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0072 SKUNKNET ROAD - Health
72 Skiilnknet Road Centerville P A = 191 113 J a No. Fee HE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS applitatlon for I8 or8 -*pstem Construttion 3pErmit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System El Individual Components Location Address or Lot No.7A- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installers Nam�e Address,and Tel.No. (,Uj//l�n � Designer's Name,Address,and Tel.No.f�/ �j10 6247 Type of Building: Dwelling No.of Bedrooms y�"7 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building l/GP No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �5-S gpd Design flow provided r I& gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank "Cl Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �6 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. Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ......� T ......-r...- ...�....V,,.7.._.-..,,.....-'•*^fir ?.N ,w... ...-.... r.. No. Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: Yes PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLE, MASSACHUSETTS I� 2ppfication for �ispdMl *pstrm Construction Per -t Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.%_, S Owner's Name,Address,and Tel.No. Assessor's Map/Parcel —� Installer's Name,Address,and Tel.No.(,�r�/� / �/)��f-�--,Designne-r+'s Name,Address,and Tel./No.Z jr1Z?j,, �9 �I/ /�GIC 7/� �/!G f�iitiQ �c�fd i /3G7J(/G��' r vbGf/(CJ/uGkl*f, J J c4. :e5 �,.. Type of Building: Dwelling No.of Bedrooms -� Lot Size - sq.ft. Garbage Grinder( ) Other Type of Building /0,C S No.of Persons Showers( ) Cafeteria( ) Other.Fixtures Design Flow(min.required) S-5 d gpd Design flow provided/' X" r gpd Plan Date Number of sheets Rev ion Date Title /- Size of Septic.Tank,,4:2!� /GOcl Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when 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.. Awl ter/c '�-�- 0 Date /`� /Application Approved by /-� � Date Application Disapproved by Date for the following reasons , . Permit No. �'/�= 'r� Date Issued - ---- - - - -- - - ----- -- - -�-- --- - -- -- - =------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Se gage-Disposal system Constructed( ) Repaired((.—)Upgraded( ) Abandoned( )by at i tom_ as been constructed in armo7ated ce with the provisions of Title 5 and the-for-Disposal System Construction Permit N�/ Installer ��/l�y,;rt� � arr G— Designer #bedrooms Approved design flow gpd The issuance of this permit shall)not be construed as a guarantee that the syste\m will-function�esigned. ~--, Date / /�f Inspector\ ------=------ ------- No. D� f Fee--�r�— - ' / I T v HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-�BARNSTABLE,MASSACHUSETTS 30isposal bpstem Construction J)ermit Permission is hereby granted to Construct( ) Repair(1-< Upgrade( ) Abandon( ) System located at �� � Jr %► i'� r�� o �J/,✓�''/�j�� 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. ' Provided:Cons Zomus a completed within three years of the date of this permit. Date // � Approved by DEC/12/2012AEIi 09: 57 Alf SandwichTownOff ices„ FAX No. 1 5C8 833 OC18 P. 001/001 Town of Barnstable Regulatory Services Thomas F.Geiler,Director ttnRMsr�,a�, � 9nAM Public Health Division Thomas'McKean,Director 200 Main Street,Hyannis,INLA 02601 Oiflce: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification orrri u Date: 4+1 U Sewage Permit# ssessor's maplParce [fit 0 Designer: �� b �� ✓1 Installer: Address: - V & � Address: On as issued a permit to install a te) (installer) septic system at .S 4h�1� 1 based on a design Brawn by (address) '{ dated , {designer) I certify Oat the septic system referenced above was installed substantially according to the design. which may include minor approved changes such as lateral relocat;ct7 of the distribution box and*or septic tank. 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 compcnent of the septic system) but in accordance with State k Local RegWations. Plan revision or certiCed as-built by designer to follow. t0 OF 9ss9 �� cy DAR N a, ME (Installer's Signature) , I �NITAR�I`� (Desigr-er's Sigr fuze) (Affix Designer's Stamp Here) PLEASE RETURN TO t3AR'Y DABLE CU13LIC HEALTH DIVISION. CERTIFICATE OF C VIFLIANCE WILL NOT BE ISSUED UNTIL ROTH THIS F'OR[I AND AS-BUILT CARD ARE RECEIV D BY THE BARN.T.�BL PUBLIC k1 .�LTH DIVISION. TSA��[IC YOE�. Q:HzalthlSepticlDesignar Certification FOM 3-26-04pdoc i i Town of Bdmstable P# Department of Regulatory services4-1 Public Health Division Bate_ `� ' j ably `b� 200 Main Street,Hy#nnis MA 02601 ArfD►M't�' � . Date Scheduled Time C1 Fee Pd. / i . i r5oi�' Suitability AssessM n 'for Sewage Disposal Performed By: - "I 1✓ Witnessed By: i LOCATION & GENERAL INTORMATION Location Address Owner's Name U " ' I Address DC �r P.G�� T Assessor's Map/P4rcel: 6 C( ` /I I Engineer's Name ��` �i•C���-1 e 13 i- NEW CONSIRU [10N -REPAIR Telephone# (�$ LDS/�i Z '2 2- Land Use � rSl 1J�i� I �i Slopes(90) U �-� Surface Stones /V0�E — >L F/Q Distances from: Open Water Body ft Possible Wet Area ft Drinking Water We117 y"'b ft • i Drainage Way >,U00 ft Property Line eft O01eC ft SKETCH:(Street name,dimcnsiods of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 0 g • j j j j i i i i i Parent material(geglogic) �(.-� v" J Depth to Bedrock ' }Depth to GroundwaterGroundwaterStanding Water in Hole:'�t- i Weeping from Pit FaCe - Estimated Seasonal i iigh Groundwater 1 l DtTERMINATION FOR SEASONAL ffiGIE WATER TALE Method Used: I . • - Depth Gbperved standing in obs.hole: in. Depth tdh Sa 1fl9ttl"; In. Depth toiweeping from side of obs.holes in. ©roundwnter Ad�uatment i I Adj.GmundwaterLevel.,,,e Index Well#_ Reading Date Index Well levdl __ AdJ.f 1�tOr. __�. j PERCOLATION TEST . Date —. TIMO Observation Timeat9". J .�. Hole# Time at b" Depth of Pere qZ -- Start Pre-soak Time-@ ��D Time(9"-6") End Pre-soak f Rate MinJInch Additional Testing Needed(YIN)' Site Suitability Assessment: Site Passed Site Failed: Original:,Public I;e'#Ith Division Observation Hole Data To B e Completed on Back---- I ***If percolat,ibn test is to be condracted within 1.00' of wetland,you must first notify the Barnstable Cdnservation Division at least one (1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel D"-4 A' a.Vv N It �i1 2,. 7� SRO FF 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) _:, �'� LAB Sa 1 ,, q 30 `iVl ) Sqh 2,'5 (- / DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseli) Mottling (Structure,Stones,Boulders. Consistenc %Gravel i I I i DEEP OBSERVATION HOLE LOG Hole# JA Depth from Soil Horizon Soil Texture Soil Color Soil 1 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten Gravel) F Flood Insurance Rate Map: 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? S If not,what is the depth of naturally occurring per ious 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 require aining,expertise and experience described in 3.10 CMR 15.017. Signature 1AADate /G I�/ QASEPTIC�PERCFORM.DOC ,. TOWN OF BARNSTABLE LOCATION SEWAGE# Q:�II qP_ —3�l VILLAGE ASSESSOR'S MAP&PARCEL_/ / INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) J& (size) � XF >. NO.OF BEDROOMS. OWNER PERMIT DATE: COMPLIANCE DATE: �f 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 - 3s g� - as ?; A2 - .� a.� , ��s r� �� l o v�� . fi TOWN OF BARNSTABLE LOCA i{'i0N `7c� �Ic�v�kv►f- 41 SEWAGE VILLAGE oleo q 1 ely `!e ASSESSOR'S MAP& LOT _._.. INSTAI.PR'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FA.CIfl.. T: ( ) � (size) � -�DOO NO.OF'BEDROOMS__:2__._. BUILDER OR OWNER. FERMIT®A' :--, COWL1ANCE DATE: .�.�..� _- Sepamdon Distance Between the: Maximum Adjusted Groundwater Table to the:Bottom:of Leaching Facility eei Private Water Supply Well and Leaching Pacility (If any webs exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet a eachinz facility) r I�cc Furnished by ��1� �aG a D � D a 014 03 4 -I -36 e .6-l- as' l9 -a ,Ps , d-3- '/s' c-y-se- TOWN OF BARNSTABLE LOCATION 3a S17f) (12C �c2������ SEWAGE # VILLAGE � ASSESSOR'S MAP&LOT nbhW &PHONE NO. l yµp,x t►.�f _ 5,�>q^ +�� SEPTIC TANK CAPACITY ( I®Mx`10 rl A LEACHING FACILrrY: (type) (size) (92�(off 110co NO.OF BEDROOMS 3 BUILDER OR OWNER T g.X !. A PERMTTDATE: l Kf k-- COMPLIANCE DATE: o tJL-- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility i 2> 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 hing facility) Feet Furnished by Umm&') { ' i, Pr C3 1 J rR3 C '/ �l 49 41 w r/ r Town of Barnstable Barnstable fTHE Regulatory Services Department as ;�t�acm 1I , g BARNSTABLE,+•I� �' m� �9Q MASS. i63q Public Health Division -oA �0 gb MAI 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7008 3230 0002 5178 2756 November 20, 2012 David Holt Today Real Estate 1533 Flamouth Road/Rte'28 Centerville, MA 02601 The septic system located at 72 Skunknet Road, Centerville, MA was last inspected on 10/29/2012 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. J The inspection of the septic system showed that the system "Fails".under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. i You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH �3asOKean, R.S. CHO Agent of the Board of Health r Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\72 Skunknet Rd,Cent Nov2012.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: I ., (771 Shawn Mcelroy Name of Inspector Upper Cape Septic Services t `- Company Name 29 Atwater Dr Company Address 01— E. Falmouth MA 02536 t,a City/Town State Zip Code;, 1-508-495-0905 S13971 �1 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Eva uation by the Local Approving Authority 10-29-12 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 P Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) _ Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection.if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 u Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health and Public Water Supplier, if an Y ( pp � Y) 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each-of the following for all inspections: Yes No . 0 ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than'Y2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well , If you have answered "yes"to any question in Section E the system is considered a significant threat,- or answered "yes" in Section D above the large system has failed.The owner or operator of any large, system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® -❑ Has the system received normal flows in the previous 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 backup? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts s Title 5 Official Inspection Form � w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10-2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•1 U10 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes; volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 821 Title 5 Official Inspection Form VX Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line'. feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) - If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: . 1000 gal Sludge depth: 12" .t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: . Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 2" 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.): D-box had water at 2" above outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Both leach pits were filled above inlet inverts at inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately R ,C3ac� 6 Li / -a 6 31 . A`3` y t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Centerville MA 02632 10-29-12 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Skunknet Rd Property Address Bank Owne (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-29-12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 THE Town Barnstable Tp £x`s�st.3t.:taa�t� Regulatory Services Thomas F. Geiler, Director n � � BA MASS. Public Health�Di Division 1 MASS, �A 9°�p, i639' Aim - Thomas McKean, Director FD MAC 2_007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 5, 2009 r Ms Vera L. Godoi 72 Skunknet Road Centerville, MA 02632 Dear Ms Godoi, The Health Division Office has.received reports of up to eight (8) vehicles at your property parked over night. On the mornings of November 3, 2009 and November 4, 2009 Health Inspector Timothy B. O'Connell, R.S. observed five (5) cars at this property at 7:30am. This is in violation of The Town of Barnstable Comprehensive Occupancy Ordinance, Chapter 59 (b). Your property is limited to three (3) bedrooms maximum based upon the septic system(permit# 85-1000). Under Chapter 59 (b) you are only allowed four(4) cars parked at this property,ovemight based on your bedroom count. This includes any vehicle not parked within a garage or structure. This chapter may be enforced under the provision of MGL Chapter 40, §21D. The fine for any violation under the provision of MGL Chapter40, §21D shall be one hundred dollars ($100.00). Each day of co ed violation may be deemed to be a separate violation. S' , Thomas A. McKean, R.S. Director of Public Health Citizen Web Request Page 1 of 3 fir§J �a r #', % r An �4 Logged It"As: C'Jti t0 5C:`:`5 tic":i" .. Reca E'sts L.€'t: toReoues':S Changes saved Request Information Request ID: 27429 Created: 11/3/2009 3:07:02 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: Yes Request Category: Chapter 170 : Housing Overcrowding - Night Only Routine work: No Estimate: No Date scheduled: Estimated 11/18/2009 Change Estimated Oct November 2009 Dec Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 25 26 27 28 2930 31 1 2 3 4 5, 6 7 8 9 10 11 12 13 14 15 16 17 IS 1920 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 Created By: O'Connell, Timothy Priority: Medium Health Office Citation Numbers: Requester Information Requester Request DETAILS: LOCATION: 72 SKUNKNET ROAD Centerville, Ma 02632 Request Parcel Number , To many cars over night!!! Map: 191 Block: 113 Lot: I Parcel_Looku p V r http://issgl2/intemalwrs/WRequest.aspx?ID=27429 -•a 11/3/2009 Citizen Web Request Page 2 of 3 Email: Edit Request-of.._Informatio_n ......._....._..............._.........._..................._.._...........__........._......................................__._.........._.._.............._................._.............................................................................._......_......_._.........._......._._._............._.... .........__............_._..._......_......................_.._........_.............................. Track Request Progress Request Work History: Internal Note History: Entered on 11/3/2009 3:09:35 PM System entry on 11/3/2009 3:07:02 PM: by O'Connell, Timothy Assigned to O'Connell,Timothy On 11-3-09 went to said property at 7:30am. Observed 3 cars in driveway and 2 in front Parking l area. This drive way looks to big. Will have to investigate further. update delete Enter work progress: Enter internal note: (!dewed y everybody) (Viewed internally only 1 E { �e 1 [ F e i[{ 1 V —nyn, ,spell Check Sell Check Add document or image link: Browse You can also type in a folder Marne to see everything in the folder Current Links: Time worked on request: - Response time: 3$ u Tirne entri.-s are in hours. Examples of entries: 1.2 , M, O.75, 1, 15, 0.125, 0.10 Response time. Measured `torn the creation date to your first actions on the request. ' Do not include nights, �vveekends, and holidays in response tirne for most depar-tr eats, F- Check to notify town employee below http://issgl2/intemalwrs/WRequest.aspx?ID=27429 11/3/2009 • Citizen Web Request Page 3 of 3 (; Save changes I-, to review this request. Save changes and notify Office =-Health ce O citizen* ICabot, Jaime Close request Brief message to reviewer: C Close request and notify citizen* *notify works it email address was given �. Update ' S ell'Check Public Use: Printer Friendlv_.Version Internal.._Use: Printer Friendly.Version http://issgl2/intemalwrs/WRequest.aspx?ID=27429 11/3/2009 Health Master Detail Page 1 of 1 Logged In As: T;.lc"UN Conmelt Health wah Master netail es"'ay, N,�Yfm.. Appkation Center PaP�cel LooKu p Selection Items Parcel S e,P U Peat: wen Frei "rank Parcel: 191-113 Location: 72 SKUNKNET ROAD, CENTERVILLE Owner: GODOI, VERA L. & Business name: Business phone _ Rental property: rDeed restricted: F. Number of bedrooms Contaminant released: rFuel storage tank permit: SaveParcel Changes 3 Return to Lookup . „f.. Parcel Infra Parcel ID: 1.91.-11.3 Developer lot:LOT 7 Location:72 SKUNKNE f ROAD Primary frontage: 100 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-0 MM Sewer acct: Road index: 1494 Asbuilt Septic Scan: 191113_1 Interactive map: y , Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: GODOI, VERA L & Co-Owner:ADAO, ALEANDRO CL Streetl:72 SKUNKNET RD Street2: City:CENTERVILLE State:MA Zip: 02632 Coui Deed date: 7/13/2005 Deed reference:20039/098 Land Info Acres: 0.38 Use: Single: Fam MDL-01 Zoning: RC Neighborhood: 01( Topography:l...evel Road: Paved Utilities:Public Water,Gas,Septic Location: Construction Info E ;.�lciig NoYear auiltl ffective Ar-ea ,;ns 'Bathroom, 1 1973 1768 3 Bedrooms2 Full Buildings value:$134,400.00 Extra features: $2,600,00 Land value: $157,500.00 http://issq l/intranet/healthMaster/HealthMasterDetall.aspx?ID=191113 11/3/2009 SENDER: COMPLErE rHis SEcriON COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse .0 Addressee so that we can return the card.#o you. B. Rec ed y( nted Name) P- C. Date of D ive ■ Attach this card to the back of the mailpiece, �� or on the front if space permits. D. 1 delivery address different from item 1? Lyed 1. Article Addressed to If YES,enter delivery address below: ❑No 72 Skurikrlet Road CenIt rville,.MA 02632 a. Service Type PLreertified Mail ❑Express Mail ❑Registered PWum Receipt for Merchandise ❑Insured Mail ❑C.O.D. t 4. Restricted Delivery?(Extra Fee) O.Yes 2. Article Number �f 11 li608 J�32�30 0002" 517T'18728 f (frahsfer from service label) 1' PS Form 3811,February 2004 Domestic Return Receipt 10259¢-02-M-15 UNITED STATE106M'SWOE ass I • Sender: Please print your name, address, and ZIP+4 in this box • I I I Town of Barnstable ;-lealth Division 200 Main Stxeet Hyannis,MA 02601 I I I I I I Postal N m CERTIFIED MAIL. RECEIPT I`- r. Only; . Insurance Coverage Provid•. m deliveryFor mation visit our website at www.usps.corn�,co USE- d isuxa �• Postage $ 0 Certified Fee l ReturnReciept Fee / ` Po (Endorsement Required) O ^� Restricted Delivery Fee ``�Q 1• {I rO (Endorsement Required) `� / 1 r=1 Total Postage&Fees m p Sent To s=------a_/.4fJ-._A.---1-- G��Q�------ r`�' Street Apt IVo.;or PO Box No. City,State,ZIP+4 Ce er ut I a Certified Mail Provides:■ A mailing receipt (asianay)ZooZeunr'ooseWJo{ dsd ■ A unique identifier for your mailpiece i ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mails or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mall addressed to APOs and FPOs. P�oFt„ET�� Town of Barnstable o� Department of Health, Safety, and Environmental Services * BARNSTABLE, 9 MASS. Public Health Division �A z6;q. �0 rED 39. a 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health March 28,2006 Ms. Vera L. Godoi 72 Skunknet Road Centerville, MA 02632 Dear Ms. Godoi, The Health Division Office has received reports of eight or more vehicles at your property located at 72 Skunknet Road, Centerville, MA., However, your property is limited to three (3) bedrooms maximum based upon the septic system capacity and Town's assessor's records. Please contact this Office by telephoning 508 862-4640 to arrange an inspection of the interior of the dwelling. Sincerely, Thomas A. McKean Director of Public Health w f - CF IME A Town of Barnstable "* BARNSTABLE, * RegulatoryV Services MASS. 1G39. Thomas F. Geiler, Director ArFD MA'S A � Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 20, 2005 Mrs. Vera Godoi 72 Skunknett Road Centerville, MA 02632 It has come to the attention of the Town of Barnstable Health Department that you are doing some improvements to the basement of your home. We want to remind you that your Septic System is restricted to three (3)bedrooms maximum. No person shall use the basement for sleeping purposes. If you intend to do any construction work in the future, you shall obtain a building permit first before any construction begins. BARNSTABLE HEALTH DEPARTMENT COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + d DEPARTMENT OF ENVIRONMENTAL-P1 OTECTION c veW FEB 0 8 2005 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 72 Skunknet Road -�p 191 Centerville,MA ARCEL. ,, 'i-----i-�-�r Owner's Name: Mr.Wendell Luke f Owner's Address: 72 Skuhknett Road , Centeville,MA 02632 Date of Inspection: 1/10/05 Name of Inspector: (please print) Mr.Carmen E.Shay Company Name: Shav Environmental Services,Inc. Mailing Address: 34 Thatchers Lane East Falmouth,MA 02536 Telephone Number: (508)-548-0796 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: XX Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 1/10/05 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 3' effective depth available at time of inspection in Leach pit#1. Evidence of liquid level being 6" higher in Leach Pit. ****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 1 �`+e Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1110105 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1/10/05 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1/10/05 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. XX Any portion of a cesspool or privy is within a Zone 1 of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX 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 forma No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure.. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1/10/05 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks? XX _ Has the system received normal flows in the previous two week period XX Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up? XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS, located on site'? XX _ 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? XX _ 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 XX _ Existing information.For example,a plan at the Board of Health. XX _ 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)] f Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1/10/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: l 10 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 96,000 gallons—2003/92,000 gallons in 2004 Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/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: None Available Was system pumped as part of the inspection(yes or 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 XX 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: 7/13/73—per BOH Records Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1/10/05 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction: cast iron XX 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: XX (locate on site plan) Depth below grade: Cover 12"Below Grade Material of construction: XX 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: 5' x 8' 1,000 gal.septic tank. Sludge depth: 4. 0' Distance from top of sludge to bottom of outlet tee or baffle: 2' Scum thickness: '/4 inch scum laver noted Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Structural cesspool was ok Inlet Baffle present at inlet end Outlet Baffle present and in good condition Liquid level equal with outlet invert. GREASE TRAP:_(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 recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): r �„ 7 r Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1110105 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Present (if present must be opened)(locate on site plan) 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.): No evidence of cracks or carryover. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): r Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 72 Skunknett Road Centerville,MA Owner: Mr.Wendell Luke Date of Inspection: 1/10/05 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions:_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): No evidence of hydraulic failure,ponding damp soil or stressed vegetation. Excavated cover and inspected pit—Yeffective depth available in pit*a No evidence of past hydraulic Failure noted. Liquid level has been 6" higher than at time of inspection. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): 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.): 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: 72 Skunknett Road Centerville,MA Owner: Mr. Wendell Luke Date of Inspection: 1/1.0/05 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. SKUNKNETT ROAD Water,Line Swine Ties: A- Tank in—36' B- Tank out—25' Garage Exist House A-D-Box 28' (3 Bedroom) B—D-Box—3 P IA B A- -Leach Pit 1-49' C D B—Leach Pit 1-41' C- -Leach Pit 2-58' O 1000 Gal D—Leach Pit 2-51.5' Tank D-Box Leach Pit#1 Leach Pit 2 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: 72 Skunknett Road Centerville,MA Owner: Mr. Wendell Luke Date of Inspection: 1/10/05 SITE EXAM Slope Surface water -'/z mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water Over 15' 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: XX 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) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Ouadran2le of USGS Map,MA GIS and performed GW adiustment calcs. Per Barnstable GIS: Elev.of Ground=34 Feet Elev.Of Groundwater=25.3 Feet Elev.Of Bottom of Leach Pit=27 Feet Therefore: 27—25.3 = 1.7 feet separation between Bottom of Leach Pit and Groundwater. Groundwater Adjustment using Index Well SDW 252: 5.3 feet Adjusted Groundwater Separation=20' +5.3'=25.3' feet Grade=Elev.34 feet Leach Pit D-Box Bottom of Leach Pit=Elev.27 feet Tank Adj. Groundwater=Elev.25.3 . s i Fx$. ....... THE COMMONWEALTH OF MASSACHUSETTS Y f 113 BOARD OF HEALTH ( V.V11.4�1'...............OF......�� 1+ :k�lr� TV�I v ................._....__.. Appliratiun for Ui_qpusal Workii Cnunitrur#'tun 11trutit Application is hereby made for a Perm l o C t (�-A or Repair ( ) an Individual Sewage Disposal Systems aty: / r X La d r or Lot No. t ------------• ----- • - �' �. �.r r!r..t.c-.-------.............................................. ..I C .. O ner Address a ----- .. ............................................. •--._._......_. .....�� ............................... Installer Address 5� y1 .....S fee Type of Building Size Lot.�__._.{__ __ . q. Dwelling—No. of Bedrooms..........3............................Expansion Attic ( ) Garbage Grinder '4 Other—Type of Building No of persons............................ Showers Cafeteria dOt er xtures .-- -' ------bVj ----------------------------- --------------------- ----�� Design Flow....._ _ !� gallons per persm per dp. Total d•il pow.............`,,1�.' 1< _.._.._.___- to SV ---------------- - - - WSeptic Tank—Liquid capacityLO.06.gallons Length--- Width.s-�. . ....__. Diameter________________ Depth. l . x Disposal Trench—No. .................... Width......(............. Total Length.............._._.. Total leaching area--_...-----.--.....sq. ft. Seepage Pit No....... ------------ Diameter......�)....... Depth below inlet............. Total leaching areaIDE.Isq. ft. Z Other Distribution box ( Dosing t t('_� '-' Percolation Test Results ..._ Performed by........ ....... -................ Date___.1D _.) _. �_.�. a Test Pit No. 1.....� minutes per inch Depth of Test Pit---1.1�....... Depth to ground ater....t o y. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Dep to,ground water...... ._ .............. O Description of Soil.. Q t�E� 't" ?.� _... .. 1�7 .� CbS-7 _....._ .: CC �.1.--.... w -- {f:: x ------------------------------------- � t:::: t :::: :-:------------..---------.----..---.--.------------:::::::------::: U Nature of Repairs or Alterations—Answer when applicable......:..................................................::.................................... .... .-•----------•----------------------------------•---•.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewa e Disposal System.in accordance with the rovisions of iITLi� of the toe Sanitary p 5 State S tary Cod T e underslgne urt r grees not to place the system In operation. til a C '-sate of Compliance has been ' s e b e ..... •... ...... .. ... --...---.---• � Da `` Application Approved By............................ ---_ .. ---•---------•��- --.. ate Application Disapproved for the following reasons________________________________________________.............................................................. -•-------------------------------------------------------•--•----------------------------------------••-•----------•---.._..------..--------•---------------------------------------------•-----....._._ Date PermitNo............. -------....�.-------...---------------- Issued....................................................... Date Finc..�' ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �V.. . .... ...............OF....... ._............. ........ Appliration for Uiipusal Workii Tomitrurtiun rami# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ....._-------LLT-1 !��kUt.�Wn LoyatTo d r or Lot No. ............ •- '+,^`� �..................•-•_.._... . _............... ...................•.. -.............. ............. ............. W Owner Address Installer Address Type of Building Size Lot..k_�'.QTJ.....Sq. feet Dwelling—No. of Bedrooms----------3............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building a YP g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .................................. W Design Flow.......1j-0------------•--•: ,1 g P P ay d4 y �i ` 5.�._........ gallons per e d Total it ow................ WSeptic Tank—Liquid capacitylbodgallons Length_...�t__. Width.___-�--._�__._ Diameter................ Depth_. . x Disposal Trench—No. .................... Width......1............. Total Length............. Total leaching area........ _ _ sq. ft. 3 Seepage Pit No........I............ Diameter......�,7-_-_--- Depth below inlet......4Q........ Total leaching area..L�I.S_.�_sq. ft. Z Other Distribution box (1)6 Dosing to (__I. Percolation Test Results Performed .......�:...-'f"n l�J ..-................. Date..... �' __�' '�..�. Test Pit No. I................minutes per inch Depth of Test Pit....15(a....... Depth to ground ater.._..�46i rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Dept ,to ground water...... _.............. a (r r� �4e d /� X�r ` t rt`' D Description of Soil - _s ._....1.C.t... L�X`►` ..C_ ! !t? :....... . -- !`� ......J�I'�y w -------------- -------- --- -: �':: . ( - :�: _ #:::�� .. Nature of Repairs or Alterations—Answer when applicable.............................•....._.................._...._.._............._..._..........._.. •----------••------------------•----••----------------------------------•--------.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provi ions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation` til a Ce cate of Compliance has been issued by the board of health. ----•------ ----------•-•------•--- '•--•--- Application Approved By.......... .......... ........ '�( <' I� ......... Application Disapproved for the following reasons:... --------•-------------•...--•-------------------•-•-------'-------------•--•-------.._......_............... ---------..•.......-•---......---•-------••--.....'--••-.......--•-......•----•••'•-•--•"'-•-••••-••.....------•-----•....•-•-•-•-•-•••-•---•••....--•••-------••---•-•-•••-----•---•---•••-•--•.--_.... Date Permit No............ == - -..4�.Q.' `� ... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF Trrtifirutr of Tuntpfittnrr THIS IS TO ,CERIFYi That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) 11 by--------------- ......-• .......'----•--'••-.......------•'--•-----'-----•"-'-.....--'--•--•'-------'•-- at Install¢cry .................... ---- --•--•- -----------------------•---...-- -•---.. ....------------- has been installAd in accordance with the provisions of TITLE 5 of The State Sanitary Code as c�Zcr�,bed in the application for Disposal Works Construction Permit No....���==�._..�.��� dated-----------Q._f-�� [ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT40N SATISFACTORY. DATE} � 71��� ? ....... .............................. Inspector--••-L----....-----------------•-••••--•-••---•----•--•----'-- ................... 5" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (Q� Cs.......................................... .OF....................................:................................................ No.... ., ... FEE........................ liopooal Workii Tnns#rntion rrrmit Permissionis hereby granted........................................................................................................................................ .._.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:No........•••••........................•----•-'-•'-'••---.__......•-•---.....:--•-••-••.....••-'•.••---••-------------•-•-----•--•--•-••'•••----•••-•.......------••-•-•......-•-................ Street j ff as shown on the application for Disposal Works Construction Permit NOR<'' _�.��'Dated...._. 1....t_.� r..ti...':`.......... t r � Board of Health DATE........... FORM 1255 A. M. SULK]PI;'�INC., BOSTON h'f1^� '? .�t f ss�� TOWN OF /B�ARNSTABLE ,^.ATION�c�C.11lY SEWAGE LAGS �&,�{��-.��-�& ASSESSOR'S MAP Cz LOT INSTALLER'S NAME & PHONE NO ���:(!�1Z, �2� ��a SEPTIC TANK CAPACITY �� LEACHING FACILITY:(type)d,—/IPL � (size) NO. OF BEDROOMS• R ALL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: "^ � _ �y VARIANCE GRANTED: ;" r ,51 \ v / Cp "J gq� . � ' No._-14- _ 36Z F�s... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tnnitrartion jhrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .. ....------ - .... --....(may .....-•-------------•-----•----------......_ ....•.........•.......................... .--cati Address or Lot No. •----- ----......•..... ---•------•-----•— ner r �d s a ... ----.... '✓ t... ..... Installer Address d Type of Building Size Lot.. �..12.�.f�._Sq. feet Dwelling�`No. of Bedrooms.............................................�v Expansio ,Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons f ------------ Showers ( ) — Cafeteria ( ) w Other fixtures -------------------------------- - . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/L?Pgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width_----___--_-____-_-- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------_------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (A,f Dosing tank ( ) Percolation 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 Depth of Test Pit.................... Depth to ground water........................ a - O Description of Soil., ... ....... - = x ----------- -------------------------------------------------------------------------------------------------- - ------ ------ U Natur f Repairs or er ons= wer when applicable__ _____4_7Z ____ _�..j______________.__..__.__....._..........•.............. ----------------- ---•------.-_------------•---------•----------------------•----•--•------------------------•-----•-----------------...........•--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue by board of health. Signed ... .......ls .------- . ...... -. ----------------------- am Application Approved By ................ $ I0. Application Disapproved for the following reasons- --------------------------............................................ ------------ ------------------------------------------------------------------------------ ---------------------------------------- Permit No- ............. =... .. Issued --- -----------------------------------------------late----- Date No.....9X: � Fps..... e'9 --' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE A,pVtiration for llhiposal Works Tonstrurtilorn thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• � � 1 ....�:�.....: � .::I�t •. � --------------------------------•-...........----.................--------------.........._--..-- L•cationflAddress or Lot No. ------------------------•------------- ............................................... ..................... 'A --------- / • "er dress \ Installer Add Type of Building Size Lot..._ . _4)-.a.?9.Sq. feet U g ._...Expansion Attic age Grinder( ) Garb ( ) Dwellin �1Vo. of Bedrooms ................................ — aOther—Type of Building ____________________________ No. of persons...._�t-t-----•-___-__-__-_-__ Showers ( ) Cafeteria ( ) Otherfixtures -------------------------------•---•--------------••---•--•••-•-••--------•--••-•••---------•-•--•--••-•......--•_.. W Design Flow.............................................gallons per person per day. Total daily flow............._.............................gallons. WSeptic Tank—Liquid capacity_.J.D.P.gallons Length_............. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( .Dosing tank ( ) aPercolation Test Results Performed bY.......................................................•.................. Date...............-........................ Test Pit�No. 1................minutes per inch Depth of Test Pit..........-......... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.........-.......... Depth to ground water........................ ^------------------------------ O Description of Soil a .'"^�'• -t. ' _.... _..�---------------------------------------------.------------------------------------------------•--•------------- x UW ......................------....---....._...._._......_....._._..........._.._.._......_..........._............ ... _........n_ ........................ r Nature_o f Repairs or Al era v� ns`A-saver when applicable.---- .. !yL% Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the y p p ee ,issued by the board of health. system in operation until a Certificate of Compliance b -Signed ..... �r.,c-G T� � .- O' .. , .s....................... ................................................. ..�..--�-Dare ---- A lication A roved B ,� PP PP Y -s-•--------•- '�:� �e ------------------------------------------ f{ .-.[>a,,? ', �\ t Application Disapproved for the following reuronr: --------------------------------------------------------------=``...... ........................................... --------------- ------------------------------------------- ----------------------------------------------------------------------------------------------- ........................................ Permit No. Issued .. - I?are...... .. Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Q-TWertifirate of Cnuntylian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) -- ------------------------------------------------------------------------- ---------------------------- /� Installer -•-�q. at ............ ------------------ 4 %/ --------?vc� I .... --------------------I------------------- �is� - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........, ...�--..---- dated -------------- -------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI,LL,F�C TION SATISFACTORY. /�I DA -V.. �.. r��.I.) Inspector t .:....:......�.=�� ------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No....Z.:. �/�. TOWN OF BARNSTABLE� � � FEE. ........... Elisposal Works Tonstrurti.vrt ran it Permission is hereby granted.........�'4• � .......r _��dr -----•---•-•................................................................ to Construct ( ) or Repair ( an Indiv*ual Sewage Disposal System at No..............`7... ...... ..,_�✓�.�--........ .. 44 �1 r-Q .................. Street as shown on the application for Disposal Works Construction Permit No.__, .... 1.,l;.7Dated.......................................... � •------••.......................•. ...................................................... ` Board of Health { DATE.................. .��I?.:..Q. ................................ v FORM 3850E HOBBS Q WARREN.INC..PUBLISHERS No....... .......... Fimx...` ,............�.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... OF.........C.� ... . .................. Appliratiun for DiiiVooal Works Tomitrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t a 7 '�.le .. ........./ --3------------- 2 4 Loc ion- ddress or Lot ir Address a i 2d ----------- nste Address // � Type of Buildi/n� Size Lot-,-la/-__________________Sq. feet U Dwelling{�—NO. of Bedrooms--------------- ------------------Expansion Attic ( ) Garbage Grinder ( ) pa-, Other—Type of Building -_:-_--•____________________ No. of persons.................. Showers ( ) — Cafeteria ( ) a' Other fixtures .. W Design 1`low.........................�„ 6:---.gallons per person per day. Total daily flow........... . -_.__gallons. WSeptic Tank Liquid capacity. gallons Length--------- Width_--_---___.___ Diameter________________ Depth_--_-_-__..__. x Disposal Trench—No..................... Width............. ._ _ Le th___ __. _ ._.. Total leaching area . ...sq. ft. 3 Seepage Pit No. Diameter_ __. e�yG 1 et - Total leaching area. dq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date------------------------------------.--- a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-.----_-_.--_-..-_.. t=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-__--_-____--______--.-. 0 ------- ------------ -- ----------------------------------------------------------------- ODescription of Soil-------------_- - -•-• . -- •. - ------------------------------------------------------------------ x U ----------------------------------------•-••---•-•••----•--••------•-•---------------•--•••-•--•----------•-------......------...------•-••---••----•-•-••-------------------------------------------- w ----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 by the board of health. r ( a (:YSigne_ '-"' 0 _._: _..�.��-4?-1--411a .(;1�._--_---- -:0. Date Application Approved By---••---•• !.!/1/L ----------••••-- G'Z 't .fir- .�� _ Application Disapproved for the following reasons-.............. ------------ -----......---------------------------------------------------------•--•- Date PermitNo......................................................... Issued-_--------------------- .............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH w Appliratinu for Uiipuaal 10orku Tuuitrurtion Prruti# Application is hereby made for a Permit to Construct. ( _) or Repair ( ) 'an Individual Sewage Disposal [r "-rs ... }{-._s ...d �` f ..._. 1 ..............7 __........... �}t_� �b��g, &�y.���1. fsyp����4...�..... .kx+d0 �+�y:+�.'LM � •+��±•._""�� �+--€ �-_-__• � ..... ocahon- duress or Lot, �r y jam+' '--•*^t�f'----:�,,,'..st`-t_ lr*r�#�--- --`�---+�'a`+,: •r y -------------•-•------------•-- ---+ls'�eC-t- '�"CA'-- '.`�':.F... Ef.,' _. .._...---------- ..-#. f - ,r t�0 ner " � "�tTddress '�'`� WM ............................... -- ! ""f In f A3dres5 Q Type of Building Size Loty_P��__.�'"��____'Sq. feet Dwelling No. of Bedrooms________________ __________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a � .Other fixtures - --------•---------•-•-------------------•---------•---••---.._-•-------------------------- --- --._...__.--•-------•--------.. W Design Flow........... __ gallons per person per day. Total daily flow______ r _..-'''_._gallons. WSeptic Tank 4 Liquid capacity/_4,4, gallons Length................ Width...........----- Diameter................ Depth_-_-___-_.__.-. x Disposal Trench—No.____________________ Width___ ;__ T al Ler_gth `"._ ' Total leaching area--------------------sq. ft. Seepage Pit No ..___:_.__.._____ Diameter -' Z��_._ 'oy' ke"t" `�__ _._ Total leaching area_ _ .;-sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-1 Percolation 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. Depth of Test Pit.................... Depth to ground water---_------------------ r.-4 -- D Description of Soil a - .- - U ---------------- .....................----- ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------•-------------------------------------------------------------------------------------•-------------------------------------..------------. V 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 by the board of health. Signe =-" ,a. '---t , ,a 1/'C i. d Application Approved By....." ,�' �' "r` - ate ,: - Application Disapproved for the following reasons:------•---•-=--------- ----------•---------------------•---------------••--------------•---- .............••------------------•---------------------------•------•---•---------•••-----------------------•------------------------------------------------------------------------------------------- Date PermitNo. ----------------------------------------- 4 Issued_------------------------ ............................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARDQF HEALT s r ..................OF.....�±'�,, t#�°'t°'lr' , y... . .. .. :.. (9rdif iratr of Toutpliuurr TH,,,I 0 CERTIFY, ThAt/the ndividual Sewage Disposal System constructed ( ) or Repaired ( ) by � e t ------. :In t°yll f �l ------ b .. ______. f at ij r s f j�� r -------- �: has been installed in accordance with the provisions of Article XI of The State Sanitary CIV, de as desc ibed in the application for Disposal Works Construction Permit No..................'f --------------- dated---- .,. __ �r THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE:----- ... - X.... ............................... -Inspector . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r v �� :: ......... ..OF........ tr.'. rE.. >[. ..No.. ...9 ........ .f ................. ............. EE-:a�+� s Ti-splallal War ii Tory Xon pruti Permission is hereby'gran "' " ___ --------- � ,_ ___. to Constru epair ( )ran IndivtduaL,Sewag- <D posalzS,ysteln ____ a ___. a Sy,. s i<h�Sr --- as shown.on the application for Disposal Works Construction Perim- No _f ated_:_,;, ;! T, ____ - '� AW.(H ' --------------------_ �+ Board of Iealth s" DATE -----_--_-------- FORM 1295 HOBBS & WARREN. INC.; PUBLISHERS r LEGEND CENTERVILLE PROPOSED CONTOUR 01-0 UPOLE — ®— PROPOSED SPOT GRADE EXISTING CONTOUR F PARCEL ID: + 96.52 EXISTING SPOT GRADE ��2 0 090 192/062 W— EXISTING WATER SERVICE TEST PIT 2�z E r ON! LOCUS N it 0 O ,' �' %.,, 161 8 AMES WAY 2 TBM: COR BLHD o PARCEL ID: h 191/113 ` / . /, AREA=16,344t S.F. „ 9 �\ LOCUS MAP ` LOCUS INFORMATION 3 #7 2 ¢8, m5p ports PLAN REF: 224/127 vent TITLE REF: 25540/297 3 TOF=60.14 �°�' 1 PARCEL ID: MAP 191 PAR. 113 I— ! N ' O S ZONING: "RC" V hN s PARCEL ID: FLOOD ZONE: "C" i 40 191/120 COMMUNITY PANEL: 250001-0015-C DATED:08/19/85 ` -,--- ---_,�_ GASATfR ' ;;,,;; . ;' �` _ SEPTIC SYSTEM , i i _ REPAIR PLAN EXIST. 1,000G 2 n - SEPTIC TANK LOCATED AT: 7`---- H (RE-USE) TWIN --+- ASP 72 SKUNKNET ROAD t � , AST pR/v __ ,. „ p _ EXIST. LEACH PITS CEN TER VI LLE, MA. GARAcf ;� (NOTE 10) `\ PREPARED FOR FEDERAL NATIONAL W MORTGAGE ASSOCIATION DECEMBER 07, 2012 PARCEL ID: 37 40„Eclq/ / _--- HOLLY PARCEL ID: ���P��N OF 191/112 SHfD �� 191/119 0� . 1140 GENERAL NOTES: �65 27 c�sl�p 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. �NITAR�p� BOARD OF HEALTH AND THE DESIGN ENGINEER. 8, ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED ( 1 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED BELOW: LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION —310CMR15.405(1)(b): 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. 1) A 0.94 FT. VARIANCE FROM 310CMR 15.221(7) TO ALLOW 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION MEYER 8C SONS, INC. LEACHING TO BE 3.94 FT. BELOW GRADE VS. REQ'D 3 FT. (H20/VENT PROVIDED) 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE 13ACKFILLED PRIOR 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING P.O. BOX 9 81 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) PARCEL ID: DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW 191/118 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN FOR THE USE OF A GARBAGE GRINDER EAST SANDWICH, M A. 02537 ti ENGINEER BEFORE CONSTRUCTION CONTINUES. 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 17. EXISTING DECK SONO—TUBE TO BE RELOCATED IF IT LANDS (5 0 8)3 6 2—2 9 2 2 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF ON TOP OF EXISTING TANK. THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SCALE: 1 "=20' SHEET 1 OF 2 J 1494 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:55.46 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. 14* T.O.F. EL.=60.14 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER INSTALLED OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. LENGTH F.G. EL.=59.50t F.G. EL.=59.50t F.G. EL:59.30t F.G. EL: 59.40(MAX.) OF �gsSq f 9.45' o D R N �yo 9" MIN COVER/ VENT L = 151t ` 36 MAX COVER ' L = 35' L = 15'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) 12 37" 1 1140 0 S=1% (MIN.) EL-57.76 0 S=1% (MIN.) 0 S=1% (MIN.) 4"SCH40 el PVC 4"SCH40 PVC 4"SCH40 PVCC/STC� t0" 14• 6 10.75" TO MNITA0 \INV.= 56.60 'M'UW/D INV.=56.35 INVERT COUPLER DETAIL 2 ) LEVEL PROPOSED INV.= 55.00 1 GAS BAFFLE D-BOX 4 ROWS OF 4 UNITS ® 5'/UNIT + 3 COUPLERS ® 1.16'/UNIT = 23.48'/ROW INV.=56.0 D�2 of 55.80 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1.000 GALLON SEPTIC TANK EXISTING OUTLET RESTORE VEGETATIVE COVER BACKFILL WITH CLEAN PERC SAND 60. TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=55.46 _ GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.= 55.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 54.13 EXISTING SUITABLE 310 CMR 15.221(2) 2.88' MATERIAL 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 5' MIN. ABOVE BOTTOM OF WITH 1500 GALLON SEPTIC TANK IF FAILED, T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.88' = 11.52 DAMAGED, NOT H2O LOADING, OR UNDERSIZED. (6.43' PROVIDED) USE 4 ROWS OF 4-ADS ARC 36HC 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL.=47.70 -_ (1-120) UNITS - NO STONE W/ 1 COUPLERS GAS BAFFLE AS REQUIRED IN EACH ROW SEPTIC SYSTEM PROFILE TYPICAL SECTION 1s" N.T.S. wT.s SOIL LOG P#: 13808 DESIGN CRITERIA DATE: DECEMBER 7, 2012 SECTION f0.75" NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 INVERT HEERT END CAP WITNESS: DONALD DESMARAIS, BARNSTABLE HEALTH SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. 9. TP- Depth 9.2 TP-2 Depth 0. ADS - ARC 36HC CHAMBER (H20 LOAD) GARBAGE GRINDER: NO NOT DESIGNED FOR GARBAGE GRINDER) 540 011 . 5 .20 0" ( A LOAMY SAND A LOAMY SAND MODEL ARC 36HC SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK 59.07 B 1OYR 3 2 4" 58.70 B 1OYR 3 2 6" LENGTH 63" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT LOAMY SAND LOAMY SAND EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 10YR 6/8 tOYR g/g " DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. SIDE WALL HEIGHT 10.75 57.15 C LOAMY 27" 56.70 C 30"LOAMY OVERALL HEIGHT 16" DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) (1-120) SAND SAND OVERALL WIDTH 34.5" 4640 TRUEMAN BLVD PRIMARY S.A.S. 2.5Y 6/4 2.5Y 6/4 10.7 CF s HILLIARD, OHIO 4JO26 USE 4 ROWS OF 4 - ADS ARCHC 3616 H2O UNITS-NO STONE 55.07 52" 55.7o C2 42" CAPACITY ADVANCED DRAINAGE SYSTEMS, INC. AND EXTENDED 1.16' W/ 3 COUPLERS IN EACH ROW pert test MED-COARSE MED-COARSE (80.0 GAL) ® 54.40 �`"° BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) 2.5Y 7/4 2.5YY 7/4 PROPOSED SEPTIC SYSTEM/SITE PLAN (CHAMBERS: 4/ROW)16 UNITS x 5.0 LF x 4.80 SF/LF = 384.00 SF 47.90 138" 47.70 138" 72 SKUNKNET ROAD, CENTERVILLE, MA (COUPLER: 3/ROW) 9 UNITS x 1.16 LF x 4.80 SF/LF = 16.70 SF TOTAL AREA = 448.70 SF PERC RATE <2 MIN/IN. ("C2" HORIZON) Prepared for: Dedecko DESIGN FLOW PROVIDED: 0.74GPD/SF(448.70SF) = 332.03 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN MEYER&SONS,INC. AfecBorjaU Survey NTS D.M.M. • 1, Darren M. Meyer, R.S., CSE, hereby certify that 1 am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX98f (508) 419-1086 DATE: CHECKED to conduct soil evaluations and that the above analysis has been performed by me consistent with the SHEET N0. EAST SANDWICH,INA 02537 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 508-362Z922 12/07/12 D.M.M. 2 OF 2 SECTION --SEWAGE f; Z 1 SEPTIC TANK— tJ' 1 _*'Do'BOX - 1j -LEACH /T TOP OF FON (MSU• IT"OF IlaTO A&" � WASHED STONE 7� \ IN. OUT IN• OUT- -loco G I N TANK ` 'fj✓r - i I f ' ELEV: ELEV. ELEV ELEV. ELEV. OF'4"-I%" � A ' �YVASHED STONE LoT 6 - _., - r ' Zvi 5 .. — TEST HOLE LOG ' � 3 — _ a :>✓v, <F, r fl . . . 1 — _ . TEST BY WITNESS TEST DATE BEDROOM HOUSE DESIGN 3 I T.H.:* 2 ELEV.�7,J O ELEV. NO 11 5L{ G 2 DISPOSER DISPOSER 3p GOp PERC RATE MIN/IN.' 4 rj4 ,60. FLOW RATE 33O(GAL.�DAY) L OT f+9 —� O+ A I ;i G� SEPTIC TANK GO REO'DSEPTIC TANK SIZE:,. �Os�O : : i ; LEACH'FAC[tITY Q. SIDE WAt G/D. «. {�g G��j,10 BOTTOM3. .G/D. 0 2.7, 3a�A / u' I � .. USE: OIL LEACHING ��'7" �� ' WATER ENCOUNTERED. NOTES: (UNLESS OTHERWISE,NOTED) I — O SIDE I 1.DATUM(MSU TAKEN FROM �An-L�,/G QUADRANGLE MAP 2.MUNICIPAL WATER AVAILABLE 3.PIPE PITCH:1k-PER FOOT_ ft� { 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO:- �k� -44 _ Nod0MkFr 4 - y 5.MIN.GROUND COVER-OVER ALL SEWAGE FACILITIES,:-(I)FT. - - - 3 _. 6.PIPE JOINTS SHALL BE MADE WATERTIGHTAFM - 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH-COMM.OF MASS. — n STATE ENVIRONMENTAL CODE TITLE S ---- --` a _ — —-- —-— - SITE PLAN LOCUS: L U T'- ~J 5 KU N IC N E•T I�pAp - ►-�OT ` _ Of CENTERV)LLE, •iIASS _REG.P NEER} REF: 'boo K AL./O PA down Al eneerin� TF w A -' PREPARED FOR: L_. S6,LL'O�s _ CIVIL ENGINEERS r , - - LAND SURVEYORS BOARD OF HEALTH CONTOURS ----- b + �l lAM9 SCALE (EXISTING)--...... (PROPOSED)-O-O-O-O- - APPROVED GATE ._. -H'"�`�MA 1, �• - pATE `r S �/ �fi ,