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0108 HOLLY POINT ROAD - Health
108 Holly Point Road Centerville A=232 -041- /// SMEAD No.53LOR UPC 12543 smead.aom • Made to USA S y y No. �� '� � � � ��' Fee 400 w THE COMNSONVVEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Applicatiou for Mi5 �Upgrade f �pgtem Congtructiou Permit Application for a Permit to Construct( ) Repair( ( ) Abandon( ) El-Complete System ❑Individual Components Location Address or Lot No. 40$ 061It) f6mA- f omJ Owner's Name,Address,and Tel.No.rwr 1E t Chtun Assessor's Ma /Parcel O13Z I OH i it* NAb Pjn+ �.4 p Cft1 YA 11 e_ MA Installer's Name,Address,and Tel.No.e A�oe4 14 r Designer's Name,Address and Tel.No. fQ} qo 1.L 1PAAa-PAY,4,cv%jftA q2I Type of Building: Dwelling No.of Bedrooms "1 Lot Size Q0) 1-413 sq.ft. Garbage Grinder ( ) Other Type of Building OWAN)jl q No.of Persons Showers( ) Cafeteria( ) T Other Fixtures Design Flow(min.required) Wi O gpd Design flow provided Ll Lj gpd Plan Date g �3� 1 Number of sheets 1 LRevision Date D ® Y� Title Ply �e� WaS}��vdO� tC' �ejat,< Oqi$ 1�1l� P'1rTT �Q- i Cal m MA Size of Septic Tank 1�© JAI Type of S.A.S. A-ab 0q q_ Description of Soil I-10ATA q-n LI`c��2(t� ehu •(0%('&- 't� TO Nature of Repairs or Alterations(Answer when applicable) T6 Px ii lnq rLy¢?�1 Z 5�'S1•LY"1 w\� u On 0- TX�4 6 corn 1 14 n�- ttyn c.l,nel rn a.s 15-►'0 1br%�► S.c l c. 0%,r>k, 5�rs, >~ an and Wch-PI Afe CV,5 Date last inspected: rj I v 3-t O-zk$ 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. p Signed + Date ( �Z3'Ix3a9 Application Approved by et. /efs Date ®o— Application Disapproved by: Date for the following reasons ———— Permit No. 2— �� �✓ Date Issued � � a-oo . ————————————,.arils-———— —————— ———————— }ia Fee / No. p1= /�� Entered in computer: t THE COMMO:N.W52ALTH OF'�MASSACHUSETTS J , Yes , ; PUBLIC HEALTH DIVISION_ TOWN OF BARNSTABLE, MASSACHUSETTS, . ,r _ J ZIppgication for TDiopont 6p!5tem CCongtruction Permit , f Application for a Permit to Construct( ) Repair( 1Upgrade( ) Abandon( ) ❑.Complete System Individual Components r Location Address or Lot No. 108 j�j111,)"QJ)n`I' 120ad Owner's Name,Address,and Tel.No. ?,V<< Assessor's Map/Parcel C�1L�Y�1 MA 'GZ �p, Installer's Name,Address,and Tel.No.C BW rflPd*( Designer's Name,Address and Tel.No. )Q+ l u; J oic7b3 1�otSLcy-CA q s �0 piy.. ,.��4 u /r° i O 12oU1.G &A �Sq'P.� t cl% nA v.S(Ot Type of Building: w Dwelling No.of Bedrooms Lot Size QO, L-113 sq. ft. Garbage Grinder ( ) Other Type of Building tW'Aml No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) Wi O gpd Design flow provided 1i Lio gpd Plan Date '9 13i 0'1 Number of sheets 1 Revision Date +''-�r'� spa Title 91��A �y�S Gv�/o� tt- P-Q-AT ,14Z 1�11h p614 *d h)A Size of Septic Tank 15-00 1 qtj Type of S.A.S. A-t m c1n.I S 6 Description of Soil 1_,Mayn w,nA Lt 1e " aluyin O th d - Nature of Repairs or Alterations(Answer when applicable) ))at .QN 15 f;nck 4u�i 1 L 5!3'5 4 fln W 1� 1 � QAAtAd VJ'V\-k .� 1 1�IG S c�melIQ11 SL►51-tm 1rN L11Ael I-Al " w 15-0-0 cqa11�,rU ltAle A. Y))r- T �15k{t�In�,ar� lr�.x Ord '-1 wcl't,ro ikodf,,5 Date last inspected: rI 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 4 -Compliance has been issued by this Board of Health. Signed / Date ' Application Approved by ! ~ / .$, Date Application Disapproved by: / Date for the following reasons Permit No. Date Issued1. 2OP Y"1""_THE COMMONWEALTH OF MASSACHUSETTS 0,01 OM BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (cle pgraded ( ) Abandoned( )by at kO J a;ml IZO. C._ �_ u1 Ls, G has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ! Qr��j•,• �,Q14 dated Installer Designer r),2SLlr_/ Li H i T`TIFKI #bedrooms Approved design<flo'A I /\*y 4/0 gpd The issuance of this permit shall not be construed as a guarantee that the system�l l fun ion as design d. (` Date �,��,���(}� Inspector No. '—G 47-6—uj Fee A00 � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS -Migoat *pgtem CCow5truction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at /0 6.4 /X1 7 AZD i%' -,rg z V/LL lis and as described in the above Application fbr Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construc ion mus'be completed within three years of the date of this permit. Date 7 �c� - ! Approved by s l A ` o w AUG. 4.2009 9:18AM BARNSTABLE'BOARD OF HEPLTH NO.3.92 P.1i7 t + r APPLICANT: p6i c)C ADDnSS: Val V D r U IIi1� DESIGN FLOW: t#1�o gpd REVIEWD'EV: DATE: NIA OR NO Le al boundaries denoted 310 CUR 15.220 4 a c✓ Street,Lot,tax parcel number and lot number noted on,plan[310 CMR 15,220(4)(u)] Locus Provided f310 CMR 15.2204 t Plan proper scale?(1"=40'fox plot plans, 1"=20'or fewer.for components) 310 CMR 15,220(4 t✓ Easements shown 310 CNM 15.220(4) System located totally on lot served[310 CMR 15.405(1)(a);For u ades -f not, a variance is required 310 CMR 15.412(4)] Location of impervious surfaces(driveways,parking areas etc.) 310 CMR 15.220 4 d Location all buildings existing and proposed 310 CMR 15.220(4)(c)) Location and dimensions of system components and reserve areas 310 CMR 15,220(4)(q)] System Calculations L110 CMR 15.220 4 daily flow `p septic tank capack re uired andprovided) soil absorption s stem(required and rovided whether system desi ' ed for garbagejrbdoi North arrow 510 CMR 15.220 4 ExisthIg and proposed contours 310 CMR 15.220 4 ✓ Location and log of deep observation holes(existing grade el,on each test 310 CMR 15.220 4 0/ Names of soil evaluator and BOH representative[310 CMR 15.220(4)(h)and i Location and date of percolation tests(performed at proper / elevation?) 310 CMR 15,220 4 i ,i Percolation test results matgh loadin rate?Q10 CMR 15.2421 J , Certification statement by Soil Evaluator 1310 CMR 15.220{4 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)and 310 CMR 15.220 4 n ' Location of every water supply,public and prlvaw,,[310 CMR 15.220 4 k Address Sheet 1 of 7 AUG. 4.2009 9:18AM BARNSTABLE BOARD OF HEALTH NO.302 P.2i7 within 400 feet of the proposed system location in the case of surface water supplies and Mel packed public water su 1 within 250 feet of the proposed system location in the case 11/ within 150 feet of the proposed system location in the case / of rivate water supp!j wells Location of all surface waters and wetlands located up to 100 ft, beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220 4 1 Water lines and other,subsurf'ace utilities located[310 CMR 15.220 4 rn if water line cross see 310 CMR 15.211 1 1 Profile of system showing invert elevations of all system com ouents and the bottom of the SAS t310 CMR15.220 4 o Stara of desi er f310 CMR 15.220 1 d 310 CMR 15.220(2) Stamp of Registered Land Surveyor(required if construction activities within 5 ft.of lot line) [310 CMR 15.220 3 Test Holes adequate(two in each of the prlmary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as approved for an u de under LUA at 310 CMR 15.405 1 Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.1034 Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15,103(3)] Benchmark'within 50-75'of! stem 310 CUR 15.220{4 Materials specifications noted? [various sections of 310 CMR 15.000 System components not;>36" deep(unless Local'Upgrade Approval or LUA requested)[) [310 CMR 15.405 1 Address Sheet 2 of 7 -• T i t AUG. 4.2009 9:18AM BARNSTABLE BOARD OF HEALTH NO.302 P.3/7 Size OK? 310 CMR 15.223 1 Inlet tee located ten inches below flow line 310 CMR 15.227 Outlet tee 14"or 14"+5"per foot for increase ft depth (310 CMR 7 1122741 Outlet tee with gas baffle or approved filter 310 CMR 15,227 4 Note regarding installation on stable compacted base [310 CMR 15.22$ 1 Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227 2 Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5))or perrx fitted for upgrades under LUA 310 CMR 15.405 1 Minimum cover 9"(Tanks buried more than 9"must have risers on all openings and on the d-box) [310 CMR 15.2228(1)and 310 CMR 15,232 3 Three access covers(inlet and outlet must be 20"or greater) - middle access at least 8" k 7/07 310 CMR 15.228(2)] Access to Within 6 "of grade - one part for systems<1000 , two for Mstems>1000&2d 310 CMR 15.228(2)) . All at-grade covers secured to unauthorized access? [310 CMR . 15,228Q] +� > 10 ft from building foundation 310 CMR 15.211 1 BuoyMg calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? 310 CMR 15.226(3 Setbacks from resources 310 CMR 15.211 ligo MIN Required when other than single-family dwelling or flow>1000 d 310 CMR 15,223 1 (b)] First compartment 2000/16 daily flow; Second compartment 100% daily flow 310 CMR 15.224 and 3 V. fluff pipe through or over baffle,outlet of each compartment with as baffle or approved filter 310 CMR 15,224(4)] Address Sheet 3 of 7 4 AUG. 4.2009 9:1eAM BARNSTABLE BOARD OF HEALTH NO.302 P.4i7 V Located at least ten Feet from any watee Iine? [310 CMR 15.222(2)] Disposal piping at least 18"below water line(when water and sewer cross, see 310 CMR 15.211 Cleanouts required/provided ? 310 CMR 15,222(8) Thrust blocks specified in force mains?310 CMR 15,221 6 c Slope of sewer line not less than 0.01 (1/811/ft) 0.02 preferable , 310 CMR 15.222 Proper pitch on all runs?(.005 within gravity-distributed trenches and beds) (310 CUR 15.251(9)and 310 CMR 15.252(2)(c)] Siphon roblem/aea&Reld below pump chamber Endca s or vent manifold specified? Size and orientation of discharge holes specified (trot smaller than 3/8"not larger than 518") [310 CUR 15.251(8)and,310 CMR 15.252 2 1S Materials specified (310 CMR 15,251(5)specifies various pipe types allowed)- • - t Stable compacted base[310 CMR 15.221(2)and 3'l 0 CMR 15.232 2 a �/ Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) (310 CMR 15.323 3 a Riser if deeper than 9" 310 CMR 15.232MOI Inside minimum dimension 12" 310 CMR 15,232 2 Minimum sum 6" 310 CMR15.232(3)(e) Watertight cover if<000gpd);waterproof manhole if>2000gpd 310 CMR 15.232 3 d Capacity(emergency storage above wo=sS2ntic flow)? [310 CMR 231(2)] Pro or setbacks 910 CMR 15.211 sarue as tanks Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] y/ Service components accessible(not too deep with piping, disconnects accessible Alarm floats-alarm on circuit se arate from pumRs specified? ,J Exceeds two units must have two pumps operating in lead-lag mode, [310 CMR 15.231(6)and 8 Stable Com doted Base 310 CMR 15.221 2 Buoyancy calculations needed ?Pr6ided? 310 CMR 15.221(8)] V Address Sheet 4 of 7 U AUG. 4.2009 9:19AM BARNSTABLE BOARD OF HEALTH NO.302 P.5i7. Calculations correct? 4 feet of naturally occurring material demonstrated?[310 CMR 15,240 1 Re aired se amtion togroundwater? 1310 CMR 15,212 AgMgate specified as double washed 310 CUR 15.247(2)] �0 System Venting required/provided?(system under driveway or >36"dee 310 CMR 15,241 Inspection ports specified and within 311finaI ode?[310 CMR 15.240 13 Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document Chambers and t�aI.in trench configuration supplied with inlet ev 20 ft, 310 CMR 15.253 Each structure with one inspection maAhole(if>2000 gpd must be to ' ade) [310 CMR 15.253(2)1 A ate I'minimum-4'maximum. 310 CMR 15.253 1 a 2'sidewall credit maximum 310 CMR 15.253 1 a In bed confi uratio inletevery0s .ft 310 CMR 15.253 6 Width 2'minimum 3'maximum 3I0 CMR 15.251 1 b 100 feet�maximum ten 310 CMR 15.25 1 1 a 1Vliniroum separation 2x effective depth or width-whichever - eater ft if reserve between trenches 310 CMR 251 1 d Situated alM&contours 1310 CMR 15.251 Breakout OTC? 310 CUR 15.211(l)[41 and Guidance Document Minimum 2 distribution lines 310 CMR 15.252(2)(a)] � Maximum separation between lines 6' 310 CM R15.252 2 d Maximum separation between lines and outside of bed 4' [310 CMR 15,252 2 e Aggregate depth below discharge pipes 6"minimum, 12" maximum. 310 CUR 15.252 2 V Se station between beds 10'minimum. 310 CMR 15.252(2)(f)] �y Bottom area used in calculations only 310 CMR 15.252(2)(i)) Address Sheet 5 of 7 AUG. 4.2009 9:19AM BARNSTABLE BOARD OF HEALTH NO.302 P.6i7 Y Pressr�re based System P Provided pump and piping calculations as required 310 CMR 15.220 4 r Pressure dosing required on alI systems>2000gpd or alternative systems under remedial approval 1310 CMR 15,254(2)and I/A Remedial Use AEproyalsl If used in gravelless system -make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly >2000 dgood to note on plan 310 CMR 15,254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet V the specification of 310 CMR 15.255 3 ? hn ervious barrier and/or retaining wall ?[Guidance Document Impervious barrier installation must be supervised by � desi er 310 CMR 15,255 2 Retaining wall must be designed by Registered Professional En ineer[310 CMR 15.2552)(g Side slope not exceed 3:1 ? 310 CMR 15.25 5 2 . Breakout requirements met?[310 CMR 15.252(2)and ✓ Guidance Document At least 5 ft.from impervious barrier to edge of SAS (101 recommended) [310 CMR 15.255 2 e Check DEP Approval letters for credits and desi conditions If used with pressure dosing do not allow pressure discharge V to scour soil interface Was DEP Approval Letter provided and/or have you V reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance a eement? An alarms involved on separate circuits Did the applicant submit azi operation and maintenance manual? Hasa I licant submitted a coa of a maintenance V Aare the variances listed on the plan? [310 CMR 15,220 / 4 'V RLS Stamp necessary on plan if a component is within five 7 feet of property,line 310 CMR 15.412L4)] New construction or increased flow proposed- [Refer to 310 CMR'15.414 �✓ Address Sheet 6 of 7 AUG. 4.2009 9:19AM BARNSTABLE BOARD OF HEALTH NO.302 P.7i7 Is the system in a Designated Nitrogcn Sensitive Area(Zone II to a public supply well)?[310 CUR 15.214, 316 CMR 15.215 and 310 CUR 15,216-also refer to Policy regarding upgrades of such ✓ existi stems Is the system proposed on the same lot as served by private well? 310 CUR 15.2142 Are the nitrogen loads proposed in compliance? [3 10 CMR 15,216 1 V Pum ing to septic tank? f 310 CMR 15.229 V Shared System 310 CMR 15.290 1 Address _� Shoot 7 of 7 77, 77 12/14/2009 14: 13 5088333150 HORSEY WITTEN GROUP PAGE 01/01 1.0/27/2oua 08:42 FAX D084263M CAPEW,IDE `F.J"V Town of Balrnsftt► e , Re-2-uiatory Services Thomas F,Geiler,DirectDr. Public Realth Division. Thomas McKean J)trectur 2()O Main Street,Hyannis,MA 02601 Fax: 508-790-6304 Office: .508-862-4644 �nsta�Ier,.&Desagnerr Cerd cation_lF, o Date: jjjq.- Sewage Permiit# 0009 - 2_4_�_Assess0er Map\Parce 2' ©y Designer.- Om Address: A Address* a I�k 7 Go 3 On: i"1 Oq C_Ape,,j',J c, Cvt�X Jr i->eS was issut;d a permit to install a (date) (installer) septic systeaxt at `+� tlti Pc,,M t (� -bused on a design drawn by (address) 09 fo_�?_ dated 1 T (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include Tnip.or approved changes such,a.s lateral relocation of the distribution box.and/or septic tatrk.. I certify that the septic systtcm referenced above was i,tastalled,with major cha:n.ges greater tbat 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with..State &Local Regulations. Platt revision-or certified as-built by design.m to follow. _A, A,,a FAT PtU er's S aturC} CIVIL Now i SIGNAL (D signer's Signature) (Affix Designer's StampHere) PLEASE RETURN 'TO B�:RN�T�,�� PUBSf. ALUL_9M§.M CM11FICATE, O JE (`nMPL1t�NCT ILL,N9T BE T DOT S , A T CARD RE BB BYUM RAMSTAIDLEZULIC REALTH PDMI—Q&MA K.XOU. Q:Hoarth/SopticMcsigncr Ceitficution Form 9-26-04.doc Town of Barnstable P#_ j ' $ Department of Regulatory services Public Health Division Date 4 200 Main Street,Hyannis MA 02601 Date Scheduled d Time 0 `"t Fee Pd. Ja Soil Suitability Assessment for Sewage isposal Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address IID8 1'0`1 ) �1/n/� a� Owner's Name Address i-llij Assessor's Map/Parcel: Q12 0 VJ'1 Engineer's Name lioC{q.t,L W\kn etopy S� ldcndxso,•�.. NEW CONSTRUCTION REPAIR Telephone# r0la $$3 r(9_b 0,z� Land Use �tg t�.t�r►�'la l O Y Slopes(` )=� 5 Surface Stones Jew Distances from: Open Water Body C i o� ( ft Possible Wet Area Ll t ft Drinking Water Well Llad ft Drainage way �O ' ft Property line Id 1 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) S AV-4 0A C',D Parent material(geologic)Cr'64,J61,, 5'}� Depth to Bedrock 7 1 Depth to Groundwater. Standing Water in Hole:.. n 0(1.C1 Weeping from Pit Face Estimated Seasonal High Groundwater Eve PA y61Ct �_:f`... 31i'a/ DETERMINATION 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: Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,iketor-,,,,aa,..@_ Adj.flroundwater level, PERCOLATION TEST Date Ill'Oal TIma O;o0Am f Observation Hole# 1 7 P_1 Time at 9" -C.-SAL ra . Depth of Perc y�t Time at 6". Start Pre-soak Time @ o'Ili OV\ Time(9"-6") End Pre-soak Rate Min./Inch Zro, in 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 1009 of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. � Q:1.SEP1ICIPERCFORM.DOC I DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Oar Surface(in:) (USDA) , (Munsell) Mottling (Structure,Stones,Boulders. nsistency.%Givall 0- zS 10 �L3 313s ^S'i C ► 1►�-L 5 0 ��Co v �-- g�-)0 CZ to DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% .0-12- L5 Q14fL3I hno,5sif4 o G•tdr-I )V10 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 Offer Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Con ' e Flood Insurance Rate Mae: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes W;od-in !o0 yPatfloodboundary No— _ Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in ail areas observed throughout the area proposed for the soil absorption system? C 5 -- If not,what is the depth of naturally occurring pervious material? Certification I certify that on-34nw-1-20 t (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 tr 'ning,expertise a experience described in 510 CMR 15.017. Signature Date ro ll , Q:WEPTICWERCFORM.DOC. MAP 232 LOT 42 as ELECTRIC SERVICE �—Ieo 1 94 HOLLY POINT ROAD PROPERTY 014 700 FOOT BUFFER FROM s - EDGE OF POND xf PAVED DRIVEWAY WATER SERVICE a 4' w w / W "' '" �. \ � � w I s" / Q 44 108 HOLLY POINT ROAD s` £X/SANG �cP"/lC EXISTING 4 BEDROOM �� QR DWELLING / �`.� i 1 R�'' ��� o t GAS T Is GqS GAS GAS SERVICE Horsley Witten Group Sus(amabla EnNronmwf.NSclvfinns MAP 232 LOT 40 ^ 'V 120 HOLLY POINT ROAD 8 North Test Pit Locations 108 Holly Point Road N o zo Centerville Massachusetts E Figure 1 Scale in Feet 05/20/09 JH 9026 EX.dwg i f Town of Barnstable Barnstable Regulatory Services Department > ea Cft IARtVSCAHLE. 1639* Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO August 21, 2008 Albert Colton 8811 Spring Creek Trail Longmont, CO 80503 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 108 Holly Point Road, Centerville MA was last inspected on April 7, 2008,by Brad J. White, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the.system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days 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 THE BO OF HEALTH Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1041 7750 Q:\SEPTIC\Letters Septic Inspection Failures\108 Holly Point Road.doc Town of Barnstable Barnstable MHUn niCeCRegulatory Services Department Bnrrs3ix 1 6 9, ,� Public Health Division m 200.Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 16, 2008 Paul Massik 5135 Gulf of Mexico Drive #201 Longboat Key, FL 34228 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 108 Holly Point Road, Centerville MA was last inspected on April 7, 2008,by Brad J. White, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:. • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ER O THE BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1042 0224 Q:\SEPTIC\Letters Septic Inspection Failures\108 Holly Point Road.doc I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 108 Hollypoint Road W cN` [L J L\'t Property Address Andrew Massik 5135 �,, _ n[i r DAB- ��Ja O LA Owner. Owner's Name �, 3yZZ.$ information is Centerville w-�� ` MA 02632 04/07/08 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key , to move your Brad J. White cursor-do not Name of Inspector use the return key. Bluewater Septic Company Name VQ 350 Main Street Company Address West Yarmouth MA 02673 City/Town State Zip Code (508)775-2800 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 �ed 04/07/08 Inspector's Sign r 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. Massik108hollypointrdt5.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f t Cammonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wN 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 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: 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 Massik108hollypointrdt5.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 I " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. City/Town 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. Massik108hollypo1ntrdt5.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. CitylTown 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 10 1 ® 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 ❑ ® 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. Massikl 08hollypointrdt5.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. City/Town 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 10,000 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. Massik108hollypointrdt5.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 I ' Commonwealth of Massachusetts ti, W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments p Y 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 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? El ® 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? Z ❑ 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. ® El Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Massik108hollypointrdt5.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 i ' Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)):2&v l o0o= 2 S 364.38 gpd Sump pump? ❑ Yes ® No Last date of occupancy: Seasonal 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): Massik108hollypointrdt5.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 i Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped approx 11 months 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): Approximate age of all components, date installed (if known) and source of information: System was installed in 1960 per owner Were sewage odors detected when arriving at the site? ❑ Yes ® No Massik108hollypointrdt5.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2'-1" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Two inlets entering cesspool. Both made of 4"schedule 40 PVC. No evidence of leakage all piping appears to be in good condition. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No --------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: 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? Massik108hollypointrdt5.doc-03/0& Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 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.): 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): Massik108hollypointrdt5.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. CitylTown 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 IA 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 Massikl08hollypointrdt5.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. City/Town 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: I Type: ❑ leaching pits number: ❑ leaching chambers number:. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Massik108hollypointrdt5.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. Cityrrown State Zip Code Date of Inspection Do System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):- Number and configuration 1 Standard Depth—top of liquid to inlet invert 4'-4" 11 Depth of solids layer 4 Depth of scum layer 1/4" I Dimensions of cesspool 6'x 6' Materials of construction Cynderblock Indication of groundwater inflow ❑ Yes ® No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Vegetation is dirt. Evidence of solids above both inlet pipes. Heavy root infiltration in the cesspool. Evidence of overflow with solids up into riser. 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.): Massikl08hollypointrdt5.doc-03/08 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 1 • Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. P N� i `--r#9 q vaco qq 5 34 CevtC ar+ 7 1FpC6 ^� L woa A p¢FP I Massik108hollypointrdt5.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15. i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 Hollypoint Road Property Address Andrew Massik Owner Owner's Name information is required for Centerville MA 02632 04/07/08 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope :> ® Surface wate Sty Conann�frs 61Et.aw ❑ Check cellar ❑ Shallow wells Estimated depth to high.ground water: 13+ 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: —'� There is a pond in the rear of the property which is sloped down from the system. Used a tranist to. shoot elevations @ adjacent property (94 Hollypoint rd) and this front yard is sloped up from the adjacent property 3' +. E�2 C W-a2T in, KIQEX'C-- pA;-r4E Massik108hollypointrdt5.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 cc r�s4 c,'��l^a�.w;�`-,'Vic.•i•'c��-/��.+ I 4ASIT -b 5{fOO- f2-CV4(RVNS' 'To Afl&W-6S 100/,Mr fir j —�6NO . No Gp-c)UAfD W,47-29-rZ 0 /:2 -//" bj,4'r rr_(g /3,4. � 5 us 4�,-3 OAP W ITt.-I :q I w 2 y-� JOB HcL-Lti Poles- CE-N 1-MV i LLi AIA i Town of Barnstable 0p THE T� Regulatory Services �„t1lS7,,B Thomas F. Geiler,Director MAS& g 9`b 1639. Public Health.Division AjED MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862 4644 Fax: 508-790-6304 r 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/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s 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 listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. 4" SCH. 40 PVC OBSERVATION PORT PROVIDE COVER AND PROVIDE COVER FINISH GRADE OVER 4 SCH. 40 PVC SYSTEM CONNECT DISTRIBUTION MIRAFI 140N FILTER FABRIC INSTALLED IN ACCORDANCE WITH 310 RISER TO WITHIN 6" AND RISER TO FINISH GRADE DISTRIBUTION BOX- 46f MIRAFI 140N FILTER FABRIC LATERAL TO VENT VENT MANIFOLD OR APPROVED EQUAL 4" SCH. 40 PVC SYSTEM CMR 15.240(13) OF FINISHED GRADE GRADE OVER TANK OR APPROVED EQUAL MANIFOLD (TYP.) VENT MANIFOLD Cv 9" MIN FIRST 2' LEVEL ' y EL.-4 f 3 MAX �I IIII JI IIII LIII III IIII LIII IIII IIIIIIIIIIIIIIIIIIIIIilllllllllllllllllllllllllllll IIIIII""""""""""""""III IIII IIIII IIIIII_IIIIII IIII EL. 46t II ll I_LI JII III III I� I II IIII IIIIIIIIIIIIIIIIIIIIII IIIII IIII III I III II CD i , _ _ _ _ __,�' LOAM & SEE D .,,�_ ��_„'__ ,,___; _ I_ II_ _ _ II_ _ II_ I!! L �I I III__ IL I IIIII L II��III II _ IIIIIIIII IIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIilllll 9 MIN i=iii=in�ii;�itiI-'-;iiii; ;;;-;u-;;; LOAM & SEED -;n ;--;;;!: ,; i;! ,,; iii�Iliii�I iiiiiiii�Il;;iiu�Ilii���iii;"'iii'� ; ;;-;;-'.-F;-i;i-i;il;ii iii"' ' ' it- -�-; !u-Ji- o, i_i i i-i LOAM AND SEED =- __ , .. 3.5' MAX. - _ ,._.... m a GRAVEL DRIVE CLEAN BACKFILL :.. BACKFILL BACKFILL a BACKFILL :. .. - o.. .BACKFILL: BREAKOUT • LATERAL aCL 9 u_ a 10 DISTAL EL. W T:- m.,. RESIDENCE J- 14 2.0' o , 2 C o <_ 10 MIN. 4 3/4» - 1-1/2- DOUBLE WASHED STONE 2' o 0 MINIMUM GAS {. `•.' i" DROP N BAFFLE N 6" OF 3/4" COMPACTED CRUSHED STONE _ BOTTOM OF aaaaaa � ID SYSTEM 6" OF 3/4" t m COMPACTED UNDISTURBED EARTH TYPICAL DISTRIBUTION BOX DETAIL 4" SCH. 40 0LL CRUSHED STONE NOT TU SCALE PERFORATIONS SET AT 5 & 7 O :LOCK EVERY 3-FEET. MIN. PVC ORIFICE SIZE 3/8-INCH MAX. 5/8"-INCH 1500 GALLON SEPTIC TANK PROFILE PROVIDE 5-OUTLET DISTRIBUTION BOX DISTRIBUTION 2, 4, 2, NOT TO SCALE INSTALLED ON LEVEL STABLE BASE. 24 5 MIN. LATERAL (TYP.) 4-OUTLETS USED, 1 CAPPED TYPICAL TRENCH PROFILE PROPOSED 1500 GALLON CONCRETE SEPTIC TANK INSTALL FIRST TWO FEET ° 00 LENGTH: I1 '-0" WIDTH: 6'-2" DEPTH: 6'-0" ' CT LO OF OUTLET PIPES LEVEL. I!"i��T'1C�'` MODEL # 1500 H-20 BY ACME PRECAST OR EQUAL MODEL N0. DB5 H10 BY ACME PRECAST OR EQUAL GROUNDWATER EL. 34.8 '` ,� - co ( ) o UNDISTURBED (BASED ON BEARSE POND WATER LEVEL) , -` B�e 1 r, ".,y" °•'`k O 4 K -4-INCH PVC EARTH ��., WATER SERVICE WATER SERVICE LEACHING TRENCH DETAIL Shall* p o THREADED CAP r i ' . l C SEPTIC SEWER PIPE NOT TO SCALE34 4" MAX. BELOW GRADE r' 'q" A o • r' ------ - 'I I�I i _ „ �- 10 10 ,- .c i o_ ---------------------------------------� 18 MIN. PROVIDE END CAP - * � ,, � �o a� r o ,... 9' MIN 9' MIN T "� 3 M Va N 12 MIN. ! t1 . M o a •.. :. • i ao ao 0 s Q y � G ao ao ai 00 SEPTIC SEWER PIPE SEPTIC SEWER PIPE WATER S�RVICE II' I -" '' - - "t - - _ ° o �a o o ROVIDE ADAPTER TO - » "~'' _ a;MT fi. } k Co 3 0) rn 10 o 0 JOIN SEWER OR y D +` �, _-m ��� �� \ 6 LOAM & SEE 45 DEGREE PVC BEND ,, . » i s. - LATERAL SAT END OF LINE SEWER ALWAYS BELOW ~' '" 4 SCH. 40 PVC _ SYSTEM VENT- 4 INCH `� • TO 4-INCH ELBOW WYE CONNECTION FOR .IF .CONDITIONS REQUIRE PIPES TO BE CLOSER IF SEWER LINES MUST CROSS WATER SUPPLY LINES, BOTH PIPES SHALL BE CONSTRUCTED VENT HEADER SCH. 40 PVC, MIN. i � �'at345@� t'ry IN LINE THAN 18", ENCASE SEWER 10' EACH SIDE OF OF CLASS 150 PRESSURE PIPE OR BETTER AND SHALL BE PRESSURE TESTED TO ASSURE '--'��sland ' CROSSING OR USE D.I. FOR SEWER WATER TIGHTNESS. IF CROSSING IS WITHIN '18" MINIMUM BOTH MAINS MUST BE ENCASED IN ''II CONCRETE 10' EITHER SIDE OFF CROSSING 'I 2.5'f LOCUS PLAN � �C SCALE: 1"=1000' Q' l4 TYPICAL CLEAN-OUT DETAIL WATER SEWER CROSSINGS ZONING & RESOURCE PROTECTION NOTES 0.' Z6.4 NOT TO SCALE NOT TO SCALE TYPICAL SYSTEM VENT DETAIL W W NOT TO SCALE 1. ASSESSORS MAP#: 232 PARCEL: 041 O '� NOTE: NO VARIANCES ARE REQUIRED c„ OWNER OF RECORD: MASSIK, PETER E & STAEHELIN I ADDRESS: 108 HOLLY POINT ROAD, CENTERVILLE, MA 02632 N \ ^V MAP 232 LOT 42 ELECTRIC SERVICE \\ DESIGN CRITERIA T SHOWN LOCUS LOCATEDISF.I IN FLOOD0ZONE C (AREA OF MINIMAL FLOODING) AS 94 HOLLY POINT ROAD NUMBER OF BEDROOMS 4 C SYSTEM VENT FLOW PER ROOM 110 GPD 2. THERE ARE NO SURFACE WATER SUPPLY OR GRAVEL PACKED WELLS WITHIN i DESIGN FLOW' 440 GPD 400 NO TUBULAR PUBLIC WELLS WITHIN 250'. 8� _ NE a� 10.2' i `4� i t� pROf'ERTY U TP 1 l PROPOSED FOUR (4) 2 FOOT WIDE BY SEPTIC TANK 3 THE SITE IS IN THE BARNSTABLE GROUNDWATER PROTECTION AREA AND / \ -- --- - - STATE ZONE 11 RECHARGE AREA. 46.0 x46.6 46.�a / 2 FOOT DEEP LEACHING TRENCHES SEPTIC TANK(DESIGN FLOW): 440 GAL ` GENERAL NOTES O '� m� PROPOSED 5 OUTLET DISTRIBUTION BOX � . - _ �$ 10.1 USE 1,500 GALLON H2O SEPTIC TANK INSPECTION PORT LEACHING SYSTEM DESIGN CRITERIA w I _-_ 1 UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION � (q SPIKE SET fATE og �2 SOIL ABSORPTION SYSTEM _ ENVIRONMENTAL CODE ANDMETHODS SHALL BE IN C�HEARULES NCE WITH TITLE REGULATIONS OFT THE O O � a9'' PROJECT BENCHM.tRK EL 46.81 i I BARNSTABLE BOARD OF HEALTH. Q $ \ REMOVE HEDGE ---------______ __ _-,_.- LEACHING SYSTEM USED: STONE TRENCHES ^mil 100 FOOT BUFFER FROM + = AS NECESSARY x /- DESIGN PERCOLATION RATE: 2 MIN./IN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD (� EDGE OF POND �' a i/ ✓ _ OF HEALTH AND THE DESIGN ENGINEER. SOIL CLASS: CO ~� .�' LONG TERMACCEPTANCE RATE(LTAR): 0.74 GPD_/S.F. w 04 TOTAL AREA REQUIRED-LOCAL CODE: 595 S.F. 3. USE 4 IN. SCH. 40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE n - NOTED ON PLAN. ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE.\ 22.6' n 24.0'------_I _ TOTAL AREA REQUIRED-TITLE_ 5_. 59_5 S.F. I PAVED DRIVEWAY SAWCUT AND WATER SERVICE _ a a \ a , PATCH DRIVEWAY - -- 4, THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE TOTAL AREA PROPOSED: , i _ WITH A GARBAGE GRINDER. _ - ---_ A(sidewell): (24'+ 2'+ 24'+ 24)x 2'x 4: 416 S.F. 5 ELEVATIONS, PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE $ w A b ottom 24'x 2'x 4: 192 S.F. w A(bottom).- _ BASED ON FIELD SURVEY AND PLAN BY HORSLEY WITTEN GROUP, INC. cn \ BUILDING w ._� TOTAL AREA: 608 S.F. w `w -_w _ _ _-. PERFORMED MAY 11, 2009. m� SEWER #1 / ! / w w -w TOTAL ALLOWABLE FLOW- Al 449 GPD o $ � WATER/SEWER USE 4-24'L X 2'W x 2'D LEACHING TRENCHES 6. CALL "DIGSAFE" AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION 00 10.0 y' CROSSING (SEE DETAIL) AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES NECESSARY TO C3 p FIELD VERIFY LOCATION OF EXISTING UTILITIES. o c� / - 3 > / $. 5�- 7. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS 2 - w 108 HOLLY POINT ROAD 4 S q TEST PIT LOGS WHERE PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. d � EXISTING 4 BEDROOM EXISTING SEPTIC COMPONENTS TO BE - -� 8. REFER TO SITE PLAN FOR LOADING CAPACITIES OF INDIVIDUAL SEPTIC � ABANDONED IN ACCORDANCE WITH O INSPECTOR. J. HENDERSON (JUNE 2001) D WELLING -- -- SYSTEM COMPONENTS. 0 , I TITLE 5 (SEE NOTE 14) SOIL EVALUATOR:D. STANTON / 63 5� Hti� \ r $ h DATE: 511112009 9. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT, DUST AND FINES. �,n�, � ti PERC#•-� f12557L a lat" J Q) - 10• THE CONTRACTOR IS RESPONSIBLE TO REPORT ANY DISCREPANCIES FOUND IN o / I / ` ,/ // (1, SITE CONDITIONS FROM THOSE SHOWN ON THE PLAN TO THE DESIGN , ENGINEER. a /� �' TP-1 TP-2 1 CHANGES TO EFFLUENT FLOW GRADING OR LANDSCAPING EITHER ON-SITE _ '� I ��� i i a 0.0 _ ___ _ 46.6 0.0 46.6 , 8 / a �Q, C) OR ADJACENT TO THE SITE, OR FAILING TO PROPERLY INSPECT OR PUMP N / , I REPLACE SLATE WALKWAY AS A A - THE SEPTIC TANK MAY EFFECT THE PROPER FUNCTIONING OF THE LEACHING 1 o - -' I / NECESSARY REDUCE OF ELEVATIONS BUILDING a LOAMY SAND I LOAMY SAND SYSTEM. SC I 10 YR 3/3 12. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 0o SEWER 2 '� � � 10 YR 3/3 1.0 , ' 45.6 Er cn INV. EL. # � \ 0.7 45.9 o - - YEARS. 6 o \ 8 14? Irl FOUNDATION 46.91 i I MEDIUM 13. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION oo .4 M M TOP OF FOU o MEDIUM SAND U SAND 8 WASTEWATER_BUILDING SEWER#1 43.16 8 / / NECESSARY TO LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL � `" _ y �'' 10 YR 5/6 10 YR 5/6 ¢ o0 0 o WASTEWATER BUILDING SEWER#2; 43.16 // / \ 2.0 44.6 1.$ 44.9 SYSTEM REPRESENTED ON IT AND SHOULD NOT BE USED FOR ANY OTHER o >, o o^o a� o - PURPOSES. o CLEANOUT /� t I` SEPTIC TANK-INLET 42.73 / \., 14. ALL EXISTING SEPTIC COMPONENTS SHALL BE ABANDONED IN ACCORDANCE IS 00 _. SEPTIC TANK-OUTLET 42.48"I + �6, h / /� �� ���crs I WITH TITLE 5, 310 CMR 15.354(3). MEDIUM - Registration: D-BOX-INLET 42.20 ` l l / / COARSE SAND ; 15. PRIOR TO CONSTRUCTION THE CONTRACTOR SHALL COORDINATE WITH THE tNOF D-BOX-OUTLET, 42.03 ' 1 i __. _. p____.__.,_._ g �- ` 10 YR 6/6 MEDIUM- HOMEOWNER AND ENGINEER ON THE CONSTRUCTION SITE ACCESS AND oaf �� a -___ ® ( 2 MIN/IN PERC COARSE SAND MATERIAL STOCK PILE AREAS. FAT"U TRENCH INVERT/N 41.91 GAS SERVICE ' _. m RATE 10 YR 6/6 am LEE BREAKOUT 42.24 N � i o LATERAL DISTAL INVERT 41.79 �, g I DEPTH OF PERC 48„ INSPECTION NOTES BOTTOM OF SYSTEM 39.911 I I ESHGW 34.80 SEPARATION TO ESHGW 5.11 RSr� 7.0 39.6 7.5 39.1 1. FINAL CONSTRUCTION INSPECTION OF ALL SYSTEM COMPONENTS INCLUDING �� p o - C 2 C 2 INVERT ELEVATIONS ARE TO BE CONDUCTED BY THE DESIGN ENGINEER AND THE Project Number: H GRAPHI SCAL -------- ---- ;- -- -- BOARD OF HEALTH OR THEIR REPRESENTATIVE PRIOR TO BACKFILLING SYSTEM. ai MAP 232 LOT 40 s 0 5 10 2 40 MEDIUM SAND i MEDIUM SAND 9026' `~ 2. IT IS THE RESPONSIBILITY OF THE CONTRACTOR(S) TO MAINTAIN UP TO DATE 0 120 HOLLY POINT ROAD 10 YR 713 ( 10 YR 7/3 AS-BUILT MARK UP DRAWINGS AND NOTES PREFERABLY IN A SURVEY FIELD 9.0 ' 37.6 9.0 ' 37.6 ( Sheet Number: � '" NOTEBOOK) INDICATING THE HORIZONTAL AND VERTICAL LOCATION OF ALL 4 $ (l IN = 10 FEET) NO GROUNDWATER/MOTTLES NO GROUNDWATEWA40TTLES SYSTEM COMPONENTS INSTALLED. THESE MARK UP DRAWINGS AND NOTES WILL 1 of 1 BE UTILIZED FOR THE PREPARATION OF A RECORD PLAN.