HomeMy WebLinkAbout0225 SKUNKNET ROAD - Health 225 Skunknet Road
Centerville P
A 171 285
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TOWN O, /
F, B/ARNSTABLE
J LOCATION 2 2S . FU.,k-46r 4 SEWAGE # 2007- y 7 q
VIZLAGE �Fr1rEf'V/�I/, ASSESSOR'S MAP & LOT 1171495
INSTALLER'S NAME&PHONE NO. 14 -1 10-FlI
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS 3
BUILDER OR OWNER fte d/y111i
PERMITDATE: COMPLIANCE DATE: liQJI-VON
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 leac 'ng facility Feet
Furnished by.
-�i�yl�fl�nLT (��
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Fee v`'
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZtppYicatiou for �Digoal �&pgtem Cootructiou Permit
Application for a Permit to Construct( )LRepair( ) Upgrade( ) Abandon( ) ❑.Complete System �htd v dual Components
Location Address or Lot No. 2 Jct Sly e lekIf,5 r < Owner's Name,Address;and Tel.No.
/514/rrrI� I�— r�s�
Assessor's Map/Parcel —
Installer's Name,Address,and Tel.No. J v 0 gyp?90 Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms . Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �Q�,�/AGM � � y� /,Poo 6*1; wlYl
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.
Signed - Date
Application Approved by - Date —�L(`0
Application Disapproved by: Date
for the following reasons
Permit No. �� T ' -( 7'07 Date Issued
-- ----------------- —----- ..---
--
Fees
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS
Rpplication for �Bigponl �&pztem Con0truction Permit
1
Application for a Permit to Construct O+ Repair O Upgrade O Abandon O ❑.Complete System ❑ ividual Components i
Location Address or Lot No. Z 2 SY /�..1 agk,1C T /G Owner's Name,Address;and Tel.No.
Cr,✓s'r-ell i/
Assessor's Map/Parcel '
Installer's Name,Address,and Tel No.
0 —p?Q Q Designer's Name,Address and Tel.No.
a a
Type of Building: f
i
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures !
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date !
- Title`''
Size of Septic Tank Type of S.A.S.
Ij Description of Soil
i
'Nature of Repairs or Alterations(Answer when applicable) �j=�'J� /� %�,e�rST yli /Od 6, 6,41
t
i
Date last inspected:
Agreement:
A � I
s The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in iI
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in.operatii6muntil a Certificate of
Compliance has been issued by this Board of Health. 1+1
Signed Date J'
Application Approved by 1 — Date
Application Disapproved by: Date 1
for the following reasons (� I R
Permit No. �o Date Issued j6
- --------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTSI
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( )
Abandoned( )by p �.
at 7 2 S,l-&• Are,,5 T A,."a/?fcC V/���_ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2001—q_-l dated 16- '0 !
Installer aSr,,oa.4 42,. ,rd/p+p Designer ,
#bedrooms Approved des• I now is d o gpd
ti The issuance of this permit shall not bet onstr 'ed as a guarantee that the system ' I fu cti n design d.
Date Inspector 9p ;'� -
--------------------------
------- -----
n� / � —
No. dL6 y 7 l ` � Fee
THE COMMONWEALTH OF MASSACHUSETTS
` PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1
Dfigpo!5al *p!gtem Construction Permit '
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( )
/ I
System located at
G cti tGr l//��J= 1
` and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date 10` �� Approved by
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A
OFTHEt Town of Barnstable
o�
Department of Health, Safety, and Environmental Services
MUMSrnBLE,
'""N.
i639. Public Health Division
♦0
ArF�'A°�A 367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
April 21,2005
Mr.Luiz Brescia
Mr.Luiz B.Netto
225 Skunknet Road
Centerville,MA 02632
NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2, 105 CMR
410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF BARNSTABLE
RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 225 Skunknet Road, Centerville, MA. was inspected on April 21,
2005 at 10:35 a.m. by Jack Fitzgerald, Building Inspector, Martin McNeeley;Fire Inspector and Thomas
McKean, Health Agent for the Town of Barnstable because of several complaints. The following
violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title
5 and of the Town of Barnstable Rental Ordinance,Article 51 were observed:
105 CMR 410.300 and 310 CMR 15.00: Inadequate septic system capacity: There were a total of five(5)
bedrooms observed in this dwelling: (Three bedrooms were observed on the main floor and two bedrooms
were observed within the basement). However, the existing septic system was not designed for five
bedrooms;it was designed and constructed with a maximum capacity for three bedrooms total only.
105 CMR 410.280: No windows or mechanical ventilation provided to the sleeping rooms observed
located within the basement.
105 CMR 410.450: Two separate sleeping areas with beds observed within the basement without adequate
emergency egress(second means of egress)provided within each of the three bedrooms.
105 CMR 410.481: Postinlz of Name of Owner: Name, address and telephone number of owner not
posted on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance.
You are ordered to remove the illegal bedrooms from the basement by removing the
entrance doors, by removing the beds, and by opening all door-way entrances (by
partially removing walls) to each room in the basement to minimum of five feet wide
openings within thirty (30) days of your receipt of this letter.
You may request a hearing before the Board of Health if written petition requesting same is received within
seven(7)days after the date the order is served.
Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's
failure to comply with an order shall constitute a separate violation.
PER ORDER O THE BOARD OF HEALTH
Thomas A. McKean
J
. 1
Z. TOWN OF
LOCATION: � � A
VILLAGE:
L p -7/ PERMIT #
INSTALLER' S AME: 1�a INSTALLER' S PHONE # : �
LEACHING FACILITY: (type.) _ /' Qo& (size)%TX2#�xa
NO.. OF BEDROOMS': 3
BUILDER OR OWNER:: M �i L,
PERMIT DATE• 4-6
COMPLIANCE DATE:
DRAW DIAGRAM ON BACK
I
1
Avo
�1
/! k
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
s
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpprication for )Digpaal 6pgtem Congtruction Permit
Application for a Permit to Construct( GRep r pgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. ,Sk Z1 kvW7- Owner's Name,Address and Tel.No....
Assessor's Map/Parcel 171
Installer's Name,Address,and Tel.No. y�/!V'�U� � Designer's Name,Address and Tel.No. 6.60 �
'r iA/ CAR
Type of Building:
Dwelling No.of Bedrooms _ Lot Size Z_fQ34 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 Tit e 5"BH
al Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued y s
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. SY Date Issued M
No. � I �/ 5 Fee �
' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L/
- es
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpplication for _ig o5al &p.5tem Conotruction Permit
Application for a Permit to Construct( . )�Repair( -Upgrade( )Abandon( ) ❑Complete System O Individual Components
Location Address or Lot No. sl C•U & ,, Owner's Name,Address and Tel.No.J {
Assessor's Map/Parcel /.7 _ag 5- U04",
C�
Installer's Name,Address,and Tel.No. &&1,4(vrTE Designer's Name,Address and Tel.No. 660_%:w
0-7 r p1 tag mw G1Qd'f,,9 S zw 3d 4-G
Type of Building: 2
-Dwelling No.of Bedrooms 3 Lot Size 0 34 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria,( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: f
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 Tit e 5 of the ronme al Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued y s B d H
Signed Date
Application Approved by Date In ll I
Application Disapproved for the following reasons
Permit No. Date Issued 0k
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
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. i dated , tl v
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the syste w,,U u,n,cti n as designed.
Date 0/ I)t Inspector t ,
No. 2`1U� _. �5�( — ------------- ------Fee ✓�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mopool *y—o-t-m Conotructton Permit
Permission is hereby granted to Construct( )(Repair( ) pgrade( )Abandon( )
System located at S'2L6 'SkL,11CAt
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:.Cofns/ ction must be completed within three years of the date o�per`mit.
Date: C/ (� aC1 __ Approved by
. Qwrn
TOWN OF
LOCATION:
VILLAGE•
L -7/ r y PERMIT #
INSTALLER'S , AME L$e �
INSTALLER' S PHONE
LEACHING FACILITY: (type) —Sr (size)
NO. OF BEDROOMS: 3
BUILDER OR OWN'E`R������,, J �
PERMIT DATE: .
COMPLIANCE DATE:
DRAW DIAGRAM ON BACK
PA
Aw
k � , .
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: 411
Designer: al q U+� ►C.tI�: kf, Installer:
Address: Tylcymj�. n C[d Address: 6.6 ZQ To C1A
On 4C-(?-Oq IOl4V A VIG was issued a permit to install a
(date) (installer)
septic system at QLo _9(/.JMx. -1-62 t based on a design drawn by
(address)
00 yi d 0. 60VO 4"W r' dated `;' r �� W04.
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
1�0F
cy
Dix GU,
(Installer's Signature) Noiw
CWw't� R y
# l o93�o
9FGIsS��,*�
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Desiper Certification Form
w
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
MAP 1-71
���
PARCH, 2 8 S
FAILED INSPECTION LOT -�-
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 225 Skunknet Road
Centerville, MA 02632
Owner's Name: Virginia McNeil RECEIVED
Owner's Address:
Date of Inspection: February 24, 2004 MAR 0, 3 2004
Name of Inspector: (Please Print) James M. Ford TOWN OF BARNSTABLE
Company Name: James M. Ford HEALTH DEPT.
Mailing Address: P.O. Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
✓ Fails
Inspector's Signature: Date: Feb
ruary bruary 25, 2004
The system inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 225 Skunknet Road
Centerville, MA
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not 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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 225 Skunknet Road
Centerville, MA
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
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:
3
Page 4 of l I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 225 Skunknet Road
Centerville, MA
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped—
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
Yes (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 System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either`yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY
ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 225 Skunknet Road
Centerville, MA
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ _ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection ?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ _, Was the site inspected for signs of break out?
✓ Were all system components,excluding the SAS, located on site?
✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the battles 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:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)).
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 225 Skunknet Road
Centerville, AM
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIAIA NDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): end
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: Pumped 3 years ago-per owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: _gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
` Other(describe):
I Approximate age of all components,date installed(if known)and source of information:
Installed 719186-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 225 Skunknet Road
Centerville, MA
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 10"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: --
Scum thickness: 10"
Distance from top of scum to top of outlet tee or baffle: --
Distance from bottom of scum to bottom of outlet tee or baffle: --
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level in the tank was half way at the seam ioint The tank has not been pumped The tank appears
to be leaking.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 225 Skunknet Road
Centerville, MA
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: --
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was not dug up. The leach pit was in failure.
PUMP CHAMBER: None (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.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 225 Skunknet Road
Centerville, W
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1 -6'x 6'(1000 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.):
The leach pit had 2'ofwater on the bottom. The scum line was up to the top ofthe pit Solids were present The pit showed sins
of failure. The cover was 28"below grade. The bottom to grade was 10'
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
9
Page 10 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 225 Skunknet Road
Centerville, AM
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
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.
A ,
0
B
►o a
I a5 a�
3 y o
10
Page I 1 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 225 Skunknet Road
Centerville, MA
Owner: Virginia McNeil
Date of Inspection: February 24, 2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 25 +1- feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
The bottom of the leach pit to grade was 10'. Using the Barnstable topographic map and the water contours map The maps
were showing approximately 25'+/-to groundwater at this site.
This report has been prepared and the system inspected and failed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed,written or implied, relating to the system, the inspection and/or this report.
1]
4 II
ECOJECH iAAP
Environmental PARCEL
www.eco-tech.us LOT a
THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT
OF ENVIRONMENTAL PROTECTION(revised 6/15/2000)
TITLE 5
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 225 Skunknet Road
Centerville
Owner's Name: Virginia&Joseph McNeil
Owner's Address: 11 Shannon Way
Centerville,MA 02632
Date of Inspection: April 8,2004
Name of Inspector: (Please Print) David DDavid D. Cou�anowr,R.SR.S. 1 xa•
Company Name: Eco-Tech Environmental
Mailing Address: 43 Triangle Circle < tv
Sandwich,MA 02563 ' N co
Telephone Number: (508)364-0894 -a '
CERTIFICATION STATEMENT: ca
I certify that I have personally inspected the sewage disposal system at this address and that the' ormatio eporR
below is true,accurate and complete as of the time of the inspection.The inspection was performt d 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:
X Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature ° l� kS Date: rl ( lot w o
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
Inspector's Note—> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger
any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed
on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination.
****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.
Tide 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D:
A] System Passes:
Yes I have not found any information which indicates that any of the failure criteria described in 310 CMR
5.303 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,or 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 breakout or high static water level in the distribution box is due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.The 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 four times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain
2
Page 3 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
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 and 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 by a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form
3) OTHER
3
Page 4 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
D)System Failure Criteria applicable to all systems:
You must indicate either"yes" or"no"to each of the following for all inspections:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.
The basis for this determination is identified below. The Board of Health should be contacted to determine what
will be necessary to correct the failure.
yes no
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high groundwater elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well
X Any portion of a cesspool or privy is within 50 feet of a private water supply well
X 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 by a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form)
No (Yes/No)The system fails. I have 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 II of a public water supply well.
If you have answered"yes" to any question in Section E the system is considered a significant threat,or answered
"yes" in section D above the large system has failed.The owner or operator of any large system considered a
significant threat under section E or failed under section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
r
Page 5 of I I
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following:
Yes No
Y _ Pumping information was provided by the owner,occupant or Board of Health.
N Were any of the system components pumped out in the last two weeks?
N Has the system received normal flows in the previous two week period?
N Have large volumes of water been introduced to the system recently or as part of this inspection?
Y _ Were as built plans of the system obtained and examined?(If they were not available as N/A)
Y _ Was the facility or dwelling inspected for signs of sewage back-up?
Y _ Was the site inspected for signs of breakout?
including
Y _ Were all system components,exeluding the SAS. located on site?
Y Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for
the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of
scum.?
Y _ Was the facility owner(and occupants,if different from owner)provided with information on the proper
maintenance of subsurface disposal systems?
For information on the proper maintenance of subsurface disposal systems please go to:
WWW.ECO-TECH.US
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Y _ Existing information.For example,Plan at the Board of Health.
Y _ 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)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
FLOW CONDITIONS
RESIDENTIAL
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 gpd
Number of current residents 0
Does the 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): n/a
Seasonal use(yes or no): no
Water meter readings,if available(last two year's usage(gpd): 122 gpd
Sump Pump(yes or no): no
Last date of occupancy: November,2003
C OMMERCIAL/INDUSTRL4 L:
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: System not pumped in recent past(Owner)
Was system pumped as part of the inspection: (yes or no) Yes
If yes,volume pumped: 1000 gallons--How was quantity pumped determined? 1000 gallon tank was pumped dry
Reason for pumping:Install new soil absorption system
TYPE OF SYSTEM:
X 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/Alternate 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:
Age: 0 years A new soil absorption system was installed on 4/8/04.B.O.H. permit#2004-154)
Were sewage odors detected when arriving at the site: (yes or no) no
6
Page 7 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
BUILDING SEWER_(Locate on site plan)
Depth below grade: 2 ft
Material of construction:_cast iron X 40 PVC other(explain)
Distance from private water supply well or suction line 20+
Comments: (on condition of joints,venting,evidence of leakage, etc.)
Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling_
SEPTIC TANK:Yes (locate on site plan)
Depth below grade: 1 foot
Material of construction: X concrete_metal_fiberglass_polyethylene
other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of
certificate)
Dimensions: 8.5 ft x 5 ft x 5 ft(1000 a1Q lon)
Sludge depth: 0 in
Distance from top of sludge to bottom of outlet tee or baffle: 34 in
Scum thickness: 0 in
Distance from top of scum to top of outlet tee or bale: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How dimensions were determined: Probe to top of tank
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 was pumped dry and maintenance pumping is recommended every 2 years. Tank and tees appear structurally
sound and functioning as intended.No evidence of leakage in or out.
GREASE TRAP: none (locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass_polyethylene
other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:_
Date of last pumping:
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
TIGHT OR HOLDING TANK: none (Tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal _fiberglass_polyethylene_other(explain)
Dimensions:
Capacity: gallons
Design flow:_gallons/day
Alarm present(yes or no):_
Alarm level: _ Alarm in working order(yes or no):_
pumping:Date of last
Comments:(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX: Yes (if present must be opened) (locate on site plan)
Depth of liquid level above outlet invert: at outlet inverts
Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of
leakage into or out of box, etc.)
D-box appears structurally sound with no evidence of leakage in or out.Effluent level at outlet inverts.
No solids in tank.
PUMP CHAMBER: none (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.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required)
If SAS not located, explain why:
Type:
_leaching pits,number
_leaching chambers,number
X leaching galleries,number 1
_leaching trenches,number,length
_leaching fields,number,dimensions
_overflow cesspool,number
—innovative/alternate system Type/name of Technology
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
New leaching gallery was dry.
CESSPOOLS: none (cesspool must be pumped at time of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,
etc.):
PRIVY: none (locate on site plan)
Materials of construction:
Dimensions:_
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 225 Skunknet Road
Centerville
Owner: Virginia&Joseph McNeil
Date of Inspection: April 8,2004
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'(Locate where public water supply enters the building)
LOCATIONS
LEACHING
GALLERY A 6
1 26 Ft 39 Ft
0 03 SEPTIC 2 28.5 Ft 60 Ft
2 o D-BOX TANK 3 33 f t 63 f t
to 0
A g
EXISTING
DWELLING
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W
W
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3
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SKUNKNET ROAD NOT TO SCALE
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Postage $ 6, 37
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Certified Fee 3 0 O?
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Receipt Fee �f APR 2
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Total Postage&Fees $ t
p�` Street,Apt:No:j------------------------------ ----`--1-- �^/�� R�
or PO Box No. �a� I SC.I.� `^_.---------!-----
City State,ZIP+4
Certified Mail Provides:■ A mailing receipt (esianey)ZppZeunf'OOSEur1ojSd
■ A unique identifier for your mailpiece
e A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may ONLY be combined with First-Class Maile 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 The waiver for
a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is
required.
e 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
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■ If a postmark on the Certified Mail receipt is desired,please present the arti-
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IMPORTANT:Save this receipt and present it when making an Inquiry.
Internet access to delivery information Is not available on mail
addressed to APOs and FPOs.
o�IME Town of Barnstable
K
Department of Health, Safety, and Environmental Services
Public Health Division
7
ArED"""N�a 367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
April 21,2005
Mr.Luiz Brescia
Mr.Luiz B.Netto
225 Skunknet Road
Centerville,MA 02632
NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2,105 CMR
410.00 THE STATE ENVIRONMENTAL CODE TITLE 5 AND THE TOWN OF BARNSTABLE
RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 225 Skunknet Road, Centerville, MA. was inspected on April 21,
2005 at 10:35 a.m. by Jack Fitzgerald, Building inspector, Martin McNeeley, Fire Inspector and Thomas
McKean,Health Agent for the Town of Barnstable because of a complaint. The following violations of the
State Sanitary Code, 105 CUR 410.00, 310 CMR 15.000 State Environmental Code, Title 5 and of the
Town of Barnstable Rental Ordinance,Article 51 were observed:
105 CMR 410.300 and 310 CMR 15.00: Inadequate septic system capacity: There were a total of five(5)
bedrooms observed in this dwelling. (Three bedrooms were observed on the main floor and two bedrooms
were observed within the basement). However, the existing septic system was not designed for five
bedrooms;it was designed and constructed with a maximum capacity for three bedrooms total only.
105 CMR 410.280: No windows or mechanical ventilation provided to the sleeping rooms observed
located within the basement.
105 CMR 410.450: Two separate sleeping areas with beds observed within the basement without adequate
emergency egress(second means of egress)provided within each of the three bedrooms.
105 CMR 410.481: Posting of Name of Owner: Name, address and telephone number of owner not
posted on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance.
You are ordered to remove the illegal bedrooms from the basement by removing the
entrance doors, by removing the beds, and by opening all door-way entrances (by
partially removing walls) to each room in the basement to minimum of five feet wide
openings within thirty(30) days of your receipt of this letter.
You may request a hearing before the Board of Health if written petition requesting same is received within
seven(7)days after the date the order is served.
Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's .
failure to comply with an order shall constitute a separate violation.
Zas
RDER OF BOARD OF HEALTH
A.McKe
OF1NE Tp�� Town of Barnstable
�7
Department of Health, Safety, and Environmental Services
* sexivsznBt.E.
ass.
1639• Public Health Division
♦0
AlED nlu'1" 367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
April 21,2005
Mr.Luiz Brescia
Mr.Luiz B.Netto
225 Skunknet Road
Centerville,MA 02632
NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE CHAPTER 2, 105 CMR
410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF BARNSTABLE
RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 225 Skunknet Road, Centerville, MA. was inspected on April 21,
2005 at 10:35 a.m. by Jack Fitzgerald, Building Inspector, Martin McNeeley, Fire Inspector and Thomas
McKean, Health Agent for the Town of Barnstable because of several complaints. The following
violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title
5 and of the Town of Barnstable Rental Ordinance,Article 51 were observed:
105 CMR 410.300 and 310 CMR 15.00: Inadequate septic system capacity: There were a total of five(5)
bedrooms observed in this dwelling. (Three bedrooms were observed on the main floor and two bedrooms
were observed within the basement). However, the existing septic system was not designed for five
bedrooms;it was designed and constructed with a maximum capacity for three bedrooms total only.
105 CMR 410.280: No windows or mechanical ventilation provided to the sleeping rooms observed
located within the basement.
105 CMR 410.450: Two separate sleeping areas with beds observed within the basement without adequate
emergency egress(second means of egress)provided within each of the three bedrooms.
105 CMR 410.481: Posting of Name of Owner: Name, address and telephone number of owner not
posted on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance.
You are ordered to remove the illegal bedrooms from the basement by removing the
entrance doors, by removing the beds, and by opening all door-way entrances (by
partially removing walls) to each room in the basement to minimum of five feet wide
openings within thirty (30) days of your receipt of this letter.
You may request a hearing before the Board of Health if written petition requesting same is received within
seven(7)days after the date the order is served.
Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's
failure to comply with an order shall constitute a separate violation.
PER ORDER F BOARD OF HEALTH
Thomas A. McKean
FORM30 Hoses a WARREN'"" THE COMMONWEALTH OF MASSACHUSETTS
->
BOARD OF HEALTH
}} /TOWN
a DEPARTMENT
ADDRESS
TELEP
Address?fir ` ka-'^Ienel- Q� cei do"cI pant D2432
Floor Apartment_No._. No. of Occupants .
No. of Habitable Rooms___- No.Sleeping Rooms73
No. dwelling or rooming units_____ No.Stories
Name and address of owner- 2
uj /�. S �;2 Ci47__ G u, G�_ �3e1 �Q; t1
L(Ai z l� xau ?0—/-_ Os —3 1 Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT, Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N E ui . Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line: c ca a ,�; ,,ate �s; c 410 3
H.W.Tanks Safety nd Vent s-.-�,r
ELECTRICAL Panels, Meters,Cir.: v S "' Cg-I A r00a0, e)69P�vJ
❑ 110 ❑ 220 Fusing,Grnd.: hui i� c�suo l Inc�, ��a laaav l'
AMP: Gen. Cond. Distrib. Box: 6P(.+fit ,Apra') aon,s-lWC_k4 r,,.f,,K
Gen. Basement Wiring: UJltb W11
DWELLING UNIT ..�
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom(3)
Bedroom 4 '`C WD Id` W--, r9w,1ar� 1� -�-�Ra a+s%� ewd;i f�,�MS) In ?A
Hot Water Facil. r Sup.Ten.,Gas,Oil, Elect.: e �, ,} i ` 1 ,0 A 0
Stacks, Flues,Vents,Safeties: V t9 n la nn „ f
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats; Mice, Roaches or Other:
Egress Dual and Obst'n: No SatOAA IWGn� ea rp w, 4410 �, dAl
General Building Posted AM r --k A3(2 NIWIA J__Q J1=1 dA r,1,IAA
Locks on Doors: A+na`r'S cS5 z.,Q (�►1.
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR. (See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY."
INSPECTOR I Oh"E'S mG _ TITLE tree-�w �bISC Q
A.INe
DATE TIME 11)/ 35> P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a,person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered,crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable. .
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
P Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750 A through O shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
1'--..,-....,'�,---v• .,.T"s-�,�.i,�Y 1*t"�y.®;�y--� _.. ..: .rR.!^....-•ter-._.rvlfin^..+"'.^"..'r...N"'„•,.,irn..-'.,.,_.--._.•.^'� -•
FORM30 Caw HOBBS&WARREN M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. arns��
CITY/TOWN
wP0,
b
DEPARTMENT
0 -�atn_ > � ann� ,
ADDRESS
M
TELEPHONE'
Address uG'1► 'rJ'!�Q (,AA 0Gp3
�.[�--� _____ __Occupant_.
Floor Apartment No. _ _ No. of Occupants _
No. of Habitable Rooms. __ No. Sleeping Rooms_'_
No.dwelling or rooming units_____No. Stories
Name and address of owner _ r_V_ .a 'c�,u ✓IC pa:,?cj
70— ,?1(VR1marks Reg. Vio.
YARD Out Bld s.: Fences: "�
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Sup ly Line:
❑ MS ❑ ST ❑ P Waste Line: Rk- !!5-z 15-tcA ran,.,:4 a s r r l�l
H.W.Tanks S fety Ind Vent s /, d A,,, , . ,, jj %
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.: '
AMP: Gen.Cond. Distrib. Box: ,r,.r
Gen. Basement Wiring:
DWELLING UNIT ,.
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
... -
Bedroom 4 It��r► ,ana'" al, n �r �'«- : ' ft°cJ �f.R1.� t
Hot Water Facil. f Sup.Ten.,Gas, Oil, Elect.
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n: No—sac anrj twcA fQ fel A� )V1 J'C, q19 Aijo
General Building Posted r - L jn(7
Locks on Doors: 1A l&S t(� �
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDIAON WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY." `-
INSPECTOR IVAW S _Ft TITLE—b i(e(Aw o (� tieiohc 14-nt[A
CA-7
DATE A - .7 ) TIME In; 31; _ P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION � C*Y Z P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedysaid condition within the time so ordered b the Board of Health.
Y
r
a �
H1
i
fr
J55 COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci
DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector
ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119
TeaTicket,Ma.
(508)564-6813
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI 1 DAVID B.STRUHS
Governor Commissio er
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f
PART A
CERTIFICATION
Property Address: 225 SKUNKNET RD. CENTERVILLE LOT 7
Name of Owner SAMUAL AND PEARL LAROSA
Address of Owner: 428 FOSTER RD.TEWSKBURY MA.01378
Date of Inspection: 4/6/99 J. ` Tip' 9Z9 gy
Name of Inspector:(Please Print)JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) ,
Company Name: n/a
Mailing Address: n/a
Telephone Number: n/a
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 inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:.
X Passes The inpection is based on criteria defined in Title V
Conditionally Passes code 310 CMR 15.303.My findings are of how the system is
Needs Further Evaluation By the Local Approving Authority performing at the time of the inspection.My inspection does
_ Fails not imply any warranty or guarantee of the longgevity of the
septic system and any of its components useful life.
Inspector's Signature: Date:4/20/99
The System Inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM NOW AND THEN MAINTAINED EVERY YEAR.
revised 9/2/98t Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 226 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA'
Date of Inspection:4/6/99
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated
are indicated below.
COMMENTS:
System passes Title V inspection
B. SYSTEM CONDITIONALLY PASSES:
nta 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.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not.
nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
nLa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
broken pipe(s)are replaced
obstruction is removed
_ distribution box is levelled or replaced
nLa The system required pumping more than four 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
revised 9/2/98 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 225 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:4/6/99
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 the public health,safety,
and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis 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,Method used to determine distance Wit- (approximation not valid).
3) OTHER
nta
r
revised 9/2/98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 226 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:4/6/99
D. SYSTEM FAILS:
You must indicate either"Yes'or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow,
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped Wit.
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds,
ammonia nitrogen and nitrate nitrogen.
X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure.
E. LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X 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)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the
Department for further information.
revised 9/2/98 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 225 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:4/6/99
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health.
X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates
during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined.Note if they are not available with N/A,
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout,
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption
System on the site has been determined based on:
X Existing information,For example,Plan at B4O,H,
X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[1 5.302(3)(b)]
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2198 Page 5 of 11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 225 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:416/99
FLOW CONDITIONS
RESIDENTIAL:
Design flow:-=g.p.d./bedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):3
Total DESIGN flow: IQ
Number of current residents:11
Garbage grinder(yes or no):NQ
Laundry(separate system)(yes or no): NO If yes,separate inspection required
Laundry system inspected(yes or no)-.JM
Seasonal use(yes or no):M
Water meter readings,if available(last two year's usage(gpd): Wa
Sump Pump(yes or no): NO
Last date of occupancy: 2/1199
COMMERCIAL/INDUSTRIAL
Type of establishment: nta
Design flow: nLa gpd(Based on 15.203)
Basis of design flow: Wa
Grease trap present:(yes or no):�IQ
Industrial Waste Holding Tank present:(yes or no): NQ
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available:nta
Last date of occupancy: nta
OTHER: (Describe)
n&
Last date of occupancy: nta
GENERAL INFORMATION
PUMPING RECORDS and source of information:
LVA
System pumped as part of inspection:(yes or no):NQ
If yes,volume pumped nLa_ gallons
Reason for pumping: nLa
TYPE OF SYSTEM
X 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)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other: Wit
APPROXIMATE AGE of all components,date installed(if known)and source of information:
1986
Sewage odors detected when arriving at the site:(yes or no) NQ
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 226 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:4/6/99
BUILDING SEWER:
(Locate on site plan)
Depth below grade: V 6"
Material of construction:_ cast iron X 40 PvC _ other(explain)
Distance from private water supply well or suction line: TOWN
Diameter: Wit
Comments: (condition of joints,venting,evidence of leakage,etc.)
OLa
SEPTIC TANK: X
(locate on site plan)
Depth below grade: V
Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain)
Wa
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ
Wit
Dimensions: L 6'6"H 5'7"W 4'10"
Sludge depth: 4"
Distance from top of sludge to bottom of outlet tee or baffle: 22'
Scum thickness:5
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 13"
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING NOW AND THEN MAINTAINED EVERY YEAR
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain)
Wa
Dimensions: Wa
Scum thickness: t11a
Distance from top of scum to top of outlet tee or baffle:_ita
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: Wa
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
Wit
revised 9/2/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 225 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:4/6/99
TIGHT OR HOLDING TANK: MQ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: Wa
Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain)
Wa
Dimensions: Wa
Capacity: nta gallons
Design flow: nM gallons/day
Alarm present: NLQ
Alarm level:j3L& Alarm in working order:Yes_No_ NO
Date of previous pumping: nta
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
Wa
DISTRIBUTION BOX: _
(locate on site plan)
Depth of liquid level above outlet invert:Wa
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
DID NOT EXPOSE
PUMP CHAMBER: NQ
(locate on site plan)
Pumps in working order:(Yes or No): N_Q
Alarms in working order(Yes or No): N_Q
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
nla
revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 226 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:4/6/99
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
Wa
Type:
leaching pits,number: 1000 GALLON LEACH PIT
leaching chambers,number: jiLa
leaching galleries,number: _nLa
leaching trenches,number,length: nLa
leaching fields,number,dimensions: nla
overflow cesspool,number: nta
Alternative system: nLa
Name of Technology: jiLa
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT WAS EMPTY AT THE TIME OF THE INSPECTION NEVER MORE
THAN 4'OF
CESSPOOLS: _
(locate on site plan)
Number and configuration: Wa
Depth-top of liquid to inlet invert: Wa
Depth of solids layer: WA
Depth of scum layer. Wa
Dimensions of cesspool: WA
Materials of construction: WA
Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)Wa
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Iva
PRIVY: _
(locate on site plan)
Materials of construction:Wa Dimensions:nM
Depth of solids: WA
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
nta
revised 912/98 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 225 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:416/99
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
n/a
G�Se
AA
G
d3
6C 31 H
revised 9/2/98 Page 10 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 225 SKUNKNET RD.CENTERVILLE LOT 7
Owner: SAMUAL AND PEARL LAROSA
Date of Inspection:4/6199
NRCS Report name: nLa
Soil Type: nta
Typical depth to groundwater: nLa
USGS Date website visited: Wa
Observation Wells checked: NQ
Groundwater depth:Shallow _ Moderate _ Deep _
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
_ Shallow wells
Estimated Depth to Groundwater 12 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
- Obtained from Design Plans on record
X Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
_ Checked FEMA Maps
_ Checked pumping records
Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
USGS MAPS AND CHARTS AND VISUAL-12"FEET
revised 9/2/98 Page 11 of 11
CENTERKLE. MA
PLAN REFERENCE CONTOURS EBEN
LLW PLAN BOOK 583 PAGE 98 EXISTING - - - - - - - 60 S' RD
Ems ASSESSOR'S MAP: 171 MINIMAL GRADING PROPOSED
<w M LOT: 285 DDLARA KS AD
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WZo BENCH MARK M A P
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00 o<o /�
WN NOT TO SCALE
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ELEVATION - 60.60
VSGS DATUM ASSUMED
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ap Q .< z N d p \ \ C
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wr o 1000 GALLON o
I--_j �W �, (,,,m
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W LL ' u, o" o m-.4 D-BOX
OH w I � 0 a,T r Z= Grh/ TEST PIT
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O+ o c� LOT 7 i 1 O e EXISTING
rl {' 3 - 15034 sr �- ! I Ln LEACH Per
AREA 0
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o TREE
10 I �--- -I�MER REFERS TO D/AP—T64*
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i �P
---"% � 57.85 ft 58 O
LU Z Y 58 ` /9;1 `
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<LL — — SEWAGE DISPOSAL SYSTEM PLAN
Z -�
O $ o �m U 58 61.52 ft
LL -TO SERVE EXISTING DWELLING
olf � LLI1. C)l PLAN
ZN1 'X w NOFtius JOSEPH & VIRGINIA McNEIL
a- � + � p � 24ftxI2.5ftx2ft � _ �'� s9�
o LEACHING GALLERY ,' SCALE: 1 in - 20 ft =3 [)AVID %N 225 SKUNKNET ROAD CENTERVILLE. MA
� LL R o G:I ,�,a � ECO-TECH ENVIRONMENTAL
LL , g ��c P� 43 TRIANGLE CIRCLE SANDWICH MA 0256
1 o BgN�TA�
O `�P� 508 364-0894
ETE-1597 MARCH 26. 2004 /� I/2
/ THS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT
BEAR$ TW STAMP AND SIGNATURE OF THE DESIGN ENGINEER
�V 1Ys N TA
a .
ORIGINAL PLANS INTENDED FOR SUBN1tT L TO THE BOARD
OF HEALTH WLI BE SIGNED N BLUE AND STAMPED N RED.
TEST:
SOIL TEST LOG SOILEEOVALUATOR: DAVID"D. COUGHANOWR. RS
WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT DESIGN CALCULATIONS
NO GROUNDWATER
TEST PIT I PARENT MATERIAL: E ROGLACIALDOUTWASH_ DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD
ELEVATION - 58.20 +-
PERC AT 58 in : 2 MIN/INCH IN C SOILS
SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS
DEPTH SOL USDA SOIL SOIL COLOR SOS: OTHER USE EXISTING 1000 GALLON SEPTIC TANK IF IS SOUND STRUCTURAL
(INCHES) HORIZON TEXTURE (MUNSELU MOTTLING CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED))0-10 FILL DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
10-12 0 SANDY LOAM 10 YR 2/1 NONE FRIABLE
12-15 A LOAMY SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH
Abot - ( 24 x 12.5 ) - 300 sf
15-40 B LOAMY SAND 10 YR 5/8 NONE FRIABLE A s d w - ( 24 + 24 12.5 + 12.5 ) x 2 - 146 .s f
Atot - 446 sf
40-68 Cl LOAMY 10 YR 6/4 NONE LOOSE
MEDIUM SAND Vt 0.74 x 446 - 330.04 GPD
68-120 C2 COARSE SAND D YR 6/3 NONE LOOSE-20% STONES USE A 24 f t x 12.5 ft x 2 f i GALLERY. Vt - 330.04 GPD > 330 GPD REOUIRED
GROUNDWATER
ADJUSTMENT LEACHING GALLERY
EXISTING GROUNDWATER LEVEL
BASED ON BARNSTABLE GIS CONSTRUCTION DETAIL
DEPARTMENT RECORDS
DRYWELL UNIT
OBSERVED GW: 34.0 W-O"x 4•-10•x 2*-9- STONE
INDEX WELL: SDW-252 2 ft EFF. DEPTH
ZONE: D 24.0 ft
READING: FEB 2004
LEVEL: 47.2 0
ADJUSTMENT: 3.3 ft M
ADJUSTED GW: 37.3
- o
NOTES
N
_O
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 2.5' 8.5' 2 fr 8.5' 2.5'
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 24 O ft Nor TO
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) SCALE
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES
BEFORE EXCAVATING FOR SYSTEM.
5) EXISTING AND LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE
7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN
8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES SEWAGE DISPOSAL SYSTEM PLAN
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK
9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT -TO SERVE EXISTING DWELLING
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.
10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. JOSEPH & VIRGINIA McNEIL
11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE, TO GRADE ON A LEVEL 225 SKUNKNET ROAD CENTERVILLE. MA
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH
SIX INCHES OF CRUSHED STONE HAS BEEN' PL.�CED' TO MINIMIZE UNEVEN SETTLING ECO-TECH ENVIRONMENTAL
12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 43 TRIANGLE CIRCLE SANDWICH MA 02563
ETE-1597 MARCH 26. 2004 2/2