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0085 HOLLY HILL ROAD - Health
85 HOLLY HILL RD., CENTERVILLE LA= l/ll' UPC 12534 No.2�153LOR ► �NAATINOO.YN, TOWN OF BARNSTABLE LOCATION 2-00 SEWAGE# VILLAGEC,Vr"z///L f. ASSESSOR'S MAP&PARCEL rISTALLERS NAME&PHONE NO. 4, ,ASEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER �D�3f/lr /yAQTris/ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist .on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 'Tdvy �.�id�•�/6.�d ; � .,�. ,.. ' G �5�3. � ,� Ovfll�o4� '� ^� /N,diX CFSSA�oc G'SSsp�t� �ti ,- --- - CO(Jf't Y•�DFt'� covtn q"�ff� Town of Barnstable P# I Department of Regulatory Services „,R,.,BIA : Public Health Division Date MASS 1 9." 200 Main Street,Hyannis MA 02601 Date Scheduled 4 Time / Fee Pd. Soil Suitability Assessment for wage Dis o Performed By: o Witnessed By: LOCATION& GENERAL INFORMATION Location Address © G`� Owner's Name ,I. 3&v .. `�fy ram•}a�N C F� C'J'\9�1 'Ln Address ��' j'..`,otl y Assessor's Map/Parcel ©C1 Ze Engineer's Name If 30\J\A�Z,,0O NEW CONSTRUCTION REPAIR Telephone# S-0 Land Uses Slopes(%) �� Surface Stones Distances from: Open Water Body /0O ft Possible Wet Area l fl 0 ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ,?,( fNFA ' Pr;L D TP-� �-13 - ? D - 46 3 1 GF- 3A TAn K S EwAY �LC( #14e- jLo.40 Parent material(geologic) S N Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /J oT 0 gf Weeping from Pit F... Ifo7- o-ff-J Estimated Seasonal High Groundwater /V O T O T DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __— in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Weil level__md,_m__� Adj.factor— Adj.Groundwater Level,, PERCOLATION TEST Date p e e lq 3 Observation Hole# TC 'X 75me at 9" d y Depth of Perc 4 �� Time at 6" Start Pre-soak Time @ ;l o - Mme(9"-61) End Pre-soak f Rate Min./Inch 'Z P Site Suitability Assessment: Site Passed " Site Failed: Additional Testing Needed(Y/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:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# / Depth from Soil Horizon Soil Texture :Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. istenGravel) /�►aT DEEP OBSERVATION HOLE LOG Hole# z Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. CD10sis"ecv.%Gravel) /o A--Y p ^V �-z 9 " �w F/.�r� ta.�a /o yam..•.��� �`' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling' (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No Yes . Depth of Naturally Occurrine 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? If not,what is the depth of naturally occurring pervious material? Certification I certify that on S— (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,ex ertise and experience described in 310 CMR 15.017. 11::�3 Signature Date Q-.\SEVnCVERCFORM.DOC r r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,.•''p 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: I LL only the tab key to move your DOUGLAS ABROWN TT cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Ale Company Address CENTERVILLE MA 02632 'E°0D Cityfrown State Zip Code 508-420-4534 S14297 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 ands intenan a of Ate ,sewage disposal systems. I am a DEP approved system inspector pursuant. Section` t.340%f Title'S(310 CMR 15.000). The system: o -n ® Passes rz p° ❑ Conditionally Passes ❑ F-Ai s tv ,. c? ❑ Needs Further Evaluation by the Local Approving Authority w cry /�' 4/2/13 Inspectoro i�ure 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 1.0,000 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-11/10 Title 5 Official Insn,,.. Vubsurf..Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS ONLY 7 YRS OLD AND HAS HAD REGULAR PUMPING FOR MAINTENANCE B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is CENTERVILLE MA 02632 4/2/13 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M 'to 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Citylrown 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 hea[ttu=,. 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•11/10 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 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Cityrrown 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- 10,000gpd. ❑ ® 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 tie- necessary to correct the failure. Large Systems: To be considered a large system the system must serve a facility witl '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 E ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Cityfrown 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 twoeweek 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. City/Town State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 3050 [N )TTRATORS IN A 10X30X2 AREA Number of current residents: 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? ❑l Yes ❑ No Seasonal use? ['j: Yes; ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail: 2011-------------—291 2012--------------267 Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: PUMPED IN 3013 AS PER OWNER 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: 1z Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 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: SYSTEM INSTALLED IN SEPT OF 2006 Were sewage odors detected when arriving at the site? ❑ Yes [R:w No. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(Locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA. 02632 4/2/13 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,.sta-10 liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS RECENTLY PUMPED AND WAS CLEAN AT TIME OF INSPECTION Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments CGM , 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below.grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is MA 02632 4/2/13 required for CENTERVILLE �I every page. Cityfrown 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 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO SOLIDS OR CARRY OVER BOX HAS RISER AND SPEED LEVELS 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.): Soil Absorption System (SAS) (locate on site plan,excavation not required): If SAS not located, explain why: 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I - Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-3050'S ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): NO SIGNS OF FAILURE AT TIME OF INSPECTION Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Cityfrown 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.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every 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 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 4/2/13 every page. Cityrrown 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: NONE ENCOUNTERED AT PERC feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M s 85 HOLLY HILL RD Property Address SEELEY Owner Owner's Name information is.required for CENTERVILLE MA 02632 4/2/13 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Z Inspection Sumrmary: A, B, C, D, or E checked ® Inspection Summary D (Systen '174ilure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high"groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or atth hbd in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ,''Assessing As-Built Cards Page 1 of 1 1UW1�1 tom'lfAKLV,IaaClfl.L' LOCATION $ SEWAGE N V � ASSESSORS MAP&LOT SEPWTA.MCAPACfff .J Sfn c3celtere 11 LEA FAC9=-,(type)jM= hus rAd (siu).LA"cjkc NO,OF BZDROOM-3.- f .KN DBtOROWM IIII Muff DAT COMMOCE DATE; Sepaniiimt Di+wec�c Bomvn dW Mu�umA�urtoS�T�ertdw�terT�+ktoA�eBottomoPLaachiugPaciIity Airele wow SuPptylYNAarmedLemFidit of my weld exbt _ ,1,• .r Q�irii6 el[N' 1�JiR YiEW S*dWMW and LcaftSFacility(Vmy wedend exbt 0 X10 fen dkacbwj 64W 1rm F by 1 2. z-17 Y T .3 I 30 http://www.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=188097&seq=1 4/4/2013 - Town of Barnstable CF THE 1p� ;4 � o Regulatory Services B"xAs Thomas F. Geiler, Director 9�A 69. �•� Public Health Division rE0 MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 31, 2006 Mr&Mrs Robert Dillard 85 Holly Hill Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 85 Holly Hill Road, Centerville, MA,was last inspected on July 5th 2006 by, Antonino Caponiqro, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System is in Hydraulic failure You have 2 years from the date of the of the system failure to bring the system intyo compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. B LE HEALTH DEP TMENT Thomas A. Mc ean, R.S., C.H.O. Agent of the Board of Health + �-\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL IriSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ,;;79a- CERTIFICATION Property Address: �S- �D,C.!y/l/L.l Paw O Owner's Name: Ddtc,-W.ACA� f11,fAVI P/GL/!.w Owner's Address: S',tr�1F Date of Inspection: 7 O Name of Inspector: (please print) Antonino Caponigro Company Name:.Tony Cap cr oniro's Tnsnpct•inn Service Mailing Address: 216 North Main �t Manst ie1d, Mass. 02048 E Telephone Number:. (508) 339-821.9 CERTIFICATION STATEMENT _ I certify that I have personally inspected the sewage disposal system at this address and that the information-r'epotted below is true,accurate and complete as of the time of the inspection.The inspection was performed based onimy c.� trainingand experience in the proper function and maintenance of on site sewn a disposal s stems.I am a DIP y Pe P Pe g fm y approved system inspector pursuant to Section.15.140 of Title 5(310 CMR 15.000) The system: r Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails In Signature: Date: -7 o,�c 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 s4init the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments AA. "WW!5 ,!/or /�i�'�.ficd.�ice- To Ty/s sysrE•+ **"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. Title 5 Inspection Form 6/15/2000 page 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: eff/f�l,(�f�/.CL G _ Owner. Date of Inspection: zzz 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 components mores stem as described in the"Conditional Pass"section need to be replaced'or y 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 d exhibits substantial infiltration or exfiltration or tank failure is imminent:System will ass'inspection if the unsound, Y P Pe 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 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: 2 `f 4 w . OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ?5_11014 y`//LG 'Fe l Owner: O6fia7�.0,ar y f/1�. 'DJ�G9so� Date of Inspection: C. Further Evaluation is Required by the Board of Health: Alp 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. Thes system has a septic tank and SAS and the SAS is within a Zone I 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 front 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: _J�f'11OL dy /+1/,(4 va" CE•�filyi.�.�F; i'Y.tss Owner. Date of Inspection: 7 fps D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Ye Backup of sewage into c system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'%.day flow TRequired pumping more than.4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped j!!'// Any portion of the SAS,cesspool or privy is below high ground water elevation. a( Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface k water supply. _ Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. -T Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) fS (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: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: ('Ilse 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 11 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 15304.The system owner should contact the appropriate regional office of the Department. 4 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: � A �G/• Owner: D:1f•�'>"�.dt�>•s�i5/ f. yev/?�/,ll.b.�� Date of Inspection: 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? X _ 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? C�SSPOGUC .too 0,O,vS XWere 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? ✓X _ 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 th'e,baftles..or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of setup? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no 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)) 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Sr D.0 C V 11244 Vel • �iS/Tf/11�l,CLF /9,(�SS Owner: Date of Inspection: ZZ*Le a F W CONDITIONS RESIDENTIAL �t:Sfl�6o,C .vv�,G4'•fC5 d eo/ir ' Number of bedrooms(design): XyNumber of bedrooms(actual): 3 DESIGN flow based on 310 CMR 1 .203(for example: 110 gpd x R of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): fs Is laundry on a separate sewage system(yes or no): 1 Z [if yes separate inspection required] Laundry system inspected(yes or no):�i Seasonal use:(yes or no):_,4�) Water meter readings,if available(last 2 years usageYgpd)): Sump pump(yes or no): Div Last date of occupancy: A7- COMMERCIALIINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgfi,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: /V ed Was system pumped as part of the inspection(yes or no):-,,V 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: AGf o j0//.e9e4V ' Were sewage odors detected when arriving at the site(yes or no): W4 6 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �S^��0.lL Y ZI-ZeU ZY Owner: D40.dr0 , 1J7->"Y Date of Inspection: 9 y' BUILDING SEWER(locate on site plan) Depth below grade: 2.? 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.): e✓oNDt>`io.s: a.�' E7"O�NT's �(/fNTI/Y6 Gd190 ilB E!�/11f:SiCg o C,1Fd��E SEPTIC TANK:-(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene _dther(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 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: A'1r1-s#eAep ow Sires Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): IIIZFT E O!/TL FT T-s .ST,64/C7-&.4&-'Y -5-,0a vo ZI"1,0 D�r-,c E r- i.�yF.e r- yo fyir��,vcF o,` ,CP,rs,�r�.v4C �F����'.vv 7'�"/✓k .C/E Go�/•�v.�Eo. E'd�Ly yids, T.�f,�f,�Fr�e GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other "Piree /7"/s .r'CKOAV4f0V®f (explain): Dimensions: " Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition..structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Au Y, IV111L Owner: Date of Inspection: TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): . Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be openedxlocate on site plan) Depth of liquid level above outlet invert: '04--r ET/Nd�iL1' 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.): AbX /S 1 A-P 77/S 7/2/1347/OVY — -,E74 ZZ€ PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no)-. Alarms in working order(yes or nor Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 A OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: v Owner: 9 Date of Inspection: 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. innovatiQjatternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): - / O �Y o2 f�f7f�-T/O Oti/,�!//1Fi�s �yf/l�zo� Fssooae ,tr��ro.t f�fe_.7a ry�f,���'Rio ��,r,�vf f spy CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) -AY/ Number and configuration: /10 V O'✓Q Depth—top of liquid to inlet invert: Depth of solids layer. /'Z" Depth of scum layer. Dimensions of cesspool: ,S'y6 r.y Materials of construction: nomc I-C4ZIe S Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 7711J i11DT 1pyl�-1P T>!!E'Ty �/licyC f 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.): 9 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: f i1v,t,Lf Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. --1 X1Nf 9",OEfP Cavfr� S"Veto 10 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address- Owner:_- -16ordfF.r??'.�1,C�/2`rTy�l/fi•/YI.�II.G/7>i.G�.4i1r� Date of Inspection: 7/S/p4 SITE EXAM Slope A-.4'✓' Surface water /Yoh Check cellar /fS Shallow wells WeA-?�' Estimated depth to ground water/Y fee1(2MeP,0T TaY7-_e 1!it/Fy Z74"e' 7 e/.PS SAW ge bw IT fo r° BD// d46 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: Observed site(4butting property/observation hole within 150 feet of SAS) 1 Checked with local Board of Health-explain:T, gf a i10 ov 9/�/od Checked-with local excavators,installers-(attach documentation) Accessed USGS database-explain: You wust describe how you established the high ground,water elevation: State Enviromental Code Title V Chap. 5 Inspection Procedures Guidance on Completing Inspection Form Part A Certification. The Certification Section has two principal functions. First it .provides identification information on the property being inspected and the inspector. Second, it presents the results of he- inspection relative -to-the-f-a -inn--3:10 -� CMR 15:303. In the certification statement, the .inspector is cer... tifing. that the conditions existing at the time of inspection are accurately 'presented in the inspection report; the inspector is not certifying that the system is adequate for the current use Hof the system nor for the future use of the system. tI _ w Y0111 Septic System and How it W011411CS 's important to understand how your system works and how this treat int affects it in rder to protect your investment. The typical system consists o ee (3) main compo ents. The tic Tank The Distfibuti'on B '� Box � The eld The Septic nk Waste exits the ho a and enters the septic tank w re solids settle to the bottom, grease and scum from ie household detergents oat to the top, and liquids stay i6 between. The solids that ttle create their ow ' acteria which decompose the solids naturally. There is no need add addition enzymes and bacteria-to the tank. The tank eventually fills with solids nd scu equiring it to'.be pumped. The Drainfield The liquid (gray water) flows to a distri tion box where it is evenly dispersed into ' the drainfield. Finally, the dra' field begins ting the gray water. Microorganisms in the soil consume organic llutants in the gra grater and the pure water is absorbed by the ground below. How Problem Start From the first da of use, the drainfield of your septic syste begins to deteriorate. Some solids, ase, and scum always pass through the septic kin' the laterals. This is Za- a of natural solubility or the lack of settling time the septic tank .during per' ds of heavy use. Problems especially arise when the septa system is not maintain d and the septic tanks .fills with solids and scum that ove w into the drainf l& As the drainfield becomes clogged, the water flow becomes r tricted. Since the water cannot drain into the soil, it filters upward causing ponding, foul +odors, wet spots in the yard, and an unhealthy environment. TONY CAPONIGRO 216 No. Main Street Mansfield, MA 02048 Title V Inspections TOWN OF BARNrSTABLE LOCATION S5 14-011v ITo11 Rr � SEWAGE # VILLAGE 0 illy ASSESSOR'S MAP & LOT_ra_Z9_'k0? U STALLER'S NAME&PHONE NO. _Do��� h �Ze-3 SEPTIC TANK CAPACITY l SM &2110rO LEACHING FACILITY: (type) 1(7X3Q '4 1fJ1 L4f6W (size) . 1(,AA6:r.ACC NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: bdoc, COMPLIANCE DATE: l Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility CYNP DV, 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 �V 2-33r 'CIE ` f 3 i0 30 Fee Q� THE COMMONWEALTH OF MASSACHIISETTS Entered in computer: Yes .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for DigozaY 6p9tem Con.5trurtton Vertiatt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. E3 S 9447 It,� Owner's Name,Address,and Tel.No. co he Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ONf O� k `3r© a Nzi Alfag-y77_ 19®q Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title 1 Size of Septic Tank isoo GCcWr to Type of S.A.S. N tr4l l Fret ioPS 30 X(Q X°1-- Description of Soil Nature of Repairs or leer tions(Answer when applicable) J) C enrZe. , &—pi C . M a �-n .`\)d'P 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 of He th. Sig d Date I, t� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. / Date Issued ' No. / ) Fee q ` Wb Entered in computer: -(HE COMMONWEALTH OF MASSACHUSETTS p PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppricafion for Migogal *potent Construction Permit b Application for a Permit to Construct O Repair O Upgrade O Abandon O ❑Complete System ❑Individual Components Location Address or Lot No:,65 f�v/l7 It,Y YJ Owner's Name,Address,and Tel.No. /V1w i,,/&3 p Go p Assessor's Map/Parcel '/S 8-" C)/7 Installer's Name,Address;and Tel.No. Designer's Name,Address and Tel.No. 1'g so�ro d1C y77-dog- y9o9 Type of Building: Dwelling No.of Bedrooms 22 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow,pr11videil1 ! _ H© gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank It SOp C-,C,) Cry Type of S.A.S. U 114 4f a}Or S 30 X(O X°l-- Description of Soil Nature of Repairs or ltpr tions(Answer when applicable) 0 Q G 5ep'}1 C C.Y) P ,� 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 of He th. Sign d ,� tt, Date Application Approved by t�_.� Date Application Disapproved by: Date for the following reasons Permit No. O�'' �� Date Issped THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CER Y,that the On-site Se way Disposal System Constructed ( ) Repaired ( ) Upgraded ( X) Abandoned( )by at q5 t \� Ce�xr� t has been constructed in accordance 1 1 with the pr isions of Title 5 d the for Disposal System Construction Permit No.9DO b 31 y dated '� I �p Installer 1 � Designer �y Af�G tJ #bedrooms Approved design flow 330 gpd The issuance of this permit shall of be or trued as a guarantee that the syst wily c' esigned. Date Inspecto No. Lo / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS i�po�af �potem Construction Permit Permission is hereby granted to Co,struct ( ) Repair ( ) . Upgr de (X) Abandon ( ) System located at 8 5 0017 �� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special condition . Provided: Construction must a Vnpleted within three years of the date of is per Date I Approved by Town of Barnstable `"E" Regulatory Services. Thomas F.Geiler,Director MAs ., ►b,9 �mg Public Health Division Thomas McKean,Director 1 200 Main Street,Hyannis,MA 02601 1 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 9�/�! 06 Sewage Permit# Assessor's Map\Parcel / o19-7 Designer: -1bAt41e-Z- -S°rt`.'f o'`' Installer: 2�, o-6- $,zo s Address: O *"J- 63t Address: OP n � // 0 6 ,b o a d- ��'�'.o was issued a permit to install a ' O (date) (installer) septic system at �5' ¢lfl4t f t�+u �� G���'``"� based on a design drawn by (address) dated 9 1/f/0 6 (designer) / I certify that the septic system referenced above was installed substantially according to � the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank I i I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. ,r aller's Si afore) 8 .4 ''F ;ITA (Des gner's, ignature) (Affix Desi a isStamp Here) PLEASE RE TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/SeptidDesigner Certification Form 3-26-04.doc CO.NLMOXWEALTH OF MASSACHUSETTS _ EXECUTIVE OFFICE OF ExWRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE RI\TER STREE . BOSTON DLL 0210c (61'1 292.550e TRUDY COX: Secre:a-% ARGEO PALL CELLUCCI DAVID B STR'..•I-IS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Prop"Address: 85 Holly Hill Rd. NamteofOwner Wald-on Caldwell/D . DeCenzo Centerville Address of Owner: Date of Inspection: Name of Inspector:(Please Print)WM. E . Robinson Sr . 1 am a DEP approved system!inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) Cornpan mt yNae: Wm. E . Robinson Septic Service Mailing Address: PO Box 1089, Centerville MA Teleplwne Number: CERTIRCA71ON 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: — Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails 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 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 tMre system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS 000 Ike \ !F revised 9/2/98 Page Iof11 M �� w ^!ed on Req•clyd Papa r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART A CERTIFICATION (continued) "rop"Address:85 Holly Hill Rd. , Centerville Owner: Wald.on Caldwell Date of Inspection: 3 -7--a9-6-e—` INSPECTION SUMMARY: Check 6A, A C, of 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. YSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon ompletion of the replacement or repair, as approved by the Board of Health, will pass. Indicate ye , 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 revised 9/2/98 Page 2ofII J r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Ica ttinued) Prop"Address:85 Holl Hill Rd.. , Centerville owner: Wald.on Caldwell Date of Inspection: ,? ozo a � C. RTHER 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. 21 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 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). 1 OTHER revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 85 Holly Hill Rd.. , Centerville 0.,1.f: Wald.on Caldwell Date of Inspection: ,J—.2 Oz ova-* D. SYSTEM FAILS: You mus indicate either "Yes" or "No" to each of the following: I ave 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 No 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 pipelsl. 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 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. 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. LA GE SYSTEM FAILS: You mus indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The 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 health and safety and the environment because one or more of the following conditions exist: Ye)oner 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 11 of a public water supply well) The or 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 9/2/9E Page 4ofII I � I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART B CHECKLIST Prop"Address: 85 Holly Hill Rd.. , Centerville Owner: Wald.on Caldwell Date of Inspection:3 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes , 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. L/ _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or indus trial Iwaste flow. LL _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ 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: _ 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) f15.302(3)(b)] The facility owner (and occupants,if differera from owner) were provided with information on the proper maintenances-0f v SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION •rop"Address: 85 Holly Hill Rd.. , Centerville Owner: Wald.on Caldwell Date of Inspection:3 FLOW CONDITIONS RESIDENTIAL: Design flow:96-`CJ g.p.d.lbedroom. Number of bedrooms (design): 3 Number of bedrooms(actual):3 Total DESIGN flow Number of current residents:AA Garbage grinder(yes or no): 6 0 Laundry(separate system) (yes or no/L d If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):A,,0 Water meter readings, if available (last two year's usage(gpd): 1 999 56 r ��� gal Sump Pump(yes or no): �' O Last date of occupancy: 1998 19, 000 gal. COMMERCIAL/INDUSTRIAL: Type o establishment: Design low: gpd I Based on 15.203) Basis o design flow Grease rap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non-sa itary waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: Last d to of occupancy: O R:(Describe) Last of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: / Ci 9 '7 Syst m pumped s part of inspection: (yes or no)4 0 If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Ingle 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 lif known)and source of information: �/!�• S Sewage odors detected when arriving at the site: (yes or no)A, U revised 9/2/91 Page 6of11 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirwed) 'ropertyAddress: 85 Holly Hill Rd.. , Centerville Owner: Wald.on Caldwell Date of Inspection: - 7 BUIL NG SEWER: (Locate n site plan) Depth be ow grade:_ Material f construction:_cast iron_40 PVC_ other(explain) Distance rom private water supply well or suction line Diameter Comme ts: (condition of joints, venting, evidence of leakage,-etc.) SEPTI TANK:_ (locate o site plan) Depth bel w grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_otherlexplainl If tank is m tal, list age_ (sage confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth Distance from top of sludge to bottom of outlet tee or baffle: Scum thickn ss: Distance fro top of scum to top of outlet tee or baffle: Distance fr m bottom of scum to bottom of outlet tee or baffle: How di sions were determined: 'omments (recommen ation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence o leakage, etc.) GREASE RAP: (locate o site plan) Depth belo[s:- Distancerade:_ Material ofstruction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimension Scum thic frtop of scum to top of outlet tee or baffle: Distance tom bottom of scum to bottom of outlet tee or baffle: Date of la t pumping: Comme ts: (recomme Ydation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rev-Sled 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION(continued) 'ropertyAddress: 85 Holly Hill Rd.. , Centerville Owner: Wald.on Caldwell Date of Inspection: TIGH OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate n site plan) Depth be w grade:_ Material o construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimension Capacity: gallons Design flo gallons/day Alarm pres nt Alarm level Alarm in working order: Yes_ No Date of pr ious pumping: Comment (conditio of inlet tee, condition of alarm and float switches, etc.) DISTRIB TION BOX-.— (locate on site plan) Depth of li uid level above outlet invert: Comment (note if le el and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP C MBER:_ (locate on site plan) Pumps in orking order: (Yes or No) Alarms in orking order(Yes or No) Comments: (note Condit on 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) 'rop"Address:85 Holly Hill Rd.. , Centerville Owner: Wald.on Caldwell Date of Inspection:3-- 7 -a-6-C--6 SOIL ABSORPTION SYSTEM(SAS):L/ (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, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) CESSPOOLS:_ (locate on site plan) t Number and configuration: Depth-top of liquid to inlet invert: 7' Depth of solids layer:_,:?-y" )epth of scum layer: Dimensions of cesspool: 1` Materials of construction: / / S r Indication of groundwater: h 0 inflow (cesspool must be pumped as part of inspection) Z Comments: (note condition of soil, signs of by aulic failure, level of ponding, condition of vegetation, etc.) _ s PRI _ (locat on site plan) Mater als of construction: Dimensions: Dept of solids: Co ents: In a condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revise_^.'. Pagc9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Noperty Address:85 Holly Hill Rd. , Centerville Jwner: Wald.on Caldwell Jate 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) �I v U 1 L revised 9;2/9R Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C SYSTEM INFORMATION(continued) ropertyAddress: 85 Holly Hill Rd.. , Centerville Owner: Wald.on Caldwell Date of Inspection: 3_;7_a 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 ) 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 Checked with local Board of health _.Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/95 Page 11of11 G / �jT�M 1500 GALLON SEPTIC TANK ��PTf`r," " TEST PIT DATA I MODEL SHOREY ST•1500-H•10 ' r L. r96.5 � \�', FINISHED GRADE Perfcrn�e� may . Dan_c�. :. "ohr.son _ _ 24"DIA 24"DIA 91MIN) 24"DIA Witnessed By: Don Desmarais ' H 10 _.a e : August 29, 2006 6„ OUTLET RISER COVER TO 4"SCH 40, EL =96.50 WITHIN 6"OF GRADE OVER TP-1 (EL. = 99.0) j THE OUTLET COVER 4"SCH 40 10 FLOW LINE 14' ZABEL FILTER A• 100 'w/HERE FILTER IS EL =96.75 96 . 3; A, 0" - 8" 10YR3/2 Sandy loam SEPTIC TANK TO MEET OCATED 4" ,CH dQ TEE 4`UQUID LEVEL REQUIREMENTS OF (96 . 8 ) Bw, 8" - 27" 10YR5/8 Loamy very fine sand GAS BAFFLE 310 CMR 15.226 FOR C1, 2 7" -132" 2 . 5Y4/6 Fine-medium sand 4"SCH 40 WATERTIGHTNESS 2 . 5Y6/1 TEE ETC o' 132" Bottom of TP-1 !No Observed GW/ESHWT! ALL WALL S LE EVE S/GASKE T S SHALL 9E CAST IN PLACE OR 6'. (MIN ) EL =72,6 �'! o _ MECHANICALLY INSERTED AT FACTORY o � Q CD COMPACTED %j. TP-2 (EL. = 99 . 5) , CRUSHED STONE ( 98 . . ., 0" - 10" 10YR3/2 Sandy loam STABLE LEVEL BASE <=3i4"DIA. SEPTIC TANK DIMENSIONS 10' 6"L X 5' 8"W X 5V H ti (97 . 1 ; Bw, 10" - 29" lOYR%/8 Loamy very fine sand :9" -126" 2 . 5Y4/6 Fine-medium sand C1tAIr, c. Fr f1i )I.EN4( .-. ---..___....___ ..__...._._..Y__.. DISTRMOOELIBUTION BOX SHOREYDB 3 `H �10 PERCOLATION TEST DATA REMOVABLE COVER i 4"SCH 40 OUTLET LATERALS r'.:au.: DISTRIBUTION BOX TO MEET SHALL BE SET LEVEL FOR A REQUIREMENTS OF 310 CMR MINIMUM OF THE FIRST TWO 15.232(WATERTIGHTNESS. FEET AND CONNECTED TO �F SOi i3SS : L:iaSS i ,0. !4 v%SF) CONSTRUCTION ETC) -_ � 2 !�) EACH DISTRIBUTION LINE 99. d WITH SOLID SCH 40 PVC PIPE 4 Perc Depth : 40" - 50" (TP-2 ) , MF a ; . ! NO. OFOUTLETS E S 40 6" " -- USED 2 L .2 EL =9610 a o C, ) a o _-- CRUSHED STONE ;'_ '4' a SCHEDULE OF ELEVATIONS o U - DIA STONE l"r' q�fb ) I --+`-`�Tr�t•F 1..E4'E! RA'�+: DlA STONE TO BE 991L7 po� Inv. Out Fcundation (exi sting 97 . :i TP�99� 99f5 CFI _nv. :n Septic Tank 96. ��. inv. Cut Septic Tank 96. 50 \ ox '9r9 Pr Inv. In Distribution Box \ oov \ ` :9 _ Inv. Our Distribution Box 96 . 1�J __._--- �'j A �,s _ FEn�cF anv. in nfi'_tr3tars 4 The High CapvcnySiclewindwChamber � ' �'' io q iNFiC.TK�roRS C Sot.t�>m of Infiltrators q�t l �� 8 %O ` y x 1. R( Y f 'r! p 1 s ' r i Ov.rtav at a rnq N/lCIWIST ")b 5 . '�TIY� 1 fs t{M1 i T- - - 97 � -'- t,�EC,=96.1� 9t4 / Ertlsrrn(b Sks Cyr Nofts i5• o pro �»� � CrA�A6-t: �E�'GE i . All construction methods shall conform to the Title V ( 31n O O 08 rn, ��IST/�(r NovSE CMR 15) and the Barnstable Board of Health Regulations. FFL= loo.b� 8FE 9�•5 There are no known private or public wells within 15i , 99,6 o feet/400 feet, respectively, of the proposed leaching area . f Size(W x Lx H) ......34'x 75" X 16' "^ The proposed leaching area is not with4.n 10Q feet of a 3e�N��M.4�K _ ! wetland nor is it within 200 feet of a river front . ' Storage ;aoscary ....1toQaula.3tt' '155jmf EL.l(oo.00 D2rjEwA-1 _DP oor 0ILI�K Srvo � �Nro G Fxi sting cesspools to be pumped and removed prior tc ........... ................ ....� W4ugnt 37 ibs :nstaiiiny the new septic tank. H a vSE f � __.. }- Louvared S;�*-4911 Hw9rt p" + �' . . No changes are to be made ic. -he Meld without the approt.'a _ of the Board of Health and the design. engineer. .�+rVs�,.Hlr►.«.wc.I.r....;.r..i..w i.wln� ��T..r�aue.. ! +M•*'N•r n ,�*A.MI'•'rrn+ev Ntl w 11r*•'kYr'RwM wr N►71�o�•..•NM 4 w tl.0 ..�wrrrr w.r•pn... 1 r v f yak MIM+n w4r•NMr..aw+, ,� - ='reposed leaching field S lot designed _or :]Se With •^�*+r*�•ti..r .r.a«.,..,n,,, "'�""'"'""�"„'�"'�ro +r/�p +a., ,,... - �+n• ..►/y�M'N.r.Y�'IYy i. /!!h++M.w1!mw+/�.r M�Wi MY}n!ur ro' garbage disposal . #am b�a� Ys'tMlMll h�.NYM W1ri�i� •Y� •r lMii�II.IPYMip w FMa-. y '.atiM���•r.i 4�y=,��y r���rr�.w•,•+Mrgr�•yy ww.�1F M M1 r.» .,rr , � 6. Contractor Safe r 4 ���MI•;Ir/.iIN/rpM� _c notify Dia �a_e 72 hours crior to -. � � �•��.rrse+.roe r � ��"�� _ construction . (800) 344 233 � � R11� lf`�1 ♦w wr�.i:.�'F �k.. r y M � ��F�Y IM'ai1M r r,INMiM�si}Wyy�t�Mo1MiaA►ANN i1..11/K1iHy ON% �q 140 Flew i8il E06'E Or Propert}' line infGrmaLi on taken from c pdr� �f :lari +"' ' " r, �', r "�•.1. a•.w...+w,,. ww .wr ,, y�r�1rIL' w r i0/ww" . wiM.." �„ `n.;;w w�.. ...r.sw31"m f!f)o Rif 3.1ao 4W-S77-rC_lxj T(�PPlLoX� (subdivision) , dated August 28, 1957 . The septic plan is �»�++ �w«w•» �«.�..,..., w�iF rr-rix,� not to be used as a property ' ' ne survev. p p +�•�w•,�.«...,«.r i �~ y wvwl,Ir,Hfir&tE)ra 6ti7n18.�Jtn - - - 01.L ____.-_ _w.__..__ _.� _ . ._. . __ �__. _ -_ �- -__ - - ... - 3 . Remove existing a n` lac- i cam _ woewaw�.Aft.4wpX" P.e..r "r. f.w� �. a..44d Q� f.JILL R ��4D w+,-«air.w.r •.ww.erlw w w•raw ,� „.�.r..r+.•.... s.. r�et�� ( ewra.w.,n�raa�:sapfe gray w ,.r • 'Gil' °. e ` ' ng le china area and any leach ace 'mpg te- M-��•�•...A...,..,,...,..,�.,. so_=, if encountered an reel ; r�, ' 9 - a e W_...!. -.i t 7 e :/ f:.__ +...... ;,.e,.,.,r wr ar.�r�r«w ►n.r• +�w�.w.tinrw.•+r.....� S TI< Sy EM v E P �T ( sand, ref. 310 CMR 15} The total amount of fill (sand• : ._._ fFE= ion 4S Sk�ww i estimated to be 10 - _20 pubic yards . � For teemisg s1�►��.oAt��t11 FS 6� S R o SS �c.n ON ,4 � �-i S r I J 6 (AM+ 11stemt.at 1-800�z31-�, s Contractor shad ver: f aim clumbing from existing structure 0o jZrf f� .CavEK. i=l be connected tc the new septic system prior `o construction. If any existing plumbing exiting the W,T µ(me structure is found t D tp ,zi`feron* the `:~gat sh':wr: r: • �� _.___ 9 3 approved septic system C%Ian, -.F1F? tint :"%ic'r:.t_ �?Ri 3 i.1 n<)1 , 'f� ---- . r;,,c / y.�+ C"�y$ 6jj t�Ea' 'itP''it )r a i""cTy'. , , C'• 1 et r a. � to i low CALCULATIONS: .=rz G+L'"E'` � aM M . �� ,�< raN` 3 Bedrooms (existing) too PL ' ! 110 GPD/Bedroom X 3 Bedrooms 330 GPD =.o ± 16 z i) / r ; t -----i Perco i at ion Rate < 2 MPI, C ( . 7 J .` Q v � ! lass I 0 4 G/SF) A PROPOSED LEACHING AREA . 3/4 �° waskEu �P-►.�f "Yt r ! Infiltrators . 4 'at 30 L x 10'W x 2' H 6, 10 cs o -�aa CENT e, ! y LEGEND Side Area: 160 SF X 0. 74 (3/SF g 118. 4 GPD 7 a _ �•t".:`9 E }: E R ��Ly °� y ��N�E�;;o3 _ . Bottom Area: :300 SF X 0. 74 G/SF = 222. '0 r,AD .�, C _ C'¢ I ILLS u P'.K1J3 T' 1g �l%rl _ - _ . _ ,_ _ � l � � .� � ri 94 otaI Leach apAk' rV: 140 4 : ��11 O • aNOREA h. -i.I R `N ` O T'�i f '] _ -.-.� ) - t 5 , C.S.. C i~ F k � r llc ER F Q a BfE' 9� sr �{ rNFit,riL ro9-S i N4-.1 i - �w �:A `'<cF� y ��ow P Y a Ito a l Finished Floor Elevation FFE � r a• A tWt " •;v�� s �y RQd� 47M ? -00 &ALC orb e 39 c rt (o Yv ,c z 'H S.' "ws 1. e y „"f = _ 019 " �� w/tl >;4v o' 4.. r �~ I ,KEf p3JE?!lent C C_.: E1evat.4.n 3.^� 5 E P 7 T�4n(K Lot s W �a e. Water Line •� , ; ty, MAP 46 W - e u J +3 y V � � r ~ _ P y "t 0.D tif� ' ;tO ftk'nG i ' SC1:4"I :o ` = ror - Over Head Wire OHW PA SAY q0 K' SC i w ? ` n :,. LE4 r t a vas Line �oTTUM rP'•2 CFz' �9 86 SUBSURFACE SEWAGE DISPOSAL SYSTEM 85 Holly Hill Road, Centerville SCAL.Er APPROVED BV: DRAWN BY x, ' ' k DAYS 9/11/06 Daniel B Johnson REVISED 0+00 0+10 o,��0 0,`30 otQo ofSo p+bo ar o ot8o Qi9D 1t00 spar o rt rtyn ror: 85 Holly Hill Road, Centerville, HN 02632 14012, ( = to � ~/ Prepared - DRAWING NUMBER by P O. Box 931, Osterville, NA 02655 T-2101