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HomeMy WebLinkAbout0472 SKUNKNET ROAD - Health CSkunknet Road, Centerville l UPC 12543 a No.53LOOR HASTINGS, MN i i 0 TOWN OF BARNSTABLE.00ATION 412' S A-un it yy' 1#�SEWAGE# 1p 1t" Q 4 o o- 'YILLAGE Ctry r U�r� �{ ASSESSOR'S MAP&PARCEL & e INSTALLER'S NAME&PHONE NO. 6001- r86 SEPTIC TANK CAPACITY' 1 0Ob.. LEACHING FACILITY:(type) -3"5'00 04AIAgA",ilr' (size) /.?X 33y oZ2 �0 • c��0 N�LG'`�g� NO.OF BEDROOMS r-J Vn OWNER d%^ PERMIT DATE: Al lit COMPLIANCE DATE: W t'. 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 r SkJ tc /U'&�-t— 26, ao Pr- v o • No.c)eq u 4� Fee .le THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLation for Mispo8al 6pstrm Construrtlun permit Application for a Permit to Construct( ) Repair( -Upgrade( ) Abandon.( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4`7 a S/1411/Z A ek 4 Owner's Name,Address,and Tel.No. d - �? C-e ih 1 ��r `ftivr°� ��1 Assessor's Map/Parcel o U p) Installer's Name,Address,and Tel.No. S'G6 3&p9 fpa `�� Designer's Name,Address,and e.I& A l es Q ws ConSd bowl Type of Building: 9 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(1 0 Other Type of Building j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date ;JSh I D J Number of sheets �X Revision Date Title T 1J C*' e � " Size of Septic Tank Type of S.A.S. -Z ci,7Lp" � r�j j Description of Soil -�Qe So LA�= Nature of Repairs or Alterations(Answer when applicable) S-ef Ze `r_ kUS Date last inspected: Agreement: The undersigned agrees to ensure the.construction and maintenance of the afore described on-site sewage disposal system in i 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 H Ith. £" Signed Date �`��� Application Approved by Date 1. Application Disapproved by Date for the following reasons Permit No. j 4> "���.� Date Issued No. � U""1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered'incomputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE', MASSACHUSETTS Zippfication for-MisgosaY bpstem Construction permit Application for a Permit to Construct Re`l"Z(_ rade Abandon S pp ( ); p ( )' pg ( ) ( ) El System D44vidual Components Location Address or Lot No. 4-7o'l ✓!!c_h ek Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (�j .001 h ✓f Installer's Name,Address,and Tel.No.Sc (P O t Designer's Name,Address,and Tel 'o. -44 " Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder A .. Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 32> gpd Design flow provided ( gpd) Plan Date ,7,r g i r D 1�r Number of sheets Revision Date xt Title A! e/4/ � ' L-J 1 AJ"1 01✓�/s' s F� a ,/if Size of Septic Tank J d 0 �/ Type of S.A.S. - '-sir,�-f f�.H G-�y' �� S� `96" Description of Soil .,e e &O Log- Nature of Repairs or Alterations(Answer when applicable) -e"-P 2-(',o Y; Ilo r Date last inspected: e 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. <Z11" / F. Signed Date Application Approved by * ' /f Date , Application Disapproved by r Date r for the following reasons " Permit No. ,F / 'Y t Cam~ 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( ) _. .Abandoned( )by. f ! �.S A3ro IMP S r` C0 at W-7oA �;)e t4 n J/ ra�' �'? , 'ry,l has been constructed in accordance with the provisions of,Title 5 and the for Disposal System Construction Permit No.Wg'-0 18 dated Installer P,' d 1 S s r'o 1'�D f Cc e Designer St l ✓ Z" a , a sa C Vr #bedrooms Approved design flow gpd The issuance of this permit shall not •e construed as a guarantee that the system will fari t oonnaas�designed. , Date Inspector_ ohj - --•------ --------- -------- --------------------- ---- - No d L'41 Fee `. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Vs oral Opstem Construction permit r' Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at Li Ce l 110 r,L,r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction '.�ussstt be_-completed within three years of the date of this permit. Date CdzS�f ' ` Approved by ` - - -- We, Gary Thompson and Jodi Lynn Thompson declare:The house located at 472 Skunknet Road Centerville Massachusetts purchased in 1997 was purchased as a three bedroom home. No additions nor alterations have been made, the house is as it was when purchased in 1997. Ga p Thompson Jodi lynn Thompson 472 Skunknet Road Centerville Ma 02632 M A Swor at �s �1 this 1day of a 2018 efore me: MAT,�L -1(Aj -MOPA 4 MOLLY H.TEIXEIRA ¢ Notary Public Commonweaim of h4assachLafts Pdy 00n1rTASSiOn Expires Aug.30,2024 C'e� c- r�Dj 00 �jLA --------------- j . ' Town of Barnstable DIME Regulatory Services Richard V. Scali,Director HAMSTA8M MAM Public Health Division '°Tiro 39. 6. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: s- "2" Sewage Permit# ���'�¢� Assessor's Map/Parcel d �3-461 Installer& Designer Certification Form Designer: S ��/✓� G 90QD "7 Installer: �` S Address: C 1 Address: C CD�✓�c� � 02s'�3 �� v� tYe ZS On 2—2 "/� �lUS Ego S was issued a permit to install a (date) (installer) septic system at 4 72 K &E - G� based on a design drawn by y 7J / dated (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. Stripout (if required) was inspected and the soils ,vere found satisfactory. I certiA, 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructe _ ce with the terms of the I/A approval letters (if applicable). DAVIDCIZ51 yGN � ^ D. C c FLAHERTY. JR. n (Iiista a 's Signa e) No. 1211 !. T R IITAR%- ( esigner s S'gna e) — -' (Affix Designer's Stamp Here) PLEASE RETURN TO B STABLE 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. gAoffice formsWesignercertification form.doc 4 Town of Barnstable P ' Departitnent of Regulatory Services ' _ 1211PIUAW4 Public Health Division Date i MA89. ' �d3a 200 Main Strcet;Hyannis MA 02601 rFc► a 17 W. 1,10 Date Scheduled Tu D0 _j • na Fee Pd,_ Sail Suitability Assessment for age Disposal N Performed-By,_ ����2�,4. ���� • Witnessed tByr. CATION&.GENERAL INFORMATION Location Address 47Z. u q y Owner's Name--r—f v U 6 �a Lv GINS-//e-c.�. Address 7Z cS/Ct//c/ �✓�� Assessor's Map/Parcel: Engineer's Name�b' NEW CONSTRUCTION REPAIR Tele hbne# � Land Use Slopes Surface Stool's 6 Distancoa from: Open Water Body---=-f-4_fk possible Wet Area 104 ft Ddtildng Water Well 7N, Drnihago Way M ft Property Lino G U ft Other Q ft �IKETCHt(Stroot name,dimensions of lot,exact locations of test holes&pora tests,locate wetlands-in proximity to holes) AM � _r11 Z t , Parent material(geologic) �Y c / �d4a ,-t/ nG Depth to Bedrock Depth to Groundwater. Standing Water In Holo:_ r` Woaping*oin Pit Fnoa M Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL'HIGiI WATER TABLE Method Used: Depth Observed standing in obs.hole: _^/ � lu, Depth to loll mottlee Dojlth weeping from sido of ob,hole: _A1Y4, In, Groundwater Adjuatmdnt Index WellRoading Dato; index We111eYol A�,•fhetbr ArQ,grnundwator•Leval,,a 17 PERCOLATION TEST j Data ` ' Time Observation Hole# Z Time at 9" Depth of Pero `�2 Time at 6" Start Pro-soak Time @ ° Z� Time(91141) End Pro-soak /G Rate Mtir./Lrch Site 3ultablllty Assessment; Sltd Passed_Q�_ Sito Failed: Additional Testing Needed(YIN) Original: Public Health Division (( Observation Hole Data To Bo'Complated on Back------ ' ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Consarvation Division at least one(1) week prior to beginning. Q:\SEPTIC\PBRCPORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 34, Depth from Soil Horizon Sol Texture Sdil Color Soil. Other Surface(In.) (USDA) (Munsell) Mottling (Stnueture,Stoner,Boulders, enfulatencz 96'Orkval) � l 2Z-11 11¢ e La�/235��t/j Z'S DEEP OBSERVATION HOLE LOG Hole# Z' ' Depth from Soil Horizon Sall Texture Soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 8 •i `va �•,7 y� cs�.h .r— DEEP OBSERVATION HOLE LOG 11010# Depth f roni Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color 81311 Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Flood Insurance Rate Maa: Above 500 year Mood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No.-,-- Yes . Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring porvii it mtiterial exist in all areas observed thrpughout the area proposed for the soil absorption system? le If not,what is the depth of naturally occurring pervious matarial`? . Cer'tl--fication I certify that on 146//�95 (date)I havepassed the soil evaluator examination approved by the Departme nt of nv ronmental Protection and that the above analysis was performed by me consistent with . the required trainl x rdse and xp rle,cc described in�10 CMR 15.017. Signature Date �- /7-/� • • Q;\3BpTIC\PBACPORM.DOC A Commonwealth of Massachusetts Executive Office of Environmental Affairs J FN 2 2 199� Department of Environmental Protectio Wllllam F.Weld Oj 6 spry cioMrrwr Argeo Paul Celluccl vld B.Struhs U.oowmor OommWe w► SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 472 Skunknet Rd, Centerville, MAAddressofOwner. Michael Botvin Date of Inspection 1 -1 6-9 7 (If different) 48 Hallett Lin Nameoflnspector. W,E. Robinson SR Marstons Mills, MA Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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: _v'Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority — Fails Inspector's Signature: Gt� s ` Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A,B, C,or D: A) ,SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BI—7 TEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Ji(re 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,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 Fonforming septic tank as approved by the Board of Health. d 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)W6.1049 is Telephone(617)29 -um i��Printed on Recycled Paper ,1 A 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddrew 472 Skunknet Rd, Centerville, MA Owner. Michael Botvin Date of Inspection: 1 —1 6—9 7 B)SYSTEM CONDITIONALLY PASSES(continued) 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 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) FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: nditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the blic health,safety and the environment. 1) STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A 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 water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply 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 is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for ooliform 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. 3) THER (revised 11/03/95) 2 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION.(continued) Property Address: 472 Skunknet Rd, Centerville, MA Owner. Michael Botvin Date of Inspection: 1 —1 6—9 7 DI SYSTEM FAILS: 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. Backup of sewage into 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 an overloaded or clogged SAS or cesspool. Static liquid level in the distribution boa 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). Number 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 I 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. El E SYSTEM FAILS: 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 signifies threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requiregents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 f A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 472 Skunknet Rd, Centerville, MA Owner. Michael Botvin Date of Inepeotion: 1 —1 6—9 7 Check if the following have been done: _,A/camping information was requested of the owner,occupant,and Board of Health. 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. Z`As built plans have been obtained and examined. Note if they are not available with N/A. 1�The facility or dwelling was inspected for signs of sewage back-up. ✓f he system does not receive non-sanitary or industrial waste flow _iAhe site was inspected for signs of breakout. jAll system components,excluding the Soil Absorption System, have been located on the site. , 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 existing information or approximated by non-intrusive methods. ZThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. r (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 472 Skunknet Rd, Centerville, MA Owner. Michael Botvin Date of Inspection: 1 —16C-—9 7 FLOW CONDITIONS RESIDENTIAL: Design flow 3 3 O osliona Number of bedrooms:_3 Number of current residents: Garbage grinder(yes or no): LJ Laundry connected to system(yes or no):V,7 5 Seasonal use(yes or no):_ Water meter readings,if available: 1 9 9 6 - 54, 000 gallons 1995 - 71 . 000 gallons Last date of occupancy: COMMERCIAL/INDUSTRIAL- Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Bolding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yea or no)_ Water meter readings,if available: Lest date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: - C A ' x `Cq / w J"�SI System pumped as part of inspection: (yes or no) A,0 If yes,'volume pumped: gallons Reason for pumping: TYPE OF SYSTEM L/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yea or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yea or no) A-p (revised 11/03/95) 6 s ^J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 472 Skunknet Rd, Centerville,MA Owner. Michael Botvin Date of Inspection: 1 -1 6-9 7 SEPTIC TANK, (locate on site plan) i ' Depth below grade:, Material of construction:Zboncret,_metal FRP_other(eplain) Dimensions: --V Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:3 IV 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 /®` Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid I in relation to outlet invert,structural integrity, evidence of leakage,etc.) 9- !R1 E P:TRA (locate on site plan) Depth low grade: Material of construction:_concrete_metal_FRP_other(e:plam) Dimensi as: Scum ess: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or bane: Commen (recomme dation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence f leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Addresm 472 Skunknet Rd, Centerville, MA Owner. Michael Botvin Date of Inspection: 1 —1 6—9 7 TI T OR HOLDING TANK:_ ( on site plan) i Depth grade: Ma of construction:_concrete_metal_FRP_other(explain) ns: Ca gallons Design w sallona/day Alarm 1: Commea : (conditio of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX- ( locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP C BER:_ (locate site plan) Pumps' working order:(yes or no) Comments: (note condi on of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 e 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 472 Skunknet Rd, Centerville, MA Owner. Michael Botvin Date of Inspection: 1 —1 6—9 7 SOIL ABSORPTION SYSTEM(SAS): (locate on she plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:7 leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number: Comments: (note condition of soil,signs Ahydrapc failure, level of poonding,condition of vegetation,etc.) /o o a ���Q s i S i o_z ` Y.e�.K�of G. � � 1 � � cv n i c•� .-)- 6 CESS Ls:_ (locate n site plan) Number d configuration: Depth-to of liquid to inlet invert: Depth of solids layer. Depth o scum layer: us of cesspool: Mate ' of construction: Indica ' n of groundwater: inflow(cesspool must be pumped as part of inspection) Commen : (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc. PRIVY: (locate site plan) MEf of construction: Dimensions: De solids: Mate ts:(note condition of soil,signs of hydraulic failure, level of ponding,.condition of vegetation,etc.) r (revised 11/03/95) g m SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddr+ess: 472 Skunknet Rd, Centerville, MA Owner. Michael Botvin Date of Inspection: 1 —1 6—9 7 SINMR OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 13��L K (�ouSF 17 c d DEPTH TO GROUNDWATER Depth to groundwater:j -1' feet method of determination or approximation: (revised 11/03/95) 9 7 Z/7 21 �O �3 s� CO CATION SEW PERMIT NO. VILLAGE C E2 cLl INSTALLER'S NAME i ADDRESS BUILDER OR OWNER tJ SNl 17-d vLs o DATE :=PERMIT ISSUEDl � _ DATE COMPLIANCE' ISSUED 0 D )EE i • b. No......... `r Fiz$..3..................... THE COMMONWEALTH OF MASSACHUSE*S BOARD OF HEALTH Town. ............ .OF..............Barnstable _. ........................................------................... Appliratinn -fear Riipuiitt1 Works Tontrnrtion Vrruift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lot 1 Skunknet Road,--Centery.1.11e._ .._..._._.. --•-•--•-----------------•---•------...----•-•-----..---- Location.Address or Lot No. .................• James_.K. Smith - - _.. .........Barnstabd-e............................................................. Owner Address aVetorino Brothers-----................................ ---------Barnstable.-------------------------------------------................... Installer Address Q Type of Buildin Size Lot-------15_ 0.QQ_......Sq. feet Dwelling7No. of Bedrooms----------two...........................Expansion Attic (x ) Garbage Grinder (noj aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...................................................... W Design Flow_______________ .___...-... _gallons per person per day. Total daily flow.......�.a-_)..................._.gallons. WSeptic Tank Liquid capacity/ gallons Length................ Width................ Diameter----------...... Depth................ x Disposal Trench—No..................... Width__ -__---__-------- Total Length------------ ------- Total leaching area--------------------sq. ft. Seepage Pit No.-_--____B......... Diameter....... _ ....... Depth below inlet ..... Total leaching area-n2_Q-1....sq. ft. Z Other Distribution box ( ) Dosin tary G Percolation Test Results. Performed b ._.. .... Date..... a Test Pit No. I... _minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------_-.-_.-..__. f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-_----_-:-.-------__. O r- . r-_..1.2 f... Description of Soil------ U ----- �---_-----•----* ----------- e- --- xt - - - V -----------------------------------------------------------------------------------------------•...---•••••••••-•--•••-•---...-•----------------------------------•-------••--•-•---......-------- --- 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 provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe --- --••-----------•----------------------••--------------•----------- •------•-•---•------------------ ate Application Approved BY -. . — n = Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------•---•-------••--------••-••----------------------------------------•-•----••-----------------------.._........---•-••--•-- Date PermitNo......................................................... Issued........................ ............................... Date No.....--..w ..... Fine.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ._ .Town _....... .---.OF...............Barnatabie.............. --...........- Appliraation -for Ropoiial Morks Tonuitrnrtion Vrrmft Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......................l t..i:_.Sty> 1mat__-mad$..Cenker—yule .-----------------------------------------------••--------------------•--•-----------...-•------- Location-Address or Lot No. .....................=0_$..K,e..UJLttl-_.....-----------------------------•------. ----------Barnstable................................................................. r Owner Address ,Wa �etQ itiQ-_Brs.thems------------------------------------ ----------Barnstable--------------------------------------- Installer Address UType of Building Size Lot--------- ssQQQ_.__.Sq. feet Dwelling-�No. of Bedrooms-----:__.._tea-------------------___-_Expansion Attic ( X) Garbage Grinder ( J pa, Other—Type of Building ___________________________ No..of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures ----------------- _ _ W Design Flow.. .T.__. gallons per person per day. Total daily flow_______ %�_.�r ............... ....gallons. WSeptic Tank Llquld capaci i gallons Length................ Width_.___. _. . -._ Diameter .__-..- ...... Depth_--...•_._.._ . x Disposal Trench—N _____________________ Width.. .._..__..______ Total Length----- Total leaching area_._.__.-___-.______sq. ft. Seepage Pit No------ Diameter......________ Depth below inlet_______ o 0 --- . P / �----_-- Total leaching area.__.____. _ sq. ft. z Other Distribution box ( )`; - Dosm� a Y - - s�J' P� -"--- t4 40—W.-A ------ Date. '-' Percolation Test Results Pei-formed b '�` HTest Pit No. 1--- !X"minutes per inch Depth of Test Pit.................... Depth to ground water..-._`___---_.__.__--- G14 Test Pit No. 2-----------------minutes per inch Depth of Test Pit-------------------- Depth to ground a' --f 1... .. .�. water_____._____..__.______ . •` I �DDescription of Soil_ �_.... ---... ----- •-- -------------------------- ................................................................................................................................... ..xs ------------------------===----------------------------=--------------------------------------------------------------------------------------------------------------------- U k� Nature of Repairs or Alterations—Answer when'applicable._'-------------_____________________________--------------------------------------------------- N - - ----- ---------------------- ----'------------------ - -------------- -------------------- - N- ----- -----------------------greement ;Y The undersigned agrees to install the aforedescribed Individual. Sewage Disposal System in accordance with the provisions of-Article YI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Si ne g --------------------•--------------•-•------•--------•----------- •---- PPlication Approved BY �'" .._t ....-- ! w ,, te --------------- •._.Application Disapproved for the following reasons:-------------------------------------- —--- ----•------------•---•-•-------------•-•---------Date-_------------ • ----••-•••--•-••••--•-----•--- ..................... -------•-------- Date PermitNo...................................................------ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD.,- OF HEALTH Town Barnstable :,: ........................O F,.......................................................,,:...............::......... Trrtif ir�tr atf Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) VetorinoBrothers ------------------------------------------------------------- --------- Installer Lot 1 Skn at .............. knet Road, Centerville-- ------•. . has been installed in accordance with the provisions of _ r, The State Sanitary Code d 'bed in the.;,. t7' '. s- 7 , ,yt application for Disposal Works Construction Permit No. -_ _______ ...................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COF:,,DA�AUARANTEE THAT THE SYSTEM V� L F�NCTION SATISFACTORY. DATE..... ................�...--�- ........................................ Inspector--:•----...---------•--•--•-••--------•---•-'-------- •-•------•-----•----......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH u.. +y TAtil7 RawnaMah�s � No. ....... FEE............... ........ �i� >Qtti ork �oaatratrtioaa Vrranit i hereby' r Vetorino Brothers Permission s e eb an .............. G` to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at No.____.-_.._.lAt- 1 Skunknet Roads Centerville ----------------.•-•-- .. ..-------•---------- --------------- ---------- -------- Street 12 as shown on the application for Disposal Works Construction PejNo..__r.. :_.__..__ ated___� _ . bar' ----------------- ,.,....� ✓' - �v� Board of Health .. �...----•-•-•-••---.._..... DATE---•------------------------------------------------...-------------•----------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ` Y�ootic AAA eS �`��. � oA��� �-t�ov../ : Ito i j +- 3�0 C.•P.t7t " ', _� -- SE.P-n C. T A%-IBC • `aJo+t " x ' L�'�t�tri �C - u;E 1000 G ac= T:stSPcSAL PtT V;rc 1000 er-A . 98 %� .• . ._ Ta. Zoe SIVNEWALL �XJ�i.'Z t S�' 3�� G•r'D � �i _ � ro P/t�l? �"�•' I SoTTOA/M AREA 1,0 = so WD ; I 20 ToTa vE�S1�a�t .. j 1 9GG Af4,v, VSzC.oL.AT totJ 2A,T--- Cow u It Aw ov-LEA6 JO i Rid! WLA Nn i ' is-- 2/U4i'E N *t 98 � 7rrTlT '� G�7 4 G •n . �e 77.t`r4 �' IIJ�R•48 G n� M 4 �vE iaao �•�v ,: •$vE�SOK. ¢ �P4 VKT i�c 4a�-• 4'l.5 r S�Pf�C TAuk � (QOO QG•U WV. t1JV i�: LEAGt•1 - ;V MEv Pt Y � 3I4•Ot WASUSD CTUNi. Go.6 cEe T �rr!�D �oT pt_A�..► pQo Ft t...a- 6'G�•p !z 4JO se-ALA= SGAt,6 L DAT (�o'(2-tBid 06 u/A TW. t GE1CriF`f T"AT Y'c-1f� 1"Ot�t.�IDa�10E�I� 54do�u�.1 DLL�.��i 2E.rrE3Z�.lG� 1-1E2EOrr-J GOMP�-Y S W t TH Ti•l� =il�El.1 w1E= L�-- I Awl> SETBACK REDv�Q�•ME�►T�j� OF TWe Tbw�1 oF�A�-,�34i�"A, t..� f�vl� ►�t�+.�J �iM.4c.� �.�T �C f,`,�� �A`t`k`1h D11,TE. L 8AXTev_ 4 u�E tyC•, IZW-r tSTrm TZEC� LLaf.JD Sl1QVE`(Oe� T44S PL&W IS UOT 'Aey6D OU AU t►4TROMEMY 0eTE.ZVtt t C- M,.tyS. 5ucvt--( 4 TNG 09=F9iT; -5"OULD 'WOT wr= ulpe> APPL%C-AW r To -PETr-Zmi NE t..oT U&JE4. QW eS oQ- ' ►1�l 1 0 t 1{ a 7x LOCUS DATA A T A BENCHMARK:CORNER \ f' OF CONC. BULKHEAD ' ELEVATION 40.53 CURRENT OWNER GARY THOMPSON �yA 1 --_ = - N a JODY L;NN \ AMES WAYT En THOMPSON Oy,�tD a� A M E S WAY z 7 PLAN REFERENCE 340-78 a 1 / <G� LOCUS DEED REFERENCE 10611-79, 1997 / ) 060 v UTILITY \ POLE ' 28 ZONING DISTRICT RC / GP / / OHP \ OHP pHp OHP — pHp LOCUS MAP FLOOD ZONE "X" \ S 87'16'47" E 109.70"�'\ NOT TO SCALE: ASSESSORS MAP _ 169 �y� 3 ' // ��� Doti BARNSTABLE 18-0101 // � S 7 E 128.43� � FOUNDOAD BOUND TWIN PARCEL 093-001 �I P / 823'25" OVERLAY DISTRICT NOT A ZONE II 1 / DAMAGED I LOCAL RPOD 1998 A / l / 15.2 ) LOT AREA 15,000± S.F. REMOVED I \ / I / / O UTIL T� \ BARNHSTABLE\ D T.H. #2 SITE 8c SEWAGE I POLE RQUAD NDBOUND / O REPAIR PLAN EXISTING LEACHING PIT /4 72 ~ I \ \\ #472 r TO BE PUMPED, — — — 36 CRUSHED AND EXISTING S _ / REMOVED FROM SITE Li 10 3 SKUIVKIVE T ROAD Z I ' \\ DWELLING NGM / 9.7 / / / PROPOSED 13'x33.5 z I = / w \ / / S.A.S. (3) 500 GALLON C E N TE R VI LLE, MASS o M w E _`D #�� / — — _35 o LEACHING CHAMBERS DATE: JAN. 18, 2018 DECK / / / /,-- U OWNER/APPLICANT: co o z GARY THOMPSON � � � _ - _ _ _ _ _ �� #472 SKUNKNET ROAD _ j � 1 W CENTERVILLE — _ _ _ _ M A 02632 � -LOT 1 ARTIFICIAL GARDEN o 15,000f FEATURE SHEET 1 OF 2 3A � � � \ N 78 27 25" w � PREPARED BY: ���-�`OFA 146.38, E A S' SURVEY, INC. EDAARD EXISTING 1,000 P. O. B O/�v 1729 7 2 9 STONE A GALLON SEPTIC No.2898 TANK TO REMAIN. . SANDWICH , MA 02563 0 20 30 40 LOT 2 PH. (508) 888-3619 DELL (508) 527-3600 �1 U � GRAPHIC SCALE: 1 INCH 20 FEET EAS.SURVEY©YAHOO.COM = SYSTEM DESIGN RAISE COVERS TO WITHIN 6" OF FINISH GRADE TOP OF FOUNDATION END CHAMBERS RISER DESIGN FLOW, RAISE TO WITHIN 6" BEDROOMS AT 110 GPB D 33Q GPD ELEV. 41.20 FINISH GRADE FINISH GRADE � 3 / ELEV. 39.1 -'OF FINISH GRADE 40.00 \ \ \ \ ELEV. 39.2 ELEV. 39.1 LIND ELEVATION 38.2 REQUIRED SEPTIC TANK TOP ELEV 36.40 1' MIN.-3' MAX. COVER ___330 x_2 _ 660 GAL. 5' CAS= 0.37 EXISTING SEPTIC TANK SCH 40 - 4 PVC 4" PVC SCH 40 8'C�S=0.016 0 p O p O. o o O p O p 0 0 INV.= 2 MIS x t' EXISTING INV 37.77 10"TEE 14"TEE INV.= O 00 00 0 o p Op Op SIZE OF LEACHING FACILITY REQUIRED TO REMAIN INSTALL 37.57 g" 00000 �' o 00000 GAS BAFFLE 3 OUTLET DESIGN PERC RATE «----MIN./INCH LIQUID LEV THREE 5'-0"x8'-6"x3'-0" CHAMBERS LONG TERM APPL. RATE_0•74_GPD/S.F. 4-1 EL H-10 D63 INV.=35.70 S.A.S. (13.0' x 33.5') o SIZE OF LEACHING SYSTEM PROVIDED: TEE-REQ. INV.=35.53 a L 33.40 DATUM: 0 0 330 + 0.74 SF/GPD = 446 S.F. MIN. REQ. • • • • • • INV.=35.40 � Sri VERTICAL DATUM: EXISTING 1,000 GALLON 26.4 USING H-20 CONCRETE LEACHING CHAMBERS MSLt / BARNSTABLE GIS PRECAST CONCRETE SEPTIC WITH 4' OF STONE ALL AROUND BENCH MARK USED: TANK TO REMAIN CORNER OF CONC. BULKHEAD BOTTOM (13.0' x 33.5') = 435.5 S.F. ELEVATION 40.53 CONSTRUCTION NOTES: SIDE WALL (13.0' + 33.5') 2x2 = 186 S.F 18-0101 621.5 S.F. 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 0 OO OO o 0 O0 OO 621.5 S.F.x 0.74 G/SF = 460 GPD SITE SEWAGE ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 0 p 0 p 0 o U00 0 0 O 460 GPD PROV > 330 GPD REQ. =130GPD RES. WORK ON THE SITE. 00000o00000 REPAIR PLAN 2. NO DETERMINATION HAS BEEN MADE A. W COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT � NO (GARBAGE DISPOSAL / GRINDER ALLOWED) IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. �-4.0' 5.0' --{ 4.0'--� #15572 ,�4 72 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND 13.0' -I D.T.H. #1 D.T.H. #2 S.A.S. AREA IS PROHIBITED SIDE VIEW DATE: 8 DATE: 8 SKUNKVEET ROAD GROUNDD ELEV. 39.4 GROUNDD ELEV. 38.4 GENERAL NOTES: NO GROUNDWATER NO GROUNDWATER N 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. I CERTIFY THAT I AM CURRENTLY APPROVED BY THE - TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS DEPARTMENT IO ENVIRONMENTAL PROTECTION TO CONDUCT C E N TE R VI L L E MASS FOR SUBSURFACE DISPOSAL OF SEWERAGE. SOIL EVALUATIONS AND THAT THE RESULTS A MY SOIL FILL � EVALUATION ARE ACCURATE AND IN ACCORDANCE WITH 310 8.. 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE CMR 15.1 U7,V1 5 7 A A DATE: JAN. 18, 2018 ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING i � - ---- ---- ---- LOAMY SAND LOAMY SAND ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. I _ 10YR 4/3 12" 10YR 4/3 8 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE EDWARD A. STO E, CERTI ED SOIL EVALUATOR OWNER APPLICANT: CAPABLE OF WITHSTANDING H-10 LOADING UNLESS B B OTHERWISE SPECIFIED. LOAMY SAND LOAMY SAND GARY THOMPSON 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION ,WOF 7.5YR 6/6 7.5YR 6/6 OF ALL 5. ANY MASONRYEUNIP UNITS R TO ANY EXCAVATION.USEDTO BRING COVERS TO GRADE DAM DTH #1 (NDICATESTEST HOLEDEEP EL. = 37.6 22 EL. = 36.4 24" #47 2 S K U N K N E T ROAD OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. �� D 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER $ F H ,JR N , CEN TERVI LLE FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. 1 INDICATES C-1 C_1 42' MA 02632 7 SCHEDULE T K SANITARY SHALL EXTEND BEA CONSTRUCTED MINIMUM OF 6"FABOVE ��isTE P-1 42" PERC TEST COARSE SAND COARSE SAND 2.5Y 7/6 2.5Y 7/6 SHEET 2 OF 2 THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND S4NiTAR�PN NO MOTTLING LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. { NO WEEPING 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN PREPARED BY: 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT l �� 144 INDICATES ADJ. GROUNDWATER NO G.WATER NO G.WATER ELEVATION OF THE OUTLET PIPE. NO OBS. GROUNDWATER 144" 144 EAS SURVEY, INC. 9• THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES EL. = 27.4 EL. = 26.4 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS P• O. 0/�v BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC B.O.H. 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND NO OBSERVED GROUNDWATER DON DESMARAIS i SOIL EVALUATOR SANDWICH , M A 02563 SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE j DEPTH TO BOTTOM OF HOLE 12.0' ED. STONE FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL VARIANCES REQUESTED BACKHOE OPERATOR. BE LEVEL PH. (508) 888-3619 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION ELLIS BROTHERS NONE SOIL TYPE: 1_ TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW CELL (508) 527-3600 AND APPROVAL. PERC RATE: <2 MIN. PER INCH 0_74 GAL/SF/MIN EAS.SU R VEY©YAH 00.COM 13. MAGNETIC TAPE ON ALL COMPONENTS. LOADING RATE: