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0078 BIRCHILL ROAD - Health
78 Birchhill Road Centerville A= 189- 023 Q i i x I UPC'12534 No.2-953L0 , r � No. Z L , ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 9pptiLation for !18f o aY *pstrm Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addres or Lot No.; � `) �D Owner's Name,Address,and Tel.No Assessor's Map;2:1 `e����/�� r Installer's a AdAress and Tel. o D sign Nam Addre an�,Tel.No n `'JAI Q r' %Z%L.2f 95 B'�-6� o/ � �9�� ? SSA Type of Building: Dwelling No.of Bedrooms Lot Size al)lsq.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 '0'!U Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Board of fteal . Sign Date Application Approved by Date c3 Application Disapproved by Date for the following reasons Permit No. , � Date Issued 1 ;.r i No. �d" �+3� w±�: � ,,,..;� � �V,, - Fee \ THE COMMONWEALTH OP MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -_TOWN&OF BARNSTABLE, MASSACHUSETTS ZippliLation for -Misposal Wp-strm Construction Permit Application for a Permit to Construct( ) Repair grade( ) AJ3andon( ) ❑Complete System ❑Individual Components .Location Address or Lot No.�� �/�1!l Owner's Name,Address,and Tel.No sy ©au 'Uee Assessor's Map/Parcel �. Installer's1a1We,A ss,and Tel. � % � { /d D s�nV am Addre aq Tel.No � Q ;!�;rc Type of Building: L Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder 211 ( ) 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 1 Title Size of Septic ZfOle s Type of S.A.S. "O'k1l Description of Soil • i Nature of Repairs or Alterations(Answer when applicable) OQ j f � • Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in f, 1 accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal T�7 Sign Date J / Application Approved by Date T� Application Disapproved by Date I S for the following reasons i Permit No. c7— Date Issued i THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,that the On-site�S a Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of T' e 5 an truction Permit No. 1 D y?dated Installer Designer #bedrooms Approved desi fio �,� a gpd j / e The issuance of this permit shajI /trio be o/nstrued as a guarantee that the system wil function I des' ed. Date Inspector Inspector I No. �U I ' Fee 10 b THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct ) Repair( Upgrade ) Abandon( ) t • System located at G' 'r 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 completedwithin three years of the date of this pe J Date ' ( �- Approved by f G Town of Barl'stable ' �,WE Regulatory Services Thomas F. Geiler,Director HAMSrns[.€. 9 H"� Public Health'Division `1639• �0 Thomas McKean, Director 200 plain Street,Hyannis,lid 02601 Office: 508-362-464, Fa: : 508-790-6304 Installer & Designer Certification Form Date: Z �'t Sewage Permit., Assessor's Map\Parcel L� n.. Designer: (VIL • Installer: Address: t oC l� Address: 5 )o W UA On -- vas issued a permit to install a (date) ^� *intal2erl septic system at I )i2L' '1 L� based on a design drawn by (address) DI� t _S dated � �S (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or an,; vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certifled as-built b designer to follow. OF Mgss9�y fDAR INN Mj (Installer' gnature \ N,,oQ: 1140 STSOIT EM (� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BAR STABLE 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: Heal th/Septic/Desigoner Certification Form 3-264doc i Town of Ba"I nstalbie Department of Regulatory Services • = Public Health Division Dace �wxrreree[.e. • I . KA . ie39. tee$ 200 Main Street,Hyannis MA 02601 ` ArFD 1M't F i - Date Scheduled / / Time Fee Pd. I • oil ,Suitability Assessm*ent for S e Disposal Performed By: ` i t-. Witnessed By: i LOCATION & GENERAL INFORMATION Location Address Owner's Name Tr' 6_0 ^� �O kVA Address w �9 Assessor's Map/P4rcel: :Z,`3 I Engineer's Name NEW CONS1RUt 20 I REPAIR X Telephone# Land Use i � Slopes(90) Surface Stones LV Distances from: Open Water Body >- l d o ft Possible Wec Area >I C O ft Drinking Water Well ft -' ]drainage Way � / 11 i7 ft Property Line y ft Other ft PARCEL ID' 189/031—008- 189/155 PROP. I,5000 - _ " -/ SEPTIC TANK 189/00i—� ,proximity to holes) SKETCH:(Street name,dimrns`020 s,o W J Q / 143.50 ♦W� 4� Ins Ports / PlrvE- I 5 / O.y AIL OAK . 91f0' � PS 416 logOAK% I I In i3SYf' / L N46.0 1 Existing Cesspools o il, .iWc N J6-W (Nate 10)'I✓/'I ` c $960 n £IN TRM:BlNO A 10 o E ID-MAP E,Vm51.0 PARCIF 189/ #78 11 CAR. - N r/• TOP OF MD 1 ElE=51.0 I V, .L. V, p A £ w I / 1 RCEL ID: 39/022 PARCEL ID: C, y./ 789/0 AREA=20.823 I i 92t S.F. O O I R�132.69 �.. N 71'25'S0"W 60.00 L=38.20 - . OP Z. IRCHILL ROAD J I f1 1� G'�d l ►�1lts� dx Parent material(geologic) CiC/ I ' Depth to Bedrock t�A Depth to Groundwater. Standing Water in Hole:' �� i Weeping from P[t Face Estimated Seasonal ilbgh Groundwater /�' ��� DtTERMINATION FOR SEAM VIAL ffiCJE��YATE TALE Method Used: I. - Depth C b� rved standing" ohs:hole: lu. Depth-to sall-tnottles: tt. in, Oroundwnter AdJusttnent Depth toiweeping from side of obs.hole 1 _ A ,f tetOC.. ._�- AcQ.t�rnundwater Level.— Depth Well# _ Reading Date Index Well level -- I P�ERCOLATJClON TE5'I' D$:p___I�.a x p--- Observation I Time at 9" 1 --- Hole# 1 Time at61' _._�... Depth of Perc �JJO 07 1 Time(V-6") _ Start Pre-soak Time.@ 10 — End Pre-soak Rate Mnllnch ssed Site Suitability Assessment Site Pa k Site Failed; Additional Testing Needed(YIN) Original:,Public pe;lth Division Observation Hole Data To Be Completed on Back— ***If percolaOn test is to be conducted within 100' of wetland,you must first notify the Barnstable C4#servatiou Division at least one (1) week prior to beginning- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. p Consistenc %Gravel pal— �It T1n /� o�'/ ' AA DEEP OBSERVATION HOLE LOG I Hole# ?� Depth from Soil Horizon Soil Texture Soil Color Soil Other ` Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gra el ►I ,I 13 > ff J.aJ'y�e�h� �. �'A, i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel i I I I I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USD (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra I • E r 4 Flood Insurance Rate Mau: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No Yes. Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviQ1 material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification I certify that on b 1�9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required n expertise and experience described in 3.10 CUR 15.017. Signature K1, Date 7 ' Q:\SEPTl0PERCFORM.DOC r TOWN OF BARNSTABLE LOCATION I rc b 1 f �� SEWAGE# VILLAGE� &0 SSESSOR'S MAP&PnELF �- INSTALLER'S NAME&PHONE NO. C-A44"n ! r-V'X ri )0 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) o f C>T A-QC, (size) 1� NO.OF BEDROOMS OWNER PERMIT?DATE:_ - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply:Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any,wetlands exist within 300 feet of leaching cility A Feet FURNISHED BY �-n/ US1E. _3 2 co 5'0,8 e,o, 33 TOWN OF BARNSTABLE ,o Tzorr A0V SEWAGE # M AGE— <::�e.4 le �ASSESSORS MAP&LOT _____ NS rALt I-Eit.S NAME&PHONE NO. iE C 'TANK CAPACTI'1C eSS dy .EACIIYNG FACILTi'1': (type) �. - - - (size) 40.OF'BEI)ROOMS_—.,1._-. lUELDER OR 'El I'T®ATE: ; C0WLIANC.E DATE;- :apaxation Distance Betw@en thc; Aaximurn Adjusted.Groundwater Tabic to the Bottom of beaching Facility .. eet 'ivate Water Supply WePI and Leaching Pacifity Of ii y wolls exist on sit-,or within 200 feet of leaching facility) :Age of Wedand And Lcaclgng Facility(if any wetlands exist within 300 feet of Ic clung facility) T'ect Vrnishcd by `S awn ✓1ii l� ( wv _ - Of � -Q - s7 ' r� - d - ��� •� � 4A - - TOWN OF BARN-S/TABLE LOCATION rI� I&A cj_. p '04 UI SEWAGE# VILLAGE(Z � AA SSOR'SS MAP&P EL i f�0.4&2 SEPTIC TANK CAPACITY -- LEACHING FACILITY:(type) (size), NO.OF BEDROO S , OWNER PERMIT DATE: COMPLIANCE DATE: p�o 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 I FURNISHED BY 1 0. �, ,�. . , �,, `,, , � � s� � �'� �, h i .��� . . ,,� � ,. ,�3 � 1 Town of Barnstable Barnstable THE ry Regulatory Services Department I�"��F fty iIIAnNS'CABLE, s m -• �A� m1639. Public Health Division rED"'"`p 200 Main Street, Hyannis MA 02601 2�1e7 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7011 0470 0001 4525 7215 June 25, 2012 David Holt Today Real Estate 1533 Falmouth Road (Rte 28) Centerville, MA 02632 Re: 78 Birchill Road Centerville ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 78 Birchill Road, Centerville MA was last inspected on 6/18/2012,by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5(3 10 CMR 15.00); due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\TOB Itr Commonwealth of Massachusetts J U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s y , M 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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. A. General Information I� 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and thaUhe information reported below is true, accurate and complete as of the time of the iP°t�p'ection. Thy insertion was performed based on my training and experience,in the proper function and maintenance of on @e sewage disposal systems. I am a DEP approved system inspector pursuanti,,d Section 15 340,of Title 5(310 CMR 15.000).The system: ° CD ❑ Passes ❑ Conditionally Passes ® Falls ❑ Needs Further Evaluation by the Local Approving Authority 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 9t] 61U tv t5ins•11/10 5 Official Inspeclion Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection p Summary: A,B,C,D or E7 alwa s complete,all of Section D rY Y p A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board.of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20'years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. City/Town x State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cunt.): ❑ 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-11/10 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 „ 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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 ® ElBackup 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 '/z day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Ady 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 systemthe system must serve a facility with a design flow of.10,000 gpd to 15,000 gpd. I For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ,❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is,considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•`'y 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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) F Z . ❑ 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 t 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder?" ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 5-2012 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-11110 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 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: •. . I ' 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 r Commonwealth of Massachusetts F Title 5 Official Inspection Form M Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1960's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"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.): Good condition. Septic Tank(locate on site plan): 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: Sludge depth: t5ins-11110 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 „ 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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 Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 l I Commonwealth of Massachusetts . . F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448), Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons ' Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e' 78 Birchill Rd Property Address Bank Owned (Contact David,Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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 N/A 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.): r 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.): 1 Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page U of 17 K Commonwealth of Massachusetts i~ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ 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.): Overflow cesspool had clear signs of hydrolic failure with stain lines above inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2-inline Depth—top of liquid to inlet invert N/A Depth of solids layer 12" Depth of scum layer 2" Dimensions of cesspool 6'x8' Materials of construction Block Indication of groundwater inflow ❑ Yes ® No t5ins a 11/10 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 M 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1- 0 -966-2448 Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments note condition of soil, signs of hydraulic failure, level of ondin , condition of vegetation, ( 9 Y P 9 etc.): Both cesspools had clear signs of hydrolic failure with stain lines above inlet invert. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 ,4 Commonwealth of Massachusetts Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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 4rY' r I t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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: 20 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 and town maps show groundwater 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 ^S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Birchill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 6-18-12 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 k . DATE 5/9/06 PROPERTY ADDRESS 78 Birchill Road Centerville MA 02632 On the above date, the septic system at the address above was Inspected. This system consists of the following: 1., 2-6X8 giock cesspoo 2s., Based on inspection, I certify the following conditions: 2., 7h.is .is not a 7.itie T.ive se/?tic system.1 7h.is .is a .sewage system., 3., Sewage .system .is .in i2ao/2ea woak.ing oadea. at the paesent time.) SIGNATURE• Name: Robert A. Paglini Company: Joseph P. Macomber & Son Inc . Address: P. O. Box 66 Centerville. Mass 02632 = - Phone: 508-775-3338 or 508-775-6412 = ' r , t tJ EWA. JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachf fields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 026.32-0066 775-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECU'i'IVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION yf TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA CERTIFICATION Property Address: .. 78 Birchill Road c'PntAryille MA 02632 Owner's Name: Nancy Pratt Owner's Address: Same Date of Inspection: S./9/n 6 Name of Inspector:(please print) Rob .rt: .A _Pao.l'ini Company Name: _�, 1.Pacom'.e S:o.n Inc. � Mailing Address: Cen eav,.c e,_ a.6.3..02632 Telephone Number: 5 0 8-7. 7 5::3 3 3 8 CERTIFICATION STATEMENT 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 M000). The system: XXX Passes Conditionally Passes Deeds Further Evaluation by the Local Approving Authority . '1 Fa ,, 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 DEP.The original should be sent to.the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""Thisreport 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 differegt conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION:.FORM—.NOT' FOR VOLUNTARY ASSESSM9NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 78 Birchill Road Centerville MA 02632 Owner: Nancy Pratt Date of Inspection: 5/9/0 6 Inspection Summary: Check A,B,C,D or.E/ALWAI'Svomplete all of Section.D A. System Passes:�((SS NO I have not found any information which indicates1hat 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: Sewage .6t1,3tem .is -in Rao Rea woak.ing o2dez at .the Rae4ent tame B. System Conditionally Passes: Noj 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 apllroyed,,by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. NO The 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. . ND explain: NO Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken;settled.or uneven distribution box.System will pass inspection.if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: NO The system required pumping more than 4 times a year due to broken or obstructed pipe(s)..The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2. Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 78 Birchill Road Centerville MA 02632 Owner:. Nancy Pratt Date of Inspection: 5/9/0 6 C. Further Evaluation is Required by.the Board of Health: NO 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: no Cesspool or privy is within 50 feet of a surface water a o Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh e. 2. System will fail unless the Board of Health(and Public Water Stipp�aer;if any)determines that the system is functioning in a manner that protects the public health,safety and environment: no The system has aseptic tank and.soil absorption system(SAS)and the SAS is within 100 feet.ofa surface water supply or tributary to a.surface water supply. L a The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water supply. no The system has a septic tank and.§A&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 v.izua e **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 78 Birchill Road Centerville MA 02632 Owner: Nancy Pratt Date of Inspection: 5/9/0 6 D. System Failure Criteria applicable to all systems:. You must indicate"yes":or"no"to each of the followingfor all inspections: Yes No . X 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 X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less thank"below invert or available volume is less than'/2.day flow X Required pumping more than 4-times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface wgter supply or tributary to a surface water supply: X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within.50 feet of a priva%w.-ater supply well. X 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 coliform bacteria and volatile organic compounds indicates.that the well is free from pollution from that facility and.the presence of ammonia .nitrogen and nitrate nitrogen is equal to or less than ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached.to this forip.] y_(Yes/No)The system&jLs.I have determined that one or more bf 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• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ the system is within 206 feet of a tributary.to a surface drinking water supply X 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 78 Birchill Road Centerville MA 02632 Owner: Nancy Pratt Date of Inspection: 5/9/0 6 Check if the following have been done.You must indicate"yes"or"no"asto each.of the following: Yes No v Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X — Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? �l/$ 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'bp;V 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: Yes no X Existing information.For example,a plan at Fhe Board of.Health. . Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) 5 Page 6 of 11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISP.OSAL.-SYSTEM.-INSPECTIO.N FORM � PART C SYSTEM:INFORMATION Property Address: 78 Birchill Road Centerville 2632 Owner: Nancy . Pratt Date of Inspection: 5/9/0 6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): .: 3 Number of bedrooms(actual): 3.. DESIGN flow based on 310 CNM 15.203(for example: 110 gpd x#of bedrooms): 3 3 0 Number of current residents: 1 Does residence have a garbage grinder(yes or no):rz o Is laundry on a separate sewage system(yes or no):n-Q [if yes separate inspection required) Laundry system inspected(yes or no),i o Seasonal use:(yes or no): a 2004=33, 000 gaiionz (7%D=90.41 Water,meter readings,if available(last 2 years usage(gpd)):20.0 5=4 :,, 0 0.0 oa i i o n s G/P . D=115.,0 7 Sump PAP(yes or no):Da Last date of occupancy:�n n e z o n-,t COMMERCIAL/ USTRIAL N/A Type of esta nt: Design flowed on 310 CMR 15.203): gpd Basis of design'flow(seats/persons/sgR,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system.(yes or no):_ Water.meter readings,if available: Last date of occupancy/user OTHER(describe): GENERAL INFORMATION Pumping Records Source ofinformatiod. 20/02 .m.ian.t ;.,P., Nacomtez Was system pumped as part of the inspection(yes or no): If yes,volume pumped: 10 0 0 f;allons--How was quantipumped determined? m e a z u 2 e d Reason for pumping: - r-o,A A Q Q n oA 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) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 30 f yeaah 4. _ y Were sewage odors detected when arriving at:the site(yes or no): 20 6 Page 7 of 11 _ OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 Birchill Road Centerville MA 02632 Owner: Nance .Pratt Date of Inspection: 9/Q BUILDING SEWER(locate on site plan) Depth below grade: 2 4" �'`` Materials of construction:_cast iron L_40 PVC_other(explain):My hotbe rV jig f!4 45 o MAJt� e-bUfjc Distance from private water supply well or suction line: 2n Comments(on condition of joints,venting,evidence of leakage,etc.): lo.intz aRrzea/c t ight , Nn o»idanne QA 906ikage- yenieti tough hoaze . vent SEPTIC TANK: n o (locate on site plan)* Depth below grade: Material of construction:_concrete metal_fiberglass polyethylene _other(explain) , If tank is metal list age:_ Is age confirmed by a Certificate of Complianee(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined:. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid.levels as related to outlet invert,.evidence.of.leakage,etc.): Sel2i-ie tank is not R2eze-nt GREASE TRAP: ao(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 4aeaze taaR ,i.6 not Q/Le%enl 7 Page 8 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 Birchill Road C'_r-ntPrvi 1 1 e MA. 02632 Owner: Nanr jz Pratt Date of Inspection: c;1191 6 TIGHT or HOLDING TANK: NO (tank must be pumped at time of inspection)(locate on site.plan) Depth below grade: Material of construction: concrete metal fiberglass . polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and floatswitches,etc.): 71ght olt hoid.inq tanks a/te not .122e,6en.t DISTRIBUTION BOX:NO (if present must be opened)(locate on sitdtlrin) 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 11age into o out of box,etc.): 't.6 1ti ut.-on a o x .is not /2aeZent PUMP CHAMBER: NO(locate on site plan). Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(not co dition of pump chamber,condition of pumps and appurtenances,etc.): l.umR ca�Zml ea .cis not 122e3ent 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 Birchill Road Centerville MA 02632 Owner:. Nancy Pratt Date of Inspection:` 5/9/0 6 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located see /2¢ge 10., Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: 1 innovative/alternative system Type/name of technology: Comments(note condition.of soil,signs of hydraulic failure;level of pordding,`damp soil,condition of vegetation, etc.): Loamy to medium .s¢rzd.- So.iez ate day., No- -6•:i:gns oJ-P 7_0¢.i&,ze.1 Vegetation zz noam¢ CESSPOOLSV e's (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: . Depth—top of liquid to inlet invert: 3`' Depth of solids layer: ►'I Depth of scum layer: �2 Dimensions of cesspool: &VIK Materials of construction: e_ Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of,ponding,condition of vegetation,etc.): Lo¢mu to medium .3and , No .sg.ins o Pai.euae , So.ii,6 ¢ae day., Vegetation .is noama.9 PRIVY: NO (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.): a.ivy 1.6 not /1aezent 9 Page 10 of 11 v`• J OFF CIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SU,�SURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONFORM PART C SYSTEM INFORMATION(continued)' PropertyAddress: 78 Birchill Road Centerville MA 02632 Owner: Nancy Pratt Date of•Inspection: 5/9/0 6 F SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building: . 1 � 10 Page 11 of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 Birch; 11 Road Centerville MA 02632 Owner: Nancy .Pratt Date of Inspection: 5/A/0 6 SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground water e, feet Please indicate(check)all methods used to determine the high ground water elevation: •NO Obtained from system design plans on record-If checked,date of design plan reviewed: u e s Observed site(abutting property/observation hole within 150 feet of SAS) h Checked with local Board.of Health-explain:g 3_ ku i ft ca2d - no Checked'with local excavators,installers-(attach documentation) yez Accessed USGS database=explainAtt/R t town.1 gaanztal ie,,ma..-u,3. You must describe how you established the high ground water elevation: llsed Cape Cod Comm.i ion Cdatea 7akie Codtouas And Pukiie 6late2 Supply Oete head /2.¢otect.io-n a2eaz mad - Sept 1995 JJatea /tezou4cez oeeice cage cod comm.L.ion Leaching Pit Feet Groundwater: /fleet Below Bottom.of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical.separation distance between the bottom ` 1 of the leaching pit and the adjusted groundwater table is feet: ll ' rowN of A� F.BARNST T. BOARD QF 11RA1T11 ,_ y ,9Up8URFACR SEWAtit piBF'USA4 SYSTEM IRSPECTIQN FORM - PART D.- CERTIFICATION ....,.•� -TYPE Olt PRINT CGUM— PROPEItTy M8PC07*ltiD STREET ADDRESS 78 •Birchill Road Centerville 02.632 •— ASSESSORS MAP BLWK AND 'PARCEL OWNER-' NAME _ Nancy.:� Att PARr'.* D 0HJirIF70Ar30N , NAME -OF 'INSPECTOR Rog.eat Pa.041A.1 COMPANY NAME 40"Ah 11acomiiz - Srsn Inc doz 66 ' .Cen4tAv.LUz Oabb' 02632 COh1PANY AUD�ES$ stye. V Town-or 01tV. State- L P COMPANY TEUPHONE { 508. Y�7.5 - 3338 YAX : 1'.508', 790 f 578 W-Un4aw Nov. CERTIFICATION. STATEMENT I certify that, I beivo personal�lY .ins'pected the Qewage •digp0 system at this address and that• ;tti$' information reported ,is true,. aooUra•te-, and omplete' as of the time .af'•inspection.v The Jn4peotio'n was performed and any recommendations regarding upgrade, .ma•intenance,' and repa•ir .afie oon$is'tent with my trainiil,8 and expgrience in th@ ppoper functi-on' and maintenanoe of on- site sewage disposal. systems. , Cheek one; ' System PASD . The inspection which '.I. have .condugted has .,nat' Yoobd any information . which indicated that the s.ystsm fails to '.adeq -tely. protect .public health or the env i.ropmen t as defined in- .310 CMR. 15' 30.3•o 'Any failure criteria *6t evalua 'ed are as stated in the FAI'LUIM CRI.TM 1A ;seation o•f this form. System FAILED* , The inspection which I have o6kV ited -.has .found that the system fails to protect the public health itnd the enV4room' ent ' in acooirdemce with Title 51 310 CMR 15 , 3031 and as • specifioallY noted -on .PA'RT' C - . FAILURE CRITERIA of this inspec'ti n• orm, ' —. Inspector signature' Date. ne' copy of this ceirtifioi;tf:-'n"mu*st -be ovi•ded 'to the' .QUM, tho BUYER' where aypli.oabla) and the DQARD OV HEALTIts „ 1 w / r * If the inapeeLion FAIL'L'b., thb .own�V.oxl"91�erator -whall . upg•rade'•the system. within one year of the da't•e of the inspection, unless: allowed Qr' regK#.,red nt.harwlae as Provided in FAO CHR 15 ,3061, - TON"OF!B�ARN-S/TABLE LOCATION rI !�!� � �504 Cl' SEWAGE#r VILLAGE AS ESS R'S MAP.'&P� EL LUSTA ' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size), NO.OF BEDROO S i OWNER PERMIT DATE: \' COMPLIANCE DATE: (o 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 I !P� • r li i b e � ' A G JAN o 3 2005 COMMONWEALTH OF MASSACHUS ETTS TOWN OF BARNSTABLE EXECUTIVE OFFICE OF ENVIRONMENT H DEPT. DEPARTMENT OF ENVIRONMENTAL P PCO" SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 508-966-2 00 MITT ROMNEY Governor ELLEN ROY HERZFELDER Secretary KERRY HEALEY Lieutenant Governor ROBERT W. GOLLEDGE,Jr. Commissioner URGENT LEGAL MATTER:PROMPT ACTION NECESSARY December 22,2004 New Colony Oil Co/Red Wing Oil RE: BARNSTABL (Centerville)-, BWSC PO Box 2328 Brchliill Roa Centerville,Massachusetts 02632 RTN#4-18817 NOTICE OF RESPONSIBILITY M.G.L. c. 21E,310 CMR 40.0000 ATTENTION:Rick Mahoney On December 9, 2004 at 7:12 pm the Department of Environmental Protection (the "Department") received oral notification of a release and/or threat of release of oil and/or hazardous material at the above referenced property which requires one or more response actions. During a home heating oil delivery, the aboveground storage tank was overfilled resulting in a discharge of oil thru the air vent which contaminated soil adjacent to the foundation of the house and garage. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c,21E, and the Massachusetts Contingency Plan (the "MCP"), 310 CMR 40.0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. ' The Department has reason to believe that the release and/or threat of release which has been reported is or may be a disposal site as defined by the M.C.P. The Department also has reason to believe that you(as used in this letter, "you"refers to New Colony Oil/Red Wing Oil)are a Potentially Responsible Party (a "PRP") with liability under M.G.L. c.21E §5, for response action costs. This liability is "strict", meaning that it is not based on fault,"but solely on your status as owner, operator, generator, transporter, This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. DEP on the World Wide Web: httpJAvww.mass.gov/dep 0 Printed on Recycled Paper :1 2 disposer or other person specified in M.G.L. c.21E §5. This liability is also "joint and several", meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties. The Department encourages parties with liabilities under M:G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials.By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the Department in taking such actions. You may also avoid the imposition of,the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L. c.21E is attached to this notice. You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. The Department encourages you to take any action necessary to protect any such claims you may have against third parties. At the time of oral notification to the Department,the following response actions were approved as an Immediate Response Action(IRA): • Removal of the aboveground storage tank. Provision of temporary ventilation. ACTIONS REQUIRED Additional submittals are necessary with regard to this notification including, but not limited to,the filing of a written IRA Plan, IRA Completion Statement and/or an RAO statement. The MCP requires that_a fee of$1200.00 be submitted to the Department when a RAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the Department for the implementation of all IRAs pursuant to 310 CMR 40.0420. A completed Release Abatement Measure (RAM) Plan must be received by the Department prior to the implementation of any Release Abatement Measure pursuant to 310 CMR 40.0443. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. In addition to oral notification, 310 CMR 40.0333 requires that a completed Release Notification Form (BWSC-103, attached) be submitted to the Department within sixty(60) calendar days of December 9,2004. You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals by calling(617) 556-1145 or visiting http://www.state.ma.us/lsp. Unless otherwise provided by the Department, potentially responsible parties ("PRP's") have one year from the initial date of notification to the Department of a release or threat of a release,pursuant to 310 t w 3 CMR 40.0300, or from the date the Department issues a Notice of Responsibility,whichever occurs earlier, to file with the Department one of the following submittals: (1) a completed Tier Classification Submittal; (2) a Response Action Outcome Statement or, if applicable, (3) a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is December 9,2005. If required by the MCP,a completed Tier I Permit Application must also accompany a Tier Classification Submittal. This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c.21E and the MCP. If you have any questions relative to this Notice, please contact Mark Jablonski at the letterhead address or at (508) 946-2819. All future communications regarding this release must reference the following Release Tracking Number: 4-18817. Very truly yours, Richard F.Packard,Chief Emergency Response/Release Notification Section P/maj/bhh 4-18817nor Attachments: Release Notification Form;BWSC-103 and Instructions Summary of Liability under M.G.L. c.21E Department's guide to hiring a Licensed Site Professional. Cc: Board of Health Board of Selectmen Fire Dept Nancy Pratt 78 Birchhill Road Centerville,Massachusetts 02632 LEGEND PARCEL ID: "PARCEL ID: ` CENTERVILLE + 189/031-008 PROPOSED CONTOUR ' 1'89 1 5 PROP. 1 ,50OG PARCEL 1D: ® PROPOSED SPOT GRADE �q. =o _ •05,1Oft SEPTIC TANK 189/031-007 f EXISTING CONTOUR ' --g8 -- O Jv Q ♦,' ,', � Z� 2 � - '000.,, + 96,52 EXISTING SPOT GRADE "�' ,' 2�'2° 0 1 143.50 W— EXISTING WATER SERVICE �5 qM wAY QO _ 6 LOCUS TEST PIT J'i O� / , / /' 22"OAK ♦ / / �' PINS 11.52 Insp Ports ♦ i i i Q i _J VQ i / ' ' ' O• / / SP ' o �'0"o K ,OAKS ,,' TH-2 LOCUS MAP i „ 4"OAK N�6o ',/ ' ,' , ', ',� ,' , ' , ' ,' ,l � ♦ � LOCUS INFORMATION ' 16" PLAN REF: 477 36 �3 ..� ' ' ,' �',' ,' � ' E �stin Ces oo/s �� rn / 8 '�� 9 P T \1 0i TITLE REF: 21794/64 $ ` (Note 10)i / ` fV PARCEL ID: MAP 189 PAR. 23 9 8� ' ' ,' ' / %' ZONING: "RC" FLOOD ZONE: "C" IO ►� `' 24" g COMMUNITY PANEL: 250015-0001-D DATED:07/02/92 10"MAP TBM: BLHD PA p Sj PINE i / ELEV==51.0 N �x co 1O'�AK ��- ,..- SEPTIC SYSTEM d �i ,,,,,,,,,,, , , 1 , PARCEL ID: " REPAIR PLAN a """' ' ' " I 189/024 LOCATED AT: ♦ (D i #78 I GAR. #78 BIRCHILL ROAD ♦ TOP OF FND ELEV=51:0 CENTERVILLE, MA GENERAL NOTES: W, , y PREPARED FOR w DEDECKO/FNMA 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS i 0I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE I O LOCAL RULES AND REGULATIONS. W JULY 25, 2012 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \` ` I �0 + \ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE ' DESIGN ENGINEER. is OF A1gsS 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING PARCEL ID: ` FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN \ 1 O� p ��� �Cy ENGINEER BEFORE CONSTRUCTION CONTINUES. 189/022 ;p D pm Gr 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. PARCEL. ID: I \ Y�R 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF j O m No. 1140 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 3 189/023 v HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. p Z AREA=20,892f S.F. ` 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. IC/S(t�`" 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED I f NIT TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. \ ` "1 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY i ` `� I ; / THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING ` I CONSTRUCTION. 10. EXISTING PITS TO BE PUMPED AND FILLED W/ CLEAN MED. SAND11. 12. rHiS PULANNSTICE TO BERUSEDI FOER CERTIFICATIONR SEPTIC SYSTEM PURPOSES ONLY I� 32•69 �� _ l , MEYER �C SONS, INC. x AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY \ —3$.20 71.25 50 W 60- -- ` �- - ---------------------1----------------=�R9 P.O. B 0 X 981 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHINGQ�-'-'"-�EOP R� 14. ALL PIPE TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) EAST SANDWICH, M A. 02537 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE WI A GARBAGE GRINDER B I R C H I L L ROAD 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING SHEET 1 OF 2 J 1449 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:47.74 FOR A DISTANCE OF 15.' AROUND THE J PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=51.0 INSTALL RISERS & COVERS OVER- INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER 14' `s OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. INSTALLED F.G. EL.=50.0f F.G. EL.=50.0t F.G. EL: 51.0t F.G. EL: 50.70(MAX.) LENGTH OF Mq J9 9'45" o� DARR �yG 9" MIN COVER/ ME R L 20't ' 36" MAX COVER L = 30' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) CD ' 0 S=1% (MIN.) - EL. = 49.25 0 S=1% (MIN.) 0 S=11% (MIN.) 12.37" No. I 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC to" 14 8' 10.75" TOG/S1E INVERT ' NITA��A� INV.=48.10 4B"uouiD kNV.= 47.85 INV.= 47.28tEVEcPROPOSED COUPLER DETAIL GAS BAFFLE D-BOX INV.=47.38 4 ROWS OF 6 UNITS ® 5'/UNIT + 1 COUPLERS 0 1.16'/UNIT = 31.16'/ROW I INV.=47.5 DB_� SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED 1.500 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND INV.=48.50 TO TOP OF CHAMBERS -- 60' NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING .;; :..::•,.: : . ,: PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=47.74 2) TANK AND D-BOX SHALL BE SET LEVEL AND INV. ELEV.= 47.28 TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 46.41 EXISTING SUITABLE 310 CMR 15.221(2) 2.88' MATERIAL 3) INSTALL INLET & OUTLET TEES W/ 5' MIN. ABOVE BOTTOM OF GAS BAFFLE AS REQUIRED T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.88' = 11.52' (6.31' PROVIDED) USE 4 ROWS OF 6-ADS ARC 36HC 4) INSTALLER MAY SUBSTITUTE A POLY TANK IF NEEDED, ADJ. GROUNDWATER EL.=40.10 - (H20) UNITS - NO STONE W/ 1 COUPLERS TANK MUST MEET 310 CMR 15.226 (2)(b) REQUIREMENTS. IN EACH ROW ' SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S.. a.TA 16" i DESIGN CRITERIA SOIL LOG P#:13703 NUMBER OF BEDROOMS: 4 BEDROOM DESIGN - NO PROPOSED INCREASE IN FLOW DATE: JULY 24, 2012 SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION iNiER r SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONALD DESMARAIS, BA� Depth R7NSTABLE BOH HEIGHT END CAP Elev. DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 440 G.P.D. TP-1 Depth Elev. TP-G GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 51.1.20 0" 51.10 O" ADS - ARC 36HC CHAMBER (H20 LOAD SEPTIC TANK: 440 gpd x 200% = 880 gpd USE PROP. 1,500 GALLON SEPTIC TANK A LOAMY �D A LOAMY SAND MODEL ARC 36HC DISTRIBUTION BOX: 4 OUTLETS (MINIMUM) / LENGTH 63" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT 50.53 B 8" 50.43 B 8" EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY ° LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F. LOAMY SAD LOA 6/4 MY SAD SIDE WALL HEIGHT 10.75" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 6/4 OVERALL HEIGHT 16" PRIMARY S.A.S. 48.11 37" 48.01 37 OVERALL WIDTH 34.5 USE 4 ROWS OF 6 - ADS ARCHC 3616 H2O UNITS-NO STONE HiLLIARD, OHIO 4JO26 MEDIUM MEDIUM 10.7 CF • I AND EXTENDED 1.16° W COUPLER IN EACH ROW SAND l SAND CAPACITY 80.0 GAL ADVANCED oRaNACE sYsrEMs wc. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) 2.5Y 6/4 2.5Y 6/4 (CHAMBERS: 6/ROW)24 UNITS x 5.0 LF x 4.80 SF/LF = 576.00 SF PERC O 45.70 PROPOSED SEPTIC SYSTEM SITE. PLAN rr (COUPLER: 1/ROW) 4 UNITS x 1.16 LF x 4.80 SF/LF = 22.27 SF 40.20 132" 40.10 132" TOTAL AREA = 598.27 SF 78 BIRCHILL ROAD, CENTERVILLE, MA PERC RATE <2 MIN/IN. ("C11" HORIZON) Prepared for: Dedecko/FNMA DESIGN FLOW PROVIDED: 0.74GPD/SF(598.27SF) = 442.72 GPD > 440 GPD req d NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN Meyer&Sons,Inc. dlecDouz&R Survey NTS D.M.M. • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX981 (508) 419-1086 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam In October, 1999. 508.9622922 07/25/12 D.M.M. 2 Of 2