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Home My WebLink About0199 SKUNKNET ROAD - Health 9 skunKnet F.oacl Centerville P { 171 291 t ik � 3 Commonwealth of Massachusetts /44- a-9 ry Title 5 Official Inspection Form i- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name / information is Centerville ✓ MA 02632 04/01/2021 ' required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 51-r is so5 on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Q Company Address Teaticket Ma. 02536 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 04/09/2021 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �n c � 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary.: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: This 3 bedroom home has an H-10 1000 gallon septic tank with a D-Box feeding a 13'x 35' x 2' leaching trench with stone. At the time of the inspection no visible failure criteria was found. 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 FIND (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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c� Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I I ' Commonwealth of Massachusetts ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 I I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(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)] I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Citylrown State Zip Code Date of Inspection D. System Information 1. 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): 33plus GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (gPd))� Detail: In 2020- 168,000 gallons were used and in 2019- 108,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp cod •rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New leaching installed 3/12/2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 17"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments(on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is Centerville MA 02632 04/01/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 8 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: H-10 1000 gallon Sludge depth: 411 Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is Centerville MA 02632 04/01/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: One 13'x35'x2' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Yn 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately yg o ; y" r•y3 I of 1 4/l/2021, 11:19 AM t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 11 plus feetfeet 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: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 f Commonwealth of Massachusetts -. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 199 Skunknet Road Property Address Bryan and Monique Decoste Owner Owner's Name information is required for every Centerville MA 02632 04/01/2021 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No.� )0 �� `7 Fee V "' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpliCAtion for ]Disposal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No/ i�,F.�c�7� Owner's Address'and Tel No. Assessor's Map/Parcel �� ` �� y 9 J'-16- Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. oef' lier Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �'�`f No.of Persons Showers( ) Cafeteria( ) v Other Fixtures Design Flow(min.required) 3 gpd Design flow provided gpd Plan Date 7:!� �� a Number of sheets Revision Date Title Size of Septic Tank -��` T�+'�Y �-PoI'ype of S.A.S. ; a_a you Description of Soil Nature of Repairs or Alterations(Answer when applicable) �GrC O�C.41`�✓' 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 It . Date Application Approved by Date / c Application Disapproved by Date for the following reasons Permit No. �.yI a �,N Date Issued e v Z .;.,,..... ,"'fE„�`;,•r h..._ -- �.--•"-rye:; ;�,..+.. _ _ _ _ _ No. � l) _ � `� Fee 11d ". THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS' Yes 2PPlication for Nsposal 6pstent Construction 3permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System .;Individual Components Location Address or Lot No19� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ��/ `�/ 9 9 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 7 7 f` b Type of Building: .r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ccd"J'- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 3 �o Number of sheets Revision Date Title Size of Septic Tank F-X ✓'T�� /o o Type of S.A.S. Description of Soil o�� `�� '�.fid�J,BE6�X Nature of Repairs or Alterations(Answer when applicable) a, 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 Board9f.14ealth. S'gn Date'i Application Approved by ! Date Application Disapproved by �CTDate for the following reasons Permit No. ' — Q j�� Date Issued e /✓ — !{ Z v t -------------------------------------------------------------------------------------------- ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by ��y! .0 G�_aig!FO at �9 9 cl'•f'Giv�'�.��'rQ C has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 Id dated Installer Designer #bedrooms �' Approved design flow gpd l The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �> �� a J Inspector �✓ Yl�. �, No. 'u/D- Fee Ido THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS 39isposal .4pstem Construction permit Permission is hereby granted to Construct( ) Repairj�< Upgrade( ) Abandon( ) System located at eoe d C GG ie,.T 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:Construction must be completed within three years of the date of this permit t P Date 3 I, j/l 0 Approved by TOWN OF BARNSTABLE L0,iATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL ram/ 9i INSTALLERS NAME&PHONE NO. U/n? SEPTIC TANK CAPACITY LEACHING FACILITY. (type)7W E'--Gift (size) 3 X 3S x r NO.OF BEDROOMS -5� OWNER --ef? PERMIT DATE: J" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / Feet FURNISHED BY 07;',W r .,d f s-- y 3 TOWN OF BARNSTABLE LOCATION �94 . U/u,� 2��P� SEWAGE # VILLAGE ('n�R-r� - ASSESSOR'S MAP & LOT ��vs ec rle�x, /7/ NAME&PHONE NO.CW 172 lsr�d'201 is . SEPTIC TANK CAPACITY 10009 A11I0A,,, LEACHING FACILITY: (type) ,04 (size) Ka NO.OF BEDROOMS BUILDER OR OWNER Jim PbolyLi PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 25h S 2j ocLiia p T ir . 3y` as' , vtSlly'' �•,�' t n • �� G �� .,. Mar 12 10 03: 49p p. 1 Town ofBarnstlable- Regulatory Services /~p�i#�Fp•. + T1d4)was F.Cealer,Mrector UAkeNbTiA81.$,. " Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA.02601 Office; 508-862-4644 Fax: 509-790-0304 Installer &Designer Certificatioo iF'oraro Date: j9q�H 12�7DIC Desiguer--2AY15)-J!�' Nocaj InNtaller: Address: � � Address: r �� Oilwas i=ed apcur,it to instaJJi (da e) (installer). septic system Ott l�_&iscd on a design.draWrl ey (address) dated (desiem.er) - urtify that the SQI)Iic system re-tereavtd above was installed subskulti,lly-accordis�g.� . iae design, which may iarclude nunor,approved uhauges such as loaceal z'loc.7tiozz of the disttibution boss.and/or septic tank, — — I ees4zfyr;that the septic system zeferenced alcove was instalkd with`i*r cl�tanges (ire. greater€}maxi 101 lateral rclocatioaz Of the SAS ar,ally Hectic l 1600fdiOn of auY co nponc tt of the Septkpy-tem)but tst aeeord�a cc with State&Local Regti�I:ttioats. Pkin revision or certified as-bir it',y desioer to follow. Of !)AVID .c (Installer°s Signature) MASON m No.1066 { iex s Si nature -— er's Stamp Isere :('I,1+'.AS3, RE'l RN ': O J3A CS'I�A�6��? ��JI3�.lC; AL -DIV&SION- �.i�:I�� OFC: MPLIfA NCE .L.. NOTZE ISSUE D �[ '�, CDTH"�WS SPORM A D AS- SIJIL`Y` C.-AR AR E(-"rl�i) B YTHE.BAR N S`�'ABLE PWLIC READ ]Ii�V�S[fll�t. '11A.&Nike YO-U. Q: k:ea)th/ticpticJllcuik;uar C'•�riilicatiou Foot Town of Barnstable P# 2e� Department of Regulatory Services F Public Health Division Date S� 200 Main Street,Hyannis MA 02601 Date Scheduled� Time Fee Pd. /00 Soil Suitabili Assess ent for Sewage Dis osal I 9 � Performed.BY: Witnessed By: LOCATION& GENERAL INFORMATION Location Address/99 J'k v�„f/v �" G>r'�j Owner's Name G AddreSs/9,9 Assessor's Map/Parcel: —a 9J Engineer's Name NEW CONSTR ON REPAIR Telephone# �`� /,",7 Land Use 26� Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&.perc tests,locate wetlands in proximi to holes) nr / l Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Nee Estimated Seasonal High Groundwater DETERIVIINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ___in. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level,. PERCOLATION TEST we�, Thne.� Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate MinJlnch Site Suitability Assessment: Site Pass Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation testis to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) 1 (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate May: s Above 500 year flood boundary No_ Yes ._.✓___ W11hin 500 yrar boundary No Yes Within 100 year flood boundary NotY Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi u rial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the deptl of n urally occurring pervi us material? Certification t'� I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envirompental Protec' a d that the above analysis was perform by me consistent with . the required ,e peruse d x ri c described in 110 CMR 15.01 Signature Date cJ Q:\.SEPTICIPERCFORM.DOC I!� C0ALM0NTj&TF:AT:TF. GAF VA�C'S,.A,(1MTSVTTS Eci1Ti QPPtC AFnA-rpq DFPARTM NT OF ENVIRONMENTAL PROTECTYON PARCEL .CT -171LE 5 OFMCIAL IllSPEMI ON SI:FOPU I—NOT P VOLF U?:T AI:Y ASSUSIMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM P(3!M PART A CERTIFICA ION Property Address- i 99 Skunknet Road n, Centerville,Bass 02632 c s 11,Ty v ie a7iZ'3i 3 l�Stl'TiC. roes:J � owner!%Address: i39 Skunkn3t Road r-y Centerville,Mass.02632 Date of inspection: April 23,20U4 o imoth e.Cash Name of inwnertor:(pie Printl Company Name: C'.ash's Trucking Inc, :IA"I g Address: Po Box 7 .. ar moth{Pori, 1v11asa 1%1,2vi5 d TelephoneAumber: (508)362-322i CERTIFICATION STATEMENT T ....ti♦=.. T yy,�, ;�[.�nnn 17 ♦��{L. .i l s,.«...{♦ .i.Y' ntl �1+ F Vla rt.` iit..:,i 1 VLd tllj L 114v�.Y�'JVtlauy ia,S�'i:.Ct:,ti the SVwV 4ts}.rsal JyJLVLlI at utiiLS aLLlu L LV WWl below is true,accurate and complete as of iue 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 15.30 of Title 5(310 Cltillt 15.000). The system: xx Passes Coi do^na dly E':sses TidEdS I iiriiLci Evaluation by th2 I.�:ai nPPI-Oving Audiority _ Fails Inspector's Signature._ �—— Z Date. April 23,2004 The system inspector snail 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 owrwr shall submit the report to the appt 'at,regtonai otflc of the DEP.The migival sliould be sent to the system owiier and conies sent to the buyet,if afmlicable,and the a»nmving authority;. Notes raid Ccnannenis ""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 nwe, Titic 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFF10AL!NSPEC T iON Ft3 MIL—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 199 Skunknet Road Cen+wrsiiie,Mass M32 Owner: James,Dooley Date of inspection-.A pfii 23,2004 Inspection Summary: Check A,B,C,D or E t ALWAYS complete all of Salon D A, System Passes; 1 have not lviu'iai any infommfirm which iiitllu es wad any of the iadure Caiteiia aaiescibedi in 310 CAIR 153u"s or in 31 u CM-R i 5.304 exist.Any faiiwe criteria not evai late d are indicated Wow. Comments. l have found nothing to indicate that this system fails in any way. accordinrl to the repulatiobs set by lmal and state. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"scetion need to be replaced or rerraired.The system,upon corrtnletion of the replacement or repair,as approved by the Board oruealih,.will rraSN. Answer yes.no or nui deimnined(sY."N' D)in am itir lire ioliuwing siaientenis.ii"rnii ueierrniFlOd"please cxpiain. The sejstic tank is metal and over 20_years old*or the semic tank(whether metal or not)is structurally TTncnrmcl CX}ti}11tC$T ybsfAntial infilfm.ion ur cxfilfrR.tion or fairy fRifirm is immin rii, Rvsficm will nRSC in.TCCtiriri i�thc existing tank;w replaced;+pith a co:npl d.g;-ptic tanks as approved by the Board of 111=19L *A ameiai septic tat&-wtli suss ias a"tiGii it it is ski ctii'iaiiy swund,not leaking and ii a.C rtiucate of CoiiiV�c ace indicating that the tank is less titan 20 years old is avaiiabie. ND explain: (tt,servation of sewage baclnrti o7 break o„t oT high static water level in the disi*lt+iAon bnx due to broken obstrijetcd p.pc(s)or.3uc to s broken,settled or urcvcn distribution bvx.S,stcyi riit pays irspec io n�-(Wirth approval of Board of Health): _ Qroicen pi. )are replaced _ obstruction is removed distribution box is leveled or replaced ND pv4ai r: The sysiew requireu pwilplllg►woe'haft 4 6wes a year`flue to blinded of ulisUticked pin(s).Tile systeni will pasts inspection if(with approvai of the Board of Heaitf(y broken pipc(s)arc ri placed ohs- iction is removed ND explain: Title 5 Inspection Form 6/15/2000 ` i par.U.e 3 of 11 OFFICIAL iiiSPECTION FvR%v"t-NOT FORVOLUNTARY ASSESSiVIENTS SVBSIJR ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A f ERT011 CATI O (continued) Prnncrty Addrtys: 199 Skunknet RanaAem, owner: �� . .. Cat ,iie..kdsss rd2637 tiwne : j.—nes DooIV] Date of Inspection.motif 23,2004 C. Further Evaluation is Required by the Board elf lIcalth: Condition%exist Which rccprirc fierthcr c:valnatinn by the Rnard of Hcaith in nrtScr to ticterminc iffhc system is&ifi n-to protect pub fir.health,safety or.the enviiournera. 1. System will pass unless Board of Health determines in accordance with 310 CM—c 15303(i)(b)l that the system is not functioning in a manner which will protect public health,safety and the environment: n me nt: Cesspool or privy is within 50 feet of a surface water CLsspnoi or�nriw is broil_hin 50 fire!of a bonder%v ortalyd w0lo—ntj or a salt marsh 2. System will!fail unless the Board of Health f and Public Water Supplier;if any)determine%that the systcm is fnnetio : g in a maser that protects the g,_bl-r heafth,safety and cnv�-ommen+t- _ i ire systems has a septic:lank and suii alvanpEion system(S;�►S)anti die SAS is wiliiin i 00' tei a surface water supply or tributary to a surfkm water suppiv. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ ?he syste n has a septic tank and S A c any!the SAS is with-in 50 feet cf a privates water supply well. _ The system has a septic franc 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 cmified laboratory,for coliform bacteria and volatile organic mmpoim ides indficates!fist� hy vis » iio 3fti i1 an the prescnc;.cf'w.mcria ni�es..:WnQ.i'�tc n:::agcn:s egos!tc or:css ter.S ppm,p.o:idc.�.t�:t�,c other are triggcri�i t►ixg7y of t'ac a178ij ads must be attached iv this forni. 3. Other: Tit1c 5 Inspection Farm 6/15/2000 ' Page 4 of 11 OFFtCM_L iNSFFCTtt'i. N FORM—NOT FOR VOLUNTARY ASSESSMENTS S'LJBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Skunknet Road CentetrVille,mass 0226321 Owner.. .iiarnes Dooley Date of Inspection:April 23.2004 D. System Failure Criteria applicable to all s_y3tems: Ymi mtist.indicate"yes"or"no"to car..h of the following for all inspr..ctions- Yes No Xc Baekrp of sewage into facility or system component date to overloaded or clogged SAS or cvwTooi xx Discharge or ponding of eftlueht to the surface of the ground or surface waters date 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 ccs5;?ool xx �iyt:id dtti in c^. ^,aa:is:^.�,fuaa h"9.^lc .:•:�t ar a.a:la�lc.a,s: :is l;ss tt:an is:.ay:law RN aired lxiinprrl,,rLVIC tlydll Y twrBS in tue IdJi 7 1\�T due to clogged of obstruciixi plpe(s).Nwijbff of times pumped xx Any portion of the SAS,cess4x>o1 or privy is helrnv high ground water elevation. xx Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a sairfacc water supply. X k_-y portion+of a ceSspool Or pr:l,r i5 9!^.Tl]-a Tone l ofa pi lie I 15. )m Airy por6ori of a cesspool or privy is within 50 fCCi of a V..vaiC water sai fply wel,. xx Any porbon of a crospool or privy is ietis dia n 100 feei bui greater than Sae feet frtnra a privaie water siipply well with no acccptatslc water cptaiity analysis,tThis system passes if the well water anaatysis., performed at a DFP certified laboratory,for roliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate.nitrnffn is equal to err lFcg than 5 ppm;nrovitde[d that no other failure criteria are triggered.A cop,of the analysu,ar:st be attached to this fora,; AJ (YesiNo)The system fails.1 have determined thatt one or more of the above failure criteria exist�as described in 310 CMR 15.303,therefore the system fails_'Fhe system owner should contnctthe DOM of Health to determine what w411 be necessary to correct the failure. E. Large Systems: To u0 considered ai&i"Ke system iii8 5y3tcelii IIuu3t slave a;5iriiity i itu a fiiai u ijOis fIi av,".wS j rs'r io 15,00 €pd- You must indicate either.'yes„or"no"to each of the following: (The fallowing criteria apply to large systems in addition to the criteria above) ev n'e XX the system is within 400 iwt of a srirflacc drialdng watc.-Supply the system is within 200 feet of a tributary to a surface drinking water supply _ x�c the system is located in a nitrogen sensitive area(Interim Wellhead Prclection Area-IWPAA)or a mapped Zone 11 of a public water tiarpPiy well If you have ariswcrcd try;i"t;t any yuai�tiit iii nG�tiws i�u t}iC SyStCtiA i5 a{;iaSiu4r.d a isi�ititiyiiiii uir�at.�:a^iivr%7(i "yes"in iection D above the Barge system has failed.The owner or operator of any iargc Sysiem conr-idered a, significant threat gander Section E or tailed under Section D shall a pgonde the system in accordance with 3 trl CMR 15.304,The system owner should contact the appropriate regional office of the Department. A Title 5 inspection Form 6/15/2000 If Page 5 of 11 OFFtCtAL iNSPECTiON FORM—NOXt FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOIL PART B CHECKLIST PrWrty Address: 199 Skunknet Road ...entci ville,I'Aass 026"32 Owner:James Dooley Date of inspection: April 23,2004 Cheek if the followiro have been done.You must indicate es"or"Po"as to each of the L-Il wing Yes No xix _ Pumping information was provided by the owner,occupant,or Board o€Health U Were any of the system components p,—,mpcd out in the previous hvo ccLs? xx Has the system received normal flows in the previous two week period? xx Have large volumes of water been intarduc:ed to the b system recently or as,part of this inspection? xx Were as built rl2RS of the.cvetpm o'btAinPd and pxanrjQad`j(if they were not gygiloirjP note as AtIk) XX .. r a:—. n r__ r ,. ._ yr as he iBf;Lrry yr dwerrrrrp;:ns—pe ted nn signs va sewage vain ufi? xx _ Was the site inspected for signs of break out? xx Were all system components,excluding the SAS;located on site? XX r « r. w i a a r ,, r > tank a a. _ Y►rr4 the s.ptic twan mawuww=covw�y opened,land the interior va the tank inspected for th1 c con-.loon of lI1G Ui1 1lGS of tees,iiieieilai of i'oli3t!!iCt1Uiy uiiuGitsic�lis.dcjiili of uyiiiu,drilled of siuuge and ue3tu of swift. xx _ Was the facile owner and occupants if different.front owner_ facility ( p )provided evith information an the proper maiuteiis-nee of subsurface scmage disposal systeiiis? The size and iocation of the Soil Absorption System(SAS)on iiie site has been determined based can: Yes no xx _ Existing information.For example,a plan at the Board of liealth. xx _ Deetarnu e d in the fi el (i e f f--ry of th . w 1e Cr., t ,teria relae to:'Wh C is a s t issue ppro;;.Ar on of dis is unacceptable)[3I3 CDA:I5.302(3)(b)j Title 5 Inspection Form 6/15/2000 Page 6 of 11 "a" OFFICIAL MSPECTION FfiRK—NU FOR VOi U NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ID ART L SY SUEM INFORMA7!10N $raper Address: 199 Skunknel Road Cariz—villa.amass 02G32 Owner.,lames Dooley Date of InWetion: April 23,2004 FLOW CONDITIONS RESIDENTIAL Number of bectrooms(desi,): 3 Nrwarber�of bedrot=4(a tuai): 3 NT flow o Y�b=-A on✓1.0 CINI i 15.203(for exar-p.1c: 1 1 V gpd x#of bedroom,). 330 1 •r A T3wiiirer of i;uiteiit i'esiucliu:a Floes residence have a garbage grinder(yes or no): N Is laundry on a separate selvage system(yes or no): &I rf yes separate inspection required] Laundry system inspected(yes orno):�V fieasonal iise-(ves or no)- Water meter rcadirgs,if a r—ai?abic(last 2 ymm usa-(gpol): 2002-1170 X} 2003-740"j, Surr.rp pump(yc;,s or-.,o)j:YiL Last date of occupancy: 4123104 COlVEWERCIAL/INiDUSTRUL Tyne of establishment: e."sign tiow cha�syed on 310'CMR 15 201): pd aH.'.&i of desir L:o. (Pa u^tS�ilerwi.Slu^y{a#.�tt.j: Grease trap present(Yes or no). industriai waste voiding tanic present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ :Water meter readings,if available: Lasts date of occupancvfuse: OTHER GENERAL INFORMATION Pumping Records Source of information: Rome Owner Was system Planned as part of the im-pection(yes or no): if yes volume porn,Pri: gallons--How was qu—n-ivy pumped Bete mi—m-ed? rRewson for pumping: 'T?YPIv Utc',�YS`I`EM xx Septic tank,distribution box,soil absorption 6—stern _Single Cesspool r i 1verflow cesspool rlj: _Shaieal sysieu(yes Or no)(if� ,aunGi previous tiou Fecotdbs,ii aii ) _innovativeiAiternative tecnnoiogy_Attach a copy of the current operation and maintenance contract(to be obtained tiom system owner) Tight tank Attach a copy of the DEP approval Other Appioxii wee age of all con"ae ts,date installed(if kaowa)and source Of iiu`Ui `a t7dL June i3, 1986 Were sewage odors detected when arriving;at the Site NOS or no):IJ Title 5 Inspection Form 5/15/2000 ° i Paget of 11 OFFICL4L INSFEMON FORPH—[•i0T FOR VOLrUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM iNFO MATION(continued) laraperty Addrems: 199 Skunknet Road Centerville.1kUss 022632 Owner:,;aces Doolley, Date of inspection: Afril 23,2Gi4 SiA€.Dl IG SENVER(locate on site titan) Depth beloLv grade. Materials of coned iw'tion:_cast iiCw 40 i N Hauer(explain): Distance form private water suppiy weir—or—suction Hine: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK.-_(;o^:tc on sltc plan) Depth below grade:8•5" Material of construction: xx concrete_metal_fiberglass_-plyethylene ather(explain) Tf tarttc is rrretai list age:_ Is,age confirmed by a Certificate tit Cuffinliance(yes or no):_(,attach a ccmy ar certificate-) Di=nsions: Seotia Tank 1000 a l(an Sludge ueptic IT Distancc form top of sludge to'rmttom of outict.tee orimffic:27" Scum thickness: 4" Distance from ton of scum to top of outlet tee or baffle: 6.5" DicfianCc fmm hottom of g(11rM to hoff(TM of ortticzt ter,or hR.f e.- 8.0" Hoe.%,vere uUmersion determined: Me-ag—ured ::i3ii IUCIAS(oil tiulwing rewramendatio",inlet and oiitle.tec or bafficc wPtuittiton,Structrial irtic ttt .t uiu levels as related to outset invert,evidence of ieaicage,etc.): Tank is in Good shape no failure present. GREASE i•FFL :_(i`vcaic Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum Nc;.kne�c: Diswa e ftm top of Scum to top of watiCt tee or ba f le: Disiaiiiz fiow botiout of scu nl io butiuut tit ciuiici WC of bafik' Date of ima pumping: Cosmrtcnts(on punVing recommendations,inlet and outlet kv or baffle condition,structural integrity,liquid levels as related to outlet invert,cvidencc of leakam etc.): Title 5 Inspection Form 5/1512000 , Page A of 11 OFFiCt'A'L iNSPEC TiON FQ►FcM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART is SYSTEM INFORMATION(continued) Pmperty Address: 199 Skunknet Road Centen0e.,Mass 02632 James Dooley Date of ir ;nspcc"a-. ADN 23.2004 TIGHT or HOLDING TANK:_(tank must be pumped at time of inspection ate on site plan) Depth below grade: Mate.-la]of---=ttuct:on: c:arre*r;_ry et:1 t erg�...s�_ lyc:�:y?cae_--the(explain): Dimensions: Capacity: Gallons Design Flaw. gallons/day Alarm present fvcs or no): Alarm level: Alarr-in%,orkmg order(yes or no):_ Date GI last pumping: Coiiiiiiriiis Cwiiuiiiuii of airii`iii aliilfloat swei;lies,etc.}: MST RIBU TION BOX: (if present must be oNcaed) ocat on si*w Plan) Depth of liquid level above outlet invert:even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of boa,etc.): No failure present box in good shape Pu`M CRAMRER: (iocate on site plan} Pumps in working order(yes or no): Alarms in wofkttic ofdcf fees or not: Comments(note condition of pump c,amt,er,condition ofpjmps and a p1Lrtm—ancess,etc.): Title 5 inspection Form 6/15/2000 I Page 9 of 11 OFFICIAL iNSPEC T tON ry il'NI—NOT FOR ilf`LIUI N T Awl ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART SYSTEM LN-FORMAT ION(continued) Pmnerty Adilmm.: 199 Skunkmt Road Centerville,Mass 02632 Owner: James Dooley Date of Inspection: r"wf ii 23,2004 SOIL ABSORPTION SYSTEM(SAS):_('locate on site plan,excavation not required) ii SAS wi located cnplain why: Type XX lcachinsy pit.-;nnmhcr I 1--hinb ehambers,number: leaching galleries,nur"ber. leaching trenches,number,lengih: leaching fields,number,dimensions: _oN,crftoNv cesspool,number: innovative/alternative system Type/mime of technaloff: Comments(note condition of coil,signs of hyd*aiilic i'aikre,level of pon�dbno ida—W coil,condition-ofve�et�on, etc,• Leachim;)11,in,fair{:i'indiiion wator lovci 13"1*roa i irive t. CESSPOOLS: (cesspool)dust be pumped as part of inspectioilMocate on site plan) ]L=b.—and coa garation: !Deplub—iop of liquid'Ill unct invett: Depth of s—OH&s layer: Depth of scum)layer: Dimensions of ccsstxwl: MRtcrialc of non 'on Indication ofgro n&.vatcr inflo`.'.'(ycs or noh Con- inca (note Condi ion of soil'Signs of iydhii lie aigurc.,ic.'vci of-winding,condi lOn elf wgctation,etc.): PR-V'Y; I`locate,on site plan) mateeM6 of wastruction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)- Title 5 Inspection Form 6/15/2000 7 Page 10 of 11 OFFICIAL INSPE m ON FORM—NOT FOR v 6`.ea,Uiv"FAR ASSES' a S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM aa".1 �P.T C A SYS.1.EM IN OR-M-1A�!ON(continued) Property Ardllrne s: 199 Skunknet Road Cet�ter,iLle. �vass C2632 fiwner:,iailles`vuuiey Date of Inspection: Argil 2:3,2004 SKETCH GSA'SEWAGE DISPOSAL S S"i'F.Kv Prev de.,sketch of tl:e se:aage disposal systet:t including ties to at!east:v:ro perm. neat ref:enc-e land�.r+ks or 11..,, 1.� i e tl il..._.'A.:� lh/t k �7� 4t:,.._.., t n t 1_P:1,7'._� Ve1l�.limark's.Locate[Ul W elfJ wJuJlll J\lll feet.Locate here�li Vfl�.watel slipr,,I'eiiteis the viulleilJK. a, .• Aw _-7 { 'All O — .A l00eqAIP1 Q 7 �Y .1 • F + "Tit,c:5 Inspection Form 6/15/2000 iv I i i Page 11 of 11 OFF iC ifw iNSFEC"P iON FORM—NOT V—ORVOLUNTAWi ASSESSMENTS ENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAIRT C SYSTEM INFORMATION(continued) Property Addrmm 199 Skunknet Road Ce^;er:EHe,t.4;;s Owner: James D001'ev Date of inspection: Agri!L5.2004 SITE EXAM. Slone $nrfnr..c wafer Check cet.ar Shai;o:v wells estimated depth to ground water iu.7 feet Please indicate(check)all methods used to determine the high ground water elevation: _Jbta n::::o L'c6cckcd,W:tc ot'd;sigg ptan r—mi'cwed: ot7sefved Site(abumiijs pfopel-tyiobsew tioci hole Within 35v"feet of SAS) Checked with local Board of health-explain: Checked with local excavators,installers-(attach documentation) roc Recessed USGS database-explain: Cape cod Commision Yau;53iiS�a 1 , .. w you estaviished the high ground water c1ciation: Auger 194 rio water, note next page Title 5 Inspection Form 6/15/2000 'i Permit Number: pate: 4/23104 Completed by: Timothy E. Cash HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 199 Skunirng:Toad Centarniti(a —Lot NO. 4 •� Owner:James Dooley Address: Satt?e- - Contractor: lash's Trucking Inc. n-� address. PO Etax 7, Yarynouthport Notes: No Water Encountered STEP 1 Measure depth to water table to nearest 1/10 ft. . Date 4/23/04 12. monthlday/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: Appropriate index well........................... inr25; ® Water-level range zone..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to J14 d7 water level for index well........................... L' - month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 28) — 1.3 determine seater-level adjustment .......................................................................................... STEP S Estimate depth to high grater by subtracting the water- level adjustment(STEP 4) fran measuretl depth to water levelat site(STET' 1) ............................................................................................................ tG.r f a 1 jSSESSOR'S MAP N0. PARCEL LOCATION i�'; » j - SEWAGE PERMIT NQ. VILLAGE. C r� ��. \- INSTA LLER'S NAME i ADDRESS )- llUILDER OR OWNER c Qe.�x> '0" sa\\vim DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 'l 16// �X ti {• 4f 1 No... Fe �........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i� Taus . .:...............oF ....... c -----•-----........----- Q' Appliration for R-4pm�al ork5 Clonstrurtion Prrutit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at: lC �i'•x• ..`yi ........................ ...... .. 1.!.�/ or Lot No.......................................... .... ..._............._... ^- ..... - ` ner ' - ------.Address Installer� Address Type of Building Size Lot. �_+_q-----Sq. feet ,., Dwelling—No. of Bedrooms.....................................Expansion Attic ( ) Garbage Grinder Other—Type of Building No. of persons............................ Showers a YP g --------•------•----•-----•- P ( ) — Cafeteria ( ) Other fixtures ------_----------------------•- ---------------------------------- - --•----------•----------------- W Design Flow........... .._ ......................gallons per p@p@@K Rer�iay. Total dailyt Pow..............6.-'3�7._ ._.......... lore. WSeptic Tank—Liquid capacity__ 6M.gallons Length_e_.(a..... Width...Li k? ... Diameter................ Depth. (o.__. x Disposal Trench—No. .................... Width._.._ .......... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No......I------------- Diameter....... ...... Depth below inlet.._.40.1......... Total leaching area.20.s.1sq. ft. Z Other Distribution box Dosin nk ) a Percolation Test Results Performed by.__ ... 11111................... Date..... 1�ate . ._ �_..... a Test Pit No. I----L�ninutes per inch Depth of Test Pit.. , ..._... Depth to ground .C._.. f;Lf Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a rr {f j t+ .........--- ....... . may. r 1 O Description of Soil.-�. ......... --�... u�a �- 1- ..- x ---------------------- - --------------- ---------- ----------------------------------------- ••.....---------........._. 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 iITIE 5 of the State Sanitary C —.The un rsigned further agrees not to place the system in operat' until a Certificate of Compliance has be i e b he oar health. , g, � e Signed---• --- --- - ----- ...................................... .jl/._Da .. , Da Application Approved By... . ....... .. . ....• --......................... 't4= G/---_�--' Date Application Disapproved for the following reasons------------------------------------------------------------•-•-----------------------•--•-•---------•---.....-- ....• --------------------•--------......................-----------------•----•-------•----•--------•-••---------•••-----•---.__._Date ^•-----------.. PermitNo..S.- ./....4......................... Issued............................................ --------- - Date No... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .- ---TC�.� 1...................OF........... z2.. Pf. ..._.. Appliration for Diupniml Murky Tonstrurtiun rrrntit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ....:..:.1,� 1.... . . : .... ._ ......, 1 �1 ... ...- --•-•............... tirp �i °� ( J�C ----•--••-•-•---or Lot No.' Owner Address Installer - Address Type of Building Size Lot_.� .�. 2 -----Sq. feet ►—I Dwelling—No. of Bedrooms...........3...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures _________________________________ ¢ brio, ---------------- W Design Flow............ .... .._gallons per r day. Total da•1 ow_._._ ...___•------------------- g P I�e' �F tt Y' �yl� --• --��_. .-----•-•---g�llons. WSeptic Tank—Liquid capacity__ 00Dgallons Length_. __( __.__ Width_.. _ ___. Diameter________________ Depth.,L _t ... x Disposal Trench—No_ ____________________ Width___._'.............. Total Length.................... Total leaching area ..............sq. ft. � ISeepage Pit No.______ ___. Diameter....... ........ Depth below inlet___............ Total leaching area.�.V_�.A__�.sq. ft. --------- P Other Distribution box�,/) Dosin ) Percolation Test Results Performed b -_: ............... Date...... l�?..1�Ait_____________. a Test Pit No. 1_._. inutes per inch Depth of Test Pit•-�1�Q_0_.__. Depth to ground ter_.. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil__._ ___ V_l:___ V�.�...._._._1 �_._ f� Y� C)� _ .__... _ _ ��(r, .(.0 -1................ x .---- - = .................................... w -----------------------------------------------------------------------------------------------------------------------•-----------•-•-•---••-••••--•••••••-•--.....-•-•--••-••••-••••••-•-•-•-•-_.._. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .- •-•-•------•-------------------•-----•--------••-----------------------•----------•-----------------------------------------...-•--•••-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T m 1E 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operati until a Certificate of Compliance has been issued by the board of health. �, I Signed...................................................................................... �'� Date Application Approved By lf!'' N ..........--•------ Date Application Disapproved for the following reasons:.............................................................................................................. .. --••--------------•------------._...-----•-•------•----'-----••------------••••-•------••-•••••..._.--••------•-•----•----••--•--•- ---•-------•- Date ,! PermitNo...>t:�. ...................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH ............ .......OF....:.. :.....................:.:. (9rrtif irab of Toutpliattrr THIS IS T12. ER Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------------------- .(:..-•-- ---••-....------•-••-------------...----••-•-----••-•---••---....------....:..................• - fInstaller has been installed in accordance with the provisions of TITLE �jo The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ""__1' ______________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL U CTION SATISFACTORY. DATE ...................................... . Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C ...........................................OF........ ..................................... Fes........................... Disposal Workii Tonutrttrtion pan it Permissionis hereby granted................................................................................................................................:.........._.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No -..................... .....................................................................................................Stre C / Q L, as shown on the application for Disposal Works Construction Permit No�`_��£_-____ Da ed___/�/__.____ 1�................ DATE_ • .r ................................. Board oalth FORM 1255 A. M. SULKIN• INC., BOSTON STATE' FOREST. t 134. 91 �t =LOT . rQD .� Z 10 Y z� y 82.33 EBEr� SthtTH Rop,� - SHO roe # 85-420 kIi�IGT rA��3 U I L i CEPTIFIED PLOT PLAN g p-nc 4r�Emi PP.EPAP.ED FOR. LOCATION: LOT-1- SKUNKNET RD CVILLE SCALE: I " =40 DATE: 06/09/86 REFERENCE. PB 403 PG 27 LEBEL-SOLLOWS I HEREBY CERTIFY THAT THE BUILDING SHOWN GROUNDOASTHIS SHOWNLAN IS HEREONLOCATED ON THE � 1N OF o`' ARNE yG H. `•��^, OJALA H down cape engineering A No. 26348 CIVIL ENGINEERS �ss9F6! T LAND SURVEYORS. ROUTE 6A YARMOUTH MA DA E REG. LAND S VEYOR r xti r SECTION - SEWAGE; F�1,1T — 20�� r - • —SEPTIC TANK— :—"D"BOX — A —LEACH �I�E I TOP OF fDN I t I0 1 (MSL)* ..2..OF716TO Ph!" Y. WASHED STONE. , 9 Pi M Lr.IP i r P - - -__ IN , 'OUT• e. OUT,• vov 5`TaT� F�h a tv -SEPT C r b0_ l , t, - � ,TANK � .. .: .• - .�/L� r,,r....s.. ., :.. ., i .: oY E EV. - - k ELEV.. ELEV: _ ..<, _, :ELEV: ELEV. .ELEV. O .,' t ,y _ . I •WASHED STONE h o� -r+4- - TEST HOLE'LOG # : . h 502 r t�, 42q' ' E T�Y•�►� 'C/!�l'(�1 �l-;GOf��o 1'>f,,: .� T S � WITNESS ; i, ;� - TEST DATE 4. � DESIGN �r BEDROOM HOUSE T-H" .� T;H,,.at,2. N� _ _T-u ELEV.57iS� ELEV. { ii - + \ ' . . . - ivy L2 OISPOSER' DISPOSER PERC.RATE MINAN O GAL DAY FLOW RATE,33 l /. -l i G �• SEPTtC.TANK��33C.� >,a{J�,: dIr�- - : ,'�� '�, u -LO . RE4'DSEPTIC TANK S14E LEACH ;FACILITY - \ dSIDE WALL.� (v ,gj (Z,.�rj 377� G/D. n lO.Ly BOTTOM f rTr-5 ,3 I/,o) 3 . D. ?; r. _ - �(o�j A3:So TOTAL Zc�I Z7r G/t7 r � r _ USE: LEACHINE a �� F�. n r , - WATER ENCOUNTERED - - ; ,•� t - 0 NO"M- .(UNLESS OTHERWISE NOTED) • AKEN,FROM'' A D�IG�QUAORANGL.EMAP / -1.DATUM(MSU-T 2.MUNICIPAL WATER �-f�-- AVAILABLE 3:PIPE PITCHt 4h"'PER.FOOT 4.DESIGN:LOADING FOR ALL'PRE-CAST UNITS:AASHO- / &,MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. 7:CONST INTS SHALL:BE MAOEDE-ACCWATER TIGHT ARNE M.\ __.- - ___ —_.. ----__.__._. __ 'S ].CONSTRUCTION DETAILS TO�E:A'CCORDANCE WITH COMM.OF MASS. STATE ENVIRONMENTAL.CODE TITLE 5 s , - - •- - - �oL-.�ort�.�_��-c�-i�-��..._.a 5•-�ex��.'� �I LOCUS: REG:PRO / EERY G --REF:-- down 1 �f GE4�: � o ApNE _.. a a engi eei .g � - u �`= PREPARED FOR: i - - CIVIL ENGINEERS y BOARD OF HEALTH RE - - - SL (EXISTING) okr%IH�/t� M Y O��.�. S�(: _ 8 8� CONTOURS _ _ _APPROVED DATE - .A t ATE AL LAB ALE -�' /d (PROPOSED)-0--O-'O"O- ASSESSORS MAP : , 171 _ -_ TEST HOLE LOGS PARCEL: E 'NOTES: FLOOD ZONE: t'- CST' I ,1G �_ �.. _ ---- SO I L EVALUATOR: 0q 1 0 W I TNESS : 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: C�""' '_7?r1 � 7 DATE: Health Regulations � I PERCOLAT I ON RATE: G AAIIA . i I tti ) verify the 2 omponent rpriorl to installation aand setting tion of base elevations.ies, sewer .and septic 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first TH- I TH-2 two feet out of the d-box to the leaching shall be level. LD 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. �l 7) The property is bounded by property corners and property lines. LOCATION - MAP a 8) The property owner shall review design considerations to approve of total ` design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow b the owner. pP � Y 9) The existing leaching or cesspools shall be pumped and filled with material // per Title V abandonment procedures. Those within the proposed SAS shall FocZEST b+ ! be removed along with contaminated soil and replaced with clean sand per A S'T -�E g /_-� c.� I/�(�� Title V specs. 134.91 J 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if ' SEPTIC SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service !o _ o line. The line is to be sleeved as aforementioned and maintained in place. FLOW ESTIMATE 11) If a garbage grinder exists it is to be removed and is the responsibility of the � �Z a owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such O BEDROOMS AT j I GAL/DAY/BEDROOM - GAL/DA �1 �W� exists (-M71to7 �p'2 B 13)The installer shall verify the location,quantity and elevation of the sewer ID S`EPT(C7TANK -_ W lines exiting the dwelling prior to the installation. i `Z GAL/DAY x 2 DAYS - GAL -- - ---.-- ---- --- ---- = Lo-r co USE ,DD GALLON SEPTIC TANK 1 1 !� SOIL ABSORPTION SYSTEM Ld N, I SIDE AREA: x � z �' YC2- X -7 = 7 �� DgID z o I Y BOTTOM AREA: , MASON r s pZo� !n � /l ,/ y Ve .12 �g�� Sr,►-rH ROA-n C SYSTEM SECTION -- -- -- - a� 14 or, 008 ��13Uw1 q M! , lt� , yl, A o AX, GAL ur f ►� t -= -� - - - i SEPTIC TAN .-._ -�-- - - ----- — ,, q 00 ! SITE AND. :S EW GE PLAN I LOCAT ION : l VILA PREPARED FOR t � (IL,, P O FIII b SCALE: I a DAV I D B . MASON, DATE: 0 DBC ENVIRONMENTAL DESIGNS DATE HEALTH AGENT EAST SANDWICH . MA W � ( 508 ) 833- 2177 Z