 ti® PREPARED FOR °�, �� '�` ' 116 I oo I o - �� CATCH ', ESTATE OF MARION B. HANAGHAN I J L j*'13 ~ I I I WAIL BASIN 7 't PARCEL ID: IVW4 I f SCO ' ATCH JULY 24, 2011 ,BASIN 227/093 ; ! / `;, 5oll Removal SCALE 1" = 20' r AREA=.48 ACRES ; I ; I', i I sP 0 see note 17 1 v R ------------ + r I NI ,1 k� �\ I 1 ���, -,�� o EDWARD � DARREN M. ✓� I I ,' ' Q'�� W \� A. c MEYER S75.4 --- �` STONE " No. 1140 I IINo 2 O II 1i I Ag8'��� - F /0 \� T ! S Ncl AR\N VARIANCE REQUESTS — MAXIMUM FEASIBLE COMPLIANCE Aj3Vw5 \ PER 310 CMR 15,405 (1) (0) /OR BARNSTABLE BOH REGS: - A 13.66 FT. VARIANCE FROM 310 CMR 15.211 TO ALLOW LEACHING TO BE A MIN. OF 6.34' FROM DWELLING 77 MEYER & SONS, INC. VS. REQUIRED 20 FT. (LINER PROVIDED) AL t _ PER 310 CMR 15,405 (1) (A) /OR BARNS TABLE BOH REGS: — LOT 8 P.O. B 0 X 981 A 8.94 FT. VARIANCE FROM 310 CMR 15.211 TO ALLOW LEACHING TO BE A MIN. OF 1.06' FROM PROPERTY \ \\\\\ LINE VS. REQUIRED 10 FT. \ PARCEL ID: 4 PER 310 CMR 15.405 &/OR BARNSTABLE BOH REGS: \ \\ \�� 227/094-001 EAST SANDWICH, MA. 02537 - ALLOW THE USE OF A 1 FOOT SOIL REMOVAL VS. THE REQUIRED 5 FEET, DUE TO SITE LIMITATIONS. \\ (5 0 8)3 6 2-2 9 2 2 (PROPOSED LEACHING IS BOTTOM AREA ONLY.) PART.III. CH. 360, ARTICLE 1: N } - A 40.11 FT. VARIANCE, TO ALL LEACHING TO BE 59.89 FT FROM EDGE OF WETLAND VS. REQ'D 100 FT. �BVW6 + SHEET 1 OF 2 J#1342 • NOTE: To IPREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:12.39 DESIGN CRITERIA FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 3 BEDROOMS PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. SOIL TEXTURAL CLASS: CLASS I T.O.F. EL.=16.89 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER DESIGN PERCOLATION RATE: <2 MIN/IN OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. • F.G. EL.=15.7t F.G. EL.=15.0t F.G. EL: 14.8t F.G. EL- 15.3-14.0 (MAX.) DAILY FLOW: 330 G.P.D. DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) L = to't 9" MIN COVER/ PROPOSED SEPTIC TANK: 330 X 200% = 660 GPD, USE EXIST. 1000G TANK ® S=196 (MIN. 36" MAX COVER L =5, TEE L = 10'(MAX) INSTALL TWO;INSPECTION PORTS (MIN.) a"scH4o PVC) ® S=1% (MIN.) ® s=131; (MIN.) LEACHING AREA REQUIRED: (330) = 445.94 S.F. 4"SCH40 PVC 4"SCH40 PVC .74 LLi10.1 14• 6 11.2" TO DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) INV.=13.57 .Uouro INV.=13.32 INVERT PRIMARY S.A.S. LEIS PROPOSED INV.=12.60 USE 4 ROWS OF 4-160OBD ADS BIODIFFUSER (H2Ol UNITS-NO STONE GAS E 4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25'/ROW L 1- INV.=12.77 pB-5 INV.=12.0 SOIL ABSORPTION SYSTEM (PROFILE) BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSER) (BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.73 SF/LF = 473 SF EXISTING 1,000 GALLON SEPTIC TANK DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 350.02 GPD > 330 GPD req d EXISTING SEWER OUTLETS RESTORE VEGETATIVE COVER EL.=13.70 BACKFILL WITH CLEAN PERC SAND 75" NOTES: i) CONTRACTOR SHALL VERIFY ALL EXISTING TO TOP OF CHAMBERS PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=12.39 GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.= 12.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 11.06 310 CMR 15.221(2) EXISTING SUITABLE 3) REPLACE EXISTING 1,000 GALLON SEPTIC 2.83' MATERIAL 5' MIN. ABOVE BOTTOM OF TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.83' = 11.32 1� 78 IF FAILED, DAMAGED, OR UNDERSIZED. (6.09' PROVIDED) USE 4 ROWS OF 4-16" HIGH CAPACITY (H20) 4) INSTALL INLET & OUTLET TEES W/ ADJUSTED GROUNDWATER EL.=4.9 ADS 160OBD BIODIFFUSER UNITS-NO STONE PROFILE - GAS BAFFLE AS REQUIRED OBSERVED GROUNDWATER EL.=2.17 SEPTIC SYSTEM PROFILE a GENERAL NOTES: N.T.S. TYPICAL SECTION 16" 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL -- r`r's 11+2 BOARD OF HEALTH AND THE DESIGN ENGINEER. ZN OF� U•. �"q 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL LOG P#: 13314 �1� ,,��++ C � OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE C4,Ifi�.E DATE: JUNE 23, 2011 34" LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED ON PAGE 1. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR pfEYFR SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE WITNESS: DONALD DESMARAIS, BARNSTABLE BOH No. 1140 DESIGN ENGINEER. 'P a TP-1 Elev. TP- 16" ADS 160OBD (H-20) BIODIFFUSER UNIT 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING c� FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LISTER Elev. Depth 2 Depth ENGINEER BEFORE CONSTRUCTION CONTINUES. Sq-NITAR��`a 13.70 0" 13.75 0" „ 5. ALL ELEVATIONS BASED ON NGVD DATUM. J 1 FILL FILL MODEL 16 16008D i Z f 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF ` 10.20 42" 10.25 42" LENGTH 76„ NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF A A 7 " TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY R PROPER INSPECTIONS I CONSTRUCTION. EFFECTIVE LENGTH 5 HEALTH FOR SECTIONS DURING CO U LOAMY SAND LOAMY SANG I DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 10YR 4/3 10YR 4/3 SIDE WALL HEIGHT 11.2" 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 9.79 B 47" 9.92 B 46" OVERALL HEIGHT 16" TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. SANDY LOAM SANDY LOAM OVERALL WIDTH 34" 11118 Ory; 4640 TRUEMAN BLVD 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 2.5Y 6/8 2.5Y 6 8 HILLIARD, OHIO 43026 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 8.54 62" 8.50 / g3" CAPACITY 13.6 CF • CONSTRUCTION. C1 C1 (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. 10. EXISTING LEACH PITS TO BE PUMPED AND REMOVED, REPLACE WITH CLEAN MED. SAND PERC O EL. 7.0 MEDIUM SAND MEDIUM SAND 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 2.5Y 6/3 2.5Y 6/3 PROPOSED SEPTIC SYSTEM SITE PLAN r 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 171 RIVERVI EW LANE, CENTERVI LLE, MA _ AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 1.70 t 44" 1.75 144" 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING PERC RATE <2 1MIN/IN. ("C" HORIZON) Prepared for: Estate of Marion B. Hanaghan il. 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED OTHERWISE) GROUNDWATER OBSERVED AT 139" (ELEV. 2.17) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER I OBS WELL: MIW-29, ZONE C, LEVEL 7.80, ADJUSTMENT 2.80' Engineering by: Surveying by: SCALE DRAWN JOB. NO. 16. INSTALL 40 mi POLYETHYLENE LINER AS SHOWN FROM EL 12.39 - 8.39 TO Meyer&Sons,Inc. E.A.S Survey Inc. NTS D.M.M. PREVENT FOUNDATION INFILTRATION. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 po SOX 981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the DATE CHECKED 17. REMOVE ALL UNSUITABLE SOILS 1 FT. AROUND LEACHING TO EL. 8.50 OR TOP requirements of 310 CMR 15.017. 1 further certify that I hove passed the Soil Evol. Exam in October, 1999. EASTSANDW/CH,AM 02537 (508) 527-3600 SHEET NO. OF C LAYER AND REPLACE W1 CLEAN MEDIUM SAND PER TITLE 5. 508-3622922 07/24/11 D.M.M. 2 Of 2