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Home My WebLink About0480 SKUNKNET ROAD - Health 480 SKUNKNETT RD.j CENTERVILLE A = 169 093 i i i ;k Said UPC 12534 ' No.2153LOR , HASTINGS,MN E Q / I T W OF ARNSTABLE f/�- ✓/ LOCATION p� 6 SEWAGE#. !® VILLAGE ASSESSOR'S MAP&PARCEL /Cq INSTALLER'S NAME&PHONE NO. eZ aO77I" au SEPTIC TANK CAPACITY t LEACHING_FACILITY:(type) / (size) q. NO.OF BEDROOMS .3 OWNER @ e% ri r r Vvs PERMIT DATE: COMPLIANCE DATE: d 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 �1 e J q� No. s r Fee 119 Z) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppitration for �Dfs�pOgal 46p5tem Cow6truaton Vermtt Application for a Permit to Construct( ) Repair(il,/Upgrade( ) Abandon( ) ❑Complete System 11 Individual Components Location Address or Lot No. [�� Owner's Name,Address,and Tel.No. �6s D�3.ov z ` G -- Assessor's Map/Parcel �ej/f ��I YJ,p , �,��( Installer's Name,Address,and Tel.No. cI Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size ✓ sq. ft. Garbage Grinder et�b Other Type of Building Vec No.of Persons Showers( ) Cafeteria( ) Other Fixtures p� Design Flow(min.re uired) gpd Design flow provided •�"-G/ gpd Plan Date c Number of sheets Revision Date s�Title Size of Septic Tank ZA0W Q1 g�;��'jos J°-f�ypType of S.A.S. Description of Soil "`'— Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa of alth. �l Signed Date 4/9 Application Approved by 1 Date Application Disapproved by: Date for the following reasons Permit No. I? Date Issued 6 - 1 0 No. `iL Fee t V €s Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, Yes ZIPPrication for M.5poal *p.5tem Couttructiori-J)ermit Application for a Permit to Construct( ) Repair(Vl/Upgrade( ) Abandon O ❑Complete System I Y ndividual Components Location:Address or Lot No. U�i� 3�lleley �rOwner's Name,Address,and Tel.No. AssessoParcel Installer's Name,Address,and Tel.No: (y Designer's Name,Address and Tel.No. i Type of Building: Dwelling No.of Bedrooms .4 Lot Size .S Z/3 2� sq. ft. Garbage Grinder (11�6 Other Type of Building /` r'SW,eAICE' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ?j' � gpd Design flow provided J��Q gpd Plan Date I 9 Number of sheets / � Revision Date Title S / �Y' / G7 fJ Size of Septic Tank Aezf0 gQ, Type of S.A.S. ?2/— t_jre /��/4w Description of Soil adz Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: k The undersigned agrees to ensu%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 alth. Signed i0 �c%'� Date i!� Application Approved by C Date Application Disapproved by: Date for the following reasons Permit No. p�b�� 17� Date Issued f O Cl THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Com4pliartce THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( V<Upgraded ( ) Abandoned( )by at L/8'p ,.51c4rW r CIgN,>t 1111le has been constructed in accordance q with the provisions of Title 5 and the for Disposal System Construction Permit No. d ! 3 dated 15-- y/ Installer Designer #bedrooms Approved design flow ?3 U gpd The issuance of this `ermit hallp�not be construed as a guarantee that the system will unctt"o a, designed (� Date `� + t Inspector �2 cr No. 6 01 _ .7 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5po5ar 6p5tem Construction J)ermit Permission is hereby granted to Construct ( ) Repair ( Y)lo, Upgrade ( ) Abandon System located at 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 npe^rmit.`. (! Date 1/ V ( Approved by !/►� V I L,f El(o U 9 Town of Barnstable P# �TW Department of Regulatory Services / �� BARNRTA13M : ]Public Health Divisioll Date 6 MASS' 200 Main Street,Hyannis MA 02601 Date Scheduled Time i4_°<�-9 I+eePd. Soil Suitability Assessmentfor Steivage Disposal Perfonned By: w` ` Witnessed By: -- LOCATION & GENERAL INPOINIATT Location Address ZOO Jkt,,_�kli� / Owner's Name �J'n (// l Address Assessor's Map/Parcel: �—Q�oC Engineer's Namc 0L_j NEW CONSTRUCTION REPAIR Telephone It61 koz Tv�7 ll p l Slopes go ®—Z /0 Surface Stones Land Use's 1.�','' W' P ( ) 3 f ft Distances from: Open Water Body fl Drinking Ft Possible Wet Area � g Water Well Drainage Way fl Property Line �y ' ft Other ft SYM'TCII: (Street name,dimensions of lot,exact locations of lest holes&pere tests,locate wetlands in proxinuly to holes) � t �pi.z5 Parent material(geologic) 0-bTLAJP6 Depth to Bedrock 3� ` Depth to Groundwater: Standing Water in I[ole: Weepiltg[1-011)Pit Flice_f V Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to wil mold.m Itt Depth to weeping from side of obs.hole: bi, Groundwater Adjustment _ It Index Well M Reading Date: Index Well level AdJ.ftletor_ Adj.Groundwater Level F I'I;tRCOLATIOR TES' ' Observation Cinte ut 9" --- Hole B Time at 6" Depth of Pere Time(9"-6") Statt Pre-soak Time @ End Pre-soak Rate Min./Inch 4� Site suitability Assessment: Sile Passed Sile.Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted Within 100' of Wetland, you must lBrst nobly the. Barnstable Conservation Divisiolj at least one (1) Wcck prior-to beginning. QNSEPTIC\PERCFORM.DOC DE El ['.OBSERVATION HOLE LOG Hole # ly Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other (Munsell) Mottling (Structure,Stones;Boulders. Co istenc % ravel `�3 --2�' . •fig �•.� � --__-_ 4 -5 YP— mc1 S z,L-✓�11-J i DEE, [e OBSERVATION MOLE LOG Mole# � Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency.°k Gravel) .Pq—,zcf DEEP OBSERVATION FOLD, LOG Depth from Soil Horizon Soil Texture mole# Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Col istency. a Gravel Depth from DEEP OBS RVATION HOLE LOG Mole#_Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other r (USDA) (Munsell) Mottlln g (Structure,Stones;Boulders. Consi2tengy.c oraygn Flood Insurance Rate Ma Above S00 year flood boundary No_ Yes Within 500 year boundary No_ Yes Ym Within 100 year flood boundary No Yes . Depth of Naturally Dccurrlln Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ` If not, what is the depth of naturally occurring pervious material? Cen•tfiEcation I certify that on tt (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required train' ,expertise and experience described in �10 CMR 15.017. Signature 14 r G Date Q:1S.F,PTlC1PERCFORM.DOC �}1 �-� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION ) f Property Address: 480 SKUNKNETT RD. CENTERVILLE MAP 169 PAR 093 LOT 002 Name of Owner JEAN HANRIGHT Address of Owner: SAME 9q tic Date of Inspection: 3/13/99 kA '``v Name of Inspector:(Please Print)JOHN GRACI l am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) o� 9 Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: (608)664-6813 y t CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The Inpection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does Fails : not imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:3/14/99 The System Inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM NOW THN MAINTAINED EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are Indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: n/a One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. NO The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. NO 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 M The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed revised 9/2198 Page 2 of 11 j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of inspection:3/13199 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has aseptic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a , surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla_(approximation not valid). 3) OTHER nla revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of,the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n(a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X, Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13199 Check if the following have been done:You must indicate either°Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)j X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 FLOW CONDITIONS RESIDENTIAL: Design flow'.-M g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 Total DESIGN flow: 22Q Number of current residents:3 Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no).JMQ Seasonal use(yes or no):JMQ Water meter readings,if available(last two year's usage(gpd): $t'a Sump Pump(yes or no): NAQ Last date of occupancy: n& COMMERCIAL/INDUSTRIAL Type of establishment: n(a Design flow: n!a gpd(Based on 15.203) Basis of design flow: Wa Grease trap present:(yes or no):JIQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):No Water meter readings.if available:n& Last date of occupancy: nla OTHER: (Describe) Wa Last date of occupancy: WA GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM HAS NOT BEEN PUMPED IN THE LAST 4 YEARS System pumped as part of inspection:(yes or no):MQ If yes,volume pumped nt& gallons Reason for pumping: WA TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval . Other: n(a APPROXIMATE AGE of all components,date Installed(if known)and source of information: 1980 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 14" Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: n& Comments: (condition of joints,venting,evidence of leakage,etc.) nta SEPTIC TANK: X (locate on site plan) Depth below grade: 8". Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): XG nla Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: E Distance from top of sludge to bottom of outlet tee or baffle: 3r Scum thickness:) 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: Jr How dimensions were determined: MEASURFn 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 COMPON NTS AR cTRUGIURALLY SOUND,RECOMMEND PUMPING YST M NOW AND THEN MAINTAINED EVERY TWO YEARS. GREASE TRAP: A (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nla Dimensions: nla Scum thickness: n1a Distance from top of scum to top of outlet tee or baffle:iaLa Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: n& 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.) nla revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or 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: ji& gallons Design flow: n(a gallons/day Alarm present: NO Alarm level:ja&- Alarm in working order:Yes_No—: NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Wa DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NO (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.) nIa revised 9/2/98 Page 8 of 11 � G . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Wa Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: _n/a leaching galleries,number: -nLa leaching trenches,number,length: n& leaching fields,number,dimensions: nta overflow cesspool,number: nLa Alternative system: n& Name of Technology: J7La Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROP R y PIT HAD't IN IT AT THE TIME OF THE INSPECTION CESSPOOLS: _ (locate on site plan) Number and configuration: n& Depth-top of liquid to inlet Invert: n& Depth of solids layer: nLa Depth of scum layer. nLa Dimensions of cesspool: nLa Materials of construction: n(a Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:n& Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a pc�k a � do aQ AA lit ,fir ay Ai) ��Y OA revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 480 SKUNKNETT RD.CENTERVILLE MAP 169 PAR 093 LOT 002 Owner: JEAN HANRIGHT Date of Inspection:3/13/99 NRCS Report name: n/a Soil Type: Wit Typical depth to groundwater: n& USGS Date website visited: Wit Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2/98 Page 11 of 11 _ is Q.o. S _ s� �r—r. �. .. ---------- i — I � i � i 3 K►�25 I ea. ►s zx8_lam"ate i - �� , _.`7 _.._.... ...w., _ m (30 2 t CD CD cin Mew F-• 1 CD p CD CD W UI cn rocn Area FAMOMOMMI i -o D m m D `ia� "'�f �♦ O D KiS LD a N J e-� _ m D p. m 9 cr n O P W D i W il cn n W ID � LkW cv 9 —1 i `Y � Liv I n � Room Mas te e Badpvom, j - � o m n -- - m 0 LO m _ boom, m POOL a r. CD MAM dp oom M Cl) Ul (31 IAwl 00 C" r _ - — m —a WOOM Ll ving Room jai V x i:2- A r` yTOWN OF BARNST LE /� I LOCATION ` �c) � UC1 C , SEWAGE VILLAGE Q 0 l tf1�� ASSESS 'S MAPG LOT INSTALLER'S NAME&PHONE NO. /, SEPTIC TANK CAPACITY //000 LEACHING FACILITY: (type) V f r(2Sf_ Q 1 t_ (size) 1 G()0 NO.OF BEDROOMS \ ,, BUILDER OR OWNER " PERMTTDATE: COMPLIANCE DATE: Z 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by oe& IA T51A r� lei bAf�� A R ACM AD 41 � 3� O CATION D S E AGE PERMIT NO. ��v^flk.C-1- VALAGE Cep- INSTALLER'S NAME i ADDRESS -BUILDER OR OWNER Swr rT� DATE PERMIT ISSUED -� �(D DATE COMPLIANCE ISSUED -,Z_0 - �. `l ' Q 'a l� i � � �� n i 4�1 �o. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OP.............. .. Appliration for M-4#niial Works Toutitrurtion ramit Application is hereby made for a Permit to Construct (') or Repair ( ) an Individual Sewage Disposal System`-at: \ \\ C. ��^Cesd�\\e Location-Add ess or Lot No. J r-e s Srn �.. Owner Address a .............................\j ``v---- N s.............................................. --•••---...--•-----•-----------------.•----- -----------------...•••--...------ Installer Address _ d Type of Building Size Lot----Y�_ 9_ ....... feet U Dwelling—No. of Bedrooms..............a- ._ ---Expansion Attic ( ) Garbage Grinder Other—Type e of Building ............................ No. of ersons_-------_-_____-_-_____-_-__ Showers — p., yp Yg p ( ) Cafeteria ( ) 04 Other fixtures ........................................................ W Design Flow.............. 5..........__..._._..__gallons per person per day. Total daily flow............ ''......................gallons. WSeptic Tank—Liquid capacity.! '__gallons Length................ Width................ Diameter__._____-__-.._- Depth................ x Disposal Trench—No. .................... Width...r.................... Total Length.................... Total leaching area..........._........sq. ft. Seepage Pit No._..._..X........... Diameter....... Depth below inlet......9............ Total leaching area.�...'.....sq. ft. z Other Distribution box ( ) Dosing nk ( ) aPercolation Test Results Performed by.._____ _._0L_AvG__-V_A___.... `...____ _.y................... Date_....3e�� Test Pit No. I................minutes per inch Depth of Test Pit......�. �__... Depth to ground water.....N_�'1e-_. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-__--_____-____--_____. 9 ............................... ........... O Description of Soil------------ s U 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�T I p 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. i ned........ v'.... � ....--------•-••---••-•...... -----•..............� Date Application Approved By-•...--- . --- .....................• -----• _e Date Application Disapproved for the following reasons----------------------------------------------------------------------.......................................... -----------------•------•------------••--------------•••----•-----••--•----•-----•-••------------•••-------------•--•---•-•--•-•-•--•------------------•••-•------------•-•--•••----•-------•--...--•--- J Date PermitNo......................................................... Issued..... . --------•--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD "OF HEALTH yE.,......... ..OF................................... Trrfifiratr of Tomptiaurr THIS IS TO CERTIFY, hat the Individual Sewage Disposal System constructed (Vle or Repaired ( ) . •--•-----....-•----------------------•------------............................--------•-------•--------•--•-....-••••---•...._......-- Installer c \ x has been installed in accordance with the provisions of TIT13 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit _________ da.ted.-.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONST AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. --- Inspector_... -•.................•-----...........--- THE COMMONWEALTH OF MASSACHUSETTS Mrs. BOARD OF HEALTH ..............OF............ as � s�....._..._............... //jj ............... FEEY-........ Permission is hereby granted-------Vcn.T7&�-r.q-o...........t-z.'05 -------------------•---- ..................................................... to Construct ( or Repair ( ) an Individual S v ye Disp9sq.1 Sys \ Street as shown on the application for Disposal Works Construction Permit No..................... Dated---------_._.__._.._.:..._............... --- ,�j� Boayel Health DATE------ -- 1 FORM 1255 HOBBS & WARREN, INC., PUBLISHERS f THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ------...VO-....................-OF.............. ......................... Appliratiou for Uhiv i al . orko Tomitrurtion amit Application is hereby made for a Permit to Construct (VI-1) or Repair ( ) an Individual Sewage Disposal System at: ��- Location-Add ess or Lot No. Owner Address Installer Address Type of Building - Size Lot.___.\.. -------Sq. feet v Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ;( ) Other fixtures . .._.. --•-•-•--••----------------•-•---•------- -= W Desi n Flow.............. 5_.___.___.__ ...___.gallons per person per da - Total dailyflow______.__.__5- '� _. _ lons. WSeptic Tank—Liquid capacity ' __gallons Length............... Width._____._.____._. Diameter___-..- Deptlk}__;_.'..___...- x Disposal Trench—No.................:... Width___.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No......... Diameter....... _.______.__ Depth below inlet...�4__.......... Total leaching area..; 0.....sq. it. Z Other Distribution box ( ) Dosing nk ( ) '-' Percolation Test Results Performed by-______:.. _= .______!...... `_V.. .3 \N,�!� a Date--------------------- ----------- Test Pit No. 1................minutesperinch Depth of Test Pit___...�. .�_.___ Depth to ground water:.__ �.��—_- f� Test Pit No. 2................minutes per inch -Depth of Test Pit.................... Depth to ground water........................ a -----•---._._...-•-----__....-•---••--•---•-----•----•......................................�._...------.......---.._._. Descriptionof Soil-•--••-• �'•---•-•--- .--•--•---------------•-------••----••-•--••--------•----•-•--•----•-•••-- UW -•••---------------------------------------•----------------------------------------•----••-•----•-•----•--••-----------------------=--••-----•---------•------•----•---------------------...-----•---- 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 iiTL - p 5 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. Sined•-•- Date Application Approved BY r... '!' � -------•--•-. "_ Date Application Disapproved for the following reasons----------------•----------------------------------------------------------------------••--• --••-•--••-----•--- .......................................----••-••-••••••-------•-••--•-••----•----••--....•••••--•---•-----•--------•-----------•--•------•-•---•------•----------••------------•----•--------•••-----•- Date PermitNo......................................................... Issued....................................................... Date o �l�� baTa C]l Sll.{si,t_� t`o,nntt...�! - 3 �331✓vtzooM � (�TQ, ' .�.• ��k-�. �� •. UO 6,A2•SA�.E 41ZI Qr->E-SZ Tao►G.�! u Ste- t Ooc:�, C=Ali_. ply A� PtT VSE (Ooo VAS 1� b h i ! � alL A2EA - l5D S F. N �• 1 SF' � 2.S _ ' �'7S �.P.�. .� � � �� I(.� MI►J 8aT'i27it�t Aeress= ST=. ems'. 1 .o so �.P.Z). � �. 1 . 0 �x 8 TOTAL 'flESl6Q = 4SS �•9r�. `' TOT&�- Teal L--( Flow = 330 6.>�. �� 41 44 .y WILUAM i► C. t t1 4 t 4cj' " t'"tCi• `re-ST � Tar y A5S131-'� �r - Sepnc IWV. T'Ajl �K (DGO �t .4 1,et►,�R LINE. �. GAL.. LeAr,►a 1 'A E FtT • W/t�-I-L �, ws►st•Ia4a ,off � CEC�TtFt>rD P1-bT� fi�t_.,41J F->ROr-:'tLIv LOGATlO" C6-lJ TEeVt L LC-/Pf, -/2. I .p ►.J o ScAL.C--'.k5 Lbtt�V bAT>r 4.10.86 c m tZ r t r--� T$.A A-r T"r-- cot -- Pvu a3 D 5 Uoti ►J G01-.a CcWi,pt_VS WITtA T"G:. 51DrLl►-tom N'S�.lL7 SETC3ALIC V:G4UiCeAAE-WTS OF THE C C_A-O -POIZ lit-..► Q tl. ET v w IZcGtS it2�LJ L.AWC� Su2v�Ya>`S Ti-1!'S le, ►I OT SAS Cta U rr l A�J O aTEf�'V1t_t..Jr c� M`rLSS• �., 1(4-9rCJAAt W i >ut,.t�� " 'TIiL c�Fc�, T'�, iI•Ice�rt� A�cat_1 Cl�.►-JT_ J Afi`�Lv . ► k>T' E'er :J�,GG� 1'c► MI► C 1� t_I "� h1e•.� ALL SYE SHALL SYSTEM PROFILE MAR ED�WITHCMAGNETICTTAPE OR BE NOTES COMPARABLE MEANS FOR FUTURE LOCATION. o 0 PROVIDE IF REQ'D, 20" MIN DIAM WATERTIGHT (NOT TO SCALE) 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE e 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 41.5' \ 38.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER P e - RECAST PRECAST H-10 4. DESIGN LOADING FOR ALL PROPOSED PRECAST n/ UNITS TO BE AASHO H-10 RISERS (TYP.) 2" DOUBLE WASHED PEASTONE 2 0 38.0' 4"OSCH40 PVC PIPES LEVEL 1ST 2' OR GEOTEXTIL FABRIC 5. PIPE JOINTS TO BE MADE WATERTIGHT. 'mac .,. 35.1' y EXISTING 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10" 1000 GAL H-10 14" �s o 0000 V TEE SEPTIC TANK TEE + o00 oo WITH * 310 CMR 15.000 TITLE V. 6.6 f 6" MIN. SUMP o 34.6 0 ) (RE-USE)** o00000000goo 12" MIN. INT. DIAM. �3 GAS BAFFLE o 0'ono _ Locus Clop 0 2' q 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 34.77' 34.6' o 00 o gg 32.6' NOT TO BE USED FOR LOT LINE STAKING OR ANY H-10 3050 INFILTRATORS OTHER PURPOSE. pe 28 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 3/4" TO 1 1/2" DOUBLE WASHED STONE 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [2]) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' CONCEALED WITHOUT INSPECTION BY BOARD OF 5' HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND ( 7 % SLOPE) VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF BOTTOM TH-1 & TH-2 27 6' WORK. FOUNDATION EXIST. SEPTIC TANK 26' D' BOX 2' LEACHING No GROUNDWATER FOUND ASSESSORS MAP 169 PARCEL 93-2 FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL PROPOSED LEACHING FACILITY. NO CONSTRUCTION PROPOSED; UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS _ SEPTIC UPGRADE ONLY PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT SAND. 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 99 - EXISTING CONTOUR WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. x 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR SYSTEM DESIGN: 198•4] PROPOSED SPOT EL. TH1 40.13 GARBAGE DISPOSER IS NOT ALLOWED .TEST HOLE YY / DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD z SLOPE OF GROUND USE A 330 GPD DESIGN FLOW UTILITY POLE O // S�.89 - BENCH MARK - CORNER 7OFFIRE HYDRANT � CONC. BULKHEAD EL = SEPTIC TANK: 330 GPD (2) = 660 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING ® / wow " 9.15 RE-USE EXISTING 1000 GAL. SEPTIC TANK** 39.78 / X 383 LEACHING:' // 67 �X SIDES: 2 (30.4 +10.25) 2 (.74) = 120 GPD TEST HOLE LOGS / r " S> LOT 2 BOTTOM 30.4 x 10.25 (.74) = 230 GPD 16 -ARNE H. OJALA, PE, SE / TH2 -SOAK 3 .61 15,432± SF ENGINEER. / o EXIST. fCA ' 38\ TOTAL: 473 S.F. 350 GPD WITNESS: DON DESMARAIS, IRS / DWELL. xo 92 6 �TH � � USE (4) H-10 3050 INFILTRATORS, JUNE 12, 2009 / TOP FNDN. = 41.45 �2 \ N AN 3' AT SIDES DATE. y f WITH 1 STONE AT ENDS D < 2 MIN/INCH / 8 75 41.45' 32 38.51 PERC. RATE _ / - o � � �2'' OAK / � k CLASS I SOILS p# 12596 x 38.64 39.32 X 3 \� 3,9 DECK 38.64 GRAVEL DRIVE O / / o ELEV. ELEV. 8.61 � '7 37.71 o 0" `V' 38.6' 0" `� 38.6' 3 g2g / PLAYGROUND / x FILL FILL / "38-� / 37.58 23" 23of MA/ x 37.60 / / _ 37 / / APPROVED DATE BOARD OF HEALTH A/B A/B x 36.79 4,6.39 /\ LS LS // TITLE 5 SITE PLAN 249p 10YR 3/1 36.6' 2409 10YR 3/1 36.6' 162.2E 36.47 OF E E 480 SKUNKNET ROAD Fs FS CENTERVILLE 29" 10YR 7/1 36.4' 29== 10YR 7/1 36.4' PREPARED FOR B B BORTOLOTTI CONSTRUCTION/AUGUST LS LS 36" 1OYR 5/4 35.6' 36" 1OYR 5/4 35.6' JUNE 12, 2009 OEMASS � �cA4SNOFMA�s �� Y OPM g ° DANiELA �� p��N Mass ��µ AS off 508-362-4541 PERC C C o A. OJAtA a' ?� q�ti ti fax 508-362-9880 ° C7ANlEL ` N �° DANIJ=L G� o�' DANIELA. G� MCS MCS " OJALA o A. �� OJALA ,' downcope.com� �� CIVIL o s No. 4 2 0 -+ o ++ 2.5Y 6/4 ++ 2.5Y 6/4 61 P � ��F <o �-= OJALA v � P � CIVIL ¢ down cope engineering Inc. 132 27.6 132 27.6 � o �ssi �G / 0980 No.46502 i -. oNAt E-. / o- °� o F civil engineers � �-��. . �� -1f.�1 � "0 uRVE�SS\ � ss ST ��: -� land surveyors NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' �/( ° / 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 09- 122 09-122.DWG(SBo)