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HomeMy WebLinkAbout0579 HUCKINS NECK ROAD - Health 579 Huckins Neck Road Centerville F 234 042 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Bigo!gaY *p$tem Cutt.5truction Verna Application for a Permit to Construct( ) Repair�>4 Upgrade( ) Abandon( ) Complete System ❑Individual Components \\\ Location Address or Lot No. CJ / G��IYr t��`� /mob. Owner's Name,Address,and Tel.No. r66, 4 MD j1 A-.J C_rN- r_)"`1ICLL' e510N 4lnL(41wS n/kCjG AIDAID, CiErvt�rtv)tcl� Assessor's Map/ParcelZ*3�-/b /.1 lo,r 16A Y` In•s�t Her's Name,Address,and Tel.No. F_t4A jG Nf C®I�KWCn o,,/ Designer's Name,Address and Tel.No. VALM,v\,r r /,N&IN Ge 3'.0 . O . Ram 10�3, 5o�,-r H "1 K1t2MmH�N O ) BA(.L 5ove.,r �,gZ*�o�Y+l K►q Mtn O2664 6040— -775' V3 1 0,11,540 — 49S- 1a 5— Type of Building: Dwelling No.of Bedrooms tA Lot Size 14,406L sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Des, flow provided 34.2 d Plan Date " U�` ( Number of sheets d� Revision Date Q� Title (b-r P L_nr / t 17_rP-t '�/G Y— 4�rcm r llJ g& s` Ty'/ h1na),AW Size of Septic Tank .-Type of S.A.S. Description of Soil Nature of Repairs or Alterations f4riswer/when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainteriance 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. Signe njl Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued " TOWN OF BARNSTABLE LOCATION r'711 14&Z k g Ae C1C l SEWAGE # .2C1ra 4'ILLAGE ���� ASSESSOR'S MAP & LOT g +3`-/ 6"- INSTALLER'S NAME&PHONE NO. irhAir4t 66'.)SAI SEPTIC TANK CAPACITY /sbd �a LEACHING FACILITY: (type) 3 Row VckSt-r s (size) NO. OF BEDROOMS BUILDER OR OWN/ER 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 1 ching.facility) Feet Furnished by_� A-Ici4r Eck �3 43.=69, q ��rs �Y Vo I a-Ll r` No. Fee THE COMMONWEALTH 6F MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for 3h5po!gal Qap5tem Coi�5truction Permit h Application for a Permit to Construct( ) Repair(>�: Upgrade( ) Abandon( ) Complete System ❑Individual Components t 57� 1-rvrc)c,,,.s Nevk Rb,, �/ 1 Mo gar+f ( Location Address or Lot No. Gj�.�-fF1<V i C.LL� Owner's Name,Address,and Tel.No. '`,2be f'Y ?j �,�� Nv,�tcl�s Nkci� ftoA,�, G�Nt&►�vlur�' Assessor's Map/parcel234/04-A I-O'/ 16A YA ! : r Installer's Name,Address,and Tel.No. FNl41Gz Rf �Or�S4KtnctLPt✓-1pesigner's Name,Address and Tel.No. i<1L�n�v�i�j / 'N 6In lUr F �(..0 . )30-* IOG3, 50(.rf4 19A9Moh'r14 10 ) 'fur IRAu �4�naryty, F' L,,,�a,nrit Mq 1•0A o6q666 ISO% - '7-7S--3sC13 09,540 G3 41I'l 1216" Type of Building: Dwelling No.of Bedrooms Lot Size 14, 416 sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) " µ Other Fixtures . Design Flow(min.required) j -3l7 gpd Design flow provided 342 gpd Plan Date N\A t4 4 � Number of sheets Revision Date (. Title i --r PLr--tN f �1 11 �YSTi=M &_'. 1L Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(answer when applicable) I_/1 13 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe�dI,.; � E i��j« ( /J Date 5/,< /�It Application Approved by ;�/ `�� Date 'Application Disapproved by: r` �+j �Ar Date r for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compiliauce THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by v / at 1 l�c,t�C ��p e c.i l 7Z ,C����c'r�,�� < has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. tt dated Installer �"e i r-" %.,0 Designer #bedrooms Approved design flow gpd The issuance of this permit shall/ (of be construed as a guarantee that the system'w I fum n as designed. Date '� I " Inspector", &2-Z No. �9� �� ----------------•-------Fee f�_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwi5po$at �&p5tem (Cou$tructiou Permit Permission is hereby granted to Construct ( ) Repair ( k) ",Upgra/dde ( ) Abandon ( ) System located at 41'(L (,s\s WCC )Z., & and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty' to comply with Title 5 and the following local provisions or special conditions. Provided: Conch actiorymust be completed within three years of the date of this pe Date / � Approved by /I a T p� TOWN OF BARNSTABLES�c�d� LOCATION S 7 / �Vc_ Aj p C VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(t} e� (size) NO.OF BEDROOMS OVER -"�$$�-rrn�—DATE: 0 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 Town of Barnstable. P# Department of Regulatory Services • ' Public Health Division Date ' areer� • • 200 Main Street,Hyannis MA 02601 �Fp lllA! A. Date Scheduled Time lI Fee Pd. Soil Suitability Assessment for Sewage Dis osal Performed By:�e Witnessed By: LOCATION&GENERALINFORMATION Location Address lVveki 0-6 A c A Owner's Name Address Assessor's Mapffl4mel: X0 t�, I •neces Name-11 NEW CONSTRUt'T10N REPAIR eiephone#�d FS� T ��� •3 Land Use Slopes(96) P !-/U Surface Stones Distances from: Open Water Body 74SIZ Passible Wet Area ft Drinking Water Well _ft Drainage Way ft Property Ling 7/a ft Other ft SKETCH:($treet name,dimcnsious of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) i i • j i Parent material(geologic) i Depth to Bedrock Depth to Groundwater: Standing Water in Hole:�•f rl 45*VCyyill+Ul�,Weeping from Pit FA, Estimated Seasonal"gh Groundwater 710 DtTERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: I l Depth C14erved standing;in obs.hole: _ in. Depth to soil mottles; ln. Depth tolweeping from side of obs.hole: in. Groundwater AdJuettneflt ft. Well#—r Reading Date index Well level ' ..,.. ArU•factor.. Adj.OrpUt[dWflter 1 t Ve1.,,�.• PER 'OLAT16N TEST Date Observation .L I Time at 9" _✓•_,., 17,. Hole# At 3�t -- Time at 61' ' �Z Y • Depth of Pere h J Start Pre-soak Titne.0 /a••,5 Time(9"-6") 70 W eN End Pre-soak Rate MinJInch 'S i �l ¢ Site Suitability Asselpsment: Site Passed Site Failed; Additional Testing Needed(YIN) Original:.Public Health Division Observation Hole Data To Be Completed on Back' \ — ***If percola#pn test is to be conducted within 100'of wetland,*You must first notify the Barnstable C4#servation Division at least one(1)week prior to beginning. i 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 (o A woY o4 312- /Zo G z.sY7lY s�aaos �co �S i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) $/ ojgq tro,4a1 fL 3 L cow* s �u �s/6 �Lo G s to Z-s y7( W�snwvca Kofft, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color ? Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No— Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? _..�. Certification I certify that on (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 train' g,expert a and experi nce described in 3..10 CUR 15.017. Signature Date y�6 Q:\.SEPTICVERCFORM.DOC Vl - t. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . n DEPARTMENT OF ENVIRONMENTAL PR TION fo RECEIVE® F, ED INSPECTION AUG 2 5 2004 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 579 Huckins Neck Road iAAP Centerville PARCEL Owner's Name: Marilyn Hollisian Owner's Address: 151 Coolidge Ave, 1608 LOT —Wat-prt MA Date of Inspection: Name of Inspector:(please print) Wi 1 1 jam E_ .Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P 0 Box 1089 Centerville, MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT i certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 eeds Further Evaluation by the Local Approving Authority Inspector's Signature: —6 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION;(continued) Property Address: 579 Huckins Neck Road Centerville Owner. Marilyn Hpllisjan Date of Inspection: Inspectio ,.Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syste Passes: I hav not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 10 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Co ditionally Passes: One or mi ire system components as described in the"Conditional Pass:'section need to be replaced or repaired.The sysi em,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no o not determined(Y,N,ND)in the for the following statements.if"not determined"please explain. The septi tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound,ekhibi substantial infiltration or exfrltration or tank failure is imminent.System will pass inspection if the existing tank* eplaced with a complying septic tank as approved by the Board of Health. •A metal septi tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that a tank is less than 20 years old is available. ND explain: Ob rvation of sewage backup or break out or high static water level in the distribution box due to-broken or obstruct pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The ystem required pumping more than 4 times a year dire to broken or obrnt_�cted pipe(s).The system will pass inspect n if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rttmotred ND explai Page 3 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 579 Huckins Neck Road Centerville Owner: Marilyn HQ 11slan Date of Inspection: — v C. Further Evaluation is Required by the Board of Health: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing o protect public health,safety or the environment. 1. Sys em will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the syste is not functioning in a manner which will protect public health,safety.and the environment: _ C sspool or privy is within 50 feet of a surface water _ C spool or privy is within 50 feet of a bordering vegetated wetland or,a salt marsh 2. System w Il fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is func inning in a the that protects the public health,safety and environment: _ The s tern has aseptic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surface wat r supply or tributary to a surface water supply. _ The sy tem has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The sy tem has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The sy ern has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more froul a private wate supply well•• Method used to determine distance "Thi)an m passes if the well water analysis,performed at a DEP certified laboratory,for coliform bactervolatile organic' compounds indicates that the well is free from pollution from that facility and the prof ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failureia are triggered.A copy of the analysis must be attached to this form. 3. Other 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 579 Huckins Neck Road Centerville Owner: Marilyn Hollisian Date of Inspection: - D. System Failure Criteria applicable to all systems: You must indicate')+es"or"no"to each of the following for all inspections: Yes No/ Backupof sewage into facility or stem component due to overloaded or clogged SAS or cesspool g Y Y P gg P Discharge orpondingof effluent to the surface of the ground or surface waters due to an overloaded or /clogged SAS or cesspool Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or /cesspool _ _✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow 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 (lie 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.] (Yes/No)The system fails.1 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. Lar a Systems: P6a�, ® � "� /t'i t1 �; �``! i LG To be c; sidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,v00 gPd• You mus indicate either"yes"or"no"to each of the following: (The foil wing criteria apply to large systems in addition to the criteria above) yes no I ie system is within 400 feet of a surface drinking water supply I he system is within 200 feet of a tributary to a surface drinking water supply e system is located in a nitrogen sensitive area(interim We Protection Area—1WPA)or a mapped one 11 of a public water supply well If you ha a answered"yes"to any question in Section E die system is considered a significant threat,ar answered "yes"in ection D above the large system has failed.The owrier or operator of any large system considered a signific nt threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. he system owner should contact the appropriate regional office of the Department. 4 f Page S of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 579 HLcki n s Neck Road �antPrvillP Owner: s 1 1 Date of Inspection: — '+, Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? -fzl_ 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? _AIO_�%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? Ga Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance., is unacceptable)[310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 579 Huckins Neck Road Centerville - Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL. .3 bedrooms(actual): Number of bedrooms(design).. Number of bedr DESIGN flow based on 310 CMR 15103(for example: 110 gpd x#of bedrooms):3 G-0 Number of current residents: Does residence have a garbage grinder(yes or no):Wit) Is laundry on a separate sewage system(yes or no):oL [if yes separate inspection required) Laundry system inspected(yes or no):AL v Seasonal use:(yes or no): 5 Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 3 — 36 , 000 Sump pump(yes or no): 2002 — 51 , 000 Last date of occupancy: COMMERCIA USTRIAL Type of establishme Design flow(based n 310 CMR 15.203): gpd Basis of design flo (seats/persons/sgft,etc.): Grease trap prese (yes or no):_ industrial waste olding tank present(yes or no):_ Non-sanitary w ste discharged to the Title 5 system(yes or no):_ Water meter r adings,if available: Last date of cupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: -1—AA Was system pumped as part o the inspection(yes or no): tl-r If yes,volume pumped: allons--How was quantlumped determined? Reason for pumping: TYPE OF SYSTEM _;mgle tic tank,distribution box,soil absorption system _ 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 compo eW,ate installed(if known)and� �q�nformation: 6 /� /�Y Were sewage odors detected when arriving at the site(yes or no):��O 6 I,age 7 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 579 Huckins Neck Road Centerville Owner: Maril n Hollisian Date of Inspection: (y BUILDITo: EWER(locate on site plan) Depth bolrade: Materialsonstruction:_cast iron _40 PVC other(explain): Distance private water supply well or suction line: Comments(on condition ofjoutts,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on ite plan) Depth below grade: Material of construction: oncrete metal fiberglass_polyethylene other(explain) — —" If tank is metal list age: Is age confimed•by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet Ice or baffle: Scum thickness: Distance from top of cum to top of outlet tee or baffle: Distance from bott of scum to bottom of outlet tee or battle: How were dimensions determined: Comments(on mping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to o let invert,evidence of leakage,etc.): GREASEjs :_(loc to on site plan) Depth bele:_Material ructio :_concrete metal fiberglass_polyethylene_other (explain):DimensioScum thicDistance p f scum.to top of outlet tee or baffle: Distance om of scum to bottom of outlet tee or baffle: Date of laing:Commentntping recommendations,inlet and outlet(ce or baffle condition,structural integrity,liquid levels as relatedt invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 579 Huckins Neck Road en ervi e Owner: Marilyn Hollisian Date of inspection: TIGHT or HOLD G TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grad : Material of const ction: concrete metal fiberglass_polyethylene other(explain). Dimensions: Capacity. allons Design Flow: allons/day Alarm present es or no): Alarm level: Alarm in working order(yes or no): Date of last pu ping: Comments(co dition of alarm and float switches,etc.): Yd DISTRIBUTIO/BO *: (if pre tust bE opened)(locate on site plan) Depth of liquid loutlet invert: Comments(notevel and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or otc.): PUMP CHAMBER: (locate on site plan) Pumps in working o er(yes or no): Alarms in working rdcr(ycs or no): Comments(note ndition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 579 Huckins Neck Road Centerville owner:-Marilyn Hollisia Date of Inspection: �� �G SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,ezcavation'not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: Ve 1 'aching trenches,number,length: aching fields,number,dimensions: overflow cesspool,numbed innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): / fi4 'K AQ 00 �ieD Az 0 0 Z-. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:_ .7--- (, a, Depth—top of liquid to inlet invert: t.� ' Depth of solids layer: Depth of scum layer/ �- Dimensions of cesspool: ,k $' G Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of,pponding ondition o egetation,etc.): PRIVY: (locat on site plan) Materials of cons ction: Dimensions: Depth of solids: Comments(not condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 579 Hucki nG Neck_ Road Centerville Owner: Marilyn Hnl 1 i g ' n Date of Inspection: —116 -- . 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. 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 579 Huckins Neck Road Centerville Owner. Marilyn Hollis n Date:of Inspection: c- SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water 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) �21 eked with local Board of Health-explain: �/ ecked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the hi g ground water elevation: 11 Flue 01 06 03:30p p. 1 Towel. of Barnstable Regulatory SeMees 1 i Thomas F.Geller,Director Public Health Division " Thomas McKean;Director 200 Main Street,Hyannis,MA 02601 Of ew.508-867-4644 Pax: 509-790-6304 Installer&Desiener.CertWcatfon Form Date: ) Sewage Permit# �Eb6 _o�sS Assessor's MapWarcel �+e2 Designer: ��nldkPll E/l y��yle-Installer: /i1�hRie�1}t CflNSTYCt�G?)a�/ Address: . 1PJl -17,A& et `7 ./_Q._- Address: -0 , la�'13 On (=. I Zo Cnry�1�e1-C",L,,� was issued a pe3rnut to install a (date). (installer) septic system at 5 7q ffiAcI67S U based on a design drawn by addr,e") F_Enjaw 6nq)RQP/,',g4�I G. dated ( sigaer) �.I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10, lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if regtt' ected and the soils were found satisfactory. �K of 8�c MIOMEW. BORSELLI (�gt CIVIL No 25054 A fit► u' signers Signature) (Affix igner"sumpHere) �5,E R U Q R{ WTABLE PUBLIC HEALTH DM9IUN. CERTIFICATE P CE L O BE UED B RE E O QASeptic\Dusignec CmtM=don Po=Rev 03-09-0d.doc NOV 07,2004 13:42 page 1 I 4AII2OO6 11r 16 AM a.tr ,'fi 1/4'./- 4'-51/8' p r -_________ ________ ------------ re d r r r r Lr r r ___________________ _____ ______________ D 1/4 I> r-1,t/4- -F� �u mho =3i F x' z = F - ----- --�-- ---- w g r r r r r o r O I vr• 3'-6 In• = I - I � 4'-3• v321 a ms 10'-03/4' � r 3,q• r - go: �22 Na I k 9 °F Hat rn HA IFT) z + 6.q. 01 I 1 m I A I o I m y I M a u sa g o m y Ile H IT =fin N C O O O N S C a s a Additions and Alterations to the Archi-Tech Associatn.Inc.hereby - Ih�s eslAaresnrveeccer copyright to thIf .. .. .o M oz i a n Residence -Architecture Works Copyright Protection cP of 1990.An v N o' 579 Huckins Neck Road ;iohraoi;6e;erpi ns v tnout the A R C H I —TECH 6 school street t 508.420.5335 i 508.420.5304 ,prase wci,te Inc..is of frohl ASSOCIATES I - Centerville, Massachusetts Tech Associate,nc.,is an inlrings- �` 4 o mans of hat aoi.Any err°r,.om1,- cotuf,ma ossss 4 info@architechassociates.com O a or dimr%pancres on these LJ O Erawings shall bs brought Ic the 0 Ilenlion of Archi-Tech Assoc.. 1 Foundation Plan n°..or Ic beginning ark. ua a Eaaas°og>'e°° not architectural d e s i n 9 architech associates.com O E O u o a N t V v � w m C V T'-0' l'-0' 6'-5' II'4'•% 4'-10' 4'-l' II'-l'./. e.-b. E o E 0 Ao u s n m m m M1 c %yy% % % % m Cm mm tI(mm ^ 1X4 Mylgi.DECKING ON PT.FKA 1t n �ASCGM-3559-L a 2-1)3/4 x 4-II 3/4 in ASLiRLM-3514 �� EDGE OF SLOPED/ C 2-11 3/4 X 12 3/4 A FLAT CEILING I �� A 5 A S 2-0' \ \ EX6TIN6 EXTERIOR KITLI1 -L,� rr„JJ IYALLs TO BE REMOVED BY OTHERSENDE56N XI6H-LEVEL O cu DEN --__ _c=-------- ---- ------- '--- -- _°;-- GAS FIRE METAL C OO -0 DIRECT VENT FIRE- T-11 3/4' PLACE WITH FLUSH HEM o - KITCHEN 5H m w - '.\v ry ASLLM-3559-R � i I I ____M.B.A7�-. ___ _ h 2-11 314 3 4-11 3/4 „ DININ6 j i i 2-11 3/4%1-2 3/4 ry REF. __________ 11 BATH -b%6-0 n ry ��EDGE OF HIGHER m $IYS' CEILING IN DININ6 IX4.T.FRA DECKING a ROOM PANTRY ON P.T.FRAME 5/B'F.L.6YP.BD. LINEN ry AT CEILING AND r LASED OPENING ! I'-O EO. 3'-1' Ea. FVJISE WALL(TYP) - ry Q P.T.STEPS - HALL J RELOCATED EXISTING pOR CTR.W/RIWE ABODE PULL-DOWN STAIRS m 3 v2' 1a•-10 1n• A�'E 21-0' ; o ;LIVING ROOH w ; GARAGE -------- -'- ..------ BEDROOM TCONT.SOFFIT _ Q ASLAW-3525 GARAGE SLAB'i TO BE 4'—I A�� ry CONCRETE(3500 PSU ON ,4.+, \.�i 'AIL ry 2-II 3/4%2-I 3/I ^ 6•WELL GRADED 6RAVEL 1 EXN15i VEN5,TO 15%TO DRY FIREPLACE ' TED c o�Ua os gv DENROX.SLAB TO TO SLOPED ' ' BEDROOM LEILIIG APPR0X.3'DOWN TO __ __________ ______ //�4 - - ua` OVERHEAD DOOR$ ___ - °�, c _ �-------- ----------------------- PAD :3^ �N"- I I '�I�COFFERED oY- `m-: =ao I.E. , , �J , I WALL A5 NEEDED TO "CEILING /" __________________________________ Q B I BALANCE BUILT-IN5 A00VE ./ 1,i u _ I ii ,i FT 0Ou - Il4 X B4 CARRIAGE 'cmam- »�cn u nm�emca-ucc I STYLE ON.DOOR I BY LLOPAY(OR 511AMR) I I � I 10 LONL.APRON i ^ x - N n m 10'DIA,F.COLA-W EXI5TI"WALL5 TO REIMIN •� U ro ui EDGED LANOI t NEW WALLS cu -`Z Ln STEP5 W/CONL.PA W SET IN51DE(T.M.EJ ¢M 0 C -PELLA WINDOWS/DOOR$Wl C G LU5TOM GRILLE PATTERN /4' IT-O. I'-2 /4' 4'�' 4'W 2.9. 2,_4, 3, (SEE ELEV) CIO V Q� 19'-$In- N 7•� 1W-3 1/4'./- O 0 O \ _ Q Ln V LLL job no. o&ol w aI date APRIL 10,2006 s - scale A$NOTED drawn : PAH FLOOR PLAN a SCALE: I/4" 1'-O" V. rev. s a 8 A-2 ISSUED FOR CONSTRUCTION sbc: of 6—----_ ROV HYANNIS GOLF CLUB PROJECT LOCATION Y� Ravo G CB/DISC CB/DISC FOUND FOUND ��Arwer i LOCUS NOT TO SCALE \ LOT 15A PARCEL 32 �\ 60'48'30"w x ,0 0 71.82 •�� \\ I N ' 's �� IP \ \�N65-42'50.W j FOUND \ --- // \ �95.82' RAILROAD o TIES r Z x 7�� w o' '•o �.2 / 1 Q i ►� 7o1 u. LOT 6A / h 15,486± S.F. / N{ APPROX/MATE OICwxw 1 04 c I / W 0 z OF EXIS77NO SEP770 SYS7EM. CELLAR \ m 12 Pill'DRY ANQ REM0k,-147LL ENTRANCE EXISTIN' G \ ILLJ D r I #579� \ \ 3 V o r I F.F. EL. . w r x 7. 106.30 \ o 0 PARCEL 33 3t 7011, ' 2¢' 42't 9 1' 1500 GALL ON E CL. \\ o w SEPT/C TANK P RCH \ a f � N3 'n v � 3�11f! �`:.c7F^5'Ti�r✓L'� __ � � _ .�\�,� � � nU �J �'� � 10 _ �CARP091N. TIPR W 106 2x \ ,\\ \�� ADD/>1�D ifS4TER S'Ei � Z 79.t %' PAVED DRI o 7� ; / VEWAY BENCHMARK: 4. , IRON PIN \ 0`O / / 0) 2 EL. 105.61 \\ /� 7 i//-H /co I •Q / I Z I \� N5826'00"W / p / BLOCK . WALL � 20 0 10 20 40 70S SCALE: 1 INCH = 20 FEET PARCEL 34 sHEb; PARCEL 41 5/30/06 SHOW WATER SERVICE LOCATION 5/26/06 ADD RESERVE AREA DATE REVISION PLOT- PLAN PREPARED FOR ROBERT MOZIAN GENERAL NOTES: IN CENTERVILLE MA 1. HOUSE NUMBER: 579 PLAN DATE: MAY 4, 2006 PLAN SCALE: 1"=20' 2. ASSESSOR'S NUMBER: MAP 234, PARCEL 042, LOT 16A CIVIL ENGINEERING � O r,� WETLANDS PERMITTING 3. ZONING DISTRICT: RF-1 m HAZARD ZONE: C ��,'(N OF�4ss�c'. WASTEWATER DESIGN COASTAL ENGINEERING HA 4. FLOOD Z 5. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SURVEY. ° NtICNAELJ. BORSELLI TITLE 5 PLOT PLANS � PIERS AND DOCKS 6. ELEVATIONS SHOWN ARE BASED ON ASSUMED DATUM. CIVIL �GI R�� No 35054 LAND USE PLANNING E COMMERCIAL/RESIDENTIAL7. LOT COVERAGE BY EXISTING STRUCTURES: 1,652 S.F./15,486 S.F. = 10.7% .o v w� 9�.o9FGISTERO ��� Sendny Cope Cod and Southeastem Massachusetts 8. LOT COVERAGE BY PROPOSED STRUCTURES: 2,096 S.F./15,4$6 S.F. = 13.5% `�Ss:oNAt ° 101 TOWN HALL SQUARE — FALMOUTH, MA — 02540 — 508.495.1225 — 508.495.3229 fax 5�� P ROJECT 'NUMBER: 05159 CAD FILE NAME: 05159SP DRAWN BY: L. SHEET 1 OF 2 , 1-7N/S;/ GRADE S1/4LL BE 2,r M/N/MUM OtfR ALL SEPAL SYSTEM 06MPONEN73 USE 4 O/A. SCHEDULE 40 PVC 6W CAST IRON PIPE ?0'M/N/MUM SETBACK FROM EDGE OF STUNE TO CELLAR K'ALL 10'M/N/MUM SETBACK REMOVABLE COVERS SET TO WITHIN REMOVABLE COVERS SET 12" OF FINISH GRADE (TOTAL OF 3) TO WITHIN 12" OF FINISH a GRADE (MIN. OF 2) 7 a I.,Jn 1 -1 it ,n ,il -(AIL TEST -7 „ C i;, ir ii .,I h.;I „ —. �.1 .II - i Date of soil test: 5/3/06 Test taken by. DAVID MARTIN S = .02 ----- /NYFRT ELEI! 41111111111"Results witnessed by DONALD DEMARIS s = 10T00 Percolation rate: < 5 MIN./IN. Ground water NOT ENCOUNTERED - JOO GALLON SET FIRST SLOPE 0AR/ES 2"LAYER G 1/8' TO 1/2' o SEPTIC TANKrg -------------- 2'LEPEL S = .01 M/N. WASYED SMVE D/ST. BOX Muff INSTALL 3/4" TO 1 1/2" • W V V W q it #1ASYED, CRUSYED STONE AU �. Q � W SET SEPTIC TA-NK AND D/SIRIOV170N BOX �. 4ROZIN.0 CHAMBERS AND ,00MV � � ,� � � (eorr� a- rEsr H<xE� ON 6"LA /1' OF CRUSHED STONE W 7?l AIE BOTTOM of lIE CHAMBER � ,;� u SYSTEM. REFER TO LAYOUT OIL TEST HOLE #1 TEST HOLE #2 C sYSTE,t!FA4'¢/ORE oETA&s 0w .A 0" A INSTALLER 70 COMRRM EX/SANG/N1ERT ELEhA17OIN PROFILE � Z 6 6" PR/OR TO/NSTALLA)76W NOAFY FALM0U7H ENOYNEER/NG 3O" LOAMY SANSD 3O" LOAMY SAND TO MAKE/NkERT AD✓USTMENTS IF REQUIRED NOT TO SCALE 3 REMOVA LE 24'D/A. COMERS REMOVABLE 24"O/A. 00kER 2- _�IE� OPEN AT TOP SET %NLET KNCCKGYIT 3 M/N FRGM TANK CO{�£R x 'i t 2 — OUTLETS 1 3/4- - GY/7LET KNl.Y�YG1U i /NLRf'T TEE SE7 OUjZET IEE SE 10 AIIN. BEL Offs _ OUTLET INLET c C TYPICAL OF 5 - 0 14 BEL ow COARSE SAND COARSE SAND — I tFr s- L/OU/D LEPt7 L/Ol//D ZZ EL c0 2.5 Y 7/4 2.5 Y 7/4 s- 3- '1 N, GAS BAFR_r 2— OUTLETS 4 ' 19.5- 19.5- ,I , 4y* PLAN MEW ASS-S CT10 120" 120" 1 A% D — ows-rRIBu'no p i �ox -1 �A® _ -NOT TO SCALE 10' - o" 1O' — 6" 5' B" 1 %51 000 GALLON SEPTIC TANK (H-10 LOADIN-0 NOT TO SCALE I- ---- -- - -- , ——— — — —— —— I A BASIS FOR DESIGN: R7r,4L 0,4&;'.AZOW/S BASSO oN .T BEDROOMS, NO GARBAGE DISPOSAL A I — ( SEME MAMON TOTAL OA/L Y FLOK'= 110 GPO EDROOM X.T BEORooMS = ,T.TO GPO �- �1N OF /b _ _ _ _ _ 1.) CONCRETE STRENGTH F'C 4,000 PSI � 28 DAYS. yti'� 4p DENSITY 150 PCF. j MICHAELJ. y BOTTOIN AREA PROPO,SZ-O = .T84 SA. '— '— v 2.) CEMENT, PORTLAND TYPE I OR III. ASTM C150-81. BORSELLI 0 SIDE AREA PROPO,5 0 = 79 SF. I I 3.) ADMIXTURES, AIR & PLASTICIZERS 0 ASTM C233-82. CIVIL TOTAL LEACH/h'G AREA PROPOSED = 463 S.F. � ( I 4.) REINFORCING ASTM A615 FOR WIRE FABRIC, GRADE No 35054 60 BAR. A9o�9F�is APPL/C.9AGYV RA7F = 0.74 GPD/?%F. I 5.) DESIGN LOADING AASHTO HS20-44. FSSIOkAI � - ,01V6W LEACH/NG CAPALYTY= 342 000 > .T30 000 B 8'-O" PLAN VIEW 0 s" 5/25/06 REVISE INVERT ® ® ® 7; o ® DATE REVISION - SEPTIC SYSTEM DETAILS 30 2" X 5 1 2" OPENINGS 9" KNOCKOUTS FOR ( ) / I PREPARED FOR CONSTRUCTION NOTES. BED INSTALLATION FRONT VIEW SIDE MEW ROBERT MOD. AN 1. INSTALLAAOW OF TIE PROPOSED SEPAL SY57EA/ SHALL BE IN ACCORDANCE Of7H A7LE 5 ANO THE BOARO 6F HEAL 7H REGULAAONS 2.-9" 8„ IN 2. A OYPY OF 711E PLANS SMALL BE AVAILABLE OW S/7F FOR REFERENCE AT ALL AMES -.- -.-- 2 1/2" CEN TER VI LLE MA DURING THE/NSTAL/_4 AOYV all- 7HZ-SEPAL SYSTEM. 4 1/2" 3�8 SLOTS v PLAN DATE: MAY 4, 2006 PLAN SCALE. AS SHOWN .T NO OT/ANGES TO 7NF DESIGN-WALL BE PERFORMED W)1 VOY/r Th'E APPROVAL OF BOA/ _ - 4' DIA. FALMG071 ZN,Gi'NEER/NG, INC AND 711Z-BOARO Oh'HEALTH Q O — L FL❑W LINE r.lrri� 4. )?`f-SEPAL SYSTEM IS SUS"T TO IN.SPECAON BY FALMOUTH ENGINEERING INC0 _,� 11 1/ � CIVIL ENGINEERING T 4 O T T WETLANDS PERMITTING AND THE BOARD 0/ HEAL 7H lv� U WASTEWATER DESIGN � � COASTAL ENGINEERING 5. THE OYWTR.4C7OR SHALL NOAFY FALMOUTI ENGINEERING, INC AND THE BOARD OF HEAL 711 4" F-9 3" 2 1/4" 77 IN,SJ0ECT THE SEPAL SYSTEM PRIOR 70 BACKF/LL. IN SOME INSTANCES, MORE THAN ONE T © TITLE 5 PLOT PLANS ` PIERS AND DOCKS /N_Wf-6WOW M BE AYNEEDED. 7NE 6W)7?40,r0R SHALL ONLY946,YALL Th'E,06W)7OWS 0r TIE SEC 1 11 ON A—A SECTION !�—C.p B GI NEE 1�I SK57EM THAT HALF BEEN INSPECTED AND APPROkEO BY FALMOU7H ENGINEER/NG, INC. AND LAND USE PLANNING COMMERCIAL/RESIDENTIAL THE BOARD 6F HEAL 711 6. /F THE 00,V7RA6'70R ENCOUNTERS AND VAR/AAONS/N SITE CDND/AONS SUGiV AS D/PEER/NG TYPICAL FLOW DIFFUSOR DETAIL S&-Wl7y Cape Cod and soUtheaSt&M Massachusetts SOILS; 70,006WAPf/Y, # 7LANOS OR OTHER COND/AONS 71VATMAYREQU/RE RE-EhALUA17ON OF NOT TO SCALE 101 TOWN HALL SQUARE - FALMOUTH, MA - 02540 508.495.1225 508.495.3229 fax 77/E DES/rwV TIE CLW7RA076W SMALL /MMEDIATEL Y COWTACr FALMOI/7H ENGINEERING, INC. PROJECT NUMBER: 05159 CAD FILE NAME: 05159SP DRAWN BY: L.M.,D.H.M. SHEET 2 OF 2