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HomeMy WebLinkAbout0395 SKUNKNET ROAD - Health 395 Skunknet Road Centerville F J A = 170 118 `I TOWN OF BBARNSTABLE LOCATION 4 SEWAGE # CIL/—04 VILLAGE GeNI�-� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.--a) SEPTIC TANK CAPACITY -'fir S'� U LEACHING FACILITY: (type) Vfllaff (size) NO.OF BEDROOMS (D IL Pr 8S FcM•�- BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L rl 1 s�now d 1 e o� 3 N.. �?T • Fee_ `© THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYicatfon for Mtopogal *p5tem Construction Permit Application for a Permit to Construct( )Repair(>�Upgrade( )Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. 3'05 51r4>0XT1&k Rd Owner's Name,Address and Tel.No. AA46_,%V,1_ (Zoo*mA1Npt i M'A SAME Assessor's Map/ParcelI TO I 11 b LM*LAM Installer's Name,,N>c Address,and Teel..No..}, Designer's Name,Address and Tel.No. ,-Z p*;c sar%Ace arQ��`oc meta\ Svcs. ccmoo*N A (o`ker 5b\0 �.. n�'e. M Type of Building: 0 �, v l 3 Dwelling No.of Bedrooms Lot Size IbTsq.ft. Garbage Grinder 41.4 Other Type of Building 24 &4C&1 N No.of Persons 3 Showers Cafeteria(v� Other Fixtures L14d%—%-b 2Y 1"C;idna. �a, Design Flow 3 0 gallons per day. Calculated daily flow Bat.ate—gallons. Plan Date Number of sheets� �� I C..- Revision Date Title N CC91� 59i&_;C- �5u skm L 7[ RM& Size of Septic Tank ICj�\��}. 1,t)m QO. Type off S.A.S. lD X Z9-AS Thenc�n W 15,t N Description of Soil :F�99_f- -tfl V?\CA-1 Ft trTR�1T0 QS Nature of Repairs or Alterations(Answer when applicable) 7j?Q 5FaC AW�, Q%QA1• 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 oft vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee y th' o4rdooea Sig. Date Application Approved b Date Application Disapproved for the following reasons Permit No. 2ko Date Issued O No. 7c Y � 7 �..--,- i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes "V PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Z_izpIwml bpgtem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System/Individual Components Location Address or Lot No. JC(J �. ��C� Owner's Name,Address and Tel.No. L1n.-1-a i mC S Ec k Assessor's Map/Parcel W-T -t�r UkA\ -, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C �jc�N\Ce F1� D' 'v jaX Cod WGrrncauacV, P� t:,"��-Sb\a �e 1c�oc MA b253b Type of Building: ),j ? ;�t ,) Dwelling No.of Bedrooms Lot Size 15 j 9J5 A sq.ft. Garbage Grinder(OA Other Type of Building Q(`A`iQA No. of Persons Showers( ✓) Cafeteria( ✓) Other Fixtures LAQP,\tD R-Y, K�ACh9IN 4a;\(lk, Design Flow 0 gallons per day. Calculated daily flow '331 .9c) gallons. Plan Date Jr- A5 10 4- Number of sheets I Revision Date Title L Sq4 SAO�m UDC C► _ Size of Septic Tank rCX 1A 1 U DO Ga Type of S.A.S. + X 5 A TD 25 Description of Soil __ _ �F l � P\C 1-, W J N F L_TR y Nature of Repairs or Alterations(Answer when applicable) �Rc V\a(- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y thi , oard`Of ea Sign �- 1 Date J `D Application Approved b Date � Application Disapproved for the following reasons Permit No. C y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( )Upgraded ( x) Abandoned( )by � C 5 S e g- C �-i u\Gsz at_ r'S-1 )1A• . CQ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer ho �5 QkCe Designer _�,�eJ�r`es PC)U;C� n'tOX Svcs. The issuance of this per it9hall�ngh®p�construed as a guarantee that the systb` *`i 1 fliAtion as designed. Date ,/ `f Inspector No. �..oD�"�— �-(o C/. -----------------------Fee t THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Df5pogal *pgtem Congtructiou Permit Permission is hereby granted_to Construct( )Repair( )Upgrade(A Abandon( ) System located at 3c1 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: Constructi n must Pe completed within three years of the dat of hi p, � `d^Date:_ '� G G Approve lhy . 5eN • 20-01 13 : 62 BARNSTABLE HEALTH DEPT 5087906304 I P. :�C)TICE; This Form Is To Be Used For the Repair Of Failed Septic c Systems Only. I � P Y � y. I PEKU)LATI0.N 'TEST AND SOIL EVALUATION EXEMPTION FORM - I v) hereby certify that the engineered plan signed by me concerning the property located at �p say �t� f1��'� �•t 2[V-�Ie meets all of the IC110,v,n0 ::ntetla: I • This ('ailed system is connected to a residential dwelling only. There are no _ommer �1! or business uses associated with the dwelling, Tl�e foil is ciass;;:td as.CLASS I and the percolation rate is less than or equal to -Ti..') lees per inch. The applicant may use histoncal data to conclude this fsc: or may n�uc( are'tm�::ar% tests at the site without a health agent present I • There :s no increast to flow and/or change in use proposed i i her are no vanances requested or needed. I • The bottom of the proposed leaching `acuity will not be located less than fourteen l,s lee: aoove the maximum adjusted groundwater table elevation. �Adiust the nundwater table usin; the Fnmptor method when applicabtcl I, Please Clomplete the following: �. fop )( Ground Surface Elevation (using GIS information) _ ',ju I 5; t W E;evar.on ad;ustnent for nigh EETWEEN > and B T•90 I NOTICE 3asec on, ere above ir.formacion, a room( permit wil! be issued for 'Dedroorns bedrooms ue authorized to the future without engtneerec api.: aem plans. ° ':0C1 PCiCCAMP I I i I I .. Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION i Site Location: Lot No. �nC� Owner: AO-a0- C­A�k Address: MQ Contractor: � t,7t Address: Notes: Li I ' i I i STEP i Meiasure depth to water table toi earest 1/10 ft. .............................................................................. .Date S I mo th/da�Iy,,r STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: M► AO Appropriate index well.................................................... ^, ©lWater•level range zone ..................................................... V I STEP 3 Using monthly report "Current Water Resources Conditions" det ermine current depth to l water level for index well ........................... 41f14 7�� monthlyear I STEP 4 Using Table of Water level Adjustments for lindex well (STEP 2A), current depth to water level for index well (STEP 3), and1water•level zone (STEP 2B) determine water-level adjustment I STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to,water i ^ level at site (STEP 1) v�• i i I I Figure 13,--Reproducible computation form. i i 15 i 1 TOWN OF B STABLE LOCATIO:2r--LIC� K� SEWAGE #VILLAGEe'")C ASSESSOR'S MAP & LOT INSTALLER'S.NAME&PHONE NO.� � SEPTIC TANK CAPACITY F S?S*k U L` 1 / LEACHING FACII,ITY: (t, e C+X4LrVq,,Wf (size) ,, 7 Kl� k t NO.OF BEDROOMS V BUILDER OR OWNER _ �^ FERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching•Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by + Yvi _��� 0 6 z N/' C9' wi ca, Town of Barnstable �OF I H E 1p� do Regulatory Services * Thomas F. Geiler,Director * BARN3rABLE, 9�A M�: � Public Health Division TFp �s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: S Designer: Sc_�O� Installer: a �S Address: Address: 0o4in m/A On 'S was issued a permit to install a ate (installer)septic system at_115 � U(� '�- ,, ►t 6based on a design drawn by (address) Q-,t) N dated �s 1 (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. CARMEN E(Installer's Signature) �� a SHAY n No. 1181 0 G l S T �<. (Designer's Signature) (Affix Desi 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/Designer Certification Form FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI RECEIVED DEPARTMENT OF ENVIRONMENTAL PROTECTION d APR 2 8 2004 TOWN OF BARNSTAbLE W 0.......... e HEALTH DEPT. �M Se TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION vAP 11 Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 PARCEL Owner's Name: STARCK Owner's Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 LOB Date of Inspection: 4/2/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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 _ Conditional asses _ Needs Furt a Evaluation by the Local Approving Authority X Fails f Inspector's Signature: Date: 4/2/04 a The system inspector shall submit lo py of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti .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 SYSTEM FAILED TITLE V INSPECTION. LIQUID LEVEL IN LEACH PIT AND D-BOX IS FULL OVER PIPE.D-BOX IS STRUCTURALLY UNSOUND. LEACH PIT AND D-BOX NEED TO BE REPAIRED TO TITLE V STANDARD. ****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. Titles 5 lmnPrtinn Fnrm Fi/15nnnn 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 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: SYSTEM FAILED TITLE V INSPECTION.LIQUID LEVEL IN LEACH PIT AND D-BOX IS FULL OVER PIPE. D-BOX IS STRUCTURALLY UNSOUND. LEACH PIT AND D-BOX NEED TO BE REPAIRED TO TITLE V STANDARD. 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. n/a 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: n/a n/a 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: n/a n/a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 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 n/a "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: n/a Page 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: 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 ''/z 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 NOT IN THE LAST YEAR PER OWNER. X Any portion of the SAS,cesspool or privy is below high ground water 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 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 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 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 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. a Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 Check if the following have been done.You must indicate"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 Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period'? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum`' X _ 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 X _ Existing information.For example,a plan at the Board of Health. X _ 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)] S I Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 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 Number of current residents:3 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)): d2_ „ \Cj Sump pump(yes or no): NO Last date of occupancy: n/a d l Z to oo-) COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sq$,etc.): n/a 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: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST YEAR PER OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a 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/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): n/a Approximate age of all components,date installed(if known)and source of information: APPROXIAMTELY 20 YEARS OLD Were sewage odors detected when arriving at the site(yes or no): NO Page 7 bf 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction:_cast iron =40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete_metal_fiberglass polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 1011" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:30" 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 were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUN TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: OVER PIPE 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.): LIQUID LEVEL IS OVER PIPE IN D-BOX.D-BOX IS STRUCTURALLY UNSOUND.RECOMMEND REPLACING D-BOX. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): DID NOT EXPOSE LEACH PIT.LIQUID LEVEL IN LEACH PIT IS FULL OVER PIPE INIDCATED FROM THE LEVEL OF LIQUID IN THE D-BOX LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING AND LEACH PIT NEEDS TO BE REPLACED. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 395 SKUNK-NET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 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. OIL AC�) W in Page 11 of 11 a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 395 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: STARCK Date of Inspection: 4/2/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. No...V Flcs... THE COMMONWEALTH OF MASSACHUSETTS '3 BOAR® OF HEALTH i o ...... .. ..... �" L ,� lira#lun for Uhi uual Work.5 Tunutrnrtiun VarAit Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal System at: G ✓��� �N ....L: .-..._ .............................................. ocation-Addres or Lot No. Owner � r-�' . dress `7"�_�AY_ ....---..�' r . .�1C`��.. C.,.. ..................... Installer Address -- Type of Building Size Lot---- `T-Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder (j `-4 Other—Type of Building No. of persons............................ Showers — Cafeteria P4Other fi t es --------.............................................................................................................................................. w Design Flow..........................................gallons per person per day. Total daily flow__.___. ...................gallons. WSeptic Tank—Liquid capacity.1v��.gallons Length_. .. Width................ Diameter__._____.._..... Depth-:-__-------.-_. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------I--------- Diameter......I?e....... Depth below inlet....A:-t `��......... Total leaching area.z ....sq. ft. Z Other Distribution box (�/ ) Dosing tank ( ) ~' Percolation Test Results Performed by..__ AFt Akg._ _&S...-- JJC........:..... Date__I V*�k4_........ Test Pit No. 1___�' "____.minutes per inch Depth of est Pit......s_'..._.. Depth to ground water_.___---............... (s, Test Pit No. 2----------------minutes per inch_ Depth of Test Pit.................... Depth to ground water..:_.................... P4 ----•--------------------------------------------------- ---- ------ ------------------------------------- Description of Soil------.... �7.�_. v -------------- .-.�2-..__... ..1 N--P...... - ..........------------------------------------ w UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ --------•-------------------------------------------------------------------......................................-.................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the proisa of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation a Certificate of C mpliance has en issue y board of health. tT Signed. G�/Y/0 ..... a PPlication Approved B PP Y-------------- ---- --- -----••- - -- -----._.._.._......---•-- ...-•--••-�------fix- - Date Application Disapproved for-the f owing reasons---------------------------------------------------------------------------------------------------------------- _.l ------••---------------------•-----•-•---•--------------• ---....----•---- Date PermitNo......................................................... Issued....................................................... r { No........................ Flms.........................._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - . .. ..........................OF......'�i��...iL..�_......__.. �... ���_.-_...-.-..._. Apphratiun for Diupuual Worku Tunitrnrtiun ramit Application is hereby made for a Permit to Construct ( 1�or Repair ( ) an Individual Sewage Disposal System at: ..... . -)...-t ..�...... ...... `J I...� � <i..'..:_l.'...... ....................................... ............1 1 � .... .......................................... -.. Location-AddressNo :.�_.. ri r l.l�r, c — ...........................................1 � '��. "� L1 t.-1 hi i ,y or Lot A/ � s. - ......... _._.:................. --....._.....----------•-----........_.---.........._..----.._........------..._.........-- Owner r,- F -- dress Installer Address Type of Building 7 Size Lot.......L._:__:._.'. _..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (i1 �`q Other—Type T e of Building No. of persons............................ Showers YP g ----------•----------------- P ( ) — Cafeteria ( ) Otherfixtures .........................•----•-•--•--••--•-----•-•-•.•-••••---------•----•-•-------•---••......•----- W Design Flow.........................................•_.gallons per person per day. Total daily flow.._....."- _`.-__-------....__..._..gallons. WSeptic Tank—Liquid ca.pacity.!.`.i_.gallons Length_'.__ .. Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------f--------- Diameter.......,.._........ Depth below inlet.-_.`.�..._.... Total leaching area.:-_`�'2----sq. ft. Z Other Distribution box (v ) Dosing tank ( ) aPercolation Test Results Performed ........_............................... z Date... ..�� 1`{_............... Test Pit No. 1................minutes per inch Depth of Test Pit......!.: _........ Depth to ground water.i-_---______---_--_. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 O Description of Soil. � ----r`>-V.-- --- v C - 'c,_.!L �� 1� -' 2_ �/ i = `� =�� 1 r- ►� U W -•----•-•--•----------------•----------------........--•-----•-----•-•-•--•-••--------•--------•--•----•---...------------------------......------•---.................................................. . U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------•-----------•--•----•-----------------------------------------•---------------------....--•---•-------------------------------------------------------------------••-•-----••::::.............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the prgj&jZM of TIT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation unN a Certificate of C mpliance has been 'ssue y e board of health. �- VAkJ Signed. a!:::. <-' R lication A roved B Application Disapproved for the owing reasons---------------------•----------------------------------------------------------•••-• ------- ..---•--------------------------------------•......----- 1 -------------------------------------------- Date PermitNo.•-•-------------------•------•--.........--•--•-......-- Issued-........................................................ r • r THE COMMONWEALTH OF MASSACHUSETTS BOARDT r F HEALTH OF....... ..:...y %. ';t'..: ... `j..�-�.... .-................. . (9rdifiratr of Tautphatt r ,tea THIS IS TO C RTIFY,.,That the Individual Sewage Disposal System constructed ( �or Repaired b ..... .. :f 'e. s --/------.f�: '?. "" - r��r=- tp !�' . -- -------------------------------------------------- -- -----..... In e r has been installed in accordance with the provisions of Ti 1E 5 of The State Sanitary Code�as described n the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL //FUNCTION SATISFACTORY. DATE........... ..7...- ` ............................................ Inspector..... 74SETTS • ---------•_-------------.._. THE COMMONWEALTH OF MASS BOAR F HEALTH I I No..G? °.......................................0F.:.. . ... /, . -..... ...........--- FEs. U .... �iu�uu�a1 � �u ,��rttr�iun rrntt� Permission is hereby granted...- ) �<== / '' . _"`1r/ ..ev to Constr>cr Repair ( `) an Individual Se a e sposal System at No. fir_ _!a!*.......... r-. > ---••-••---......... -•-- .............•. �j... Street �t as shown on the application for Disposal Works Construction Permit No.___ .............. Dated------------4— ........ DATE.----- .... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .b r SECTION A -A 10' min. from "NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. ALL OUTLET PIPES FROM THE VENT PIPE (0 Least 24 inches tall) PROFILE VIEW OF ADDITION TO LEACHING SYSTEM DISTRIBUTION BOX SHALL BE Existing Foundation I house to septic tank Schedule 40 PVC w/Charcool Odor Filter - SET LEVEL FOR AT LEAST 2 FT. - 12• CONCRETE COVER TOP OF FOUNDATION = ELEV. 100.00 (Assumed) _ Septic tank covers must be 3" of 1/8" - 1/2" Washed Peastone within 6 in. of finished grade Grade over Septic Tank - 99.00 __-Grade over D-Box - 99.00 -Grode over SAS - 99.00 3/4 CO 1 1/2 Washed Crushed Stone �- - I 3 - 5'OUiLET -.♦ ':��.i.'• 2 i �< KNOCKOUTS 5.5• - i 12• 0/LET SI .OUTLET 3 HOLE H-10 - e• +°�-1�� ' DIST. BOX 3' Maximum Cover -iop Load - Ekrv. -95.75 ` EXIST. - S=o.ot o crater // I 2• °- C� � " tBY.P1PE y^ 1.000 GAL. -- 5- o.o)• toot _-- • / -tss•- - - ; �- - -_ PK a - scH. 40 T ,.7s• - "'►i 1 4` FROM EXIST. FO11//DATIDN lSEPTIC TANK N 5 10" Enecttve Depth •� N�1r H-to a; O 20 --- 5 units a 6,25' = 30' PLAN SECTION CROSS-SECTION ". •3 !/J 0.,ew. rn r, o in CONCRETE FULL FOVNQA n rn a, rn �0.83' (10 inches) 6 hot 3/4•-1 1/2 i E „ 1 --- 37,25' -- - 3 HOLE H-10 DISTRIBUTION BOX `,�•� ' l ,� r `A. SYSTEM PROFILE n , C compacted stone 5 u u •' rn Effective Length NOT TO SCALE L �sroa �.•,' Not to Scale - c u .•P"�'.-: io ' O'Dat are kcMrr c:xw•r.a mo+Nxntlaion T«+.pw,.s a' a' ° S_C'IL ABSORPTION SYSTEM (SAS) c [-2 > 6 in.of 3/4•-1 1/2• 05y INFILTATR❑R HIGH CAPACITY (H-20 L❑ADING)/ GE❑RGE ❑'BRIEN GENERAL_ NOTES -- compacted stone Effective vktth OR EQUIVALENT Not to Scale NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE - a ( ) 1. Contractor IS responsible far Digsafe notification a Bottom or Test Observed e , d 0 132 00 m NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" FFECTIVE HEIGHT IS 10• and protection of all underground utilities and es. No Groundwater Observed O 132• - � p g pipes. 2. The septic tank and distribution box shall e se level on 6" of 3/4"-1 1/2" stone 3. Backfill should be clean sand or gravel with no -- -------- - - - - stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. X#6425. The contractor shall install this system in accordance LOT PERCOLATION TEST ly with Title V of the Massachusetts state code, the approved plan LOT #643 and Local Regulations. 6. If, during installation the contractor encounters any Date of Percolation Test: MAY 24, 2004 soil conditions or site conditions that are different Te'tt Performed By. CARMEN E. SHAY, R.S., C.S.E. o from those shown on the soil log or in our design Wit nessed tnessed By WAIVER ( per Barnstable B.O.H.) installation must halt & immediate notification be SHAY ENVIRONMENTAL SERVICES, INC. S 35d 29 06 W _ _ _ made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 MPI ® 48" 105.00' 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. - I 23.5' 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole 11� 4" PVC 10. All solid piping, tees & fittings shall be 4" diameter No. 1 VENT Schedule 40 NSF PVC pipes with water tight joints. Failed- DEPTH SOILS ELEV. Q s 11. Municipal Water is Connected to ALL OF The Residence and Abutting Leach Pit 0 99.00 3 C14 •'•.. Properties Within 150 Feet. Sandy LL Loam 0 C0 e THE PROPERTY LINES ARE APPROXIMATE AND 10 Y 3/2 co .t> COMPILED FROM THE SURVEY PLAN GENERATED BY 0"-12" A r 37. 5' '4 / s6.00 BAXTER & NYE OF OSTERVILLE, MA �_` (\ ENTITLED " SUBDIVISION PLAN OF LAND IN CENTERVILLE, Sandy iz 'it -- isr^';:� D-Box Loam to f EXIST 00 gal. p't MA", DATED MAY 8, 1984, PLAN BOOK 386, PAGES 90 to 94 10 vR 5/8 ~ - ''' � Septic Tank AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN '"' IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 12"- 36" tie 96.001 y f �;_~ N THE SEPTIC SYSTEM INSTALLATION. Fine Silty O Q r; Sand 0 ------....- 2.5 Y 8/6 M EXISTING LEACH PIT TO BE PUMPED OUT AND 36---48" c, 95.00 10�V CO REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION Med. TEST HOLE #1 Sand ELEV.= 99.00 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 2.5 Y 7/4 \ 48•-t32' G Ae.00 [T� ko FROM THE EXISTING LEACH PIT TO BE DISPOSED ^y ;�'% OF AS PER BOARD OF HEALTH SPECIFICATIONS. --- DECK LOT #645 NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY - o EXISTING ASSESSORS MAP 170, PARCEL 118 ►� -- --- 1 2 BEDROOM LEGEND A HOUSE Perc #1 - tvtunici-pal Wnter- {_ine- -- - #395 Depth to Perc: 48" to 66" [04X 1 DENOTES PROPOSED Perc Rate= Less Tho 2 MPI GARAGE SPOT GRADE Groundwater Not Observed 98 No observed ESHWT DENOTES EXISTING ADJUSTED H2O Elev. = None X 104.46 SPOT GRADE PL PROPERTY LINE PROJECT BENCH MARK \ o TOP OF FOUNDATION - -- - kX) - p PROPOSED CONTOUR ELEV. = 100.00 (Assurned) ' - - -- - - -97 EXISTING CONTOUR LOT #644 TYPICAL 1000 GALLON SEPTIC TANK 15954 Square Feet DEEP TEST HOLE & NOT To SCALE PERCOLATION TES1 LOCATION 2-18" EXAM. ACCESS MANHOLES \� ��� ' . -- 6 FOOT STOCKADE FENCE T - _ �-_- �- - _29 -06_" - - - P 0 PLA 35d H_ET I / 7 1 --- 1\1 OUT11T �7 \ htE „ 55CovERSFDRTHE �P„D1ANK, ------ -- - - - - OF PROPOSED SEPTIC SYSTEM UPGRADE DISTRIBUTION BOX AND LEACHING COMPONENT '• - _ SET DEEPER THAN 6 INCHES BELOW FINISHED 00 PREPARED FOR - •:'- ^-• -- GRAD ALL BE RAISED TO 1MTHIN 6. OF ,Sr KUNKNF h CA FINISHED A I� STEEL REINFORCED PRECAST CONCRETE A N T O NIA R . STARK PI A KI IC1A1 INSTALL TUF-TITF GAS BAM-ES OR EQUALS 3-24"" REMOVABLE p(ABLE ,bs (40 FOOT RIGHT OF WAY) Al # 395 SKUNKNET ROAD I 3• min clearance I ) N ,DILL _ 2'-min. -- ---- --- -- INLET min 1 Inlet to outlet 8. ".rn =I � Lbaa level ` -- Design Calculations 1a-mk,. °�� �`'� PREPARED BY: 5' -Y E --- I Number of Bedrooms: 2 Equivalent to 220 Gal./Day (330 Gal./Day Min. per Titie V) N �/'� /�/f�,�J �I a ��H11 Y E a ems'. �-a min Garbage Grinder. No E. !1 L�l 1 , oa w depth Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) J rn - Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. O 10 4U 5Q N 181 ENVIRONMENTAL SERVICES, INC. t � S ."., ,..�.� r '•:... ,_;',:i; r- ... •. .. . _-: . . _ .i - Using pert at in./inc .p� Rip OIL ABSORPTION AREA Us percolation rate of <2 m h 4 - -- gal/sq. q q _ - -- STE P.O. BOX 627 e'-o• - - Bottom Area: 0.14ft. x 370 s ft. = 273.8 alloys G Sidewoll Area: 0 74 gol./sq. ft. x 78 s . ft = 58 g CROSS SECTION END-SECTION Providing = 331a gallons ,vfTr;RtP�'.�ti EAST FALMOUTH, MA 02536 " TEL/FAX : 508-548-0796 Use: (5) INFILTRATOR HIGH CAPACITY H 10 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE' 1 ' =20 SCALE: 1 "=20' DRAWN BY: CES DATE: MAY 25, 2004 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE ON THE ENDS. NO STONE UNDER. PROJECT#SD577 FILENAME: SD577PP.DWG SHEET 1 OF 1