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HomeMy WebLinkAbout0180 RIVERVIEW LANE - Health i80 RIVERVIEW LANE, CENTERVILLE A= 228 169 s�lslll REcrnEo r/teaa�{/n,, 2J� pp2m UPC 12543 ;o J10 S3LO ��bsrcoc�'� HASTMOS,MN TOWN OF BARNSTABLE OCATION jZ'tLx--RLAL-ZJ L�,( SEWAGE# 103 VILLAGE Me ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. G.. O� SEPTIC TANK CAPACITY U%Xj t 5ZO 4- M L-Z,� 1—`2Jd io CoC l.sa�y e LEACHING FACILITY-(type) e4an, (size) NO. OF BEDROOMS -3 OWNER f��& PERMIT,DATE: -( 't7t COMPLIANCE DATE: i5 AI-h Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d-•- Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) $ I60 Feet BY FURNISHED r u �Tb a9 TOWN OF BARNSTABLE LOCATION < Cam` SEWAGE # VILLAGE C' AvT ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (Size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yk& No 71) A 0, i1 Q f ss �,� —_. 3 S n®I� 3��� �i 5 i No4 /S' a3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes fipfitatiou for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair()K Upgrade( ) Abandon( ) C mplete System ponents Location Address or Lot No. /:90 F�y ve.-r V",per, L,,�j f. Owner's Name,Address,and Tel.No. ifs-')(0- V/9 se;I i'X G.'arsles 03,7iJ-Kea y, 9 Assessor'sMap/Parcel C"�eruiir_ 4o. ar o l4 c9a6&q Installer's Name,Address,Land Tel.No. 5Z6•'79 - 9 3 W yD�e�sign�er's Name,Address,and Tel.No. e' 'G�lV CUVtSTCuCCl`01�, 1rlG �53 vSde� K.�%��''1 Q iYle 1 ,�Y`L OL(�%. �lv?S Type of Building: 4- Dwelling No.of Bedrooms 3 Lot Size �`�o �3 — sq.ft. Garbage Grinder( ) .Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3U gpd Design flow provided gpd Plan Date M u r4, a h. ;mg Number of sheets , Revision Date Title 1�'��S Sr 4e � nF���PCUI �..2."11Fero;lk Size of Septic Tank 14, Type of S.A.S. S 0ope &AAA /{�/l�q la.$-3 xas Description of Soil_ O Nature of Repairs or Alterations(Answer when applicable) Date Mast 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 C and o place the system in operation until a Certificate of Compliance has been issued by this Board of Healt ed Date q Application Approved by Date Application Disapproved by Date for the following reasons + Permit No. c l �o Date Issued g 0 N117""�� / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: n. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for -misjosal 6pstem Construction Permit Application for a Permit to Construct Repair( UPgrade Abandon V�' Xomplete S stem `�Iridividual-ComPonsn Location Address or Lot No. } w-r v j _ Owner's Name,Address,and Tel.No. :520S • 6 V19 d' Ceruil t �, SC;t(c. d;1 � 1e.5 �7�n/i.euctiir�SF, rat cll9 Assessor's Map/Parcel �a8 f/4�9 :tx)^ t/rt royiou+4, . A-t A D 3 G�•r� Installer's Name,Address,and Tel.No. `Designer's Name,Address,and Tel.No. 3oc-1-c.,i6t& C'u rsFr�,eN�-�►� rrc Llslr�,ss-e; j e rC kS Chi t/ �ivr�i r_a'ir ,-Ix�. f xr i-,laznSr - lE.� ..tY aA �n!4 i l f s 01 A 0;)&q I C71"•ffi (SAJ�kZ dice r i , A, Type of Building: p r 4- Dwelling No.of Bedrooms 3 Lot Size 3"t' 3 35' _ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3y gpd Design flow provided .31W gpd Plan Date t"A rCk �h, ;�0 Number of sheets � Revision Date Title I� - S �� ��� OtiQ JAC) d' ih...rij;son-,6501)40 �d r�l�ft;o AV Size of Septic Tank 1`3v0 „ {� Type of S.A.S. d %. L7ra4',,z 2 ,6aJ 1 , Description of Soil Nature of Repairs or Alterations(Answer when applicable) a, DateAast inspected: f 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.notto place the system in operation until a Certificate of Compliance has been issued by this Board of Health, SignSigned f \ --t' "" Date q ( '7 f I<a Application Approved by 4 Date / 6 it I Application Disapproved by Date for the following reasons Permit No. 1�30 I _ AG> Date Issued ~7 �)1 A --- - -- -- - -- - - - - - - -- - - --- ------'------------------------------------ � 'R THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( J+) Upgraded( ) Abandoned( )by N7u r I.r r , - - at 1 IS(ate e st a"'�.nn • � c� F r�a��j has been constructed in accordance with the provisions of Title 5 and the for /JDisposal System Construction Permit No&6 16'S dated !rs '` Installer i_ nt �cS c ran r� r_6 ann 1 r,C Designer �.tra-•c,, C5��.A-,c #bedrooms r !Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ..��.... Date h Ml y Inspector - -- ------------- ---- -------------------`-------------------------------------- No. ^�'t "" �� Fee Al ✓/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction J)Prmit Permission is hereby granted to Construct( ) r/Repair(1i Upgrade( ) Abandon( ) System located at C&-n-if rot ' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title.5 and the following local provisions or special conditions. Provided:Construction m/ust,be co hpleted within three years of the date of this perrni't. Date �/ f ('M Approved by Town ®f Barnstable P�ogswe Regulatory Services Thomas F.Geller,Director sexxsre�, Mom. 8 Public Healt1;1)<Division i63g• �0 ' �rF659 Thomas McKean,Director 200 Main.Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit## o20 f o` Assessor's Map\Parcel Designer: DOWN CAP, &6l( Imo_.(W6 Installer: Lom CMmC lofq Address: HAIN qZ(PZ0fY oA� Address: . 4 IMmg-my 2� YAt��toI Pore- A NO 5 MMWONI5 MfLL� rA 021 8 On I`� R,�- I " was issued a permit to install a •(date) (installer) septic system at ��D Ve.,r-V1 d Q based on a design drawn by (address) c ►� f: AJ dated (desi er) �I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. ✓ I certify that the septic system referenced above was installed with major changes (i.e. • greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic,s but in accordance with State &Local Regulations. Plan revision or certified as wilt y designer to follow. ' N OF Mgssgcti DANIELA. OJALA (Installer's Signature) " CIVIL N No.46502 p0; lSTE�F�a�� �SSr�NAL (Designer's Signature) I (Affix Designer's Stamp Here) i PLEASE RETURN TO BARNSTABLE ]PUBLIC HEALTH DIVISYON. CERTIFICATE OF COMPLL4NCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE i RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIrVISION. THANK YOU. i I Q:Healih/Septic/Designer Certification Form 3-26-04.doc i 1� �, U 5 6 �p✓�, !.�er���D , Town of Barnstable �oFIKME �p o Department of Regulatory Services HARNSCABLH, : Public Health Division Date Wz—fzl � y MASS. Q� 0 9.61�0 200 Main Street,Hyannis MA 02601 i r-3/ Date Scheduled Time Fee Pd. /00.0V Ti P4? Soil Suitability Assessment for S 15e Disposal Performed By: 06H t Witnessed By: LOCATION & GENERAL INFORMATION Location Address )g Q` V Owner's Name - - - - -/.Ce✓11`fi✓�/�l�t---`--Y` -Address ,Address / Assessor's Map/Parcel: ZZ► �p 9 Engineer's Name ONl^- Ca NEW CONSTRUCTION !!!!! REPAIR X Telephone# l Land Use L a wf / Slopes(%) S- w Surface Stones /Vey)e I /-/j Distances from: Open Water Body �` ft Possible Wet Area e)1OG ft Drinking Water Well 7 r J- ft Drainage Way > toy ft Property Line > l 0 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) " 1.4,I EGG/ a Parent material(geologic) t , G aC�Q I Gu4 tL10 A Depth to Bedrock Depth to Groundwater: Standing Water iin/Hole: 1 A ` Weeping from Pit Face Estimated Seasonal High Groundwater/V DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: W - Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. _Index Well#t -Reading Date:___ Index Well level--_ Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation 1 Hole# I Time at 9" 3/p Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak / Rate Min./Inch L 2 H1 7/,r/?� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ,- ***If percolation test is.to be conducted_within 100'of wetland,you must first-notify_the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in!) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 0-/0 L 10-It L 10YR I("9 DEEP OBSERVATION HOLE LOG Hole# ? Depth from Soil Horizon"-' Soil Texture Soil Color Soil - Other Surface(in.) (USDA) (Munsell) : -Mottling '(S,truciure,Stones,Boulders_.' Consistent '%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) x , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other ° Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No V Yes Within 100 year flood boundary No V Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio material exist in all areas observed throughout the area proposed for the soil absorption system? V e If not,what is the depth of naturally occurring pervious material? Certification I certify that on ��/ /1 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature 6�'� !� -" Date4 Q:\SEPTIC\PERCFORM.DOC • F-0290 or DEED RESTRICTION ��� WHEREAS, MIR119ti'l ))69, 0 S` dmcm 4 of (owners name) 'p t-arKIEe_ E s_rA 02-y32 MA (address) is the owner of l g0 A(Je t' V I ti kan--P_ . located (address) at P" l I e . VYI Pr MA (hereinafter referred to asC'�S and being shown on a plan entitled "Subdivision of Land in 12�-tc& cS NfAa�Fs S�cf-�;'MA, Property of Qjt f- , 9 9+11ytr k ill �04-movA Cvh'rc-ry�i7�, mJj' duly recorded in Barnstable County Registry of Deeds in Plan Book lQT , Page Or on Land Court Plan Number as WHEREAS, Mirt4m!-* �mci,r� �o6�►FS.bM the owner of said lot has (owners name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a .pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum . Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compiance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr 5 ,GrVsFe e- NOW, THEREFORE, ft)ipiim bnpFinaN A-,,) does hereby-place the (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. ti,&p, pjvnhn I.&A Q 0M4_, ATU , mo, cy,7_63zmay have constructed (address) upon the lot a house containing no more than e (3) bedrooms. >nxlp m btf4yyA* a*d Rowf-S my>r&khrees that this shall be permanent deed (owner's name) I restriction affecting located on :MA, and being shown on the plan recorded in Plan Book L 9 D , Paged 1�j3 Or on Land Court Plan For title of- seethe following deed: Book 31 XHki Page Or Land Court Certificate of Title Number . Exec ted as a sealed instrument 2 day of Gt v 2� Owner's signature Own is signature Owner's signature COMMONWEALTH OF MASSACHUSETTS �� ' Zoe' ss 2 � f V�f�_Wr , Then personally appeared the above-named known to me to be the person who executed the foregoing instrument and acknowledged the same to be 7HYr fL free act an eed, before me, Notary Public My commission expires: 3 Z1- KARL R. HEMR. te * Notary Public (d a ) COMMONWEALTH OF MASSACHUSETTS My Commission Expires deedr March 8, 2624 34,kRNS)A13LE 'REGISTRY OF DEEDS John F. Meade, Register a m A lth Com l n � 5� at , ✓� § u -.,R� Via.paits � Complaint Numbed 18835 ' Time 10 03 00 Al I Date 05/26/2006 REF (2RED TQ DALE SAAD 4�# �'t`A #1,01Y THOMAS MCKEAN = M PLAINyTTYPE _ GENERAL , , CO � '^ ass+ & ^";MPLAIN�TLOCATION� Number°,�180 S'�treet Riverview Lane B�Sin� YILt.At3E :CENTERVILLE ASSESSQfS Map:.Parcel n 4 rpf dge, wW tom"' r -. 1kr 0/6 O "'Investigation Date! Tlme yp q s Response Summary - , Z, r _ TOWN OF BARNSTABLE BAR-W � Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 1� } �, - 1c < Address of Offender / ?o 4 y,(r\j , C-W MV/MB Reg.# Village/State/Zip e r\t (. r k) t l\ r OL ° P '- Business Name 1 Vv k/&t-Z. 4 C11k am/pm; on-V 20,,) Business Address III Signature of Enforcing Officer Village/State/Zip 4, , a 4 c ^1! , 't1 r) c_ Location of Offense Q t lz4 „ Enforcing Dept/'Division CL 5 'Offense Kfln s, """ r^h elk .20 Facts t' _ � . . 4 1r�"� �1 +i�i : 4 _ � �,� "��, � r~ .s" ,^�,,' a �C�? ' hf:�fC%t - 266( This will serve only as a wayrning: At this time no legal action has been t0aken It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. .,..,...,.-...-.� :'x-.R.,•...-w+sw�w..�" =.:J.;",�.R.J...-Yv„-•w^f--' �'v..r--i-.yy..r,11'R. 1"I�.v�} '"l-hm Pw... ..:,�"., ."r"++wr'."1r-S'.r+....^i"n t.:' .N"wn-wa^It-nY'.� '."�+.5'•i•:.e�.*.R..A.m++: TOWN OF BARNSTABLE BAR-W 3492 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �rjr�, kA � cr Tw , cC,! �`. y Qt"c�iC, Address of Offender () Vs V k\,}C P\j MV/MB Reg.# Village/State/Zip 1, e r\t .Q (-k)1 tk r , h c , n q g Q... Business Name ( ry `1c t- 400� \ am/pm; on e M,) (, Business Address Signature of Enforcing Officer Village/State/Zip C"P yN+-eP\1 A In A, 0 6°3 2- ,�j x Location of Offense Enforcing Dept/'Division Of f e n s e. t 5 C. C` C C.. E n d SA ©r m 1 r''__ (CY1.' ,r' c), a Facts i" iir) �Y Y+ 5 V0 ► r* 0CIN0\jYC r. F \e,. �-t��T .,. 1'� a t i Ji b , C"3 6 6 ~fA t�11�� �" ��'�� ti�� 160 I A�. 4� This will serve o ly as a waning: At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. r r SEPTIC PUMPING AND INSTALLATION 350 Main St. • W. Yarmouth, MA 02673 • 775-2800 Heating&Plumbing,Fire Sprinklers SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .Address of property /810 1�li"1.1Wr_ �1, Owner's name c bC1,r-r KLef, -MAP# Date of Inspection PAR# 7_ao_ 5 PART A CHECKLIST Check if the following have been done, Pumping information was requested of the owner, occupantd Health. , an Board of None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that , period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained' and examined. Note if they are not r�available with N/A The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. NO ,. All system components, excluding the SAS, have been:•.located`on th'a site. The septic tank 'manholes were uncovered, opened, and the interior Of . the septic tank was inspected for condition of baffles or tees, . material of construction, dimensions , depth of liquid, depth. of Sludge, depth of scum. A<G The size and location of the SAS on the site has been determined bared on existing information or approximated by non-intrusive methods. << The facility owner (and occupants , if different from owner) were provided with information on the proper maintenance of SSDS. 0 Q UG 3 ,� 1995 to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM F.; PART B SYSTEM INFORMATION !. FLOW CONDITIONS If residential 3 number of bedrooms number of- current sidents garbage grinder, or no laundry connected to aystem, yes or no t seasonal use, yes orOPP no If nonresidential , calculated flow: 1�93 � Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of information: _ \ "o 151151"Xy 0/- 10,47,01-v6- rl� avfct SE�llc )�,11)Ali System pumped as part of inspection , yes or no if yes, volume pumped Reason for pumping, Type of system vw , How Septic tank/ Single cesspool Overflow cesspool Privy Shared system (yes or no) ( if yes , attach previous inspection records, if any) Other (explain) Approximate age of all components . Date installed, if known. . Source of information# tJ ni/f No w Sewage odors detected-when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK, (locate on site plan) depth below. grade, material of construction, V concrete metal FRP other(explain) dimensions: _.L sludge depth distance from top of sludge to bottom of outlet tee or baffle o• scum thickness to distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments, (recommendation for pumping, condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert , structural integrity, evidence of leakage, recommendations for 'repairs , etc, ) � V/Lt/` C�vr�C Y vk 4r wa�p/ri.�G ,t tutL t�d�ON C,lr Pv�oFD ate!,Z£i Co+�t,c di�}�s}� DISTRIBUTION BOX, V,✓I((i 'Al (locate on site plan) depth of liquid level above outlet invert Comments, (note if level and distribution is equal , evidence of solids carryover, evidence of leakage into or out of box , recommendation for repairs , etc . ) PUMP CHAMBER: (locate on site plan) Pumps in working order , yes or no Comments: (note condition of pump chamber , of pumps and appurtenances , recommendations for maintenance or repairs , etc. ) ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SoIL' ABSORPTION SYSTEM (SAS).: ON Ir/V0V✓ ( locate on site plan, if possible ; excavation not required, but may be approximated by non-intrusive methods ) Tf. not determined to be present , explain: 0e #ck -f&,, i*l tik � cw•v V5Yp .Zcc €c�,e£R i �+�d lvc�f C'ovL7) irrc7T A4> - Type leaching pits and number . leaching chambers and number leaching galleries and number leaching trenches , number , length leaching fields , number , dimensions overflow cesspool , number Comments, (note condition of soil , signs of hydraulic failure, level of ponding, .condition of vegetation, recommendations for maintenance or repairs , etc. ) CESSPOOLS (locate on site plan ) : 1 � number and configuration C// depth-top of liquid to inlet invert '7 depth of solids layer 0 dimensions of cesspool materials of construction ock indication of groundwater inflow (cesspool must be pumped as part of inspection) ey'o �,Cov,✓� ,�,�� Comments: -- (note-�condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs , etc. ) -,7r L i S oI� PRIVY: /V 0 (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, recommendations for maintenance or repairs , etc . ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells ithin-100 ' fr I I i i DEPTH •TO GROUNDWATER depth to groundwater method of determination of approximation , O c/S F Q o L T N 01— .s �/f -- SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes , no, or not determined (Y, N, or ND) . Describe basis of determination in all instances . If "not determined" , explain why not Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or N-D surface waters? CcvLo vo7- Static liquid level in the distribution box/above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 da flow? /✓ Required pumping 4 times or more in the last year? number of times pumped Al ' Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS , cesspool or privy : below the high groundwater elevation? /✓ within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? N within a Zone I of a public well? within 50 feet of a private water supply well? N less than 100 feet but greater the 50 feet from a private water suppl well with no acceptable water quality analysis? If the well has been analyzed to be acceptable , attach copy of well water analysis for coliform bacteria, volatile organic compounds , ammonia nitrogen and nitrate nitrogen. A) 7 7E: SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM > PART D CERTIFICATION Name of Inspector Company Name A & B Canco Company Address 350 Main Street , West Yarmouth MA 02673 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems . Che one: I have not found. any information which indicates that the system fail CIV to adequately protect public health or the environment as defined in 310 CMR 15 . 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. yvv-7-j ,�f�clf,,•�t �i�.s u-1 I' have determined that the system fails to protect public health' and the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. NOTE: A & B Canco has had no control over the use and/or routine maintenance of the septic system. Circumstances such as a recent pumping Will significantly alter evaluation results . No guarantee or warranty is hereby given, express or implied , as to the evaluation . THE ISSUANCE OF THIS INSPECTION FORM SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY If;,,you have any questions , please call me at 508-775-2800 between 8 . 30 am and 4: 30 pm, Monday through Friday . Inspector ' s Signature Date. a-o-9f Original to system owner Copies to: Buyer ( if applicable ) _Approving authority /f `6 _ � � 1< NOTES: pp�yy Lec-ENc P6'�G�.C.=._E LE[t�,n"µ: © FA g DDPLfy OUTLETF_PLIT WIRED ADJUE AEIE RECESSED LED L-1.1 ®EPE—,-, g DUPLEx OUTLCT s(a}'---I LIGHT ®SM 11 DETECTOR YY � 22C VOIi Olrt�, CfIL4VG!-C ®CA R^1in`MONOY.IDF CETECTCR O. FLOOR DL'P!FY CUTLET WALL LiGn.T ® 'ATI.—FAy $ SWTCY.SINGLE PCLF -0W 11—T REC—ID Oa VATON SEn5CR $a jwITCY 2 POLE � LED STGF IIGnT N PnoNE B BULB FLCU?F=CENT 0 CAN E 1NG C!RECTICNAL LIGHTING DECKIbe PC RT WA L OUTIEt FLGJD LIGni tKITCHEN i=a PRE BEDROOM 2 _ J TA w o E M a ®Q +ILL y� -I PROPosED i /M�STEf��- `PROPOSED _ //� _= / �.' �' ;•�.� / BEDROOM \�� \. m �� LIVING ROOM wo MUD ®° i `__ J \ ✓ / LiJ w0_i N Z PROPOSED \\ j I I -\ � `/ GARAGE (�.) J / �Q LiJ w =m / ?; J a PROPOSED •\ //, / \ DINING s \\ m STUDY PRaPoseD 1 / _ FOYERMASTENeATH / \ J // 1 i F --- `✓� PROPOSED O Z II I. \ U. PROPOSED �� N \ REPLACE+L -� +REPLACE BEDROOM�� 0 N \ E%ISTING FC(ISTING �\ Q wZ R PROPOSED r--J I.' � /� I) a PORCH \ j -- ;�� / R m g o \/ U a ❑ ❑ 0 13 �� �,Y / a w Ln > it Z >> aw x w m H J w n D`o w DO c� PROPOSED REV, GATE OESORIPTION FIRST FLOOR PLAN 4� Date:07/02/18 Scale:1/8"=1'-0" BASEMENT ELECTRICAL E-2 NOTES: E I , i /O E7USTING PATIO O, O LU V J I I J_ C=Z N M wgc g� I PROPOSED L Ca w V O ob RECREATION r w_o °'o I ROOM PROPOSED Z n Q RECREATION $� DN. uj 2_ z W w ROOM i a J I ------ Z W IG PROPOSED POOL STORAGE PIPES O DN. UP ` > PROPOSED POOL AREA LL PROPOSED KITCHENETTE z I VENTED ;I PROPOSED PROPOSED O Z W Q DOOR ' oO' BATHFV FITNESS RM U1i 5 O w ui CL Otr m >� ' 0o off >> U- LU a: o Z NQN U LL G REV. DATE DESCRIPTIO Date:06/13/18 PROPOSED Scale:1/4" BASEMENT FLOOR PLAN BASEMENT FLOOR PLAN A-5 ALL SHALL TE SYSTEM PROFILE MARK DS WITHCMAGNETICTTAPE OR BE NOTES FFLR EL. 35.6' PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS NAVD 88(NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. Route 28 \ ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE �Sf 2. MUNICIPAL WATER IS EXISTING.. FILTER FABRIC OVER STONE s� 26.7' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 25.8' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. r�4° P NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST sr� PRECAST H-io BLOCKS OR RISERS (TYP.) THICKNESS REQUIRED UNITS TO BE AASHO H-Q Pine St. 2'0 4"0SCH40 PVC PRECAST RISERS 23,7 MOFTAR ALL H-10 ..,. 6" MIN. SUMP PIPES LEVEL 1ST 2' �ENDSJ 4. COMPONENTS INV'S EL. 22.0 4' 5. PIPE JOINTS TO BE MADE WATERTIGHT. on a12" MIN. INT. DIM. (TYP.) SIDES 22.83' 10- 1500 GAL H-10 14 pap oo oe o 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE D \*24.2 f TEE SEPTIC TANK TEE °°°°°°°° a`0000000° o 22.33 �D�O �0m� � WITH 310 CMR 15.000 (TITLE 5.) °°°°°°°°°°°° WATER1 D'BOX o°o°o°o° ���o���aoo� oo�a�0000®a °o°o°o° = > o 0 0 0 � � � o � � � 0000 oo � o � 0000 0 0 0 0 0 0 �\ ° ° ° ° ° ° '°°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Locus A GAS BAFFLE ::: o°°°°°o°°°o °°°°°°°° �0��0000(]C�� �a000aoaaoa ,°°°°°°°° 22 58' ° FOR LEVELNESS �i �ao�aE21E al �aaa0000000 '°o°o°o°o d NOT TO BE USED FOR LOT LINE STAKING OR ANY ": 4' LEVEL (ACME OR EQUAL) °°°°°°°° °°°°°°°° 22.28 22.1 1 ° ° ° ° °°°°°°°° 20.0 OTHER PURPOSE. °°° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. °°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°° e o°�°qnq°9,�ng,°°°°°°°°°°°�� 9°� °,g q°°°°• H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. '� •1 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED, ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR *THE INSTALLER SHALL VERIFY INVERT OUT OF EXISTING SEPTIC 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' CONCEALED WITHOUT INSPECTION BY BOARD OF THE LOCATIONS OF ALL UTILITIES TANK IS ASSUMED AT A DEPTH OF COMPACTION. (15.221 [21) HEALTH AND PERMISSION OBTAINED FROM BOARD OF AND ALL BUILDING SEWER 7.5'f; INSTALLER TO VERIFY INVERT HEALTH. OUTLETS AND ELEVATION'S PRIOR OUT OF HOUSE PRIOR TO 10. CONTRACTOR SHALL BE RESPONSIBLE FOR TO INSTALLING ANY PORTION OF INSTALLATION OF PROPOSED SEPTIC CALLING DIGSAFE (1 888-344-7233 AND VERIFYING SEPTIC SYSTEM SYSTEM THE LOCATION OF ALL UNDERGROUND & OVERHEAD LOCUS MAP ( 2 1 14.0' BOTTOM TH-1 UTILITIES PRIOR TO COMMENCEMENT OF WORK. % SLOPE) ( % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND SCALE 1"=2000'f LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL FOUNDATION- 81 ' SEPTIC TANK 5' D' BOX 12' FACILITY BE REMOVED BENEATH AND 5' AROUND THE ASSESSORS MAP 228 PARCEL 169 PROPOSED LEACHING FACILITY. ' 12. EXISTING LEACHING FACILITY SHALL BE PUMPED iAND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND SAND. l 99- EXISTING CONTOUR CD BENCHMARK: I SAWCUT AND PATCH X 99.1 ) CEMENT BOUND PAVEMENT EXIST. SPOT ELEV. f =20.4' NAVD88 TH1 �� i POSSIBLE DRAINAGE PROPOSED CONTOUR ! STRUCTURE-INSTALLER TO VERIFY 198•41 PROPOSED SPOT EL. / TH2 PRIOR TO INSTALLATION OF v ro PROPOSED SEPTIC SYSTEM TH1 / INVERT OUT OF EXISTING SEPTIC TANK SYSTEM DESIGN. TEST HOLE IS ASSUMED AT A DEPTH OF 7.5'f; " �' �"� �� N INSTALLER TO VERIFY INVERT OUT OFQ_7SLOPE OF GROUND �q O O HOUSE PRIOR TO INSTALLATION OF GARBAGE DISPOSER IS NOT ALLOWED UTILITY POLE 0 1 O �� PROPOSED SEPTIC SYSTEM L /o m O �, 3 EXISTING 3 BEDROOM DWELLING o �' 1 Ro FIRE HYDRANT �\ �` ` DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING r' � � (^1 •� USE A 330 GPD DESIGN FLOW 27 � �l 1 i2. 3' SEPTIC TANK: 330 GPD (2) = 660 W " TEST HOLE LOGS TWIN OAK TREE USE A 1500 GAL. H-20 SEPTIC TANK u TO BE PROTECTED ENGINEER: DANIEL E. GONSALVES, SE #13587 �2 PAVED 30 LEACHING: DRIVE SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD WITNESS: DON DESMARAIS, IRS \ / � '� �� B - OTTOM 25 x 12.83 (.74) 237 GPD DATE: 3/19/18 LT AR 32, 35±S. . 1� ��J TOTAL: 472 S.F. 349 GPD PERC. RATE _ < 2 MIN/INCH CLASS I SOILS P# 15614 \ 1�1 o f 0 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR j00 33 O EQUAL) WITH 4 STONE ALL AROUND ELEV. ELEV. EXISTING Rcy � �� •� 4 4 \ DWELLING 0" 24.0, 0" 24.0 �� '•\ FFLR = 35.6 34 26 A A '� - - - - - - APPROVED DATE BOARD OF HEALTH MA /LS �LS If 10YR 3/2 10YR 3/2 •�• ••• TITLE 5 SITE PLAN 10 10' DECK OF LS s o �'� 180 RIVERVIEW LANE 10YR 5/6 10YR 5/6 \ \ �\ rx 22.5 20" 22.3' W 26 / � 18" , CENTERVILLE, MA \ �:5<� SHED �� �� s PREPARED FOR C BORTOLOTTI CONSTRUCTION/ PERC ZS �� PRISCILLA L. BERGLES M S M S ,�� �� ''•\ N 22 o S 6 26 DATE: MARCH 27, 2018 Op �� 5 �ZHOFM S � L CNOFMgss9 � 2.5Y 7/6 2.5Y 7/6 p 2 �, �� /oC' DANfEL ti� UNSUITABLE O ti s� �� DAN!EL A �„ off 508-362-4541 SOIL F o OJALq 0 fax 508-362-9880 '24 0 1 A 23 " CIVIL No.40)(30 I downcope.com �d 2 \F P pNo 465020 120" 14.0' 120" 14.0' 2 21 s rISTE�G,�� �q osUR���o�.. down cape engineering, kC. 6���� �� �S/UNAL civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' _7,77 15 land surveyors l 939 Main Street ( Rte 6A) cE # , 8_®56 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0 10 20 30 40 50 FEET 18-056 BORTOLOTTI_BERGLES.DWG ....-..-._.-........_ .... ..........