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HomeMy WebLinkAbout0273 RIVERVIEW LANE - Health 273 RIVERVIEW LANE, CENTERVILLE A= 228 093 A eo fop.. 0R MOO HASTINGS,MN LO -C'NTION SEWAGE PERM jel'12ZER t/l V I L. AGE �`�dI C 11d Wyy IN TAIL R'S NAME �' ADDRESS t�fv 9 d U I L D E OR OWM E � 1Q 'r 6 p. ze DATE PERMIT I S S U E D DATE COMPLIANCE ISSUED : J J I 1'4 � 9 TOWN OF BARNSTABLE LOCATION S 'J �c�e.�;I cc�c� ►.� SEWAGE# an V, f-Lr 8 VIJ,,LAGE Coe-*rC j A\e ASSESSOR'S MAP&PARCEL:Z ®� INSTALLER'S NAME&PHONE NO. S A 1. �C)cnStDN SEPTIC TANK CAPACITY �XiS r^P LEACHING FACILITY: (type) H=`NO soo Q!L./J&&K(size) ►�, �(� X Z NO.OF BEDROOMS OWNER A q, PERMIT DATE: 1 a [Cs—I COMPLIANCE DATE: Separation Distance Between the: /V o N t._.cA_fr ()es G 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 �uc i=2(��1T #k 273 lZwe:u�r�D h ©J'T i -307 - 3q 2 r _ TOWN OF BARNSTABLE LCICA..TION na1 3 �1[�JP�(1_ V 1t w LIB SEWAGE# VILLAG : ASSESSOR'S MAP &LOT 01,�LI Oc13 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000$+4 LEACHING FACILITY: (type) p 1 (size)NO.OF BEDROOMS BUILDER OR OWNER DATE: I COMPLIANCE DATE: Separation Distance Between the: t Maximum Adjusted Groundwater Table and `—` 3LQ) Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) P- v Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ �� • Feet Furnished by �-tf � a? 3 � . . ���� . � � b L � 3 / l - �5 - 7 ILL- 35 � 3Z- 30 1�3- 3�orL1v �33- 3��6 y ��� ab ���- 3�' No. L+ ' (.�/ Fee UV 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .. e . PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Applitation for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. A 7 3 1-^0' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel e ` Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ,,JJ Al � �'7� !'N j NY-Y✓I N �v��tr d -7 7 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 2 G0 sq.ft. Garbage Grinder( ) Other Type of Building t C-5 0�-Yu+ G,; No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) T:30 gpd Design flow provided 1-162 7 gpd Plan Date /Obt4l o/ Number of sheets '2- Revision Date Title Size of Septic Tank (°X 15}�N!� Type of S.A.S. 2 S e) G C'Jfey^J C1i&^6 AI-Y,S bulk Lj Description of Soil y z a� 5 iv de '^'W Y?• by 7 fors Nature of Repairs or Alterations(Answer when applicable) wsJ -41I 1. S-oo!;'Gc e N C h&,,6p/j cu i"A 'y Y 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. S' 4 irADate 2 G J t Application Approved by Date 6 Application Disapproved by Date for the following reasons Permit No. d f y _I � Date Issued a W4 No. Fee U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pphcation for 30isposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(kil"Upgrade() Abandon(4) Complete System �ndiidtial Components Location Addressor Lot No. 7 3 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .1 Installer's Name,Address,,and Tel.No. Designer's Name,Address,and Tel.No. i A N. r-zi i rx -yo0-7/5-5 ,� INY / G(�v✓�C 50 - Y7 3/ Type of Building: Dwelling No.of Bedrooms 3 Lot Size I j 2 G U sq.ft. Garbage Grinder( ) i ,a Other Type of Building f PS„ CYUX No.of Persons Showers( ) Cafeteria( ) y Other Fixtures i Design Flow(min.required) -30 gpd Design flow provided 31 7 gpd • ' Plan Date /(7 'Z�l/z/ Number of sheets 'L Revision Date tv t �` Title ) j Size of Septic Tank ('X►S F N� Type of S.A.S. 2 S00 G C ( Ae. n t�r.S Gv i�Lj Description of Soil Nature of Repairs or Alterations(Answer when applicable) t.JS4 c,I R sxyo G Gc bro tvLj S U N U &-A) P L-3 - T3 O X /2 C� S X `Z 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. S' Date /7- /G / ,4 Application Approved by Date / Z Application Disapproved by Date for the following reasons Permit No. d - h ' 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 A 1�(to uj r a Z !U r at .J (Pn)t Pw 1) has been constructetd/in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No) 7 dated 1 -2 �16 1/ r Instal ler-D" ; q i3 --- c Designer #bedrooms r Approved design ow 3 3(' /Jf gpd _ n 1 n� The issuance of this permits all oLb construed° as a guarantee that the system l/function as designed/1 Date ( � �� Inspector -------------------------- --------------------------------- --------------------- /_ - - -------- No. 20 t y~ hI I Fee /U U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pste onstrUction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade()~ Abandon( ) System located at J 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:Constructi n must be completed within three years of the date of this permit.( Date f c� A roved b I PP Y o r( oF� Town of Barnstable P#_ gyp' Department of Regulatory Services &Uwarnare r Public Health Division Date �p t63p `6� 200 Main Street,Hy nnis MA 02601 Date Scheduled �y ` .� Time Fee Pd.(�Pl O o , C/0 I �) � Soil Suitability Assessment for Srl, MccV5 4ol P Performed By: V Q C✓'M�— rCC sEi S y Z Witnessed By: J LOCATION & GENERAL INFORMA / Location Address 273 �� f y Owner's Name iEkl Cn e�- G- Ce!'l�✓1/ 1 Address Lr7 Assessor's Map/Parcel: 2 2 8^Q p 3 CtN ft✓v 4, Mq 0 2!0 3 Z- I Engineer's Name Q&./,thG64f-e_ C NEW CONSTRUCTION REPAIR ' Telephone# Land Use S 'G Slopes(%) Z— Surface Stones i Distances from: Open Water Body _ft Possible Wet Area 7 ft Drinking Water Well 7�TV ft Draihage Way n / ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i z Ge. t Parent material(geologic) � Depth to Bedrock Depth to Groundwater. Standing Water in Hole: '+^-9��� Weeping from Pit Face /lam Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE �* Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: Depth to weeping from side of obs..hole: in, Groundwater Adjustment Index Well# Reading Date: Index Well level Adj,factor— Adj,Groundwater Level Observation PERCOLATION TEST Date��, Thne_� � Hole# gLTV" Time at 9" .� Depth of Perc ""' rl j II . - - Time at 6" Start Pre-soak Time @ �.. N 'Time(9"•6") � (S End Pre-soak Rate Min./Inch. LZ Site Suitability Assessment: Site Passed .1 Site Failed: Additional Testing Needed(YIN)_ 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:XS EPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistengy, Gravel) VAL S z•sYP DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil , Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% v o 711 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o t3ravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. NY Consistn t - Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No—y Yes.: Within 100 year flood boundary No Yes Depth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervioup material exist in all areas observed throughout the area proposed for the soil absorption system? --e If not, what is the depth of naturally occurring pery ous material? Certification I certify that on 1 r (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 tr 'ning, xperdse and experience described in�10 CMR 15.017. t. Signature Date Q:\.SEP1riG1PERCF0RM.D0C .S L Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 273 RIVERVIEW LN ' Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every 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 A. General Information forms on the '{U1 computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 'EROJ City/Town State Zip Code 508-420-4534 S14297 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 ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority a -7 - -P� Inspe or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form. u urface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ' ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to r g g q o 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. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS located on site? P 9 , ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. City/Town State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1000 GALLON TANK D-BOX AND LEACH-PIT Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): tz)ms•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w„ 273 RIVERVIEW LN Property Address AGEL Owner Owners Name information is required for CENTERVILLE MA 02632 7-28-14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 AS PER AS-BUILT Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS UNDER SOME VERY THICK JUNIPER SHRUBS AND HAD SOME ROOT INTRUSION RECOMMEND REMOVAL OF THE SHRUBS AT LEAST IN THE AREA OF THE TANK Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): i PumpChamber locate on site plan): ( P ) Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): PIT WAS ALMOST FULL AT TIME OF INSPECTION WITH STAINING ON THE BOTTOM OF THE COVER INDICATING SURCHARGE AND HYDRAULIC FAILURE Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is CENTERVILLE MA 02632 7-28-14 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER THAN 5 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 ® 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 273 RIVERVIEW LN Property Address AGEL Owner Owner's Name information is required for CENTERVILLE MA 02632 7-28-14 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 2 of 2 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=228093&seq=1 7/28/2014 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCA71ON SEWAGE g , ASSESSOR'S MAP&LOT 8 O 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l bt]o 5 1 LEACHING FAC11.X Y:(type) (size) NO.OF BEDROOMS---!- BUILDER OR OWNER PEDATE: COMPLIANCE DATE: Separation Distance Between tie: Maximum Adjusted Groundwater Table and 2-O Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) plr! Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility). _ N IF Feet Furnished by DAD-as tK�cz �' .............................................. i �1 a R 3 � I AA- 35 1al-a7 j RL-3Si(,u gZ-so' C) ;AA"3- Ob'('� �13- 37i.y A-4-A Bq- 3G' i http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=22 8093&seq=1 7/28/2014 ♦) 'Own of Barnstable Regulatory Services Richard V. Scali, Interim Director BARNSTABGE, f MASS. �,�� Public Health Division ' l;a 39. Thomas McKean, Director 200 lain Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit4 • 0114- Assessor's MapTarcel Designer: „A 6� - Installer: e Address; g 2 W2,s j.- C;rrss�t eiG� � . Address: �•O _ drC ��'� On -i CG -)LI 9A 1`�' was issued a permit to install a (date) (installer) septic system at �� L-"� based on a design drawn by (address) Ll dated (designer) _�. I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils _ were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. � jt.NP�'`'�•��Ad�4 I certify that the system referenced above was construc,�' 0P p with the terms of the IAA approval letters (if applicable) ry PETER, McEWEE wj Civil- �" % - •� � ,� No.35�09 ry � taller s ignature) a en,�.� i '70 AL (Designer's Signature) Affix Designer's Stamp Here) PLEASE RETURN TO BAIZNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COIYIPLIANCE STILL NOT BE ISSUED UNTIL BOTH TBIS FORM AND AS - BUILT CARD ARE RECEIVED BY THE BARINSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Desiper Certification Form Rev 8-14-13.doc Town of Barnstable Barnstable ��pgTHE Tp�y Regulatory Services Department ;e"aC P 1+ RARNSCABLE, • • • - �A .1.639 Public Health Division 9�pI MAC C, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 4303 August 13, 2014 Margaret G Agel 273 Riverview Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 273 Riverview Lane, Centerville, MA was last inspected on 7/28/2014 by Douglas A Brown, a certified septic inspector for the State of Massachusetts. f' The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic system is in hydraulic failure. • Tank is under some very thick juniper shrubs and had some root intrusion. Recommend removal of shrubs at least in the area of the tank. 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 • T ma J cKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future EvM73 Riverview Ln Cent 2014.doc 168!3f 6". 13/a"w/casin —2917Ig2'-- - --2627/32p r543/4"(offset sink cabinet%g'to right 299(6'---�r r i ! 11---' .A 3 23/i s'(or as needed) 4 I 1~ needed) 3 —A 24"t— 3 " --�i gv4"- ^ ` Under floating shelf hghbng .tlnal here I j I o H C�M I Z� � C iI e I I _ Ili i I V I i � I m - i 'a a ly'. 19 I 64 " i ck- pull ' f�-I�Z 3 (pull b ! from back) f Undercabmet lighting here ----38" 21%"--r---35'546- - 113/4 I e I Ge'3(6" ,30/6291 O ' l ern Gaul II s I I i I,vz lull i 1 I N �= N j N ( i Isnoaueglnwis unj of alge JPmOHspue4 JOmOHG ouaq „s I , v o v, 1004 aqo,�� �Ln algnoa .poop 6u1Ms-algnop . q lomol j ri s j �C�iuen ��ss I I I Na N N � I c� M. 6 I . 3 = I t I ,' jauloo woj4 .,z/s A4iuen Il6d 1 Ohl N 1W V, C D Mo I� � emu , r3If r a COMMONWEALTH OF MASSACHL'SETTS EXECUTIVE OFFICE OF E?�'VIRO�'�4E�TAL AFFAIRS DEPARTMENT OF EN-VIRONNIE\TAL PROTECTION 13t— , :-cj , ONE WINTER STREET. B0570�. NIA 0_, C•15 61?-_S_ (C �F �^.t* 7RLD U-ILLI AM F.K ELD . . • 199, ARGEO P.4L1 CELLL'CCI „Lt.Govemorr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM C ionc- PART A CERTIFICATION CC) 0 Property Address; ' �j ��v.CWd[v-,� t.N I C'.e,., t C:t, (R, Address of Owner: 0:2.\01T WGlk�u� Date of Inspection: (Q�7 l � . O�(I '(If different) _ .. Name of Inspector: 1C�a 1 am a DEP ap,,PProved system inspector pursuant to Section 15.340 of Title S (310 CMR 13.000) Company Name:A-S P'r' I Mailing Address: 2,0 /3,=x e_3> H ASf; 4 H I`r o e-C4-q Telephone Number: r5-eV et 9-9— /L1c Zeo CERTIFICATION STATEMENT I ce.^.if1 that I have personally inspected the.sewage disposal systernz at this address and tha: the information reported below is true. accurate and complete as o:the time of inspectoo The inspection was performed based on my training and experience in the proper function and mamtenance of on-site sewage d,sposa; systems. The system: Passes _ Concit,onaik Passes Neecs Further Eva!uation Sy the Local Approving Authorim _ Fa.-., 7:Inspector's 'Signatur Date: Z T;ie Svs:e^ Insnecw, sha!' submit a copy of this inspec-oon repor, to the Approving Authorim. within thirr (30) daps of completing this inspection. If the wstem is a shared system o• has a design flow of 10,000 gx or greater, the inspector and the system, owner shall submit the repo-, is the appropriate regional office of the Depanment of EnvironmenW Protection.. The orig!na! should be sent to the system owner and copies t-nt to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system vioiates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: ` c,_ O . k P vCA w Ivy Qc�n ICI av GL 14 1 A lie cl i LAj v_i BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N. or NDi. Describe basis of determination in all instances. If'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenry (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health, tra.•:a•d Page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y PART A CERTIFICATION (continued)Property Adde4ss: - Owner: .r�..f:_.. .�3. e-• .._,'�:,,a��.r.. _ _ :. .� Date of Inspection: / `- '-81 SYSTEM CONDITIONAL ,Y„y'PASSES tcontinjl�d' S,e" '=age backup or breakout or high static water level observed in the distribution box is due to broken or obstructed tprpe;sl ordure to a broken, settled or uneven distribu;ion box. The system will pass inspection if(with approval of the Board �Health). Describe observations: broken pipe(s) are replaced d obstruction is removed - distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): - broken pipessr are replaces obstruction is removed ' C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require furthe• evaluation by the Board of Health in order to determine if the system is failing to protect the public health. safe*•and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or prig, is within 50 feet of a surface water Cesspool or pri%,- is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UtiLE55 THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFc'TY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supaiy well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less thar. 100 feet but 50 feet or more from a private water supply well, uniess a well water analysis 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. Method used to determine distance (approximation not valid). 3) _.OTHER (revised 04125/9-7) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 boa 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 112 clay flov.. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s(. Number of times pumped _. An; pon.on of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Am portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or pri,,ti• is within a Zone I of a public well. Am portior. of a cesspool or privy is within 50 feet of a private water supply well. Anv 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. 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. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria appfv to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B , CHECKLIST Property Address: O`13 .`lwe itw-Z Owner: t kW6, ,Vu Date of Inspection: (0 1Z 1 S J Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. _ 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 available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the 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. —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from ow-neri were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field iif any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR-M PART C SYSTEM INFORMATION Propert,. Address: ?-73 ,61<'VCVI'-ir v J Owner: ( -t4fl—, Date of Inspection: b , FLOW CONDITIONS RESIDENTIAL: Design iloN _2-'36 e o.d./bedroorr. for S.4�S Number of bearooms Number o:'current residents Garbage g•; der (yes or no, Laundry co-•^ected to system (yes or no` Seasonal use ryes or no,:—L—) —T Water meter readings, if available (last two ;21 vear usage tgpd): S Sump Pump Ives or nor 1J Las; date o-'occupanc, _Ql)l& COMMERC14 INDUSTRIAL: Type of establ,shmen: Design fio%% ¢alionsda\ Grease trap present tees or no_ Industrial \%aste Holding Tani; present -ves or no Non-san,tarn A2sie discnargec to the T!tie 5 systerri ,yes or no_ \%arer meter readings ,f a�ailabie Las:pate os o ";Pa-.c, OTHER: Describe Last care of occuoanc. GENERAL INFORMATION PUMPING RECORDS and source of ,niormatior. System pumper as par, of inspection: Ives or no. If yes, volume pumped I(A-W gallons Reason for pumping Mul,syTetmrx TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Prny Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technologv etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: k (O U (ZS Sewage odors detected when arriving at the site. (ves or no) A)h (revised 04/25/9'7; Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: C1. Owner:Lf6-c'Len- Date of Inspection: BUILDING SEWER: (locate on site plant Depth below grade. Material of construction. _cast iron _40 PVC _other (explain! Distance from private water supply well or suction Ir-< Diameter Comments: (condition of joints, venting, evidence of leakage. etc.) SEPTIC TANK:w (locate on snep7arl l Depth below grade material of construction: concre:e _meta _Fiberglass _Pol\,ethvlene _other(explain If tank is metal. Iis: age _ Is age cor.firmec b\ Ce1,fica:e of Compliance _(1•es.;No Dimensions (r' !3Ctf}'� Sludge depth Distance from top o: s.udee to borttorn o; outie: tee o, ba;-;e Scum thickness C2 11 Distance from top of scum to top o+ outlet tee or ba^ie(6 rr Distance from bosom of scurn to bo-o—. o;outte: tee e• bane How dimensions were determined 8&9SA-1AA8SPI . Comments trecommendation for pumping .condition of iniet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural 9i tegnty, evidence of leaka�. etc.: "'j lj� C GREASE TRAP:�" (locate on site plan; Depth below grade. Material of construction: _concrete _metal Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 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, etc., (70,ivad 04/25:97) page 6 of 10 h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 11 SYSTEM INFORMATION (continued) Properh Address: ON ner.Lt,6/kLLVL.' Date of Inspection: 044 t TIGHT OR HOLDING TANK: U"U 7ank must be pumped prior to, or at time, of inspection: (locate on site plan, Depth below grade. Material of construction _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions. Capacm: gallons Design floe gahons da, Alarm level A:arm in %+orkrng order _ Yes: _ No Date of previous pumping Comments (condition of inlet tee, condition or a'a,rr and float switches. etc.) DISTRIBUTION BOX JOCZiZe on site p:ar Dep: of mould le e: aoo�e outie: in�e wl tlt:�ZzT �� �T Comments to ie ,f level and d,st•ib:;,or is e/o�ua' evidence of solids carrvover, evidence of leakage into or out of box, etc.) \. l C�'YL I V 11.f11�1 Y Q ., . Q LAll ( , C' (L`t vL"!- - 4 PUMP CHAMBER:- (locate on site plan. Pumps in working order: (Yes or No, Alarms in working order (lees or No Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (zevieed 04/15/9-) Page ? of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORa1 PART C 2 p y SYSTEM INFORMATION (continued) ' Property Address:a2 3 l l IJCK V t e� Owner: 4(k& 1�i Date of In pection:, l��q SOIL ABSORPTION SYSTEM (SAS):S,�Q� (locate on site_plan, if possible. exca,.Tn8n' not required, but may be approximated by non-intrusive methods; If not determined to be present, explain. Type: leaching pits. number.�(pX So leaching chambers. number. leaching galleries, number: leaching trenches. number,length: leaching fieids, number, di-nensions ovet4low cesspool, number Alternative system Name of Technology Comments. (note condition of soli, signs of hydraulic failure, levei of pondin condmo f ve tation, etc.) - c ( 4 �- ct ej17 t vIrk-) CESSPOOLS: bub (locate on site plan Number and config;;ra:,or. Depth-top of liquid to inlet Inver, Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of constructior Indication of groundwate- inflow, (cesspool must pe pumpeC as par, of mspection'r 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.) (revised 04/25/97) Page' s of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION' FORM PART C ^ 1 SYSTEM INFORMATION (continued Propem Address: 3l�Q�•� "�' Owner: Date of In,peclion: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reverences landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house! 2 3 t, (r•�la•1 0� 'ZS!S"! )•q• 7 0: 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �- SYSTEM INFORMATION (continued) Propert% Address- oc t 3 f( tot-vp� Owner: 9 0(,'UN-1-1 Date of Inspection: i2 G 6 v Depth to Grcd'adwateri� Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation o-' Site (Abuning properry. observation hole, basement sump etc.) Determine it from local conditions Cnec'h %%ith Iota' Bcarc o• neaar Chec" FE A Macy Chect P-imp,nF retorts Checl Iota' irs:alle•s t-se Da-a r• DescnCe in %c-j• o,,- no-., %o_ es:ae;!spec Ine Crouncwate• Elevation Imust be co-rie!e- Page 10 of 10 f LEGEND N -- 98 -- EXISTING CONTOUR o Q rE--220 - r ` .i Main St O m o = o = x 100.98 EXISTING SPOT GRADE . Pine treet N/ EXISTING WATER SERVICE �. \ 2. EXISTING GAS SERVICE 100. n� \ I G s \ H.W.-- OVERHEAD WIRES f Y -LOT 56 & 57 � \�� \�� U UNDERGROUND WIRES 8 M B U-228--W 3. . +.35.13 \\ \ TEST PIT LOCUS \ 13,260 ±SF \ \\ 1\ �. BENCHMARK X 36.98\ \ + 35�3 _ s,86 LOCUS MAP 39,01( X 37.35 -� \ NOT TO SCALE _ 36.98 ` DECK - _ x _ ( ove �gLKOU ab T TKO (be/ j - 0. 6,34 P� 1�3 GENERAL NOTES: Bq I 19 0 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. EX/STING/�� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE HOUSE(#273) C,, 316.85 1 LOCAL RULES AND REGULATIONS. T.O.F. VARIES C�J ;:J.°; . •. r � Il 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ,`.: _' cv v TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE PO m 37,19. . . . . A� j DESIGN ENGINEER. /O -2 44,36X t'Y/ E�TRr \ 37 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING WHITE PAINT MARK 1` { ENGINEER NEEROBEFORESE WCONSTR�CTIONACO NTINUESORTED ?0 THE DESIGN ON BOTTOM STEP EL.=45.00 45,1 +� 44.14 / �' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE G.I.S.t). 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 7.77 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF EXISTING SEPTIC TANK 3, HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 2. 5 a,•..•... 7. WATER SUPPLIED BY TOWN WATER SERVICE. TOP OF TANK, EL.=42.82 O 1 INV.(OUT)=41.48�• ^,; o X WA K I ". :'• EXISTING LEACH PITS 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 44,32 / 43,3 CONTRACTOR SHALL PUMP, 9, ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS �•'; : O .O \�o� -`::,:.; FILL WITH SAND & ABANDON AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 39, 4 is DIRECTED BY THE APPROVING AUTHORITIES. \'• 4 i / 39,92:.' \ 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY O / / C .30 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. +'43.49 / \ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS TC-2 TP-1 �\`L• L 'Z IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND � REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). / � 4 .448\ 1 pf 41A 44,80 \ SS 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 180 96 41,92 : .1. ,0 �r �c�P fly INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. / o PETER T. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND UP Mc TEE IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. " p,4 CIVIL o CI / edge Of PGvemAen�2.17 39,16 No. VIL 35109 45.01 MAGNAIL I 6IST \ PROPOSED SEPTIC SYSTEM UPGRADE PLAN 43,82 LANE ' F toPre 2d3o RIDVERVIEWIncLANoE,g CENTERVILLE, MMo2s32 7BM-1ERVIEW l 1o)2I ( 14 pMAG. NAIL SET I Engineering by: SCALE DRAWN JOB. No. EL.=43.82 OWNER OF RECORD 1"=20' P.T.M. 212-14 ri AGEL, MARGARET G Engineering Works, Inc. 1 273 RIVERVIEW LANE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. } CENTERVILLE, MA 02632 (508) 477-5313 10/21/14 1 P.T.M. 1 1 Of 2 ,t b 1 NOTE: TO PREVENT BREAKOUT; THE PROPOSED FINISH GRADE SHALL NOT BE < EL:41.5 EXISTING FOR A DISTANCE OF 15' AROUND THE SEPTIC TANK H0USE(#273) INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. T.O.F. VARIES PROVIDE ACCESS TO GRADE OVER OUTLET COVER INSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" ENTRY ' OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F. COVER SET TO 6" OF GRADE F.G. EL.=44.1 t F.G. EL.=45.6t F.G. EL.=45.5f F.G. EL.=44.8(MAX.) , MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 3, L5' Z ® S=1% (MIN.) ® S=1% (MIN.) C s 4"SCH40 PVC 4"SCH40 PVC �o"t EXISTING 48" LIQUID t4s"LEVEL cASADDDFFLE INV.=41.27 PROPOSED INV.=41.10IM4" � 0'oINV.=41.48tD-BO� - EXISTING INV.-41:00 2-500 GALLON LEACHING CHAMBERS EXISTING SEPTIC TANK L� SURROUNDED WITH STONE AS SHOWN / �,• H-10 RATED TOP BREAKOUT EELEV.4418.50 IN SEPTIC LAYOUT NOTES: INV. ELEV.=41.00 eaaa W. *� aa1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE oases INVERTS., PRIOR TO INSTALLATION. BOTTOM ELEV.=39.00 4' X 8.5'=17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURRING PERVIOUS MATERIAL EFFECTIVE LENGTH = 25.0' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED ®:E3 ®® ® ®®® STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION ® ®®®® ® ®®®® 33" 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP-1, EL.=34.4 — - x w ® ®®®® ® ®®®® 4) CONTRACTOR SHALL INSTALL AN APPROVED GAS 3/4" TO 1-1/2" DOUBLE CV > ® ® BAFFLE ON THE OUTLET TEE. WASHED STONE I ? SEPTIC SYSTEM PROFILE 3" LAYER OF 1 DOUBLE WASHEDHED STONE 1 O2'� (OR APPROVED FILTER FABRIC) SOIL LOG 4" KNOCKOUT DESIGN CRITERIA 20" DIA. COVER DATE: OCTOBER 16, 2014 (REF#14,503) 'J' NUMBER OF BEDROOMS: 3 SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 4" KNOCKOUT / 4" KNOCKOUT 58" SOIL TEXTURAL CLASS: CLASS I WITNESS: DONNA MIORANDI R.S. HEALTH AGENT 0 DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH (0.74 GPD/SF LOADING RATE) 45.6 q C)" 45.8 q 0" 4" KNOCKOUT DAILY FLOW: 330 GPD LOAMY SAND LOAMY SAND DESIGN FLOW: 330 GPD 45.3 10YR 4/2 4" 45.5 10YR 4/2 4„ GARBAGE GRINDER: NO B , B 500 GALLON CAPACITY, H-10 LOADING 24" 43.8 LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF Lo0MR 5/8 LOAMY 5/8D 24" CHAMBERS 43.6 .74 GPD/SF C C N.T.S. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS PERC USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 3s"/48" PROPOSED SEPTIC SYSTEM UPGRADE PLAN MED. SAND MED. SAND SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 10YR 6/6 1oYR s/s 273 RIVERVIEW LANE, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................471.2 S.F. 34.4 1 J 136" 34.6 136" NTS P.T.M. 212-14 Engineering Works, Inc. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD NO GROUNDWATER, PERC ,RATE: <2 MIN./IN. 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. REFERENCE PERC 3/26/81—SOILS CONSISTENT WITH RATE (508) 477-5313 10/21/14 P.T.M. 2 Of 2 t