HomeMy WebLinkAbout0526 SKUNKNET ROAD - Health 52.6'Skunknet Road
Centerville F/R
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152113 ORA 100/0 P2
Town of Barnstable Health Inspector
Office Hours
�FTHE T do Regulatory Services 8:00—9:30
Thomas F.Geiler,Director 3:30—4:30
* RU MSTAsLE, Only
9� 6 ,�r Public Health Division
ArEo �A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT QUESTIONNAIRE
1. General Information:
Address: a-(n ks l fle �� Map Parcel
Name: i ` M b �! T i�E{�1('U Phone: lz-�,f3�
2. How many bedrooms exist on your property now? �Ni f ��(�ryt I n1M (�'1�'�e p1 S)
2a. Please include a copy of your floor plans for thee entirre property
3. Is the dwelling connected to public sewer? YES or . NO
If the dwelling is connected to public sewer, skip questions 4-9 below. °
4. Location of dwelling is INSID or OUTSIDE a Zone of Contribution to public
supply wells?
5. Is the dwelling connected to an ONSITE WELL or to UBLIC WATE
6. Is a disposal works construction permit on file. YES or NO
6a.If yes, how many bedrooms were approved actor mg to this permit? _
Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or
8. Is there an engineered septic system plan on file at the Health Division? ES or NO
9. the septic system been inspected by a DEP certified inspector within the last two years?
ES or NO
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FOR OFFICE USE ONLY
TO BE SIGNED BY A HEALTH INSPECTORIAGENT ONLY `T
The Public Health Division haspo.objection to bedrooms at this property.
Signed: 97- . Date: — 7/ c 3
Inspector(Prin
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The Town of Barnstable
• BARNSTABLE, : -
9� M" Growth Management Department
s63q. �0
367 Main Street, 3rd Floor
Hyannis,MA 02601
Tel:508-862-4678 Fax:508-862-4782
June 18,2008
John C.Klimm,Town Manager
Janet Joakim,Town Council President
Barnstable Town Hall
367 Main Street
Hyannis,MA 02601
Re: Tim Perry- 526 Skunknett Road, Centerville MA, one-bedroom accessory unit
This letter is to inform you that the Accessory Affordable Apartment (Amnesty) Program has
received a request for a project eligibility letter under the Community Development Block Grant
(CDBG) Fund and under Article II of Chapter Nine of the Code of the Town of Barnstable and the
criteria for the Local Chapter 40B Program.
This office is reviewing the request. If the Town has any comments on the project, please forward
them tome so that they can be addressed in the site approval letter. This letter gives you official
notice of our receipt of the above application(s). We will issue a decision as to the acceptability of
the sites and the consistency of this development within the guidelines of CDBG.
Sincerely,
Elizabeth Dillen
Special Projects Coordinator
Growth Management Department
cc: Building Division
Health Division a/
4
TOWN OF BARNSTABLE
LOCATION � ��;^��{. i SEWAGE #-�
VILLAGE �a"(�UI 11 ASSESSOR'S MAP & LOT LS'
iNSTALLER'�NAME &PHONE NO. S�'__�
SEPTIC TANK CAPACITY X 5 l 0
LEACHING FACILITY: (type) �� d'� 6-61 r U
NO.OF BEDROOMS_
BUILDER OR OPINER
PERMITDATE: + O COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facili; � tCL� Feet
Private Water Supply Well and Leaching Facility (If any wells exist p .
on site or within 200 feet of leaching facility) 11 Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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FAILED INSPECTION r I S �
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
w
� d RECEIVED
ce^M S�e� SEP 2
3 2003
TOWN OF BARNSTABLE
HEALTFI DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL-SYSTEM FORM
PART A MAP
CERTIFICATION --
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2 LOT —
Owner's Name: JOANNE CROSS ' .
Owner's Address: 526 SKUNKNET RD CENTERVILLE 02632
Date of Inspection: 8/25/03 C0§1V
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
_ Conditionally sses
_ Needs Furth valuation by the Local Approving Authority
X Fails
Inspector's Signature: �` Date: 8/25/03
The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspec on. 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 Conunents
SYSTEM FAILED TITLE V INSPECTION.THE SYSTEM IS PAST THE EFFECTIVE DEPTH OF LEACHING.THE
LEACH PIT WAS PONDING AT THE TIME OF THE INSPECTION.
****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.
TitIP S incna.rtinn Fnrm Fii si?nnn 1
Page 3 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
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.THE SYSTEM IS PAST THE EFFECTIVE DEPTH OF LEACHING.
THE LEACH PIT WAS PONDING AT THE TIME OF THE INSPECTION.
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 detennined(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: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
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 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
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 1 YR AGO 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.
d
Page,5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
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)]
5
Page,6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 4
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)):at (, — `"10(—'�O
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establislunent: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,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: 1 YR AGO 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:
1980 PER ASBUILT
Were sewage odors detected when arriving at the site(yes or no): NO
F
Page 7 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
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: 12"
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' 10`1
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness: 2"
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: ate.
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 SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND. 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
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
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: n/a
Conunents(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.):
DID NOT EXPOSE DUE TO LIQUID LEVEL IN SYSTEM
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 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 61 X 61 leaching pits, number:
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.):
THE LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING-THE PIT WAS PONDING AT THE TIME
OF THE INSPECTION.
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
4
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
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.
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 526 SKUNKNET RD CENTERVILLE 02632 L2
Owner: JOANNE CROSS
Date of Inspection: 8/25/03
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 10+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:
GROUNDWATER WAS DETERMINED BY HAND AUGER- 10+FEET
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NPORTAN uT — UPGRADE REQUIRED
STATE RULDING CODE REQUIRES HE UPGRADING OF
SMOKE DETECTORS FOR THIE EN1'IfiE DWELLING WHEN M 1
ONE OR MORE SLEEPING AREAS A,RE ADDED OR CREATED.
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INSTALLATION 0F SMOKE DETECTORS THE ELECTRICAL
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McKean, Thomas
From: McKean, Thomas
Sent: Wednesday,April 12, 2017 3:52 PM
To: Scali, Richard; Roma, Paul;Jenkins, Elizabeth
Cc: Quirk, Ann; Soto, Kathryn
Subject: RE: RAO - 526 Skunknet Rd.,
This property is limited to four(4) bedrooms maximum. The Health Division had no objection to the approval of the
amnesty program application which was submitted by Timothy Perry in 2008;this was for a basement apartment. An
agreement was made to eliminate a bedroom on the first floor.
Currently,the basement apartment is not registered with the Board of Health as a rental. Ms. Kathryn Soto sent them a
notice to register back in 2015 but there was no response.
The Zoning Board of Appeals approves amnesty program apartments. The Growth Management Department assists
clients through the amnesty application and approval process. Therefore,the RAO inquiry should be forwarded to the
Growth Management Department to request and obtain the apartment approval record and to understand what
conditions were placed on record.
From: Scali, Richard
Sent: Wednesday, April 12, 2017 3:32 PM
To: Roma, Paul; McKean, Thomas
Cc: Quirk, Ann
Subject: FW: RAO
Paul and Tom:
Would you check on the status of this property and advise the realtor.
Richard
.From: Marietta Nilson REALTOR [mailto:capebuyerbroker@comcast.net]
Sent: Wednesday, April 12, 2017 1:45 PM
Subject: RAO
RE: 526 Skunknet Rd., Centerville, this house is listed for sale in MLS now as having an accessory apartment in
the basement and a vacation rental in the main house. I have a client interested in purchasing but I'm concerned
about the status of the permits for the house as currently used. The owners do not live on the premises. The
rentals have been done thru online booking services. What do you have in your records that would indicate the
property is in compliance with town regs? Thank you.
Marietta Nilson
REALTOR
Cape Cod& Islands Association of REALTORS (Marietta Realty)
talk: 508 2217703
email: CapeBuyerBrokergcomcast.net
website:
1 .
Commonwealth of Massachusetts
OfficialTitle 5 Inspection Form .
Subsurface Sewage disposal System Form -loot for Voluntary Assessments
, 526 Skunknet Rd
Property Address
C/B Asset Management U,,9 • (-)k5 - oo a
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. City./Town State Zip Code Date of Inspection
Inspection results must be submitted on this forrn.Inspection forms may not be altered in any
way.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Shawn Mcelroy Enterprises
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
1-508-495-0905 S13971
Telephone Number License Number " ry '
B. Certification
t �T7
Ifs tt ;"i
I certify that I have personally inspected the sewage disposal system at this address:-and that Rib
information reported below is true,accurate and complete as of the time of the inspM*on.The inspection
was performed based on my training and experience in the proper function and maintenance ofbn sites
sewage disposal systems. I am a DEP approved system inspector pursuant to Se ion 15. Q ofrYs
Title 6(310 CMR 15.000).The system:
Passes ❑ Gonditionally Passes ❑ Fails
❑ Deeds Further Evaluation by the Local Approving Authority
1-30-€l8
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer,if applicable, and the approving authority.
****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.
t5insp•08/06 Tittle 5 Qffidal Irtspechon Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r< 526 Skunknet Rd
Property Address
CB Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. Cfty/Town State Zip Code Date of Inspection
B. Certification (cont.)
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 is in good working order with no sign of back-up.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system,upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not
determined,"please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfittration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Dissposaf System Form-Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C/B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. City/Town State Tip Code Date of Inspection
B. Certification (cant.)
B) System Conditionally Passes(cone.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ -broken pipe(s) are replaced'
❑ obstruction is removed
D Explain:
lain:P
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.
t5insp•08/06 Tdfe S Official ttaspectioa Form Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C/B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent 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:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
0 N Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6° below invert or available volume is less
than 'h day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
t5insp-08/06 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
V Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C/B Asset Management
Owner OwnWs Name
information is required for Centerville MA 02632 1-30-08
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cant.)
D) System Failure Criteria Appti:cable to Alt,Systems (cunt.):
Yes No
❑ ® Any portion of a cesspool or privy is within a:Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is,less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis,performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent 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
and chain of custody must be,attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® 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.
For large systems, you must indicate either"yes`or Ono'to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim wellhead Protection
Area—IWPA)or a mapped Zone.Il 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.
t5insp•08/06 Title 5 Offiaartnspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y< 526 Skunknet Rd
Property Address
C/B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. City[Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate'yes"or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ z Were any of.the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions,depth of liquid,depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner)provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposals System Form -Not for Voluntary Assessments
526 Skunknet Rd
Property Address
CfB Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: 12-07
Date
Commercial/lndustriat Flow Conditions:.
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/personsisq.ft.,etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
t5insp•08/06 Tide 5 Of6 W.tispection,For=Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C/B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)Y (
General Information
Pumping Records:
Source of information:
N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank,distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (Yes or no) (if es, attach previous inspection records, if any)
❑ Innovative/Altemative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components,date installed (if known)and source of information:
2004
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposat System Form-Not for Voluntary Assessments
526 Skunknet Rd
Property Address
CIB Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Building Sewer(locate on site plan):
Depth below grade: 12"
feet
Material of construction:
❑ cast iron 0'40 PVC ❑other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints,venting,evidence of leakage,etc.):
Good condition.
Septic Tank(locate on site plan):
Depth below grade: 6"feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
--------------------------------------------------------------------------------------------------------------------------
Dimensions: 1.000 Gal
Sludge depth: 12"
Distance from top of sludge to bottom of outlet tee or baffle 20"
Scum thickness
8"
Distance from top of scum to top of outlet tee or baffle
4"
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? Tape
t5insp•08106 We 5Official Impec5orr Form Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M v 526 Skunknet Rd
Property Address
CB Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
Recommended pumping for solids. Tank in good condition with baffles in place.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
t5insp-08106 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposat System Form Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C/B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cant.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity: gallons
Design Flow:
gartorrs per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches,etc.):-
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
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.):
Good condition.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
t5insp-08/06 TdteS f2Hiaal:Brpec6bn;fvram Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
w 526 Skunknet Rd
Property Address
C/B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 3-500's
❑ leaching galleries number.
❑ leaching trenches number,length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of
vegetation, etc.):
Leach chambers in good condition and empty at inspection. historical stain line at 5"from bottom.
t5insp-OW06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts
Title e i is Inspection For
- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C/B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-O8
every page. Cityrrown state Zip Code Date of Inspection
D. System Information (font.)
Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp•08106 Title 5 Official fnspectior.Form:Subsurface Sewage Disposal System•Page 13'of 15
Commonwealth of Massachusefts
Title ci
Subsurface Sewage Disposal System Forma-Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C/S Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 $-30--03
_
every page. Cdyfrown State p Code Date of Inspection
D. System Information (coat.)
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 welly within 100 feet.
Locate where public water supply enters the building.
601ck
f�ec.V, - - --
15insp•08M6 Fde 5 101T49 iasp se fo:FmcrSttubsuftt SRwa gee Ds saI System-Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
IP Subsurface Sewage Disposat System Form -Not for Voluntary Assessments
526 Skunknet Rd
Property Address
C{B Asset Management
Owner Owner's Name
information is required for Centerville MA 02632 1-30-08
every page. Citylrown State Lp Code Date of Inspection
D. System Information (cunt.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to ground water. 20
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked,date of design plan reviewed: Date
® Observed site(abutting property/observation hole within 1.50 feet of SAS)
® Checked with local Board of Health-explain:
® Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
original design plans show no water at 12'.
t5insp-0&06 Tdle-50 'Inspection Formc Subsurface Smage Disposal System•Page 15 of 15
Town of Barnstable
OF 1HE Tp�
Regulatory Services
,erns Thomas F. Geiler, Director
, 1639. ,0�'
ArED MA'l p Public Health .Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
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(C{u-�A)X 4)C.7r
n
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NI`;ME in town (which you
must do by M.G.L.- it does not give you permission to operate.) You must first: obtain the necessary signatures on this for '. at 200 Main St., Hyannis,
Take Ilia cornple.ted form to fhr Town Clerk's Officer, 1 sl Fl., 36/ Main St_, Hyannis, 02601 ('Town Hall) and get th(-: Business Certificate that is
required by lavv.
DATE Fill in please:
APPLICANT'S YOUR NAME S: S v
...
BUSINESS YOUR HOME ADDRESS: cI'� d- v�,i I y v�',.«,�,.,
r C )i,
SpS `I cl q -FT-
TELEPHONE # Home Telephone Number c�661
1 S S k B
h
NAME OF CORPORATION:
NAME OF NEW BUSINESS �, .
C h w, TYPE OF BUSINESS. 'C(r C. h
IS THIS A HOME OCCUPATION? — YES NO
ADDRESS OF BUSINESS SA 4 6
AP/PARCEL NUMBER6
S
&A (Assessing)
When starting a new business there are several things you must do.in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -
�, Y .____________,{corner of Yarmouth
Rd. & Main .street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMM)S95 ER'S OFFI E ,
This individual as k� inform d f ny p r it requirem nts th pertain to this type of busine�.UST COMPLY WITH HOME OCCUPATION
RULES AND REGULATIONS. FAILURE TO
Auth ized Si ' t re* 1---- COMPLY MAY RESULT IN FINES.
COMMENTS:C_��,ryl f/U �4 V-0 -,tl
2. BOARD OF HEA H
This individual has T
en i r e �o jthe permit requirements that pertain to this type of business. MUST ,OM°LY VVITy ALL
Authorized Signature** !:,. 1.C'_il. Pv:r`, ,-.-;:, S
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
p
-'' Datelb /Zg/ Z-o j(5
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE
NAME OF BUSINESS: T�: U �-::M., ��%%, , .�� r
BUSINESS LOCATION: G �, ,�ll���/'�VCiAo r/� INVENTORY
MAILING ADDRESS: f P;# h 11 L" a;' T�,:dl fi / �.�,�,� TOTAL AMOUNT:
TELEPHONE NUMBER: `v `l5,S �br
4 CONTACT PERSON: ,�,j an ;I vr_
EMERGENCY CONTACT TELEPHONE NUMBER: n60 MSDS ON SITE?
TYPE OF BUSINESS:
INFORMATION/RECOM MEN DAT ONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The board of health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants -
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with"poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
,,,Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS jorpPliC6nt's Signature Staff's Initials
Town of Barnstable
Regulatory Services „ 4 #j L 1 V
".. Thomas F. Geiler,Director
r ; a): � S
* ' `MAS& Public Health Division r11 " 0
1639. ' Thomas McKean,Director
200 Main Street,Hyannis,MA 02601 ......."k-"-��✓
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: Sewage Permit# Assessor's Map\Parcel
Designer: n Ev't�r ee ^� Installer:
Address: /�/ Hoc I r\ v Address:
On was issued a permit to install a
(date) // (installer)
septic system at K�n&6� A
a4 cJn . based on a design drawn by
(address)
0_/�_rz aL_ dated 1/ 46/60Y
(d igner)
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.
ARNE H cyG�
(Installer's Signature) 0 OJALA
CIVIL N
No. 3 792
i.
esign r' na (Affix De i s Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc
' N
4 LOT 2 160 ' �#
O� 15,534t SQ. FT. 00'
�i
w
o
EIOST. \
DWELL
DECK
SUN> O
ROOM/0
� o
Jo�
1 s068,
3 500 GAL LEACHING CHAMBERS
WITH 4 FT OF STONE ALL AROUND
INV. OUT S.TANK - 26.57'
W. IN DBOX - 25.95'
INV. OUT DBOX - 25.78'
INV IN TO CHAMBERS - 25.75'
TOP CHAMBERS - 26.6'
JOB # 03-313
SEPTIC AS-BUILT PLAN
LOCATION 526 SKUNKNET ROAD CENTERVILLE, MA PREPARED FOR:
SCALE : 1" = 30' DATE : DECEMBER 23, 2004
REFERENCE : LOT 2 PLAN BOOK 339 PACE 49 GARY CROSS
ASSESSORS MAP 169 PARCEL 15-2
I HEREBY CERTIFY THAT THE SEPTIC SYSTEM H OF/f4
SHOWN ON THIS PLAN IS LOCATED
AS SHOWN HEREON. �� ARNE sG
o H• �,
off 508-362-4541 U OJALA
fax 508 362-9880
4 NO 34
down cape engineering, inc. %0
CIVIL ENGINEERS � �` V�V --_--_--
LAND SURVEYORS
939 main st yarmouth, ma 02675 DATE REG. I SURVEYOR
TOWN OF BARNSTA.BLE
LOCATION �� ���'�► !�l a Rol SEWAGE# -
L
VILLAGE Z'e0T eI U ASSESSOR'S MAP&LOT
�R
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACrrY I OOO a
LEACHING FACILrrY:'(type) L e a e4 C 4,ws el-S (size)
NO.OF BEDROOMS 7
BUILDER OR OWNER
PERMITDATE: 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) f T Feet
Furnished by J44t.'o lryS' i0�2 lh Sj0ec��.,r
r +{nL)
�/ a c k h
Oeck
A -D- Ise
ys'
o E Do
-
TOWN OF BARNSTABLE
tLr3CA1:1ON ,� _ )������,{� SEWAGE # 00 C�.� (o
«LAG ASSESSOR'S MAP & LOT C.. _
INSTALLER'S NAME &PHONE NO. PQ�
SEPTIC TANK CAPACITY X.1 S l U 6U _
LEACHING FACILITY: (type) s��� U C3-GtrV�si'zd;+S (� �� "I �3nt
. NO. OF BEDROOMS
,I ILDER OR OWNER _--
ERMITDATE: I I '� .0 U LI COMPLIANCE DATE:
eparation Distance Between the:
aximum 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 an'd Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) _._SZe Feet
Furnished,by._�__
Ali }
1 1
'100
�
No. 3� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
91ppYication for 30i5pooal *pgtem Cougtruction Permit
Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 4'2 GO S vi►/� T .� Owner's Name,Address and Tel.No.
�j C9-hRY CROSS
Assessor's Map/Parcel S-:2<., 5.-t1V V1<-vETXI
I f,tq
Installer's Name,Address,and Tel.No. 6-2) $ Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design.Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issuedjQhis Board of H
Signed INq ° Date
Application Approved by Date
Application Disapproved for the following rea
Permit No. s Date Issued r
1(09
No.l ,00 i
lll..1!! 'Fee
l r' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
�Jy.. .' ✓
PUBLIC`HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppliqation,for M ogar !teat Conitruction Permit
Application for a Permit to Construct( , )Repair(.Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. S CB v�� Owner's Name,Address and Tel.No.
S
r p
&� I C co-AgRY CXoss
Assessor's Map/Parcel ✓"'� r.2 lP 5.-eW V1-<-E T�
1 u9 A047,# u2 h3 2
Installer's Name,Address,and Tel.No. S U ^7 7 Pi—b_X c/9 Designer's Name,Address and Tel.No.
G��7Y•�arvr�/ /�Ui�i�s .. . y�euiA/ c.�f'E .�-.�y��E.�s
�1'3g/ .ai.✓Sr ygi.o�,dvrS rn>-4- 0-24-7S- .
Type of Building:
Dwelling No.of Bedrooms Sl Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of.Persons Showers( ) Cafeteria( )
Other Fixtures
Design.Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b7this Board of He /!
Signed /I o ., Date
Application Approved by _ / rD i Date
Application Disapproved for the following rea Us
Permit No. ' Date Issued
it I
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (f�,)Upgraded( )
Abandoned( )by
at _ �s,,b,,een constructed in accordance
with the provisions o tle 5 and the for Disposal System Construction Permit No. ated /
Installer Designer
The issuance of this p9mut Shp not be construed as a guarantee that th sys e �I ut tion as de
Date `� /'a—�d— Inspector 1.
— -- — -- —_ � —
71
No Fee
THE COMMONWEALTH OF MASSACHUSETTS.
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migpolar *pgtem Congtruction Permit
Permission is hereby granted to Construct )Repair )- grade.( )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:Constdiiction Tust be completed within three years of the date of th' permit.
Date: / Approved by _�
DUMAS LANDSCAPE CONST.
564 OLD STATE ROAD
CENTERVILLE,MA 02632-
775-0249
r
TOWN OF BARNSTABLE
LOCATION Ta(4 SEWAGE #'K7*0 9
VlLLAOEC�� ASSESSOR'S MAP& LOT1 �n
INSTALLER'S NAME&PHONE
SEPTIC TANK CAPACITY X�
LE.ACHNG FACILI"T': (type) au.0 w
NO.OF BEDRC7OMS I
BUILDER OR OWNER L-I ( r +�
PERMI'TDATE: t I `! O COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
� Feet
Private Water Supply Well and Lwhing Facility (If any wells exist
on site or within 200 feet of leaching facility} kc ��� Feet 1
Edge of Aledand and Leaching Facility(If any wetlands exist Q �ev1 Fcec
within 300 feet of leaching facility)
Funs shed by a— ----
.9
1
1
Lq
1
i
�- IX t .
LOC=ATION SE AGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME i ADDRESS i
`'S UILDE R OR OWNER
DA T E PERMIT ISSUED
DATE COMPLIANCE ISSUED j�_ � -' �
a
6 S�'
a
THE COMMONWEALTH OF MASSACHUSETTS
9
BOAR® OF HEALTH
..........TQ.I I J....................OF............B M,9.t.ab1.
Appliration for Disposal Workii Tonutrnr#iun Vantit
Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal
System at:
Skunknet road Lot 2
................_........................... ... --...... ------------............... .......••--...--•-................................................................................
James K LotmioiAdaress Barnstable or Lot No.
Owner Address .
w Vetorino Bros. Barnstable
•------•----------------•--•----............---••--------....----•----•-•-•--------••......---- -----..._._........_.._.................-•--........._......•-----q;•---...
Installer Address .,
Type of Buildin�-- Size Lot............................S feet
�., Dwelling—No. of Bedrooms..............3._........_........--.--..Expansion Attic ( ) Garbage Grinder Vc)
`k Other—Type of Buildin No. of persons............................ Showers
Pk YP g ---•----------------•-••---• P ( )--- Cafeteria ( )
Other fixtures ... ------------------------------------•--------- --
w Design Flow.............\\.:)..........gallons per person per day. Total daily flow.............11 ..........-.......gallons.
WSeptic Tank��iquid'capacity.�Qk)ngallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by...................................................................... -•-- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.............
.._.... Depth to ground water.......---..............
Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water......---...............
a A-)...................................................................................-----------.._..•-•-•...---••---•--..............._---•--
O Description of Soil......��.�.'..?`............. .----.?......... •---------------------------------------------------------
•-•------
v .......................................
U Nature'of Repairs or Alterations—Answer when applicable................................................................................................
-•------•-------------------•---•----------------•-•----.....-----•-----------------.....--------•-- ---...-------------------•----------------•-----------------•--•--------------------••-------•--•--
Agreement: I'
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'LU 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 ofhealth. p
9gned4 ......V. �. -----------------•---•
Date
Application Approved By... =- ..e � �� f C -�-�'..
Date
Application Disapproved for the following reasons----------------------------------------•--------........------•-•------- .......................................
..............•--------------•------......._....._....------------••--.....------•---........-----•....---•----•--------•-••-------•---•----•--•----•--------•-•••••--------••----- ......•-•-------
Date
PermitNo......................................................... IssuecL.... . -1t.. .............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
ro
BOARD OF HEALTH
Town Barnstable
..........................................OF......................................................................................
Cnrdif iratr n fin t�rli�anrr
THLS JS TQ CEITIF , That the Individual Sewage Disposal System constructed (X ) or Repaired ( )
ve orllnv rothers.
by..........................................................................................--------•----------------------•---------------------------•-----------•---------------------------------
at...._----' 'ot 2--Skunknet .Road# Centerv.i�`f g
i has been installed in accordance with the provisions of " , j f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ----�- -.�........... dated--/�_-" -. ._�"---Ad--I---_--.
' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL,- UNCTI N SATISFACTORY. }
I �
DATE........ ...`. `v---• •.............................. Inspector---- ........... .................................................
i THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G� d .............T.own..............OF............Barmgt- ble......................................... lJ �''��.*
No...................... FEEs,.,Z----..-.-.------
Disposal Works Tonotr ion rrmit
Permission is hereby granted........... - ---•-•-----•----------------------•--•---•-------------_--.------------
to Construct,(X) or Repair ( ) an Individual Sewage Disposal System
atNo...... �---Centerville---------------- ------------------------------------------------------ --------------------------------
Street n
as shown on the application for Disposal Works Construction Per o..... .... . .... ted.... "".'?. �.. ...�`' ..
L� �) Board o H th !�
DATE V -•.... -(-T--.......
FORM 1255 'HOBBS & WARREN, INC., PUBLISHERS
t
i
No........... ..... ... s Fz$..... .........._.
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
----..Town...................OF............B4=e!tab1.e
ApplirFatinn for Disposal Works Tonstrnr#inn rumit
Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal
System at: -
Skunknet road Lot 2
................_........_...........,---•-- ..... -----------...-----........... ..._.........•-••-••-•-----•--------•-••-•-----•-•--•-•-•-•-••.....•----•......_......---.........
io
Ames K«Logt mi jress Barnstable or Lot No.
• .._....................... .......-•r.............. •••-••••---•......................................................................................
w Vetorino Brosa Barnstable Address
.........................................•----------.....------------------------------------...._ ....._••••. •----••--....._._...-••---•-••:...-•••-•............••-•-•-•....................---
Installer Address
Type of BuildiW-` Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms..............� .........................Expansion Attic ( ) Garbage-Grinder (�
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures --------•-•---- ---•-•-••-•-••.............•--•-•---••------•••-••-•••--•--•------------•.
w Design Flow .. ...... \0....__..gallons per person per day. Total daily flow.............-33 ..................gallons.,
WSeptic Tank Liquid capacity..kOQC)gallons Length................ Width................ Diameter.....---.----... Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.........---.--.....`Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by---•-•---••-•-----------•--............................................ Date........................................
Test Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water.--.................---.
G� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-----..............---. .
•---------------------------------••-----•-•--•-•---------•-•--•--........••----•-------------•••---._................................................................
O Description of Soil 5 -._.;e?_ ...........\0_PCM e--•----------------•-----------------------------••-------•-•-•---- -
x ..... , --------V-------- 5�� �r��d.-----------•---------------
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 provisions of iITLL 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.
gned... ---•• ................................
Date
Application Approved By-•-.."......•� � �• --•-•-. ---•--
Application Disapproved for the following reasons:...-„�-------..............................---..........................---•-------•-----Date--------------
..••--•--••-•-••.............•-•---•-----...••--•••••-•-•---...•-•-••••--
Date
PermitNo......................................................... Issued-.......................................................
.
Date r
_Q lC�►�l T>A,-rA _
sp i py 00 ...,�.
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G
7 SFo�LPL SIT - USE-- (Onc, C,44-•
S.P.
5b 6.R D.
,f TOTAL "Z-.)EStGIJ = 42S' . G.P.U.
fZL0W = 330 6at%D. Peon
� ' PST •
rA414 ? + rN-
�1.CGDlAT10U2ht�a.1�olZ
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;_ Tt-�1:'• C7I..A�-t 1�, WOT LA;L.C7 L'" A&.J 05TE�c�/11..1.G
1tJ;('�J:nl_�JT �,uc�./s'-`�' ;�•T►�L: c3F�;�,C•�, it_ioujLa QPPt_t G/`-.t,.,T
T-0 X- [ t::_:�l
TOP FNDN. AT EL. 31 .5' SYSTEM PROFILE TEST HOLE LOGS
NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN
•,, - ACCESS COVER TO WITHIN 6" OF FIN. GRADE � ,
ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: BAXTER & NYE, INC
MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM DATE: 1980
28.5' - 29.0' NFi
2" DOUBLE WASHED PEASTONi: PERC. RATE = < 2 MIN/INCH
EL. 28.0' RUN PIPE LEVEL _
FOR FIRST 2' 3' MAX. �NFcgc EXIST. 1000 GALLON SEPTIC `� 6't* T 26.8' CLASS i SOILS TANK (H- 1OG2 6.0 3' E� [� (� C7 0C7 [� CI (�
RE-USE) BAFFLE 26.20' �"� 0 25.93' C] 0 [] [] [� Il rl 4' AROUND
6" CRUSHED STONE OR MECHANICAL [�] C O ED 0 0 0 0 ED TH ELEV.
COMPACTION. (15.221 [2)) oag 2' 0 0 E-1 0 0 0 ED 0 0 a 23.93' �" 28.7'
DEPTH OF FLOW = 4 MIN 1
(TEE SIZES: 1 7 SLOPE) ( SLOPE) 3/4" TO 1 1/2" DOUBLE WAS-IED STONE LOAM
INLET DEPTH = 10" `
14" SUBSOIL
26.2
OUTLET DEPTH 30>, LOCATION MAP NTS
FOUNDATION- EXIST SEPTIC TANK 26' D' BOX 12' LEACHING
FACILITY 7 23' FINE ASSESSORS MAP 169 PARCEL 15-2
*THE INSTALLER SHALL VERIFY THE SAND
LOCATIONS OF ALL UTILITIES AND ALL _
BUILDING SEWER OUTLETS AND ELEVATIONS 96" 20.7'
PRIOR TO INSTALLING ANY PORTION OF CONTRACTOR TO CONFIRM SUITABLE SOILS
SEPTIC SYSTEM AND NO WATER FOR 5' BENEATH BASE OF
LEACHING FACILITY ELEVATION PRIOR TO
INSTALLING ANY PORTION OF SEPTIC SYSTEM 16.7'
MED
SAND
,t 25.4
/
/ I 144" 16.7' . ..
T 2
¢ 25.8 15,5340t SO. FT. �6Q00"
NO WATER ENCOUNTERED
q � NOTES:
/ + 24.1
/ + 24.7
/ 25 SEPTIC DESIGN: (GARBAGE DISPOSER is NOT ALLOWED ) 1 . D��TUM IS ASSUMED
NOTE: SEPTIC TANK HAS _
/ ACCESS FOR� PUMPING 25 err l rl r ( 1 1 Q ) - 4C 7 3 rlrtlr`
a 4 (2)E 7f'l33;(S GiPD L7`:..:D'.'uJJf'EVIki./IJ :LSD_ __ i,IG.J!�7IV r.-VVY.
`V
/ `, 25.1 + 25.2 USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
o &6'0 SEPTIC- TANK; 440 GPD ( 2 _ 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASiiO H- 10 "
) -
25.3 USE A 1000 5. PIPE JOINTS TO BE MADE WATERTIGHT.GALLON SEPTIC TANK (RE-USE EXIST.) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
/ APPROX. WATERLINE + 2 •_ ..._
26.0 ENVIRONMENTAL CODE TITLE V.
269 OXWELL �` 27 LEACHING: = 137 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT _
/ W TF = 31.5' DECKj+ 2 �� SIDES: 2(33.5 + 12.83) 2 (.74) - TO BE USED FOR ANY OTHER PURPOSE.
/ 33.5 x 12.83 (.74) = 318 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
/ 9.7 SU + 27.5 BOTTOM:N O 3 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
�5 NOOM� O o 28 TOTAL: 615 S F 455 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
- FNDN)/ 7.7 USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. w
OVER N� 9.3 \ �/ / �° $ o + 28.6 EQUAL) WITH 4' STONE ALL AROUND 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT
1/27.9 \ \ 7.+ 9.1 + 28.3 Q)* ,ICb
GRAVEL
PARKING LEGEND
/ + 28.1 T 2 .6 TITLE 5 SITE PLAN
/ + 3 9100.0 PROPOSED SPOT ELEVATION -
28.6 �F 526 SKUNKNET ROAD
28,6 ,�
100x0 EXISTING SPOT ELEVATION "
+ 2 �Sp 68, + 29. + 30.7 IN THE TOWN OF:
29.4 2939 100 PROPOSED CONTOUR (CENTERVILLE) BARNSTABLE
+ 29.6 30 100 EXISTING CONTOUR PREPARED FOR:
BENCH MARK - NAIL SET IN + 29.5 3a.____---�•� GARY CROSS
16 OAK ELEVATION = 30.9
+ 30.4
+
20 0 20 40 60
+ 30.8
BOARD OF HEALTH
APPROVED DATE MA SCALE: 1" = 20' DATE:, NOVEMBER 11 , 2003
off 508-362-4541
+ 31.0 fox 508 362-9880
31 1Sr l __
down cape engineering, Inc. Of
o ARNE H. �G Jqc ,
CIVIL_ ENGINEERS !: " I .:w OJALA , " AHN tiJ
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