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Home My WebLink About0325 SKUNKNET ROAD - Health 325 SKUNKNET ROAD, CENTERVILLE _ A= 170 252 1 E Ti TOWN OF BARNSTABLE �� SEWAGE # �1:0 A-11ON C1C� C � VILLAGE f��l2ni r- ASSESSOR'S MAP & LOT LM--2,�i)- INSTALLER'S NAME&PHONE NO. ,L) SEPTIC TANK CAPACITY AP eb b LEACHING FACILITY: (type)f--Vl Z-,4--,2 rO ie: (size) 33 x I G•83 �(/ , NO. OF BEDROOMS— BUILDER OR OWNER �0 PERMIT DATE: <!S% COMPLIANCE DATE: 9., Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility "Z 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 leachin facility) Feet Furnished by `� , �- T3 ' + No. Fee Fee7esTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mie;poal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 1 4 Assessor's Map/Parcel /7h— VW -2_5 2— Lot Installerr''s Name,Addre$s,and Tel.No. (�,,�.�_1;j,� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size I .6 F3 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow - -�c5 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /y e_!� U Type of S.A.S. y�61�* Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agreeso ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions Tit 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y s and of%allth. Signed �" Date Application Approved b Date Application Disapproved for the following reasons Permit No. ,V Date Issued AMC No �6r 1#*4 N Fee . " M1I• a" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS application for �Bigonl *pztem Congtruction Permit ��' Upgrade Abandon( ) ❑Complete System ❑Individual Components Applicatton for a Permit to Construct( )Repair( )Upg ( ) p y po Location Address or Lot No. U�U e.7d &e Owner's Name,Address and Tel,No. Assessor's Map/Parcel 17h- 26W 2,1 Installer's Name,Address,and Tel.No. r n .�_1 ',(�t Designer's Name,Address and Tel.No. 4Type of Building: Dwelling No.of Bedrooms Lot Size /,P,6 R.3 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 /v a U Type of S.A.S. 23Z ZU IV Description of Soil Nature of Repairs or Alterations(Answer when applicable) " i 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 bf T le 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue"bytVs ard of •alth. Signed ,_ Date Application Approved b Date ''"tQ 0_�Wzf-el ' Application Disapproved for the following reasons Permit No. 0 010, _ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificated Compliance THIS IS TO CERTI1wY that the On-site Sewage Disposal System Constructed( )Repaired( r' )Upgraded( ) Abandoned( )by f P Afo xP/Ku at � ./ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permi*A'i` dated O- 7-6" 0 l Installer Designer The issuanc of this permit shall not be construed as a guarantee that the sP�m will function as dfe�s gned. Date �"" g,/� InspecLo ------ No.��/'� P0 ---- Fee - - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migogal *proem Construction Permit Permision is hereby granted to Construct( )Repair( LI)Upgrade( )Abandon( ) System located at 3 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:Construction must be completed within three years of the date of this rmit. ,t Date: ''"� ? ^' ( Approved I � .Sires /�L / spa -r- i of 2- 41 sties LOCATION .eP.!? ?Y.!�4. .. M�... . .. SCALE , /•� 3c! . . . DATE ;S&;P7 ZZ-zoo Pc. L� ��ss�so!zs i"J.QP i 7.0 �. 00 Doc Off: 1 1 LD71 # 2 /8 0 8 3 sq, rr. `I P, -�►A 1 \ r \.o to 7-0 v �P`� Of o`er EDVU"'R Na 26100 ,o L LA�� i`70,E iti - pd'77 7 0A. I-x7Z 5 oo �L7-S �— TO? OF F0UN= ION =NCPRTr. C DVL.?S tt ,/ ,'` OR SCi'.""_.U:S 40 ' 4` 4 M •j. _ _ _. = shoo EV�C.PLa_ MIN. r�L ., = S ;=L7*_. O :?V.C. (ONLY) ��MIN. LEACHING TRENCH V J REQ.. ,]Primt i ?-=i1. PIPE-MIN. ,a// I/Bpi 112� WASHED STONz 't Y ( ( Pr cm 1/4"PE?.r i..�-C`� `, GE✓r�- �.vVEPT of z.8— ��' S/.Z 3 GAS Zc"�. {L---•�{ DISC. — 913 BOX 6C.4R90 6"CRLLSH� t D84r we-I1/2".,-1 1rvFrcrir,�ToAl- WSH D STONE u✓� •�i EX/STING- I . 5-1.C, /4, Rpl.0,1 L; 0" �••''-'� P�So73 SOIL L0 S'c`Y�'.^,G E D I S PO SAL GROUND w� ,:,a_y N0 SCC. 1- Ms,, mol I i- , HOLE 2 .s¢sa.... v. .. . ..._ ... DESIGN DATA : 3G Sue-soi� TOTAL G ALLD N ' •• n �• S/.�0 9.., r M LZACMING AREA . 357.31�..SO.r s,�vD SIDE L_..CM IN G A?._.. —J,r G2gvGz GARBAGE DISPOSAL -?.EA 1NC..R ASE) 96 C-"G. 4�30 ;0:.3L. U.'"rr.NG AREA • 'ov ?ERALA,ION P.AiZ-LEss ?�1a.�Two �/i.✓- •r�.�.INC.-i Fv. S4uo LEACHING AREA PIER PP-�QL.:.TIDN P.:u:.w?ra 6/ZAVEL APPROVE -. - - . . .. . ._.-._ RO4 OF r iiEA.Trl DA��..._•-. --_-• .•_.. ..---.. N��F�44ss,_- E-SSED �,�H OF Pt SY : :��_r:+ OR JUSP=;off �P�, cy 30 AsED OF HB:.LH . . . - _ •�T .Z-7 0 C� R i • v K 9 tY N v can 2. �ifii/2 3�iv�Gs r-� 32 S �i(!uvsl • ' - . . . . . 26100 c 7 GIST C_ �.�!rc-�zrl�ccG ' y s ;. . . .. . . . ._... . . . ... ... .. - - .i�A, aN�41 LAN® EVAE 5/25/01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify th at the engineered plan signed by me dated Scar: z1 Zvc> , concerning the. property located at meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation (using GIS information) B) G.W..Elevation d + adjustment for high G.W. - DIFFERENCE BETWEEN A and B • . o SIGNED DATE NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in. the future without engineered septic system plans. q:health folder:percexmp t� '}5 L 3PY+,.Sp•ai r z # #;, t :( -"''.' �.tt-r`.� :.�4"t" 'd.t it rx' kxt,,Fr� a; z�'t ','1�1r Y .,y ,�A i £. d"�s a s yF,s.'+a t o,.tE.,6r�a''�di�s�,l rk F �a t„r ss+��1:��' "f-1�7.*ah i -;�F4?..ra'{t kf L'x�,,�r €k s:--+-ki.'t Aa.�3u2r>t°•<s�,.0''SAtj 7'C,y.�,�:�a rA v} .'.i"''a�- 'k''�.rr-�G:d"yj.4'"3r�-}+?,•r+tPr�£nJnt>..tr"tui".c t k'""N'.'�.',sw.r.^'�p.•.} as� S TOWN x ...OF BARNSTABL :LOCATION. SEWAGE # J0d I- 6 VILLAGE n i ---- ASSESSOR'S 1.MAP 1.& LOT17 �2 � INSTALLER'S NAME&PHONE NO. S:EPTIG TANK CAPACITY LEACHING FACIL Y: (type) ' % 7-- r-- (size). NO;QF.BEDROOMS: z BUILDER_OR OWNER d. 0 PERMIT:DATE: : -,•`: G ,c % COMPLIANCE DATE:_ 9.11>�'t�J Separation Distance Between the; : aximu :Bottoin of•Leaching FailitYm d0djustedGrotindwaterTable:to-the c Feet Private Water Supply Well and Leaching.Facihtq (If any wells exist on site'or witliin 200 feet of leaching,facility)_ v w Feet ZJ Edge of Wetland and.Leaching Facility(If any wetlands exist " within 300 feet of leachin facili ) Feet Furnished by .6G/l�r 107 c 7 a d A�� ESSOR'S MAP N0.f�l�I � PARCEL 616 6 C A T IONL°f *� S E W A G E PE R M I T NO. C a7 � firy h� - VILLAGE 3 � s INSTA LLER'S NAME i ADDRESS Co linve4a 001 U I L D E R OR OWNER I� o DATE - PERMIT , ISSUED h Y DAT E COMPLIANCE ISSUED ( 2v� ' /000 Zb /000 9AL- l4iT ^ u THE COMMONWEALTH OF MASSACHUSETTS OARD OF H LTH-� .._...... ...�lv........ ....OF.......r... .... ..4 ... .L_11.%1_ ..................... Appliratinn for Disposal urkii Tonutrudinn Frrmit Application re �id�F%� ns or Repair ( ) an Individual Sewage Disposal system t: . . .��. � ..1 G ....... d .�_�c4_...6-:�� ............. Location s No. EIJ�J ................ :Y ... :: .. . .__..._... --.........--- --•---------- ...--_-Z`1_!.`1--!.1`. __.............................._._...-. wner 'q ddress .............................. Ins Ilex Address //�yy��yy Type of Building Size Lot... .llll .:Sq. feet � Dwelling—No. of Bedrooms................ .._...__.__.___.__..Expansion Attic ( ) Garbage Grinder 044 Other—Type of Building ____________________________ No.. of persons 'persons___........___._._._.__._._. Showers ( ) — Cafeteria ( ) d Other fixtures 1>�C_____________________________.............................•^� W Design Flow............(.10- -•-•----. gallons per geesen �rrcy. Total d�i f flow...........�� !............ 1 r . WSeptic Tank—Liquid capacity0oa.gallons Length.__ _..�Lt.._- Width; _._ Diameter:............... Depth._..._( ... x Disposal Trench—No..................... Width.................... Total Length.............. Total leaching area____ ..._.rr_. Sol ft. 3 Seepage Pit No........�__----------- Diameter_.._-�....... Depth below inlet...._....... Total leaching area__.L_ ..Tsq. ft. Z Other Distribution box Dosing tank0-4 Percolation Test Results Performed by... ..L Lt !4L4k.i ............... Date....Test Pit No. 1.__-.___. IL inutes per inch Depth of Test Pit.._�.r—__�o_..___. Depth to ground water.._aA:.._. 44 Test Pit No. 2................minutes per ch Depth of Test'Pit.................... Depth to ground water........................ r� -- . . .._ Ll..... .. O Description of Soil...�� lt_.. ._... _ 1� _ 1 8. �tq/ _ x -- •-_ �.. � .. .C% V ..........•-•-•••-•-•••-•.......................... /� d.... n �/'�t-�� .._..--•--•..............:..................................................•••----•-.... _5,d._--•-•- U Nature of Repairs or Alterations—Answer when applicable.....:......................................................................................... ...............................••----••-•--•--•-•--•---------•-•-------..._......---•------...---•----._._.......-----------....-•--••-•--•.--------........__...-......__._....--•----...•-•-.......... Agreement: The undersigned agrees to install the aforedescribed Indivi ial ewage Disposal System in accordance with the provisi ns of: "' 5 of the State Sanitary Co The ui er further agrees not to place the s,stem in operat o t ertiticate of Compliance has bee t b f health. t, Ligned_-_.... --••........ .....•-.. ......•-----••---....••••--._......_............. ��....D;. ........_/..Application proved By_._..__..._ ...............4........... '.............................................. ....... • 2--t-•ram'-•-. . Date j Application Disapproved for the following reasons:................................................................................................................. -••--•--•...............•--•--••------........__........-•------...._....---------•-----........---...................--•--•-----...•---•--•-•--•--........--•---._...._.......----........._______-__--- Permit No.________.�� Issued............................. --•..... ......... ............... � ^•-••----....Date...... Date ,.4 ,✓ 'F is. :��?........... ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r .... W....... �� _ Appliratiun for Disposal Works Tunstrurtion itlern it Application.,isrhereby-made for a Permit to`construct `' ) or Repair ( ) an Individual Sewage Disposal System at: F 'V/ . ---- - .. Location-6Add ess �`"""'' or Lot No. ••-•-•-•--••-- -- --- ..... --•-•- a _1~1.�� _a% f �Q-f�J . Address ............. ....---••-...••... .......... J?.W.........E.. Installer •. Address Type of Building r` Size Lot._ :�. ..Sq. feet Dwelling—No. of Bedrooms................�` ....................Expansion Attic ( ) Garbage Grinder ( )� e of Building a Other—T yp g •-•-..-•----•............... No. of persons....................•....... Showers ( ) — Cafeteria ( ) a Other fixtures ................................. ....---•......................0............•_. ..... ••--• �l fC,t.Y�� Vfii W Design Flow...........�. .�. .......-�y ...gallons per person p1r day. Total daily tflow......._ "' �� .._.__:...._gallons W Septic Tank—Liquid capacity M--gallons Length 4�__-).._. Width. ......._.......Diameter................ Depth f t:�._. Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...........�..&Sq. ft. �?. 3 Seepage Pit No....... ............ Diameter......_?....... Depth below inlet.....C ....... Total leaching area.-:��(. (sq. ft. z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by.... :..�. ............... Date....1 �.!,�� a Test Pit No. L.4�—..�minutes per inch Depth of Test Pit.. �___._. Depth to ground water... L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (....._ ........ ........�..._ O Description of Soil...:2 1�• dal�� /(1 - r�cf�� - � •_(�1� ;! �z .. --- r ------. U Nature of Repairs or Alterations—Answer when applicable..............................° .. .........................••------••••••------------••--•-•••.-••••----•••.......----...........................---............. Agreement: The undersigned agrees to install the aforedescribed Individual ,Sewage Disposal System in accordance with the provisions of.I LZ 5 of the State Sanitary Code'— The un er�signeed further agrees not to place the system in operatir(—, otf t�iiihha Certificate of Compliance has beenf%issued by�the oarrjd,,bff health. \\ Signed- ... .................................................. ................... ( +E / Dater /fflA:ication�proved B / t.? r ` Date Application Disapproved for the following reasons:...................................................................................------..Da.t e.............. v........... ........ ........ Issued........................................................ Da .... Date Permit No.- _ ��.._..... .--. _..... Date --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH-----_E .......................................... -�� b Trrtif utt#r of Tontplia"r THIS IS, TO CERTIFY, That the Individual Sewage Disposal System constructed ( L-)-or Repaired ( ) - -- ... s .•••• -� .......................••••---• •....-•...................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__ . ._( l��'�..... dated.......... hz/ef .. ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION',SATISFACTORY. DATE. �f.jv----•.--- ........................ Inspector.. , ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH_,-_ OF.�l. l� l ..'�..... ............ f.. ..................... No..�.... .............. ✓ Fes.----.....:............. Disposal Works Tonstrurtion 11rrutit Permission is hereby granted............ ; ._" .. ..1......_.v._.. !:.................. r ,.... :.. ....:.. 1 to Construct (L) or Repair (. ) an Individual Sewage Dis,po9sal System /') at No............................ 17 "� �-........................ �........................................................l ( + j -....... V Street as shown on the application for Disposal Works Construction Permit No.=?5- Dated..�///;z ......................•----------------------------•---•------------------.........-----••............._ 2 Board of health DATE..... -•-2-••---••/.. a.. Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection Jitl One winter Street,Boston,Ma. 02108 D.E.P.Titlee Sept i V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.wELD (508)564-6813 Governor ti j ARGEO PAUL CELLUCCI 1 Lt.Governor 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM NN PART A CERTIFICATION �9ip M4 10 G� t \"lc� Ldc � yea '761 Property Address: 325 Skunknet Rd.Centerville Address of Owner: Date of Inspection: 3/4198 (If different) TyF92sl '1998 Name of Inspector: John Oraci Paula Conners r�� I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) CW Company Name,Address and Telephone Number: 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 This Inspection Is based on criteria dented In Title V Conditional) Passes code 310 CMR 16.303.My findings are of how the system Is y performing at the time of the Inspection.My Inspection does — Needs Furt r Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity ofthe Fails septic system and any of its components useful life. Inspector's Signature: Date: 3wils The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any Information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. 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 infilliation or exfillialion, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 0 Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 325 Skunknet Rd.Centerville Owner: Paula Conners Date of Inspection:314199 _ Sewacle backup or,tlreakout or hioh.static water level observed.in.the distribution box is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced 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 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 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 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined 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 Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to nn overloaded or clogged cesspool. SAS is in hydraulic failure. (reyleed O4127187) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 325 Skunknet Rd.Centerville Owner: Paula Conners Date of Inspection:314199 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool Is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: 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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revleed 0412T)8T) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 325 SkunknetRd.Centerville Owner: Paula Conners Date of Inspection:314198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 04117)871 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 325 Skunknet Rd.Centerville Owner: Paula Conners Date of Inspection:314108 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g•p•d./bedroom for S.A.S. Number of bedrooms: J Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): e nra Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nia Last date of occupancy: nda OTHER:(Describe) roe Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has never been pumped. System pumped as part o In ection:(yes or no),�,�QS If yes,volume pumped: I�gallons Reason for pumping: - Milt t(l kZAG ri TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(it known)and source Information: 1996 Sewage odors detected when arriving at the site:(yes or no) No (revised 04R7)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 325 Skunknet Rd.Centerville Owner: Paula Conners Date of Inspection:314199 SEPTIC TANK: x (locate on site plan) Depth below grade: V Material of construction:x con create—meta l FRP Polyethylene_other(explain) If tank is metal, list age n/a . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: l e'6"H 67"w 4'10" Sludge depth:6" Distance from top of sludge to bottom of outlet tee or baffle: 22" Scum thickness:t' Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle:6" 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 and functioning property.Recommend pumping every two years. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rya Scum thickness:We Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumping;,f, 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.) n!a BUILDING SEWER: (Locate on site plan) Depth below grade: iv, Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction lineto— Diameter: 4° Qmments:(conditions of joints,venting,evidence of leakage, etc.) (revised 04127)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 325 Skunknet Rd.Centerville Owner: Paula Conners Date of Inspection:3f4198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: We Capacity: rja gallons Design flow: n1a gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nla Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rda I (revlaed 0427/97) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address; 325 SkunknetRd.Centerville Owner: Paula Conners Date of Inspection:314198 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rds Type: leaching pits,number: one leach pa leaching chambers,number:Ne leaching galleries, number: nla leaching trenches,number,length: rda leaching fields,number,dimensions:nla overflow cesspool,number:nla Alternate system: nra Name of Technology:_nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach ph and all components are structurally sound and Nnctloning properly.System has T of water In It. CESSPOOLS: (locate on site plan) Number and configuration: nia Depth-top of liquid to inlet invert: Na Depth of solids layer: NO Depth of scum layer: nla Dimensions of cesspool: nla Materials of construction: rda Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) nia Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) rda PRIVY:_ (locate on site plan) Materials of construction: nla Dimensions: nla Depth of solids: nIa Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) roa (mleed OM27I97) J i V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 325 8kunknet Rd.Centerville Paula Conners 314198 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 1 �ecY— ��la i I3 A ;i3 0 'q AC kt (nvlud0MST) page ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 325 Skunknet Rd.Centerville Paula Conners 314199 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts. (nvlsad04127197') page 10 of 10 Health Complaints 21-Nov-00 Time: 10:00:00 AM Date: 11/21/00 Complaint Number: 2621 Referred To: GLEN HARRINGTON Taken By: K.S. Complaint Type: NUISANCE CONTROL REG. 1. RUBBISH Article X Detail: UNSANITARY CONDITIONS Business Name: Number: Street: SKUNKNETT RD. Village: CENTERVILLE Assessors Map-Parcel: 1 SECTION - SEWAGE } 14. SEPTIC TANK I _..D..BOX - ¢l -LEACH. TOP OF FON 14, <f7O(MSIJir • O STONE OUT. WASHE D } • vEFc 1> � . . OUT _ t IN• • IN- OUT�-°ur' IN _ v� ,. -- SEPTIC 52.32 5 o�S G 5'/,83 s�, so L o l 23. TANK r e t ELEV. ELEV.. .ELEV._ € -- - ELEV (. G ELEV. ELEV. ' 5�50:. (' .. r /O • OFi4 1�h 1 WASHED STONEr. _ t TEST HOLE--LOG fay 5073 TEST BY ��N ..I zog-L-O� G a •: Z WITNESS . 3 9' T TEST DATE D $IG BEDROOM HOUSE `. TAI sa► 1 T.H. 2 z3� ELEV.Gj4,1j ELEV. NO E_ �I LoQ 116 PERC RATE G2 MIN/IN DISPOSER DISPOSER 5 S FLOW RATE 330(GAL✓QAY) 33 k SEPTIC TANK 3?,o (1, ��S w. L O T -+ 26- klTH^ VSL- REQ'D SEPTIC TANK SIZEel 6a S ` s�-(o�y LEACH FACILITY _. _._ .. SIDE:WALL - - ) ' G/D. �atl 5 o MEpTT2o ...15b....8 ..... . _:. �� BOTTOM , 3 (f�0} GfD TOTAL USE: Ot�CL LEACHING �1? 1, �S�T _L WATER ENCOUNTERED ` NO I'Es:' (UNLESS OTHERWISE NOTED) 1.DATUM(MSL)r TAKEN FROM '�AI`'�2wlc7 QUADRANGLE MAP _ 2.MUNICIPAL WATER AVAILABLE 3.PIPE PITCHt%%-PER FOOT _ 44-lO "4:OESIGN'LOADING FOR ALL PRE�ASTUNITSs AASHO- -44_ _... ... . _ . . .. ��t F� ; 2�� m b.MIN-GROUND COVER OVERALL SEWAGE FACILITIES:(1)FT. " T - �` , �I�{; if 1�lV p E . .,. 6:PIPE JOINTS SHALL BE MADE WATERTIGHT - - pN� �� 7:CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. ARNI_ }+ i.•%, �� I ( At^ - - STATE ENVIRONMENTAL CODE TITLE S ti rL G,xJ .e.._, ` '1 LOCUS: L 6T- 27 SKU1�iKNET 12AAb Ty b 0 'S+-10�� b I W t-..lo-e- �E USF.,D ram. �t.07t...L `C t_.�-tG- �c'b.�n._►G ? - -. - -- - REG. IV `r GINEEFI-t h4" rw ''S REF _....._ } d . n ;: RNE y -boo �/0 3 PA bF z own capea 1I eer n�' • c PREPARED FOR: kI S 1 CIVIL ENGINEERS d u LAND SURVEYORS BOARD OF HEALTH -- --- 5 �_� s�jQ Maln. '.;a. -'_ 'SV SCALE - CONTOURS .(PROI(PROPOSED) 0-OHO'-0- APPROVED DATE MA Y " t"t..� `"`" " DATE j e l , SECTION SEWAGE , � -SEPTIC TANK- 1 _•.D..BOX - ( -LEACH. TOP OF FON 2 •tC7O(MSL)• "2"OF:/8T0%" WASHEe TONE IN• ,- i . 1d OUT• IN• OUT- SEPTIC G i t �2 i CO�j I TA K .5/i 8� i �� O 1 , ELEV. ELEV. ELEV. 1 ELEV. s1,751 5�sg � �1 ►,. _ ELEV. ELEV. l -4'S 5 - _ OF 3w^-ice•• .'. I /1 cOI WASHED STONE _ LOT-27 t�,• / tK l t:ei'roM n T+(�1 C U-+- I g,083.51%'` I$.50 >ra u I S 1 2 2 U 7 ai 2S HOLE LOG 73 4 TEST � - A. TEST BYr-pq WITNESS •-!� � - �. 4 -T a WITNESS .3 Q� TEST DATE Woe, I U� ' BEDROOM HOUSE t� DESIGN T.H.- �► 1 T.H. +� 2 ELEV. -rjt�,� ' ELEV. 2 NO J tl p,� PERC RATE MIN/IN. DISPOSER DISPOSER' 5 5 FLOW RATE 330(GALroAv) '..3�3 �/ lP-�� Ed S�&IJ D SEPTIC TANK 3� (� �9� � �, �r"T w '\ 2 0 T Z C� j •. VA T+f' VS REO'DSEPTlC TANK SIZE r LEACH FACILITY SIDE-WALL r9TT7n l>b,g . (Z�j + OG D. � BOTTOM (/,p! G/D. TOTAL Z L}27, 00 Lj USE: C� LEACHING T L4_>77_ �� •c� WATER ENCOUNTERED NOTES: '(UNLESS. OTHERWISE NOTED) Ate. 1.DATUM(MSU�TAKEN.F.ROIyI•� f��v1r_,}{ QUADRANGLE MAP to 2.MUNICIPAL WATE AVAILABLE �C -��.L �J cl ' 3.PIPE PITCH:*•'BER FOOT' .. / r o" 4.DESIGN FdR ALL PRE-CAST UNIT' AASHO- O 44 - a LtN OF F�+,IT ; 2_0� 01M147, S.MIN.GROUND COVER OVER ALL SEWAGE FA 'LITIES:III FT. 6:PIPE JOINTS SHALL BE MADE WATERTIGHT4 'c b I V l`I {LIJ 7.CONSTRUCTION DETAILS TO BE ACCORDANCE.WITH COMM.OF MASS. ARN)_ t' �� I r r1 ' SITE PLAN STATE ENVIRONMENTAL CODE TITLE S' 8. T�-a,� ��.� Fot � � :wa'C�C o..�� n._,n -5•+o�„a 1 2 (2 LOCUS "l .:I G. RI3„Ft _.DIVA; GINEEFt :`air. ;./C) /I %` 7 _ . . ... u:.:,� RNE9 REF: �. '- }' ..-,t=- 7 �®fin cafe e� s��er,� �+ - '7 /Jo - •„c:. ,,, PREPARED,FOR. - CIVIL ENGINEERS LAND SURVEYORS -- r BOARD OF HEALTH • 1 Ca:, :ND y , S . _• s�8 In St, - J 1 EXISTING)__...-•-• y�� « �. .- � SCALE - �-�-- t_ 5 f S � � r U R ::. CONTO P F•� MA � ------ s; � --� �•, I c� DATE ( ROPOSED)-0-0-0-0-- APPROVED DATE y��.,��.. �f„r r,, eaa