HomeMy WebLinkAbout0052 FARM HILL ROAD - Health 52 Farmhill Road
Centerville
A= 247-089
i
E
5 M E A d
No.3-153LOR
UPC 12534
smead.com • Made In USA
TOWN OF BARNSTABLE
LOCATION T2 f� A !}`�l I �Z(, SEWAGE#
VILLAGE C�f� ��)�' ASSESSOR'S MAP PARCEL
INSTALLER'S NAME&PHONE NO. .t- I1G�,
SEPTIC TANK CAPACITY 1 00 1A - I CO
LEACHING FACILITY.(type) SMa(�l) �A-Jo C�CMn (size)
NO.OF BEDROOMS 3r( - rJ
OWNER f4V�e lo��ft�t'lf�
PERMIT DATE: `q -13 j COMPLIANCE DATE: lo "q -16
Separation Distance Between the: A)0 Je
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C`i F'/ 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 leachi facility) Feet
FURNISHED BY
OUT-
Lid
C
OJr-
clu
�--33
-74D
C- W i �
ir
TOWN OF BARNSTABLE
LOCATION �A"!PL47 /P ja SEWAGE #
VILLAGE CV-qSR/SSOR'S MAP &LOT A 1'7- 621
INSTALLER'S NAME&PHONE NO. _Xd A160 Al 7 7 s� �77�6
SEPTIC TANK CAPACITY D" II1—
1
LEACHING FACILITY: (type)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 3/ '�12 f' COMPLIANCE DATE: �
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
r I
`1` f.
V
'Q
i
J
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftPliLAtion for Misposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 6,2 7:1,1/n1 wil R Owner's Name,Address,and Tel.No.
1-41
Assessor's Map/Parcel 2 Y Z IM
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms :2 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building /t' dr-wAlc_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date fi-- 31 Number of sheets 9L Revision Date
Title L
Size of Septic Tank Na°C&) /�/O Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) "� te- C: Mr i,� / OOLj
k f /J/
2 \l— S n/
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 Health.
9 Date q
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
..�, 'r .. :'„�.� •i ,-s7:.�.M :.wq.y -+.t � � :,..__� - ...-.._,.'-d tiR.fi:.� ltia.`''L•...�* .2.,..�,. .. .,-�sL.,,�_,^�e....4�,5.,.�. .., ,ti..
No. Fee .�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for sos Y 6pstem Construction Vermit ,
Application for a Permit to Construct( ) Repair 7) TU1pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 5:2 ;ra' Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 'L/'
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 2 ►► 1 Lot Size 7 sq.ft. Garbage Grinder( )
Other Type of Building lKS/�/-h//Gl No.of Persons Showers( ) Cafeteria( )
Other Fixtures
M Design Flow(min.required) gpd Design flow provided gpd
Plan Date — 3/ '/ Number of sheets Revision Date
Title
Size of Septic Tank �/ /�l i'(,u/ /Q Type of S.A.S. C70 --/Q 1,m S f
Description of Soil
t
l
Nature of Repairs or Alter 'ons(Answer when applicable) G `•> / (jQ G/CyV ,/Q j,v1j
Date last inspected: ;
Agreement:
The undersigned agrees to ensum 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 Health.
/ 4 r Date 9
Application Approved'by. r �f61 ; '/ t��� y Date r
Application Disapproved by v /� / Date
_ v
for the following reasons
Permit No. Date Issued
/
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance y.
THIS.IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Pr___*'Upgraded( )
Abandoned
( ) y a C�i G / /D nJ �JG
--at - 2" D/M 1 r k tl9 1e. .has been cons cted in ac;4., �d 'cg"
with the provisions of Title 5 and the for Disposal System Construction Permit No. ted
Installer LDD()An, Designer er I ev r"t'r,f ev
#bedrooms 2 Approved design flow A gpd
The issuance of this permit shall not be construed as a guarantee that the system Willfunction as'desig'ne`d.i
Date I o �! b k Inspectors ��+��
- No - - - _ - ---------------------- ----- ----— ------- - --�_
e -
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal �pstem onstruttion permit
Permission is hereby granted to Construct( ) 1/ Repair( Upgrade V
�) Abandon( )
System located at Plilf�`tP/ �
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. r'
Provided:Construction usy)e mpaeted within three years of the date of this permit.
Date Approved by )
Town of Barnstable
°FINE r Regulatory Services
Richard V. Scali, Interim Director
• BARNSrABLE, `
MASS.
�e3q. a Public Health Division
o° ,0m
4 Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Off ice: 508-862-4644 Fax: 504-790-6304
Installer & Designer Certification Form
Date: 1,0 ` '4%_�\ Sewage Permit# �C`�lF) 'XQjSAssessor's 1!'Iap\Pareel 2 -7 - U
Designer: ;ytee f,n 1.t3c r-1 ts, (rr Installer: A; 3
Address: IZ W, Crt;ssi�'e tj Rd Address: -C -0
Wires v-0t0'e MA MA 6 Z(032
On r i l �— �` � '`�"� �'''< was issued a permit to install a
(date) (installer),
septic system at S Zrvti ``1 ►�\ k-1`1 based on a design drawn b
everI yC_c.,
(address)
/4 c , dated ' ,�1
(designer)
r 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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
arcater 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. PIan revision or
certified as-built by designer to follow. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructs nce with the terms
of the I1A approval letters (if applicable) %OF
PETER T.
M*NTEE
CIVIL
nstaller's Signature) Np.35109
�FG/STER
(Designer's Signature) (Affix Designer tamp Here)
PLEASE RETURN' TO BARNSTABLE PUBLIC HEALTH DIVISION, CERTIFICATE
OF COVIPLIA_NCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION
THANK YOU.
Q:`:Scptic:0csiener Certification Form Rev 5-14-1 3.doc
. T
� 1
il8...! l 7 z i' IJ1�'I R�!• 9�
BH ENTRY
w
0
J
" BATH KIT./DIN.
BEDROOM
HALL ENCLOSED
PORCH
BEDROOM LIVING ROOM
W �
Cn J
O w
J U
U
ENTRY
FLOOR PLAN
52 FARM HILL ROAD, C ENTERVI LLE, MA
I
r
Town of Barnstable Barnstable
Regulatory Services Department A*AnWCfty
6 9 ,� Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4990 5701
August 21, 2018
HUFF, ANGELA S & GRIFFIN, JOHN P
7576 FIREBIRD LANE
MANLIUS,NY 13104
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 52 Farm Hill Road, Centerville, MA was inspected on
08/14/2018 by Troy Williams, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• The available volume is less than '/Z (half) day flow.
You are ordered to repair or replace the septic system within two (2)years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF TH;B;OA F HEALTH
mas
Agent o the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\52 Farm Hill Road Centerville.doc
I
1
Town of Barnstable
+ BARNSI'ABLE,
9� b 9. a Regulatory Services Department
ptfp AAA
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 5/11/16
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x"marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
c� Commonwealth of Massachusetts ay - 009
Title 5 Official Inspection Form.
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I .1e3
. �4 52 Farm Hill Road, Centerville ✓ M -247 P -89
Property Address
_Q
Angela Huff
Owner Owner's Name
information is 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
required for every '
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information Sl# J 3
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Troy Williams
use the return Name of Inspector
key.
Troy Williams Septic Inspections
Company Name
19 Hummel Drive
Company Address
South Dennis _ MA _ — 02660~t
Cityrrown State Zip Code
(508) 385- 1300 _— S1682 _
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 16.000).The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
August 14, 2018 —
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
{
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
1
c Commonwealth of Massachusetts
� - - Title 5 Official Inspection Forrn
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
52 Farm Hill Road, Centerville M -247 P -89 _
Property Address
Angela Huff _
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY_ 13104 August 14, 2018
—
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
c� Commonwealth of Massachusetts
�a Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
52 Farm Hill Road, Centerville M -247 P -89 _
Property Address
Angela Huff
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
-
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments
-� 52 Farm Hill Road, Centerville M -247 P -89
Property Address
Angela Huff _
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14 2018
_.
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
52 Farm Hill Road, Centerville M -247 P -89
Property Address
Angela Huff
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
--
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000g pd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspaection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
52 Farm Hill Road, Centerville M -247 P -89
Property Address
Angela Huff
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
--
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?
❑ 0 Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were,all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 2 — Number of bedrooms (actual): 2-
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): _220
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�' la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
52 Farm Hill Road, Centerville M -247 P-89
Property Address
Angela Huff
Owner Owner's Name
information is 9 required for every 7576 Firebird Lane, Manlius _NY 13104 August 14, 2018
page. Cityrrown 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? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ® Yes ❑ No
Water meter readings, if available last 2 ears usage d 17=28,000 gals.
g ( y g (gp ))' 16=26,000 gals.
Detail:
Sump pump? ❑ Yes ❑ No
Last date of occupancy: occasional use _
Date
Commercial/Industrial Flow Conditions:
Type of Establishment: N/A
Design flow(based on 310 CMR 15.203): Gallons per day(gpa)
Basis of design flow(seats/persons/sq.ft., etc.): N/A _
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: N/A
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Officilal - Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
`V 52 Farm Hill Road, Centerville M-247 P -89 _
Property Address
Angela Huff _
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY g
_ 13104 August 14, 2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: N/A
Date
Other(describe below):
N/A
General Information
Pumping Records:
Source of information: No pumping info available.
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined? --
Reason for pumping: -------- — —
Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
® Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
52 Farm Hill Road, Centerville M -247 P-89
Property Address
Angela Huff
Owner Owner's Name
information is 7576 Firebird Lane Manlius NY 13104 August 14, 2018
required for every � _ _
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:
Cesspools are original to home built in 1966.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 18"feet —
Material of construction:
® cast iron ❑ 40 PVC Orangeburg _—
® other(explain):
Distance from private water supply well or suction line: N/A —
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Lines were found clear at the time of inspection. Orangeburg pipe was in need of repacement.
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: N/A _
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: -
Sludge depth: —
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
-- Title 5 Official Inspection :Form
to Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments
52 Farm Hill Road, Centerville _ M -247 P -89 _—
Property Address
Angela Huff _
Owner Owner's Name
information is 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
required for every —.
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle —
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):
K/A _
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
N/A
Dimensions:
Scum thickness N/A —
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
N/A
Date of last pumping: Date
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
��. 52 Farm Hill Road, Centerville M -247 P-89
Property Address
Angela Huff
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
page. Citylrown 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.):
N/A
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: N/A _—
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: N/A _
Capacity: N/A —
gallons
Design Flow: N/A
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: N/A — Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Date
Comments(condition of alarm and float switches, etc.):
N/A
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
cam, Commonwealth of Massachusetts
� - Title 5 Official Inspection, Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
52 Farm Hill Road, Centerville _ _ M -247 P -89 _
Property Address
Angela Huff
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
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 —
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(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.):
N/A
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L 52 Farm Hill Road, Centerville M -247 P-89
Property Address
Angela Huff
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
-
page. Cityrrown 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: --
5' X5'
® overflow cesspool number: 5' --
❑ 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.):
Cesspool was found in poor condition and is need of replacement.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration main cesspool—
0"
Depth -top of liquid to inlet invert -
2"
Depth of solids layer ----
Depth of scum layer none
Dimensions of cesspool 5'X 5' --
Materials of construction cesspool block
Indication of groundwater inflow ❑ Yes ® No
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-"Not for Voluntary Assessments
52 Farm Hill Road, Centerville _ M -247 P -89
Property Address
Angela Huff _
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Cesspool was dry on inspection due to vacancy with the walls found stained up to the inlet lines.
Sidewall of cesspool was caving in with missing block. Crown was loose and seperating and starting
to cave in. Cesspools need to be upgraded to Title V at this time.
Privy (locate on site plan):
Materials of construction: N/A
Dimensions N/A
Depth of solids N/A
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts'
Title 5 Official Inspection. Form
�= a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
��. � 52 Farm Hill Road, Centerville M -247 P-89
Property Address
Angela Huff _
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
page. Cityrrown 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
(3(
3
Z,
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
C Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 52 Farm Hill Road, Centerville M -247 P-89
Property Address
Angela Huff _
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY_ 13104 August 14, 2018
--- -- .
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: 20.0'+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:
past inspection
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
USGS map shows groundwater to be over 20'. Bottom.of cesspool at 7.0'was found not to be located
in the high groundwater elevation at the time of inspection.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
52 Farm Hill Road, Centerville M -247 P -89
u -
Property Address
Angela Huff
Owner Owner's Name
information is required for every 7576 Firebird Lane, Manlius NY 13104 August 14, 2018
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
E Inspection Summary: A, B, C, D, or E checked
E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
E System Information—Estimated depth to high groundwater
E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Town.of Barnstable r# sq-fa-
Departineittof Regulatory Services
It
.uwsrwsrg ]Public Health Division Date I'w
200 Main Street,Hyannis MA 02601 n,
rFa�.t a
Date Sclieduled v -�,
Time Fee Pd.1. 1 ) - �� (�O Q
cl',
Soil Suitability Assessment fbr S ge-Disposal
Performed By: 'Fe-V_r C L"1 k� Sb�' (SA--e— Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address , 1,• (` Owner's Name A �g C Q N of
f` (� Address vrZ r4rt^' t-�` Il t.tit
Assessor's Map/parcel
: ^� -T _ Q O` Engineer's ame
✓L�c. 2Q r��� VNJOVUtin
NEW CONSTRUCTION REPAIR `-Y Telephone# S U$ L 77 _s :{
Land Use 2 -` ✓t�K J -
Slopes('Yo) 1 _ Surface Stones a
Distances from: open Water Body ft Possible Wet Area /v(V ft. thinking Water Well
Drainage Wayft Property Line /S ft Other ft
SKE'TC :(Street nnme,dimensions of lot,exact locations of test holes&perc tests,locate wetlands(n proximity to boles)
2 �
Parent material(geologic) Depth to Bedrock.
Depth to Groundwater. Standing Water in Hole: IJ Weeping from Pit Pnee
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH.WATER TABLE
Method Used:
Depth Observed standing in obs.hole: — __ in, Depth to soil mottles:
Depth to weeping from side of obs.hole: - _ in, Groundwater Adjustment ft.
Index Well#,___ Reading Date:.. Index Well level o Adi,factor- _ Adj.Oroundwnter'Le;vel
PERCOLATION TESL' Date e. Thne
Observation
Hole# (I� �` Time at V'
Depth of Perc. 1 Time at 6'
Start Pre-soak Time @ 2 51,q k1cs�S T (9 -6")
q. \
End Prc-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on$ack-----------
***If percolation test is°to beconducted within.100' of Wetland,you must first notify the
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\S E PTIC\PERCFO RK DOC
DEEP OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders,
Consistency,%(ravel
I1-t— 4-2- to`P�•�
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil'Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
C'enjt en % %Craver
La`GrzI/c,
C
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,.Boulders.
n isc c Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color. Soil other
Surface(in) (USDA) (Munsell) Mottling (Sttucture,Stones,Boulders.
onsi ten ra
4
]Flood Insurance Rate Map:
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 pervi,ous.material exist in all areas observed throughout,the
area proposed for the soil absorption system? .' e--5 --
If not,what is the depth of naturally occurring pervious material?.._
Certification
I certify that on � Q 5 (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 trai expertise and experience described.in 310 CMR lskl.7.
Signature Date
Q ASEPTIC\PERCFORM.DOC
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
52 Farmhill Road 46
Property Address
1v John Fletch 9 -1 —6%9
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important:When filling out A. General Information
forms on the t ,�
'computer,use 1. Inspector: -
only the tab key i
to move your # c ,
cursor-do not Robert Paolini r,j
use the return Name of Inspector ,1 I �
key. Capewide Enterprises,LLC. p -�
Company Name - v)
P.O.Box 763
Company Address ry r
Centerville Ma. 02632 -_j M
'B"01 Cityrrown State Zip Code
(508)428-4028 S 14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
8/12/2008
Insp tor's ignatur 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.
52 Farmhill Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2
i -
Commonwealth of Massachusetts
W Title 5 Official Inspection Form p om
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. . 02632 8/12/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The septic system is in proper working order at the present time.
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.
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 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:
❑ 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
52 Farmhill Rd.-03/08 Title 5 Official Inspection Form:subsurface Sewage Disposal System•Page 2 of 2
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ 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:
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
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.
52 Farmhill Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3
i '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. City/Town State Zip Code Date of Inspection
B.,Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 coliform
bacteria.indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
0 ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ z 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
❑ ® 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.
52 Farmhill Rd.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4
I .
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is Centerville Ma. 02632 8/12/2008
required for
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,006 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
52 Farmhill Rd.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,• 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
52 Farmhill Rd.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 2 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 2
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
Seasonaluse? ® Yes ❑ No
Water meter readin s,,if available last 2 ears usage 2006:30,000
9 ( Y 9 (gpd)): 2007:25,000
Sump pump? ❑ Yes ® No
Last date of occupancy: 8/12/2008
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:
Last date of occupancy/use: Date
Other(describe):
52 Farmhill Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M ,•''y 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Capewide Enterprises,LLC.
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1000
gallons
How was quantity pumped determined? measured
Reason for pumping: Check for groundwater
Type of System:
❑ Septic tank,distribution box, soil absorption system
® Single cesspool
® Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
'inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
1946
Were sewage odors detected when arriving at the Site? ❑ Yes ® No
52 Farmhill Rd.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 18„feet
Material of construction:
❑ cast iron ❑ 40 PVC Orangeburg
� other(explain):
Distance from private water supply well or suction line: 20'+feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented.throu h the house vents.
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:
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?
52 Farmhill Rd.•03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 9
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every 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.):
i
Pump main cesspool every two years.Outlet tee is in place.Cesspool appear to be structurally sound.
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
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):
52 Farmhill Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10
Commonwealth of Massachusetts
ti. W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
9 p Y rY
°M 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
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
Distribution Box (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(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
52 Farmhill Rd.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM , 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008 ,
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (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:
® 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.):
52 Farmhill Rd.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every page. Cityrrown State Zip Code Date of Inspection
,
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration One main and one overflow
Depth—top of liquid to inlet invert 1.
Depth of solids layer 3„
Depth of scum layer
Dimensions of cesspool 2-61x8'
Materials of construction Concrete Block
Indication of groundwater inflow ❑ Yes ® No
Comments(note condition of'soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Sandy dry soil.No signs of hydraulic failure.Main cesspool was full to overflow invert.Overflow
cesspool water to invert was 6'with stain line 5' below 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.):
52 Farmhill Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13
Map Page 1 of 2
Town of Barnstable Geographic Information System
Parcel Viewer Custom Map Abutters .Map Size ® Zoom out
In
y IC R T
1
1
r
r , r
r r
I I i r i
F ir 1
t 1
r ,
-
� {E r
' ' I
A
� , 777���
1 �
Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER
r—;,rinhf T--of Q.—O.W. KAA All A hfe rcecnr•
http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?proper yID=247089&map... 8/12/2008
Commonwealth of Massachusetts
v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 52 Farmhill Road
Property Address
John Fletch
Owner Owner's Name
information is required for Centerville Ma. 02632 8/12/2008
every 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: Bottom of cesspools 30'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: pate
❑ 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:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plater#2 annual ranges of
groundwater elevations.-
52 Farmhill Rd.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15
I -
e
Town of Barnstable
�Op1HE 1p��
Regulatory Services
:QBARNS.ABM ; Thomas F. Geiler,Director
9Q MASS.
1
OATE639..a Public Health Division
Thomas McKean, Director
200.Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number
of bedrooms approved at a particular property would be 1isted on the "Disposal Works
Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
QASEPTICUsclaimer Private Septic Inspections.DOC'
CONTOUR N LOCUS MADISON AVE
x 100.98 EXISTING SPOT GRADE
N/ EXISTING WATER SERVICE
ca
} G EXISTING GAS SERVICErn
HILLS RD FARM HI
4L--OVERHEAD WIRES a =
U UNDERGROUND WIRES O A
� o
2 m A
_ TEST PIT 0
o
$ .62*56'40 E BENCHMARK N
75.01 LEGEND r tJ
201-
� q+ 101.27
� r
100.89 25�.-..r.
SHED r PROP.1007
:Asa • ;"'t' + �i.o6 °�
0 oD TP-1 + 10 65
EXISTING cEssPooL <? '. BENCHMARK LOCUS MAP
t•100.5 "-"�" COR./CONC. PATIO NOT TO SCALE
TO BE REMOVED TP-2 10027 EL.=103.39 -�
(SEE NOTE 11) 1 00 GENERAL NOTES:
PROPOSED BM:::
100,69
+ 100.77 100,69 '. : `r 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
SEPTIC TANK cn BOARD OF HEALTH AND THE DESIGN ENGINEER.
PA : �...... Z 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
RINS .•'�.'...:.
BH OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
w P'1 000
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
100.81 EXIST SEWER -310 CMR 15.405(1)(b):
x INV.=99.9t 00 C,i 1) A 5' variance, septic tank to cellar wall, for a 5' setback.
io
SEX ST/NG2) A 5' variance, S.A.S. to cellar wall, for a 15' setback.
p HOUSE(#52) to IT► 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
�... . I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
CV T.O.F.=101.93E 9 DESIGN ENGINEER.
Z I m :; 1 02 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
":�`.:.�•: ENGINEER BEFORE CONSTRUCTION CONTINUES.
0 ? 5. ALL ELEVATIONS BASED ON AN ASSIGNED DATUM.
100,85 x \ 101.35 1 0, 3;: 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
\ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
\98 9 73 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
100, _ I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
x 100.94 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
j, ::.
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
LOT 8 ) AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
7,700 tSF /': :'. •; 9 .57 DIRECTED BY THE APPROVING AUTHORITIES.
0
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
75.00' � THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
100,63 CONSTRUCTION.
-W-1'52 30� W 99.56
99,35 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
i IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
edge of pavement 99 57 99.09 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
99,72 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
99,78 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
FARMHILL ROAD , NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC
OF MAssq�9 " SYSTEM COMPONENTS NOT SHOWN ON THE PLAN
o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN
M CIVIL EE N 52 FARM HILL ROAD, CENTERVI LLE, MA
No. 35109 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
S OWNER OF RECORD Engineering by: SCALE DRAWN JOB. No.
HUFF, ANGELA & GRIFFEN, JOHN P Engineering Works, Inc. 1"=20' P.T.M. 234-18
PARCEL ID: 247-089 7576 FIREBIRD AVENUE 12 West Crossfield Road, Forestdole, MA 02644 DATE
MNLIUS, NY 13104 A CHECKED SHEET N0.
(508) 477-5313 8/31/18 P.T.M. 1 Of 2
d
t
%y
r NOTE: TO PREVENT BREAKOUT, FINAL GRADE
SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=98.2
INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE
OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D—BOX OF THE PROPOSED S.A.S.
INSTALL RISER & COVER PROPOSED S.A.S.
SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND
T.O.F=101.93t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT 1EXISTING
F.G. EL.=100.8t F.G. EL.=100.8t F.G. EL.=100.8f F.G. EL.=101.0f HOUSE(#52)
MAINTAIN 2% SLOPE OVER S.A.S. T.O.F.=101.93f
RIM
L = 12' L = 10' L 5'
® SCH4 (MIN.) ® SCH4 (MIN.) ® S=1% (MIN.) 2" LAYER OF 1/8" TO 1/2-
4 BH
4"SCH40 PVC - 4"SCH40 PVC "SCH40 PVC _
DOUBLE WASHED STONE
�p^I ma 0 as (OR APPROVED FILTER FABRIC)
LL-iINV.=98.75 48" LIQUID 14^ 7 6 Baaaaaa —3/4" TO 1-1/2" DOUBLE 4? N
LEVEL WASHED STONE 00
ADD INV.=97.97 PROPOSED 4' 4.8' 4'
GAS BAFFLE _ INV.=97.80 6, pK
INV.=98.50 D BOX EFFECTIVE WIDTH = 12.8' cr
3 OUTLETS INV.=97.70 T
FLt PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS N I
SURROUNDED WITH STONE AS SHOWN N I PROP. S.A.S.
CONNECT TO EXISTING SUITABLE SEWER L1___
PIPE AT HOUSE, INV.=99.9t(verify) H-10 RATED 3" LAYER OF 1/8" STONE
NE
DOUBLE WASHED STONE -l- 25' i
TOP CONC. ELEV.=98.5f (OR APPROVED FILTER FABRIC)
BREAKOUT ELEV.=98.20
NOTES: mama
INV. ELEV.=97.70 0
00
0
0
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & aaaBaaaaama SEPTIC LAYOUT
INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. aamaaamaaaa
BOTTOM ELEV.=95.70
2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 2 x 8.5' 17.0' 4'
TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0'
SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL
IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W.
3 INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION F
®® 0
BOTTOM OF TEST PIT, EL.=90.7 3/4" TO 1-1/2" DOUBLE
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE WASHED STONE I- ®®®® ® EO®®® 33"
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. W
N Z ®®®® ® ®®®®
SEPTIC SYSTEM PROFILE
102"
DESIGN CRITERIA SOIL LOG 4" KNOCKOUT
DATE: AUGUST 30, 2017 (REF#15,766
NUMBER OF BEDROOMS: 2 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE(SE 1542) 20" DIA. COVER
WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT
SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) ELEV. TP— 1 DEPTH ELEV. TP-2 DEPTH 4" KNOCKOUT 4" KNOCKOUT 58"
DESIGN PERCOLATION RATE: <2 MIN/IN 0110••
101.2 FILL 100.7 q
0
DAILY FLOW: 220 GPD 100.7 A 6 LOAMY O %2 D 4" KNOCKOUT
DESIGN FLOW: 330 GPD LOAMY SAND 100.0 8"
GARBAGE GRINDER: NO—not allowed with design 100.0 10YR 4/2 14" B
LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF BOOAMY SAND LOOMR 5/80 500 GALLON CAPACITY, H-10 LOADING
.74 GPD/SF 977 10YR 5/8 42„ 97.7 C 36" CHAMBERS
C
PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY PERC
PROPOSED D—BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED 42"/60" N.T.S.
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES MED. SAND 2.5Y 6/6
2.5Y 6/6 52 FARM HILL ROAD, CENTERVILLE, MA
SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO.
TOTAL AREA:.. 471.2 S.F. 91.2 120" 90.7 120' P.T.M.
............................................................ � Engineering Works, Inc. N.T.S. 234-18
PERC RATE <2 MIN/IN. C" HORIZON CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 8T 31 18
(508) 477-5313 / / P.T.M. 2 Of 2
s