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HomeMy WebLinkAbout0602 SKUNKNET ROAD - Health 602 Skunknet Road 169-015-014 Centerville S�I- J___-�J JaQfCIQEO� UPC 12534 No.2_ � HASTING$,MN Ll F44 'tl V v n VA TSL ® ,� v izo r Commonwealth of Massachusetts /&j_0tG7- 01 Lf - Title 5 Official Inspection form iI,. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC- PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is CENTERVILLE MA 02632 8/24/2020 required for every 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. fi lling out f rms A. Inspector Information filling out forms on the computer, use only the tab Christopher Maki key to move your Name of Inspector cursor-do not Cape Cod Septic Services use the return Company Name key. 350 Main St. Company Address W Yarmouth MA 02673 City/Town State Zip Code rarer 508-775-2825 SI-14423 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector In full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true;accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8/25/2020 nspec rs i`�gri to ure 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS IN WORKING CONDITION 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC - PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired., ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts ,tip Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fall 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. c. Other: 4) 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts - ,, Title 5 Official Inspection Form l' la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC - PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts --_-- , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15:304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c °y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 602 SKUNKNET ROAD t_r Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE . MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1, Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 Z No Water meter readings, if available last 2 ears usage '19- GPD '18 - 9 ( Y 9 (gpd)) GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of is. Commonwealth of,Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC-PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every. CENTERVILLE _MA 02632 8/24/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter-readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 602 SKUNKNET ROAD Property Address ABBA REALTY LLC - PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 2001 PER PLAN ON FILE WITH BOH Were sewage odors detected when arriving at the site? ® Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 12"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.): LINE.CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 9 of 18 � Commonwealth of Massachusetts ------- Title 5 Official Inspection Form `a -- --.- I1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 5"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: 1500 GALLONS Sludge depth: 211 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? ESTIMATED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 GALLON TANK IN GOOD CONDITION. PVC TEES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL. COVERS 5" BELOW GRADE t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts x� __--.; Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 0 polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts -�- , Title 5 Official Inspection Form -- �i� Subsurface Sewage Disposal System Form-Not for'Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN 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.): DISTRIBUTION BOX LEVEL AND WATERTIGHT 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC- PO BOX 2417 HYANNIS NIA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10, 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. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers_ number: 4-CULTEC C-4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc rev 7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts =- -,7 Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 602 SKUNKNET ROAD Property Address ABBA REALTY LLC - PO BOX 2417 HY_ANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 _-_ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs.of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 4-CULTECS C-4 CHAMBERS WITH STONE, 12'X48'X4", FOUND DRY DURING INSPECTION WITH NO EVIDENT STAINING. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid.to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.00c-rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC-PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 6/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13, 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.): I5insp doc•rev 712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cs �, 602 SKUNKNET ROAD Property Address ABBA REALTY LLC -PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 15insp,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title- 5 Official Inspection Form li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 602 SKUNKNET ROAD Property Address ABBA REALTY LLC-PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 page. City/Town - state Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +11' 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: 9/15/01 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: TEST HOLE DATA PER PLAN ON FILE AT BOH. TEST HOLE OBSERVED WATER @ 139". MOTTLES OBSERVED @ 78". SYSTEM INSTALLED PER PLAN AND CERTIFIED BY ENGINEER WITH A 4.5' SEPERATION TO MOTTLES. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15nsp doc•rev 7/26/2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts y - ; , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 602 SKUNKNET ROAD Property Address ABBA REALTY LLC - PO BOX 2417 HYANNIS MA 02601 Owner Owner's Name information is required for every CENTERVILLE MA 02632 8/24/2020 _ page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 L-A �ca� QC 30 AF`6 9D . 0 ADS3 BE G/ 7Rra'�' D�o�' DATE: +� 4 jc/ FEE: BARNSTAB[.E. ' 7 MASS. C Qjol t63q. Aim REC. BYL--,r FDMAy Town of- Barnstable J SCHED. DATE:�����-�G Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 ' Susan G.Rask,R.S. FAX: 508-790-6304 r� Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 602 k,umk&�--* /2�4 Assessor's Map and Parcel Number: 16f' /¢ Size of Lot: ✓, 409S Wetlands Within 300 Ft. Yes Business Name: hPr w��S�i 7— No 1/ Subdivision Name: rU67 Cvg.v��e..s �/ 2 A.PPLICANT'S NAME: R,J: tn/{d j /,t�i Phone 7—�=`' 7ev O Did the owner of the property authorize you to represent him or her? Yes >/ No PROPERTY OWNER'S NAME/� CONTACT PERSON /e Name: ks pP� / D O , 2?,g1?R E,7JJ20 Name: L/fiy��) Address: 9/k4 7 Address: �C/O '7 S29 0?-670 Phone: Phone: 710 — 7CI50 VARIANCE FROM REGULATION(List Res.) REASON:FOR VARIANCE(May attach if more space needed) p u� 31 Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of engineered plan submitted(e.g. septic system plans) —k Four(4)copies of floor.plan submitted(e.g. house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same owner/leasee only),outside dining variance renewals[same owner/leasee only),and variances to repair railed sewage disposal systems[only it no expansion to the building proposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask, R.S:., Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/WP/VARIREQ afl, MAP SKETCH ADDENDUM Borrower tClient F:lisberto C. Barreiro M erty Address 602 Skunknett Road -- — —"--�� City Centervil Le County Barnstable _-� V State lender _-��—_— First FeV era.l Savings Bank of America BUILDING SKETCH :S£Lr�r�1 LEVE' f aJ` t � ay ldN D Er d LOCATION MAP [`SUBJECT PROPERTY] IL Y Coil r � 'd O96L-06L-60S- i outau,aeg euuoQ dGZ :Oi i6 SZ inC RONALD J. CADILLAC, PLS, RS Professional Land Surveyor & Registered Sanitarian P.O. Box 258, West Yarmouth, NIA 02673 (508) 775-9700 (800) 520-5591 ABUTTER LAST AND NOTIFICATION DOCUMENT To: Rn c n St LX66- :13bClcA CJ ue C� l Date: —7J (. C'i Re: Proposed project at: (n�� ` U4< l LC- AM p , Lot Owner/Applicant: Signature Date Notices Mailed ABUTTERS: Map-/L2-9Lot i 5- 1 Map Lot �j � J k*uVik n Q�v �Roc� , �ox 0o9 Ma M Lot 5- a �(� /` P q Lot - P� ' � 1 1 5 3 I - Map�Lot��� Map I lS�7 Lot Vi Ulain -FuG�� �, l�hn Mao^i no I R- vf\�V��. Map Lot Map Lot .. �f RONALD J. CADILLAC, PLS, RS Professional Land Surveyor Registered Sanitarian P.O. Box 258, West Yarmouth, MA 02673 (508) 775-9700 July 26, 2001 NOTICE OF BOARD OF HEALTH HEARING To: Abutters Project Location: 602 Skunknet Road, Centerville A.M. 169, parcel 15-14 Applicant: Mr. Felisberto G. Barreiro P.O. Box 47 W. Hyannisport, MA 02670 Project Description: Applicant seeks to repair a failed septic system. Variances requested are for a gravity feed system: Vary separation to mottles(groundwater) by 1' (4' provided) 3IOCMR 15.212 Vary cover over proposed 1500 gallon tank by 3" (6" provided). 310CMR 15.228 (1) Applicants Agent: Ronald J. Cadillac Pp Hearing Scheduled: A hearing for this project will be held on August 21, 2001 at Barnstable Town Hall, 2nd floor hearing room, at 7 P.M. Plans are on file at the Health Dept. (508-790-6265), which is open Mon. —Fri. 8:30 A.M. to 4:30 P.M. JuJl' 25-" 1 10: 27p Donna Barreiro 1 -508-790-7950 p. 1 f 170Y -CCU c-, 602 SKUNKNETT ROAD CENTERVILLE, MA 02632 428-4282 Town of Barnstable P# C 10 z _ � Department of Health,Safety,and Environmental Services �Twa ' Public Health Division Date Au / 367 Main Street,Hyannis MA 02601 eARNa"rABM rrn,3s. �ATfDIM�A Date Scheduled 71�f5 / Time 3�6'0^1 .Fee Pd. l col ' Soil Suitability Assessment for Sewage .Disposal r Performed By: /'C lj,O �igQj 7�e. .S. Witnessed By: (x, ^ f Pd/tq 97471, LOCATION:& GENERAL INFORIYIATION Owners Name Location Address / Q ^� ('ku�4�6 i p�� /fS��A (C� G. ��—U/ Address RO-®O!X 47 Assessor's Ma /Parcel: j�— ` - 0��70 P Engineer's Name� J.C.4 NEW CONSTRUCTION REPAIR Telephone# 77$-2700 Land Use 414Wt,,.f Slopes(%) /Z Surface Stones III-eiy Distances from: Open Water Body ft Possible Wet Area R Drinking Water Well R 1 / / �. Drainage Way /ZJ it Property Line � R Other R SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i �6T 14 a � Parent material(geologic) . Depth to Bedrock__ Depth to Groundwater: Standing Water in Hole: /J Weeping from Pit Face A-11 Estimated Seasonal High Groundwater bE 'ER1V A`- 0 FOR�FASONAL,M. VVATE�i><TABT�E may, j Method Used. /i/��/�� Depth Observed standing in obs.hole: in. Depth to soil mottles: 7r4 sV in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R, Index Well# _-„.._. .Reading Date: _ Index Well level _i Adi.factor Adj.Groundwater Level - — PE tCO)L�TTOI�i 7CEST Jute. � Observation .Hole# L`.�Q Time at 9" —L� :Depth of Perc Time at 6" I Start Pre-soak Time @ Time(9"-6") -5 End Pre-soak j Y — :Rate Min./Inch 2 /- Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant -D E OB ERVATION HOLE LOG !HoI� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,°o Gravel l DEEP OBSERATIQN HOLE LOG Holy . _ Depth from Soil Horizon.,. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel 1 DEEP OBSERVATION I�bLE LOG Hole Depth from Soil Hori?y°n Soil Texture Soil Color Soil Other Surface(in.) f! (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel r DEEP OBSERVATION HOLE LOG Hole# >4 Depth from Soil Horizon Soil Texture Soil Color Soil .............. Other i Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%p Gravel) 1 3Z)- no" Cl 7e Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Re. Naturally of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �5 If not,what is the depth of naturally occurring pervious material?. Certification ,�I I certify that on / ✓ / 3(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 require raining, xpertise and ex riencce described in 310 CMR 15.017. Date Signature r� r i/ �r i YOU WISH TO OPEN A BUSINES52 For Your Information: Business certificates (cost$4 0 for 4 years). 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.) ou must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE: t Fill in please: / APPLICANT'S YOUR NAME S 1 i l i I� ►�c' `�Ju�� t - ji:.f YOUR HOME ADDRESS: � nI Y v'i ll� ,- .'y:•,rsy :�,�°• I} �e.i.; BUSINESS - U 1� Jilt lji•© TELEPHONE # Home Telephone Number CCAI - 1 ,it'!!iv'" �rryad NAME OF CORPORATION: NAME OFNEW BUSINESS G oVa TYPE OF BUSINESS IS THIS A HOME OCCUPATION? _ YE NO ADDRESS OF BUSINESS�� wile M0 0, 30. _MAP/PARCEL NUMBER I(0 Q I (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 yflur business in'this town. 1. BUILDING COM ISSION R'S O ICE T COMPLY WITH HOME OCCUPATION This individuA h n Infa mmd f y r it e u• em rits that pertain to this type of bus i LDS AND HEGULATIONS. FAILURE TO Aut oriz Si n. ! re** COMPLY MAY RESULT IN FINES. . 4 YMMENT9�j�� 1 ` �' - v A TH l ' MUD MPLIf'fl"!A 2. BOARD J H This individual has,b en informed o it requirements that pei=tain to this type of business. H—RDQUS MATERIALS--REG�I 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: . Town of Barnstable Regulatory Services 0 FSHE Tp� o Richard V. Scali,Director Building Division WARMNSTAUELE MLgC Paul Roma,Building_Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us' Office: 508-862-4038 Fa,,x� 0�-5790-6230 Approved: j4,q ,J(� Fee: < `� Permit#. HOME OCCUPATION REGISTRATION Data: 01 I "1- Name:R)k t�1 D ZA Phone#: 5045 3CcO - Oq q Co Address: (fQ3 SEan V—ne4 Unfe.r vi t M A-Oa(o,,)llage: Name of Business: GOVCLI t2a�-Ry)Q SiDi n Type of Business: 110a,nC, � S i Oi rA!1 Map/Lot: UT 017 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation ' within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No tra�a-c.will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities, • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. •. There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related_to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation_ • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have'read anti agree with the above restrictions for my home occupation I am registering. PP ( � A licant ( r f,, 5o 4g ( Date: 01111 0 01-� Homeoc•doc Rev.06/20/16 t Date:01 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: goVaL (Zoo no, � 5intn!�4 BUSINESS LOCATION: C�oa 5LinKne1 yp , cenAI fvii►e MA oaco,3`a INVENTORY MAILING ADDRESS: 60.1 5K,tAnV.oeA Qb, U nAey-y�ike. Mfg Qac0 a TOTAL AMOUNT: TELEPHONE NUMBER: 5D$ 3C40 Oq-4(o CONTACT PERSON: N-�1 t �patois z.Gk EMERGENCY CONTACT TELEPHONE NUMBER: 5D8 a6-j as,5a MSDS ON SITE? TYPE OF BUSINESS: Qco n SiNf) INFORMATION / RECOMMEN ATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applica t, Signature Staff's Initials �%LDate d / Physical Street Address-Check database'to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines., thinner to clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? If none, note that. L---6—isposal Information -where and who? If none, note that. 4.�_ Applicant Signature - understand what is listed and noted ��*Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it ttach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A, BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). 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) Arm DATE:otl-on Fill in please:' a1�y 4T&f142LAK1,110 APPLICANT'S YOUR NAME/S: PW BZ,,, o Sl 1.�r Al �� BUSINESS YOUR HOME ADDRESS: (, ) >lcM1, ti 1. n_i Z R�l C r nrTr-r%_\ 1 L r r--� o Q G 3. §- (rJ �qp1llFf alk - T i j3gil) LEPHONE # _ Home Telephone Number 1�r;9- r'I�r,- o`ho �'•,' - 4J1tlt,11,dfL�!'dM1�'8.;7�1�'sj� l� NAME OF CORPORATION: NAME OF NEW BUSINESS G N c i Vi TYPE OF BUSINESS 1 P,ry c a Pt IS THIS A HOME OCCUPATION? X YES NO ADDRESS OF BUSINESS C i-,�,Z CLRv1 k_6- MAP/PARCEL NUMBER �`o►�-o - I L( [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,Mai. St. - (corner of Yarmouth Rd. &Main Street) to make sure.you have the appropriate permits and licenses required to legally operate your usiness in this town. 1. BUILDING COMMISSIONER'S PFFICE This individual has b -ifi rmed of a�riy/permit requirements that pertain to this type of business. �85 girl s/_� MUST COMPLY WITH HOME OCCUPATION ` Authorized Signature** RULES AND REGULATIONS. FAILURE TO COMMENTS: CnM121 Y MAY REST 11 T IN FINES 2. BOARD OF HEALTH This individual has rme f per it r .juireme s that pertain to this type Y WITH ALL ��/ '�"- Authorized Signre HA.ZA-RDOUS MATERIALS REGULATIONS. ** � - 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: TOWN OF BARNSTABLE Date:©q /oR TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: �n2 S1c�,n.1: wart R\*) CLn.T-IZVI = ►n r- Q 3,)INVENTORY MAILING ADDRESS: TOTAL AMOUNT. TELEPHONE NUMBER: Sod- Li 20- og o 3 CONTACT PERSON: Rv�3>✓ ,.. nr� St i \�.. ,�$- -�60- ` k�j 9� EMERGENCY CONTACT TELEPHONE NUMBER: 5nj- 1I$S; MSDS ON SITE? TYPE OF BUSINESS: Lrc/vp5Cpp1= INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum (� Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners p Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) g Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout , Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash W ITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials c y Y q IFox, I, : P /I 4 a � F ,r h 1 TOWN OF BARNSTABLE L=tCP".TIGN la�nC ��yM`r.t/e'Tc/� SEWAGE # AGO I ViLLA al✓ CE-1TC A V-1 Af ASSESSOR'S MAP & 1,07� D S=AL LER'S NAME&PHONE NO. FRp1i-V c ape 41 �775 v7 0 SEPTIC TANK CAPACITY / S 0® e—'Al/v—0 5 LEACHING FACILITY: (type)6/) ICI;e CrslTcclS (size) '5007'X /-2 X F, S® NO. OF BEDROOMS B JILDER OR OWNER /—�I�s�F 1't� �/� ✓2 /. 2 PERIvtIT DATE: COMPLIANCE DATE: I �' 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 0".4.41 R /r 1� 14 fsc 3a 6F 16D 7,,,-,c7 I A D 573 B t' 6 f IA r V Fee No. THE COMMON WEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for Miopozal bpe;tem Comaruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j �'� ,�y,�`y�'l ✓'c 0 Owner's Name,Address and Tel.No. Assessor's Map/Parcel c Installer's Name,Address,and Tel.No. © Designer's Name,Address and Tel.No. 7� 7 Type of Building: Dwelling No.of Bedrooms Lot Size �� "� sq.ft. Garbage Grinder ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow rY gallons per day. Calculated daily flow , gallons. Plan Date 05- Number of sheets 1 Revision Date Title Size of Septic Tank /` ��0° Type of S.A.S. �/ Gei�Y� G � �:,✓e'� Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��������� ��rc�'.3� vlJ r'Lnif t.j ti: IN3T;,L1_ ,T:G\J AND CERTIFY IN 1.!F7,jTWr11 THE SYSTEM WAS INSTALLED IN STRICT 10 PLAN. 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 issuSajy this Bparj of Health. Signed Date 9 ,� Application Approved by Date Application Disapproved for t e following reasons Permit No. "r __142,1!7Date Issued • 1Vo. O �/ , ,� '^-c, Fee THE COMMONWEALTH OF MASSACHUSETTS ;�; Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migpogal 6pgtem Con5truction,30ermit I Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. d 0 t�k V y � l /?,0 Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7 O O 0-/� G .4: 0e-olt- v 7v d? lT� �/!-jam /oo�ox•It'�P ��.t�xry L N ,�y, �/I • o zoo �v,- Ott. Type of Building: p Dwelling No.of Bedrooms Lot Size ��"£� sq.ft. Garbage Grinder) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures F. Design Flow gallons per day. Calculated daily flow gallons. Plan Date OP OP. to nlr"d i Number of sheets 1 Revision Date Title Size of Septic Tank ra o Type of S.A.S. GGL X G _41' Z- Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned'agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu y tlis Boar of Health. Signed Date Application Approved by Date Application Disapproved for t e following reasons Permit No. Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS IV BARNSTABLE, MASSACHUSETTS � �� 915�e�r Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded A � Abandoned( )by at A h s constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer 1 Designer The issuance of this permit shall'not be construed as a guarantee that the sys_m will function as-designed. Date 19,�, Inspect or. 0. N Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogaf *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(K)Abandon( ) System located at 6047-Z J1''<-G ti ,:,-,P B.t,,D and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct n m be co pleted within three years of the date oft fipet Date: Approved b `' PP Y Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: (</&lTrUS (2 CEO F i I\j 6 BUSINESS LOCATION: C-. Iljjr 2y i(-Lit, MAILING ADDRESS: -6 n_2. S K K Q 0 u Mail To: TELEPHONE NUMBER:_0502) LA. ,U-�� S � 9 Board of Health � Town of Barnstable CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT TELEP IONE NUMBER: a 6;0 )-,??o PS L-i Hyannis, MA 02601 TYPEOFBUSINESS:_ Loop- of r, Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. . Quantity Quantity Antifreeze(forgasoline orcoolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IV Ste .. , .. - 4/-��/Jp (f +—mow-•-r.. y ., zz R R m-fit. ,� .�;��� � . . • 0 ^to 10 (ramAO coAc LCAJ t CQ� to S 7 ,�;.' �F � . _. u •:, _ _. n p � ..y� s .. , Yes- .• � .^ .. . � . � ` s. 4 i.. pt^ � jam` .e `¢, �;,Ytwj�R''S MAP N0. P - PARCEL � LOCATION 1 -7 SEWAGE PERMIT NO. VILLAGErG � b INSTALLER'S NAME & ADDRESS S U I L D E R OR OWNER DATE PERMIT ISSUED E RATE CRMPLIANCE I S S U D -�� 15 O to r LOCATI�ON SEWAGE (VRMIT NO•. I-Q!7- /!1 VILLAGE INSTAIIE- R'S NAME R/y/�� ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED !Z -��` j DAT E COMPLIANCE ISSUED 7� �^� r . . c �1 e e- i THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH `�ca.,.�.r,................oF............. 't.h. .oaxa.lam........................... Appliration for Disposal Works Tnnitrnrtiun rumit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ..... ............ . •Location-Address - or Lot No. ..... - 0.M - 1�---....... -•1.`-`---•.........: ............ 0. r�._s ° .........--•--•-•----....-••--•..... Own ddress Installer Address _ Type of Building Size Lot.A5.,-A. ----Sq. feet Dwelling—No. of Bedrooms........................_......._...__.._...Expansion Attic ( ) Garbage Grinder (W) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------•-----------------------••----------------------- ..::---•--------------- w Design Flow...............\V0...................gallons per person per day. Total daily flow__._..... _ :C)---..................gallons. WSeptic Tank—Liquid capacity PPjotzallons 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._.._ G .S'iL.... .... ------- -.:. .................................8 �-7 Date �-� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .................. O ------ ...------------•••-- ---- ....... ...._..------•-----•---••--------------•--•--•-•-•--------..:--- Descri tion of Soil.........5�.e_.._._.. .� - x U ........................................ ,= - '------------kr� ...... Z .....�.�.na............................................................. w UNature of Repairs or Alterations—Answer when applicable............................................................................................... -••-------------------------------------------------•-------------------•----•----------•-------••------•------------------...-------------•-•--------•------------------------•-•--•--•-•-----•....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIL7E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..... lrY,.Ae......Y.).... s, ' ------•-------------- ........ Date Application Approved BY ' /✓�� - ,1 ---•----------•-- ....-`�i ......% Date Application Disapproved for the following reasons-----------------------------•-••----------------------------•................................................ --------------------------•---------------------•---•-••---.....---•-----•----•-----•---••---••------------------------------•-•••-•-----------•----•-----•--•-------•--•-----•---•-•- ................. Date PermitNo......................................................... Issued....................................................... Date r r N00.W-5-?.. r Fss......3.b.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH HQ_`'?^---------......OF.......... Appliraffou for Bispaaal Works Tonstrnrtion rrmit Application is hereby made for a Permit to Construct (6/) or Repair ( ) an Individual Sewage Disposal System at: k. , ..................... -------------------- ................................ - .................................................. Location-Address — or Lot No. .. ..__._................... ....................... ......•.... ........... _ ..........-----_.........•.................... \ ' Owners ddress -u--••._...... -. Installer Address d Type of Building Size Lot_X5...4.�D-V Sq. feet Dwelling—No. of Bedrooms............... .........................Expansion Attic ( ) Garbage Grinder (No) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow...............V\_...................gallons per person per day. Total daily flow......... ...............................gallons. W Septic Tank—Liquidca.pacityMn .gallons Length................ Width................ Diameter..._.__..____.._ Depth................ x Disposal Trench—No..................... Vidth.................... 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 ( ) _ aPercolation Test Results Performed by �4�.k... �.... d--................... Date... :------�:--Z' Test Pit No. I................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........................ 9 ----------•---••-•-••-• -...... •••. Description of Soil-------- ``�. -----a�...a----------- ----- G`-M .....` � ------.... 'b.. .�_1...................... - --- - x c.� ............................ ----------�................... " ^ W --------•-•-----•-----------------•-••--•----------•---------••-------------••••--- ------------------•--•--•---------•-••----------------•-------------------------------••---•--•-----............... U Nature of Repairs or Alterations—Answer when applicable................................................................................._.............. ... ..........•......----........-•-------•-•--•-----•-•------------•-----------•----•---------•---•---------•-•---•-•---•----•--•---•••----. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITILE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. .. Signed....(C-yi-Or!Y ,a..... �Y i J ...... �: a .y- 1 D Application Approved B .............. G /3d ___.___... Daatete Application Disapproved for the following reasons:•-------------------------------------------------------------•----------------...-•------•---•-----------....-- -•------•------------------------•-------------.....-------••------•-----------------...----------------•----------------•--•-----•---------------•----------•---------------•--••--•--••------•-------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tntifirtttr of Tuntpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ✓f or Repaired ( ) by••...---- \ AA. ...........\moo S ----------------------------------------------------•------------...--•---------------•---.... `' --installer \ has been installed in accordance with the provisions of TI"' r r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._e l:52............... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION AT SFACTORY. DATE.......... 24 / Inspector ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , .. FEE a................ Utoposal Vorkv ions..- nr tan anti# Permission is hereby granted........V ...:t%._ __ ___ ____________ _________ ____ ------------------------------------------------------------------- to Construct (,-j or Repair ( ) an Individual Sewage Disposal System at No........ _ ) ............... \ti v_(Q ��N 1Z. C G N_.. _ ('-� • �- ..................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... DATE------------------------ -•---tfl4 1..-••-----•----•-------.•----- so Hea th FORM 1255 HOSES & WARREN. INC.. PUBLISHERS r, SI4W&Lr. 1=AMIL`f 3 BEoeOoM5 .. - --,- LIo 6AV-Vwh. r Qzl UDE2 AV& =kb-1 t-y t`L.ow • 3 x 110 a S;o Gpa gMPITtG -r Awt4 = 33o a ISO yo • k495 4PC , � StbEW/�t.t_ li¢�a •� �t3 SF , , .. � 4 :�: ,. . t •r►� �.¢• i , f :-a C�+4.t3�1•oB)CZ•S) = 14d. G•Pv. .._. { -- �.._.... _ ._��. .. _ � � - : -'� . :. . BoTToM AV-EA = 288:'SF. �l2't2d:��-t.o� s 2"68 6•PD. ... .. K .. ,�. c�•xR � BEa: TOTAL T�E�SI 6tJ d 62 6 PD. 1 .. . .. � •_ . : �? ' AtL or J. I __ -___ - f - . • ;y %� G -. . . } ....... 92-7 PLOW r 'l4 a 1 Ct=Z FY TI4 AT TW l= F OkIDA C.l6 51aouJ :; x t=O k� uE�ZL--ot,l GoMR..YS WITS. T41E.--------•--� __.._.. .. -1 �- , } 5(vsu uE Awn 4m, Acv- tz uIEF-u ; THE -rOW u of ...... _ -a&iTEQ. Llyt-: ItJG 3 pl..�,t,i a, : t T-. P4-: 9 • F�. ; 26&5TCZF-('�� LAI,tD 57uai-lVJLDC5 . .. . . . :- •tee.—r�ee�,� ; .G .. . _..___.... .. ..._. . I�«.�- 5 B�"�• �r ,r• ,...E,, f i I►t . s`, ItJV tJ� T J ay ab is ray t* IQ4 .. �y 97o l000 l `Q 1� 9,G 8 �� 9G,G `�•,� t3ot 9GZ �° g �• Z�g jx�k�' rt �' �r �r •9�•¢' fi W I TI.1 A'CF 31A TO I/: W*ED F•��` ,`��`'" : " �s r(�� 4TOue All AZo)wl>- 24 of ;l I WASt PIIASToWIL 06.1 TOP s %y� A Jt� \-F IL WATILQ W.2 RAO SE ' /S.GE-- -D1 POe7& 5 TE + no sco% 1 I B01-(")7 NOTES Barreirrc).dwg Q11 1. LOCUS 15 A.M. 169, PARCEL 15-14 2. ELEVATIONS SHOWN ARE ASSIGNED, 04. 3. LOCUS 15 IN FLOOD ZONE C ON FIRM DATED AUGUST 19, 1<,85. CL 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS. N07ED'N 5. MUNICIPAL WATER I,,, AVAILABLE. LOT-, WITHIN 1,010' ARE ON TOWN WATER. -ated pipe level cI<:)wn ceFmter of C-4 Unit, as shown, �,,ap end.Loy perfoi 6. 'COMPONENTS 70 BE AASHTO_ H-10, UNLESS NOTED. 1 Jse 410 filter cloth, no peastone. 7. INLET TEE TO PROJECT DOWN 13-, O�)TLET TEE DOWN '14". NOT 10"o-A 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW SCALE ;�j T Stone e 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MIlqT BE PROVIDED. RTE 28 st e D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. Stone BUILD I.JP COVERS TO WITHIN V OF GRADE. MORTAR CHIMNEYS IN PLACE. ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. 12' Tf- LOCATION MAP 1 C). STONE TO BE OCAUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON O;P. LEACHING CROSS SECTION 1. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC.' 1 =21 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING TEST HOLE IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). N/F 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN LEA.`C.H AREA, AND DISPOSE OF A!-- DIRECTED BY HEALTH AGENT, DEPTH 1 iriches) ELEV-(feei') STEIDING 14. ALL CONSTRIJCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. ) O/E layer 110y 4/3 22.3 Approx. location from TEST HOLE DATE: July 11, 21)01 1011 loamy sand Asbuilt--some ties do PERFORMED BY: Ron Cadillac, Soil Evaluator not fit. REPLUMB SEWER TO EXIT WITNESSED BY: Glen Harrington RS B I Yr 1�rlyr 5/6, 'HER. RAISED I3E[,--USE ONE F01 KATION 14 HIG PERC RATE: <2'-r`O"/inch "Cl layer' y oarn r,,C N S EURSE OF LAN0`,`,CAPE SOIL SURVEY(199,3): Carver loamy coorse. sand 42, S AROUND NEW TANK GEOLOGIC MA'P(10'8i6): Barristcible plain deposits 32" 10 PROVIDE 6" MIN. Invert 21.613 COVER. % C1 layer 2.5y 6/4 PROPOSED--REPLUMB Invert 20.98 4 CULTEC; �.,® CL Fine sond r N /V-,;e Go-8 Baffle Invert 2'0.64 7 1.1" mottle;;t q�- Proposed UNITS Proposed Ilk1. 4-A FUCHS � 1 1"(!" 'aa T 1 6" 12.3 D a4:31 C2 sandy loam To I:i�Stone 0 Fabric PA VED r,1,RIVEWAy New 1390, 10.7 oEserved water Invert "3 nvert ' I,' 21.21 -15 0 10 i G c]I nj Proposed 1. 144" 10.3 F1__0`B 4 IAA5 . ........ 2........ 20.3 ....... Invert 1�Invert 20.81 Invert 20.63'a-a's j// El:�42/ 4.5, co 6" Stone or (�,ornpejf.-,t Bottom Proposed Proposed E 1. 15.8 X CV �2` �17� zv5 C) C) M-ttles V " 'aa,A .... 1.8 L CO N < /I El. 14.0j DESIGN DATA Ljj 3. ' AdjU"I.Arrien t .tj 0 z 22., June 21001--Zone D BEDROOM`., 4 SC W 252 p GARBAGE GRINDER: No Observed water=l 17 ...... REOUIRED CAPACITY- 44C) GPO: LEACH AREA EXISTING SEPTIC TANK: 1000' GAL, USE 4 CULTEC C-4 UINITS, '--ET IN A BOTTOM LEACHING AREA: 574.3 Sil" a AN 8' C,A P IN THE (':ENTER N/F RC WITH le'48' X 1"'%-1.7 S.F. -.'X, A N D 4' OF STCNE ALL WITH D-B C) BENCH --S.E. CORNER OF 30.6 SF CONC. MARK PEREIRA SIDE LEACHING AREA: AROI.)NE FOR A 48' LONG By 1-' WIDE 3 4 I JLKHEAD=22'-1,N BL .199 ASSIIGNEU [2(12'4 48`� X "'.33' DEEP'�] BY -7, DEEP LEACH AREA. RUN F)ERF `R- DESIGN CAPACITY: 454 GFID "F C 21 2 [(,319.6 SF 574_3 SF` X .74 GPD/S,F] ATE[ PIPE LEVEL r WN ENTER' C -4 COVER WITH FILTER FAPRI­ LOT 14 N I T, AND C IV n *Bottom area of D-box is subtracted. go .48 ±S.F. 15 REMOVAL 78 .02- 15s4zu N/F 150,q 'A `EREIRA '0 D 0 r)' ALL AR�.."UND AND I.JNDER RE- F MOVAL D0.VN 132"± TO FINE SAND. BEN;H MARK--TI-P OF W01OU TAKE= 22.19 ASSIGNED OFF HOUSE CORNER'- ENGINEER MIJIST SUPERVISE DESIGNING AND CERTIFY IN k.,VnITING INSTALLATIU4 THE. SYSTEM WAS INSTALLED IN STRICT MAXIMUM FEASIBLE COMPLIANCE APPROVALS REQUESTE11 ,ACCORDANCE TO PLAN- 1. VARY SEPARATION TO MC)TTLES BY (4.5' PROVIDED". 310 CMR 15.212. SITE PLAN 2. VARY COVER BY 3" OVER SEPTIC, TANK (6" PROVIE)ED). 310CMR '15.228 (1). FOR THIS FLAN IS A VALID ONLY IF IT BEARS C� 7% AN 0RI( INAL RED ..,TAMP' AND SIGNATI.)RE. FE L I S B Gp. E3 AF\ f E� � -�\A OF A4,q I�A OF LOT 14, 6022 SKUNKNET ROAD, CaENTERMLLE, MA LEGEND N L I N yGN ­ # 1060 #35779 LE. 1 "= 20' 0 7H I TEST HOLE LOCATION, NUMBER Cn -10 CADILLAC JULY 26, 2001 SCO -j W WATER LINE MARKINGS T E C%VERHEAD ELECTRIC WIRES (IF SHOWN) G/STS S s\0 9.5 >e 8.7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) /TAR do SURVEY C/� )ILLAC, BLS, RS EXISTING CONTOUR ks RONALD J. CAL PROPOSED CONTOUR PROFESSIONAL LANE) SURVEYOR & REGISTERED SANITARIAN UTILITY POLE (IF HO'WN) P-10. BOX 258 EXISTING DRAINAGE CATCH BASIN WEST YARMOUTH, MA 02673 X FENCE (IF SHOWN, NOT ALL SHOWN`; (508) 775-9700 HEALTH AGENT APPROVAL ['ATEP AG E 1 "D F 'I REV. F)I_l.,1IvIBINf_- -14" BY R.J. C'ADILLA(