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0559 SKUNKNET ROAD - Health
559 Skunknet Road Centerville A= 169- 011 -003 S M EAD No. H163OR UPC 10259 smead.com • Made in USA 41 VgcYcyb 1 \ 1 Owners: Walter and Beth Piknick . Address: 559 Skunknett Road, Centerville, MA 02632 Work: The Owners shall remove door and 4-5 foot opening to be constructed. Dimensions, are Approximate i 1 1 I. Dech 1 L�- 1 1 1 1 14.0' I Sun Pack r Room i �uh�X t IQlchan Farnlly o „ pp Room ti First Flo o m Dlnhlu 0W_IC_I__ Foyer /Irua c _ Uving Rown 26.0' l 20.0' 34.0' • Racrantlou �jf f1ntL Duch ' Room CC'A G l)ad+t.mu lJbil�Wfnl : " i✓R�t�.7:014.i F1� JI ' a !. fat{�r{i7,u Skulq.4y rywq Nw Owners: Walter and Beth Piknick . Address: 559 Skunknett Road, Centerville, MA 02632 Work: The Owners shall remove .door and 4-5 foot opening to be constructed.' Dimensions are Approximate i_8.01 _; 1 1 14.0' I - 1 4 Sun 1)U k s- Room �tlaX ; '3z'tl -Bfil lfitc role Famlly p y� Room ti i r 6i'st Floor b � i ty . Foyor Ulning 1Lua c — Living Roan 26.0' 20.0' 34.0' Racraat/dn t! Oc+UI DaM Room g�j''►p�'�y� •,y�..+pp+� *;' Clutlrr�tn is''> Res A.+�+11f J ��ie�Jl i)nttitann ' �kutU4yryw>t N"' Owners: Walter and Beth Piknick . Address: 559 Skunknett Road, Centerville, MA 02632 Work: The Owners shall remove door and 4-5 foot opening to be constructed. Dimensions are Approximate ;_n.o'_i Doch i f � f 14.0' Sun Dealt. Roorn 1 I • v3`I�X e • 3b9�, L-B.11 KlichunFamgy o Room► ti First Floor A �. Dining Foyer Arun c . = Living Ravin .�20.0' 34.0' Racraut/dn T fh Roone rLo/f Daih v�•k� '+lv. ilatlir�rnu � G ,. Second Floor Si j Owners: Walter and Beth Piknick . . Address: 559 Skunknett Road, Centerville, MA 02632 Work: The Owners shall remove door and 4-5 foot opening. to be constructed. Dimensions are Approximate, i I I I I � Dock �� • I I 1 ' 1 14.0' I I 4 Sun 0 1 Derck I r Room ao 1 I a39 a Sul 1{Itchun Family o f11Ist i—I Roof►► e: _ m N Poyor Arua c — Living Roan i _ -::---_ 26.0' 20.0, 34.0' Rocrant/dn. Lott D»Ue Built 3 Room CCk.1 !)neliptnn Lurfrt•�:u'e c ''' Second F16 r1 ' ')J�;�r{►fv'n' ' aku1U�LYryuM N."' NOTES: 559 Skunknet Road On 4/11/07 at 4:30 p.m., TM conducted an inspection of the interior. TM counted six rooms that should be considered as "bedrooms" according to DEP definitions (i.e. because of the size of the rooms and due to the fact that they each have privacy). 4/12/07, TM reviewed the file. The house and septic system were both constructed in 1984, 3+ years before the Town Ordinance was adopted in 11/87. The original system had capacity for 549 gallons per day. In 1993, there was a repair with a 1,000 gallon leaching pit constructed, attached to the original system. (Internal note: This is quite similar to the 539 River Road case reference BOH meeting March 21, 2007 except that the system in this case is not designed with a capacity of 550 gallons , rather it was designed with a capacity of 549 gallons). A. I suggest the applicant should request relief from the BOH at a public meeting for approval of four(4)bedrooms. B. The door should be removed and the doorway should be widened to a minimum five feet opening at the second floor room called a"living-room" located at the south side of the building in the newer section. C. In addition, one of the other private rooms (either the second floor"office", or first floor"TV room" or the second floor"bedroom" located in the new section of the home above the newer second kitchen area) shall be "de-privatized"by removing a door and opening the doorway to five feet. If this is not possible, then at a minimum, a door shall be removed at one of these rooms listed above in this section C. D. A deed restriction should be recorded restricting the property to the maximum number of bedrooms allowed (which is presently at three but could possibly be increased to four if approved by the Board of Health at a public hearing). Thomas McKean ALBERT A. BARBIERI, JR. ATTORNEY AT LAW P.O.Box 265 206 AYER ROAD,Rm. 1 HARVARD,MA.01451 TELEPHONE(978)456-4191 FAX(978)456-4194 HOME OFFICE(978)456-3922 EMAIL:LAW0FFICE@ABMW1E1T.NET PLEASE SEND ALL CORRESPONDENCE TO P.O.Box 265 HARVARD,MA 01451 May 2, 2007 C=P Thomas McKean, Health Inspector ci Town Hall ' 200 Main Street Hyannis, MA 02601 ; ._ -3r Re: Piknick N 559 Skunknet Road, Centerville, MA Dear Mr. McKean, I represent Walter& Beth Piknick. They have kept me somewhat informed regarding their dealings with the Board of Health concerning the number of bedrooms in the above-mentioned property. I did not represent them when they purchased, but I had the closing attorney send me copies of the entire file. Included in that file was an Official Title V inspection report issued by JP Macomber& Son Inc., which I enclose herein. You will note on page 7 part C, the certified septic inspector indicates that number of bedrooms (designed) is 5 and the number of bedrooms (actual) is 5. I showed this report and your inspection notes to a Sanitarian whom I work with here in central Massachusetts, and he agrees with me that something is very much amiss. I would like to get your take on the Certified Septic Inspectors Title V report before I make a decision as to what further action to take. Please call to discuss this matter or contact my office as the above address. Please contact our office with any questions or concerns regarding this matter. R Thank you. Sincerely, AlbertA. Bar6iery,fir. Albert A. Barbieri, Jr. AAB/melw r NOV-03-2006 FRI 10:28 AM 70DAY REAL ESTATE FAX N0, 508 790 1388 P. 02 CommoWwBAL'2 tOF MAtshcwTssm E MCMW aMCZ tam EWVUWMARCZAL pWA . MPAMURMs'OF ExvmuNbgjIUT'4L PRO.,,= ii IT=s AFIICIAL Purw1ww POW-rmr wait VOLMTASY A {Zy ��1tPA�i4ZiRAG�t D>t�O�AL,Bf1�P�1�' PPAW A UINVA710k VsvpmgAyppw SSR Skunjast Ltd t��nFn��+1t 1e Ma OIR32 ovies�eliasa�>;ti�t.Y��� QweraA.TisaS�m�_ •. r Daes.d�.a1� Nord[ Qdmwepf�p ,Robert A pnoijul Adiieeeo -- - yebpb aN—a sa 2632 C$R7MCATION HrATI9t1i M 1 acetify Mai We ft—dly-apxeed dte en"VO dlepwd q*m et No eddtter ad no the iofoma�np� blow ls true,so«e,w d aomplen M of Uw wee d olft intpocdmL Tic hrpaeioeww romod+eMa ono w oubft aed=Vwien-in Ow piper fia dco ietd mebftwee*ran doe esa ayale�fe,I asnt�r e eeea ttleeee■tne�e�rvwue ee seeW tf alu ar�111.s( C7eiu4 r Co"fiqWoy POW gwem zaCX t'eeeea • Needs ftam&aim n by des Lewd Appa ft AWbMW � I lerpeatte►'a S�isbmre: Deltet _`����'GUI fhcs7 •�IPatottda�ll+Y6mace"oroblogxomaerapnritolLeApprwtel�At�ortih( eddit .q DW wWo 3o lays of a�piatitt�tlrelt uMpeAion 1!ffie ep,6ph b e ela.al s>wart arhn a damn floe d IQAt�G poor :, get intpaWor o�q�e ay�taof owt[wfadl t l�the/sport to16s ePPmPrt dAJe on f tllotid be wu la ft eyeem owW WA mo-aat m the buttes,A eel des ep}tofl� NoW aadOommelRt e*e+'Ifie dwa9iesaae�..at i 9reliae iMes.'ItYb does�tedlrwe bir iir alitepaeltaw etex adeenM anilMr dteet avft W 4�wrpxlYeeefa IieAde:r eyertlasar�eeMtleelty o.arMtlare e[�c , Ti4eSfn9x*dalForm' 6r15"Jm pagesf. CB 3wJbd NOS 8 as w,crr 8L5T-961 08S BT!LB d66T/L8/6F! 3 f OCT-31-2006 TUE 11!04 Aft ' N REAL ESTATE FAX NO. V '80 1388 P. 02 Commam Tmow hUftAclusurm RxEcurm O m[cm cw Emvuwtqmwmu.A3WAM D(PABTMBMr OF BNVUK Mf1fIMAL PWjmMO ( T=! Bum.RWAcx8'wAOL!! wooALo tvrmPow MALT A. A�pa6i 5 R SNUW net Rd ORw'�1Q�� .�'.�•" Ff� 32 Ovrs4Adbgp t3ilaq �. 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V '90 138E P. 04 pap!of t t OMC1AL MSPEt;12ON ICOW-NOT$OR VOLMffARY ASMEMOMM SUBSURFACE SEWAGE DISPOSAL SYii'I'EM INMWAC'!'lON FORM FART A CRR1'�'iCA1�aN(eotlT p t SRO fGk%mlcMg& Rd owacrD AUM toeteorbrtpeo<ioa:9.l�.61°; C. 1FatlaurSralwtMaleasgat"bytiesmfdofBunt NO !s ffi m R >u �v�roamenR�e 13oeud ofiYr�llth la aadarea d Ktye gaswa I. �wi[i pass pales 8e�ard of Atalt6 dets+r�aa is aeoordaaes tsdth JIO t711lft IilBi(!T(OT Ant t>Se M t m b not faaodoniaaa Ina asamer witm rM protect Pablk haml(h,saEitt ma do omboam u AD Cutpeol 4!privy ja w 50 fool of a aat'Pace araemr too cimml orpivy it,within P IM ofa l;cq�vbPV eel madand err a FOR iM M6 L Jymm wm fau anku the Boatel dam da(mad I*abile Water Supplier,M m A dalermhm t4etthe i7siem b 1ppetionimj in at motover that•prota'b toe puh8c bealt�sat*and ptyiMMI@Ltt �a the aya m bas m mptic took tad soil abaotptiop ayatats(W)god die SAS is wilblp 100 fat-afa nirfeea watery PVPtY or mmw to a suphoe+setar . A e The syotettl has m cepste tic bad SAS asld the SAS b witb4t a Zane i of a pu611c wrxef st►pply. 11u aystam Lms a septlo tank sad tsn5 and t1m tiA5 it aagtin SO lom of■piM to wmr lowly well, a o m w v m bum tank and US amd the LU i/lets IM I OQ foot bm SO feet of MOM*00 a ppmle water supply well,,*.Matbod used to 6netnth,e diamm v Aue t -e'tLic tywem yyenuaa lt�wet!wptaa atudYak.perksaa�d mt a AEP cofufied Imbormt�ory Eat eoGfotm baooaia sue voladk o oetnpeta�ds tnei0atae dint ells�6 lice hoar poAatlea ft�that Soillgr at►d Au pttnsaee of aam owattbangen mad abaft nbtopuia equd to a lma than S V0,4 provldad ommo6w feitate *pre trigaered:A copy oflba analysts must ba apadlad m ibis tbtrb I Outer: 1 ' d gg 3m N4S $ vw,.j* ` 6191-M-885 Blue 066T/Met 4 S 831e7/1944 07:113. 598-798-IS70 J.P.MACDMBER A SUN PAGE 06 C 'tom t'R�Sa 9� �Ap 17a�Pl�q�unas0 uDpule yq,L'69Csf ttto Ott gaww* mnul mob4t► ►t"ammwpm mamoammap !a ap�a a++4*� )p> m rnu"o atL'p011�m4�aAJh ! 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J9 % X83 31dIS3 'IV38 At 0 90:11 3u 900d-1£-i0o OCT-31-2006 TUE i1107 AN X REAL ESTATE FAX NO. 5f '10 1388 P. 08 PgeSafli OMCIAL wspvcnoN PeRM—NOT MR VOLUNTARY A$=P PARTV CREAMOWW p,a ,Addmm 559 Skunknnb Rd Gentill^ WA 02§32 ��e -'°wlt►�brn bees d o mast mdtoete"�"ar"ao"�sto�ec�of�Talbvon� YT XO pumping krmaation was prpvided by*a ate.OcORPAK Or Hand of Heateb X Were any of she rydtem rornpotkms pufuped opt ion the pravloas two wens 7 X no Am sYskm Teoetvod aafmai Bows in the Pra lum two week period 7 Have imp volumes of water boos hrnoduoed to the rystdn taoeml7 of RL pR!!�n� o>t X ,_, 'iVae as bulk pinu of the ok�giated sad attMtobred4(lf they Rate tmt Rvailabk't�a 21/A� x „_ Wssth�eArotlityordwtlLiagiOepa�edfarcsiSn+afaeN'dpol++�t+P� -� X W4$fhp sift$mpeiied fW sipis ofbndc*M 7 _ Wert sA rymm OmPauD^jj4u&$fhs SA&,loWW an rim 7 X Vcm the seytk wak rgsoh m rnuoverad,opeovd,04 01 ffiaWr offt teak b of 8rs ��. 1 of coamn�aiou,dimansfobs.dWlfi Of 1i9�•�, dQ�° �'� . X . Was the faolllty owaar pnd owPr�if diHaept�owanr)prov(dad wkb httotuuidoR Olt the pinpat rpai of sd>swbcc sewage disposal Systems 7 The dad Ran location of the San Abwrptmn 90tam OAS)On"vita has bw desfata W!sued Q y" � Tixlstioa osfatsnafi4rt.F��mPH,a pica at 1be board of FYe11dl. X ,y Datecmined lq the field(tf sny of>i►e falhavf efliaela feh►ted to PRrL C is is issaa sp�naoimatiOe of distaoae is art1�DOOP�1a1 I310 CluIIt l5302(3Xb)) . • S NfMC'w ►mr6aym-.d'1' Bl6i-961—BRC ATUR lorrVIRIPA 6 OCT-31-2006 11JE 11'07 AR ,Y REAL ESTATE FAX NO. 5C '90 1366 P. 07 1'�e 6 of 11 OrFICI AL 1NSPEG"P CX ROM-NOT Fri$VOLUNTARY ABSEB&>VAIM SUBScWiMACE UwAGE DISPOSAL swroltd i1gHP.ECi mu roRm /^ PART C 9Y8TZU fMRMATWN haperY464ws' 5559 Skunknet &d conterv& Iii M"2632 Dat6offt"oo"M 9 76 OS QfAW COMMONS 'lt�(peo�e 5 litlmbetAf badieamr(e�moslk 5 5 5 0 . DB�GNQowbasedm}lbC�L15�1(ft0>�:itogpdaIFaf X.. 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N/A . ifm volnme�".R"Lvdkw otha _ Lymeorno)VAAym How wis quasky pumped dolamiaed4 steaautiad RaW=htPU "d Wdar'a jIrr.:tank- T1tPB OF t3YA1�M k es�t,r tknt Mac,sell abAmptla nit= slated Q'a m{yea or-)(if yes,amob Pr74M kepwdoa taoordt,O'ta►y) bwavo ivolAlw WW"technology.AUmb s on ofthe ourmt opassdoe sed nVIoUraeOa contract(to be of ed from syeDpa o lef) _'iYgbt 1A01! ..._J►asdt a copy of the UI�P ttpprtwel R up of all componcub.two bseWW4(if known)and soum of ufficn lmm Were savntge edem Abttotad svhan aalrinS ac tlse site{yet or uo)•./1 a ..� as 3M ms a m3mmm,d'r BIGT-tZfl-qaa PT,:ia ba�ri�aico 7 OCT-31-2008 TUE 11:08 AM ' ' ,Y REAL. ESTATE FAX NO. 5f '90 1388 P. 08 f p7oflf OFMCiAL INSpWnON FM—NOT FOILVOLUNIA"ASS SUBSURF/k[R SMA=MOPMAL filtWM M DQWZCTWN POIN PART C syfflF.M DOKW" m(cou*W'd) p a4AAdNta 559 I;kunkneC Rd O�e12 . awmranf+r>;a. � an BlUnX Nti SEW=ODOM 05 site pl.d). Dq*befaw 18 .. MWA of eom to idaa:_pd iraux 40 PVC=&W((CTO M* , Dfwnaa Cora P�WAW BU Y wolf ca WC"liar. 2D r o a a c aRM p no 4p�+�swo� #MrQQi k�ags..M. Vertttd t_ARou6�► Aoueo ++ants SEfr MTANK,V'e(toatoatlsit,Pleel YOpO gal8ona M&belowW&&-- 72• Maaerktlofeao>trclatlo>r.�caa a meta! Owew---p*c6yfane If pafl faro atiCpll 'atl w$c%� 1c age. by a Ca�ficua ofCompf�goe(ytt ts'pa);..�.( 'w�Y+� . '"'� D 8'tf'X5.8"X4'10' • p Dbrieee f:am orgy 4f iludgf to betto�d of outlet la0 or baffle: �mltigoslis Ra f>jetestoe that cop oiso+alt to cop of gads tee ar b du AD Val, 3Jitiauae$�►bottom of scum to bvmwi0 of oatlst the or balAa n�4 ' HogN�adiaxndaaad: elreadtt,ead Cmm�e�s(aa poa�taa ldat and outlet sae of 00m blon.*Uotad mlaf;ft.W leeek as nlatad nt oo4tet IAM%.ovWmare otkdmot,Cm paA tank 4t+m+t Z sa.&A., Ise A4 .8 oul.Lak t a i !e 14 A ,auctuaaLtw Aounda N6 ALg�a el LAaskcio• — 0XIABE TRAPI no 00CMD OR slfc Plan) Depd►belawtl�.— ' mini scam Wickmom Dbum tom MamrlafafvatssR'+�au; maul �•.����=� o�top of mdfec tes or bat: putaaot hom batom of scuts%bauM of autia ug at baft Dais o[futPlm(Qq p=pbffr--=md TOM., t aaa aaWft s�ar base caaldldon.s�aaa)ftna�tUy�liquid lei ' as n>amd m Dadra fnvrres,ovldaloe oTledo�,�h RAaat 4-tat 1d no+G RAZAAAL 1 qp WMA tJ� g W'd'I BG6L-86t-B65 9L'Le o66T/G0/£B B OCT-31-2008 TUE 11:08 AN ' N REAL ESTATE FAX NO. 5C ' 90 13aS P. 09 OWICL4L>fi`SPWDON mum—NOT FOR VWUNTAKY AN=S=x.>ca SU8i3UR8AGE t3l WAGS»osAL SYM M DffiftCodbN YOM PART C s1rsTl m DWOR SAY'ox coo 1'ropartyAddrettt $59 $kunl ee Ltd 3710 Nh 02632 OMrserl� t. ag , Daoofbgpasgoac 05 fiGICt'w HOLDING TATIIC:n o (fadc antes bt pumpDdat time o[�tptctlon)pootts oat tits p� Mer4doerldw reft oouc��mm'e�u_.•_,.tAet�t1.__._ �1Y�+r��htt( k Dimegsioce: ' De�oi;lovrs day . Alum pmeW t m or ter. Alum Itvtd: Alarm f®waoddag radar(�ar nA>~•_ DmeodLatpnmpdm6: • 7 LpAt bR hoZ�lrLq74�7Ee ta�nctxp4c4cnta DIBTRIDurION gQ7Ct t!e a(tf pttisem coat bb opaned�(looteoe oa tine p�•al n DO of T"*lave]tbow cadet toy=0 e Ceammats(Hale if lsmc Is leVal agd mudon w ouilm equal,smI svWwwe of touts char,ww avidatws of kdnph omanofbM4 Aox ie 400.1 ad 3 b 0 ed G9g 44 04 puz Die goice � PVH?CMR:_0(kau 00 ib plat) 11a1�vin ordoe hies ar no):�,,, • � . Alarm;to wow atder eyes crag): Ca�(p.A ofp=.W ,oordidon of pw "and w aetsamoce.sear Fsuep c aeltae. 2A hod AAa.sgat.• 6L 3�Vd Nm 8 wmwo W'd'C 81Gi-06L-60fi 6S L6 766i/LB/66. 9 OCT-31-2006 TUE 11:09 AN' .Y REAL ESTATE FAX NO. 5C 1388 P. 10 Psi 9 of I l omc[AL INsPSCTioN voRM--woT BoR voLUNTARY A3sS819}WM SUDSI7MACM SEWAGR DUPOSAY.gymmm IN"Ve om rom PART C SYSTEM WORMATION(odat104 P�apsrlyAddras S59 tkgaho t Ed • jZjKZjjjI"I Z632 Owaor: >Dpso>f impsdiaa: , S01L A> 'Ti01V 8Y63°BJMt(SAS)t,i�stc oa site pisw gtt�athfn swt e+taedna) • XFSAS aot located e*ism V*., boas#ed dea �a.Qa_j0 - ��pe pbs aumbsr l �- •�, tnnebo,:etmpbsr,iagth: aumbQ,dbasas M' bmavadvahbamsim sysmo: Typelasmo of todnolow Coa�eots(apse eandidw of mil,signs of hydrs:dia UUW%WM of damp salt caaditias of ve�ed:doa� s[axx .ti Le m f.o ke nd• oA ggjhAfta naRyr C=MOLs: ao(emww O-t be pumped es part of WV-60400p lte art Site plan) ' Nus�eessdtmaGglasdoa: - . Ds�l-taP of)iquid to btiet iave:� , of stlf4s layer: DqO of mum layer: Mons of aesMoal• Ms1eslMli of oonsettuxiaa: - - I"Q daa of vrstsr ln9urr(ycRm na):_ Coommmts(hate ooad9t M of 24 rigs of bydratilla War%level of Podia&Condition of vegeS".eta.): Gseeaoote d&A not # gat mI y,-mo (loom ea sbe plan! MotVI*ofeoasaaQ*& Dlri:e�loas: ' pep�afselld� (ante oAnd3tiaa�6 spa signs atbydotttli0 fiitw;e,Tavel of'ppptdiRg.O�kiom dlYOg ,off,): POUI)a -L4 mot aasesAt - — - 9 -rT Whirl b1U6 t3 tlpl'd'C fl1Si-•86L-808 8Z%t0 g66'tJlQ/� ]0 OCT-31-2008 TUE 11:09 AM' Y REAL ESTATE FAX NO. 5f '90 13B8 P. 10 pap 4 of 11 Ol cL4,L VgspE4crTYOj4$ORM—'NOT FOA VOLUNTARY ABBESOMM �. SUMMAC>t;SEWAM 119008AL SYSTEM SON Y OHM TA=U SYS'Y'!�M II�'ORMATIOIV(ostRi�d). Frop"Addrvc S59 Skunknat Ltd n]a NA D2632 Dpo sf ls+peatlmir � sOfLABS0RY7TOl'l SYg'Y'RM(SA8)l�.--fiontn m sqs pW4glQRv;tlm aos regabs�q • Ii6�S as loatcad e*'w awn rlFo tad 6aa Aa ae'j0 X��w�Pies.auaAen 2 �lesddsgf .___ Inching p wb-.lmtrnber.he& ___.__ ��•ate,di>i►eees� _ avtr8ow oosspooL ann�er:� � , —�ovsdvi�slrwrwpve�� ty�pdnmea of tOC6Aolopy:_. Cots(note anaka of soil,sips afbydrm&fsUw%IrA of ponfti 1,&PP ro'd.0=000 of YgBlull*k smk dl ' ORmp � me"" d�n�r dLgn6 0 �ae.lves_ nw eena�laa •nl/a ewe .I.V� Vona!atlen A nndgnl — CF,SMOLS:.0 (cesspool must be pumped as pert of aspce2ioaKlo oa$b plan) Number and coulipursdon: tMao gh layus hrkt itsvmt; of IWuwlela of coeukevxion lndisadica atv1padwa w'lntbw 61104w Commesss(w o oandition of soil,sips of bytimaUe faO^level of pmmfn ,Mdition of VQ5M R.SO Catdpaa.E,6 a26 not Rtiab,&&t - -- - -- rMVY:A,o Com mi site plea►) b(dwislsofoorsst UdIca, Dlmeasiod: (non eaadid a ro signs of hydrtulk tiiturs.level of poeSAGI�,condWat Of Y a4 ata): ARLU'V 34 not AdaOs t 5 TT 7t1Hd Nos S tlW'd't' BL91-86L—Bela Blue q66 C/Lesleea 1D ' OCT-31-2008 TUE 11:09 AN' lY REAL ESTATE FAX NO. U '90 1388 P. 11 y�./�q T� y pin �pv py i�q. � vM SUBM}ii�al i/'i/EVp WAGE oiiq PoRm OSAL-r;oT FOR��(�ARi A wA Utoxomm mom PART C SYSTEM INFORMAT40N( Properq Ad&M — n 02632 pa�anopnI.0 �Meeflmpaatloai , SK TM aQ UWM*jlmpo AL SYti:P)N wopw s dh"amo www disposal*IN-inoladinq to'aid load wo pepbwaed eetaawlwdooft or bo%d tft LVW4 all WPlla WWO IOU SqL Lo M WbW Fdft wWrrap*ea111 flV lioi{d* r P-) y I • I io ZZ 3�Sbd Nos 8 ]VW•d•T BLSZ-BaL-805 01:48 066T/L6/O 11 007-31-2008 TIE 11:10 AN ' Y REAL ESTATE FAX NO. Sr '90 138B P. 13 TOWN OF „W MAP Off,UZ MN' 8Ui19Uat 4 9 BTNAgR 1118MBA1.8 Tog 158MITION FORM r FART P •OTIrICATJON ...�7T�'11�1M�1..�1U'+twr.wlr�erww,y - .w�• .Vrl 01 9191"f 01""T. pRar�Rrr t�tspscfev STRUT ADVhS3$ :550 SAUnknct Revd 1 A88s6Sona mAP, DLOCK AND PAT4011L i 769-01.1-00 0089'v NAME _ 0tnjas LUta4A iiiim- PAR!'D - o8'RT, WArg IS ; NAME OF INSPUTUR Ro Ls2f Aao�E a it L . COMPANY HAREjo4aph P., Raeoa e � Qn Ire Y, .-.� COMPANY ADDRR.S 66 Can."54 t'es faa".02632 t—mg% Z • e OTC i ? QOMPANY TQLTPAONB [ 508 1.7.75 '3338 SA ('508,YPO + 1578 CERTYeICATFON STATEMENT I certify U-1. 1 have personally inspected the eswage diagosgh eyetsem at hie address Itud that the inrormation reported is Cruel accurate, end omplote ae a_ -:w ,.i16e -of;lnspee0ca. The i118P*:tL0%h WAN pertcrind and Any ecoan gpdatiotts regarding upgrade,,maintenahee, and retla• r, are 00114iatent with my training and expeg-Fence in the proper lunotion and maintemnao of VIM- sits sewage d0y.)g•-' ayasooas. Check *not , v The inepuvtie:. which I have conducted has not found any information which ind:--tv , that the sytltem Taile to adsQuatmlr protest publia lisalth or .;:e .nvirujiment as defined in 810 QMR. 116.30d•, Any tailure criteria not evaluated are an stated in the FAxLURi CRI'i'PRIA aeetloh of We. torsi, BTstom ;_L), • The ins p4otiotl utiicl. I have con ted has found that the gygUal faile to proteot L. ;tit. •iic Lu44th and the ahvisanmenb in acoordanve with 'title o, 310 Cmi, and as speci f ica•l4y notes{ oq PAST C • nXLURX CRITERIA at this inapeatio form. P — Inspector 81&j.-tu:o Sabo ..I= (o -, L!;- ' •r.w. e.-•—...-- ne a*py et t! ti f ic..ti6h must 'be. provided to the'l)WARRI t4i# guTCR khOr• aypiKo. _ ,..a trio xkgAhv Of !iI! 41mit, r ;t the innpevu:oi• FAILZI)i the own 0r or Operator mull uperade,me gretem. ait:hah one your or the dn'to of the inepecTion# ur,ltsY si,lowad or rsgUjied obherwiee o■ pr—ldvd in dj0 emn x6,3 a, hS HBtld tm 9 ?J tlP,crr 6LUI-SGI-809 ei=t0 1:1661/40/60 13 DATE 10/16/06 PROPERTY ADDRESS 559 skunknet Road Centerville MA 02632 On the above date, the septic system at the address above was Inspected. This system consists of the following: 1000 Gallon Tank 1 Distribution Box 2 10.00 Gallon Leaching Pits Based on inspection, I certify the following conditions: The septic system is in working condition at present time. SIGNATURE _ Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc_. Address: P. 0. Box 66 Centerville. Mass 02632 " Phone: 508-775-3338 or 508-775-6412 DO s JOSEPH P: .MACOMBER & SON, INC. Tanks-Cesspools-Leap.hfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 ,' COMMONWEALTH OF MASsacF-IusETTs ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION T=5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Ad&wa. 5 5 9 Skunknet Rd Cani-pr'�7i 1 1 a MA 02632 Owner.'s Name: D -h i k e ,u b a s h Owner's Address: ce Date.of bupedos:-1:�, !MC1/ Name of Inspector.(piesse print) Robert A Pao 1 i n i CompanyNamm J.P.Macomb r & Son Ind. Mailfmg Address: T;n x t;6 Centerville MA 02632 Telephone Number: 5 0 8-7 7 5-3 3 3 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information n pond 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 Tffle 5(310 CMR 15.000). The system: x x x Passes Conditionally Passes Needs Further Evaluation by the Local Approving.Audicoity Qa.1 Inspector's Signature: f y Date: f 0/ (%0 6 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 sharedsystem 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 DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****TMs report only describes conditions at the time of inspection and under the conditions of use at that. time.Ths inspection does not address how the system will perform in the future under the same or different conditions of nse: Tide 5Inspection Fonr 6/1512" page l 'Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �— PART A CERTIFICATION (continued) Property Address: 559 Skunknet Rd Gent ryi l l ed MA 0 61 Owner:Q76h.1seLubash Date of Inspection:.Zo.L1U ZO.6 Inspection Summary.: Check A,B,C,D or E/ALWAYS:-complete all of Section D A. System Passes: yES NO 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: Septic 6y.6tem i.6 in p2eope2 wozk.ing oadea at the pneze.nt time,, B. System Conditionally Passes: NO 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. NO The septic tank is metal and over20 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 asr 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: NO 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: NO 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: 2 Page 3 of rl OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: _559 Skunkriet Rd Centervi l l a MA (l?6'19 Ownerflenise Lubash Date of Inspection: 0 L 6-1,0 6 C. Further Evaluation is Required by the Board of Health: NO 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: a 0 Cesspool or.privy is within 50 feet of a surface water n 00 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: 2 0 The system has aseptic tank and soil absorption system(SAS).and the SAS is within 100 feet.ofa surface water supply or tributary to a surface water supply. 2 0 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 00 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. rz 0 The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more froth a private water supply well**. Method used to determine distance v.ihua e **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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION(continued) Property Address: 559 Skunknet Rd rent--rui I I z MA- . 0-2632 OwnerDeriise Lubash Date of Inspection: 40 1:6-106-- 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 -T 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 X cesspool _ Liquid depth in-cesspool is less than 6"below invert or available,volume is less than�4•.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 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.] NO (Yes/No)The system fails.I have determined that one or morelof the above failure cntgria 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 10,00.0 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 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. 4 Page 5 of.1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 559 Skunknet Rd Centerville MA 02632 Owner:D1eblacs eL ub a s h Date of Inspection:�n-z iL0 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 o 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,�xaluding 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 PropertyAddress: 559 Skunknet< Rd Centerville MA 02632 OwnerD.en..i. PLubash Date of Inspection: Z� 4 06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number.of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 5 5 0 Number of current residents: 1 Does residence have a garbage grinder(yes or no):n o Is laundry on a separate sewage system (yes or no):n 0 (if yes separate inspection required] Laundry system inspected(yes or no)?o Seasonal use: (yes or no): n o 2 0 0 3=12 5, 0 0 0 ga 2.P o n e qP D 3 4 2.- 4 6 Water meter readings, if available(last 2 years usage(gpd)):20 0 4= 17 7. 0 0 0 as Q Q o 4 8 4 9 3 Sump pump(yes or no): 110 Last date of occupancy: o n k n o wn COMMERCIAUNDUSTRIAL Type of establishment: NIA Design flow(biased on 310 CMR 15.203): �pd Basis of desip"flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system-(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): - GENERAL INFORMATION Pumping Records N/4 Source of information: Was system pumped as part of the inspection(yes or no)y e� If yes,volume pumpedl 000 gallons--How was quantity pumped determined? m ea-suited Reason for pumping: lleavy zo-eid waste in tank., 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): Approximate age of all components, date installed (if known)and source of information: 10� yea2� Were sewage odors detected when arriving at the site(yes or no):n 6 i 'Page 7 of L1 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville "MA 02632 Owner:DPn i sr-Lubash Date of Inspection: —i - -6'�04 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast ironX 40 PVC_other(explain): Distance from private water supply well or suction line: 20." C mn ens(on condition of joints, venting, evidence of leakage, etc.): o.zn a/2/2ea/z ��yet no 3.ign.3 o;e Leakage.. Vented tft2ougA /tou.6e ' vent-, SEPTIC TANK:y e-3(locate on site plan) 1000 e 2.e o n Depth below grade: 12" Material of construction:econcrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):certificate) _(attach a copy of Dimensions: 8' 6"X5 ' 8"X4 ' 10" Sludge depth: t2aca Distance from top of sludge to bottom of outlet tee or baffle: 0 Scum thickness: ' rz o n e Distance from top of scum to top of outlet tee or baffle: a o 0 n e Distance from bottom of scum to bottom of outlet tee or baffle:n o rz e How were dimensions determined: m e a�3 u 2 e d Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert, evidence of leakage, etc.): _ PumI2 tank eve zy 2 yea2z., In.2et 9 out let tee,6 ate .in. n-gace lank iz htluctu/ta Z'u .wound., No 6.ian.3 01 Po al ao GREASE TRAP:n o (locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage, etc.): C/zeahe t.za/ i.6 not / /te.6ent 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �-- PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd C.enteryi 1 1 a° MA 02632 Owner:Deni seLu Date of Inspection: TIGHT or HOLDING TANK:no (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene - other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: (�prnmetlts(condition of alarm and float switches, etc.): .- / g y oz o-gding tankz ate not /2ee.6erz.t.! DISTRIBUTION BOX:y e�6 (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.): Box i,3 leuel.- Ka.6 3 lateltal,�., ;Vo 3,iaru o-1 3o.i d U ouoa No leakage in o2 out o, &ox.- " PUMP CHAMBER: Jz o (locate on site plan) Pumps in working order(yes or no): ` Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Pump chamgerz i. not /22e.6ent.- 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Sku-nknet- Rd _CentervilleoMA 02632 Owner:n i cALubash Date of Inspection:—Lb/ j—rm/ SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why:, Located gee ,?age 10. Type X leaching pits,number: Z leaching chambers, number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool, number: innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): LOamU to medium 3arzd., no Li n,3 o ? Veuet¢t.ion .i..s nolzmnj_, 2y CESSPOOLS: 1zO (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 or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): Cea612oo2.6 ate not 122ehent PRIVY: n o (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.): i�2 ivu ih no t /I e,6 ent 9 I Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville MA 02632 Owner:DeniseLubash_ Date of Inspection: 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. . i 10 Page 11 of 1'l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville MA Q2632 OwnerD.etZi se Lubash Date of Inspection: 2 L%4-4,/n SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�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: y e s Observed site(abutting property/observation hole within ISO feet of SAS) u e h Checked with local Boazd of Health-explain:a,i Pujit c rz 2 d no Checked:with local excavators, installers-(attach documentation) Accessed USGS database=explainAt�E/2:t own., �a/znh•t a 1. e.,ma.�u� You must describe how you established the high ground water elevation: Ted : Cape Cod Comm.�, .ion Nate2 7aaie CoA;touAz And Pug.-tic ldate2 SupPQy Oei2 head pl2oteet.ion aaea,6 map. Sept 1995 Uatez 2e,5ou/zce-6 oP-41.ice cage cool comma.,3.Loao Top of Cround Leaching Pit .;;eet r- Groundwater Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method 4,W Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is aS� feet. ]1 4 r .a•rwtnrw+—R.•rr/r••.�— .+►rirrr:R+++r-nnas+rrermr:,,-'-ru.r�..+�rnn•t errvnt�ur.r.r.��r srn •�, . TOWN OF BARNST RT.F WARD OF IIEALTII SUDSURFACE SE.WAU DISPOSAL SYSTEM INSPECTION FORM - PART D •- 'CERTIFICATION •.•4••t�T•••::T—T.t tR�.TTTTTt•R:t•.T.TT1rlTf2R"T'T�-1T'StlS�ti3TRler1'tRtSR'N�1tM1TIRIRftrfR7 }fwA -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 559 Skuakne.t Road ' ASSESSORS MAP , BLOCK AND PARCEL # 169-017-003 OWNER' s NAME Deni,3e LugazA PAJ7T' D - CERTIFICATION NAME OF INSPECTOR RaPleizt l'aoi-�ni COMPANY NAHE aozep,f 10o 17acomge2' V Son Inc COMPANY ADDRESS Box 66 Cen4e2U.i.2.2e Mays. 02632 : 5craar Town or City Stag LIP COMPANY TELEPHONE ( 508 1: 7.75 -. 3338 FAX ( 508 )790 - 1578 CERTIFICATION STATEMENT. I certify that I have personally, inspected the sewage d'isposa7, system at this address and that the information. reported is true , accurate., and omplete as of the. time o'f *inspection . The inspection was performed and any recommendations ? egardillg upgrade , . maintenance , and repair are consistent with my training and experience in_ the proper function and maintenance of on- site sewage dis?osni systems . Check one : XXXX Systeln PASSED - The inspect '_oii which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Cite environment as defined in 310 CMR. 15 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FA1LLD'• \ The inspection which I have con L cted has found that the system fails to protect ilubl is I:eal th and the environment in accordance with Title 5 , 3.10 CMR i5 , 30.3 , end as specifically noted on PART C FAILURE CRITERIA of this insp ctiom form . Inspector Signt.t�.� e L�'-'J�' " Date 1021-6 ' rh, copy of tl. .. _ .� t.ifi::cticn must be provided 'to the OWNER, the BUYER re applie:.Ll ) �...d t; v BOARD OF IiSAL'I'!i. If the inspecteo;; ! AILED , the owner or operator shall upg'rade ' the oysters. within one year of the d:Jte of the inspection , unless allowed or required otherwise as P- ' ided iri 3.10 CMR 16 . 305 , . • CERTIFIED MAIL. RECEIPT .D (Domestic Mail Only; For de'livery information visit our website at www'usps.coniq lft D' r77, 7FFICIAL USE c Postage $ , 3 Certified Fee C3 Return Receipt Fee ��� Postmark � (Endorsement Required) S cc®m 2�06 p Restricted Delivery Fee fL O .0 (Endorsement Required) / Total Postage&Fees USPS%' Ln Sent To �. Street,Apt No. or PO Box No. Q. Y City,State,ZIP+4 ca��r-✓.�mac. NA Oo1QA PS Form 3800,June ,r Certified Mail Provides: (as�anay)ZOOZaun[ 008£w1adSd ■ A mailing receipt ■ A unique identifier for yoyr mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. ■ Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of. delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"RestrictedDelivery". , a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail.. ' IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is,not available on mail addressed to APOs and FPOs. SEND�R: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,'2,and 3.Also complete A. nature item 4 if Restricted Delivery is desired. X ❑Agent Print your name and address on the reverse 7 ❑Addressee so that we can return the card to you. B. Rece ed by(P' ted Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, + I a or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No jca cfph 7 macambef- •�Sop,ZNC ldO- `-8oX GG �e h t e r✓' �.�.c /j? 0,;3 6A 3. Service Type ❑Certified Mail ❑ Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 7005,_1, 60 0000 0191 1666 UNITED STATES POSTAL SERVICE First-Class Mail � Postage&.Fees Paid USPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS, MASSAC'HUSETTS 02601 I I ^^ LI Al 0 r ^ 0 �1'1111111�1�i1i'�li till/fl�l!"'lll�'1111 I'1I'II 111�111117 Town of Barnstable F tHE Tph, do Regulatory Services snxivs-rnscE Thomas F. Geiler, Director M 9. •��' Public Health Division ' ATFD MA'S A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 8, 2006 Mr Robert A Paolini Joseph P Macomber& Son,Inc P O Box 66 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The Septic inspection report for, 559 Skunknet Road, inspected on 9/16/05 and 320 Riverview Road, inspected on 4/4/2005, were not filed with the Town of Barnstable Health Division within 30 days as required . You are ordered to ensure that all future septic system inspection reports for properties in Barnstable are submitted to this office within 30 days of each inspection per order of the Board of Health. omas . McKean, R.S., .O. Agent of the Board of Health Town of Barnstable do Regulatory Services snursrnsze Thomas F. Geiler, Director 9w1639. Public Health Division ATED MA'S A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 8, 2006 Mr Robert A Paolini Joseph P Macomber& Son, Inc P O Box 66 Centerville,MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The Septic inspection report for, 559 Skunknet Road,inspected on 9/16/05 and 320 Riverview Road, inspected on 4/4/2005, were not filed with the Town of Barnstable Health Division within 30 days as required . You are ordered to ensure that all future septic system inspection reports for properties in Barnstable are submitted to this office within 30 days of each inspection per order of the 4Boardof Health. s . McKean,R.S., Agent of the Board of Health u,e C �V, & Ae • -t�(In Q Cvry�er, /-7v' I "r • r 310 CMR 15.301: System IUspection: A septic inspection report was not.filed with the own of Barnstable Health Division as required. According to the Assessors records, laid property transferred ownership on October 7, 2005. The results of the inspection "should have been submitted to the approving authority within 30 days of the inspection. Certified Mail#7003 1680 0004 5458 3503 �lie A Town of Barnstable ` Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Vidal J. &Virginia M. Camacho February 6, 2006 559 Skunknet Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V• MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE A building permit application for the property owned by you located at 559 Skunknet Road, Centerville, was denied on February 1, 2006 by David W. Stanton R.S., Health Inspector for the Town of Barnstable, because of violations. The following violations of the State Environmental Code were observed: 310 CMR 15.214: Nitrogen Loading Limitations: On February 1, 2006, a request for a total of five (5) bedrooms was noted on the building permit application submitted by you, along with floor plans showing a five (5) bedroom dwelling for said property. This property is located within a nitrogen sensitive area (Zone II, wellhead protection area) and this parcel is less than 17,000 square feet in size. No more than three (3) bedrooms are allowed at this property. Building and septic permit history: • On February 13, 1984, septic permit 1984-083 was issued for a 3 bedroom dwelling. • On January 25, 1993 a building permit was denied because 4 bedrooms were requested for this property, located within a zone of contribution and only has a 3 bedroom septic system. • On February 2, 1993 a building permit for renovations was approved with floor plans for a 3 bedroom dwelling. • On February 10, 1993, septic repair permit 1993-056 was issued for the repair of a 3 bedroom dwelling. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by eliminating or properly converting the two unauthorized bedrooms QAOrder letters\Sewage violations\559 Skunknet Road.doc r (previously approved as a "dining room" and "sitting area") back to rooms which shall not be used for sleeping, as previously approved. This property shall contain no more than three (3) bedrooms total. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable QAOrder letters\Sewage violations\559 Skunknet Road.doc .b; Certified Mail#7003 1680 0004 5458 3503 rtNV r , Town of Barnstable ti Regulatory Services BARNSCA;CME. Thomas F. Geiler,Director MASS. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax:. 508-790-6304 February 6, 2006 Vidal J. &Virginia M. Camacho 559 Skunknet Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REOUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE A building permit application for the property owned by you located at 559 Skunknet Road, Centerville, was denied on February 1, 2006 by David W. Stanton R.S., Health Inspector for the Town of Barnstable, because of violations. The following violations of the State Environmental Code were observed: 310 CMR 15.214: Nitrogen Loading Limitations: On February 1, 2006, a request for a total of five (5) bedrooms was noted on the building permit application submitted by you, along with floor plans showing a five (5) bedroom dwelling for said property. This property is located within a nitrogen sensitive area (Zone II, wellhead protection area) and this parcel is less than 17,000 square feet in size. No more than three (3) bedrooms are allowed at this property. Building and septic permit history: • On February 13, 1984, septic permit 1984-083 was issued for a 3 bedroom dwelling. • On January 25, 1993 a building permit was denied because 4 bedrooms were requested for this property, located within a zone of contribution and only has a 3 bedroom septic system. • On February 2, 1993 a building permit for renovations was approved with floor plans for a 3 bedroom dwelling. • On February 10, 1993, septic repair permit 1993-056 was issued for the repair of a 3 bedroom dwelling. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by eliminating or properly converting the two unauthorized bedrooms QAOrder letters\Sewage violations\559 Skunknet Road.doc (previously approved as a "dining room" and "sitting area") back to rooms which shall not be used for sleeping, as previously approved. This property shall contain no more than three (3) bedrooms total. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable QAOrder letters\Sewage violations\559 Skunknet Road.doc I ��' �eCeitie.� nit `��t j�6 b rev✓ ��MQ.e��u�t�l', - . r o f f�6m,r se ors- h� ��� c« III .�ev► COMMONWEALTH OF MASSACHUSET'TS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s �, 4m� DEPARTMENT OF ENVIRONMENTAL pROTECTIO ` 71 TITLE 5CC ._ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASS r- M SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTWICATION Property Address: 559 Skunknet Rd rtzntPri i 1 1 a MA Owner'SName:_DehisP Lubash Owner's Address: c � Name of Inspector.(plewe prim Robert A Pao 1 i n i ComganyN== J.P_Man-omb r & _on Inc. Ma!11ng Address: _R n x A F Cent ryi11P MA 02632 Telephone Nurnbes: 5 0 8-7 7 5-3 3 3 CERTIFICATION STATEMENT I certify that I have personally inspected the selvage 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 sewaa�e disposal systems I am a DEP approved system inspector pursuant to Section 1&340 of Tide S(3I0 CMR 15 000). The system: xxx Passes Conditionally Passes Needs Further Evaluation by the Local Approving.Authority 0- w�ailsInspector's Signatmwe• Date: `�-1(�, QS✓ The system inspector shall submit a copy of this inspection report.to the Approving Autlt dty(Board of Healthor DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of I0,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments *0*wThis report only describes conditions at the tune of nwgxxbou and under the conditions of use at that. hme.This inspection does not address how the system wr71 perform in the future under the same or different conditions of use Tide 5Inspection Form 6/15/20M page I Page 2 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �— PART A CERTIFICATION (continued) Property Address: __5 5 9 Skunknet Rd _Centprvi l l a MA 0 632 Owner:D:erllseLubash Date of Inspection: __ 9 /1 6/0 S Inspection Summary.: Check A.,B,C,D or E/ALWAYS-complete all of Section D A. System Passes: yES NO 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: Sept.�c .6ys.tem iz in pzeope2 wozking o2de2 at the pzeze.nt time.. B. System Conditionally Passes: NO One or more system components.as described in the"Conditional Pass"section need to be replaced.or repaired.T"ne 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. NO The septic tank is metal and over20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfilration 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: NO 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: NO 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTI.FICATION(continued) Property Address: 559 Skunknet Rd Cent Pryi 1 1 a MA 02Fl�) OwnerDenise Lubash Date of Inspection: 9 /1 F /n S C. Further Evaluation is Required by the Board of Health: NO 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: 110 Cesspool or privy is within 50 feet of a surface water 770 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: no The system has a septic tank and soil absorption system(SAS).and the SAS is within 100 feet.ofa surface water supply or tributary to a surface water supply. 2 o The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 110 The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. 2 o The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more frorti a private water supply well". Method used to determine distance v•i.6 uai "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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLU NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION(continued) Property Address: 559 Skunknet Rd C'Fp�nt-arvi11 - MA 02632 OwnerDeil, ise Lubash Date of Inspection: q.11 6_f12s 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 _ _ 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 X cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2•.day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number X of times pumped _ 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. 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 welt 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.] NO (Yes/No)The system fails. I have determined that one or moret"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 1.0,000 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 Xthe 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 11 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 CUR 15.304.The system owner should contact the appropriate regional office of the Department. 4 I Page 5ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 559 Skunknet Rd Centerville MA 0 632 Owner:Det0 seLubash Date of Inspection: 9/1 F J n S 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 r 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,ISc.luding 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: 559 Skunknet Rd Centerville MA 02632 Ownera. Lubash Date of Inspection: 9 1 6 0 5 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number.of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x;#of bedrooms): 5 5 0 Number of current residents: 1 Does residence have a garbage grinder(yes or no): n o Is laundry on a separate sewage system(yes or no):2 0 (if yes separate inspection required] Laundry system inspected(yes or no)n o Seasonal use:(yes or no): a 0 2 0 0 3=12 5, 0 0 0 ga Z 2 o n, G l3[D=3 4 2 4 6 Water meter readings, if available(last 2 years usage(gpd)):20 0 4= 17 7. 0 0 0 ga.Q.2 o ns GPI:4 84. 93 Sump pump(yes or no): n o Last date of occupancy: o n k n o wn COMMERCIAL/INDUSTRIAL Type of establishment: N/A Design flow(based on 3I0 CMR 15.203): a-pd Basis of design;.flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged.to the Title 5 system-(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records NIA Source of information: Was system pumped as part of the inspection(yes or no)zy e- If yes,volume pumped 000 gallon--How was quantity pumped determined? m e a,6 u lt e d Reason for pumping: /ieavy 60P.id wa,6te in tank.- 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): Approximate age of all components, date installed (if known)and source of information: 10� yea/z.6 . Were sewage odors detected when arriving at the site(yes or no):n 6 Page 7of11 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville MA 02632 Owner:Dan i cpL,ubash Date of Inspection: 9/1 F/ S BUILDING SEWER(locate on site plan) Depth below grade: 7 8" Materials of construction: _cast iron/y 40 PVC_other(explain): Distance from private water supply well or suction line: ZOf C�mnments (on condition of joints, venting, evidence of leakage, etc.): otntt a/2/2ea/z tight no 6.ign'3 o;e -Peakage.- Vented t/z2ough house vent., SEPTIC TANK:y e h(locate on site plan) 1000 ga 2 i o n.6 Depth below grade: 720 Material of construction:econcrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8' 6"X5 ' 81X4 ' 10" Sludge depth. 7 Z--ace Distance from top of sludge to bottom of outlet tee or baffle: 0 Scum thickness: n o n e Distance from top of scum to top of outlet tee or baffle: rz o 0 n e Distance from bottom of scum to bottom of outlet tee or baffle:rz o n e How were dimensions determined: m e a z u 2 e d Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid Ievels as related to outlet invert, evidence of leakage, etc.): I)um/2 tank eve2y 2 yeaa,3.� Iniet 9 out$et teen ate .irz ,Q2ace lank iz et2uctuaa�Pu 6ouizd., No 6.iorz,3 o-1 Pealcczcgv.- GREASE TRAP:200 (locate on site plan) Depth below grade:_ 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: Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage, etc.): G2ea,6e t,za/ i.6 not /?,ze-6ent 7 Page 8 of 1 L OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �— PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Qpntprvillp MA 02632 Owner:DeniseLu as Date of Inspection: 9 1 6 0 5 TIGHT or HOLDING TANK:n o (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: Cptnm�etlts(cond�tion of alarm and float switches,etc.): cg t oz oidiag .tank.6. ¢2e not /22eze2t.! DISTRIBUTION BOX:y e 6 (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.): Box i,3 .teve2,- Ka.6 3 .Eate/ta.9h., No 3.iarz,3 o .6oi—Ed aaltlzu ouva No leakage iiz o�z out oP 9ox., PUMP CHAMBER: n° (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I)uml2 chamgeti i. not /22ehen4.- c • • 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd _Centerville MA 02632 Owner ubash Date of Inspection: 9 T1 6 0 5 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located gee nape 70, Type X leaching pits,number: Z leaching chambers, number: leaching galleries,number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool, number- inn ovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Loamu to med,;um .3and., a 3.ian.6 o e Z a i Ruz v 0/7 12nna_1 ng—d_Q� nno d2 Veg2ta.L. on c� no�mrr0 , y,. CESSPOOLS: no (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�or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): Cea,61200.e,6 ate not /2/ze,3ent PRIVY: n0 (locate on site plan) Materials of construction: Dimensions: Depth of solids: Continents (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): I VY i4 /ZO.t /?2e4ent 9 Page 10 of 1] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville MA . 02632 Owner:1)6niss,Lubash Date of Inspection: 9/1 6/0 5 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at Ieast two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. i 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville MA 02632 Owner:D.enise Lubash Date of Inspection: 9/1 6/0 5 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water IL-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: u e.6Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:(2 s no Checkedwith local excavators,installers-(attach documentation) e�®ccesseiiUSGSdatabase=explainA��/2:�own•' l¢2nzi-a�2e.-ma.,us You must describe how you established the high ground water elevation: /lied : Cape Cod Comm.�,�.eorz !date2 7aUe Cori;�ou2,3 And Pug-tic Ua.teti Sa12Piy Uetg head /22ot.ec.t.ioa uneas malz.� Sept 1995 Vate2 2e,3ouzce.3 oft.i.ce ca/2e cocl cornmt,6zoru Top of Oround Leaching Pit ( 'eet • �1 -20 Groundwater) Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Mcthod 4,W Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. ��.. I „ T'1R1T1�TRIT��TT�{1Tf. JTR.R�'.ITTfISR.RT.1.t.'iT'TY.TtTfR'CITTTTiTR�iiIA`�TTCR RCl '1'(;'M OF BARNSTART,F I YARD OF .IIEALTIi SUBSURFACE 3EN/I(;F DISPOSAL SYSTEM INSPECTION FORM - PART D .- 'CERTIFICATION -•4!•f�T••••.:T-�/171��T1t T.1•.TT'f:1T1P!'1fS�"T'��T�tTST11�TR'IOT�'rR1RlOOf R1C'IOTR�lIfrT!!7 T� • ITf!'T•Tf•wf1�1• -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 559 Skunkizet Road ' ASSESSORS MAP , BLOCK AND PARCEL # 769-071-003 OWNER' s NAME Deny.,6e LagaaA PART' D - CERTIFICATION NAME OF INSPECTOR Ro P aAt /caoi.inz' COMPANY NAME aozepA 1 Nacomge2''`&` Son Inc COMPANY ADDRESS Box 66 Cen4ezy•i22e Raj.3' 02632 StraoC Town or City. stato LIP COMPANY TELEPHONE ( 508 ): 7.75 -. 3338 FAX ( 508 I790 - 1578 CERTIFICATION STATEMENT I certify that I have personally, inspected the sewage dlsgosa'l system at this address and that the information reported. is true , accurate, and omplete as of the. time of ,inspection . The inspection was performed and any recommendations regarding upgrade , . maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one. XXXX System PASSED The inspectoni iahic;l 1 have conducted has not found any information which indicates that the system fails to adequately protect public health or tine environment as defined in 310 CMR. 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . • i System FA1LED- The inspection which I have con trcted has found that •the system fails to Protect tiIC public i:ealth and the environment in accordance with Title 5 , 310 CHR 15 .303, �_nd_ as specifically noted on PART C FAILURE CRITERIA of this inspection forma Inspector Signt.t�.. e �i' ` Date ne copy of ti_ _ :_(_ . t.i f i.:c t cn must .be provided 'to the OWNER, the BUYER ' where applic"L1 .. ) ..•d t. v BOARD OF ILEALTIL. * If the inspection, !:AIL :D , the owner or operator shall upgrade ' the system. within o'ne year of the d! ite of the inspection , unless allowed or required otherwise as p:_••v ided in 3,10 CMR 16 . 305 . DATE 9/16/05 PROPERTY ADDRESS 559 Skunknet Rd Centerville MA 02632 On the above date, the septic system at the address above was Inspected. This system consists of the following: �. 1-1000 ga-Hon tank. 2.- 1 Diztaigut.ion Box., 3., 2-1000 gaVon ieach.ing pits Based on inspection, 1 certify the following conditions: 4., 7h.iz .iz a 7.i; .ie Five zept.ic zy,5tem (78Code) 5., Sepi-ic byztem .ins .in p2ope2 woak.ing o zde z at the paezent time. SIGNATURE JW- Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc . Address: P. 0. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775 6412 ' JOSEPH P. MACOMBER & SON, INC. . Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 T . EOMMONWEAL TH OF MASSACHUSETTS EXECLTrIVE OFFICE OF ENwRONMENTAL.AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION e TUILE 5 OFFICIAL'INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM FORM FART A CERTIFICATION pr,QpertyAdd": 559 Skunknet Rd Centprvi 1 1 P MA n2 32 Owner-'sNamw pehi ka Lubash Owner's Addresm S aA Q Date.9fluipecdow 9.11 6.10 5 N=w6tluspector;(P1e p U Robert A Paolini compgyN J_P=Macomber & Son Inc. Malting Address Rnx 66 Centerville MA 02.632 TekpjwwNamber:50S-775-a338 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 performedbased on my training and experience in the proper function and maintenance of on site sewage disposal systems.l am a DEP approved system bispector pursuant to Section 1&340 of Title 5(310 CMR 15.004 The system: xxx Passes Conditionally Passes Needs Further Evatuation by the Local Approving.Autho6ty � ails Inspector's Signature: Date: The system.inspector shall submit a copy of this inspection report.to the Approving Authority(Board of Healthor DEP)within 30 days of completing this inspection If the system is a shared system or has a design flow of 10,00© gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of fhro DEP The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Qomments ***wfls report only describes conditions at the tame ofinspectiDn and under the eoaditum of use at thrtt. tm This Rion dues not address how the sum will perform in the future under-the same or different conditions tdam Titre 5Inspection Form. 6/192000 lie ff Page 2 of I 1 OFFICIAL INSPECTION.FORM NOT FOR VOLUNTARY ASSESSMENTS .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART A CERTIFICATION (continued) Property Address: 559 Skunkn,et Rd Centerville- MA 02632 Owner:Mtli eLubash Date of Inspection: 9/1 h J 0 5 Inspection Sumnnary:_ Check A,B,C,D or E/ALWAYS complete all of Section,D. A. System Passes: yl�S NO 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: Sept.jc zybtem iz in /22eo/2e2 woak.Gng 02de/L at the /22e4e_nt t Gme., B. System Conditionally Passes: NO One or more system components as described in the"Conditional Pass".section need to be.replaced:o.r 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. NO 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 hy.the:Board pf 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: NO 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: NO 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 559 skunknet Rd , Ceri cnryi 11P MA 02632 Ownerfl0`tdsa Lubash Date of Inspection: 9/16 1 o s C. Further Evaluation is Required by the Board of Health: NO Conditions.exist which.require further evaluation by the Boar&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: n o Cesspool or privy is within 50 feet of a.surface water n oo 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: n 0 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. n o The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water-supply. n o The system has aseptic tank and.SAS and the SAS is within 50 feet of a private water supply well. n o The system has aseptic tank and SAS and the SAS is less than 100 feet but 5Q feet or more frotd a private water supply well". Method used to determine distance v L3 ua e . "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: 3 I Page 4 of 11 OFFICIALINSPECThON FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A . CERTIFICATION(continued.) Property Address: 559 Skunknet Rd Cpntarvi11e M 02632 OwnerVenise Lubash Date of Inspection:9.116 f L1 D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no'.'to each of the.followingfor all inspections: Yes N� _ 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 ofthe.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 tlian 6"below invert or available,volume is less than'fi•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 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. 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€orit.] NO (Yes/No)The system fails.I:have determined that one or:more�gfthe above failure:c-riteria 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 it design flow of 10,00.0 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. Page 5 bf 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 559 Skuriknet Rd Centerville MA 02632 Owner:D9111i s eLuba s h Date of Inspection: 9/1 6 j n 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 tho inspection? X Were as built plans of the system obtained and examined?(If they were not available'hote as N/A) X Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system com onents,aXcluding the SAS,located on site? X P Y X Were the septic tank manholes uncovered,,opened,and the interior of the tank inspected for the condition of the b_affles 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 bf 11 OFFLCIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS .SUBSURFACE SEWAGE DISP.OSALSYSTEM;_INSPECTION FORM PART C SYSTEM JNFORMATION Property Address: 559 Skunknet Rd Centerville MA 02632 OwnerQ,6ii!4PLubash Date of Inspection: 9 1 6 0 5 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): .5 Number-of bedrooms(actual): 5 DESIGN flow based on 310 C?vM 15.203(for example: l 10 gpd x#of bedrooms): 550 Number of current residents: 1 Does residence have a garbage grinder(yes or no): n o Is laundry on a separate sewage system.(yes or.no).:no [if yes separate inspection required] Laundry system inspected(yes or no)r�o Seasonal usec(yes or no): no 2003_125, 000ga.eion. G1IO_342. 46 'Water meter readings,if available(last 2-years usage(gpd)):2 0 0 4-17 7. 0 0 0 as i i o n.6 G%D=4 8 4 9 3 Sump pump(yes or no): n o Last date of occupancy: o n k n o w a COMMERCIAL/INbUSTRIAL Type of estab i$ont: N I R Design flow< i.' d on 310 CMR 15.203): Qpd Basis of deft tow(seats/persons/sgR,etc.): Grease trappresent(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water-meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records NIA Source of information: Was system pumped as art of the inspection(yes or no)y e:� If yes,volume pumped10 0 0 gallons--How was quantity pumped determined? m e as u2ed Reason for pumping: K e a v y z o-e i d wa z t e- -in tan k 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 ob_tained 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: 10+ yea zz . Were sewage odors detected when arriving at the site(yes or no):'o 6 Page 7 of l I OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville MA 02632 Owner:.rjA n i-c aLuba s h Date of Inspection: 9 1 6 10 5 BUILDING SEWER(locate on site plan) Depth below grade: 1 8" Materials of construction:_cast ironX 40 PVC_other(explain): Distance from private water supply well or suction line: C ens(on condition of joints,venting,evidence of leakage,etc.): .c onz a/2/2ea2 tight no z.cgns o� .leakage., Vented thaoug.h house vent., SEPTIC TANK:y a (locate on site plan) 1000 ga ei o rz,3 Depth below grade: 12" Material of construction: concrete_metal_fiberglass_polyethylene other(explain) If_tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_.(attach a copy of certificate) Dimensions: 8 6"X 5 ' 8"X 4 ' 10" Sludge depth: as ce 0 Distance from top of sludge to bottom of outlet tee.or baffle: Scum thickness: non e Distance from top of scum to top of outlet tee or baffle: n o 0 n e Distance from bottom of scum to bottom of outlet tee-or baffle:n o n e How were dimensions determined: m e a.6 ult ed Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): l uml? tank evelty 2 yeaa,3 , Ineet 9 outiet tees ate .in peace.- 7a.nk .is Ztauctuaai2 q .sound No .6.ign.6 of ieakagp GREASE TRAP:a (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): gltease t/taR i.6 not Rize,6ent Page 8of11 .OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd 02632 Owner:De.ni-seLu as Date of Inspection: 9 16 0 5 TIGHT or HOLDING TANK:n o (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass ..polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: CQ a is(cond'tio f alarm Tnd float switches,etc.): 7 t hg 7' oa PoOM) eng taakz ate no.t p/LeZent.t DISTRIBUTION BOX:y e-3 (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.): /3ox iz .levee., /la.6 3 iate2ai,3., No 3i n,3 o zoi No ieakage in o2 out o-� gox ,- PUMP CHAMBER: 110 (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):T' Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): l umI2 chamfelt 1,6 not zeZent.- 8 i • Page 9 bf 11 OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 559 Skunknet Rd Centerville MA 02632 Owner.ppni qpLubash Date of Inspection: 9 1 6 0 5 SOIL ABSORPTION.SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located bee Rage 10.1 Type X leaching pits,number: Z leaching chambers,number: 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.): -� Goamy .to medium zancl , no ziunz o.Zai&ILQ on Qond.rng Aa.;LA nna �2y, Vegeta-tion .ie no ma.P , CESSPOOLS: no (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'br no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Ce.6,6/200i,3 ate not /2ee,3ent PRIVY: no (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.): 1/L Vy ih not /22e,6ent 9 Page l0,of 11 OFFICIAL INSPECTION FORM<—NOT FOR YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)' Property Address: 559 Skunknet Rd Centerville MA 02632 Owner:Den�iseLubash Date of Inspection: 9/16 0 5 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. PAJ Uvn I ``y I 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS '`` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 559 Skunknet Rd Centerville MA _ 02632 Owner:i?erii sp Lubash Date of Inspection: 9 11 610 5 SITE EXAM . Slope Surface water Check cellar Shallow wells. Estimated depth to ground water-- L 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: u es Observed site(abutting property/observation hole within 150,feet of SAS) Checked with local Board of Health-explain:« P u j Pt caar/ no . Checked with local excavators,installers-(attach documentation) t�e,�®ccessed USGS database-;explain / t o �.. You must describe how you established the high ground water elevation: dzed. : Cai2e Cod Commi,6-ion lVa.te2 7a&2e Contoua,6 And Pukiic Uatea SuppiB Oeii head pzoteet,�orz aaea�3 mgl2o Segt 1995 Vatea ae,30uace�3 o__rice cage cod commizzon., cp op a If'kCj-'7rounT- Leaching Pit ,eat ID Groundwater Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. �� - a•nnnr•..—rerr.r-s-T-r..+'-,m:n,r.y-..r,i..rrrm:+-r,.c.rrn+r:vrmT+.rara-ws+.ar.+s+smen 'I'OWN OF BARNSTART-B BOARD OF HEALTH SUIISURFACR -SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D •- 'CERTIFICAVON ^•4t•I-T•:•::*-T,TTA�T.TTTTI-..,1'R::fIT�TC7r�T=TT'TT \ ..TYPE OR PRINT CI,EARLI•- PROPERTY INSPECTED STREET ADDRESS .5 5 9 Skunkne.t Road ASSESSORS MAP , BLOCK AND PARCEL 169-011-003 OWNER's NAME Dgn.i,6e Lugazh PART D - CERTIFICATION NAME OF INSPECTOR Ro�eAt Pao:2inj • COMPANY NAME aozeph P•, Macomge2•g Son Inc COMPANY ADDRESS L3o.� 66 Cen-.ezviiie Na .z' 026t32 Ttre0 Town or City 8tat* ZIP COMPANY TELEPHONE ( 508 ): 7:75 -. 3338 FAX ( '508 Y 9 0 1578 CERTIFICATION STATEMENT I certify that I have personally. ,inspected the sewage disposal, system at this address and t1lat the information. reported. is true , accurate, and omplete as of the ,J.rhe of .inspection - The inspection was performed and any recommendations regarding upgrade , . maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage d isposal systems . T Check one: XXXX System PASSED � The inspection which I have conducted has not found any information which indicates that. the system fails to adequately protect public health or the _nvirociment as defined in 310 CMR, 15e303► Any failure criteria not evaluated are as stated in' the FAILURE CRITERIA section of this. form , System Fj'; 1LED' The inspe r ction which I have co n4 Gtted has found that the system fails to protect the PkIblic health and the environment in accordance with Title 6 , 310 chjr� 15 , 30.3 , and as, specifically noted on PART C FAILURE CRITERIA of this inspection formT Inspector Sigi,c.tui e Date Drne copy of tl; :. ce ..,t. ficatio'n must be provided 'to the OWNER, the. BUYER where applic-1-1 ,1 ) and thv BOARD Otr HEALTIIe * If the inspection FAILED , the owner ox operator ahall upg.rade 'the system. within o'ne year of the date of t:he . i.nspection, unless allowed or required nr.hprwiae as provided in 3,10 ChI.R 16 , 306e TOWN OF BARNSTABLE OCATION T-I SKc,I�lt 1�0 d SEWAGE # VILLAGE e ��'✓i ��- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (ty _ (size) NO.OF BEDROOMS PE A COMPLIANCE DATE: Jr 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 TOWN OF BARN�STABLE E _ � , OCA.TION � S(,C Gt,`i GL ���/I_SEWAGE # /3 f VILLAGE ('C 1CwVj))C ASSESSOR'S MAP -fz LOT 46 61 INSTALLER'S NAME & PHONE NO. J %Alto MA e SEPTIC TANK CAPACITY, o LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 16 -Y .3 VARIANCE GRANTED: Yes No V __�,` I , � .� ,3�� t1 , S�, o F " .J No.. :. .... f XFjzz...$..... -20.. THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOAR® OF HEALTH Ba'�1srd�leConservationDepanment TOWN OF BARNSTABLE 8i ;3 Appliratilarc for 14sposal Work, (foustrurtiu Purrmit Date Application is hereby made for a Permit to Construct ( ) or RepairNxx) an .Individual Sewage Disposal System at: 559 Skunk.nett Road Centerville -------------------•----...-•-----•-•----............•-•----•-•••-•---•......-•----....-----...... .......---•--••-••••--•----------.........-----•-----•---•-•-•-•------.....•-----.....---......... Location-Address or Lot No. Lubash -----------•----------.- .... ...........................................•-------•-•..... ..........•---•-....--...................................................................................... Owner Address a ...P.Macomber ..r. ................................ ........-•----•-•--•------•--•••-•••............... PQ Installer Address Type of Building U Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Ex Expansion Attic '-' g— p ( ) Garbage Grinder ( ) aOther—Type of Building ........................... No. of persons..........--.........-----.. Showers ( ) — Cafeteria ( ) d Other fixtures .............................................................. W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter...----......... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit....--.............. Depth to ground water......--.............--. 44 Test Pit No. 2------_-------minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 0 w' ..........-.................................................................................................................................................. Description of Soil...............................................................................------......................................... W Sand & Gravel v .....-----•-----------------------•--------•--------------------------••--------•...---•-••---------------------•----•-•-•••-------••-------•------•---------------------....-----•---•--------------... W UNature of Repairs or Alterations—Answer when applicable............................................................................................... _1-1000 gallon leaching pit' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has eeyj issued_by th boar of health. Signed ---- . .. .. 2/10/93 Date Application Approved BY ..... . ............................ --------------------------------------- Date Application Disapproved for the following reasons- ............................................................................. ..........................----------------------------- -------------------------------------- ------------- ------------- Permit No �j ........... 3...--.. Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tt rfifira#e of Graptiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX,) by J.P.Macomber Jr. ...................................----------- Inmile, at .......55�---Skunk-nett....Road----Center_,Dille---------------------------- ------------ ---------------.......................-... ---------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---------49.3..-.6.......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL�FUrNCT ON SATISFACTORY. DATE---------------- --- ........................ ....................----.... .------------------.......... Inspector ........ ............................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q� TOWN OF BARNSTABLE $ 30.00 No....4-0............ FEE........................ Disposal Workii Tnns#r Uan antic Permission is hereby granted...J.P.Ma c omb e r Jr. ---- to Construct � ) or Repair (X) an Individual Sewage Disposal System at No...559..._..kunknett -•_oad Centerville - -----------------------------------------.------------------------------•-------•----....._._.......------••-•-----------................ Street �� as shown on the application for Disposal Works Construction Permit No\ ... Dated.......................................... ------------ •---------- --------------------------------------------•------•---•---- 1 DATE--------------.1- 0.._.�3.................................. �- Board of Health --�.I.-- --- .- � FORM 36508 HOBBS&WARREN.INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,2 vo_ p Appliratiun for Disposal Workri To.ustrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair*X) an Individual Sewage Disposal System at: 559 Skunknett Road Centerville ...I............---......-...................................................................... ---•-.......•••--•-••--••--•-••-•-....---.....---•............•------•-....._..._.....___•-•--•••- I,ubaeh Location-Address or Lot No. a J.P.Macomber J ress r.Owner................................................. Add-•..._---•-••-••..._..--••••-••-•--•-•-------•-••-•-•••-..._....•••--••--._.....-•---------•--•_.. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------------••------•---•-•---•-----•••------••----•-•-•--•---•-•--•-•-•--•....--•-•---••••••••....__.. W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank—Liquid capacity............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........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LX4 Test Pit No. 2.............___minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ... --------------------------------- ----------------------- -.......... •----------------- •----------- ------------------------------------- ••------------------ 0 Description of Soil____________________ x Sand & Gravel V ......_..•-•...--•••-•-•...•••-•----------•...--...--••---•-•---•----•-•--••••-••••----••••-----•---•---••-•----•---•-•---•----•-----•---•-••----•-•----••-•-----•-•••----•...••••-•----•................ W UNature of Repairs or Alterations—Answer when applicable....-........................................................................................... 1-1000 t7allon leaching pit. Agreement: The undersigned agrees. to install the aforedescribed Individual Sewage Disposal'System in accordance with the provisions of TITLE 5 of the State Environmental Code=The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee I issued by theaboard of health. Signed .. .-... • Mode 2/10/93 ...........................„..................... !�.....-..............-......- -...........................---.. 1 Date Alication Approved B t -• -"-- ------------------------------------------------------------- ---------------�-e----------------- PP PP Y .-.......... Application Disapproved for the following reasons- ------------------------------------ .--__...--------------------------------......................................... ..........................................................---------------------------------------- ----------------------------- -------------------------------------------------------------------- ---------------------------------------- Date Permit No. ...........7..'?...-..96 .................. ...... Issued Date Ly0 C. kfT ION S [ WAGE PERMIT NO• VILLAGE INSTA LLER'S NAME i ADDRESS IUILDEIII OR OWNER Caw." DATE PERMIT ISSUED DATE COMPLIANCE ISSUED C ' � • • .. � -, � � .. �� "� ., No.__ zl- - F s. ....................... �. ........ `Ar THE COMMONWEALTH OF MASSACHUSETTS ROBERT g�} \�i^ BOAR® OF HEALTH c1 RAYMO D `-�;4 \1� ---..... 0.�(d... .......--OF..... v No.19 Appliration for Dispaa al Workg TouBtrnrtinn ramit ication is hereby made for a Permit to Construct (L--)-or Repair ( ) an Individual Sewage Disposal ern at: ............ 6 t.? ?l✓— .? ......' ".a.s0.................. .........................................LV� T-3 --........................------. Location-Address or Lot No. ----------------- �ld y owner A ress Installer Address _ Type of Building Size Lot...t�?-.....•- a-A Sq. feet U Dwelling—No. of Bedrooms.................... .....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----------------------------------••---•-----•--••• F W Design Flow................ �1?....................gallons per person per day. Total daily flow........_._...__.__...._............gallons. Ro WSeptic Tank—Liquid capacity.�.�_.gallons Length_iGp.. ."._ Width_ '.. Diameter________________ Depth_._._-:-_'j---- x Disposal Trench—No .................... Widths.................... Total Length........._....._... - -- . Total leaching area___.. _......sq. ft. Seepage Pit No--------- - ------- Diameter (._ Depth below inlet..__ --0..... Total leaching __- _._. .__ .G PD Z Other Distribution box ( 11- Dosin tank ( ) '-' Percolation Test Results Performed by--- 4 > (:__.�-�.:._ .`� a'? ,Date__-Ltt I� e �a Test Pit No. 1......Z------minutes per inch Depth of Test Pit....14.4...... Depth to ground water. �A? __Q�KdJ73�►TLYLtT� IT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................0...... -------------------------------••------•--•-------•----------------------- -------------------------------... ----•••••- ........ O Description of Soil.....0.-Az ... a.!t`..A"7.��'� �..... 4 1.d+�'i.... ....�2. V ------------------ W •••-••-------------------•-------•-------•---•-••----•-----------•••--•--•----•--•••-•---------•--------••-••----•--•-----•----------•-------•---•-----•----......••--•--• ................ VNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ----------------------------•------------------------------------------------------------------•-•-----------------------------------------------------•----------•-------------------------•----.------ Agreement: The undersigned agrees to install the aforedescribed Individual S wage Disposal System in accordance with the provisions of'ITS 5 of the State Sanitary Code— The er ' ned further agrees not to place the system in operation until a Certificate of Compliance has bee .s e rd of health. ne . -• --•• ................................ -• ...•.................... ................................ Date Application Approved BY -- .............................. . .. . ..... . ---••----- ---------------------------------------- Date Application Disapprove or a following reasons------------- ------•-•-------• ••---••-•-----••-----------•---••-----------•------••-..................... -------------------•------------------------------------------------------------------•---•- ------•------------- -••-------------------------------------------------------------------------...... Date PermitNo..................................................---.... Issued....................................................... Date Permit.No--------------------------------------------------------- Issued...................................................... Date -� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r '" `...............OF..... � : t 9`d"' . .......................... ...................... .. ...... .... ....... . TH 5 CERTIFY That the Individual Sewage Disposal System constructed ( vror Repaired b -------- --- r y.. ... �j j�yl�/� 1J1$�.,.+�.� r {{�j�j staller at '" _..__ ''_... 1Jlr........ has been installed in accordance with the provisions of T j. f The State Sanitary,,Cod a,+�,�d scribed in the application for Disposal Works Construction Permit No............. ..�-----.-----•----•-- datedZ.'.. � r r .._______________ THE ISSU NC CF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM W L F CI ON SATISFACTORY. DATE /�. Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l a ' t aas OF.......................................................... ..... 4 No...... FEE"......• •.......... Permission is�reby a•rated---- --••----•-•- ............................................. to Construct (r' >air (---j au In r"vid al Se al System J a .. . Street _ as shown on the application for Disposal `Torks Construction- Permit No...; ---_ Dated.......................................... Board of Health DATE ....................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS _ THE COMMONWEALTH OF,MASSACHUSETTS ROBERT BOARD OF HEALTH E. pplicati�on is hereby made.fqr a Permit to Construct (4-1-or Repair an Individual Sewage Disposal System at: Owner Acedress Type of Building Size Lot .......... Sq. feet 9 Septic Tank—Liquid capacity-l!�W_gTailons Length_10_�- Width-5., Diameter-------------_ Depth...h*------, Seepage Pit N ----t1._________... Diameter... Depth below inlet---- Total leaching . ...Sir-ft.0 Percolation Test Results Performed by---- ?�t)4�Ff sDate... Test Pit No. I......:?......minutesperinch Depth of Test Pit._J_44�...... Depth to ground ----``-``-`----' -------'---`----`--``----------''-------'— Agrroozcuc: The undersigned agrees to install theuforedescribed Individual S�Pwage Disposal System in accordance with El Lgv. ��- - - I ---- --- f (D--_ALL ELCA/ L 6 1_ HASH D Oa d v-- 917CW AL-L t✓tdES A MIA►,MUT� OF t/�"/Fnc�7 Y O C3)-- AL-L- P&PV-5 TO, .A oJ D t.J T� SYSTEM r-au_. SCWaJSOU • (D CI-- ALL. SF-9'TK: TANKS, A"D - _-=�� l��•CH�.l6 Pfr✓ SHa`L vE vEtG,°�EO Fnfi' ' �- � KENiC�✓E AL.L_ U.JS�JrTA3L..E MATEZtAI_ BE�.lE.:-.•1"L-I 0 O C) Q) (3 0 0 - T"E_ w-/Eor ELE'/AT I0..-1S of LEACH r , PrTS L j �a h n CC-)) O A QS of CL�. j F�c� �� n�~ --- r 1 Ll lS `) 1 54-�D �►U C�2.�.�/EL_ " I LJ V \J Tl+E ��► `.°�r��gal. f C� o�= t4 � L T--1 "UST Se► � E t t yCST 11` E D W N E�J T µ y STE M S "EA Z- �' 1 _Ertn,� �0 Pe+o2 Tp t�acr~FILI_t�J�w I za` _ Fes-- —�2.-� �- •-t uy• � Q ; � j Jt v O � O iJ n a. �l � ® �l � V►�t_a=S� oT1-+Et�wtSE t.�oTED At_:_. 5V5TE " I \ Q C Z SA.--1 T A J// �o Pc�w1>F."►.e�5 �►^trA '-'I 0 00 c' G 7\/PICAL DIST21bUT10t.1 E50)( _ RCLc32G/• lC� 1ti/1Tti+ TIC �E � os= T�i� STATE }= % � ►�. tiv�CX.��`t1" �� .. ubT T40 SCAL-E T- s' '_: �_�a� ��'•T`lC- TP..S� �,-�-_1.�54+-Ltil Ca P►� O6Se.`t VAT/0AA1 0/T5 P�,.,�oPlr�v �Etor�; �r..�re �y AMEtz�c,•. 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