HomeMy WebLinkAbout0320 RIVERVIEW LANE - Health 320 Riverview Lane
A=228 - 158
Centerville
Sill Qk
fill
UPC 12534 '
No.2-1553LOR qa,c�►
YA�TIYpP.MY
TOWN OF BAR STABLE
AR
LOCATION G SEWAGE# I S7
VILLAGE �? L) /L'ir�L_1)ASSESSOR'S MAP&PA CEL
;J �J
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY /
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS '/
OWNER Q a- clP,p �z-
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
r '
i
o o
00/Bi`9/'19,94 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 02
DATE. 4/7/05
PROPERTY ADQRESS�320 R.iveaview Lane
Cen.teAv.iiie
Ma s•s 02632
On ft above date, th". 9ptic system at the address above was
Inspeow.
This system oonsisft of the following:.
1., 2-6X8 cebbpooi4
Based on IngWdon, I certify the following conditions:
2., 7hib .ib not a .title )e.ive zapt.ic .system. 7hi•6 i,s a 6ewaye 13y.3tem.
3.- 30th ee4-3poo�ee waAa d2y at time oI inzpecfion.
SIGNATUR
Name: Robb t A. Paollnl
Company:
Address: .p. 0. Boxes
Phone: gob-IM338 or SM7754412
;IiOSEPN P. MACOMIDER & SON;: MIC.
Ta�imCeas<popll�hflsldt
P no a-AnstbNed
Town r.6mil�lon9
P.O. Box 66 Centerville, MA.026,32-00.66
775408 . 775.6412
< '03/09/•1,994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 03
Co.MMONWEALTH OF MMIIACMSM78 FAIRS
cuTM OFPIM GF Fil-MR NlViSNTAL AF
DEPA�'1" NT 07.1 O II TAL p 0' 'CTION
.r •s iF E 5
OFFICIAL 1NSPEC non YORM—. DI$PO�L NT*R,M�'SESSME S
SUBSURFACE SEWAGE
RM
FART•A
CERTIFIC410,N
property Addrmt .3 2 0 R v e 2 v i e -Lane-
,
ea e2vc e Ma
Oweer'eName:ffla a"a De,san ��- h 2R
Owner's Address: a a 2 g o 2 e t
o4to
Date of Inspection:
Name of lnrpeetor:(please print) R o I e 2 i P o
Company Name.• LRC.
Mng.Add�:Np a�e.•02432
?eiephone Number:
CERTIFICATION STATEMENT a disposal: at this address and that the informatf en tepoc�
I certify that I have personally inspected the sewag, spo Y a dress vas erfortged based on my
below is true►accurate and complete as of the time of the inspecteo •'�71 insP P
training and experience in-the proper fiinttion and maintenance of on-gate sewage disposal systems.l am a DEP
approved System inspector pursuant*Sktion.IS.340.ofThle s(31e CMR•1�0)• The item:
XXXPasses
•Conditionaify Passes
Needs Further Evgluationby the Local Approving.Authority
FRUR
Inspedofi's sip
Dater - V
The system inspector$hall submit a copy of this inspecdon reportV Bte.Approvit Atdhority(Board of Heallh or
DEP)within 30 daxs of completing this inspection.If the$ystw is a,�baced system or has a design flow of 10,000
e m t to the ieglmW-ottlec of the
ad or groeter,,thb iatpecW and the SysDem'owfler.sliell su6atii cY�e boys,is fps cable,and the appeoviag.
DEP.t1 a original should be seat ttrshe system erwna�a crop ;
authority.
motes and Comments `
R'+*Thb,report only describes conditions at the time of lnspectl6ir and unifier the conditions of use at-tbat
tlibc.This Inspection does not addros6 how the system will perform in the future under the®me or.different
conditIm of see.
@3/M/ 994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 04
Page 2 of 11
OFFICIAL INSPECT'ION:FORM—.NOT.FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM
PART'A
CERTIFICATION (continued)
Property Address:3 2 0 Rive 9view Lane
Cante4vzZte 17a
Owner: (1azga4e7 D93Tr_MVA7i&aAn
Date of Inspection:
Inspection Summary: Chock AjB;Z,D or.E/AIM ;complete al,l of Section D
A. System Passes:
N0 I have not found any information which indicates—that—any of the failure criteria described an 310 CMR
15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
Septic hyhtem ins .in R2opaa wD&k.ing oadea at the pae.6en.t time
B. System Condidonagy Paces:
NO ' 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.
NO. The aeptic 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 tan'
kas 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:
N 0• 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:
NO 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): s
broken pipe(s)are replaced
obstruction is removed
ND explain,
,Q3/09/1994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 05
Page 3 of t l
OF3 cL4,L SECTION FORM•NOT IFOR NOLUNIrARy ASSESSMENTS
gUBBtJRFA+C SEW-AIGE inspIm L SYSTEM INSPECMN,,11+ORM
PART A . .
CERTmcA'RON(tominued)* :
Property Address:3 2 0 R iy a v i L
en e1tui e Ma
Ow g
uer:.(Ia4aae Dzza t!A-A zea/za
Date of inspection:, /7 =----
C. Further Evalustion•ia Requited by the Board of Health:
NO Conditions,exist whichx6quire further..evaluativnby•thc Board.of HWth;ir►or8er to:detettriino ifthe system
is failing to protect public-health..safety or the environment.
s b that the
1. System will.paas unless Board.ot'.Health deteradnes-i7h ageordance with 310,CMH 15:30 (
3 1)( )
system is-not funttlonitsg in,a-manner-which fil•protect public health,safety and-the..10virontaent:
n o Cesspool or privy is within.50 feet of a.surface water
n o Cesspool or privy is within 50 feet of-a bordering vegetated wetland of a salt marsh.
2. System will fail unless the Board-of Health(and Public Water SupplierwAf any).determines.-that the
system is functioning in a mariner. that protects thtpublic health,safety and environment:
no The system his a septic tahk and soil absorption system-(SA-S).and the SAS is within 100 feei.ofa
surface water supply or-tributary to asurface water supply.
a o The system-has-a,septic tank aM SAS and thc.ISAS is-within a Zone 1 of a--public water.-supply-
n o The system has a septic tank and.W*and-the SAS is within-SO 08%of a private water.supply well.
and SAS and the- is less than 100 feet..but 50 feet or.niore fiota a
n o The system has a septic tank
private water supply well".Method used to determine distance-
l water analysis,performed at a DEP certified laboratory,for colifotm
"This system passes if the wel
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 offer
failure criteria are triggered.A copy of the analysis must bo attached to-this form.
3. Other:
•03/09/1,994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 06
Page 4 of 11
OMCLA L-�iSPECTMN FORM-NOT TOR VOLUNTARY ASSESSMENTS
SUB URFACE SEWAGE DISPOML,WSTEM INSPEC I-ON•FORM
PART A
CERTIFIGAT#ON(continued)
Property Address:3 0 R ' yiaw* Lane
L C�2t u B_6_a tic _
Date of Inspection: 4/77 0 5'
D. System Fillure Criteria applleable to all systems:.
You no.indicate"yes,-or"no"tp.each.of:the.followigg,for Ainspecdons.
Yes No
X Badmp.of se-i+ago:into&t'bity.4r system.component due lo.overloaded•.or clogged SAS.or cesspool
X' Discharge:or ponding of effluent to the,surface.of the Wund or.,stuface:watets due to an overloaded or
clogged SAS or cesspool
X Static liquid level in the distribution box above.outlet invert due to an overloaded or dogged SAS or
cesspool '
X biquid depth invesspool is less than.6"below invert or available volume is less t w An day now
X Required pumping mote-than-4 times in the last year N2Ldue to Clogged or obstructed pipe(s).Number
oftimes pumped
X Any portion of-the SAS;cesspool or privy is below high ground water elevation.
X Ariy portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water-'uppLy.
X Any porden,of e•cesspool or.privy ss within•61onc:1.ofa:public.-yell..
_ X Any portion of a cesspool-or privy is within SO feet of a private water supply well.
-7 Any portion of a Cesspool oi.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.passe9 if the well water,anslysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
"Cates;that the well is.flee prom pollatiott,fronn:•sbatAndlity and:thS presence of ammonla
nitrogen.and nitrate nitrogen is equal to or less then.S-ppm,provided that no other failure criteria
-are-triggered:A copy of the anatysls-must be attachedd.to this forrp.]
NO (Yes/No)The system fift.I,have determined that.one armoraof.the:nbove,failurr criteria exist as
described 1n 310 CMR 15.303,therefore thesystem-1hils.The system owner.should contact the Board of
Heaith•to determine what will be-necessary to correct the failure.
E. Large Systems:
To be considered a large syitem the:syattem must.serve.a:facility with.a.deslgn flow o110%000 gpd to 15,000
You must indicate either"yes'ar`%e'to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the-system is within 400 feet of a surface driekipg-water supply
X the system.is within 206 fret of a tributary,tQ a surFaae dTkddeg water supply
X the System is located in a nitrogen sensltive•area(Lnterim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have.answared"yes"to any question in Section E the system is considered a significant threat,or answered t
"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.flailed 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
'03/09/1994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 07
Page S of 11
OFFICIAL INSPECTION FORM—NOT FOR'VOLUNTARY ASSESSMENTS
9XfBSURFACE SELVAGE DISPOSAL"SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:320 RiLje'tylew Lan
er7 ezv.i .0 Ma
Owner- Maz a)t eT a-6 0,ntid -Ahea.¢n
Date of Inspection:
Check'if the following have been done.You ust indicate' s' or"no"as>to each.of the following:
Yes No
� Pumpin& information was provided'by the owner,occupant,or Board.of Health
components um `ed out in the previous two weeks?
com
X Were any of the system p p P
Has the system received normal flows in the previous two week period
_ X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of-the system-obtained and examined?(If they were not available:bote as NIA)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out?
X 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 locatio►t of the Soil Absorption System(SAS).oa the site,has been deternt'itied based on:
Yes no
Existing information.For example,a plan at the Board of Health. "
_ X Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance
is unacceptable)(310 CMR 15.302(3)(b)]
S
'03f0911994 . 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 08
Page 6 of 11
OFFICIAL IISPECT":: ORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBS MACE S'FrWAGE DISPOSAUSYSTEM INSPECTION FORM
PART.0
SYSTEM-MORMATION
Propetty Addretu:320 RiLeay Eew Lane
Cent&u ' ^ '
Owner: Ma4ga4a"t 1je3an44,z -Ahga&n
Date of laspKdon:
FLOW CONDITIONS
RESIDENTIAL
Number of beftgms(desQ: Number of bedrooms{actual): 4
DESIGN`flow based on 310 6Z 13.201'-(for eicemple:'110 gpd z 0 6fbedro6ms):4 x 110=4 4 0 y p d
Number of duawt residents: .: 0
D'oes°residence have a garbage grinder(yes or no)f e h
Is laundry on a separate sewage.system(yes or.no):.n o [if yes separate inspection required)
Laundry system inspected(yes or no): n o0
Seasonal use?(yes orno): -a ga 2003=73, 000ga2ion'h gpD=200.100
Water meter readings,if available(last 2 years usage(gpd)): 20 0 4=1 1; 0 0 0 ga P.p o n h qP D= 3 0.- 13
Sump pum (yes or no): n o
Last date of oeettpeney: h a m►n e a
COMMERCWLISTRIArL
Type of NR
Design flow an310 CMR 15.203), g!pd
Basis.of a,, ow(seats/.persoas/sgft,ptc.):
Grease UV*esont(yes of 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: .
OT"ER(describe):.
Q4$NERA,L INFORATION
Pumping Records
Source of information: NA
Was system pumped as part of the inspection(yes or no): n o
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for-pumping:
TYPE OF SYffZM
_Septic teak,distribution box,soil absorption system _
X single cesspool
X Overflow cesspool
Nay
_Shared system.(yes or no)(if yes,attach previous inspection records,if any) y
_Innovative/Altmnative.technology.Attach a copy of the current operation and maintenance contract(to be
obtained ftm system owner)
Tight tank. Attach a' -wpy-of the DEP.approvail
Other(describe):
Approximate age of all components,date installed(i€known)and source of information:
40# yeaz4
Were sewage odota detected when arriving at the site(yes or no): n o `
6
I
„03f0911994 09: 31 508-790-1578 J.P.MACOMBER & SON PAGE 09
Page 7 of 11
OFFICYAL INSPEC'TION FORM—NOT FOR VOLUNTARY
INSPECTION FORM
ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM
PART C
RM
SYSTEM INFORMATION(continued)
ProPerty Address: 320
en e fze
Owner:tT1a2ga4e 4hea42
Date of Inspection: 0 5
w
BU LDING SEWER(locate on site plan) `
Depth below gmde:_2 00
Materials of conetivction:--cast iron X 40 pVC other e
Distance from private water supply wroll or suction line: 1 e (ex ):
Commobto(on condition of'oints 4e e�
;o�n i-e ¢ ,venting,evidence of leakage )
R ea2 z fzt,I Vent � ►�. .
h o
� o/ Peaks ye.•
SEPTIC TANK:NO (locate on sit=plan)
Depth below grade•
Material,of construction:—concrete
--mew fiberglass__polyethylene
If tank ill•nVW list age:
certificate) sge canfirrned by a Certificate of Compliance
D (Y�or no): (attach a copy of
tmenaiona:
Sludge depth:
Distance fromsp of sludge bottom
s al
Scum thickness:
Of outlet tee or be:
Distance ftm top of toms top
outlet tee or baffle:
Distance °bottorm of scum to bottom of outlet tee or oe
How were rynenSions deed•
Commem(on( pumping ..................recommendations,inlet and outlet tee or baffle condity
as related to outlet invert;evidence of 1 nu,afro
Se ti age,etc.): ctural integrity,liquid levels
Id'' jlIrt
GREASE TRAP:NO(locate on site plafi)
Depth below grade:
Material construction:
(explain):: ,concrete metal fiberglass--Polyethylene other
Dimensions: --
Scum thickooas: _
Distance from top of'cumto of
Distance Cno tOP outlet tee or baffle:
m bottom
Date of last of scum to bottom of outlet tee o
r baffl�`
Comments(�mV• ~`
as related to outlet• mg m��ons,inlet and outlet tee or baffle Conditi
G2 e a e t 2¢mR�evi 4-6 zot dence of lealoage,etc.): on,structural integrity,liquid levels
2QbeZt.
MO. i Tnarertinw Vn�*n�./1 thM1l1 -
7
'03/09/1994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 10
Page 8 of I I
OFFICIAL IN-S•FECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
5 *VRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:2Z0 RiueIfL 1 fw ane
en e-4VZ e.
Owner:Ptah aRe a an iz ea/tn
Dace of Iaspeetion;
TIGHT or HOLDING TANK: NO (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade
Material of construction: concrete metal fiberglass---Polyethylene other(cxplain):
Dimensions:
Capacity: _gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working.order(yes or no):
Date of last pumping:
C�rpm n (condi on Df darm or flat switches,etc,):
7.,g�Za oz feeedcng an a a4a 20. Rzetent.-
DISTRIBUTION BOX: NO (if present must be opehe'd)(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 i to gr oulof box, ste.):
U. s�2iQu .con oz not n2eze-nt
PUMP CHAMBER: NO (locate on si(e.Olen)
Pumps in working order(yes or.no):
Alarms in working order(yes or no):
Comments(note conditlon of pump chamber,condition of pumps and appurtenances, etc.):
I�ump chmatlea .ia not fr4e,6ent.
e
03f-0911994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 11
Page 9 of 11 _
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3e� $2vi e a 26 32
Owner:.(1aa 9aae t DzhanM- Ahea&4
Date of Inspection: 4///U
SOIL ABSORPTION SYSTEM(SAS): -(locate On site plan,excavation not-required)
If SAS not located explain why:
Located see a 10
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
uutovativelalterngtive'system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation,
etc.):
Lo No
ege a con. .ce rzo zma
CESSPOOLS:_c S(gesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 2&6 X 8
Depth—top of liquid to inlet invert: em t
Depth of solids layer: 0
Depth of scum layer
Dimensions of cesspool: 6 X 8
Materials of construction: c o n c z e t ,
Indication of groundwater inflow(yes or no): n o
Comments(note condition of soil,signs of hydraulic failure,level„of ponding,condition of vegetation,etc.):
No a in .6 o h daaut.ic
e,6,6 00 XiS wzae day at Limp, O
PRIVY:NO (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids: r
Comments(note condition of soil,signs of hydraulic failure,level of'ponding,condition of vegetation,etc.):
PlLiyy i-s not o�o2f
,9
03109%1994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 12
page')0 of 1.1
OM Y�TSPF 3'�F?N'FOMt,NOT"jZ V0`LUjq'•FARY:ASSESSMENTS /
SUBpWAaM'SEWAGXE DISPOSAL SYSTEMDWECTION:FORM
PART
SY-ST-JEM P.QP RMATI.ON(continued)"
Propert Address: 320 R.jvezviaw Lane
n t e2v.c e
Owner:
l7a4gaz edan te- eu�n
Date of Inspection: 4 " ` w
SKETCH OF SEWAGA•DISPOSAL SYSTEM
Provjka sketch of the sewage disposal system including ties to at Least two permanent reference landmarks or
benebmuAg.Locate all wells within 100 feat.Locate where public water supply enters.the building.
LG 4(vt-r LitLA-L)
r
to
P3%09/1994 09:31 508-790-1578 J.P.MACOMBER & SON PAGE 13
Page 11ofit
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 320 Riva4view LaAe
CentZ4V.i1 JZ l'la
OwnerOa garret-De.3 iz Ahe/tn
Date of Inspection:_ 4/7/0 5
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water,_feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed:
u e.6Observed site(sbtming property/observation hole within 150 feet of SAS)
g"Checked with local Board of Health-explain:
n o Checkedwith local excavators,installers-(attach documentation)
Y"Accessed USGSdatabase=explainAttp:town., 9aiznzta9iz.-ma.-u,
^. You must describe how you established'the high ground water elevation:
11.6ed • Cape Cod Comm.izion lJatez 7ag$e Co2#,ouzz And Pukt.ic Idate2 ;Su/2/22y
Veee head zoteetion Q2ea.e map., Se t 1995
Watea 4e40u4cea oltice cane cod COMM44.ion
Top arrrmw
Leaching
Pit f 0. %et
Groundwater:Wfeit Below Bottom of Pit High Groundwater Adjustment 1.8 ft P Per Frim ter Method
Therefore,the vertical separation distance between the bottom
of the leaching pit and the adjusted groundwater tabic is `3_7
feet. "�
11 -
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