HomeMy WebLinkAbout0122 SKUNKNET ROAD - Health (2) 122 SKUNKET ROAD
CENTERVILLE
A= 191 - 108
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No. go �y I �� Fee I
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Z[pplitation for Mispo8al *pstrm Construction 3pPrmit
Application for a Permit to Construct(lYRepair(grade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.122 f/C(.>' /r/f� r O er's Name,A�lress, d Tel.No.
Assessor's Ma /Parcel 11obCrl' F�D�FI/'S
p /- o C //r-
Installer's N Add ess,and Tel.No.S($—`/2e—9'738' Designer's ame Add ess,and Tel.No.
,/osepb 1, �Orras ��s. U�✓, / C.
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided �j 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 whe applicable)
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. _ n y
Signed Date 5
r -7 d�
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. g U Date Issued
No. Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V'
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for -Disposal *pBtrm Construction Permit
Application for a Permit to Construct(_/,)-- 'Repair(4)-Upgrade( ) Abandon( ) ❑Complete System ❑Individual'Components
Location Address or Lot No.12.:2 (,�/t�/�/�//;J Oer's Name,Address,and Tel.No.
Assessor's Map/Parcel r ' -bl�rr
Installer's Name,Address,and Tel.No.s,98- -�f i 38 Designer's Name,Address,and Tel.No.SaC�-S`
1110o-rj"Ok b-e!_.�k'!rU S /, S
Sir sr, 7 7'/2 lflW
Type of Building: ,
Dwelling No.of Bedrooms :3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ll
Design Flow(min.required) 723 U 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 orAlterations(Answer when applicable) _ !'1'rall/
- !� `� /.J f!�e�r �.�r"/,� ��/✓/1�.d1 6�J�`"/'�'S'� L,+✓/'//!rl -7 � j'� !�r/i'r%�l'c^� �
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance,of the afore described on-site sewage disposal system in
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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. _
Signed Date " r
Application Approved by .� Date
Application Disapproved by V ' Date
for the following reasons r'
Permit No. �2 C Date Issued r
-- - - - _ - ----------------------
----------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO//CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�) .- Upgraded(
Abandoned( )by, li7
at !r7 �7 ��,i��rrl�ir--.�-,� �r-rv��rlr/ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer, 6 i�/ri /� ��jl�y'��S' Designer `>" S i�l�'(,/,U I/ 1,fl r
#bedrooms _ Approved.design flo gpd
The issuance of this ermif shall of be construed as a guarantee that the syss will func ion,gned. -,...... ,
Date �Q/, � Inspecto�
No.!;�•t! �d _ t7 t Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair Upgrade( )w-- Abandon( )
System located at / Z ZZ A 4/,/:7--T
K ,., and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
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Provided:Construction must be completed within three years of the date of this permit.
Date 2-0 Approved by `'
a
Town of Barnstable
Inspectional Services
a Public Health Division
NAM
�Aa,� Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer& Designer Certification Form y
Date: 4�- �'2d 'Sewage Permit#,XZU -/5-1 Assessor's Map\Parcel I'DB
Designer: Installer:
Address: Address: -F/
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On s- 2'J- 2vzd q0-6 dP6 'ztzrx was issued a permit to install a
(date) (installer)
septic system at /22 444_4q * 0*Zd4VI4'i based on a design drawn by
(address)
dated , --y
(designer
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
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. Strip out(if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed ' e aance with the to rms of
the I\A approval letters (if applicable)
DAVID {
D.
"HERTY,JR.
IS74dr's 7Sinat e) R'n. 1211
aoy
1ITAM
(Desl e s Si ature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
WoaWeptAHEALTMSEWER connecASEPTICOesiper Cerlification Form Rev 8814-13.DOC
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�tKE T�
Town of Barnstable
Inspectional Services Department
a,, MAW Public Health Division
59. 200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4988 1531
May 14, 2020
ROGERS, ROBERT C & LUCINDA M
122 SKUNKET ROAD
CENTERVILLE, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 122 Skunknet Road, Centerville was inspected on
04/30/2020 by Chad Hathaway, certified Title V Septic Inspector for the State of
Massachusetts.
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The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Leaching facility with standing liquid level at or above the invert pipe (per
' Town Code 360-20 h).
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
Th_.....,., . .- S., CHO
Agent of the oard of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\122 Skunket Road Centerville.doc
Town of Barnstable
+ IIARNSfAHLE,
039. Inspectional Services Department
AT fD µpal
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An "x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY-DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
Vea
driveway due to H-10 components, etc)
ching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
191-1os
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
122 Skunknet Rd i
Property Address t
Rogers
Owner Owner's Name
information is ill t enerve Ma 4/30/2020
required for every C r
page. Cityrrown i State Zip Code Date of Inspection
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Inspection results must be`submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
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Important:When filling out forms A. Inspector Information /yy9(p
on the computer,
use only the tab Chad hathaway r
key to move your Name of Inspector
cursor-do not Hathaway Septic Inspections
use the return key. Company Name i
151
Company
Address
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r� Company Address
Forestdale Ma 02644
City/Town i State Zip Code
rend 774 274 2581 ! 12866
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of ther time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
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2. ❑ Conditionally Passes;
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3. ❑ Needs Further Evaluation by the Local Approving Authority
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4. ® Fails
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4/30/2020
Inspector's Knature Date
The system inspectors �al )bmyit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable,and the approving authority.
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Please note: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.
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
122 Skunknet Rd
Property Address i
Rogers
Owner Owner's Name
information is required for every Centerville Ma 4/30/2020
page. City/Town 4 State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: CI plete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
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2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.lThe system, upon completion.of the replacement or repair, as approved by
the Board of Health,will pass..
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Check the box for"yes", "no"or"not determined (Y, N, Np)for the following statements. If"not
determined," please explain:
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The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantialinfiltration 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.
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0. Y ❑ N ❑ ND (Explain below):
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
122 Skunknet Rd 9
Property Address
Rogers
Owner Owners Name
information is required for every Centerville Ma 4/30/2020
page. CityrTown l State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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❑ Observation of sewage backup or breakout 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 pipes)are replaced ❑ Y ❑ N ❑ ND (Explain below):
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E
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
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❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND(Explain below):
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❑ 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):
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❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
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3) Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
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a. 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:
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15insp.doc•rev.7/26/2018 - Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
122 Skunknet Rd
Property Address i
,
Rogers I
Owner Owner's Name
information is required for every Centerville , Ma 4/30/2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
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❑ 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
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b. 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 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. 1
❑ 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:
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*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form. ;
c. Other:
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4) System Failure Criteria Applicable to All Systems:
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You must indicate"Yes or"No"to each of the following for all inspections:
Yes No i
® ❑ 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
dueto an overloaded or clogged SAS'or cesspool
t5insp.doc•rev.7r2612018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
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Commonwealth of Massachusetts
.� Title 5 Official Ins ection Form p
(� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
t
122 Skunknet Rd
Property Address
Rogers ,
Owner Owner's Name t
information is required for every Centerville ! Ma 4/30/2020
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria lApplicable to All Systems: (cont.)
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Yes No
❑ ® 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 Y/2 day flow
El ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s).,Number of times pumped:
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Any portion of the SAS, cesspool or privy is below high ground water elevation.
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❑ ® 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 water supply
well.
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❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
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® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if.the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates'absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be-attached to this form.]
❑ ® The system is a cesspool serving a facility with a'design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to.15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section C.4.
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
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❑ ❑ 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
t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 5 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
122 Skunknet Rd I
Property Address
Rogers i
Owner Owner's Name
information is Centerville Ma 4/30/2020
required for every
page. Y
Cit /Town State Zip Code Date of Inspection
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C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered yes to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
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6. You must indicate"yes' or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
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❑ ® Wer�any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
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❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
El ® Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
❑ Was the facility or dwelling inspected for signs of sewage backup?
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® ❑ Was*the site inspected for signs of break out?
z ❑ 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?
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® ❑ Wasthe 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:
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® ❑ 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
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approximation of distance is unacceptable) [310 CMR 15.302(5)]
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l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments
122 Skunknet Rd
Property Address
Rogers i
Owner Owner's Name i
information is Centerville Ma 4/30/2020
required for every
page. City/Town C State Zip Code Date of Inspection
D. System Information
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1. Residential Flow Conditions:
Number of bedrooms (design): no design Number of bedrooms(actual): 3
on file
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):.
Description:
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2
Number of current residents:
Does residence have a g rbage grinder? ❑ Yes ® No
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Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
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Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
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Seasonaluse? ❑ Yes ® No
Water meter readings, ifvailable(last 2 years-usage (gpd));
Detail:
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Sump pump? ❑ Yes ® No
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Last date of occupancy: current
L Date
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
i
122 Skunknet Rd
Property Address
Rogers
Owner Owner's Name
information is Centerville Ma 4/30/2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Informatib n (cont.)
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2. Commerciallindustrial Flow Conditions:
Type of Establishment: j
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Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seat/persons/sq.ft., etc.):
Grease trap present? + ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
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If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
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Last date of occupancy/use: Date
Other(describe below):
3
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3. Pumping Records:
Source of information: owner pumps yearly. was pumped 4/7/2020
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: ! gallons
How was quantity pumped determined?
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Reason for pumping:
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l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal I System.Form-Not for Voluntary Assessments
122 Skunknet Rd
Property Address i
l
Rogers 1
Owner Owner's Name
information is Centerville Ma 4/30/2020
required for every
page. Cityrrown i State Zip Code Date of Inspection
D. System Informati'n (cont.)
4. Type of System: #
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® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
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❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
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❑ Innovative/Alternative technology. Attach a copy of the current.operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
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❑ Other(de'scribe):
Approximate age of-all components, date installed (if known)and source of information:
1974 :
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Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 2.5'feet
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Material of construction: .
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❑ cast iron ®40 PVC ❑other(explain):
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24'+see asbuilt
Distance from private water supply well or suction line: feet
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Comments(on condition of joints, venting, evidence of leakage, etc.):
none
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t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
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Commonwealth of Massachusetts
i
ra Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
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122 Skunknet Rd t
Property Address
Rogers
Owner Owner's Name
information is required for every Centerville i Ma 4/30/2020
page. Cityrrown i State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on Iite plan):
Depth below grade: , 2
f feet
Material of construction:
t
i
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain)
i
i
{
i
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions.- 1000 gal H10
Sludge depth:. 1
Distance from top of sludge to bottom of outlet tee or baffle
29
Scum thickness 0
f
Distance from top of scum to.top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? tape and sludge judge
i
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
concrete baffles in place.no major visable decay present tank is at working level
t
i
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
122 Skunknet Rd
Property Address 1
Rogers
Owner Owner's Name t
information is required for every Centerville Ma 4/30/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on s i ite plan):
Depth below grade: i feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
s
f
Scum thickness i
Distance from top of scum
to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
t
Date of last pumping: i Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
I
t
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
t
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity:
gallons
I
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2018 1 itle 5 Official Inspection Foam Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
122 Skunknet Rd 1
Property Address
Rogers
Owner Owner's Name
information is required for every Centerville ! Ma 4/30/2020
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
i
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
t
Comments(condition of alarm and float switches, etc.):
1
i
i
*Attach copy of current pi mping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
t
Depth of liquid level above outlet invert
Comments(note if box islevel and distribution to outlets.'equal, any evidence of solids carryover, any
evidence of leakage into or out of box,.etc.):
No Dbox
s
}
I
f
1
F
k
l5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
t
122 Skunknet Rd i
Property Address
Rogers I
Owner Owner's Name
information is ;
Ma 4/30/2020
required for every Centerville
page. Cityfrown I State Zip Code Date of Inspection
D. System Information (cont.)
i
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
i
j
f
i{
* If pumps or alarms are riot in working order, system is.a conditional pass.
I .
11. Soil Absorption System I(SAS) (locate on site plan, excavation not required):
f
ti
If SAS not located, explain why:
i
(i
Type: I
3 1
® leaching pits number:
❑ leaching chambers number:
El leaching galleries number:
❑ leaching trenches number, length:
t '
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
f
❑ innovative/alternative system
e
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
v 122 Skunknet Rd
Property Address
Viers
Owner Owners Name
information is Ma 4/30/2020 Centerville
required for every E
page. City/Town [ State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
leach pit was located and dug up. Pit is full and black staining is over top of pit
I
E
{
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1
i
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
t
s
Depth—top of liquid to inlet invert
t
Depth of solids layer
Depth of scum layer
Dimensions of cesspool .
Materials of construction
Indication of groundwater iinflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding,.condition of vegetation,
etc.):
t
P
t5insp.doc•rev.7/26t2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
r
E
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
.• 122 Skunknet Rd
Property Address
Rogers i
Owner Owner's Name
information is required for every Centerville Ma 4/3 012 02 0
page. Cityfrown ( State Zip Code Date of Inspection
D. System Information (cont.)
A
I
13. Privy(locate on site plan):
Materials of construction
i
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
i
i
i
i
i.
1
tf)
3 '
6
t5insp.doc-rev.7I26r2018 Title 5.Official Inspection Form;Subsurface Sewage Disposal System•Page 15 of 16
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form .
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
122 Skunknet Rd
Property Address ,
Rogers i --
Owner Owners Name l
information is Centerville I Ma 4/30/2020
required for every
page. Cityrrown I State Zip Code Date of Inspection
D. System Information (cont.)
i
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one o4 the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
i
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L
s
I 1 1 W 0A 7ec�
i
t4(o
4
39
3
A-3, �
� z
3 I_ 25 1
92_
f
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
122 Skunknet Rd
Property Address
Rogers i
Owner Owner's Name i
information is required for every Centerville i Ma 4/30/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 20+'
I feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
i
If checked, date of design plan reviewed: Date
i
I
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
1:
❑ Checked with local Board of Health 7 explain:
❑ Checked with local,;excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how�you established h y the high ground water elevation:
perc test required for new SAS
1
l
I i
I
1
I
a
f
t
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
i
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
S
122 Skunknet Rd
Property Address I
Rogers
Owner Owner's Name
information is Centerville Ma 4/30/2020
required for every
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this.form inclusive of:
® A. Inspector Informaon: Complete all fields in this section.
® B. Certification: Signed & Dated and 1,2, 3, or 4 checked
® C. Inspection Summ l ry:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6 (Checklist) completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
f
For 15: Explanation of estimated depth to high groundwater included
I
{
t:
l
i
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
e
I
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I
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r
No....� f....... FicE...C,,�. <.. ..�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
.... OF. /,,
�!2
Appliratiaan for Bi-gaasal lVarkii Taaustrurtiaan famit
Application is hereby made for a Permit to Const uct (�r Repair ( ) an Individual Sewage Disposal
Spc_�,
. .... .Lo dd:ess. ...:..d.�S1.......... .... o -- ......
s..
Owxy� Address
........................... Installer �.. ...................<... ................:...........................Address.................... ....����........
Q Type of Buildi / Size Lot....,1.1a--...b,�.........Sq. feet
U Dwelling No. of Bedrooms................ .Expansion Attic Gar age Grinder
'4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria
L1,
Other fixtures --- -----------•-----------------
W Design Flow.......................: ... (.gallons per person per day. Total daily flow........... C-.�.-----_-_.___.:_,_.gallons.
WSeptic Tank—Liquid capacity -gallons Length................ Width................ Diameter................ Depth..............
x Disposal Trench—No..................... Wi " ......(..�..... . Total Length.........�.,.._.. Total leaching area._...__-,..._.... sq. ft.
Seepage Pit No._9 ...... Diameter . - --- .R Depth below inlet.... Total leaching area...�0.'�sq. ft.
Z Other Distribution box ( )t Dosing tank ( )
aPercolation Test Results Performed bY.......................................................................... Date........................................
Test Pit No. 1........�_.._..minutes per inch Depth of Test Pit.................... Depth to ground water-______________--_.-__-.
(� Test Pit No. 2................minutes per inch Dep of Test Pit.................... Depth to ground water--_________-___.___.___.
lY, ••---•--•
O Description of Soil..................
o
W
U Nature 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued e oard of hea
Sig . .. ...... ....... 1 <.. .......... ................................
ate
Application Approved BY w � y --------
Date
Application Disapproved for the following reasons---------------------------- ............................................................................
........................•-•-------------------------....--••••--•----•-------•-•------•--••••--•--------.._.....•-•-•--•••--.....••--•-•--...... .......................................................
-� Date
Permit No..••-•-•....................................••-•----•.... Issued.......l./ ram.. ............
Date
-----------____... ...........
No......-A... . .........:........
THE COMMONWEALTH OF MASSACHUSETTS
E30ARD OF HEALTH
H
. ..... . OF......... .: :. .
Applir Lion fvr 743hipoiial Workg Tons#rurtion 1hrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage' Disposal
Syst at ;
Locatio ddress �JI.�k
..... L.t. ., ..... *_. z or -- .....
Owner f Address
� ............................... ......... ........,....,......... .............. ........................................... ..._....................... ......
Installer Address
...
U Type of Build V�To
- Size Lot..... .. ."� .q. feet
Dwelling . of Bed ................... ....................Expansion Attic ( ) Garb e Grinder ( )
aOther—Type of Building ............................ No. 'of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures • -----•-------- ----•---------- ----•-----•-•••...._......••-------•-••---....--'--•--•-----•-•---- . ......................................
WDesign Flow......................... ...........gallons per person per day. Total daily flow..........,ty, .. .................gallons.
WSeptic "Tank—Liquid capacity_ ,0-gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Widf .................... Total Length---------- ........ Total leaching area....................sq. ft.
Seepage Pit No.. ........... Diameter. __ Depth below inlet,...... . Total leaching area._:. Ysq. ft.
Z Other Distribution box ( ) ` Dosing tank ( )
Percolation Test Results Performed by......................................................................... Date......................................
Test Pit No. 1........I-----minutes per inch Depth of 'Pest Pit.................... Depth to ground water-__-_-_---_-._---_--.
t-T, Test Pit No. 2................mirutes per inch Dept i of Test Pit..................... Depth to ground water........................
Q'' -•..... `` .;..............................................•-----.........--------•-••-•--••......•-----•...--•-
O Description of Soil----------
xx ----------------------------------------------
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 Article NI 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 oard of
Si
a
�a-tt
Application Approved B e�
Application Disapproved for the following reasons--------------------- -------?`.� -----------------------------------------------••------------------
..-•---•-•-•-••------------------------•-------•.....----••---------•----•--------•------------•••--------•-••-----------------•----•--••-----•------I...................................................
Date
PermitNo.......................................................... Issued.-----------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD JO HEALTH
3'`. +�a ...............OF....... �;
��
Tatifirate. of Tilutpliaurr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( r Repaired (' )
a 'r
t
' �. .,
t
at <
has been~installed in accordance with the provisions of Article NI of he State Sanitary Code as described In the
application for Disposal Works Construction Permit No____________________� >.. .... dated ._ /.W/. ,,a�7.. r-.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ........ ............................................. Inspector.....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No............ ... FEE.. .:... .........
Dtaponal Morkg Tvautrurtion rrmi#
Permissionis hereby.granted........-,--'-=•-..............................................................................................................................
to Const r Repair ( i Indivi al Sew e os Sy-(3P t�
...
�.at "treet
as shown on the application for Disposal Works Construction Pen n i To..'�! ..t D _. !t t.--.-..`�--• .•.-••-
a�rdw of 1l'altli I:fG' 7DATE. ----------------'---
FORM 1255 HOBBS & WARREN. INC.. PUSLISHERS 7 - -
TOWN OF BARNST/ABLE
LOCATION 1 Z 2 ���� ^/l�T- �ot9�1 SEWAGE#.V2O
VILLAGE�W;rl�r(1111/_' ASSESSOR'S MAP&PcARCEL,q/-/a$
INSTALLER'S NAME&PHONE
SEPTIC TANK CAPACITY ld62O //
LEACHING FACILITY.(type) - al4lm44l f'(size)' 2�X/
NO.OF BEDROOMS
OWNER 6&N y—r RDell:w5
PERMIT DATE: ,�- 2 9 �G 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 cility) Feet,
FURNISHED BY
za
IJA
r c
/3 031
A -3 133
i
20-0109
LOCUS DATA �� TMOF o
EDWARD
A v� 2tv �� N
CURRENT OWNER ROBERT ROGERS No.STONE0 2 J2�o
LUCINDA ROGERS / �,���
LOCUS P
Y 90
PLAN REFERENCE 224-127 Z AMES WA
� S6 / LOT 11
DEED REFERENCE 11393-296 / mil' TAROA AC
R 28
ZONING DISTRICT RC / AP / /
EXISTING 1,000 GALLON
FLOOD ZONE X / / L 0 T 12 TANK T s REMAIN LOCUS MAP
�� �� z NOT TO SCALE:
ASSESSORS MAP 191 / / > 16,808t S.F. / j50" E PUMP, CRUSH AND ABANDON
167.75, THE EXISTING LEACHING PIT IN
PARCEL 108 / ACCORDANCE WITH TITLE 5
OVERLAY DISTRICT NOT A ZONE II
LOT AREA 16,808f S.F.
/ C)
\ / PROPOSED
/ /3 r #122 38.1' "D" BOX .�
SITE & SEWAGE / (� / / EXISTING DECK\\ /
/ / s l / 3 BEDROOM
COMPONENT DWELLING _ o
REPAIR PLAN / = _ w / / PROPANE 0 PROPOSED S.A.S.
/ 5a
/ (2) 500 GALLON H-20
CHAMBERS. 13'x25'
#122 SKUNKNET 1?0AD l � % �l � _ _ 25.0' 0
N / EXISTING D.T.H. #2
CENTERVILLE, MASS � _ DRIVEWAY / o
312' D.T.H. #1DATE: MAY 21 2020 / /
GENE7/TOR
OWNER APPLICANT: UTILITY E / d
ROBERT ROGERS �� POLELp 1 / ° SHED I�
1
122 SKUNKNET ROAD HYDRANT / N 75 ' — �
— ,
CEN TER VI LLE, MA 02632 3'so" w
508— 771 — 0255 1 m
SHEET 1 OF 2
�s \
L 0 T 13 BENCHMARK �
PREPARED BY: TOP OF CONCRETE / I
BULKHEAD
ELEVATION 58.00 55
EAS SURVEY INC. m
P. O. BOX 1729 20 30 40
SANDWICH , MA 02563
CELL (508) 527-3600 GRAPHIC SCALE:
EAS.SURVEY@YAHOO.COM 1 INCH = 20 FEET
SYSTEM DESIGN
iN RAISE COVERS TO WITHIN 6" OF FINISH GRADE RAISE (1) COVER TO WITHIN 3" OF FINISH GRADE
= 58.00 FINISH GRADE DESIGN FLOW
TCF
3 BEDROOMS AT110 GPB/D 3 GPD
GRADE = 57.4 ELEV. 56.9 FINISH GRADE
ELEV. 56.8 ELEV. 56.7 REQUIRED SEPTIC TANK
GROUND ELEVATION 56.3
330 x-2 _ 660
GAL.
TOP ELEV 54.00
3' MAX. COVER EXISTING SEPTIC TANK = -y0-Q_GAL.
EXISTING 4" PVC 15'®S=0.016
• SCH 40 2 MIN-3 MAX 4" PVC SCH 40 7'®S= 0.01 00000
O 0 0 o O O O
a- INV.= EXISTING INV.= O O O O o SIZE OF LEACHING FACILITY REQUIRED
53.70 10"TEE 14"TEE INV•= p0 Opp Opp o 0 00 O 00 O p0 M DOUBLE
` INSTALL 53.50 6" Op Op o 0 OOpOp WASHED DESIGN PERC RATE -- --MIN./INCH
REPLACE LONG TERM APPL. RATE-0.74_GPD/S.F.
BAFFLES GAS BAFFLE 3 OUTLET TWO 5'-0"xB'-6"x3'-O" CHAMBERS STONE
WITH TEES 4'-1" LIQUID LEVEL H-20 DB3 SIZE OF LEACHING SYSTEM PROVIDED:
INLET AND INV.=53.24 INV.=53.00 o w
OUTLET INV.=53.07 S.A.S. (13.0' x 25.0') a L V 51.00 330 _ 0.74 SF/GPD = 446 S.F. MIN. REQ.
DATUM: o
Lo Lo
VERTICAL DATUM: EXISTING 1,000 GALLON o USING H-20 CONCRETE LEACHING CHAMBERS
MSL± / BARNSTABLE GIS SEPTIC TANK TO REMAIN ELEV. 45.9 WITH 4' OF STONE ALL AROUND
BENCH MARK USED: BOTTOM (13.0' x 25.0') = 325 S.F.
CORNER OF CONCRETE BULKHEAD
SIDE WALL (13' + 25') 2x2 = 152 S.F
ELEVATION 58.00 CONSTRUCTION NOTES: 477 S.F.
20-0109 O 00 p0 0 0 00000
p0 477 S.F.x 0.74 G/SF = 353 GPD
1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 0 00 p0 0 o p pp pp
ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 1000 00 0 0 000 00 353 GPD PROV > 330 GPD REQ.= 23 GPD RES.SITE 8c SEWAGE
WORK ON THE SITE.
2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE
COMPONENT WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT
IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 4 0 .0' 4.0 PT # 20-89
REPAIR PLAN 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING 13.0 -
MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND SIDE VIEW D.T.H. #1 ib D.T.H. #2 0
S.A.S. AREA IS PROHIBITED DATE: 5/19/2020 DATE: 5/19/2020
GROUND ELEV. 57.2 GROUND ELEV. 56.4
#122 SKUVKVET ROAD GENERAL NOTES: I CERTIFY THAT I AM CURRENTLY APPROVED BY THE NO GROUNDWATER ADJ. G.WATER. 45.9
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. DEPARTMENT OF ENVIRONMENTAL PROTECTION TO CONDUCT
N TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS SOIL EVALUATIONS AND THAT THE RESULTS OF MY SOIL A A
FOR SUBSURFACE DISPOSAL OF SEWERAGE. EVALUATION ARE ACCURATE AND IN ACCORDANCE WITH 310 LOAMY SAND LOAMY SAND
C E N TE R VI L L E, MASS 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE CMR 15.1 T OUG 10YR 4/3 10YR 4/3
ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING 10" 8"
DATE: MAY 21 , 2020 ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. 5o ,A �J __- B B
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE ED D A. STONE, CER IED SOIL EVALUATOR LOAMY SAND LOAMY SAND
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS 7.5YR 6/4 7.5YR 6/4
OTHERWISE SPECIFIED. I
OWNER/APPLICANT: 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION OFAtao EL. = 53.7 42, EL. = 53.4OF ALL UTI 36"
TO ANY
R 0 B E R T R OG E R S 5. ANY MASONLRYEUNIPTSOUSED TO BRING COVEERS N. TO GRADE � D I "9 DTH #1 ITESTATES HOLEDEEP COARSE 1SAND C-1
12 2 S K U N K N E T ROAD OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. 0 10% GRAVEL COARSE SAND
6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER A Y R. 1OYR 6/6 10% GRAVEL
CEN TER VI LLE M A 02632 FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. 1 INDICATES 10YR 6/6
7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF /sTE P-1 54" PERC TEST 54"
508-771 -0255 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE 60" 58"
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND SANITAR�PN NO MOTTLING C-2 C-2
SHEET 2 OF 2 LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. NO WEEPING MEDIUM SAND MEDIUM SAND
8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN 2.5Y 7/4 2.5Y 7/4
2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT 126" INDICATES ADJ. GROUNDWATER NO G.WATER 126" 126
NO G.WATER
PREPARED BY: ELEVATION OF THE OUTLET PIPE. NO OBS. GROUNDWATER
9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES EL. = 46.7 EL. = 45.9 "
10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS B.O.H.
E A S SURVEY
P. O.
B 0 X 1729 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND SOIL EVALUATOR
SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE DEPTH TO BOTTOM OF HOLE 10.5 ED. STONE
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL VARIANCES REQUESTED BACKHOE OPERATOR.
SANDWIC
H H M A 0 2 5 6 3 BE LEVEL
, 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION J. DEBARROS
TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW NONE SOIL TYPE: -1-
CELL (508) 527-3600 AND APPROVAL. PERC RATE: <2 MIN. PER INCH
EAS.SURVEY@YAHOO.COM 13. MAGNETIC TAPE ON ALL COMPONENTS. LOADING RATE: 0_74 GAL/SF/MIN