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0589 SKUNKNET ROAD - Health
589 Skunknet Road Centerville A = 169 011006 *ISM Pw f } x 1521/3 ORA 100/6 P2 _ e 4 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplication for �i8 sal *pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) 12 Complete System ❑Individual Components Location Address or Lot No. 5W Is b er P�J..� Owner's Name,Address,and Tel.No. 09-33Z— & � /� Assessor's Map/Parcel O. 1 ��!� �(_ =�10 e l a. ./fit a zr V n y 0 C � nstaller's N EXCC e Address and Tel.No. Designer's Name Address,and Tel.No. 5 D9`t 3 3_00 t{ i (3 �GZ�t D n 5��- 477-b lo53 V tt A SWuake5. Type of Building: � A L f 4 Dwelling No.of Bedrooms 9-eIl� �LeoGt'f Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required 44 qO gpd Design flow provided gpd L Plan Date 5 I I5 � O Number of sheets Revision Date Title Size of Septic Tank r Type of S.A.S. Description of Soil_ f S�Q Iy Q �. ��}7 i L1pr-oI(W Nature of Repairs or Alterations(Answer when applicable) U33 r a �._ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board omealth. Sign 9" Date JP 1 ci Application Approved by Date o? Application Disapproved by Date for the following reasons Permit No. 2°r� Date Issued------------- •2°� if - f f No. 111 �l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for his osar *pstem Construction Permit Application for a Permit to Construct( ) , Repair.( Upgrade( ) Abandon{ ) 12 Complete System ❑Individual Components Location Address or Lot No. 5W ��f� Owner's Name,Address,and Tel.No. J OO Iv .J�,t ca e P�4.. /L1 Q 2T"�/ r?y✓'I Gz.(� Assessor's Map/Parcel p /6 /I- nstaller's Name,Address,and Tel.No. Desi ner's Name,Address,and Tel.No. 5 d9 _k 3 3' DU 41 ' (3 � IVCti(On 5N �1�7-Dla53 Vt A550L�cc+e 3 iv ei O e--h Type of Building: �(� ��l�-'"� r (� Dwelling No.of Bedrooms 4r( -- e`� re�t Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures L' /� Design Flow(min.required) �1 L1V gpd Design flow provided gpd t1l1 � Plan Date 5 5 ! Number of sheets 2 Revision Date - Title 1 Size of Septic Tank `g=�.Lj.Q J.Q Type of S.A.S. Description of Soil SV o �N e: L/ d)-7 r r nitq Nature of Repairs or Alterations(Answer when applicable) ram ' G 4-f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ofTlealth. Sign Date .5 11cl , Application Approved by Date a 9 i Application Disapproved by Date for the following reasons g n Permit No. 2 VI}^'1, � Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by `) e) _Y, n at 5 LU fI ,[A A has been constructed in accordance with the Pto,vi ions of Title 5 and the for Disposal System Construction Permit No. dated Installer ( ` �� Designer \/I u 1 A55-0 A(' #bedrooms qApproved design flow 4/) - gpd The issuance of t is pe' it shall not be construed as a guarantee that the system will on as designed. Date 1 Inspector . I I --- -----------------------------------------------{ ---------------------------.---------------------------- ---1U---_---------- Fee THE COMMONWEALTH OF MASSACHUSETTS T PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 5 , cj ��1,1w 1 l f'T alJ/°f LP n t r i I P and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date c' 2° /( % Approved by , r 1 vi Town of Barnstable Regulatory Services Thomas F.Geiler,Director OWS ass Public Health Division Thomas McKean,Director 200 Main Sheet,Hyannis,MA 02601 Office: 508-962-4644 Fax: 508-790-6304 Installer&Deshmer Certification Form Date: (P Sewage Permit#2016- 15 9 Assessor's Map\Parcel Designer: y H A55DGlnkPS Installer: —BfiB Address: 3 ZO C0+U I T-�Dn[) Address: Snpw ich. , mA o266-3 7"0Gts+r1ato i A OZ64q on 5 I q (,5 R E I +"(y CWas issued a permit to install a (date) (installer) septic system at 5 R Q S h,n L f 1 Pt T Qn D based on a design drawn by pp (actress) V -A 55 at es dated 5/(51I 5 (designer) v` I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distnbu%box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Rewdations. Plan revision or certified as-built by designer to follow. AW VON PIONE (Installer's Signature #105 KNIT AR�� (Designer's Signature) (Affix Designer's Stamp Here) naam RE TO B ST LIC HFALTH DWMON. CFRrWCAU OF COMPUANCE WILL NOT OE MU_EI) T CARQ- ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Ll:HeatdVsepWDmipw CertiScethon Fom 3-26-04.doe NOTICE: The Town of Barnstable recommends.that the applicant seek legal advice to prepare a properly worded deed restriction document. DEED RESTRICTION WHEREAS, MAR VA JAAe1 4y */N of ;(owners name)- 5 89 S kun neTt o�0% t reRxi I l.E MA . .(address) Is the owner of 599 S k-Untneit—QdAo located d .at 5$9 S IGu;nl�r1tt d ..MA (hereinafter referred to as r.e Ml Elie S� and being shown on a plan.entitled "Subdivision of Land in Ckr as MA, P.ro.perty of ),,ActrlVQ 4,e-r!�Iny4aV et al, jduly-recorded in :Barnstable County Registry .of Deeds in Plan 'Book. Page ,. 2.D Or on Land Court.Plan. Number WHEREAS., Magiy t- MCI eT' NyA44 as the owner of said. lot has (ownerss name) agreed with the Town of Barnstable Board of Health to a restriction as :to the .number of bedrooms which can be included in-any>home built on said Tot as.a pre-condition to obtaining a disposal works construction permit in compliance with 310-CM.R 15..000 .State Environmental Code, Title V, Minimum Requirements for the Subsurface:Disposal of Sanitary Sewage; :WHEREAS, the Town of`Barnstable Board of Health, as a..pre-conditionto granting a disposal works .construction .permit for a septic system in compliance. with 310 CM1 R 5.:2.00; State Environmental Code, Title V, :Minimum Requirem ents forthe Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building..permit for the-construction of a single family.home on this property, is:requiring that the agreement for the restriction on the number of `bedrooms in any house constructed:on the lot be put on record with the Barnstable County Registry of Deeds by recording this document; deedr - - I 3 ,(�c Pier I oes.hereb lace.:the NOW, THEREFORE, /40,9 y y Y P (owner's:name) following restriction on his.above-referenced 'land,in accordance"with his agreement with.the.Town of Barnstable:Board of Health., which restriction shall run with the.land and be"binding upon all successors in:title:. 58 9 S , C-et ew rllt may have constructed (address) . lo�u�ppn the lot a house containing-no more than Foue .0f) bedrooms. toClyA Myke4 umvm agrees that this shafl be permanent.deed (owners name) restriction affecting located on n+ •MA, and being shown on the plan recorded. in Plan Book 36 Paged 20 Or on Land Court Plan ,For title of :see the.following deed: "Book 2$5 DO, Page 45 . Or Land Court Certificate of Title Number i Execidtp,d as a seal insttument" day of d8� d Owner's si nature: Owner's signature - Owner's signature COMMONWEALTH OF MASSACHUSETTS ' tL , .000M :SS 20�5 Then personally appeared the above-named I known to me to be the:person who executed•the foregoing instrument and acknowle! {ged the same to.:be 11 f,.r free act and deed, before me, b .G Notary_PU I MARCI C" WRIGHT My commission expires: L N-Aafy Public� . �MMONWrai fH OF MASSACHUSET 1 My. ".::f.,•,.i-con, Expires REGISTRY OF EE ate s,,- , 25 zoza RNSTABLE R. ) John F. Meade, Register deedr, ! i 1 TOWN OF CATION: VILLA E: cn-1 cr u 1 C. O l -006 �I PERMIT#: 2-0 1 5-- INSTALLER'S NAME: n&J INSTALLER'S PHONE#:_ �569• �'�'� 645 LEACHING FACILITY (type) (size) 440,X IS X G n NO. OF BEDROOMS: j'I —Dw-d BUILDER OR OWNER: Marl u nunaK PERMIT DATE Sl COMPLIANCE DATE: DRAW DIAGRAM ON BACK `Al -- 3q � a REAR a IN u 3 4 TDWWN C► BtNS`CAB , ILOCA1310N:. VILLA Iv t4 Ae e t^--—A.SS SSOWS MA.P&.LOT_.. ._,._... II�ISTALL.F,XZ'.SN.9t1 do"PtIOI*lENO ------------ . ' >> S8711C TANK CA.PACifiX 1 DE:R' O'it O'VP M'XTDX 19010satloi1 i�t cr T�cstvrc tr tk�e 5 Maximum AdjusWd'Grouitdwat�c of bi6e to(lid Bciitartx al X.t;at htn l�acil►t� `.;.. - i cet l�clvaes; J�+t4r dul�fit^j Jc�t' aicd Y cad hi ��?�ciii�Y (If my tvf;19s qt'i agtc,or�vlelhic�;�ap feee u�lcact��1�Pstr..ility�) , cyq W. . Wand ta1d Leach tfi y F661 ,(f 1Y WelAat►dy exist Fr;c9 s�lltfa�ia:ino a'ce p@ lcaulling fmcaliry) ,[ r.. ... __-T. ICurnlshecl by � � / f ..._._ F .o ' 7ioc A-e- ?c ` 'a -c- ° r y TOWN OF BA.RNSTABLE FLOCATION `� a ` �� ��/��T �� SEWAGE # U LAG C.£ti T ASSESSOR'S MAP & LOT 10 DViT ER'S NAME&PHONE NO. // V C 0 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BtMDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by S E P7-1L 71--a A-1 £ON , o i TOWN OF BARNSTABLE Q/ LOCATION 30 s�f�Al k/J��' �� SEWAGE VILLAGE ClD11el- (1 f'_ ASSESSOR'S' MAP LOT & 6 i1- . /e INSTALLER'S NAME Sk PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY !� �j/ LEACHING FACILITY:(type) �.a�, 1p6D D 510f (size) 1,00 6,4 • ` NO. OF BEDROOMS ' PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 'f A I Vf DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: S_ VARIANCE GRANTED: Yes No .i \\ O S •�.� .erg �'� V P � i &7! sU2 1 I rJ Town of Barnstable Bbar,ns�ta, ,,,A Regulatory Services Department Public Health Division m �A 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644. Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7014 1200 0001 0358 0406 February 17, 2015 David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 iThe septic system located at 589 Skunknet Road, Centerville,MA was last inspected on January 23,2015 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. I The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Although tank is in good condition; the outlet baffle has fallen off. House has been vacant and the water level in tank is not at working level. • Leach pits have signs of failure with stain lines above inlet inverts and into risers. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future J enforcement action. PER ORDER OFT BOARD OF HEALTH as 6kean, R.S., CHO — Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\589 Skunknet Rd Cent Feb 2015.doc t Parcel Detail ,:. a a r "t� A,r 1 ;. MASS, hi, r • Parcel Info . Parcel ID 169-011-006 Developer Lot LOT36 Location 589 SKUNKNET ROAD Pri Frontage 100 J Sec Road Sec Frontage village CENTERVILLE Fire District C•O-MM Town sewer eaists atthis address NO Road Indek 1494 Asbuilt Septic Scan: _ Interactive Map ' E �' ' k 169011006 1 � a *�a on "t"°s'.' �;G �>Owner Info � T� �� , - " owner US BANK NAT'L ASSN T �° C10 SELECT PORTFOLI Owner streets 3815 S WEST TEMPLE street2 city SALT LAKE CITY state UT Zip 84115 country Land Info Acres 0.35 use Single Fam MDL-01 Zoning RC Nghbd 0105 Topography Level Road Payed utilities Public Water,Gas,Sepllc Location v Construction Info, , FIV N I mMi ;, " � 5tart ��� ;Parcel Detail Google Ch� � • �� � � , _- �. � v ®�� �12 55 PM Computer name : HEALTH899JF User name : flvnni Or)eratinq Svstem : Windows NT (5.1) � I i �\ � �3 �, f� � �� i I � � ' � I �, �� 1 � �,,�\ � � �� ��: � � � � t � � � � � `� �c � � � .f � a � ��� I - -7- Commonwealth of Massachusetts " Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information q ' 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-23-15 I spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Ins o orm:Subsurface�Sew Disposaystem•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 589 Skunknet Rd Property Address P Y Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Centerville MA 02632 1-23-15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health;will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a.surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in'a nitrogen sensitive area (Interim Wellhead Protection Area IWPA) or a mapped Zone 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"non as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 330 t5ins-3/13 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease.trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5+Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 r Commonwealth of Massachusetts ., w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville' MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): �I Depth below grade: 24"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" 3" Scum thickness Distance from top of scum to top of outlet tee or baffle 10" Distance from bottom of scum to bottom of outlet tee or baffle 6" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition. Outlet baffle has fallen off. House has been empty and the water level in tank is not at working level. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts m W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �qM 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-600's ❑ 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.): Leach pits had have signs of failure with stain lines above inlet inverts and into risers. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd �M Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I - Commonwealth of Massachusetts - Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately v 10 r 36 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 589 Skunknet Rd Property Address Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Centerville MA 02632 1-23-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �qM 589 Skunknet Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 1-23-15 page. CityfTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 n t. t i - c i 4 t S New PT Platform i Joist: PT 2x& with Simpson connectors Decking: PT 5/4x& Railing: PT 2x4 t 2x2 Balusters g Footing: Diamond Pier DP SO 4'-0" DI � o New 3069 Full vrew µµ o O „ a�C OLU C.H, I 7R - EG 9 Bedroom i v New Kitchen II _ 4'-0" New WlOxl9 Drop Beam Garage 14'x24' " Existing Gelling Joist: 2xIO hDown -- Gontinuous Support 3x2x4 Post olid 2x10 New 3 1/2 Lally column below - Blocking below •--------------------------• .9 9 Bedroom 2 ; N v Living Room New 9xl Garage Door 4 . . . . . .. .. . . 4 _ Cl 0 DW Kitchen Bedroom I a""" &'Alk 8'_3ks" Down --------------------------• ; Bedroom 2 9 Living Room ; F 4 2-0" Town of BArlastable. P# 14 &q q °* Department of Regulatory Services Public Heart Division Date �� 2.0 /5 KAMs 200 Main Street,Hyannis MA 02601 Date Scheduled i Time--�x'�" ' Fee Pd. U'U , $Oil Suitability Assessment for Sewage 4 ' osal Perf"nud By: dIU "a wMr �� � Witnessed By: i LOCATION&GENERAL INFORMATION / Location Address . ✓r- S'��y� f g Q� Owner's Name �S a-WIL C/a,04h yha ' Crq e41'//�, Address 3 dI,6 Assessor's MaPMVicei: 16 f 1&'// aginmes Pram d cl:rk�; NBW CONSTRUtON REPAIlt _ I Telephone# — { Land Use �Gt�G°GJ�Q Slopes(96) ! Surface Stones iNdl Distaeces from: Open Water Body ft Possible We i Ana ft Drinking Water Well fk Drainage Way ft. Property Lineft Other fL i SKETCH:alnet name,dimensiod6f lot,exact locations of telkt holes&perc tests.locate wetlands in proxitnity to holes) Parent material(geologic) �f2G/�l (�sG � Depth toBedrock._. .....-..� - - Depth to(Imundwa jde Standing Water in Hole: ��/ ,I Wceping ftul Pit Estimated Seasonal tllgh Groundwater DERMIN F,dO'/R SEAS ALffiGH WATER TADLE Method used ems' e P" ii D� ln. Depth abperved standing�o obs.hole: �/� n, Depth t0 soli nto ultu Depth toiwrezplfig fro.n sidz 6f is hole i in. Grdundwn�uattnent 2 ft. Index Well# Reading Data= Ind ac well levdi 3 A�.!helot Ark.ilt+attndwater Lavei.,,._, PERCOLATION TEST Date Observation Z I Tune at 0" Hole# Depth of Pero 71me at r lime( ) Start Pre-soak Time-C End Pro-soak Rate MtnJlnch ! ' Site Suitability Assepsment: Site Passed Site Fail __ ed; Additional Testing Needed(Y"n_ Original•.Public Health Division Observatj I Hole Data To Be Completed on Back---- ion testis to be conducted within 100'of wetland,you most first notify the *** If percola Barnstable C 4servation Division at least one(1)wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ' other Surface(in.) (USDA) (MUM11) Moubg (Stcu WM 3toues,1104WC15. Consistency.%Gravel) 71' • v z�3 OeCl Ole Z DEEP OBSERVATION HOLE LOG Hole# ' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ff DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil ' Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. h I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones.Boulders. Flood Insurance Rate May: ' Above 500 year flood boundary No— Yea Within 500 year boundary No Yes Within 100 year flood boundary No Yes De th of Naturally Occurriny Pervious Material Does at least four feet of naturally occurring perviops material exist.in all areas observed throughout the area proposed for the soil absorption system? 5 If not,what is the depth of naturally occurring peivious material? Certification �+ I certify that on A 11V. // (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trainin ,expertise and experience described in 3:10 CMR 15.017. Signature t!JG � 'Date '/�s7 I/ RLCo6,:.s� FEB 2 2 2005 OF BARNSTABLE COMMONWEALTH OF MASSACHUSETTS 7_ .NTH DEPT. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS b DEPARTMENT OF ENVIRONMENTAL PROTECTION a t o F ti Q b� ,�'•M N e y` 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 169—011-006 Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner's Name: FAIATY,JODY Owner's Address: 589 SKUNKNET ROAD cm!!TERVILLE,MA 02632 Date of Inspection JANUARY 17,2005 Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 complet a!z of the time of the inspection. The inspection was performed based on my training and experience in the pi"per function and maintenance of on site sewage dsposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ./ Passes Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall subn it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to th system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Continents " This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUARY 17,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUARY 17, 2005 C. Further Evaluation is Required by the Board of Health:N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUARY 17,2005 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes" or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pits is less than 6"below invert or available volume is less than%z day flow -7— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 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 more of the above failure criteria exist as described in 310 CUR 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: N/A To be considered a large system the system must service a facility with a design flow.of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered u significant threat,or answered "yes"in Section D above the large system is failed. The owner or operator of any iarge 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUA.RY 17, 2005 Check if the following have been done. You must indicate"yes" or"no"as to each of the following Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CNIR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUARY 17,2005 FLOW CONDITIONS RESIDENTIAL-./ Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2003—31,000 GAL/2004—38,000 GAL. Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): 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 Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: NEW PIT 1997=PERMIT#97-96 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUARY 17,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 12" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 18" Material of construction: concrete metal fiberglass polyethylene other(explain) If tank is metal list age: Is age confirnied by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17 How were dimensions determined: AS BUILT&TAPE. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,INLET BAFFLE,OUTLET BAFFLE. NO SIGN OF OVERLOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A 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.): Title 5 Inspection Form 6/15/2.000 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: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUARY 17,2005 TIGHT or HOLDING TANK: N/A (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 Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): D-BOX IS 16"X 16"— 32"BELOW GRADE,ONE LINE IN—TWO LINES OUT.BOX IS CLEAN&SOLID. NO SIGN OF OVERLOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A. (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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY,JODY Date of Inspection: JANUARY 17, 2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why:. Type •/ leaching pits,number: 2 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.) LEACHING IS TWO(2)4'PRE CAST PITS,PIT#1 —PIT&COVER 3'BELOW GRADE, 12"WATER 16"STAIN LINE.NO SIGN OF OVERLOADING OR SOLID CARRY OVER.PIT#2 OLDER PIT,COVER AT 2',DRY 3' STONE AROUND PITS. CESSPOOLS: N/A (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.): PRIVY: N/A (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.) Title 5 Inspection Forni 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 589 SKUNKNET ROAD CENTERVILLE.MA 02632 Owner: FALVEY. JODY Date of Inspection: JANUARY 17, 2005 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. ff U I - 1 i j �J Title 5 Inspection Form 6/1 '2000 10 t, Page I 1 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 589 SKUNKNET ROAD CENTERVILLE,MA 02632 Owner: FALVEY, JODY Date of Inspection: JANUARY 17. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: �— Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: HAND DUG TEST HOLE 12' NO WATER. TEST HOLE 3'.BELOW BOTTOM OF PIT. i 3 Title 5 Inspection Form 6/1 /200(i 1 • YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for-4•yei.rs . A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate. Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: O�f�J I Fill in please: <.. APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME AD ESS: S� �' ) �P1?rT CR �iM A TELEPHONE # Home Telephone hone Number O 0 1 p ,f v1,4„+ �vi..4hly l�au{I44:.�'f'k4i�' NAME OF CORPORATION: a C Pr NAME OF NEW BUSINESS TYPE OF BUSINESS SoDQ� l e M e T 5 IS THIS A HOME OCCUPATION? YE NO (r o0 r ADDRESS OF BUSINESS ��� S N k II a.� CIWII� -n10r MAP/PARCEL NUMBER t N (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have-the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authoril Signature* COMMENTS:_ eS 2. BOARD OF HEALTH This individual has_bPen informed ear rr�it re uirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: L70 CAT ION SEWAGE PER.,MI NO. -2q ���.zx � H 7a ViLLfAG -E iMSTAI R'S NAME , i ADDRESS B U I L D R OR OWNER , 0 A T k PERMIT ISSUED DAT E COMPLIANCE ISSUED ���- yLOT NO. :,j Io ADDRESS: � L(v►J�r'•�r Cp'�,'; OWNERS NAME: ] a SEWAGE PERMIT NO: 81/-;7os? NEW: ,✓ REPAIR: DATE-'ISSUED:8 2 DATE INSTALLED; INSTALLERS NAMEP��t �,• �wti INSTALLATION OF:&Cba a.v4.L'f4gk,/T Pes f ' WATER TABLE: ®we FINAL INSPECTION BY: DIAWING OF INSTALLATION ON REVERSE SLDE : ti to-Do ab� g r, S �Cu w k h/ No..... .__..------- Fxs........ ... ........... THE COMMONWEALTH OF MASSACHUSETTS M q P�P� BOARD OF HEALTH 169 61104 -..............._...........------.......OF...............----------- = Appliration for Disposal Works Tonstrnr#ion ramit Application is hereby made for a Permit Construct (V'T or Repair ( ) an Individual Sewage Disposal System at: n s. tt s k�a�� ... .........C�«. • ........... .....................['�%- 16 ._.. ................ �—� Location-Address Lot No. /� . �.� ..__�: _....d�-1. 4.° ..ti-----...---•.................... ... �f. ....C,�Q ..S1. �✓. '1. A W �--- Owner o / Address 1.......Z�.1. 1'° p4 ................................ l Installer Address 9 CC Q Type of Building Size Lotl.5y5.'0.Q......Sq. feet U Dwelling—No. of Bedrooms.............. .....Expansion Attic (V) Garbage Grinder ( ) `04 4 Other—T e of Building No. of persons............................ Showers / — Cafeteria 04 Other fixtures ..........-••••-•-•----••---•... • -- ••---- W Design Flow........ ........S.iSt __gallons per person per day. Total daily flow............ ...................gallons. WSeptic Tank—Liquid capacity_ D_O� _-allons LengthC_.... Width---5.._...... Diameter-_. .._. Depth.... .__..... x Disposal Trench—No..................... Width.................... Total Length............o...... Total leaching area....................sq. ft. Seepage Pit No.--___-/------------ Diameter.....4...._..... Depth below inlet.....19........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------- rp..j-...... .......................... Date_/.#j9Q-_-2...P..:�........ $4 Test Pit No. 1..... -:....minutes per inch Depth of Test Depth to ground water.__!'..0V'..._.. (Zq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.....I :_1.: ® .. fCIV 1 ��<lt�......' - k�................................... x w --------------------------------------------•---•----------------------------------•-----------------------•------------------------------------------------------------------------------.._.._...... VNature of Repairs or Alterations—Answer when applicable............................................................................................... ......................................-•-•••••---•-•••-••-••-••-••-•••--•-•••-•••••................••--•....---...•••............•••---•.-••-••••-••-•••--•....•••-•---••••...........-•-•--•--••••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The unde signed further agrees not to place the system in operation until a Certificate of Compliance has been i�to f health. Signed...... �' � ate ApplicationApproved By--••--.... . .../ ---------------------------•---•--...----•-----------•---•--•----•-••--- ........................................ Date Application Disapproved_for the following reasons:................................................................................................................ --.......-•------•---.•..................••-------....-•----....----•-•-------••--•---•-••••-•••-•-••-•- -•-•-------•-••••-•-•--•-••••••--•---•••••---•-•---•-------•:..----••----••--•-••......•..... Date Permit No.- I z/- 7`��- - - -•-••••--- Issued........................................................ Date U N®._x........:.�.. FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....................................... , PPUration for 14spos al Nurks Tonstrurtion amit "Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal Sysem : a� .....�.01.....� �1 --....--••......... .........•--------..1 ..l..-.�...-----•-•----. ....- - Location-Address R r,+qr t No .... ............. ...--•- Owner . Address a ,. !°-. ...._.:rf !he...L..---------•--•.................. f Installer ..................... � Address }} Type of Building Size Lot[ 0-.___..Sq. feet Dwelling—No. of Bedrooms...........2...........................Expansion Attic (&e') Garbage Grinder ( ) Other—T e of Building g ____________________________ No. of persons............................ Showers (I )--- Cafeteria-(_---)- Other fixtures _... W Design Flow........1*4& ...S. ..gallons per person pier day. Total daily flow--.--.... ....................gallons. WSeptic Tank—Liquid capacity.10.00gallons Lengthd...6------ Width..S......... Diameter.. -_--- Depth............... x Disposal Trench—No..................... Width.................... Total Length............7...... 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......... V. '�-' ......................... Date. 'fl ........................... Test Pit No. 1.....An.....minutes per inch Depth of Test Pit. ,/_4(.____ Depth to ground water, �/o!yf ---. P� Test Pit No. 2................minutes per inch Depth of Test Pit..----.............. Depth to ground water------.................. D Description of Soil...! � _ G7! ..........rJ .............................. ............................................. x f U -----------------•------------------•--•---------------•----------------..•......---------•-----.......---------------------------•---•---------------------------......------------..........--.---•- UW -----------•--- -------•-----•----•---------•----••••--•-••---•----••-------•---•------------•--•-------•---•-------•---•-•-•••-•-----•.............•-•------•---•--•-•---•••------•-•.....----------- Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement':' : T The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The unde signed further agrees not to place the system in operation until a Certificate of Compliance has been i t oard of health. Signed ... "T 1 I( ate Application Approved BY ... .......... ------••---••---------------------------•----...-----•-•--•-----•-•-----. V Date Application Disapproved for the following reasons--------------------•------•------------------------------------------------------------------------------....._ A .....................•----...-------•----------......----------........--------••-------•-----•---------...-•----•------------------•---••----------------••-•---•••--•----•-•---•-------•---•-•--------- Date 7 e)l PermitNo.........------------------------------------------------ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t: r ......... ...........................! ' . .r tx r ................................ OF ......................................................... Trdifiratr of Tomplitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) /.0 6 c-A r- bY------------------------ --------------------------- : ----------•--•-•-----•----•-- ---------•-------------•-•---------•----------...........------••......._......------- Z L 9 J4.G J/,( G K./C c f..y'' Instal, leq(G 14 C,,14 ,� ' 1� - at..--------•-----•-•-----•-•-•--•--------------------••-••--....---------------•-----•-------•••------------•----...------`-----�-......----------•--•--••-•-••-•---------------.......------------ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works-,Construction Permit-No- a '°f...--7!r.""._.____ dated_ .................................... THE ISSU CE THIS CERTIFICATE SWALL N.OTyBE CONSTRUED A GUARANTEE THAT THE SYSTEM TION SATISFACTORY. DATE... ..._....... .: ..............:..:.: --------._...._------ Inspector--• ---•--• ------•-----------------............._....--•----•-••----------....•. THE.COMMONWEALTH OF IASSACHUSETTS ` t""to '+� ..: �-``yyk� ,,•,, (�:�,� eR I. BOARD OF 4 LTH r ..................a� " No..... FEE........................ Ri o or s Tono#rudiv. rrttti LL Permission is hereby granted..............r1_ v!. .......:!............! _+ 0.1. to Construct ( ) or Repair An Individual S 'age DispoV1 System at No............ 4 G T--=�.•------ =-=..`'I C' ._.._ . ............ CA A' + ` ---- -------------•------------- -- --------- Street as shown on the application for Disposal Works Construction Permit No... "d�. Dated.. --__ .. �............... r \. ---------- -�---------------------•--- 7 r Boa of Health DATE.._... 2..-+ . FORM '1255 A. M. SULKIN, INC., BOSTON - No. � ,fi l � Fee �� I 1__*1 THE COMMON ALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migaaf *pgtem Construction Permit Application for a Permit to Construct( )Repair(4)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I S�/,J rl (<h e- 0 er's Name,Add�gss� Tel.No. P Assessor's Ma /Parcel C e`�{� V X n/i S fA el � Installer's Name,AArS,®dejkfto Designer's Name,Address and Tel.No. 350 Main Street ,✓��9 W. Yarmouth, MA Q2673 Type of Building: ✓� Dwelling No.of Bedrooms J Lot Size ZZ 5-0 O sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets I Revision Date Title Size of Septic Tank %v a o Type of S.A.S. &oz6 G✓ 3 Description of Soil Nature of Repairs or Alterations(Answer when applicable) T n S f A I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boa WVHea__it_h. n Signed l Date Application Approved b ' Date Application Disapproved for the following reasons Permit No. Date Issued %�— Z? �' No. 7 Fee THE COMMON ALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLES MASSACHUSETTS pfication for Dioogaf *pMem Construction Permit Application for a Permit to Construct( )Repair(,- )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� 9 S v r1 �!rt e /� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,A Ci Designer's Name,Address and Tel.No. 350 Main Street j W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms Lot Size 00 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets I Revision Date Title Size of Septic Tank /v o o Type of S.A.S. Description of Soil Ntt afore of Repairs or Alterations(Answer when applicable) 1 it �f 4 I I elf AYJ Date last inspected: i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system _ in accordance with the provisions of Title 5 of the Environmental Code-and not to place the system in operation until.a Certifi- cate of Compliance has been issued by this Board f He th. r' s Signed t Call Date �-r-4 P Application Approved b ' —Date�2 Application Disapproved for the following reasons Permit No._ Date Issued - -— —————t—— ---—————— ———————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired(✓)Upgraded( ) Abandoned( )by L�,4)C e1 at CQ 4n f v i I y has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.9 dated Installer Designer The issuance of this permit shajj not be cBKt ued as a guarantee that the system will function as designed. Date ��- .`� / Inspector No: `I Fee �d " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwi5poar 6pgtem Construction Permit Permission is hereby granted to Construct( )Repair( ✓Upgrade( )Abandon ) System located at 5 B �� �: t`�va f /2CQ . �PH �P t u / e i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to j comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this rmit. j Date: i J9 Approved /' ., P# L tx f LOT 3 1 r Any D +1 x ,4 D t.4l)ry to 01 410) KI kt7 t"t 5 i f 4 17 1111A L) r It 4 �, �fly �Rf ♦ � .. Sy ���� IN Y i l V CFI i�rsk� �a SCR - � .. �' x' �'•�(�',�y�)�}•r� NR P Y `�u s.. �.t'�a},. yet c• k�s;..'"a' FF r :K.. .. ��r �a.i'*,' ffi.�ir^� �4..'h+.�"'. ... - _ e.r. .., 9 tic°..i'. .. . � _ i•.. .� • VVV Q 3 H c i1� 3 � 18•Y F(s L7 H y(,♦ O �ooc� crbI. 4 Z � U 5 ku,v k tv�7� �a �r /)7 cz r , TOWN OF/BARNSTABLE LOCATION 597 64VAIkNFf SEWAGE # 7 '-`9�, VILLAGE . :CQI�T��'�/��� _ ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY � I LEACHING FACILITY:(type) �.,, (per 3 5Tyl�(size) /dQU GA(. NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �q I VC 1/ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE'GRANTED: Yes No O F LOCU ASSESSOR'S MAP: 169 GENERAL NOTES: PARCEL: . 11 -6 i I 1. VERTICAL DATUM: _- Assumed_________ REFERENCE: PL. BK. 64 PG. 20 2. MUNICIPAL WATER __�S __ AVAILABLE. �4 �a FLOOD ZONE: X Town of Barnstable 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT t?'bert 9� #250010563J (07/16/14) O SYSTEM UNLESS OTHERWISE NOTED. Rd T a ac d os N 4. ALL PRECAST UNITS TO CONFORM TO Zr AASHTO: H_10 & 20__ °y 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. NOTE: Pump and backfill Failed Leach 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE Route 28 Pits. Remove any contaminated co WITH MA ENVIR. CODE (TITLE 5) AND LOCAL soils within 5' of Leach Field. Pump, M REGULATIONS. LOCUS MAP N.T.S. x 101.69 Crush and Backfill 'Existing Septic m 7. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES X 103.81 Tank. PRIOR TO CONSTRUCTION. CL UP 37 LEGEND: Sx�� � --0-100,98 4g'02„ �- 9s-�- PROPOSED CONTOUR X 02.3� x 101,66 �.0p. E H . 4 ss PROPOSED SPOT GRADE 100.71 - 40 - EXISTING CONTOUR 38% x x 101.12 x 100.28 IO l00 X 30.23 EXISTING SPOT GRADE x 103 7 TH-2 < ..... ::.: 22' i TEST PIT 46 100.61-1 x 101.3 0 ® EXISTING WATER SERVICE 3' , 28' ,. . . . . ;100.83 ' 100.47 ©. o 5 .�9,92:: >: X WORK LIMIT LINE in ' :L: Gara a _100,35 9 ;:. Pave co o ! o �100.96 '::: � :`;... ri o x100.70 OF 1 ,2 0 .:.i•, M.,T o � q N X ���� 1f9r #589 2 r'. �� AMY L. 2 c^� 1 5 ., TOF=102.10 i-101.01 -� ,jAp g, �.._ VON HONE :: % Deck (Assumed) _ - :,:� H X 03.26 0 9�.90' „ ` No. 1068 W ST p 10' Raise Plumbing / Lot 36 3 A R 1 13 BH Min. 9" to EL. \ X 99.85 (Exist. �o0 15,500f S.F. o 11 100.14 ✓ �(� 7' \ 3 EL. 99.1 0.4f Ac. 26' ) // Map 169 o o N 10 .46 0.3 Parcel 11-6 N (� NOTE: This plan is to be used for septic system purposes only and is not to be X 100, 4 _ ' S considered a property line survey. X 10 .80\\ / ' X 39, I 28' x�M03 , x 99.68 X 98 589 SKUNKNET ROAD 155.00. � .67 ,� CENTERVILLE, MA 101.38 o V H CB DH FND GND N �8 48 02" w \` associates PREPARED B & B Excavation Benchmark set: o SEPVS 1090696S FOR: and Right corner bulkhead \ W EL.= 102.10 (Assumed) �� 320 Cotuit Road Sandwich, MA 02563 Mariya Martynynak 99,86 99.6 5 508-833.0041 -CB DH FND BASIN 35 Quaker Road 99.65 Surveying Hyannis, MA 02601 X Terry A. Warner.P.L.S. 22 Long Roca 99 DN FND Harwich, MA o�9 DATE REVISED SCALE SHEET NO. CB 05/15/15 1 11 = 201 1 of 2 T.O.F. (Full) Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final to within 6" of final .grade magnetic tape or similar prior to final cover. grade of EL. 99.0 to be carried EL. 102.10 Cover to be watertight) I ( g ) , out a minimum 15' beyond edge F.G. EL: 100.3-100.9f F.G. EL: 101.2 F.G. EL: 101.0 Maintain Min. 2% slope over leach facility to of leach facility. Existin revent ondin F.G. EL: 101.0-102.0 Install risers w/covers over inlet and 7 Min. 2" of 1/8" - 3/4" Washed Stone or outlet to within 6" of final grade :` Geotextile Fabric Inspection Port within 3" to grade Raise L=15' Access Covers min. 20' diam. per Code) L=20' 3/4' - 1 1/2' Double Washed St e Plumbing r4H 0 P . 4" SCH 40 PVC L=10' Top of Peastone or Geotextile Fabric EL 99.0 " 4" SCH 40 PVC 0.005� slop min. 9 to 2�A io•EL. 99.85. ia• CAS=1.4% 1 o s --- Cap Ends - EL. 98.25 EL. 99.0 ®5=1%(0.5%MIN 6" Effective Depth (Exist: invert .25 Install Gas Baffle EL. 98.72 EL. 98.55 EL. 98.45 EL. 99.1) PROPOSED DB-3 Use Leach Field Bottom EL. 97.75 H-20 DISTRIBUTION BOX 40' Long x 15' Wide x 6" Deep 5' (Install PVC Inlet & Outlet Tees) Watertest for levelness SEPTIC SYSTEM PROFILE PROPOSED 1500 GALLON if more than one EL. 92.75 H-10 SEPTIC TANK outlet N.T.S. Adjusted Groundwater (Mottles) NOTE: Existing '°°° gal ADDITIONAL NOTES SOIL LOG Septic Tank to be pumped, DESIGN CRITERIA crushed and backfilled. 1. Contractor to confim soil suitability prior to installation. Contact Number of Bedrooms: Existing 4 Bedrooms SOIL EVALUATOR: AMY VON HONE, R.S. S.E. #2517 BOH and Design Sanitarian in the event of varying soils from original g INSPECTOR: DAVID STANTON, R.S., BOH soil test. (1983 Grandfathered Flow per BOH) DATE: MAY 15, 2015 11:00 AM Soil Type: Class I PERMIT: #14694 2. Pump and backfill Failed Leach Pits. Any contaminated materials Percolation Rate: <2 min/Inch PERCOLATION RATE:<2 MIN/INCH IN C1 within 5' of proposed Leach Field to be removed. Pump, crush, and Daily Flow: 1 backfill existing Septic Tank. Design Flow: 110 G.P.D./Bedrm x 4 =440 G.P.D. TH - 1 TH - 2 440 G.P.D. (Min. Required) EL. 101.5 co EL. 101.5 v, 3. Water line to be sleeved at any sewerline crossings and within 10' Garbage Grinder: "" " "' " o " " o of any septic components, as needed, per Water Department Not Allowed A " N requirements. Contractor to verify location of water line prior to .........Sandy Loam:.:.:. .'.'.'.Sandy Loam:.:.: q Y P Leaching Area ....10YR3/3; o .....10YR3/3;;;"*";.; o construction. Required: (440)/0.74 = 594.59 S.F. T 100.92.= 7 100.92 g............... g ''- 4. Existing Sewer Line to be raised a minimum 9" to EL. 99.85. Septic Tank Required: 440 G.P.D. x 200% = 880 G.P.D •.'.'Sandy Loam:.:.. .'.'.'Sandy Loam:.:.:. (Existing EL. 99.1). Minimum 1500 Gallon (Proposed) ''' 10YR5/8:;•;:;::: :;;;: 10YR5/8;;;;;;;; 24" ......................'.'.'.'.'.'99.5 29" •'•'•'. 99.08 Use Leach Field: Sch. 40 Perf. PVC with 2X Washed Stone: C1 C1 Perc 5. Septic Tank and Distribution Box to be placed on 6" crushed stone 40' Long x 15' Wide x 6" Deep Loamy Sand Loamy Sand ® or compacted, level base. 2.5Y5/4 2.5Y5/4 1 48" Bottom 36" 98.5 62" 96.33 FLOOR PLAN Sidewall Area: � Not Allowed Bottom Area: 40 x 15 = 600.0 S.F. C2 C2 N.T.S. Total Area: 600.0 S.F. Fine Sand Fine Sand Desi n Flow Provided: 0.74(600.0 S.F.)= 444.0 G.P.D. 2.5Y6/4 2.5Y6/4 589 SKUNKNET ROAD 1os" (Mottle,92.75 105' �2.7s Bed 1 ga h ► gat V H CEN TER VI LLE, MA 19" 91.ss 119' 91 Ss Kitche Bed 2 ed 3 Garage associates PREPARED g & g Excavation 129" 90.75 129" 190.75 Play Living l SEPnc SYSTEM DESIGNS a n d Groundwater Observed @ 119' (EL. 1.58) 320 Cotuit Road Mottles Observed ® 105" (EL. 92.7) Room Room ! Bed 4 Sandwich, MA 02563 Mariya Martynynak <9" ®. 14:01 minutes PERC RATE: <2 MIN/IN. ( C1 Horizon) 508.833.0041 35 Quaker Road I, Amy L. von Hone, R.S., hereby certify that I am currently approved by 1 st Floor 2nd Floor SuNwrin9 br Hyannis, MA 02601 the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and Terry A. Warner.P.L.S. that the above analysis has been performed by me consistent with the *4 Bedroom Deed Restrictions Required by BOH Na'wioMflozsas DATE REVISED SCALE SHEET N0. requirements of 310 CMR 15.017. I further certify that I have (soa) a3z-s3os 05/15/15 1" = 20' 2 of 2 successfully passed the Soil Evaluator's Exam on November, 1994. • - y LOCU ASSESSOR'S MAP: 169 GENERAL NOTES: CD PARCEL: 11 -6 REFERENCE: PL. BK. 64 PG. 20 1. VERTICAL DATUM: __Assumed_________ p a 2. MUNICIPAL WATER __�S AVAILABLE. �4 FLOOD ZONE: X Town of Barnstable I 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT �'bert 9� #250010563J (07/16/14) o SYSTEM UNLESS OTHERWISE NOTED. Rd /T a ac d cos N 4. ALL PRECAST UNITS TO CONFORM TO �y AASHTO: H_10 & 20__ °L 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. NOTE: Pump and backfill Failed Leach 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE Route 28 Pits. Remove any contaminated co M WITH MA ENVIR. CODE (TITLE 5) AND LOCAL soils within 5' of Leach Field. Pump, REGULATIONS. LOCUS MAP N.T.S. x 10169 Crush and Bockfill Existing Septic m 7. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES . X 103.81 Tank. PRIOR TO CONSTRUCTION. UP 37 LEGEND: SX 7gg-7-8- -100.98 4g'02„ PROPOSED CONTOUR x 02,4 z x 101.66 +S E / 94 1 ss PROPOSED SPOT GRADE �' 00, �38/ X 101.12 X 100.28 \10 / HYD 100.71 - 40 - EXISTING CONTOUR 0� X 30.23 EXISTING SPOT GRADE X 103 7 -- i TH-2 .. ::: 2 \ [] TEST PIT 100.61 46 -1 X 101.3 ... . ... . ' O ® EXISTING WATER SERVICE W 3, -': I 28 ,. . . . . 100.83"' :. .:. :.. 100.47 0 0 15 .�9,92:: A`' X WORK LIMIT LINE N Garage `lOQ.35 <y' % Pave - .:.`:..: co 2' ^.. riv D e. F AO X �I U 1 .2 M o .7 100 0 0� ,T• 9 O X 589 �Q goyG Z ° TOF=102.10 �'101,01 jpp (� $ VON HONE /co `� :cs Deck X 03.26 (Assumed) _ 9�7.90:` :'' �/ J No. 1068 y �V- , W S OfF'-.., Rio 0 10' *Raise Plumbing / Lot 36 E 1 .13 BH Min. 9" to EL. \ X 99.85 (Exist. ,�p0 15,500f S.F. o 1' 100.14 7' \ 3 EL. 99.1) i / 0.4t Ac. o io O p1 0 Map 169 N o N 10 .46 0.3 Parcel 11-6 1 (� NOTE: This plan is to be used for septic co x . --, system purposes only and is not to be 100 4 2 \ 22' considered a property line survey. X 10 .80 \ 2 x�03 X 99. � x 99,68 � 0' 589 SKUNKNET ROAD 155.00, �\ x 98.67 4 \\ v H CENTERVILLE, MA 101.38 N a o \ CB DH FND GND 84802" w associates PREPARED B & B Excavation Benchmark set: o a SEP s FOR: a n d Right corner bulkhead �► 320 Cotuit Road EL.= 102.10 (Assumed) \�� 99.86 Sandwich. c83MA 0 563 Mariya Martynynak ,CB DH FND BASINS 35 Quaker Road \ 99.6 X Surveying by, Hyannis, MA 02601 Terry A. Warner.P.L.S. 9 ,95 FND Harwich, MAR 9oad 2W DATE REVISED SCALE SHEET NO. rn DN (5W) 432-8309 05/15/15 1" = 20' 1 of 2 Provide Riser over D-box I NOTE: All components to be marked with NOTE: To prevent breakout, final T.O.F. (Full) to within 6" of final grade , magnetic tape or similar prior to final cover. grade of EL. 99.0 to be carried EL. 102.10 (Cover to be watertight) out a minimum 15' beyond edge F.G. EL: 100.3-100.9f F.G. EL: 101.2 Maintain Min. 2% slope over leach facility to of leach facility. Existin F.G. EL: 101.0 revent ondin F.G. EL: 101.0-102.0 Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Stone or outlet to within 6" of final grade Geotextile Fabric " Inspection Port within 3" to grade Raise L=15' (Access Covers min. 20" diam. per Code) L=20' 3/4 - 1 1/2 Double Washed Sto e Plumbing 4" SCH 40 P . 4' SCH 40 PVC L=10' 0.005� slop Top of Peastone or Geotextile Fabric EL 99.0 min. 9" to ®S=4� 2 o 10, «• 4 SCH 40 PVC Cap Ends - EL. 98.25 EL. 99.85. 14• ®5=1.4� 1 U�7 CAS=1� 0.5%l•AIN 6" Effective Depth (Exist. invert EL. 99.0 EL 98 72 EL. 98.55 Bottom EL. 97.75 .Q EL. 99.25 Install Gas Baffle EL. 98.45 Use Leach Field EL. 99.1) PROPOSED DB-3 40' Long x 15' Wide x 6" Deep 5' H-20 DISTRIBUTION BOX am Am (Install PVC Inlet & Outlet Tees) Wa more than one t for levelness if mor SEPTIC SYSTEM PROFILE PROPOSED 1500 GALLON if 92.75 N.T.S. H-10 SEPTIC TANK outlet Adjusted G oundwater (Mottles) NOTE: Existing 1000 gal ADDITIONAL NOTES SOIL L 0 G Septic Tank to be pumped, DESIGN CRITERIA crushed and backfil►ed. 1. Contractor to confim soil suitability prior to installation. Contact Number of Bedrooms: Existing 4 Bedrooms SOIL EVALUATOR: AMY VON HONE, R.S. S.E. #2517 BOH and Design Sanitarian in the event of varying soils from original INSPECTOR: DAVID STANTON, R.S., BOH soil test. Soil T Grandfathered Flow per BOH) Type: Class Class I DATE: MAY 15, 2015 11:00 AM Percolation Rate: PERMIT: #14694 2. Pump and backfill Failed Leach Pits. Any contaminated materials <2 min/Inch PERCOLATION RATE:<2 MIN/INCH IN C1 within 5' of proposed Leach Field to be removed. Pump, crush, and Daily Flow: backfill existing Septic Tank. Design Flow: 110 G.P.D./Bedrm x 4 =440 G.P.D. TH - 1 TH - 2 440 G.P.D. (Min. Required) EL. 101.5 EL. 101.5 �, 3• Water line to be sleeved at any sewerline crossings and within 10' Garbage Grinder: 0 0 of any septic components, as needed, per Water Department Not Allowed -A A.. to requirements. Contractor to verify location of water line prior to LeachingArea -.-.-.-.-.Sandy Loam:.;.: 4, ..........Sandy Loam:.:.; „ q y 440 0.74 = 594.59 S.F. construction. Required: ( )/ ;•;•:;;10YR3/3; � :;:;:;•:;10YR3/3: : q 7„ .. 100.92° 7" 100.92 ' 4' Existin Sewer Line to be raised a minimum 9" to EL. 99.85. Septic Tank Required: 440 G.P.D. x 200% = 880 G.P.D B B g Minimum 1500 Gallon (Proposed) ......Sandy Loam..;.. .•• Sandy Loam;..:. (Existing EL. 99.1). 10YR5/8;-V:-:•:•::: 24 99.5 29" .. 99.08 Use Leach Field: Sch. 40 Perf. PVC with 2X Washed Stone: C1 C1 Perc 5 Septic Tank and Distribution Box to be placed on 6 crushed stone 40' Long x 15' Wide x 6" Deep Loamy Sand Loamy Sand . 0 or compacted, level base. 2.5Y5/4 2.5Y5/4 48" Bottom 1 36" 98.5 62" 96.33 FLOOR PLAN Sidewall Area:Bottom Area: 40' x 15'= 60ci 600.0 S.F. C2 C2 N.T.S. Total Area: Fine Sand Fine Sand Desi n Flow Provided: 0.74(600.0 S.F.)= 444.0 G.P.D. 2.5Y6/4 2.5Y6/4 589 SKUNKNET ROAD 105"A ' w t 92.75 105 92.75 Bed 1]EtKitcher h Bath V H CENTERVILLE, MA " Bed 2 lied 3 PREPARED 119 91.58 119 91.58 g associates B & B Excavation 1 129" Garage s�anc srsr� oE�cNs FOR: a n d 29 90.75 90.75 Pla Living Groundwater Observed ® 119" (EL. 1.58) . y 320 cotuit Road Maria M a rt n n a k Mottles Observed ® 105" (EL. 92.7) Room Room Bed 4 Sandwich 508.833. 02563 y y y 0041 35 Quaker Road <9" ® 14:01 minutes PERC RATE: <2 MIN/IN. ( C1 Horizon) 1, Amy L. von Hone, R.S., hereby certify that I am currently approved by 1 st Floor 2nd Floor Surveying by: Hyannis, MA 02601 the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and Terry A. Warner.P.L.S. that the above analysis has been performed by me consistent with the *4 Bedroom Deed Restriction Required by BOH Harwich.hwic "MA 02"5 DATE REVISED SCALE SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have (508) 432-83M 05/15/15 1" = 20' 2 of 2 successfully passed the Soil Evaluator's Exam on November, 1994. t E V 6. N DTE'S j-. - _ I \ (D--ALL ELC.v' '5V4/.- . :' AP.t ME&AJ SSA L e,.#C - -- -- — — ----= -- � Ai-L. L.j W E J A. 0-1&J U t U�e� bF tab �a7r _ I li I r� t �� UwiLc�`> CST'►.-1E��t5E SP'�C�FIEi� •',,, 1 i I I \� �� I `Jr— ALL PtPE-S T�D Ak-JD i T Htk SYSi Lt-A, 1HA.i....i._ E!E C..^ST 1?-0►.l tom. SC�+so c_ _1'c X+`7 ALL. 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