HomeMy WebLinkAbout0226 RIVERVIEW LANE - Health L226 Riverview Lane
Centerville
A=228 — 166
�/f
UPC 12534
o.2-153L0 /
""mica-
' s COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 226 Riverview Lane
Centerville /G
Owner's Name: Pali 1 Revere III
Owner's Address: 997 Nc)-rth St- , S >; e 336 (mailing address)
Date of Inspectionnis-
Name of Inspector:(please print) Sean. Jones
Company Name: William E: Robinson Septic Service
Mailing Address: P O Box 1 089
_Centerville, MA
Telephone Number: (SOS) 775-8776
CERTIFICATION STATEMENT
1 certify that 1 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.1 am a DEP
approved system inspector pursuan7asses
ection 15.340 of Title 5(310 CNIR 15.000). The system:
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fail
Inspector's Signature: Dute: % to oto
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heathy
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 approxing
authority.
Notes and Comments }{d,,,L Cjeyrtj y F,rc �a�aoag lest a f-
`}'n1(, d< .L,.�SOIt'�ov C'C//t/pb) I,.i�.s �oHp.�._ l.✓,+� �t/v JVa',�-,c�bCC Sfgt� Lt, �>7 C
""This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _ 226 Riverview Lane
C _n ville
Owner: paiii Ravarp TT
Date or inspection; lot,
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sy em Passes:
V. 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:
r�.t: ol, _,4 .n.
B. System Conditionally Passes: J11-/ `
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or Wiiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
•A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will.pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 onus a year due to broken or obstswed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipes)are replaced
obstruction is rtt wvcd
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 226 Riverview Lane
Centerville
Owner. Paul Revere III
Date of Inspection: . et T d 6
G Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety.and the environment:.
— Cesspool or privy is within 50 feet-of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone l of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply,well.
- The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a
private water supply well•• Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence.of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11 r
OFFICIAL INSPECTION FORM—NOT FAR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 226 Riverview Lane
Centerville
Owner: Paul REvere II
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate'yes"or"no"to each of the following for all inspections:
Yes Ng
✓ 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 AS 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
�i Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
- � of times pumped
{ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface
J water supply.
_ Any portion of.a cesspool or:privyis within a Zone 1 of a.public well.
_ V .Any portion of a cesspool or privy is within 50 feet of a private water supply well:
_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet front a private rater
supply well with no acceptable water quality analysis.(This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliforin bacteria and volatile organic compounds
indicates(hat tite well is free.from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A co of the analysis must be attached to this form.
gg PY Y l
ND (YesfNo)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: /v
To be considered a large sy em the system_must serve'a;fa`cilityivith a'desigu-flow of 10,000 gpd to 15,000
gPd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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 driAi water supply
— — thesystem is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the syslean is considered a significant threat,or answered
"yes"in Section D above the large system h idled.The owner aerat r opes of arty large system considered a
as f
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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 226 Riverview Lane
Centerville
Owner: Paul Revere III
Date of Inspection: 9
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No//
Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
_ ✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
/ P
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ _ Was the facility or dwelling inspected for signs of sewage backup?
✓ — Was the site inspected for signs of break out?
✓ — Were all system components,excluding the SAS,located on site?
✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
y� Existing
information.For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b))
5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 226 Riverview Lane
Centerville
Owner: Paul Revere III
Date of Inspection: L)b
LOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3 330 6 fD
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms):
Number of current residents: 0
Does residence have a garbage grinder(yes or no): N�
Is laundry on a separate sewage system(yes or no): vD [if yes separate inspection required]
Laundry system inspected(yes or no).,✓YA
Seasonal use:(yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 5 — 1 51 10 0 0
Sump pump(yes or no): Iv o 2004 — 145, 000
Last date of occupancy: I a avDS .
COMMERCIAIANDUSTRIAL ,V
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):—
Industrial waste holding tank present(yes or no):Non-sanitary waste discharged to the Title 5 system_(yes or no):_
Water meter readings,if available:
Last date of.occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):/V0
If yes,volume pumped:_gallons--Now was quantity pumped determined?
Reason for pumping:
TYAOF SYSTEM
Septic tank,distribution box,soil absorption system
Single cesspool-
Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe):
Approximate age of ally components,date installed(if known)and source of information: ` J
I /n- A-3, 13�114 DN All e,�f- 1'Jw.� CIF (�G/n S7a(��Q �Cltrd o-' t e- f�
Were sewage odors detected when arriving at the site(yes or no): evb
6
Page 7 of I I
OFFICIAL INSPECTION FORAI—NOT FOR VOLUNTARY ASSLSSNIM'S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSITCT10N FOIUII
PART C
SYSUNI INFORMATION (continued)
ProperiyAddress: 226 Riverview Lane
Centerville
Oivncr: Paul Revere III
Date of Illspeetlon:
BUILDING SE1VEll(locate oil silt plan)
Dcpdt below grade: of• S-
► �
(\'IattrialS of construction:_cast iron ✓4(I PVC_other(explain).
Distance front private walcr supple well of suction line:_
Cununents(oil condiliol,ufjuutts,venting,evidel,ce of leakage,etc.):
SEPTIC TANK: ✓ (locate oil site plan)
Dcpth below grade: a �
Material of construction. ✓col,ctcle racial fibetglass pui)ed►ylcne
_otl►cr(cxplain)
If tarlk is racial list age:+ Is age cvl,firm
cctlificatc) ed•by a Certificate of Compliance()- n
cs or u):-(attach a cul)),of
Dimensions: >5nv
Sludge dcptl►: 116
Distance Goni lop of sludge Iv bv11un1 of outict Ice or bafilc: a•
Sewn thickness:_(o„
Distance from tup of scull,Iv toil of vutict ice or bafilc: "
Distance ports bottom of scum to bottom of vutict ice or ballie: ,
Ions•were dimensions dctcnl,incd. df
f?Q>°n( rn.iVs si�.__�flLC rtnlc�sv!(vuG•.1T•
Comments fun pumping recu►nn►cnJaliuns,inict and vutict Ice or bafiic condition, sUucWtal intcgtily,liquid levels
as�clalcJ to outlet uivut,cvidcltcc of leakage,etc.):
NO4 1?Q&C /'N L,--- Gr level 46S 0t<. �4�LC hGf(.rS' '16� Ale Ctelaie
GHEASETRAP: N/(locale un site plant)
Depth below grade:_
Material of constmctiul,:_concrete metal Iibctglass_pul)ctlq lcnc _older
(explain):
Dimensions:
Scum thickness:
Distance franc top of scull,to top of outict ice or bafilc:_
Distinct Goln bottom of scum to bvllun►of outict 1cc or bafilc:
Dalc of last pumping:
Cul,unenis(on pumping rccol,unendatiol,s,inlet and outict(cc or bafilc conditio:►,slluctulal inlcpIly,liquid Icvcls
as rclalcd(o oWicl invcil,c+•idclicc of leakage,ctc):
r
7
'
,'age 8 of I I
OFFICIAL INSPEC-1'ION 1`0101 - N01' F01t VOLUNTARY ASSLSS11lLN-1-6
SUUSUIWACE SEWACL DISPOSAL SYSTEM INS1►EC'1-ION FORM
PART C
SYSTM INF0101ATION(continued)
PropertyAddress: 226 Riverview Lane
Centervi e
Owner: pa,,—�RF' re I I
Dale of Inspection: I ob
TIGHT or IIOLDING TANK:tq (tartk t►tust be pumped at time of in spection)(lucate on site plan)
Depth below grade:
Material of eoustruction:__concrete_ntetal_fiberglass_llulyelhylene other(explain):
Uinrcnsions:
Capacity: rallons
Design flow: galluns/Jay
Alarm present(),cs or no):
Alarm level: Alann in workin urdcr
Date of last pumping: 6 (yes ur nu):Date
(condition of alarm and float sus itches,cr(:.):
DISTRIBUTION BOX: �/(if present must be o►cr
i rcJ)(localc on silc plan)
Depth of liquid level above outicl invert: O►�
its
Conune into
(note.I box is Icvc)and d1s ribUtloll to outlets equal,and•evidence of solids ca►r)•over, any evideucc of
leakage into or out of box,etc.):
-Qa 1 .4j
PUINI'CRANIUM: (locate on site plan)
1'unrps in working order(ycs or nu):_
Alarms in%Vorking order(yes or no): _
Cununcnls(rrulc condition of pulnp chantbcr,condition of pumps and ahpurlcnan(cs,ctc.):
IPage9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 226 Riverview Lane
en e—r v 111 e
Owner: Paul Revere TIT
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): V/ (locate on site plan,ezcavation*not required)
If SAS not located explain why:
Ty v
✓ leaching pits,number: 1 (100 6a1i01 0-3D
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/altemative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
4
11- �-as clr .vo yiSibG 5,� �. LC1 Cf
CESSPOOLS: ,cesspool must be pumped as part of inspect ion)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: �Nllocate 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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 226 Riverview Lane
Centerville
Owner: Paul Revere III
Date of Inspection:�` '.Lola
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
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10
.Paged 1 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 226 Riverview Lane
Centerville
Owner. Paul Revere III
Date of Inspection: � o
SITE EXAW
Slope ,/
Surface water /
Check cellar
Shallow wells
Estimated depth to ground water 54' feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-if checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation: p
2jeve.+#'O � 6c1 �0001Si't/ l�..., c)� Dc✓✓I labl(
/a CJM PcreJ 4D .�P ��h�'i�'�4 P�t7 Re,f'fV_r, -
i
11
i
APPLICATION PREREQUISITE TEXT
4 bedrooms only Septic inspection says 3 bedroom and permit says 3 bedroom,
but the original permit plans said it had a 4 bedroom capacity (443 GPD)
Outside ZOC. Foor plans reviewed, however only large scale present during
permitting, so we must get floor plans for our record. Reviewed with TM on
septic capacity and that its outside ZOC.
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE Ce&Ae rvn 8 ASSESSOR'S MAP & LOT-2Z �3—14040
INSTALLER'S NAME & PHONE NO. q wflrWirs
&EPTIC TANK CAPACITY _ C 3'D O
LEACHING FACILITY:(type) r �pc/415 (size) 400
NO. OF BEDROOMS—PRIVATE WELL OR PUBLIC WATER 7 UJ
BUILDER OR OWNER e r /f o
DATE PERMIT ISSUED: ) -- Z '4—
DATE COMPLIANCE ISSUED: '�-7
VARIANCE GRANTED: Yes No i/
e
• 5
\. .{
t
1 '
• • � Jr
c
No... � � Fins.............................:._.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-���
....................0F....� .......................................
J4 ApplirFation for Dispaii al Works Tonstruf ion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
ati _Address r Lot o
. -�._.. ..: Q...................•-..---- -•-----•----.
Owner Address
Installer Address
d Type of Building Size Lot. '�t. --------Sq. feet
Ex Expansion Attic
Dwelling—No. of Bedrooms_____________.............................. p ( ) Garbage Grinder ( )
aOther—Type of BuildingSl!A&-rll*(±4.y. No. of persons------Q................. Showers (a-) — Cafeteria ( )
Other axtures ........WAAH—M..-..4Z A&&-,A....................................................................................
Design Flow........... IZO.........gallons per person frir fday. Total d;ilypow_______-. .........................gallons.
WSeptic Tank—Liquid capacity` ..gallons Length _.__...... Width... ..__...... Diameter................ Depth....Y.........
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......1------------ Diameter----6------------ Depth below Total leaching area..`JsR-....sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) `
Percolation Test Results Performed by.__ ._. _&21' -6....... Date_..... =0�....... ..............
W
Test Pit No. 1--47-_A.___minutes per inch Depth of Test Pit-----la..__... Depth to ground water_._e�.'sweou'jmv)
44 Test Pit No. 2.A..va.`_..minutes per inch Depth of Test Pit-----A�........ Depth to ground water...: ..............j'
Q+' •-••--••-••------------------------••---•-••--•--•--•-•---•......----- •--•------------•--••------- ---------•-
O Description of Soil...../A...... +tl4:_fie_ cl d. `�- 5� ..... I1jA41 X� Ia -------------
V ....---•----•••-•-•----•...---•••--•-•--------.........................--•--------••-----....----•--•-------•----•------•-•-••-----••-•••-•••-------•--•-------•••-----...........----••......------•-
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
--------------------------------•--•--------------------------------•--•--•••----•.......-------------•---•--•••--•----------•----•--------•-•••••------•---•-•-••••••-•-••--------------•-------._--•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of THI'M 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee sued by the board of health.
Si ne g �_ l/�
' Date
Application Approved BY !....-•--------•-•-- ............................ ------- -� �,Qj
-•-_ Date
Application Disapproved for the following reasons:--•••••--••••••-•••-------•----•----••••••--•--•••------•--•-•----......--••-••--•-•--•••. ...................
......................................................------...---------...------------.....-------••-•---------------•---••--- ...............---- --- ------------
Permit No.. .`... .�----•-.... Issued.. _: ._Dau......
Date
-- -
No._..................... FEB...........: ....:=......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... ..............OF.....:_1�f.r :^:�.-
Appliratiun for Uiupuual Workii Towitrurtiun ramit
Application is hereby.*made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..�:�•' -.`�- ----...�.!��L%?.✓......... .�...------------------------------- ;t..1...., - .....
// ocation Address Lot No
txjlt.t•r:i� — ;li ............. ..._ �d f/C1 /.c11,Tt �k...rJG,_•_ l� ! l;4 ....!�r ;.. )/ /
...............
Own
- ra r r ^iAddress
is 0 t 1 od j /�
----1 -......•-•--••...................... ..... ...••--.. .........................................7...............................
Installer Address
UType of Building Size Lot_;/.Y: ��._.._..Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type T e of Buildin . �' 1. No. of persons -0................. Showers
fs.l YP g`==-•--•----'--------------- P (�,:�) — Cafeteria (. )
Q, Other fixtures . '.3,\-=I` = --�:, == t,I,l .,;�7L
d ------------------------------------- ---------•------------------------...-----------------••----
Design Flow............. f1'?.........gallons per person�er,day. Total daily,flow..........-,JO............................gallons.
W SSSS
WSeptic Tank—Liquid capacity�`>6 ..gallons Length............... Width-_-y........__ Diameter._._.__.._____.. Depth.....y_........
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------L------------ Diameter----��--_.-------- Depth below inlet_ =_ ........ Total-leaching area--- ...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Resumes Performed by....................................................!,_'L...�-.-C_t......._...fJt.,r, .__,:I Date....... .............................
e /Y
Test Pit No. 1___..... -_._.minutes per inch Depth of Test Pit . . Depth to ground water t%._-c ...--�� -�
tz Test Pit No. 2.Z ...Q....minutes per inch Depth of Test Pit......!�r?......... Depth to ground water........................
P ...-•-•-----•• ----••-----------------•-•----•---•••••••--•---••....------....•••--.......--•-----•.........................................................
0 Description of Soil...... f3 ^f' '- °"� -f' w !3 �,I - }�,� _ r (j 1? ,/cr(, ") 0
x --•---------------------------------- ------------- -----------•-•--- . ----- ••• .................
W
UNature of Repairs or Alterations—Answer when applicable-----------------------------•--__-__-__-----_-_-_--__-________-__________--__----------------.
---------------------------------------------------------------•--------------------•---------•-----------•-------------------------------------------------------------------------------------•--•--•
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T1TIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
SIQl]e(1__ �f J�.. i! //r ? 11_F}__ . �f •�f.".'i�
_ / ? 7 D
Application Approved B / / ate , -
PP PP Y -----.---•- -••------- � �'1
Date
Application Disapproved for the following reasons:-•••--•-----......-•.....•--•---•----------------------•...--•-••-------------•-•---------------•••-•-•-•----•--
..........................................................-••--------•-••--•••------...-•-------•........_.....•-•----•-----•-•------••••-•-----•••----•••------•--•------•......--------•--------------
Date
Permit No........ J-•---- Issued_..._._._____ /✓' .........-
--••-`-- -----•--..:?....----^---•-- Date .................
THE COMMONWEALTH OF MASSACHUSETTS
r--" BOARD :OF HEALTH ,
...........................OF.........i............. .........................................................
Tnrtifiratr of Tomplianrr
THL.S_E&-T$C RTI1,F , That-the Individual Sewage Disposal System constructed ( �.}�er Repaired ( )
---
at ? ` J (Y}� ler
...... ............... `...
has been installed in accordance with the provisions of T !�r of Th S to Sanitary Code s ri he
application for Disposal Works Construction Permit No...._�.�.__-•--/-_^ �. .. dated_-..._---_�/-`�`� � .-.(-_-•-
r'•----------------
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................... _ .. -. ................... Inspector........................ ..........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0
ACTH
r , ?l ...........................................OF.....................................................................................
No.....................=.:� FEE........................
iu ouul: ku TomArWiutt rranfi
Permission is hereby granted...............................
(< ,,X l
1 ...... -•--•-•----------•--••-----•-•---•--------•._...•-----....---•--•.............•--•••-
to Construct ( r Repairer( ) an Individual Sewagesposal Syst
U --2. 1 JL 1 C'�' L �......... .... �Il�✓/f `.
at No.. ' --. . .... .... . ..... ....•-•-
Street
as shown on the application for Disposal Works Construction Permit No"____`��_..__ Dated....... -___...___�.......
•.................. y-----------
....
Board of Health
DATE..............�_�_. -_ '�r..Kr..--•-•-----...._..........
FORM. 1255 HOBBS & WARREN, INC., PUBLISHERS
rEL. .3S.b. . ' ... . ,
TOP OF FOUNDATION ,ZfT )&54rp.
°. CONCRETE COVER
- CONCRETE COVERS
4"CAST IRON 10"MAX.
OR SCHEDULE 40 12"MAX, "'""'%�•7�
P.V.C. PIPE 4 SCHEDULE 40 PV.C.(ONLY) 7PITCH I/4"PER.FT PIPE - MIN:
PITCH 1/4��PER.FT. !.EACH
0 0 —INV�tt T ,a" PIT . PRECAS
/'' -' LEACHIN
EL.4IYi,O. . � a ....
SEPTIC TarJlt INVERT DIST. • INVERT p . e.; PIT OR
° o INVERT EL.Y8.0. . .. BOK . E016,... ' ; t >z EOUIV
GAL. INVERT �,
EL lor2 INVERT U� '" 3
• .' w /4"TO 11,
o EL. w WASHED
°i w STONE
G'DIA. ---{
PROFILE. OF
NOGR(TND WATER TABLE
SEWAGE DISPOSAL SYSTEM Eivcovnercc�
i
NO SCALE
SOIL LOG WITNESSED BY :
DATE .'7
..Z4:-P... TIME. . . . . . . . . .. . . . • • • ;+ , BOARD OF HEALTH
TEST HOLE I TEST HOLE. 2
ELEV. #;'. . . . . . . ELEV. .'/7,� . . . ,a,,���' .C.q,, g/�ICCt/ GINEER
TOP LoAtiJ i(5
:15:W, • ��Susso,L L' DESIGN DATA
NUMDER OF BEDROOMS 3
MeD TOTAL ESTIMATED FLOW .3 3O , GALLONS/DAY
$An/1) Qe DO,rTOM LEACHI ING AREA / . SO.FT. /PIT
19ravei "g1'aod SIDE LEACHING AREA . . . /3L , , , , SO.FT./ PIT
GARDAGE DISPOSAL „l(�, , , (5p% AREA INCREASE)
/Z TOTAL LEACHING AREA . . 2 SQ,FT
lev.
;S Q PERCOLATION RATE . ,!�,Z, R11N/INCH
/Y.O. .WATER ENCOUNTERED
LEACHING AREA PER PERCOLATION RATE .. . . . .. SQ.FT.
NUMDER OF LEACHING PITS
APPROVED BOARD OF HEALTH
DATE .
AG[N r OR INSPECTOR -r07-4C- 443 C,o /3Z XL S - 330 CARD
�clvrE : Usk -Zo CO.vDin/G S�pNAL SqN i
CL�iif/T �II/Ll `l AC081
No.814 ;
PETITIONER y �.
✓ ���wEAL��F ,`
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W.:-, +
�1 � $� F /•ZD.U D c�G s
coNJ
,yo
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FPN
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_EL. .35.0.. . . ... . .
TOP OF FOUNDATION
° CONCRETE COVER
- CONCRETE COVERS
4.,CAST IRON 12 � �r�-�r n"a' • nr1►�mnn i
OR SCHEDULE 40 12"MAX.
P.V.C. PIPE 4„SCHEDULE 40 PV.C.(ONLY) 7 I PITCH I/4"PER.FT PIPE - MIN.
a,o PITCH 1/4'PER.FT. LEACH
PIT PRECAS
' o' \—INV• T is" �y �� ° • J •.
LEACHIN
' EL.S�.�.O. . , INV RT INVERT :� w �? o�� PIT OR
�'- SEPTIC TANK DIST. EOUIV
a INVERT EL. B. U. . . . .BOX . ELyG�:• •.. ' � >z ;.;
'a' EL.S/B..Z... /..SQQ. .. .. GAL. INVE,RT - ' � ') P' '�' .� .,
-- ELYIorG EINVFRTuj Q ;:,',' 3/4 T011,
4(►s WASHED
o u-
w STONE
DIA.
PROFILE. OF -
�/OGROUND WATER TABLE
SEWAGE DISPOSAL SYSTEIVi Eivco�n erccl
NO SCALE
SOIL LOG WITNESSED BY *
• T
DATE .4�"..e4'47... TIME. . . . . . . . . .. !fir [/OG(J�//V�
. :" . BOARD OF HEALTH •
TEST HOLE I TEST HOLE, 2
ELEV. .-'/7. `-y, 9/�LCC/j GINEER
,7 E L E V. .'z�7.,S.�. . . .
TUP LoAoJ
SuB�iiL � '
DESIGN DATA :
NUMDER OF BEDROOMS 3
a1�p TOTAL ESTIMATED FLOW 3-3Q , , , , GALLONS/DAY
SANL) Qed DO,fTOM LEACHI IdG AREA �/ , SO.FT'. /PIT
79rO veP/ vG U</
9 SIDE LEACHING AREA . . . /.3,� , SO.FT./ PIT '.
GARnAGE DISPOSAL „ �. (5p% AREA INCREASE)
/L TOTAL LEACHING AREA . . 2Y SOFT
/ev. /Z'
SO PERCOLATION RAT[ .L�• , , , , , , , , , MIN/INCH
���� p I LEACHING AREA PER PERCOLATION RATE .. . . . .. SQ.FT.
/Y.O. .WATER ENCOUNTERED
NUMDER OF LEACHING PITS .Q�*E_
APPROVED . . . . . . . . DOARD OF HEALTH •174z , �G�z=
DATE . Z �. -. G•Z�C�i1 ,3s/ =./, Z
AGENT OR INSPECTOR TD7 1-143 CjDD /,3Z XZ S - 33� C�PD
,cIvTE� r.Cs� N-ZD CoADiNG �S�pNAL 84
CE.t/T �(l/LLB z a ACOB1 ,
No.814
PETITIONER 7�
✓ . . . . . . . . . NNW fA'LSN�F
i
I
1
LR -a= FLOOR aU VAE& MOVE 1
1
I 'v
I
PROVE A" FII6t'1 PL OMS
I IrTDER RJZNAf.E AND H.WYI.
I {
j EXISTING Gow*ETE SLAP i
I
I PROVE NEW V#x2bxld
I Gat ICFZM F00171N6 w/ 1 1
I 5 1/z s CZWRM r-r
FILLEP STEEL LALLY -
calm
r -�
r- ------------- -------------- -----------J I t� I 19-2"xlo" DEAA1 ID
2
-------------------------J1 PEETWTOR
I
a• Ir-+ 1r-w' Pour. t
5 ilro caNCREM FUFn STEEL
LAIJ_Y CiROvM ON A 2-6" x rid• x
i I GONrHAOUS GaNORETE FOOTM6.
I
I
I
p3
r -I r-, r--1
------------ L-------'L®1-------------
L L_J L_J
4"xA FFMOS RE TREATEP P05T
ON A lCo OGNGRETE FLLEP
.+r'ON911VE ON A 2exld•xl0'•
OON6 MM IMOOrM 4-e MR MON GRADE.
5.F d
74•-,d• 2'-d'
EXISTING BASEMENT/FOUNDATION PLAN
SCALE
Ga Mle-rOR SHALL vWrY LOGArm OF ALL Rxwm ea-z ETE Fomr-,S PRIOR To START OP cam9 I,nat
RMSIONS
Revere Residence
BEAM 13- 8'-3" SPAN MAX. 226 River view Lane
Is M-MR 40 LIVE LOAD+ Io DEV LOAF=50 x 14=70, Centerville, Ma.
god FLOOR W LIVE LOAD+ 10 DEAD LOAF=4o x 14=56p Arne zo LIVE LOAF+to DeAv LOAv a V x 14 Gene Anton 4w PA Designer/Draftsman
RTITIONS 2xlr� 27�
W4 40 William Hersey Lane
East Bridgewater
PARAIIAM 5 I/4"x II I/4"=Z19L one sNEerNo.
SCALE
. PROJECT.• k C� I1
3
y
1
d d ►r-o r,d A' d r-c r-Id 9'-a 1- , Ir-r
-----,
� s
WxW /� dOxiB xD6t
SMOMR
?Sx?8 �,------- A
I KITCHEN '
R
I N y I
Foo Ool
pFJM 2 MxO REAM 0 I.
------ ------- ----- _ - ------- ---- --
N dOxdi GO. k'Oxdi GD. N � KOxdi GD.
FAMILY ROOM
GATFMRAL GELBJ6
TWO GAR OARA rxxlr sTLDs a W oic
I � PARrrrww � �
_ PR0VM aE LAYER Gg 61W FUE GaDE OYF AD. � I I p R
O'er�OT3P AT Al W a&GELMS APJV,&W rOI ax LPA a SPACMI iL_ DINING ROOMpGsrI 1 i j
L
LIVING ROOM o 0
FOYER
r7I
18x?8 o f j I x zaxza
COVERED PORCH
1
WxW 18x28 18x18 "XW
I I 1 I I
d-d Ir-d 0-0 y O-e did Y-+P k-d S-�l 4 d
?A-d 9A--e Id-d
i
i
i
FIRST FLOOR PLAN BEAM #1 - 16'-0" SPAN MAX. BEAM #2 - 12'-0° SPAN MAX. RE
Ind rLXR V LNE LOAD+ 10 DEAD LOAD='40 x t1=AW SCAF:Va�f-ar PAW �„�SAD+ a DF�,LOAD=n x It =,rcz FAMIAM 9 l�.x 5 1/�' a ten. Revere Residence
FR Sr MMR KM eq.Fr. 226 River View Lane
6ARAM W eq.Fr, FAMI M ' I/rx 11 114 n 55s Centerville, Ma.
Gene Anton
Designer/Draftsman
40 William Hersey Lane
East Bridgewater
DAZE SHEET N0.
D `{
ScuE ,1 iL^ n
PROlECTo_ Z3 7
1LLL f
1
f
1
I I '6110W6t
"XW WxW 20x24� WXZ4
78x2h
2044 O3, O I I a
I
16x66 (3 ,I 0 - --► ; EDROOM ,
- �ATh ----_ '
�r I N I I
A'Ox6 2 bxbb O b I j y 9 j
6� I x
II _ I
DEAM A 4. �
2'i 6 +3
MASTER f5EDROOM dOx�b
N c1
%WKE I j j pF-~PARMION/c _...
DETECTM ' W.I.G. I SHOW SIVDW. _—
I I i
f5EDROOM o j I I g
I I a I I I I
BEDROOM
L----------- Jj I ,
alm TO IOYM MAM
N
2&XU Wxu Wxu Mxu 2$XU
I I I i
Iz-0 N-O 9-O y-e 0-e ly-V 4'-b" 4-6 31L" d-e N--'r
7d-e
SECOND FLOOR PLAN BEAM 14 29-0' SPAN MAX. RE�Sxx� Revere Residence
scaF. I��" -d AM, 20 LIVE L49AP+ to PW LOAP V x 12-W 226 River View Lane i
� M S. Fr FAR&IAJ 9 I/4"x W_ gar. Centerville, Ma. !;
Gene Anton
Designer/Draftsman
40 William Hersey Lane
East Bridgewater
....... DAM SHEET NO. 3
. SCALE
PROJECT. ��Q� �?
f .
2"xW" R
2"xW ReCE
+' FIDt7ZGI.AS�' SHINPAES OVER
1/2 GDX FLYWOM. ( stimrzs OVER
I/2 4-DX PLYWOW.
2"xW RAFTERS ® WO.c. i, 2"x8 RAFTERS 0 WO.C.
r ES CCL I�R 2"xs" RAFTERS ® Ib"o.o. TIES ® �s O.C. � e x8 RAF7�t5® I� TTO 9 W o.c. 10 o.e. rxb"GglAR
2" a
® WPERI 1/3" cF 10 a WIPER I/Ir OF
ATTIC, Sk, ATTIC,SPACE
T FIDEROLA55 INSULATION. 9"FIf AbS RJ5LUT10N
OOVEVER VVENT FAsaA wED/ WNYL�. 2 x8 RAFTERS® I�Wo.c. RI k
2"xv RAFTERS ® Wo.c. OVER -61A w v j,YA MIT.
M MVIVIE.
2"x f"5TLD5 ® WO.c.
DEARN6 PARTITION.
�rxW FLOOR JOISTS ® Wo.c. "0"
FLOOR JOISTS 0 W"oc.
w/ 3/4" T86 PLYWOOD OVER O 7&
w/3/4" RYWOOD OVER
MS. WP& ®MD'-SPAN &GRS.Oft ®MEAN
SOLID DLACKIN&.
SOX DLOCICRJ6.
b"f9D6t6LA55 INOU-ATICTL. W-44 N 2
2"x4" STLPS ® Vo.c. I 2"xC STID6® Wo.c.
2"x4" 5TL05® Wo.c. w/3 I/2"1`195 l.Aes 9 I/2"0 CONCRETE ILL® 2�"eTIDS® I6"o.c.
w IL 1 Z' FICERC�IA�f ?-Yxb"SILL w STEEL LA LY C 1W HSU-ATVM.
INSLIAT 2"xld FLOOR JOISTS ® �Wo.c. 2"x10' FLOOR JOISTS ® Ib"o.c. wl ' 11 PLF � / r w 9 I Z'FURa-1455
w/ 3/4" T86 PLYWOOD OVER w/ 3/4" T&& PLYWOOD OVl3Z SILL INSULATION&I/2"0
&CR5. Me. 0 MID-E'AN. & GRS. PRP&. ®MID AN ANA10R 00.TS 0 V- ox.
Z®CORNEIM EXf5T1N6 4'CONCRETE
xd Su w/ r I e FOERGLA55 R�IIATIOf•L
SILL INS.I ATION & 1/2'o I MAM # 3
ANCHOR DOLTS ® A-d'o.o.
2 ®CORERS.
15TIN6 CONCRETE FO..WATION WALL
11 1/2'0 64NCRM FELLED FO"ATION WALL
STE3 UVLY COLt1vRJ EXISTING 3"COWA;eM SLAP!
ET
YY-O' fz-d'
PARAI M 3 I/2x11 I/4" R 6C DEAM. SECTION THRU GARAGE 2
w-o" IA-d 2-e SCALE : 1,4„=r-O ns
SECTION THR I MAIN HOUSE �° °�1 I/2"GDX FLYWOGD.
SCALE
2"xId' RAFTERS ® W"o/a
caNrlrlt�ous
GENERAL NOT'E5 INSwTWN AAFFT
ALL CONSTFLICTION SHALL CONFORM TO THE MASS. ATE DLPO. CODE A th EDITION ARTICLE # 30. —r)e FASGA w/ALUM DRAKE
MR&VENT®WM 60FIT.
ALL U J CM SHALL DE W. 2 OR PEI TER 1W f ATIVE VALUE!OR MTTFR. (KILN DRIED
ALL SH
)
A WALLS ALL HAVE 9 1/2' F1NYaJ55 IN% AT w/ VAPOR P>ARRER•
ALL CELIN6S SHALL HAVE T FVWAASS W%"nON w/ VAPOR $AMBER 2"x4" 5TLPS @ Wo.c.
VW" FLOOR JOISTS a W'o/c. w/ 3 1/2" FIDERELASS
ALL EXTERIOR WAILS MALL DE 2"x4" STLDS.AT Ib"o.F. w/ 1/2 GDX PLYWOOD. w/ ve T86 PLYWOOD OVER INSILATION
ALL INTERIOR PARTITIONS 01A11 DE 2" x 4' 671.DS I Ib"o.a
&CRS. ORM. V MID-5PAK
ALL DOORS SHALL DE 6 PANEL PM STAIN GRADE
REv swNs
ALL WAILS& 6EL.IN65 SnnL RECEIVE I/2" ARD w/SK?rt GOAT PAINTED. b" FIDEREA_A55 INSLLATIGN. Revere Residence
ALL WWOWS SHALL DE VINYL a.Ap w/ INSECT & SNAP IN MULIONS SELECTION 9Y MALDER 3-2"xwl W-AM
3 1/z 0 CONCREM FELW 226 River View Lane
STEEL ALLY Centerville,Ma.
FRAMING LINTEL SGHEPU-E Fa"AnaN WALL Gene Anton
WOOP SPf6. ONE STORY O STORES SPANS IN &ARA6E OR WALLS FxIsrIN6 Designer/Draftsman
HEAPM ROOF ACr01E A,DOVE NOr 61211e. FLOORS OR ROGF
40 William Hersey Lane
East Bridgewater
2_2 x1 �-� SECTION THRU FAMILY ROOM 3
2 2"x10 (d-o" s'-d' b-d' -o
SCALE . 1/4"=r-O
-PROJECT: