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HomeMy WebLinkAbout0139 HOLLY POINT ROAD - Health 139 Holly Point Road enterville A=252— 110 N SIAEA No. H163OR UPC 10259 smead.com • Made in USA 2J �2a m TOWN OF BARNSTABLE LOCATION 3 ��01 \ pot� � SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL /10 INSTALLERS NAME&PHONE NO. ' SEPTIC-TANK CAPACITY /Wb LEACHING FACILITY: (type) A_r (size) /O'Jb NO.OF BEDROOMS OWNER Ims i 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 :n Spezra, /7107 t`t �rp�T .s GArp e, A 8 a. 3 r as 3 y3 3� �r Town of Barnstable Barn Regulatory Services Department 1 a``aC fiv `" MASS, Public Health Division ib9• I 3 10� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 1128 November 25, 2013 Frederic and Susan Klein 86 Far View Run Marlborough, CT 06447 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 139 Holly Point Road, Centerville, MA was last inspected on 10/24/2013 by Jason Burnie, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • The line between the tank and the distribution-box is crushed and needs to be replaced. • The distribution box is also rotted and needs to be replaced. • Risers need to be brought to grade. You are ordered to repair or replace the septic system within Two (2).Years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO '" Agent of the Board of Health Q:\SEPTIC\conditionally passed\139 Holly Point Rd Cent Nov 2013.doc i I No. ry THE COMMONWEALTH OF MASSACHUSETTS Entered in co u Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Mispo8al 6pBtem Construction i3Prmit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. N�ldo Assessor's Map/Parcel — Cat\ © ?� v� \}�CW �Un maC\ Goq Installer's Name,Address,and Tel.No.lr,X_R �\\QDr\ (j,).(), Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 0\\ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �.�CS`(�VE' cJC`�1 �'VC, ( }(fl �CQn�h �0 \ Rom- 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 th' oard of Health. Si d CI Date 1 Application Approved by / Date Application Disapproved by Date for the following reasons Permit No. Date Issued -----____..e,.______._______________�.Y___ _ _ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compu r: Yes PUBLIC HEALTH DIVISION - TOWN OF BARN-STABLE, MASSACHUSETTS ZfppYIcatIon fof disposal *pstem Construction Vermit / Application for a Permit to Construct( ) Repair(/ ~,Upgrade( ) Abandon( ) Complete System A Individual Components Location Address or Lot No. \ �p\� C Owner's Name,Address,and Tel.No. 0 3X0 Vcr \nw Q\Ur\- MGc 'Il, Otoy�l Assessor's Map/Parcel \\b kDp.CMD Installer's Name,Address,and Tel.No.��' ���� 1.O1 U_), Designer's Name,Address,and Tel.No. �t dfS.�Ct�mOl)�\l 506-T15 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ��`v�\e(1\S;(�\ No.of Persons Showers( ) Cafeteria( .) Other Fixtures `- Desi n F16w min.re red d `'Design flow ui .rovided d Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Na P ( applicable) �C'Cr( t' cJ C P'V C S Rmm � QAC{ h NO —Nature of Repairs or Alterations Answer when a licable 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 lias been issued by this-Board of Health. :o Si °ed )&UU401 Date Application Approved by (. ;1 f �1 J T �7 ,�:/ ) Date / Application Disapproved by Date for the following reasons , Permit No. / Date Issued TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,A) Upgraded( ) C Abandoned b � � 6 W o )� at \ \�\\� \�( �f has been cons cted in acc °da with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer Designer #bedrooms Approved design flow ) gpd' The issuance of this permit s4all not be construed as a guarantee that the system will function as designed.,, rj� �Jj�' f� r j j✓ �; Date ..Y� Inspector °�'ii- "� r I�� /,��,r ; 1 1 ` I• ; ' � �.. r a . ---------_---------_-_________________ _______h_______'_______ ___--.____._ _.__-_i __� ---___ _______ ____ =�t___. . No. � / Fee I Y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction Vermit Permission is hereby granted to Construct( ) Repair Ude( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with FTitle 5 and the following local provisions or special conditions. Provided:Constructiou'must dcompleted within three years of the date of this permit. Date / `-) � � � Approved by i C I Ilmd" of t sei s Sg sir>fa�ce Dbposal System form-Not for Voluntary Assessments 139 Hot#y Point Rd Pro"Address F-edenc.i 36 Far 1Fiew Run Majiboraugfi,C7 06447 Owner. Ownw's.Name � Centeryi�e required for every MA 02632 10/24/13 Pap. CityffoM state Zip Code Date of Inspection Ian rsa s must be d on t�form. w fornns'may not be altered in any wary.Pbase see camp c#wMst at the end of the form. > , 1rn +E3n on ifie .. 1, key to rrrove your cursor fort JaimaSumie use:the retain. Now of inspector key: Neighborhood Waste Water 35D Main St campy Address W YSrrnouth MA 02673 yfrown State Zip Code 5{ 7MVQ S501.1 Telephone Number License Number 17WHA #ion I certify.that I.have pernaify inspected the sewage disposal system at this address and that the irdbrmation reported below is true;accurate and complete as of the time.of the inspection. The inspection was performed fused 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 S(310`Clf -15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails Needs Further Evaluation by the Local Approving Authority ra"y r,V,,,i f1 ` 10/24/13 spedo's Sig Date The;system inspector shall submit a Copy of this inspection report to the in Authority Board U.v po Approving ►tty .. of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or �►as'`a design flow of 10,000 gpd or greater,the inspector and the.system owner shall submit the rt to the appropriate nal office of the DER The y repooriginal should be sent to the system owner copies serf to the buyer,if applicable, and the approving authority. '•'"This report only describes conditions at the time of ilnspection and under the conditions of use at that time.This:hispection does not address how the system will.perform in the future under the same or dif%rod conditions.of use. - Ia iSO� t5ft•3M 3 Title 5 omaal :Subsurtaoe Sewage Disposal ystem•Page 1 of 17 t s, al*tOo i FrM -Subftr ftposm Sysllem Ftum-N6t for Voluntary Assessments 139 Point Rd Property Adcdrtm E deric k ni i 36 Far Vi6 Run Marlborough,CT"0fi447 Owm Owner's Name inkrequlr attorl a CenteMWI MA 02632 10124/13 rt3QUlYed tOLeVeFJi ' Page. MMe ZO,Code Date of trispet t EL Cerfiffeafton inspection.Summary Check A,B-..C,D or E/always complete all of Section D A) Systft Passes: 0 1 have..not found any information:which indicates that any of the failure criteria described in 310 Cti R 15 303 or in 310 CIVIR 15.3(4 exist:Any failure criteria not evaluated.are indicated.below. Comments: The system is a conditional pass.This is due,to the line between the tank and disrtribution box is crushed and needs to oe replaced. The it u#ion box is also rotted and creeds to be replaced. The Mt of the septic ystern was in good working order. B) System Conditionally Passes: 1z 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 exfiltrabon 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. El Y Q N Q ND(Explain below): t5ins•3113 Title 5 Offiaaf Inspection Form:Substxfaoe Sewage Disposal System•Page 2 of 17 Com rtw of Massachusetts T t t I s cifl r1 Form ice Sev ge Disposal Syss€em Form-Not for Voluntary Assessments 139 Holly Point Rd Property Aftess Frodenc Klein 36 Far View Run Marlbpeough,CT 06447 Owner Owner's name infoffnrequwat*f0r Certtetvitle MA 02632 10/24/13 Pap, cityrrown State Zip Code Date of Inspection Q. Cot'Mcaflon (font.) El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpsialarms are repaired. B) System Conditionally Passes(cone.): ❑ 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 is a conditional pass.This is due to the line between the tank and disrtribution box is crushed and needs to be replaced. The distribution box is also rotted and needs to be replaced ❑ 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) Furthers 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 pubic health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1Xb)that Me system is not'functiloning 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 mains•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 cdhlthM�4ch ' # s .t n Form . SalSsurface e' 1'System Form-Not for Voluntary Assessments 139 Holly>Poiat.Ftd PtopetlyAdQ►ess F rio Klein 36 Far View Run Marlborough,CT 06447 Owner ownes Name lr►t'ormat�n.is, Centenr tle n�uired,forevery MA 02632 10/24/13 page. Cit)tlTt3AnRt . State Zip Code Date of Inspedion B. £eflon (ront.) z SystemVIN fait urns the Ord cif Health(and Public Water Supplier,If any) le� re That thel system is functioning in a rnanner that protects the public health, .a,nd envftonmi6t: [] The:s Cstent 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=sys#t?cn 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 supoly well. Q the :teas 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 cobbacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, prodded that no other failure criteria are triggered.A copy of`the analysis must be dbiadiW to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You.mntst indicate"Yes or"No"to each of the foHowirng 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 0 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 t5ins•3M3 Tide 5 Official Nspection Forth:Substxface Sewage Disposal System•Page 4 of 17 . c1►> ofi acetts cr 1"Wiface Sewage Disposal System Form-Not for Voluntary Assessments :13S.Iy Point Rd Prope"Address Frederic Klein 36 Far View Run Marlborough,CT 06447 Owner Otli Ws Blame worrnabw is rah for Centerville MA 02632 1:0124/1:3 Pa". Cityfiovvn State zip code .Date of Inspection ;. 15 1' n (coot:) Yes No ❑ s Required pumping more than 4 times in the last year NoTdue to clogged or obstructed pipe(s). Number of times pumped: 0 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 DEP certified labry,for fecal colrTorrn bacteria indicates absent.and the presence Of ammonia nitrogen and nitrate nitrogen Is.equal to or less than 5 ppm, pitW. d tl no other faffure 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 falls.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) twge 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"non 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 trapped 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 siifteant threat under Section E or.failed under Section.D.shalt upgrade the system in accordance with 310 CMR 1`5.304. The system owner should contact the appropriate regional office of the Departrrient. t5ins•3/13 Idle 5 Official hispedon Forth:Subsurface Sewage Disposal System•Page 5 of 17 Collnrnar Of €firuse# 0 ial C111his Sub t#ace Swrap.€fisposall SysWm Form-Not for Voluntary Assessments 139 H :Point Rtl Propetiy Address Frederic Klein 36 Far View Run Marlborough',CT 06447 OVMr Owner'sNar+�e requ Centervike MA 02632 10/24/13 Pap. eC-�i►tY TOR. State Zip Code Date of Inspection lC V',tCCkfist Check tf the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No 10 ❑. 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 inormal flows in the:pi+evious two w period?. -Havel 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) 01, El Was the facility or dwelling inspected for signs of sewage back up? ID ❑ Was the site inspected for signs of break out? 0 ❑ 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. ❑ I 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 Iasi lential Flow..Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow teased on 310 CHAR 15.203"(for example: 110 gpd x#of`bedrooms): 330gpd t5ins•3113 Title 5 Offidal hWectlon Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth lth Massachusetts f S Co. nocWo �Form 3uti t Sewage Wnpaal System i'ornt-Not for Voluntary Assessments 139 Wly Point Rd Prop ft Address FmAeric Klein 36 Far View Run Maiborough,CT 06447 Owner Owner's Name inforrnat6n is required forevery 'Centeruille MA 02632 10/24/13 page. Citi Town State Zip Code Date of Inspection . Sysrnnforation Description: The system consists of a septic tank, distribution box and a leach pit. Number of current residents: Seasonal Does residence have.a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes 0 No Water meter readings, if available last 2 year usage 12=33gpd 9 ( Y 9 (9Pd)) 11=36gpd Detail: Sump pump? ❑ Yes Z No Last date of occupancy: Seasonal Date CoinmerciaUUdustrial Flow Conditions: Type of.Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(go) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? 0 Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Nan-sarkary waste discharged to the Title 5 system? ❑ Yes•❑ No Water meter readings, if available: t5ins-3113 rme 5 official hspechm Forth:Subsurface Sewage Disposal System-Page 7 of 17 I CovM6111Miift e l ssac s Su rtace` `Sllstem form Not for Voluntary Assessments 139=Holly Poirot Rd PLy Address Frederic Klein 36 Far View Run Marlborough,CT 06447 Owner Owners Name required for Centerville MA 02632 10/24/13 required for every page. CityR'own State Zip Code Date of inspection brmaftn (cont.) Last date-of occupancy/use: Date Ober(describe below): General Information Purnpi :Records: Source of information: Town of Barnstable-last pumped 9/28/12 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/Altemative 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. El Other(describe): M-•3/13 Title 5 Offiaal hspection Form:Subsurface Sewage Disposal System•Page 8 of 17 of tss ClulSoft Tw6s.Of ki6t4nt m b F. Snbvb f t posa0 System Forth-Not for Voluntary-Assessments PrOpe139'# iy Poirl<#Rd " Frederic Klein 36 Far View Run `Marlborough,CT 06447 owner Owne e&Natne requiefb is GenterviHe VIA G2632 10/24/13 required for every Pap. City Town State Zip Code Date of Inspection E#. $' `tila►lion (cunt.) Approximate age of all components,date installed(if known)and source of information: 1980 per info available at the Barnstable BOH Were sewage'odors detected when arriving at the site? ❑ Yes Z No Btril Stever(locate on site plan): 3'2" Depth below grade: feet Material of construction: east iron 0 40 PVC ❑other(explain): Distance from.private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): We ran a sewer camera up the line and it was ok at the time of inspection. Septic Tank(locate on site plan): Depth below grade: inlet-6" Outlet-2'6" feet Material of construction: 0 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: 1000gal 3" Sludge depth: t5ins-3113 Title 5 official Inspection Forth:Subsurface sewage Disposal system-Page 9 of 17 Con bf-MaSSWAUSetts nform Surface 8"AocMspoW Sy9ftm Fond Not for Voluntary Assessments i39 Wi ly Point Rd Properh►:,Add►ess FMdenc Klein. 36 Far View.Run Marlborough,CT 06447 owner Owner's Name requhedfo e Centerville MA 02632 10/24/13 regpired flu:every page. Cityff own state Zip Code Date of Inspection System Information (cost.) Soft T;iF*(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2+ lit Scum thickness Distance from.top of scum to top of outlet tee or baffle 4"+ Distance from botto of scum to bottom of outlet tee or baffle 1 m + How were dimensions.determined? tapemeasure Comments(on.pump)ng.recomme. ons, inlet and outlet tee or baffle condition, structural integrity, Iiquid Jevefs as'related to outlet invert, evidence of leakage,etc.): The tank was found to be at a normal level upon inspection. It has both baffles in place. Grease Trap`(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scam 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•3113 Title 5 official Inspection Form:subsurface sewage Disposal system•Page 10 of 17 minusetts al:to f orm slftw ace 1`System Form-Not for Voluntary Assessments 130 Holly Abinf Rd Prop"Address FceftiftJoein 36 Far V*W Run Marlborough;CT 06447 Owner info is re4uired for y Centerville. MA. 02632. 10/24/13 Pap- Cjrlfowia State Zip Cod Date of Iron D *v dbfmation (coat.) Coifs'{ pumping r mendaataons,'inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): rqm or erg T (tank must be pumped at time of inspection)(locate on site plan): "Depth,below.gee: 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 of current ) copy attached? COPY pumping contract(required). Is El Yes ❑ No t5ins•3/13 Title 6 office Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 ,gam tl t i #0f Mass,admIetts tion Fdft Surface 3bwW Disposal System Form-Not for Voluntary Assessments 139 Holly Point.Rd PMpeity:Address Frederic Klein 36 Far View Run Marlborough;CT 06447 owner Owner`s Name infofrrtation Centerville MA 02632 10/24/13 required for every pa". Cityrrown state Zip Code Date of Inspection €� System irdofTnation (writ.) Disbiboffori Box(if present must be opened)(locate on site plan): oil Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence.of.leakage into-or out of box,etc.): The distribution box is rotted and needs to be replaced.The inlet line is crushed and holding water and needs to be replaced. The cover is 3`8"deep. Outho 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.): *If pumps or alarms are not in working order, system is a conditional pass. Soff Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: The SAS was located. t5irrs•3113 Title 5 Official Inspection Forth:subsurface Sewage Disposal system•Page 12 of V 111 11Vlf i OUMMUMhusette ;$Uwudk*Sew Msposall 4sU"n Form Not for Voluntary Assessments 139 Holly Point Rd Property.Address . Frederic 1(Im 36 Far View Run Marlborough,CT 06447 owner. Owner's Flame Wwmation js Centery iAe MA 02632 10l24I13 required for ewery pap. City/Town State Zip Code Date of Inspedion D. Sys niinforrlr>"On (Cont.) Type: leaching pits number. 1-6x6 with stone El leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool { number i n novativetaflemative:system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): The leach pit was found to have no standing water in it at the time of inspection. There was no evidence of failure. The cover is 4'deep. 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•3113 Title 5 Official Form:Subsurface Sewage Disposal System•Page 13 of IT CQIl1whot111i eaft't of sachuseft 15 a.: n Fflrm sce S System Form Not for Voluntary Assessments 139 Ho! Point Rd Property Address Frede€ic Klein 36 Far View Run Marlborough,CT 06447 Owner owners Name Cen*w He MA 02632 10/24/13 req page Caytl' ed fcrevery own State Zip Code Date of Inspection . . 0. item 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.): tNns•3M3 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 n � , GOIIII1161'1llt[kT'Eto 'f ` I mm, ecfidn Form u y ` tetan FdM Not for Voluntary Assessments race Disp ry 139 Holly Point lid Pmoefty Addtew Frederic.Kkmn 36 Far View Run Nlarlb rough,CT 06447 owner owner's tame infrequired Ib is CenterviNe AAA 02632 10/24/13 required for every , page, CWrown state Zip Code Date of Inspection D: Sy a Et formation (coot.) 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 pubEc watersupply enters the building. Cheek one of the boxes below: '.hand-sketch in t are below 0 drawing attached separately MIMI GAS i � Q O C �-c= ass u D= 31% Q C E•.3� F = 43 r_ B � . ao,6 D � N r - 36 ' fl t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Ct>� ii a►lt l SsaChusetM 6 i Ins Form submft"Bewaye k System Form-Not for Voluntary Assessments 139 Holly'Point Rd RjrAddtess F >Klein 36 Far View Run Mariborough,CT 06447 Owner 6xfner's Name infolination is Celle MA 02632 10/24/13 required ibr'evwy Pa". Cftymown State Zip Code Date of inspection m z iiIitfC34itill an (cunt.) S rxam: 10 Check Slope Surfade'water check oWlar Shtallow we�S . EsdmaW:depth`to high ground water12'+ per plan dated 1980 feet Please iaclicate all metFiods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: 1980 on ale at the Barnstable BOH Date 0 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: SDW-252 Zone B water level 46.8 1.4x12= 1'5"adjustment You must describe how you established the high ground water elevation: Per the plan Mated 1980 a test hole was done to 12'and no water was found. From grade to the bottom of the SAS you have a depth of 10'.This gives you a proven seperation of 2'below SAS to where groundwater is known not to be.We also referenced USGS Topo Maps stated 1974 that shows our property at Elev 50 and Wequaquet Lake at Elev 34.This gives you a seperation of 16'. This gives you a proven seperation of 4'below SAS:to groundwater. Byre Ming this Inspection Report,please see Report Comp ass.Checklist on nezt page. Mns•3(13 Title 5 Official Impectim Forth:Suburface Sewage Disposel System•Page 16 of 17 .. Cvrnt�ta» +af MaacMet#s _ rfaoe a pied System Form-Not for Voluntary Assessments 139 dolly Point Rd Pam+Address. Frederic-Klein 36 Far View Run Marlborough,CT 06447 owner , owners Name Cero�le MA 02632 10/24/13 required for every State Zip-Code Date of Inspection E.'Report,Completeness ChecklW, ® tl spection Summary:A, B, C, D,or E checked f'nspection Summary D(System Failure Criteria Applicable to All Systems)completed System Inb oration Estimated depth to high groundwater Sketch of sewage Disposal System either drawn on page 15 or attached in separate file o • t5ins•3113 Title 5 official hspec icn Forth:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS lug DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 139 Holly Point Road =� Q Centerville, MA 02632 Owner's Name: Selma Linskv �,� Owner's Address: Date of Inspection: February 7. 2007 'Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT t:1 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 nmy `- 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 feds Further Evaluation by the Local Approving'Authority ' ,•-r, iIs Inspector's Signature: Date: February 9. 2007, The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of cotnplet ng this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Cotntnents ****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 I Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 139 Holly Point Road Centerville, MA Owner: Selma Linskv Date of Inspection: February 7, 2007 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 detennined(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 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 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 139 Holiv Point Road Centerville, MA Owner: _Sehna LinsL Date of Inspection: February 7, 2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detennine 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. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 139 Holly Point Road Centerville MA Owner: Selma Linskv Date of Inspection: February 7, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"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 _ ✓ 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 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.] No (Yes/No)The system fails. I have detennined 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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. I You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should'contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 139 Holly Point Road Centerville, MA Owner: _ Sebna Linskv Date of Inspection February 7, 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: . Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks ? ✓ — Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(arid 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. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. i 5 Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .139 Hol1v Point Road Centerville, MA Owner: Sebna Linskv Date of Inspection: February 7. 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1.10 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage.(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown C OMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc:): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records; if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 616180-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 139 Holly Point Road Centerville. MA Owner: Sehna Linskv Date of Inspection: February 7. 2007 BUILDING SEWER(locate on site plan), Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 33" Material of construction: ✓ concrete _metal _fiberglass polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 a� 1. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recornmendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). Cement tees were present. The liquid level was even with the outlet invert.. There did not appear to be any signs of leakage The inlet cover was 10"below. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recormnendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 it Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 139 Holly Point Road Centerville, MA Owner: Sebna Linsky Date of Inspection: February 7. 2007 TIGHT or HOLDING TANK: None (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): Alain 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 opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was normal. No solids were Present PUMP CHAMBER: -None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Corn ments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ 139 Holly Point Road Centerville, MA Owner: Sehna Linskv Date of Inspection: February 7, 2007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1-6'x 6'(1000 ag l.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length:, leaching fields,number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Connnents(note condition of soil,signs of hydraulic failure;level of ponding,damp soil,condition of vegetation,etc.): The leach nit was dry. There did not appear to be anv signs of failure Used a camera for the inspection CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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 Page 10 of 11 OFFICIAL INSPECTION,FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 139 Holly Point Road Centerville, MA Owner: Selma Linskv Date of Inspection: February 7, 2007 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. rranr CNN c. O a as PV 6 � 3 a- 3 as 3 y3 3� 10 Y Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 139 Hollv Point Road Centerville, MA Owner: Selma Linsley Date of Inspection: February 7, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic-and water contours mans Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 20'+1-to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future: There have been no warranties or guarantees,either expressed,written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 r f ......._ r , Fimic .o............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ------[ .O....--_--- ----OF..... �a.�4 Appliration for Uiipos al Vorkg Tonstrnrtion Vantit Application is hereby made for a Permit to Construct (+,,�'or Repair ( ) an Individual Sewage Disposal System at: L®�. - -- ....L l----1---------------------------- Location-Address Lo N -------------- — �s? ...-... �.._... _ ---------...--••----••--......�T._ t ..o...... Owner �" Address W Installer Address Type of Building Size Lot______ _ .....Sq. feet �_4 Dwelling—No. of Bedrooms................_•_.__________-------Expansion Attic ( ) Garbage Grinder (tic) aA4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------•-----.....--•-------•----•----- ---•--------•--•--------. . ......---- . ,o W Design Flow............... ......._yy....______.gallons per person per day. Total daily flow................... .............gallons. WSeptic Tank—Liquid capacity) gallons Lengthb.rO".... Width.k-n(e— Diameter-_._____-___-- Depth.5fmF" x Disposal Trench—No..................... Width.................... Total Length-___----- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter......0........ Depth below inlet......Co.......... Total leaching area....!120..sq. ft. Z Other Distribution box (4/f Dosing tank ( ) . - `"' Percolation Test Results Performed b ._ °�------ �?.�1��_ `jow� ate...._ Test Pit No. 1__-.=` -....minutes per inch Depth of Test Pit------472------- Depth to ground water______ ____________ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ..... .... ...... _............................................................................ Description of Soil ._.. < ��--------------------••-----•---------------------------•---•--......._------ W UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ --------••-•--------••------•..............•----------------------••-------------------•---------...----•----------------------------------------...-----------------------------------•---°-....••-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance°with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system m operation until a Certificate of Compliance has been issued by the board of health. # Signed `u-'�- � 0............ .----- . �.... _... Date Application Approved BY - ••__ ...... . •--- --------------------------- ; �&................ Date Application Disapproved for the following reasons-............................................................-------------------------------------•-------•---- ___.....•------------------------•------......_....-----•......-----------...-•----•-__.._.._...-------•---------------•••-•---•-----...--•-•----•-----------------•--------••--•---•--•--•-•----------- Permit No. . ate ` Date 3 uw, p M No. .................... . .�^ Fss...., .. J............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... -u "-."..............OF......-... I e °. Appliration for Disposal Works Tonstrnrtinn rprmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: y .. .............................................. ........... ........................... Location-Address *y E or Lot No. ...............................tA..�A .....T:z.:...... ':3�,d tsq !�lai�� .3.............-•----•------•-•--^-•-•--••---•--.....----•-......................._............_. Owner Address .....................Jf a?b!.. ..... ... ±a ... ... ....---•--.._.......................... Installer Address Type of Building Size Lot------!Zl k ------Sq. feet aDwelling—No. of Bedrooms_________________ _____________________Expansion Attic ( ) Garbage Grinder (No ) aOther—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria Otherfixtures ----------•------••----------•--•-•-------•-•-•---------------------•-------•--..._.__.._.._..._..-------------- .....---------....:.---•----• W Design Flow_________________'' 1`.�:i_...._._..._..______.gallons per person per day. Total daily flow................... ............gallons. W Septic Tank—Liquid capacity(n .gallons Length._:_^ .____ Width 4_"t� ._ Diameter________________ Depth_........ ....._ __.._ xDisposal Trench—No. .................... Width.................... Total Length.__.________p__.._. Total leaching area............ ft. Seepage Pit No._.___.:�__-_______- Diameter......(,�.. __.___ Depth below inlet...... �.._.. leaching area.__� f2..sq. ft. .._. Total Z Other Distribution box ( Dosing tank ( ) 1 Percolation Test Results Performed by i ...� : a ___:..! __���....;r te__________�_t.��� .____._... Test Pit No. I....7 ____minutes per inch Depth of Test Pit........�7 Depth to ground water______ ____________ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ __..... _----- ----- ------ -------- •------- -_--------•-----•- O Description of Soil,:...... r ,M±Ztx .... `� `^� `= ►...� ,.. V ---•-•----•--------- -------- W VNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------•--.....-•----------------------------------......----•--••---........-•--•-------•-•--•---------•-•---------------•----_...----.------------...............-••••---...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System;in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .. -------- t Date *plication Approved BY �,a.' ---- ----------- Applieation Disapproved for the following'reasons_............................................................................................... "- 4 ........................................ ................ 3 Date PermitNo.....---••-••----•--•----•--•......----••---•------•----- Issued......................-------==`•/.. ------ -" Date .s` - THE COMMONWEALTH OF MASSACHUSETTS g B6A.RD OF HEALTH V- . ,. ... .... . �?-..rites. '.:.............................O"F.:.:.. ..'1 . .. - ........ �rr�tif�ctt�e of f�iam�r�i�nrle . ,,�'°� THIS IS TO CERTIFY, That the Individual Sewage Disposal System construct ( t ) or Repaired ( ) Y ........ • ,r L G� ��/ //.6 t, I alley } at ........................•-------•---•---------------• .. . .. y Dlr! - ' ' i� Vldl�t• '' has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No$ _.7:.6..3_____________ ___ do................................................ 'THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS'A GUARANTEE THAT THE ..NSYST61oef..,WILL FUNCTION SATISFACTORY� X DATE.'-: ° I'nsppctor -01 THE COMMONWEALTH OF MASSACHUSETTS �. a Y--- BOARD OF . HEALTH F 4 .................. FEa ...... ....... a Gila Irk �aanrr#uan pTmit Permissin ' hereby granted....- - -•------•-----=----- -- •. ....................................................................................... to Constru /� epair ) an In .dual Sewa a sposal S stem ... ........... Street as shown on the application for Disposal Works Constructi ermit No_________ _________ Date_________..-____.._._..___..._.___........ a BoardAT 1realth DATE? ......................................................b FORM 1255 HOBBS & WARREN. INC., PUBLISHERS : � r LC t IMP too .0c) lob.a u S loco d-A4, r Pca5A,t_ P�T V s loge ,.� P ``` fs�iaP Cr _ ► { So -- 51='Ciao �. d 1 a # ' Ila , PEBcc�t.AT i c�.l, CZdTt_ t I�t 2 MqJ '02 t. �"• � "�_'�. _ �...�•�- .._ . . 1p A. LL- r l W r�.� & �"„�, ToP F� ft3d•� .. �rlJ1�t9. �r� c�7773G'7��.. v 4��IE y. _ _ _. • tvAM 4 l 06-a mac. ¢ Poi v+sr. yac.. i ,8 11h1 � 8ox. � io�G, ras�PTK _ ia�o Is 103,E TAu V. `yv K. . Fly �. SA#Jb WITH F Grow& CV—=2 T I Fi Qa R.o-c- FIL-A u ` t crL Tt FY T"AT r� rz S%,-j pt_A.I" t2 * .tcE ►-1�2E.o w Gc>M PL-Y S W t T+4 tir. Lor ArJD St"BACK f,Z6CJJ+e.EMC��Trj OF '1'"L1� L►, -mvj" of SWZ?3 rAi$Ltw LAW—.> Lot*- "' RAQ - 2n' ti SZ .isT tz LAt.Jt� yvE�(Oe; T644 PL&LA I4 L16T 8A5ED OW AU ;W4TWMEMT osT+�vt�.�.E� MASrS• 5utvC( 4 T"r-, oGFS4T; 1"ous-l> UOT V5e APPLICAWIr To -Pe-TEKMo wE •%-07 wi.JF.;. b0oA. 'Q. (�ADV.4: r'o S i-1 -.P� A) LOCATION �usc /39 EWAG PERMIT NO. \.oT I l `7 L L Vo► A asp //o VILLAGE I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED F'RoN`r-tact u>�V w ;GARAGC 7:4QtMIT .N p NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS 1T;' &DIMENSIONS IN THE FIELD 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009 4.) 110 MPH EXPOSURE B WIND ZONE 5.) ALL LVL LUMBER/BEAMS TO BE 1.9e L/360 LOAD ' g,) VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS DURING FRAMING CONSTRUCTION r EXIST EXIST. 7.) TIMBER FRAMING TO BE FIR NO.2 GRADE DECK SUNROOM IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS A B CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION AL A2,FTABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) FF.NERTRA-- SKYLIGHT CEILING WDOO FRAMED WALL FLOOR BASEMENT WALL Ba.9EMENT SLAB CRAWL SPACE WAL U-FACTOR U-FAC.!°R R.VALUE R-VALUE R-VALUE R-VALUE R•VaLUE R-VALUE 0.32 0.60 1 49 1 20 30 I 15H9 10(2 FT.DEEP) -13 NOTES: REPLACE EXIST. REPLACE EXIST. LIDING DOOR SLIDING DOOR I.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. - 2.15119 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR o OF THE HOME OR R=15 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL t I - 3.REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS our ovErLi REPLACE, REF I :REPLACE REM 1 D. EXIST. I i I EXIST SKYLIGHT (VERIFY KAHEN I SKYLIGHT KITCQE LAYOUT W/¢)WNER)` i ) I REMOD. L -J DINING �O f S REMOD. p O; (VAULTED CEILING) 1 a FAMILY COOKTOP ROOM i I I I_EXISTING WALLS t—___ I I BE REMOVED go ZT DCEIUNG) - -ZVA :CEILING) (V LTE -H 11 2-2 x BNgR. .I;. NEW 2-1 LVL RIDGEBEAM io - &D yr �NEW2 1'.A )f0.[/4 LVLt f.*�':.• I END OF BEAM UNDER EACH END �I DN.( ^1 ' INSTALL NEW TRIPLE —/ A INSTALL NEW 30"x JOIST UNDERR NEWNEW = A 30"x 10'CONCRETE POSTS hI J_ I FOOTING UNDER NEW II, 1 POST LOCATIONS, 5'CLOS. 0 BLOCK BETWEEN THE _ 14 FLOOR JOISTS FNEW -1 REMOD. W INFLUX I LIVING J N I SKYLIGHTI (VAULTED CEILING) CLOSFI EXIST. GARAGE REPLACE EXISI. WINDOW UN OF OVERHANG'ABOVE FIRST FLOOR PLAN 14 22•-0.. r . THE ERRORS oMjSElER LSE NOTIFIED FOUNIFANY SCALE : DRAWING NO. COTUIT BAY DESIGN': ��C NEW REMODELING FOR: ERRORSOR0KTHE SUILUGCONTN THESE DRAWINGS PRIOR TO START OF FK 43 BREWSTEFt ROAD WINT,IESEDRAONGSIFF'ORINI°EC°'ONir3T 1/4RACTOR "= 1'-0" MASHPEE MA. 02649 OEMGNEDRAMIN ERRORS IF C OR tOClI(x1 S O D E R B E R G RESIDENCE COMMENCES NGS ARE SOLE Y FOR T DESIGNER OF NOTD..AN OTHER USE OF PH. {508)274-1166 THESEGRAWNGbARESOLELYFORTNEGSE DATE : FAX(508)53s-9402 OF THE OWNER NOTED.PNYD HER GSE OF THESE D"WNGS RECUMES THE VAR N 8/4/2016 139 HOLLY POINT ROAD CENTERVILLE - MACO�SENTOFTHTO I= Al ERAIECOPYRIGNT TMEON EXIST.2 x 8 RIDGE BOARD .NEW.2x 4's@16'O.c' NAILING SCHEDULE 12 EXIST.2xa RAFTERS @t6"o.c. - 110 MPH EXPOSURE B WIND ZONE EXIST JOINT DESCRIPTION NO.OF COMMON NAILS NO.OF BOX NAILS NAIL SPACING ROOF FRAMING: BLOCKING TO RAFTER(TOE NAILED) 2-6d 2-10d EACH END RIM BOARD TO RAFTER(END NAILED) 2-15 d 3-16d EACH END NEW 2 x 4BEARING lrll1ST.CEILING - WALL FRAMING: JOISTS 4-16d 5-1 Sd AT JOINTS _ BE WALL W!(R20)SPRAY REMOVEDED FOAM INSULATION TOP PLATES AT INTERSECTIONS(FACE NAILED) STUD TO STUD(FACE NAILED) 2-16 d 2-1 6d 24"o.a , TOP OF PLATE ___ HEADER TO HEADER(FACE NAILED) lad lad 16"o.c.ALONG EDGES EW 112"GYP:BOARD FLOOR FRAMING: ON 1 x.3 STRAPPING JOIST TO SILL,TOP PLATE OR GIRDER(TOE NAILED) 4-8d 4-10d PER JOIST 16"°,c - BLOCKING TO JOISTS(TOE NAILED) 2-8d 2-1 Od EACH END BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH BLOCK RO EM I �/D._'- - LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3-16d 4-1 ad EACH JOIST FAm 14..1 EXIST. JOIST ON LEDGER TO BEAM(TOE NAILED) 3-8d 3-1 Od PER JOIST 44 BAND JOIST TO JOIST(END NAILED) 3-16d 4-15d PER JOIST 1� ROOM I GARAGE BAND JOIST TO SILL OR TOP PLATE(TOE NAILEDO 2-16 d 3-16d PER FOOT ROOF SHEATHING: EXIST.2 x 4 WALLS WOOD STRUCTURAL PANELS(PLYWOOD) SUBFLOOR RAFTERS OR TRUSSES SPACED UP TO 16"O.c 8d 10d S"EDGE/S"FIELD RAFTERS OR TRUSSES SPACED OVER 16"o.c. ad 10d 4"EDGE/4"FIELD EXIST.2�)i 10's Q 18"O.C. GABLE END WALL RAKE OR RAKE TRUSS W/0 OVERHANG Bd 10d W EDGE/6"FIELD GABLE END WALL RAKE OR RAKE TRUSS Bd 10d 6"EDGEIB"FIELD W/STRUCTURAL OUTLOOKERS GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS Sd 10d 4"EDGEA"FIELD �/ CEILING SHEATHING: EXIST: GYPSUM WALLBOARD 5d COOLERS — 7 EDGEl10 FIELD WALL SHEATHING:BASEVENT WOOD STRUCTURAL PANELS P STUDS SPACED UP TO 24"o.c. ad 10d 3"EDGE/12"FIELD 1/2"8 25/32"FIBERBOARD PANELS ad — 3"EDGE/8"FIELD 1/2"GYPSUM WALLBOARD 5d COOLERS — 7"EDGE/10"FIELD FLOOR SHEATHING: WOOD STRUCTURAL PANELS(PLYWOOD) 1"OR LESS THICKNESS ad 10d WEDGE/12"FIELD GREATER THAN 1"THICKNESS 10d tad S"EDGEl6"FIELD A SECTION 0 FAMILY ROOM Az EXIST.2 x 8 RIDGE BOARD NEW 2-1 3/4"x 14"LVL RIDGEBEAM 12 NEW2x4s@16 oc _ EXIST. _EXIST 2 x 8 RAFTERS1d.18' - r:! h . r / EXIST.CEILING JOISTS To BE REMOVED `-. TOP OFP TE -------------- ' ----------- - -------------- q REMOD. REMOD. KITCHEN LIVING SUBFLOO EXIST.2 x 10%@ NEW.SOLID BLOCKING - EXIST. BASEMENT , L,_J B SECTION KITCHEN/LIVING f COTUIT BAY DESIGN LI_C NEW REMODELING FOR. THE DEDRAWNGSPRIORTOSTARTOANY SCALE : DRAWINGNO.: ERRORS OR OMISSIONS ARE FOUND ON THESE DRAWINGS PRIOR TO START OF CONSTR ON.THE 43 BREWSTER ROAD INTHES DRAWINGS CONSGUCnON TOR 1/4"= 1'-0"WILL BE RESPONSIS:E FOR THE CON1ENi IN THESE DRAWINGS IF CONSTRUCTION COMMIEN0ES V11T NORFYING TIIE MASHPEE MA. 02649 S O D E R B E RG RESIDENCE TOSSI HESE RAWINGSARRDOLELYF RTHEiS. DATE THESE DRAWINGS ARE SOLELY fOR THE USE OF THE OWNER NOTED.ANY OTHER USE OF PH. (508 274-1166 THESE DRAWINGS REQUIRES THE VIRI E FAX(5°: )539-9402 1'3 9 HOLLY POINT ROAD C E N T E RV I L L E MA AC Q1 TECTU F 19M. L COPYRIGHFPROTECTIO,N 8/4/2016 A2