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Home My WebLink About0084 BIRCHILL ROAD - Health 84 Birch Hill Road,Centerville A= r �1+01tycro�� UPC 12534 No. 2-153LOR k`�ST-coet�� HASTINGS, MN No. e ��G / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC tiE ALTH DIVISION - TOWN OF BARNSTABLE,'MASSACHUSETTS Ye 01ppliLation for ZispoSal *pstrm Co6truttion permit Application for a Permit to Construct( ) Repair( ) Upgrade)0 Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 9'(+ Bif�i(HILL. R'O d6V > Owner's Name,Address,and Tel.Np. p � ��o(g ok 1e�)CRv i ST � 5Rt0�1U 6 _ A Assessor's Ma /Parcel Installer's Name,Address,and Tel.No. 509—477- $$7'7 Designer's Name,Address and Tel.No. 50$-a'13—0 311 _4PEw1Dr✓ &Jlegj 15� Lie �G LwCsfoozkikk� µc CI L pc:r a85 CFJ l WAMAAM Type of Building: Dwelling No.of Bedrooms 3 Lot Size /4Pj l 00 sq.ft. Garbage Grinder( ) Other Type of Building RE'S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 33 , gpd Plan Date Number of sheets Revision Date Title AcH I Lj. , 90Ab Size of Septic Tank 1500 300 A COOAVWltZi Type of S.A.S. 18 60',RC HiN USlt)b Description of Soil S .A w 60,4RSE S'A01b (Q— Nature of Repairs or Alterations(Answer when applicable) t ms-U4-Lt, u IS�'Seo J*V j4 w i-CA Polur cA>i X&u L L�& AR.0 5(el4 N-.).A Q)joOI�c�.S Iki -VIjab drjWrIGc 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 He Signe Date pp l Ap plication Approved y Date y� Application Disapproved by Date for the following reasons Permit No. , (// Date Issued 1r - No. A 1/ — \ Fee TPE COMMONWEALTH OF MASSACHUSETTS Entered in computer: yPUBLICLYIEA&TH D1 1S1 N -TOWN OF BARNSTABLE, MASSACHUSETTS Ye . v. 4plication for 33isposai 6pstem Cotts11*uctlon Permit Application for a Permit to Construct( ) Repair( ) Upgrade(V Abandon( ) ❑Complete Syssltem� ❑Individual Components Location Address or Lot No. 94 [3wo WLl. RD cQ-r- Owner's Name,Address,and Tel.Np. Assessor's Map/Parcel (p D NA som -r +gw a C''MppL,V 6 , A Installer's Name,Address,and Tel.Tko. 5U8-47.7- S76'1 Designer's Name,Address,and Tel.No. 5C)%.';I-l3 .p 311 C' 4PEWIDe EiJZ WSeS LV_ :IG �t►1Cx�IJtZ A1✓ s nth' ��S cR.A� W P.E r4 Type of Building: Dwelling No.of Bedrooms Lot Size 14P jj 7 O Q sq.ft. Garbage Grinder( ) Other- Type of Building 4 No.of Persons Showers( ) Cafeteria( ) Other Fixtures/ Design Flow(min.required) _go gpd Design flow provided a gpd 1 � Plan Date Number of sheets Revision Date Title E!AcH I Lk,, ;Z64b Size of Septic Tank pp/op A GdsfypA'tg�%CiType of S.A.S. IFS AFZ�L RC Had P)IM kER t5CQS Description of Soil S ^ LAW Nature of Repairs or Alterations(Answer when applicable) m tlet—a ) b-0604 M IQ A.R 3In14 -a4 Q-)lnQ1VMr,-0&C 1LJ VIEW Date last inspected: Agreement: L 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 Heal Signe Date Za I� Application Approved y Date Application Disapproved y Date for the following reasons - I, Permit No. --�3 Date Issued ----------- ---------------------_- - - - ---------------------- ------------------------ �' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by !APr=jR)IjF Ewxeamleces LLC. 'j at has bben constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer A(PFLej(br E&nggWjeS A_A,e Designer 'SG ,' -tic #bedrooms 3 Approved design flow 3*3-N,.4 gpd The issuance of this permit shall of be co trued as a guarantee that the syst 'H n .i o esigned. � Date � ��.,_ Inspect ---------------------------------------------------------------------------------------------------------------------------------------- No. ✓ � ( Fee "--00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC-HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS I Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade()�) Abandon( ) System located at !2 4 Pj l(Z CN.i U_, QA C eWTECV 14.L 5 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 compldte rithin three years of the date of this permit. Date ) ApproveYb� �. TOWN OF BARNSTABLE ,-LOCATION Rd SEWAGE# zo I(_ gq q VILLAGE ,�- ,ny� ��°l. ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. —a 1p e l v �e� E n4cr�pr ism 10 '4 111 SEPTIC TANK CAPACITY 15'00 G Ar ARC 3c Mo +3 LEACHING FACILITY:(type) diod;f5uscn r,"I'3_ (size) 31,d X S' NO.OF BEDROOMS 3 OWNER Ro(o-er� C. Grnelou,s-+ + E"Lsnc, Pine, DATE: 1 I I'd '�t COMPLIANCE DATE: Separation Distance Between the:Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Alone- Enr 0Un'k_J eet 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/-}D. yzlJ e e-q1 i- y")-e0 ut't. A- I-3 .Y/ 1 Oecic a-a=a�:s� A-3=3g;5 r 1 A-7=35;5ac 11 r45� , .. 4-.1 -30,3� 13-6=37.�5 r - , r G-5-3317� 1/24/2012 23 :29 5082730367 #0850 P. 001/001 Town of Barnstable Regulatory Services 4 Thomas F. Geiler,Director : Public Health Division 0is0jq'�' Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 1-2 5- (2 Sewage Permit# t-t- 399 Assessor's Map/Parcel (B q 1 a2 Installer&Designer Certifica tion Form Designer: SC Encxtoe.e.cto5 , 'Tv�C. Inst:zlier: Caeewid►e_ ��EErpccses Address: 2 8.s y A-4nwoy Address: ?o Goy- -7(03 T t Past wo(6norn� HA 02,53 Sob-Z73-6377 D2fo3 2- On III Lk zoll ;JL (1i `;3 e1 way, issued a permit to install a (date) (installer septic system at 81I B(r&il l load _based on a design drawn by (address) -1 C En5tne_eci!r 5 , Tvne. dated 4cWper 26 ,2 o I (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved chunges such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 1 certify that the septic system referenced above Naas 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. Stripout (;,'required) . s ected and the soils were found satisfactory. �� JOHN L. CHURCHILL n (I ler's Signatu ) JAft R. 410 esigner s Signature, (A1"flx De gn Here) P SE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED luN T L HOTH THIS FORM AND AS- BUILT CARD ARE RECIE.1VED 0Y THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. gAoflice r'ormsldesignercertifieation form.doc Town of Barnstable P 0 ' Departitnent of Regulatory Services J > ) 9 Public Health Division Date xusa. 161 200 Main Street,Hyannis MA 02601 Date Scheduled ! ��/ Time Fee Pd. 1ST oil Suitability Assessment for Se age Disposal Performed By: H i Lm�( Q(syl en � Eif� GS C Witnessed By: i �LO� CATION& GENERAL INFORMATION Location Address L-1 Lam►rcL,a k� (j,-_ 0 Owner's Name e.P�h �-V'�`k�-e- Address Assessor's Map/Parcel: O-L Engineer's Name c4v,-W:d-t NEW CONSTRUCTION REPAIR Telephone# ��7 v S 56 8"2 73-6 3 77 Land Use 5i4a le Fcani(�a �welli Slopes(96) 2" y Surface Stones Distances from: Open Water Body ft Possible Wet Area 7i00 ft Drinking Water Well - ft Drainage Way - ft Property Line > 10 G ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) s�• a{Eac�c� Q(ten Parent material(geologic) Qi9t`uos� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 7124 (p�-S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 1.0 P—( 6Ws W a ltvvt Depth Observed standing in obs.hole: 7 t 2p in, Depth to loll mottles: Depth to weeping from side of obs.hole: In, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level ____ Adj.factor. Adj,Oroundwater Level..,7, PERCOLATION TEST Ditto ja-17-11 Thna jl;o 3+44 Observation Hole# Time at 9" Depth of Perc y�5 tJ� r Time at 6" Start Pre-soak Time @ ��'b 3 N% Time(9"-6") End Pre-soak Rate Min./Inch 4 ?- Site Suitability Assessment: Site Passed �PS Site Failed: "- Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back--------= ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistcnCy.%'Graven 29. 30 R L S jUYr34 L S 16V - y�- 2d H-C S 2. 5 Y 6 6 .5`.J fave,l DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,.%Grave r4l 2y-3o LS /DUr3/� y6-/20 C. M-G5 . 2_ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i tc c G DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes, ' Within 100 year flood boundary No. Y�Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? a 5. If not,what is the depth of naturally occurring pervious material? Certification I certify that on �d-2 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 training,expertise and xperienc a ribed in10 CMR 15.017. Signature Date QAS.EPTlWERCFORM.DOC t t COMMONWEALTH OF MASSACHUSETTS x EXECUTIVE OFFICE OF ENVIRONMENTAL.A.FFAIRS / l> DEPARTMENT OF. ENVIRONMENTAL PROTECTION d 350 MAIN STREET WL,S"f YARMOUTH.MA 5f.18-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 84 BIRC11111L1,ROAD ` CINTERVILLE,MA 02632 Owner's Name: WILLIAM'1'13G Owners Address: 84 BiRCH HILL ROAD CENTERVILLE,MA 02632 Date of hispection MAY 18,2001 Name of Inspector:(please print) JAM1 S 1).SEARS Company Name: A&13 Canco Mailing Address: 350 Main Street West Yannoulli,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected (lie sewage disposal system at this address and that the information reported below is true,accurate and complete as oldie 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 1.5.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: _ Date: The system inspector shall subunit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 3O days of completing this inspection. if the system is a shared system or leas 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 tot he buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSES. SYSTEM 1S TWO OLD CESSPOOLS. ****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 mill perform in the'future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N.ND)in the for the following statements. If"not determined" please explain. 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 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: 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: _ 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: Title 5 Inspection Form 6/15/2000 2 i Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 C. Further Evaluation is Required by the Board of Health: N/A 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 salt marsh 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 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 eater supply well". Method used to determine distance ** 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 84 BIRCH HILL ROAD CENTERVILI MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes" or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N/A 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 than 6"below invert or available volume is less than 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 water 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 private water 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)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: N/A To be considered a large system the system must service 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 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 I1 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 Check if the following have been done. You must indicate"yes" or"no"as to each of the following Yes No X 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? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X Were the manholes uncovered,opened,and the interior inspected for the condition of the tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum. X 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY M 2001 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT C OMMERCIALANDUS TRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system X Cesspool X 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): N/A 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 Compliance(yes or no): (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to the 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(located on site plan) N/A 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: Continents(on pumping recommendations,nnlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage;etc.): Title 5 Inspection Form 6/15/2000 7 �I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 TIGHT or HOLDING TANK: N/A (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 Continents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): l Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: X overflow cesspool,number: 1 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.) ONE BLOCK OVERFLOW CESSPOOL.6'X6'COVER,8"BELOW GRADE. F WATER,NO HIGH STAIN LINE,WALLS CLEAN. CESSPOOLS' X (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: I Depth—top of liquid to inlet invert: 101, Depth of solids layer: 2" Depth of scum layer: 0" Dimensions of cesspool: 6'X6' Materials of construction: BLOCK Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): MAIN POOL,BLOCK.ON INLET WITH TEE.ONE OUTLET WITH TEE.COVER 8"BELOW GRADE. PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 9 or 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 1311ZCI 11111,1,IWAI.) C-NTERVILLG,MA 02632 Owner: TLG,WILLIAM Date of Inspection: MAY 18,2001 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. D� - r Title 5 Inspection Form 6/15/2000 1('1 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 BIRCH HILL ROAD CENTERVILLE,MA 02632 Owner: TEG,WILLIAM Date of Inspection: MAY 18,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 8+ feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation 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 TAKEN OFF PAST INSPECTION REPORT ON FILE AT BOARD OF HEALTH. Title 5 Inspection Form 6/15/2000 11 i CO'M'MOXWE?,LTH OF MASSACHUSETTS 1; EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS F_ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE X'I\TER STREET, BOSTON MA 0210F (617) 292-550u ' TRUDY CONE Secretan• ARGEO PAUL CELLUCCI DAVID B. STP.L'HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 84 Birch Hill Rd.. Name of owner Wm. T e g Centervil_.e , MA Address of Owner: Same Date of Inspection: Name of Inspector:(Please Print)Wm. E . Robinson S r . 1 am a DEP approved system!inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) �„P„yName: Wm. E . Robinson eptic Service Malting Address: PO Box 1089, Centerville ,—MA MA Telephone Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: V Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to ttte system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS 1 11") s REt?IVEQ AUG 2 ® 1999 roftOF 4, E � revised 9/2/98 Page Iof11 i� �r led on Recycled Pape, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) "ropertyAddress: 84 Birch Hill Rd.. , Centerville , NA Jwner: Wm. T e g Date of Inspection: /`` Q INSPECTION SUMMARY: Check A, Q C, Or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicat yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed i revised 9/2/98 Page 2of11 I� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 84 Birch Hill Rd.. , Centerville , MA Owner: Wm. T e g Date of Inspection: 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 the public health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH IAND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3 OTHER revised 9/2/98 Pagc3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 84 Birch Hill Rd.. , Centerville , MA Owner: Wm. T e g Date of Inspection: D. S STEM FAILS: You mu indicate either "Yes" or "No" to each of the following: have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this d termination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes N Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution 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 112 day flow. 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion cesspool ortion of a is less-than 100 feet but greater than 50 feet from a private water supply well with no P or privy Y acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE YSTEM FAILS: You must ind cate either "Yes" or "No" to each of the following: Th following criteria apply to large systems in addition to the criteria above: Th system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public he Ith and safety and the environment because one or more of the following conditions exist: Yes N 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) The owner r operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address: 8.4 Birch Hill Rd.. , Ce-nterville , MA ` Owner: Wm. T e Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the.following: Ye;/ No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. v _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. v _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. V _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: A _ Existing information. For example, Plan at B.O.H. (/ _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)] _ The facility owner (and occupants,if different from owner) were provided with information on the propermaintananrw-0f SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Irop"Address: 84 Birch Hill Rd.. , Centerville , MA Owner: W e i m. Te Date of Inspection: gg Q FLOW CONDITIONS RESIDENTIAL: Design How:36 (" g.p.d./bedroom. Number of bedrooms(��n):j Number of bedrooms (actual); Total DESIGN flow_ Number of current residents: Garbage grinder Iyes or no):_A,e7 Laundry Iseparate system) lyes or no)iA d; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no)*? Water meter readings, if available (last two year's usage (gpd): 1998 56, 000 gal. Sump Pump(yes or no):Af v 1997 41 , 000 gal Last date of occupancy:'/Y-9 y COMMERCIAL/INDUSTRIAL: Type o establishment: Design low: qpd ( Based on 15.203) Basis of design flow Grease ap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non•sa tary waste discharged to the Title 5 system: (yes or no)_ Water eter readings,if available: Last d e of occupancy: OTH die Last a of occupancy: GENERAL INFORMATION PUMPING RECORDS and sVrc; of informatigr' Q System pumped as p(rrtt of inspection: (yes or no)_ If yes, volume pumped: gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: . Sewage odors detected when arriving at the site: (yes or no) revised 9/2/96 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 84 Birch Hill Rd. , Centerville , MA Owner: Wm. T e g Date of Inspection: J7 g BUIL NG SEWER: (Locat on site plan) Depth elow grade:_ Materi I of construction:_cast iron_40 PVC_other(explain) Dista ce from private water supply well or suction line Di eter Com ants: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_o Iloca a n site plan) Depth elow grade:_ Materi of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank i metal,list age_ Is.age confirmed by Certificate of Compliance_ (Yes/No) Dimensio s: Sludge do pth: Distance rom top of sludge to bottom of outlet tee or baffle: Scum thii kness: Distance rom top of scum to top of outlet tee or baffle: Distance rom bottom of scum to bottom of outlet tee or baffle: How di ensions were determined: Comm nts: (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidenc of leakage, etc.) GREAS TRAP: ' (locate o site plan) Depth bel w grade:_ Material o construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimension Scum thick ess: Distance fri im top of scum to top of outlet tee or baffle: Distance fri im bottom of scum to bottom of outlet tee or baffle: Date of Iasi pumping: Comments (recomme dation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) IropertyAddress: '84•B,.ingh Hill Rd.. , Centerville , MA Owner: Wm. T e g Date of Inspection:"wel'r TI HT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (loc to on site plan) Dept below grade:_ Materi I of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensi ns: Capacit gallons Design I low:_gallons/day Alarm p esent Alarm le vel: Alarm in working order: Yes_ No_ Date of revious pumping: Comme ts: (conditi n of inlet tee, condition of alarm and float switches,etc.) D TRIBUTION BOX:_ (lo ate on site plan) Dep of liquid level above outlet invert: Corn ents: (note i level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate on site plan) Pump in working order: (Yes or No) Alarm in working order(Yes or No) Comme ts: (note co dition of pump chamber, condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8ortl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'fop"Address: 84 Birch Hill Rd.. , Centerville , MA Owner: Date of Inspection: •'�g 9 9 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dime nsi s: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil s' nsIS of hydraulic failure, lev I of ponding, damp soil, condition of vegetation, etc.) � - CESSPOOLS:_ f- . (locate on site plan► � ) - Number and configuration: _ Depth-top of liquid to inlet invert: Depth of solids layer: 3-1i r� Depth of scum layer: Dimensions of cesspool: ' Materials of construction: 6 C, S Indication of groundwater: A_ d inflow (cesspool must be pumped as part of inspection) Comments: i (note condition f soil, sig of h draulic failure, level of pondin,9, conditi of ve etation, etc. josolids: e plan) construction: Dimensions: ds: n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revise; 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) "rop"Address: 84 Birch Hill Rd.. , Centerville , MA )wrw: Wm. T e g . Jute of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) f 7 i �(A) revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) rope"Address: 84 Birch Hill Rd.. , Centerville , MA Owner: Wm. T e g Date of Inspection: ,/Lj 9 T NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells i Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions r✓Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you es.tqblished the High Groundwater Elevation. (Must be completed) revised 9/2/96 Page 11of11 bA r A&K SEPTIC SYSTEM. Commonwealth of Massachusetts PLUS Executive Office of Envronmenta(Affaidoc 1�°Septics repaired, replaced, redesignE Department o f tS Complete from permits to landscapE Environmental Protection, �` � ;540=6706 William F.Wold Trudy Cox* GoMrrar gecret,y Atpeo Paul uod David B.Struhs Lt Oowmor commrNorrr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAddr*ss: 84 Birch Hill Rd. Centerville, Ma. Address of Owner. Dom & Ellen Savarese Date of Inspection: 7/19/96 (If different) 22 Hamilton Rd. Name of Inspector. Brian T. Axon Arlington, Ma. 02174 Company Name,Address and Telephone Number. CERTIFICATION STATEMENT I wrt*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 inspection. ,The inspection was performed based on my training and experience in the proper function and maintenance of omits sewage disposal systems. The system: + Passes _ Conditionally Paws& _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspectoes signature: Date: 7/30/96 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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&hall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A.B,C,or D: A] SYSTEM-PASSES: — •- r + I have not farad any information which indicates that the m violates system any of the failure criteria as defined is 310 CI1Dt 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components n)sed to be replaced or repaired. The system,upon completion of the replacement or repair,passes imPoctiorl Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal.cracked,structurally unsound, shows substantial infiltration or exfiltration,,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 r On*Witter Street a Boston,lrtassachusetta 02108 * FAX(617)5WI049 * Telephone(617)292.uW Printed on Recycled Paper it . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM PART l� CERTIFICATION(oontiaued) Property Address: 84 Birch Hill Rd.., Centerville, 'Ma. Owner. Ellen Savarese Date of Inspeotione B)SYSTEM CONDITIONALLY PASSES(contiausd) Sewage backup or hroakout or high static water level observed in the distribution boat is due to broken or obstructed pipe(s) or due to a broken,'Mttlod or unma distribution boat. The system will pass inspection if(with approval of the Board of . T—. broken pipe(s)are replaced obstruction is removed . distribution box is levelled or replaced Tbs system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with al�praval of the Board of Health): -,---- broken pipe(s)are replaced obst uctioa is removed C) FURTHES EVAL JATION I8 IUIRED BY.gE BOARD OF HEALTH:.: .. - ' . Ccauu#aais exist which require lisrther evaluation by the Board of Health in order to detarmins if the System is failing to protect the Pic health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 14 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: CmsP001 or PAW is within 60 fest of a surf&*water -- C069001 or privy is within 60 feet of!bordering vegetated wetland or a salt marsh !) $YSTE1t"WILT," 'AQ.UNLESSlI TIM BOARD'OF HEALTH(AND PUBLIC WATER,8t*P1JER,IF APPROPRIATE) D 'TIYATT It--SYSTEM I8'FIJ iCTIONINa IN A Ui NNER TAAT PROTECT THE PUBLIC HEALTH AND SAFETY AND,3TgE! rZ V..WNMEN'Pt The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surfaos water Sup*. The system has a septic tank and soil absorption system and is within a Zone I of a public water sup*wren. — The system has a septic tank and foil absorption system and is within 60 feet of a private water supply w a — The system bona ssptle tank aced soil absorption system and is lam than 100 feet but 60 feet or more from a private water sup*well,unless a will,water,aaalyais for oolifosm baleria and volatile organic compounds indicates-that the well is free from polhition fiva that be ity and the presence of amntonia-nitrogen and nitrate nitrogen is equal to or less than 6 PPS $) OTHER , a.• S�' p1 Yi1.�� r 'U'.'}it rj E " ' ih ..tit. (revised 11/03/95) a �. 1- :d r,.�..;1;�'r� mot... , z:=.. •• _, ;�: ,. , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 84 Birch Hill Rd. Cen. Ma. Owner. -Savarese Date of Inspeotion: 7/19/96 DI SYSTEM FAnJk I haw determined that the system violates one or more of the following failure criteria as defined in 310 CMIt 16.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid burl in the distribution boo:above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number of times pumped. Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. a Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality,analysis. If the well has been analyzed to be acceptable,attach copy of well water anabsis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: r The system serves a facility with i design flow of 10,000 gpd or greater(Large System)and the system it a significant threat to public health wad safety and the environment because one or more of the following conditions east: 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 t 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) The owner or operator of any such system£@hall bring the system and facility into Rill comPkianoe with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for Anther information., (revised li/03/95) 3 r SUBSURFACE SEWAGE DISPOSAL BYSTEM'INSPECTION FORM PART B CHECKLIST PropsrtY Add& 84 Birch Hill Rd. Cen. Ma. Owner. Savarese Date of Inspeot{on;7/19/96 Check if the following have been done: -�Pumping information was requested of the owner,occupant,and Board of Health. Now of the system components have been pumped for at least two weeks and the system has bsen receiving normal flow rates durin8 that Pew Large volumes of water have not been introduced into the system recently or as part of this inspection. L/14U built PkM have been obtained and examined. Note if they are not available with N/A _F The facility or dwelling was inspected for signs of&swage back-up. The system doe&not receive non-sanitary or industrial waste flow +The site was inspected for signs of breakout. -_-A11 system components,ezCluding the Soil Absorption System, have been located on the site. +Ths septic tank manholes were uncovered,opened, and the interior of the septic tank was ins teas,material of construction,dimensions,depth of liquid,.depth of sl depth off for condition of baffles or �� P scum. --+The sin and location of the Soil Absorption System on the site has been determined based on existing information or aPlu mated by non-intrusive methods. . --tThe facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreas: 84 Birch Hill Rd. Cen. Ma. Owner. Savarese Dale of Inspection: 7/19/9 6 FLOW CONDITIONS RESIDENTIAL: Design flow 330 gallons Number of bedrooms: 3 Number of current residentr._3,_ Garbage grinder(yes or no):—Yes Laundry connected to system(yes or no):Yes Seasonal us*(yes or no):Ye s Water meter readings,if av`ai']•a : 20'm Last date of occupancy: 7 15 96 COMMERCIAL/INDUSTRIAL. Type of establishment: N/A Design flow:_gallons/day Grease trap present: (yes or no)—, Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 6 system: (,yes or no)____ Water meter readings,if available: Lost date of oocupancy: OTRER:(Describe) Lost data of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: ' " diameter running System pumped as part of inspection:(yes or nodes over cesspool covers. If yeas,volume pumped: gallons Reason for pumping: To c eck sidewall and arourndwater infiltration TYPE OF SYSTEM Septic taals/distribution box/soil absorption system Sin&cesspool + Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: 31 Yrs Permit 10/14/65 Sewage odors detected when arriving at the site:(yes or no)No_ (revised 11/03/95) 6 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propertr Addrem 84 Birch Hill Rd. Cen. Ila. Owner. Savarese Date of Inspection: 7/19/96 SEPTIf;TAN&, /A (locats an site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(ezplain) Dimensions: Sludge depth:_ Distance film top of sludge to bottom of outlet tee or baffle: ' Scum thickness: Distance&M top of scum to top of outlet tee or baffle: ~ Distance from bottom of scum to bottom of outlet tee or baf le: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffies,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) wT�n GREASE TRAP:_' (locate on site plan) Depth below grade: Material of oo om:_Concrete_instal_TW_other(e:plain) Dimensions: awn thickness: Distance from top of scum to top of outlet tee or baffle: Distance!lam bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for loping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) 3 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrem 84 Birch Hill Rd. Owner. Savarese Date of Inspectionj/19/86 TIGHT OR HOLDING TANKa-X�A (locate on site plan) Depth below grade: Material of construction:_concrete_metal_M_other(e:plam) Dimensions: Capacity: sslloas Design flow: aallons//dsy Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BO&.WA (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distrabution is equal,evidence of solids carryover,evidence of leakage into or out of boat,etc.) PUMP CHAMBER:M/A ... (locate on site plan) Pumps in working o:der(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised ii/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 84 Birch Hill Rd. Owner. Savarese Date of Inspeotion: 7/19/96 SOIL ABSORPTION SYSTEM(SAS).,, A (locate on site Plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Typs leaching pits,number..,___ leaching chambers,number: . galleries,number: T leaching trenches,number, W—i:�_ leaching fields,number,dimensions: overflow cesspool,number. . Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,ew.) CESSPOOLS. ,S (locate on site plan) Number and configuration: 2 6X6 Rnd Block Depth-top of liquid to inlet invert: 36 Depth of solids layer: 411 Depth of scum layer: 1711 Dimensions of ossspool. 6X6 Materials otconstruction: Concrete Indication of groundwater.: None inflow(oesspool must be pumped as part of*p.Won)_Cesspools were pumped 1000 Gal sidewall Looked fin ran w er t es unc ion a ween f ow ess col was r when ire inspec wok s s unc noun ese cesspools lookea Ttt is ,su sted pumping annually orever other 91 axed Cw" (note condition of.oil.signs of hydraulic tailors,levero3 o ; ' pget sP g y Y Y No si aL,of hvdrolic failure Tee had some prus No-sign of brew out PRIVY_NJA (locate on site plan) Material of construction.- Depth of solids: Dimensions: Camnsaft(note conditioziof @,SPs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C [s SYSTEM INFORMATION(oontinued) ! PropertyAddrew 84 Birch Hill rd. Cen. Ma. V— Owner. Savarese Date of Inspsotion:7/19/96 ¢ SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I' n t, `r �f iyy t Ft F t 4 25 DEPTH TO GROUNDWATER Depth to groundwater:8�_feat method of determinatiom or approximation: Second cesspool was drv6' cesspool with 2' riser (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION` T ��Crr �� SEWAGE # VILLAGE C ASSESSOR'S MAP & LOTS'„ G II�iSTACLER'S NAME & PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY d7 c- / v,S' f E 677 o A LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 7£ 45� ' GV o / l /,0," 141S oFrTia DATE P D: �"�' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No . O O aS• �=/P®Aolf �96 LOCATION SEWAGE PERMIT NO. VILLAGE 8-Pch ; c o l �rf INSTA LE 'S A i AD 0�5 6UIL0ER OR OWNER DATE PERMIT ISSUED Zv ,Z7� DAT E COMPLIANCE ISSUED Ao►9T' ry cX FX v Pic . 7" i 00 No.... v _.5 9(v Fizs...... ../...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........ ...... - ...............OF.............��y��'�Ff .............................................. Applira Lion for Dispaii al Works Tow3trnrtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ") an Individual Sewage Disposal System t•��• --....... r .............................................................. .. . --•-__ ................:............•. Location-Add rre`ss ! :....5n. l_-.......... . (�' caner "" { ( -S Addresses E ` flk`'b�lr o:.. f ------- Installer Address Type of Building Size Lot.... �� ✓ '_.-....Sq. feet Dwelling«No. of Bedrooms.�-------------•-•-••-•----__---.-•---Expansion Attic ( ) Garbage Grinder ( ) C14 Other—Type•of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -----••-•----••••-••-•••......•• - ------------------------------------ ------- -------- W Design Flow............................................gallons per person per day. Total daily flow............................................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date......................................... a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix --------------•----------•--------------•---•--------------------•-------------------------•-•--------------------------------.-------------- O Description of Soil b- =='-`J "t----------------------------------- x x -•••-•---•------------------• ••-••--••---•---••••-•----•-----•...••-•-••---•--------•----•-•••......---•-•-•-•------J�- ----- U Nature f�f Repairs or Alteration —Answer phen appli ble._._ 5�2� .__: �1 e *' f�-............................. 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 issued by the boar of health. / J Date Application Approved By......- ............c .......a,--- Date Application Disapproved for the following reasons:............................................................................................................... ........----•-•------•..................................................•---------...------•-----...-•----.........._.....------•••-•--•--••--•-•-•-•---------•--•--••-•--•-•••----••--•••-•----....... Date PermitNo......................................................... Issued_....................................................... Date 00 No.... (V .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......��_ .................OF.......... Appliration for Bispoiial Works Tonstrartion tirrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System t ... ................ ... ........................... .......... .......... ....... Cocation- d ... .... ........... . :�................... f�� ner dress �4 .............. .. . . .. .......................... ............... Insta er Address Type of Building Size Lot...................—....Sq. feet U DwellingA?No. of Bedrooms....................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons._..____................____ Showers Cafeteria Other fixtures Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width___..........._. Diameter__._____--__-.-- Depth......._.....__. Disposal Trench—No. .................... Width......__....__...... Total Length......__............ Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.........___.._..... Depth below inlet........._.._....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.._...__._...........-_. fr4 Test Pit No. 2................minutes per inch Depth of Test Pit__-_..........._._.. Depth to ground water.__.._..__..-__......... P4 ------ ------------------------------------------------------------------------------------------------------------------------------------------ 0 Description of Soil*.' . .......... ..................................................................................................................................... U .......................................................................................................................................................................................................... ............................................................................................................. .I----- ---- --- ----------------------04-�e---------------------------------------- U Nature jot Repairs or Altemtioi4—4nswerphen applwable--A,�_ .... "5 - - ------------------------------------ ...... ....�. C-T-- ------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITIE 5 of the State.Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu;d by....e bo. d of 1 th. ,6 .... ..... . ..................... .... ........ ned.. . ...... , I ,ashI Date Application Approved By..--- ......... ...................... 4ou--------------- ----- Application Disapproved for the following reasons:....___.`______________ ...........................•-----------......------................•.Date......-•---• .................................................................................................................................................................................I...................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF....... ........................................ Trrtifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ell) by.......................... .........Z_4.4�. ................................... ...................................................................................................... at..................81---------102_6 Installer .................. ......................... -----------------------------*----------------- tie has been installed in accordance witit h die provisions of TITLE 5 of The State .Sanitary Code as described in the application for Disposal Works Construction Permit No.--,V ................ dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR44ED*AGUAIRANTEE THAT THE SYSTEM WI F CTION SATISFACTORY. DATE--------- --------- ---------------------- Inspector.... .. ........ ....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............'OF....... _TP 4:5, ✓ 4.A ........................................ ............... FEE....................... Permission is hereby granted.-- ....61-—-----I........ ............................................................................................. to Construct or Repair n Individual Sewage Disposal System at No...............�F/........... .......... Street as shown on the application for Disposal Works Construction P it No..................... Dated.......................................... ....................................... DATE- Boar �o Health ............e.... .. ... ................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOP OF FIND. = 49,4'± PROVIDE EXTENSION RISER WITH PROVIDE RISER WITH REMOVABLE, ' COVER OVER INLET&CENTER F.G. OVER WATERTIGHT COVER TO F.G.OVER FINISH GRADE OVER D-BOX= 46.7 ± " GENERAL NOTES 4 SCHEDULE 40 PVC MIN. SLOPE 1 /o FINISHED GRADE OVER BIODIFFUSERS= tl.�j,,rj' - 48,0' EL.=41.9'± F G. @ FIND. = 41.4'± ACCESS TO WITHIN 6"OF F.G. TANK EL.= 41,1' MAX. PUMP OUTLET REMOVABLE WATERTIGHT RISER SLOPE @ 2% MIN. SLAB '/--- ---- TO WITHIN 6 OF FINISHED GRADE INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION 24"MIN.ACCESS 9"MIN 5" DIA. OUTLET(S) ACCESS BOX TO WITHIN 3"OF METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL COVER(TYP.3) F.G. (ONE PER OUTER ROW) 36";AX. CODE AND ANY APPLICABLE LOCAL RULES. PROP.4" - - F -� 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE SCH. 40 PVC t 2" DROP MIN. 2"PVC SCH.40 FORCE I I DESIGN ENGINEER. - MIN.s�oPe i� 6" 3" MAIN TO DISTRIBUTION 9" MIN. 5.1' MAX. 1.2'COUPLING � __ 3" DROP MAX. 3" 9" BOX 36"MAX. SEE NOTE 21 TOP OF SAS/B.O. = 42,90' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL ' o (TYP OF 3) SYSTEM UNLESS OTHERWISE NOTED. I"5 ± " 36.75' 4"SCH.40 PVC 1 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN V 2"PVC TEE OUT TO SAS ELEVATION =42.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A PROVIDE WATER-TIGHT SEAL 1.33' 16" 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 37.00 (TYP.) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 0.90, 10.75"(TYP) LZ 48" 00 GAL. 1„ + CLEAN SAND I 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 6" 12"MIN. 42.47� �- 41 .57' laid flat 2.875'(34.5") I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 43.00' 42.83� � � TYP � (STONELESS SYSTEM) 5.0' (TYP.) I 7• LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 15.7'TO HSE. 1,500 GAL. 6"CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY 5' MIN. 8.625' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 6"CRUSHED STONE COMPACTED BASE 31.2' AND DESIGN ENGINEER. OVER MECHANICALLY 5 OUTLET DISTRIBUTION BOX i 8. ELEVATIONS BASED ON AN APPROXIMATE M.S.L. DATUM OF 42.00'ESTABLISHED _ COMPACTED BASE TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 36.50' ON THE CORNER OF AN AIR CONDITIONER UNIT AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET PROP. 1 ,500 / 500 GALLON TWO-COMPARTMENT H-10 SEPTIC TANK PIPES TO BE LAID LEVEL. 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION NOTE: BIODIFFUSERS PROFILE BIODIFFUSER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT SEPTIC TANK SHALL BE LENGTH 12'-2" WIDTH 6-8" DEPTH 5'-8" DIMENSICROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES WATERPROOF AND WATERTIGHT. SEPTIC TANK PROFILE P ECASTO(508-564-6776)NS PER NS DISTRIBUTION BOX DETAIL ARC 36HC #3616BD1 H-20 BIODIFFUSERS TO THE DESIGN ENGINEER. *CON IST. EL. PRIOR TO NOT TO SCALE 110. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING INSTALL 1-1/4"PVC TO HOUSE. JOINTS TO BE MADE TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM WATERTIGHT. WIRE PUMP AND FLOATS TO SIMPLEX NOTE: PUMP ALARM TO BE ON A SEPARATE CIRCUIT. ' ; ' . ;• • PERC NO. 13439 APPROPRIATE AUTHORITY. CONTROL PANEL No. 1-CC2 NEMA-1 MFG. HOOVER ELECTRICAL PERMIT REQUIRED BY CONTRACTOR. fl , • • INSTRUMENTS • . + ", ' ' • . j INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS N • ` LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE r , .-� . ' • EVALUATOR: Michael Pimentel, E.I.T. NEMA 4 JUNCTION BOX CORROSION RESISTANT& HOISTING CABLE 7 x 19 STAINLESS STEEL DECK W # i 0 • THEY SHALL WITHSTAND H-20 LOADING. LIQUID-TIGHT CABLE CONNECTORS SUPPORTED 1/8"DIA. / 1,760 LB. STRENGTH Z ; • • • ,, • C.S.E. APPROVAL DATE: 10-27-99 i�84 GARAGE Q • • r . 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. CONNECTORS SUPPORTED BY 1-1/4"PVC CONDUIT, EXISTING N . • '• . Cr�l " . 1 DATE: October 17, 2011 I ' JOINTS TO BE MADE WATERTIGHT 2"BALL VALVE w/UNIONS SCH. 80 PVC •. ' ,' • 3-BEDROOM • y . • GEORGE FISHER CO. MODEL NO. 560 • ,► * , • � • *: j TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE HC-1 DWELLING N „' • • • s MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. cr) „ " TOF = 49.4'± .� •r " `* + '�• ` ELEV TOP= 46.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, � 3 2 SCH.40 TO D-BOX �' • . • • I BFE = 41.9'± �l! � '• * �'. : : I ELEV WATER= <36.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). "SCH.40 TEE w/CLEAN-OUT CAP HC-3 ax s * •, + • •• T-1 - 0ALARM ON ' • ' . ' ! 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ,� . . j PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 1/4"WEEP HOLE IN DISCHARGE PIPE • . j UMP ON M a (2 O 15' �� • . ••f • . •� DEPTH OF PERC = 48"-66" 16. PROPOSED PROJECT IS LOCATED WITHIN: PUMP `- 2"BALL CHECK VALVE SCH. 80 PVC 100 v HC-2 6) i • • 1 TEXTURAL CLASS: 1 ASSESSOR'S MAP 189 PARCEL 22 P.S.I. FLOWMATIC MODEL No. 208S • - - - N / a o Hatc • �I OWNER OF RECORD: ROBERT C. GRANQUIST& ELENA PINE (2)WIDE ANGLE CONTROL FLOATS C) o " (3 5) ;•• LOCUS I 0" 46.50' ADDRESS: ROBERT C. GRANQUIST FAMILY TRUST (BARNES 07361$) 0 2 SCH.40 PVC DISCHARGE PIPE „�,- - 1: PUMP ON/OFF 120 ACTIVATION , • o Fill 67 MASON TERRACE BARNES SE411 PUMP 0.4 H.P.; 115 V; 2" BROOKLINE, MA 02146 2: ALARM ACTIVATION 1I DISCHARGE PASSING 2"SOLIDS OR EQUAL ! • 24" 44.50' (4 ` • � . { A Loamy Sand FEMA FLOOD ZONE C 10Yr 3/1 1 ,500 / 500 GALLON H-10 SEPTIC TANK DETAIL -- - -- -- -- -- -- ----- -- --- -- --- r�ln , +r'�F,�,„ • � �' � 30" 44.00' COMMUNITY PANEL# 250001 0015 C SWING-TIES SCALE: 1 -20 " ,p Loamy Sand 17. DEED REFERENCE: BOOK 18378, PAGE 298 B an Bury • 10Yr 5/8 18. PLAN REFERENCE: 1.) P.B. 477, PG 36 DESCRIPTION HCA HC-2 HC-3 -- __ ' • • . 2.) P.B. 364, PG.42 (BIRCHILL ROAD) ( 48" 42.50 FULLER MILL POND �� ! ; ,. SEPTIC COVER IN (1) 26.1 21.1 -- �► I Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. EL. = 25.6'± /..L6 � SEPTIC COVER OUT(2) 34.3' 27.2' -- � �"' • • • � • 66" 41.00' / + -�' • I 20• PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY (BASED ON FIELD SURVEY ON 10-10-11) BIODIFFUSER CORNER(3) 20.0 56.1 * '" . • FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY -- _ • � -- . • + Medium -Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Benchmark �� ti��o BIODIFFUSER CORNER(4) -- 28.6' 59.5' - - - _ - - - C 2.5Y 6/6 21, IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE A.C.U. Comer / 32 BIODIFFUSER CORNER(5) -- 41.9' 34.5' APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): Approx. M.S.L. // 62� __ ' LOCUS PLAN (1.) A 2.10'WAIVER(3.00-5.10')FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. � � ,.i � BIODIFFUSER CORNER(6) 36.5 28.4 OF OW / / / / �6/- 22.�DG THE FOLLOWING LOCAL VARIANCE IS REQUESTED FROM ARTICLE 1,SECTION 360-1:SCALE: 1"= 1000' f ( )A 24.7'(100-25.3')VARIANCE FOR THE SETBACK FROM THE PROPOSED 1,500/500 GALLON / 120 36.50 SEPTIC TANK TO THE POND. SEE BARNSTABLE BOARD OF HEALTH POLICY DATED 8-4-09. SILT FENCE g, Standing or Weeping Observed No Mottling, �-,-- i � •-� / °' MAP 189 _ EXIST. CESSi uuL i0 , �30 / , / �- BE PUMPED & FILLED � / / � ,/ `-"� p`L PARCEL 22 DESIGN DATA TEST PIT DATA LEGEND WITH CLEAN SAND / /3 / / / //- -� 16,700 S.F.± NUMBER OF BEDROOMS (DESIGN) 3 PERC NO. 13439 50xO EXISTING SPOT GRADE r 4� DESIGN FLOW 110 GAUDAY/BEDROOM INSPECTOR: Donald Desmarais, R.S. 50 - -- j � - - c'� TOTAL DESIGN FLOW 330 GAUDAY EVALUATOR: Michael Pimentel, E.I.T. EXISTING CONTOUR � / P�� C.S.E. APPROVAL DATE: 10-27-99 50 -- PROPOSED CONTOUR DESIGN FLOW X 200 % = 660 GAUDAY October 17 2011 O_ M O Q� �sr MAP 189 DATE: ❑/ ; I/W EXISTING OVERHEAD UTILITIES w USE PROPOSED 1,500/500 GALLON SEPTIC TANK o r7l M o PARCEL 23 TEST PIT#: 2 W W- EXISTING WATER LINE TVP� DECK / co g INSTALL 18 ARC 36HC (#3616BD) H-20 BIODIFFUSERS ELEV TOP= 47.00' �s ruMP r EXISTING GARAGE z & 3 ARCH 36HC H-20 COUPLINGS ELEV WATER= <37.00' GAS -- EXISTING GAS LINE w / 3-BEDROOM / PERC RATE _ % TEST PIT LOCATION #1 DWELLING SYSTEM CAPACITY _,34 /O TOF=49.4'± (TOTAL L.F. OF BIOS&COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD DEPTH OF PERC = �0 � PROP. 1,500/500 GAL. 2-COMPARTMENT SEPTIC TANK EXIST. LEACHING PIT ` ' BFE =41.9'± PROPOSED TOTAL 18 ARC 36HC (93.6')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 332.4 GAL. LEACHING/DAY r--- � TEXTURAL CLASS: 1 TO BE REMOVED 'sHRu TVP) ,� �a (#3616BD) H-20 BIODIFFUSERS IN - PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE ks.��38`_ r -�'�� w ' FIELD CONFIGURATION TOTALS: - " 0 �, s�p� a > TOTAL NUMBER OF BIODIFFUSERS: 18 PROPOSED 2 SOLID SCHEDULE 40 PVC FORCE MAIN 0" �0, / m `�� G/, o PROPOSED INSPECTION PORT (TYP OF 2) TOTAL NUMBER OF COUPLINGS: 3 47.00' 13 MAP 189 �� o� 40� oo �� TOTAL LEACHING AREA: 449.3 SQ.FT. Fill PROPOSED DISTRIBUTION BOX T 4, � PROPOSED ARC 36HC (#3616BD) H-20 TOTAL LEACHING CAPACITY: 332.4 GAL./DAY 24" 45.00' ® PROPOSED ARC 36HC (#3616BD)BIODIFFUSER(H-20) PARCEL 21 1- TP 2 BIODIFFUSERS COUPLING (TYP OF 3) A Loamy Sand � 47x0' ,,- 3' � NOTE: 10Yr 3;1 tG� TP 1 S} " 20• PROPOSED 4" PVC VENT PIPE EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE 30" 44.50' PROPOSED ARC 36HC(#36166D)COUPLING (H-20) OAF°' 46x5' C ! DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER Loamy Sand QO� di "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO B 10Yr 5/B 116 3 10 ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST REV. DATE BY APP,D. DESCRIPTION - - - - - \ --9 69 U•P.#6.5 C`,3 MODIFIED JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. " PROPOSED 1,500/500 GAL. .� R 132 � - _ ___ ___ _ 48 43.00 PROPOSED SEPTIC SYSTEM UPGRADE 2-COMPARTMENT SEPTIC TANK F,� \ �6' OR��E i J�!Hl�I DOSING & STORAGE REQUIREMENTS PREPARED FOR: O O ��821 DESIGN FLOW: 330 GPD CAPEWIDE ENTERPRISES OP�Ovi DOSING REQUIRED: 6 CYCLES/DAY C Medium -Coarse Sand PROP. DISTRIBUTION BOX � o!H!� \ �G PV��\G 330 GPD/6=55 GALS/CYCLE 2.5Y 6/5 LOCATED AT \44 6�j / P� ON AND CE RE UIRED OFF BETWEEN PUMP 84 BIRCHILL ROAD J CENTERVILLE, MA 02632 55 GAUCYCLE (USE 0.0'O PROVIDE FOR BACKFLOW) 120" 37.00' SCALE: 1 INCH = 20 FT. DATE: OCTOBER 26, 2011 NOTES: FQP STORAGE REQUIRED ABOVE WORKING LEVEL: 330.0 GAL. ►►WAI/ 0 10 20 40 80 FEET O Observed JCHN L.A" Weeping or Wee Standing No Mottling, g pg � � STORAGE PROVIDED ABOVE WORKING LEVEL: 337.5 GAL. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM ��G ��. c` _._ BY: - - -� - � ,�� PREPARED COMPONENT. RESERVED FOR BOARD OF HEALTH USE cHURCHILLJR. <,-, JC ENGINEERING, INC. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING NO 118 2854 CRANBERRY HIGHWAY SYSTEM TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TOj►}`' s EAST WAREHAM MA 02538 ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. SITE PLAN 508.273.0377 " _ _ 3.) ENTIRE LOCUS PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. SCALE: 1" =20' Drawn By: MCP ( Designed By-MCP Checked By:JLC JOB No. 2088