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HomeMy WebLinkAbout0070 BIRCHILL ROAD - Health 70 Birch Hill Road ; • Centerville 1■■■■��■■■■■■■■■■■■■■■■■■■■■■■■■�■■■�■■■■■��■■ ■■■■■■■■■■■■■■■■■■■■i�iir��ilii�■■■■■■■■■■■■■■■■■MEMO �0������������������������������� �5��������������������������������� TOWN OF BARNSTABLE LOCATION /Q ��� +��� (� SEWAGE# 014 Z !�r VILLAGE C�•?FrJU.%/�° `ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. l��rj �o ��•�"��Y .: SEPTIC TANK CAPACITY LEACHING FACILITY. (type)' f2'OF�� (size �k S NO.OF BEDROOMS Y OWNER PERMIT DATE: J 'Z 4' `Z 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 A4A1 / 12, ^�'4� Oa 1,C Q J� 2 33 ' 3 27 _ 0-3 3 ` No. �1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Misposal 6pstem Construction 30prinit Application for a Permit to Construct( ) Repair(tl/upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.7,0 0 f`C A � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel fff 02.V Installer's Name,Address,and Tel.N_� 00�oarS f' Designer's Name,Address,and Tel.No. C rc,,1L11_ TI pe 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-TV / -Z Number of sheets Revision Date Title Size of Septic Tank 40 j Type of S.A.S. L'�E✓�d� Z­�fZ� Description of Soil Natury of Repairs or Alterations(Answer when applicable) n,I Ole 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 >of nvironmenta a and n t to pl ystem in operation until a Certificate of Compliance has been issued by this Boa Signed Date 2 r Application Approved by Date c Application Disapproved by Date for the following reasons Permit No. 9 0 ' Date Issued �—f ....�.....-_. - ,_ yy. .. -.,w�.i e`•-. ::�"' a � _.J'Y .tea_ n.•Y `_` .ya.- .. l. -e -I No. 0 :. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: „1 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 5yes 0(pplitation for ZispoBal *pstrm Construction permit � n: Application forka Permit to Construct( ) Repair(Ul Upgrade O Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.7(3 A%i It pi Al V Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ��� UL y n`�Q�°"(Lt �'^�.(!�'�'► , -'P'fl>��� Installer's Name,Address,and Tel.No 4 f ��'� Designer's Name,Address,and Tel.No. !�* 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) ` " gp rr d Design flow provided �+��� gpd Pla Date �3 J-� Number of sheets Revision Date Title Size of Septic Tank 4ej a Type of S.A.S. Ct,4tir.AC Description of Soil Nature of Repairs or Alterations/Answer when applicable) /% `C4 ,t Y��✓►` F� 7 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 Environmemal.Co,k and t to placethe-system in operation until a Certificate of Compliance has been issued by this Board of a� Signed Date Application Approved by i,,. :.. ~- Date Application Disapproved by Date for the following reasons Permit No. 01 Q r ` ` 1 Date Issued ----------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO C RTIF�!Y,that the On-site Sewage Disposal systtem Constructed( ) Repaired( Upgraded( ) Abandoned( )by � _ _. -at 70 A r e h 17 has been constructed in-accordance 6 with the provisions of Title 5 and the for Disposal System Construction Permit No.�0 1-- i fst!f dated Installer, ,i e�a-Cl J9s µ.(f tea.- �' Designer #bedrooms Approved designAL ow„�-� gpd The issuance of this permit shall not be construed as a guarantee that the system It l fimction as designed. Date /_ / Inspector - -- - ---- --------- - -- -- --------- No. ,�,O . . .. d� Fee 160 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ' Misposal *, pstem ConstCUttiott permit Permission.is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at VI 40 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 completed within three years of the date of this permit.,, -""-- (I 1 R Date '1-° ( Approved by r Town of Barnstable h °DIME r s Regulatory Services Richard V.Scali,Interim Director • BARNsrAsm +' MASS Public Health Division �FAN'�s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-562-4644 Fax: 503-790-6 304 Installer& Designer Certification Form Date: 2$+Zt Sewage Permit# 11'3 a,) I /NAssessor's Map\Parcel Designer: Installer: M-Uk l71 1 11ri-NO Address: )Z VJ Cry—P,ld /Zei Address: 3S;- Ca n fe_% 4- L� On 5,9�— 2� Pq u®fl Q was issued a permit to install a (date) (installer) septic stem at 7 b �/rG�t l� J ("h 4<,V. p y t /te based on a design drawn by (address) C, �;'nee���r 1'Uc✓14s. dated ✓It 4 �l s (designer) 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. I certify that the system referenced above was constructed in with the terms of the AA approval le applicable) icy McENTEE (Installer's Signature) CIV11. typ.35109 _ O L� �,.RfQIStE� (Designer's Signature) (Affix Designees ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:',Septic'•Designer Certification Form Rev 3-14-13.doc Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill.The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,backfilling to specified grades with proper compaction and setting risers;covers as shown on the design plan. Town of Barnstable " Inspectional Services Department B" MASS.MAS& Public Health Division y 039. �0 'OTFn►�xi" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8210 April 15, 2021 MERLESENA, STEPHEN W 132 EAST 28TH STREET, UNIT#4 NEW YORK, NY 10016 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 70 Birch Hill Road, Centerville, MA was inspected on 03/31/2021 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year 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 T E BOARD OF HEALTH T omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\70 Birch Hill Road Cent.doc THE tp�y Town of Barnstable • A MASS O Inspectional Services Departm ent P7ASS. �AlFD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Thomas A McKean,Clio ()ffice 508-862-4644 FAX 508-790-6304 Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CM All "x'' marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS VStatLic YEAR DEADLINE CRITERIA liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cessp ol ❑ A portion of the SAS, cesspool; or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well pplwell ter ❑ A portion of the cesspool is located within Tl]set ° ppasses fivate the �Uateer)analysis with no acceptable water quality analysis. ( system indicates the well is free from pollution). TWO 21 YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover; relocation of a pipe, relocation of-a driveway due to 1-1-10 components, etc) ❑ Leaching facility with standing. liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline:_ --- -- —--- O:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc t aq Commonwealth of Massachusetts Title 5 Official Inspection Form ISubsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for 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 forms A. Inspector Information 5 /S3 O on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code rev (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑E Fails Brett Hickey Digitally signed by Brett Hickey Date:2021.04.07 08:10:05-04'00• 3-31-2021 Inspector'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 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 form should be sent to the system owner and.copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts = - Title 5 Official Inspection Form .ol Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every St page. City/Town ate Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments.- System is in hydraulic failure 2) 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): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts -6P Title 5 Official Inspection Form Io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road +y✓.1 Property Address Stephen Merlescena Owner Owner's Name information is required for every Centerville Ma 02632 3-31-2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) ❑ 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 b. 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No 0 ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c �r J � 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No O ❑ 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 El NA Liquid day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ O Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El 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 2000 gpd- 10,000 gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) 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 CA. 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 i t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 j Commonwealth of Massachusetts _- -- ..........� Title 5 Official Inspection Form f - i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? El ❑ 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? O ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ O 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: EJ ❑ Existing information. For example, a plan at the Board of Health. El ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts ,S. -i Title 5 Official Inspection Form 1a 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is required for every Centerville Ma 02632 3-31-2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: No design plans 4 Number of bedrooms(design): Number of bedrooms(actual): NA DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes El No Does residence have a water treatment unit? ❑ Yes R] No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ® Yes No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonaluse? ❑ Yes No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: 2020- 71,000gallons 2019- 121,000gallons Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date 15insp.doc rev.712612011 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts �- =_-- - Title 5 Official Inspection Form 1' ....... .~,�......... 1; I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: NA 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 4/2020 Was system pumped as part of the inspection? ❑ Yes F01 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �a -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 1983 per permit Were sewage odors detected when arriving at the site? ❑ Yes W No 5. Building Sewer(locate on site plan): 2,61' Depth below grade: feet Material of construction: ❑cast iron ■❑40 PVC ❑other(explain): Distance from private water supply well or suction line: Town waterfeet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts r.� Title 5 Official Inspection Form I- - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 11611 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 1 Dimensions: 000gallons Tank full over inlet and outlet Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle n n Scum thickness n n Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Viewed 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.): The tank was full over inlet on outlet at the time of inspection due to failed SAS. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c� Commonwealth of Massachusetts 17 - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts �= =PTitle 5 Official Inspection Form --- — is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 Birch Hill Road ` Property Address Stephen Merlescena Owner Owner's Name information is required for every Centerville Ma 02632 3-31-2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Over 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.): The d-box was full over inlet and outlet at the time of inspection due to failed SAS. t5insp.tloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts y Title 5 Official Inspection Form -"" Subsurface'Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): NA If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: 0 leaching pits number: (1) 6'x6' pit ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts - -r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in hydraulic failure at the time of inspection. Pit was full over inlet invert when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �d p Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 3 . x: 1 A f r 0 ) II let 4116 TJ b t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form —11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope ■❑ Surface water ❑■ Check cellar Shallow wells Estimated depth to high ground water: Undetermined as system is in failure 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: Ground water depth was not determined as system is in failure and will need to be replaced. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Birch Hill Road Property Address Stephen Merlescena Owner Owner's Name information is Centerville Ma 02632 3-31-2021 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Al A. Inspector Information: Complete all fields in this section. ■� B. Certification: Signed &Dated and 1, 2, 3, or checked ❑■ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ❑■ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 70 Birch Hill rd W Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville ✓ Ma 02632 1/24/17 page. City/Town State Zip Code Date of Inspection K.T1 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 A. General Information (`I filling out forms V /4 a- ) 13 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain ,y Company Name 8 Johns path Company Address B S Yarmouth Ma 02664 CityrTown State Zip Code 508-364-9587 S103522 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 1/27/17 Inspector'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 DER 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:Subsurface 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 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is Centerville Ma 02632 1/24/17 required for every page. City/Town 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: System contains a 1,000 Gallon septic tank as well as a New Concrete distribution box and a concrete leaching pit. Pit was dry at time of inspection. Staining indicates levels have been no higher than within 22" of invert pipe 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 Commonwealth of Massachusetts .W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is Centerville Ma 02632 1/24/17 required for every page. City/Town 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•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 70 Birch Hill rd Property Address Deidre Evel n ad Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 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 '/day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 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. El ® 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 criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: 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. 15ins•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 4M , 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 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? ® ❑ 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: System contains a 1,000 Gallon septic tank as well as a New Concrete distribution box and a concrete leaching pit. Pit was dry at time of inspection. Staining indicates levels have been no higher than within 22" of invert pipe Number of current residents: vacant Does residence have a garbage grinder? ❑ Yes ❑ No Is laundryon a separate sewage system? Include laundry system inspection( Y P P 9 Y Y El Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 158 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: None provided 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•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 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 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: 34 Years Approximated Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 2 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.): System is vented at the roof line Septic Tank (locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,G ,M 70 Birch Hill rd Property Address P Y Deidre Eveland Owner Owner's Name information is Centerville Ma 02632 1/24/17 required for every page. City/Town 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 24" Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieaking,Tees and or baffles in place at time of 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 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 Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 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.): Tees are in place and levels are normal. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 70 Birch Hill rd M Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 page. City/Town 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 New 1/25/17 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.): Replaced 1/25/17 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: l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Birch Hill rd M Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 page.e. City/Town 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.): No signs of 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Birch Hill rd M Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 page. City/Town 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.): No ponding no break out 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 page. City/Town 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 I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �p ,M 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 page. City/Town 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: 10+ ft 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: USGS Maps indicate ground water well below 15' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 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 ^M 70 Birch Hill rd Property Address Deidre Eveland Owner Owner's Name information is required for every Centerville Ma 02632 1/24/17 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Fmi..�.2...�.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA TH, -.. e!. .........OF..... .. .. _5..... ... ........................ .� lirttfioYt for Uionooal Works Tomitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( �� Individual Sewage Disposal System at: � �1......... . .. .�l-ft-. �..� ....... ...... ..................�©.. ._...... •-.��Loca' - are C or Lot No... •............•....... ..................... ..............-•--- . ...................•........•.. Owner Address W ... . -----•----------------------•----.---- ...................................................... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............... ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons................_----------- Showers ( ) — Cafeteria ( ) a Other fixtures .----------••---•••......-•..•.• _• - W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. W Septic Tank—Liquid capacity............gallons Length_............. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) PercolationTest Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ ...........................•-•••••••••••-•-••••••••••••.......................•••-••.........•••-------•--••-•-••.....-•-•------.......•-••-••-•-............ 0 Description of Soil........................................................................................................................................................................ x W -----•-•--------------------••----••-------••-•-......-•••-•--•-••......•--••-••-•-••-•••---••••••--•••••---•••......--••-••--••-•..... ......•••- U Nature of Ile irs or Alterations—Answer when applicable_..__ _ �� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the bo rd of health. ne ��xi�l ' '.. =.................... "�'�. _ . .... .- e- Application APPro -- ---------- .................... ............... r� .... Date Application Disapprove or following reasons---------------••----------------........-•---------•---••--------•----------•--•----------...__........... •••-•••••••••-••--••••-•••-••••--•••-••--•-•-•-•......••.._.......-•••------••••........•••...-•-••....................•••-•-•••••-•--•-••-•••-••...-•-•--•••••-••••-•-•••-•••••••••••--••--•••.......... Date PermitNo......................................................... Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD !-SEA TH r. .-.. oF..... /G . .. -------•---- Apphratiun for Diipu,ial lgorkii Tomitrnr#ion rumit Application is hereby made for a Permit to Construct ( ) or Repair (4) an'IndividualSewage Disposal System at ..- LoCa Addres8 or Lot No. --------------------- Owner Address ....-��---- ---- -- a = ......__.... ------------------------------------------------------- Installer Address _Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ............................... . . W Design Flow............................_...............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -•••-------•-••••-------------•-•-•-•--•---•-•••------•-._........---------.........._....------_...------• - -------------- ----------------- 0 Description of Soil........................................................................................................................................................................ x w UNature of Repairs or Alterations Answer when applicable. _ .___. ''�?✓ `____ ._.. ......... ......... 77 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sue4P the boprd of Health. agned._ _ � t ---------------------- �' _. --.....Fr.._ .ice'" Application Appro Date Application Disapproved or t following reasons-------------•------------------•----•------------------•-----•--------------•------------:.;__...........I........ -•-•-•--•-•---••-•••---------••••-----•-••----••----•------•--•------------•---------------------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH } �T...........OF.. ..:..:.!�..... R. Tertifiratr of Tomplianrr THIS I�O ;�,�-RTAIFFY, That-the Individual Sewage Disposal System constructed ( ) or Repaired ( ^Installer s atl f - --- ...................................... - -- has been installed in accordance with the provisions of T TLF State Sanitar Code s 15bed in the application for Disposal Works Construction Permit No._ 3'��� --._..__.. dated-,/-. ...................... I THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........................•---...------......-------....-----•-•------•-•--•--•• Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F.::? '�.............O % FEE .................. 1� � ® ? �iu�uu�t1 .r �o ,�#rn.r,#iun rrutit Permission is hereby granted......... -. ..f ~'.............................. ............................................. to Construct ( ) or Repair ( n Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown onZthe )plication for Disposal Works Construction Permit _______________ Dated.__________.__.._..__.___.._.___._....._.. --- Board of Health DATE---//. F. FORM 125501A. M. SULKI N, INC., BOSTON L0 ION SEWAGE PERMIT No . � O �c PILLAGE / �4 &'0.Il ; I ' f I N S T A LLER'S NAINE A ADDRESS Lu U 1 L D E R OR OWNER DATE PERMIT ISSUED DATE COIIAPLIANCE ISSUED x, 1 K 4 y 3F r s:a 2y '3 �y - y, c� MOW, so�- S � � F/ L F a ��r & 1� iy3a sf�E+ E h` 4EwE 'u �d�r,`y a `x � ° ,�- r�` ✓ k�z �` �y "'. �z r � � k€ €€ituGE F 3� a�i." � .a ti`xm a�r! zz aGY"F . q*` g ar! K, r, fa =f SSA �; �.�, # ,i.� n !rc yna4 ,E a � 5 y 1� .. 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VILLAGE INSTA ULER'S NAME ADDRESS e LL) f s 9 6 U.I L D E R OR OWNER C, D ATE PERMIT ISSUED DATE COMPLIANCE ISSUED -, ,a\ Q �) ` I� � � �� r� ��,� �� � Fir 706irchIIPRdJ -64-- EXISTING CONTOUR fa rJ Ceterville,MA'02632�y„ EXISTING CESSPOOL EX15TlNG SEPTIC TANK - X 60,98 EXISTING SPOT GRADE PROPOSED S.A.S. TO BE PUMPED, FILLED TO REMAIN ( ) 3-500 :GALLON CHAMBERS -VI/ EXISTING WATER SVC. �`. • r � � �, �`> WI TH SAND & ABANDONED f 1: TOP OF TANK, EL.=101.9t SURROUNDED W/4' OF STONE -G EXISTING GAS SERVICE � � ' ti'` '��` �`�,��` •^•. � IN (OUT)=100.55t B H: - OVERHEAD WIRES 'P 101.e8 S 63°0510" E BENCHMARK TEST PIT ��: aka 102.62 141.57' COR. CONCRETE SLAB BENCHMARK �. o o + stockode ence EL.=103.48 LEGEND 3 ' 103.07 � cam° ti, ,�. 3 +102.42 Q Q Q L I 0 SHED O N LOCUS MAP ' �i 103.02 00 /TP-1 SH 103,12 lO -F x 3/, X,4 N.0 102.2'3 N ED + 102.50 - co 0 N O BM N 25.00 _ � TP 2GENERAL NOTES: 3 0 103.4 +03.21 N 63°05'10" W 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL DECK 'x BOARD OF HEALTH AND THE DESIGN ENGINEER. 103,19 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 102,25+ 5,03 SLAB OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 103.20 BH I LOCAL RULES AND REGULATIONS. rn Ln 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Nio x TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE o 103.31 { DESIGN ENGINEER. stockade fence EXISTING s 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING HOUSE(#70) 0 . 4 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 102.26 T.O.F.=f03.9t ro N ENGINEER BEFORE CONSTRUCTION CONTINUES. oM 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. j� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10L65 x 102.20 N THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF x GARAGE HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. \ 102.85 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 3 + + 103,31 ( 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 103.48 I 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 0 + "103.38 . UK AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 102.91 WALK DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY LOTS 5 & 6B THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 15,424f LP . ;lOZ•58 ;:.::.::,. i OF Mq CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS � 9� 101.54 X-�o�•- :�PAVED::`.;�: � yG IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND o PETER T. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 101,85 .: :,'.:... � McENTEE CIVIL � CIVIL �% 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE DRIVEWAY;`. INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. = No. 35109 13. THIS PLAN IS T0. BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND PK SET IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 100.00 ------------- :.100.35:` 101.18 PARCEL !®: 189-024 s4' ; =z 8.84° PROPOSED SEPTIC SYSTEM UPGRADE PLAN l00,04 edge of pavement 99.59 100.17 100.54 70 BIRCHILL RD, CENTERVILLE, MA 100.64 Prepared for: DiBuono Sewer & Drain, 35 Content Ln, Cotuit, MA 02635 I ROAD OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. BIRCrlLLMERLESENA, STEPHEN W Engineering Works, Inc. 1"=20' P.T.M.P•T.M 192-21 132 EAST 28th STREET, UNIT#4 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. NEW YORK, NY 10016 (508) 477-5313 5/14/21 P.T.M. 1 Of 2 `.r NOTE: TO PREVENT BREAKOUT, FINAL GRADE PROPOSED S.A.S. SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=100.0 3-500 GALLON CHAMBERS O INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE r- stockade fence SURROUNDED W/4' OF STONE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D—BOX OF THE PROPOSED S.A.S. INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND BO TLF.G. 03.9f SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT N� .=102.8t F.G. EL.=103.0t F.G. EL.=103.Of F.G. EL.=103.0f 3001 fMAINTAIN 2% SLOPE OVER S.A.S. 3, SHED ' L = 2 3' _ ® S=1% (MIN.) ®LS=1%2(MIN.) Cv ODD SHED 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" l� Hff6,. DOUBLE WASHED STONE CJ! 1o"I s as $ as (OR APPROVED FILTER FABRIC) 14" 2' EFF. BaBaaaa 0) EXISTING 48" LIQUID DEPTH aaBaaaa ---3/4" TO 1-1/2" DOUBLE M LEVEL WASHED STONE ADD INV.=99.90 PROPOSED 4' 4.8' 4' DECK GAS BAD,. D BOX INV.=99.73 EFFECTIVE WIDTH = 12.8' . .. . . . . .. . INV.=100.55t EXISTING SEPTIC TANK 3 OUTLETS INV.=99.50 3-500 GALLON LEACHING CHAMBERS BH SLAB SURROUNDED WITH STONE AS SHOWN H-10 RATED EXISTING NOTES: TOP CONC. ELEV.=100.3t HOUSE(170 BREAKOUT ELEV.=100.00 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.= 99.50 aaa® S.A.S. LAYOUT INVERTS, PRIOR TO INSTALLATION. eases aaaaaaaaaaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE aaaaaaaaaaa BOTTOM ELEV.-- 97.50 ON A MECHANICALLY COMPACTED STABLE BASE OR 4' 3 x 8.5' = 25.5' 4' SIX INCH AGGREGATE BASE, AS SPECIFIED IN 310 4' OF NATURALLY OCCURRING CMR 15.221(2). PERVIOUS MATERIAL EFFECTIVE LENGTH = 33.5' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE BOTTOM OF TEST PIT, EL.=91.0 z CE3 ®® ® ®®® AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. F- ®®®® ® ®®®® 3300 SEPTIC SYSTEM PROFILE N z 102" DESIGN CRITERIA SOIL LOG 4" KNOCKOUT DATE: MAY 5, 2021 TPT-21-1 18 NUMBER OF BEDROOMS: 4 SOIL EVALUATOR: PETER McENTEE, SE-1542 20" DIA. COVER SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DAVID STANTON IRS HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP— 1 DEPTH ELEV. TP-2 DEPTH 4" KNOCKOUT 4" KNOCKOUT 58" DAILY FLOW: 440 GPD 102.5 A 0„ 1 02 5 A 0" 0 DESIGN FLOW: 440 GPD SANDY LOAM 10YR 4/2 SANDY LOAM GARBAGE GRINDER: NO—not allowed with design 101.8 g" to1:9 10YR 4/2 2^ 4" KNOCKOUT LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF B .1 B SANDY LOAM SANDY LOAM.74 GPD/SF 10YR 5/6 tOYR 5/6 500 GALLON CAPACITY, H-10 LOADING EXISTING SEPTIC TANK: 1000 GALLON CAPACITY CHAMBERS PRC PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED 99.5 C 36" 99.6 C 35" E USE 3-500 GALLON LEACHING CHAMBERS IN SERIES 30"/48" . PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES M-C SAND M-C SAND SIDEWALL AREA: 2(12.8' + 33.5') X 2 = 185.2 S.F. 2.5Y 6/6 2.5Y 6/6 70 BIRCHILL RD, CENTERVILLE, MA BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F. Prepared for: DiBuono Sewer & Drain, 35 Content Ln, Cotuit, MA 02635 TOTAL AREA:.............................................................. 614.0 S.F. Engineering by: SCALE DRAWN JOB. NO. 91.0 138" 91.0 138" Engineering Works, Inc. N.T.S. P.T.M. 192-21 DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.3 GPD PERC RATE <2 MIN/IN. "C" HORIZON 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. NO GROUNDWATER ENCOUNTERED (508) 477-5313 5/14/21 P.T.M. 2 Of 2