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HomeMy WebLinkAbout0325 RIVERVIEW LANE - Health 325 -RIVERVIEW LN,'. CENTERVILLE ' 228-187 No. 42101/3 ORA ESSELTE 10% 0 0 0 0 N 1 / � Fee lv o THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: Yes PUBLIC HEALTH DIVISION - TOWN OF-BARNSTABLE, MASSACHUSETTS 0[pplitation for 33ispoSal *pstrm Construction permit Application for a Permit to Construct( ) Repair)6 Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. :3 a s t,,1�Vi E k) LANE Own`r''sPNa e,Address,and Tel.No. Assessor'sMap/Parcel �0"1g / & dV/ 3;t P_iUGt?_j((e—cu LA06 G� yyLY� Installer's Name,Address,and Tel.No. SOS-4-77 8Ts'77 Designer's Name,Address,and Tel.No. (�,APGWiWE GVRPQSES L-/-c- S ST "?46-aP6L:sr Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) REPC-k _ _D-R o , 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 Bo d of He Signe s Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. � Date Issued -' • � F rv�p ` •ai.�y'�'�' Yv 5�3�.��_, a� �11.���"'." .� No /✓ J � " A r Fee THECOMMONWEALTH'OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVI ION`- TOM OF-BARNSTABLE, MASSACHUSETTS Yes S_ 4plita.tion for Disposal 6pstem Construction VPrmit Application for a Permit to Construct( ) Repair�J Upgrade(T-)Abandoh( ) ❑Complete System (ndividual Components Location Address or,Lot No. 3 a s R lv )Vi EU &.4N Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel - ag / -7 C.A06 C-aJ?-6YLYIC1_C-' Installer's Nar ig;Address and Tel.No. SUSS 4-7-1-8$-7 Designer's Name,Address,and Tel.No. C�tv�wl 2S� t-(-C-- Type of Building: Dwelling No of Bedrooms Lot Sine sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ..;la�. Compliance has been issued by this Bo. d of He Signe Date '7-0 - 1 Application Approved by Date I- Application Disapproved by Date for the following reasons tt� Permit No. ' (!J"C7 5 Date Issued ` --------------------------------------------------------------------------------------------------------------------------------------- �.��. <� � THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by dAP6Gt)f n6 5-u72xPq_ <-0 4-C—r at A(V6kWEW 40WC� dt 1//l4,1:"has been constructed in accordance with the provisions of Title.5 and the for Disposal System Construction Permit No, 81&l ed Installer �. /� r7) yl:.ly AiQl�t L`� Designer 1A #bedrooms Approved design flow gpd The issuance of th• permit shall not be construed as a guarantee that the system wi iti t tion,as designe Date y Inspector 1 -------------------------------------------------------------------------------------------- ------=------------------------------------- No. J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at 3 a 5 R 1'V r:Py/iEW L AIJC-7 t� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be omplet�d within three years of the date of t is permit. Date Approved by ul 22;15 05:11 p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r , 325 Riverview Lane I Property Address , Phili Denise French Owner Owner's Name =C information is required for every Centervilte MA 02632 7-15-15 page. CityrTown State Zip Code Date of Inspection CA X-:. 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. Impoling out forms When A. Genera! Information filing out forts � on the computer, �,�HCFrM use only the tab 1. Inspector: � 0�p�-'•... key to move your • . n,' cursor-do not James D.Sears DAMES use the return Name of Inspector ARS y Y CapewideEnterprises,LLC Company Name %, I RT11: O 153 Commercial Street F s INS Company Address N S rrI Mashpee --- MA 02649 CitylTown State Zip Code 508-477-8877 S1623 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: Passes ❑ Conditionally Pass s ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-15,15 e1iispector'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 shaved 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 approvi g 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 wiif perform in the future under the same or different conditions of use. 15ins-3113 Title 5 Official Inspection Form:Stbsurface Sewage Disposal System•Page 1 of 17 Jul 22 15 05:12p p.2 Commonwealth of Massachusetts 149 Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Riverview Lane Property Address Philip &Denise French Owner Owners Name information is required for every Centerville MA 02632 7-15-15 page. Citylrown 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: The system is a 1500 Gal.Tank D Box and two trench's. B) System Conditionally Passes: Q 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. Q Y Q N Q NO(Explain below): t5ins•3113 Title 5 Official tnspec i n Form:Subsurface Selvage Disposal System-Page 2 of 17 Jul 22,15 05:12p p.3 Commonwealth of Massachusetts - Title 5 Official Inspection Form d Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Riverview Lane Property Address Philip &Denise French Owner owner's Name information required for every Centervilfe MA 02632 7-15-15 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumpsialarms not operational. System will pass with Board of Health approval if pumpslalarms 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 ❑ Nib(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)4b)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•3113 Tile 5 Official Inspection Form:Subsurface Sewage Disposal Splem-Pepe 3 of 17 Jul 22 15 05:12p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary,Assessments 325 Riverview Lane Property Address Philip& Denise French Owner Owners Name iru for every n is reequiredfired f Centervift AAA 02632 7-15-15 page. City/Town State Zip Code Dale 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 ampliW is less than 6" below invert or available volume is less than 1/day flow ,f'C'lt 1� 15ins•3013 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Jul 22,15 05:13p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Riverview Lane Property Address Philip&Denise French Owner Owner's Name information is required for every Centerville MA 02632 7-15-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 1z 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 or less than 5 ppm, provided that no other failure criteria are triggered_ A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure crfterfa exist as described in 310 CMR 15.303, therefore the system faits. 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 additfon 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•3113 Title 5 Official Inspection Farm:Subsurface Sowage Disposal System•Page 5 of 17 Jul 22,15 05:13p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 325 Riverview Lane Property Address Philip& Denfse French Owner Owners Name information is required for every Centerville MA 02632 7-15-15 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 ❑ 9 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 of 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? ❑ 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)1310 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•3113 Title 5 Official Inspection Fain:Subsurface Sewege Disposal System-Page 6 of 17 Jul 22,1505:13p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Riverview Lane Property Address Philip &Denise French Owner Owner's Name information required for every Centervifre MA 02632 7-15-15 page. Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and two trench's. Number of current residents: 2 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, f available (last 2 years usage(gpd)}: 2013-63,000Gals 2014-72,000GaI s Detail Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/lndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd). Basis of design Flow(seatslpersonsfsq_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-3113 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 7 of 17 Jul 22,15 05:14p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Riverview Lane Property Address Philip & Denise French Owner Owner's Name information required for every Centerville MA 02632 7-15-15 page. CityrFown 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: 08111_ 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): t5ins•3113 TrUe 5 Official Inspedlon Form:Subsurface Sewage Disposal System-Page 6 of 17 Jul 22.15 05:14p p.9 Commonwealth of Massachusetts u� Title 5 Official Inspection Form �' Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 4 325 Riverview lane Property Address Philip & Denise French Owner Owner's Name information is required for every Centervilre MA 02632 7-15-15 Page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1996 Permit # 96-13. 7-2015 New D Box_ Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20" feet Material of construction: ❑ cast iron 10 40 PVC other(explain): Distance from rivate water supplywell or suction line: P feet Comments (on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 9" Depth below grade: 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: 1500 Gal.Precast H-10 Sludge depth: 3" t5ins.3113 Tills 5 official Inspection Form:Subsurface Sewage Disposal System•Pape 9 of 17 Jul 22.15 05:14p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Riverview Lane Property Address Philip& Denise French Owner Owner's Name information is required for every Centerville AAA 02632 7-15-15 page. CityrTown State Zip Code Date of Inspection D. System Information (cons.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2711 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 161, How were dimensions determined? Asbuilt-Ran-Tape Sludge Judge 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 at working level.Tank and covers at 9" below grade. In and outlet tees. No sign of leakage or over loading tank to be maint. Pump after inspection. 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 tap of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 TiMe 5 Oficid Inspection Form.Subsurface Sewage Disposel System-Pape 10 of 17 Jul 22,15 05:15p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form is s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Riverview Lane Property Address Philip &Denise French Owner Owner's Name information is Centerville MA 02632 7-15-15 required for every page. City/Town 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 Title5 official Inspection Farm:Subwfaoo So%age Disposal System•Page 11 of 17 Ju122,15 05:15p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Riverview Lane Property Address Philip& Denise French Owner Owner's Name information is required for every Centerville MA 02632 7-15-15 page. City/Town State Zip Code Date of Lispection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Sox is 16"xiT-21" below grade w121ine's out.Box is new 7-2015 wlcover at 6". Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 12 of 17 Jul 22.15 05:15p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Riverview Lane Property Address Philip& Denise French Owner Owner's Name information required for every Centerville MA 02632 7-45=45 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ❑ leaching chambers number: © leaching galleries number: ® leaching trenches number, length: 2 at 40' ❑ 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.): Leaching is two trenches 40' long ck D Sox and camera out lines No sign of over loading 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•T13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Jul 22,15 05:16p p.14 Commonwealth of Massachusetts Title '5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Riverview Lane Property Address Philip& Denise French Owner Owner's Name information required for every Centerville MA 02632 page. Citylrown State Zip Code Dale 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 pondina, condition of vegetation, etc.): Isins•3lt3 mme 6 omdes Inspecdon Form:Subsurface Sewage Disposal System•Page 14 or 17 Jul 22 15 05:16p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Riverview Lane Property Address Philip& Denise French Owner Owner's Name information is required For every Centervifle MA 02632 7-15-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposed system, including ties to at feast two permanent reference landmarks or benchmarks. Locate all welts within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: , hand-sketch in the araa halnw f•Al, -:3 = o =y 15ins•3113 TNo 5 Otfidal hspocdw Fam•Sub"aca Sewspo Disposal System•Page 15 or 1T Jul 22 15 05:16p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments l 325 Riverview Lane Property Address Philip&Denise French Owner Owner's Name information a Centerviffe MA 02632 7-15-15 required for every page. City(Town State Zip Code Dale of Inspection D. System Information (cont,) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ND 01+ Estimated depth to high ground water: 1 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: 9-12-85 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: T.H.on Design plan 9-12-85 no G.W. at 10'. Bottom of trench at 34"below grade_ Before filing this Inspection Report, please see Report Completeness Checklist on next page. Mrs-3113 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System-Page 16 of 17 Jul 22 1505;16p p.17 t, . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Riverview Lane Property Address Philip & Denise French Owner Owner's Name information required for every Centerville MA 02632 7-15-15 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 an page 15 or attached in separate file t5ins•3113 Tibe 5 Olfidal Inspeclion Fonrc Subsurface Sewage Disposal System-Page 17 of 17 ' TOWN GF'BARNSTABLE A LOCATION S ,C � ��i''U i. :�tl SEWAGE # "`� VILLAGE. ' AS;:;ESSOR'S MAP LOT F" , INSTALLER'S NAME & PHONE NO. C�-U cLn SEPTIC;TANK CAPACITY - 4 LEACiIING FACILITY:(type) _ 3 (size) NO;,AF BEDROOMS PRIVATEYELL,OR PUBLIC WATER A* BUILDER OR OWNERid �i_Cl/ .'N DATE PERMIT ISSUED: DATE COMPLIANCE ISS. ED_� VARIANCE GRANTED:- Yes No 000t 1 4 o ' • ?�,r.� • ( . ` �,�..t_r r.. +}`fit � oft_ No. -- '77 Fee Ind THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS otVVrication for ;DigVo!5a1 *p!tem Com5truction 3Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. P.f_I'C4 G: 3Nq LA' Y2£s — 373 C) Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ® gallons per day. Calculated daily flow gallons. Plan Date /- S—9G Number of sheets / Revision Date Title Description of Soil s 4 c Nature of Repairs or Alterations(Answer when applicable) I 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 Certifi- cate of Compliance has been ' e b§this Boardn off Health. Signed T 4 — Date 3 Application Approved by Application Disapproved for the foylowiny reasons Permit No. 1?1(1 Date Issued . .�� ,._,.r..�..y ti ;�. ,T--r^...:.,, � ,Y-..3...�^�",.� -t,rvw.,,-r.+ ., ,f,.�.,..,,-�. �34��r..;y�x �r.. .,.en:f.'i"s ...•'.fir.—�..:^�,a3�,.C; •-r...a„_- .S , -..:-�_ .. ;No. Fee THE COMMONWEALTH OF MASSACHUSETTS 5 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZippYication for -Migooar *pgtem Construction permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. �'c c f/ v�jZ 1//�w CAN". �y//17�1i%✓ S'7 -3 F&C ,t0`alle" .. Instr's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. PfS'cC.- r NG 3 VA 4A LA.-' Y-Z 8- 3730 Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3-C) gallons per day. Calculated daily flow eleI47. 8Z- gallons. Plan Date Number of sheets / Revision Date ,Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: _ Agreement:' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in=operation until a Certi_fi-. - cate of Compliance has been;s to b this Boardsfl of Health. ' Signed Date 3 / 9 Application Approved by61 --Application Disapproved for the foylowiny reasons � g ` Permit No. Date Issued l •��to � THE COMMONWEALTH OF MASSACHUSETTS , PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIIs� S TO CERTIFY,that the On-site Sewage Disposal System installed )or repaired/replaced( )on Y' by ./ / �' ' for a,,:, � ar P... as , �*'° d �+ /' r .7 '4 0 ZZ,�'"" � has been constructed in accordance with the provisions of Title 5 and the for°disposal System Construction Permit No.�G- ,�� dated Use of this system is.conditioned on compliance with the provisions set forth below: e _ V 1 V No. /!p Fee �Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �i!5po!qa16p5t m Con5tritt rti)o�] e it Permission is granted to f c Y �-•to construct(Ke'by repair( )an On-site Sewage S tem located at 1 go rein✓myt*Li C/V' - C/✓1iykR.V C� and as described in the above Application for Disposal System Construction Permit.The applicant rec gnize his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be comp eted w thi wo years of the date below. Date: Approved by U,-�y GENERAL NOTES: PROFILE OF i')RAN ntttiIONCE PLAN LC'7e0 L SEWAGE DISPOSAL SYSTEM z)tN5 RM 5 FOR RE AUGLLAMV NBAE OF AN cnnuec'.EPDC Srsllll FOUNDATION NOT W SCALE AND Mar 5 W 9 L a BE USM FOR 01[ IG ZONING Nw�eS 1)ALL IDAgWmP AND AMIEIAALS SMALL OOEisW 10 AEP. WILE 5 AND VIE LOW OF—AUM AND HIMU A1DllS r N//�//A• FOR 71E SAMWALE DORWlt OF g11fS ITV r sM NV ALL MERS W SAM L BE UAM 9UL BAmlER 7o ELM ^ a SILL/0 anM Blow NI�s Ir OF FRASED MADE s)EMIM Al0 FWL WAOA.R STALL RMEQN eU,7W1Y n8 SAhE; tiv�t-.y 4' Ap� aim NOTED AY FrAL cmmm �/`'"1°6/F'1 Y SLOPE.m em PER FL) HEFA ,A,-to MADAN:ME SMEARY� LAWN O SML BE R CAPABLE Enr ur mb NY T nr aF BOWS ae PAOOC AREAS.H-b LWBfi SMALL E LZED !ILL r L WEB aA EDlII W'OF DEIfS W PAM=UNLESS mom �i. 7.)As• NaL�DY wm 1/4D to sea cvw5 W CRAE a..,, ar �i••.. AMMER N PLACE e)„ALL OW W HE A_SM 40 AM � ur.0 DNstnbutian ++e/-1/r ta0.a rQ rAS DESIGN noes NOT t W AN4e0ll ff WAANCES eY ME S PTT1TNK (BOX �, (�E ) s'INrr PNC 40 ID)OOS➢IC MWOMA W E 1SAIPFD AM FILED ISM SAND (M-W) Leaching Trench • Sails: Perc Test TEST PIT.1 TeN ame ulowPiss D � -_..)Nnb., rob. ONIs , Bloc of MSINk Ee 9er.r Fdrd L Peee. 11•ea Zf�An .• Q A 7aPes J Leewa Las g e11• S..,L— Design Calculations: 45- Septic Tank: REFERE4CE: 1 r..t Deepnee(no onbass dbeedb Aenaesars Nap 22$ Parcel 187 1 ' / C SS-d•anal U.is m,.Z(nD as)s l0E- sea We r � `wAk rer ZONE RC-Residentlof C I ' , ' Ali Setbacks Ns VMS- a r„s Leaching FoOltles FY-20 FNr it SY-lo, / 1 1` , - TEST PIT +®+ CPO)- RY- to, v 1 f! 1 I I I sroam reA7ue ab ur 7 near-eVdl s Y see, Y ba fdoendeotar Protection Owsloy District 1 1 1 1 1�t3 r m 0 eLf AP-ANpIMtt PrOteetProtectionObtrH A rave+ CT 1 / , I 2 50�1 1 I , 1 g e' - a4t' SM-.*(2 b..h-x4wW-2.r.G7MES/N)=rxa0 GAD 1 1 1 1 1 D--h neateXMI ON-74WO/J) - auNe We g a sse7 L.sn say anal L..*A.Amm ON SF= eeiBt®o>MO LTD Own— N ` c Se a LivLive". Phlp French N Q }4 Uab Sheet (v_/ , CerltN»!b MA 120' P.iftwals,wtr o.�e w IP 1 I I I T� I 1 � r ; ����� 9 f• FANINaNTH PLAN SHOWING PROPOSED I / 1 N,E2A HOUSE & SEPTIC SYSTEM RI VERVIEW LANE BARNSTABLE (CENTEtw1Fa MA /�� �' 1 /r4*p. 1 f / f et►{ 1 OCUS JmUARY% 1996 Scaflw 1,-20' 3 Loans g , f O 1 r / N�) o.ttrlb t1A� „Penis MA L12 -07778 LOCATION YAP (1'-200W>) (5De) a2�J790 (ILIA)710-79M•0180/00 FTe14k RtJt Date NOV W o 10 >o a p Cale : RLH Dr./t RLI Redne Up SPIFFY 1 Fflc C15avnD=