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Home My WebLink About0073 PINE CREST ROAD - Health rjjj' .73 Pi>r�e Crest Road Centerville A = 247 — 125 - 005 No.Z4MWR UPC 12534 smead.com • Made In USA r Szl w ; M Z , 1 I E w� Y 1 a+'k^"h+',,,2Y ,>z��i v� s� k '�$ `� � � � f 1 � s't,"ss 'Y ,w. � ) ^3•• r s spt ti r ,� 3 �� n ra 6 a� p{ r� '" k. °�x � .: `� � f E n�.:� spy "` t �s, �} �, +• i�-{.� 8 j »� t •r 77. ��"_f'� '' �"" s,F-w•:" ,•'r+"•F•�9 �' S� ''` �'e .. .' l``.. � 2 -�s R r' t t;'a j,` "`` +fig � . u -' n s v o-c ray +i :`a.r y '�• a ' ! it r a ,sc , S .7l-car'"..P ( �'i�j{ �w l��`'+ `` w w�"`„r.. `.1�, /1 3�l ell" �.�,': 4 Lsl;' � .+< � � irr'• � .y �+� �; r�` r `z �`.sn,.. _' �{u``i' r2T � f t r r � � �Y '0 r' a t •� r i. ,V#It G�w�.•,^'o! y,M' 1 Ac"',;/ 4 y�. ✓" rt. ,!". 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DEPARTMENT OF ENVIRONMENTAL PROTECTION }• TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address• 73 Pinecrest Road en ervi e Owner's Name: Paul Rufo r Owner's Address: ' „<s r Date of Inspection: 3 °— d S S3oZ 65� `h� Name of Inspector:(please print) W i 1 1 jam E_ • Robinson Sr. 2 Company Name: William E. Robinson Septic Service 07 Mailing Address: P O Box 1 089 Centerville, MA Cn Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to�Section 15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: >, I / � 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. Notes and Comments ""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 page I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address- 73 Pinecrest Road Centerville Owner: Paul Rufo Date of Inspection; Inspection Su 'ary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys 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 C nditionally Passes: One or ore system components as described in the"Conditional Pass"section need to be replaced or repaired.The sy tem,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or of determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,cxhibits s bstantial infiltration or exftltration or tank failure is imminent.System will pass inspection if the existing tank is repl Iced 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 is less than 20 years old is available. ND explain: Observation f sewage backup or break out or high static water level in the distribution box due to-broken or obstructed pipes)o due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The 4stem required pumping more than 4 times a year due to broken or obsawed pipe(s).The system will pass inspectio if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is ntmoved ND explain: Pagc 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 73 Pinecrest Road Centerville Owner: Paul Rufo Date of Inspection: D. Sy em Failure Criteria applicable to all systems: You mu t indicate"yes"or"no"to each of the following for all inspections: Yes N 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'/,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 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 eater supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system fails. I have determined that one or more ofthe 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. Large Systems: be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 g d. Y u must indicate either"yes"or"no"to each of the following: ( to following criteria apply to large systems in addition to the criteria above) ye no _ die 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 11 of a public water supply well f you have answered"yes"to any question in Section E the system is crmsidered a significant threat,or answered 'yes"in Section D above the large system has failed.The vxrrter or operator of wry large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 73 Pinecrest Road Centerville Owner: Paul Rufo Date of Inspection: . C F rther Evaluation is Required by the Board of Health: onditions 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. Sy tem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the syst m is not functioning in a manner which will protect public health,safety.and the environment: esspool or privy is within S0 feet of a surface water _ esspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Z. Syste will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is unctioning in a manner that protects the public health,safety and environment: jprivaTte e system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a water supply or tributary to a surface water supply. e system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. e system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. e system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a 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: 3 Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 73 Pinar-re ct'Road �Pn t�Y'�7.l.l 1pe Owner: Paill Rnfa Date of Inspection: 4— 3—0 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): p DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): V Number of current residents: Does residence have a garbage grinder(yes or no): A-' a U Is laundry on a separate sewage system(yes or no):E(Jtif yes separate inspection required] Laundry system inspected(yes or no): '/L'O Seasonal use:(yes or no):,4r-v 7 Water meter readings,if available(last 2 years usage(gpd)): P' Sump pump(yes or no).-4, .O 0-4 Last date of occupancy: �;L, e.) 0 COMMERC'A " USTRIAL Type of establis nt: Design flow(bas on 310 CMR 15.203): gpd Basis of design ow(seats/persons/sgft,etc.): Grease trap pr ent(yes or no):_ Industrial wa a holding tank present(yes or no):_ Non-sani waste discharged to the Title 5 system(yes or no):_ Water met readings,if available: Last date f occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped deterrnined? Reason for pumping: TYP 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 a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: l Were sewage odors detected when arriving at the site(yes or no): / v 6 Page S of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 73 P.inecrest Road Centerville Owner: Paul Rufo Date of Inspection: 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 _ �mere 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? G' _ 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: Yes no _ Existing information.For example,a plan at the Board of Health. v— Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)] 5 Page 8 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Address: 73 Pinecrest Road en ervi e Owncr: Paul Rufo Dale of lospccllon: 1 —� ��d• TIGIIT or 110 DING TANK:_(tank must be pumped at time of inspection)(locate on site plan) Ucpth below ade: Material of onstruction: concrete_melal_fiberglass_polyethylene olher(explaul): Uimcnsior s: Capacity -allons Design low: gallons/Jay Alarm resent(yes or no): Alan level: Ala in wurking urdcr O•cs or no): Dal of last pumping: — Co uncnts(condition of alarm and float switches,ctc.): UISTIUUUT10N [BOX: /orilicsCilt nest be opcmd)(locatc on site plan) Depth of liquid level above outlet invert: J_ Conuncnts(note i(box is Icvcl and distribution to outlets equal, any evidence or solids carryover, any evidence or IcakaSc into or out of box,ctc.): PUMP CIIAMDEH:_(locate on site plan) (Pumps in wurkin rdcr(ycs or no):— Alarms in worki g order(yes or no): Conuncnls(no condition of pump cltambcr,cunJitivn of pump; and 3l1put1cnanccs, ctc.): 1 , Pao 7 of I I OFFICIAL INSPECTION 1'0101 — NO•I' FOR VOLUNTARY ASSESSIIIENTS SUBSURFACE SEWAGE DISPOSAL SYSTENJ INSPECTION FORM PART IC SYSTEM INFORMATION (continued) Properly Address: 73 Pinecrest Road Centervi i je— Owncr. Paul Ru o Dale o(lnspectlon:_j�,`j'._g 5 BU1LL)MG S'1VCIl(locate on site )lan) Dcpdr bolo grade: Materials f construction:_cast iron _4p PVC_other(explain): Distant from private %%alcr supply%vcll ur suction line: _ -- Collin Fits(un condition ofjuints,venting,cvidcncc of Icakagc, ctc.): SEPTIC TANK:Zoocate on site plan) r Depth below grade: Material of construction:✓concrete metal fiberglass_Fwl)cuiylene othcr(cxplain) _ — If tank is metal list agc:_ Is age cunfirmcd•by a Ccrlificatc of Compliance(ycs or nu):—(attach a copy of ccrlificatc) Dimensions: Sludge depth: n Distance front lop of�ludge to butlunl of uullel Ice or bafllc: Scum thickness: <<3 Distance from top of--scull, to top of outlet Ice or bafllc: r Distance 6om bononr of scull, to bollun,0 llet (cc oraflle: I low svcrc dimensions dctcrnnincd: r h 1 ` , Z Cunul,cnts(oil pumping reeurnmendations,inlet and oullct tcc or bafllc condition, structural intcgtily, liquid Icvd; as rclatcd to oullct itven,cvidcncc of et Icakagc, c. : ✓ :1 I� 7 j Q � c�L✓ /cc SE TF P._(locate on site plarr) clu grade:_ l o eonslruetiun:`concrete metal fiberglass__pulyetllylene other n) — —s'ons: _ — tickncsc from Iop of scull, Io top of outlet Icc ur bafllc: _e front bottom of scull,to botrum of outletIccorbafllc: f last pumping: ents(on pumping reconul,cndallulls, inlcl and oullct Icc ur bafllc cundmu; Structural integrity, liquid Ic�cls tcd to oullct invert, cvidcncc of Icakagc, cic.): 7 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Road Centerville Owner: Paul- Riif Date of Inspection: o 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. a l 41 Ar 6 il L-j 1 _L � ��0 d 10 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Road Centerville Owner: Paul Rufo _ Date of Inspection: 6 SOIL ABSORPTION SYSTEM(SAS): Zoocate on site plan,excavation not required) If SAS not located explain why: T 'p leaching pits,number: 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.): CESSPOO S: (cesspool must be pumped as part of inspection)(locate on site plan) Number d configuration: Depth— op of liquid to inlet invert: Depth f solids layer: Dept of scum layer: Dim nsions of cesspool: Ma rials of construction: In ication of groundwater inflow(yes or no): mments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): /RI (locate on site plan) ls of construction: ions: f solids: nts(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Road Centerville Owner. Paul Rufo Date.of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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 describQe'h wyou established the high ground water elevation: 11 J Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 2 Date of Inspection:2/16/2008 a Name of Inspector(please print)Sean M.Jones#S14522 2 Company Name: S.M.Jones Title V Septic Inspection J Mailing Address: 74 Beldan Ln. Centerville Ma.02632 Telephone Number: 508-778-4597 ' [°mot r CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported �. below is true,accurate and complete as of the time of the inspection.The inspection was performedcb_ased on n jy_- ,v; training and experience in the proper function and maintenance of on site sewage disposal systems`T m a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 1.5.000).The system: X Passes Conditionally Passes Needs further evaluation by the Local Approving Authority Fails Inspectors Signature Date: al-) 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. Notes and Comments: System was installed in 1997+/-on a vacant lot.House was built on lot in 2006. ""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. Page 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 Date of Inspection:2/16/2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: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 the 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 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 Date of Inspection:2/16/2008 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 310CMR 15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a Surface water supplyor 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 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 Date of Inspection:2/16/2008 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of cesspool or privy is within Zone 1 of a public well. X Any portion of cesspool or privy is within 50 feet of a private water supply well. X Any portion of cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] X (Yes/No)The system fails.I have determined that one or more of the above 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:N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: 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 11 of a public water supply well If you 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 CM15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 Date of Inspection:2/16/2008 Check if the following have been done.You must indicate"yes"or"no"as to each of the following_ Yes No X_ Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of system components pumped out in the previous two weeks? X_ _ Has the system received normal flows in the previous two week period? X_ —were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X_ _ Were all system components,excluding SAS,located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tee,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No X_ _ Existing information.For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance Is unacceptable)[310 CMR 15.302(3)(b)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 Date of Inspection:2/16/2008 FLOW CONDITIONS RESIDENTIAL 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 end Number of current residents:-3— Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no):—no [if yes separate report required] Laundry system inspected(yes or no):_n/a Seasonal use: (yes or no) no Water meter readings,if available(last 2 years usage(gpd): Sump pump(yes or no): no Last date of occupancy/use: current COMMERCIAL/INDUSTRIAL:N/A Type of establishment: Design flow(based on 310 CMR 15.203): and 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: Was system pumped as part of the inspection(yes or no): no If yes,volume pumped: gallons--How was this quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X_Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be Obtained from the system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1997+/- Were sewerage odors detected when arriving at the site(yes or no): No I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 Date of Inspection:2/16/2008 BUILDING SEWER(locate on site plan) Depth below grade: 2` Materials of construction: cast iron_X 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints were in good condition,no sign of leakage. SEPTIC TANK: X_(locate on site plan) Depth below grade: varies,8"-1.5' Material of construction:_X_concrete—metal—fiberglass polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1500 Gallons Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 3.5` Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle:_6" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined:Opened covers and took measurements 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 does not need to be cleaned at this time but should be cleaned every 2-3years. Tank was not leaking and was structurally sound. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd. Centerville Ma. 02632 Date of Inspection:2/16/2008 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 fiberglasspolyethylene 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: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma,02632 Date of Inspection:2/16/2008 SOIL ABSORPTION SYSTEM(SAS):_X_(locate on site plan,excavation not required) If SAS not located explain why: Type X Leaching pits.Number:_1_ Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altecnitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Soil was dry and vegetation was normal.Leach pit had no signs of past hydraulic failure System has been in use for less than 2 years.(installed in 97,house was built,in 06) CESSPOOLS: N/A (cesspools 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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd.Centerville Ma.02632 Date of Inspection:2/16/2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+_feet Please indicate(check)methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: Groundwater was determined by accessing the Town of Barnstable groundwater contour map. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Pinecrest Rd.Centerville Ma.02632 Owners Name:Paul Rufo Owners Address: 73 Pinecrest Rd. Centerville Ma.02632 Date of Inspection:2/16/2008 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building FRONT OF HOUSE deck 0 0 ARK 2 -1= b2 B-1=�a"tii A-2=7 03 L.P. A_3="41 TOWN OF BARNSTABLE LOCATION nl-i- S' /�IO Ce-Py l lfeI SEWAGE # 7 f-27® VILLAGE C ASSESSOR'S MAP& LOT4Yl_IJJ INSTALLER'S NAME&PHONE NO. A- SEPTIC TANK CAPACITY /.5"0, LEACHING FACILITY: (type) Z0000 (size) NO.OF BEDROOMS BUILDER OR OWNER STv� /1% -ex PERMIT DATE: -/`g'` COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 R. t Cre y to yy GSA -0 � 1# 5,1 Y® ' 1,Lj 7- 12s-obi No..............._....... F ............ :............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / "'� �b ..... .W .............OF....... �S.J.r`.t• ................................ Appliratiun for Disposal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct (A//) or Repair ( ) an Individual Sewage Disposal System at NL cl� .....0:... C If16J 1 l-l_(= __ .....:- .._.. ..._ .. ....... Location- d ress �_ r Lot No .��-.................. �� -��•� �YI '. ........ '�. ....... .. --.a. 1.1 1�-... - ------...?...-�-.._ t ry..-!� '.----��'kla 4_� 1!-4�.............. e Address Installer Address - Type of Building Size Lot... feet U 11 Dwelling U No. of Bedrooms............................................Expansion Attic ,( ) Garbage Grinder (Q'�,) a4 Other—T e of Building No. of persons............................ Showers YP g --------------••--••------•• P ( ) — Cafeteria ( ) Otherfixtures-----•-----_------------•--•••--•--------------•---•----------•----••••-••------------•--........------......-----•-••••-•-----.............--- W Design Flow....................'-O25.............._.gallons per person per day. Total daily flow............. ...........................gallons. WSeptic Tank—Liquid'capacity) gallons Length.S..G.`".... Width.¢...!.Q...... Diameter................ Depth_S'. '.... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....._.._.I----------- Diameter....J�........... Depth below inlet.....(........... Total leaching area._.? ..sq. ft. Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by...._p__.S.Ud-�d...�!V....._.�� yLDate.......5-- .J.�� W LZ p �v .._.....l Test Pit No. 1................minutes per inch Depth of Test Pit......1.3......... Depth to ground water................... w� 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .............. ............................. ----------------------------------------..-..--.-------- O Description of Soil......... - ......... ?+..................................................... ......-��------m 4 .'- = -- 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 TL 1TL LE 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. Sig ------------------ =•-• .. -------- •---....---••--•-••-•----•......--•---•. --- ;��..... Application Approved By--------------•. ��:.._.. .. ��" ... . ----- Date Application Disapproved for the following reasons--------------------••-•-•--•----...-----------------------•--------------------------------------••--•---•-•. ......................•---••-•---•---......-•------•-----•--•-----------......------.........--------••----••-•••...----------•------•-••••-•-•-••-----•---•-------•-•----•-•-•------•-----•------...._. Date -- Permit N j-�--o a-+Arm �=' Issued_...... '' ------•-•..--- � Date No - F�s....;.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH + .w' .............. OF........ -N Si1F� ,L Appliratiun fur Dhipmal Works Tontitrurtton Prrutit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: ........... uT S {.I �1 L (..K L.,-r ;�.b... -------•-------------- .._....................................•-•-----------------------....--- --...........-----------.......---...--------...-------- ------......-------- Location- dd ess _ o Lot No. --------•-•- `Tl N "�-K L tc�------------e:� 'r........................................, �1:�_...............................................1 . Owner Address a 1- L j' vL �� . S ------------------------------------•----. ........ __.... -.............._. Installer Address Type of Building, 3 Size Lot._._[. .i�-- ZSq. feet �., Dwelling No. of Bedrooms............................................Expansion Attic (A4) Garbage Grinder (f-'J a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtu es. W Design Flow............................................gallons per person per day. Total daily flow................ .....................gallons. WSeptic Tank Liquid capacity_`'Ilons Length._N.��'__. Width._¢_.'v..'. _ Diameter________________ Depth_. __ x Disposal Trencli—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I---------- Diameter....... Depth below inlet......6......... Total leaching area.....2:`6__Z�:.sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by._.__.Pr_.. - !-L�_ ..____ XZ � y�Date.__.-_- _.-.. _r._ '�' a r.Z 7 U.. 'Sc---�-- � 4 Test Pit No. I................minutes per inch Depth of Test Pit....... Depth to ground water-------____-_•__--__-.:. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....-.................. D Description of Soil ._.. C v�1-r� �s 5 0(�S a, 2 3 1=�� > J x P •-••-•-- .. . . • ••- V .........-•-......•-•-------•-•---••.......•-••-......-•----------•...-------••••••-•-----••---•-•••-••...-•-••-••----------••-•••-•------•-.---- -•••••-----•------------•---------------•--••-••--••--•----•--••--------•-••••--•-----•---•••--•-...-••-•-•----•------------•-----•---•-----•------------•--••••---•••--•----•-••--•---•......---....... 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 TITLE 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. Application Approved By... {`--- ... ... ................ Date Application Disapproved for the following reasons:-----•--•-•-•-----._....-•-•----•--•--•-----•-•---••----•--•-------------------------------•-•---•-•---•-•------ ...............•-••••--------•-•----•-••--•...--••----•----•------•.......•---•-••--•---•-••••--•----•••-...--•••----•-•••-----••---•-----•-••--•------••-•-----••-••---•-•--•-•--•--•-•••-•-••-----•.--- . Date PermitNo.....6u.............. - •--•- ._-. Issued....................................................... Date THE- COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............`�W..........................0F...........�'�...i...1�.N.��Z-:�.......................... Trrufiratr of Toutpliatta THIS IS TO CERTIFY, Th t the Ind -idual Sewage Disposal System constructed (�or Repaired ( ) A l� r t l by....... ............ ----- 2.W-12�-------------------•---.--------------------------•-------------------- • _ .,� Install- at............�'`' ' S' ... r)N t C 1 ��! = �..fZ'4_1 O v t t. L_t.=`..... has been installed in accordance with the provisions of T �..� 5 of The,�talte Sanitary od as ribed in the application for Disposal Works Construction Permit No._75&!'�_ __ dated..- .. ........................ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................:.:1.__- -6- ............................... Inspector......................... ---•-•-------•-----------•-----•------•--- THE COMMONWEALTH OF MASSACHUSETTS L —�- BOARD OF HEALTH ...............�1.......................OF............. ............................................................. �- Nc� ....-------•-- FEE...... . �-�--r�i��raauul Turku �uttu�riu �erani 1 � T• r a ,—� AKW Permissi n is hereby granted-- -° - to Construct ( L11"or Repair ( ) an Individual Sew,�age Disposal System at No... ��-1•----•... h!_4.. 4.tz LS�_ K-1�.__.: d'<kA 1 v ---.....-- •-•-- ---•--. .. . ........... } Street as shown on the application for Disposal Works Construction Permij .N/o�,,�. Dated..... ..._.. ......... ... .....__.r.;-_....a`-'•--•'.ill_:. �0 �___ ... ................ ..•-----•--_........__....._ _._.. DATE----•--•--------------------------•-•-----------._....�� Board of HealtG"^+- ............. Board • ( 1 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS S/GAI OA 7-4 7 S%MG-LE lrAMJL- ' - 3 6CURo01y We) G•A lZP6 RGG G9_i►J D E R- I ? DAIL*y FLov&t = 110 Y, 3 = 330 G. P. D. SEPTr c. TANK = 33o x 1507. • 495 G.P.o. 5 A 1. Q IT -� `� D lS P o V 5 E I U00 G-AL . 15"0 5.F 2 S 3 Y �s o-. F. goTT�M -A R A = So .S F. x L.o 5'o 0 5. G. P. D. ab Dv wit tJ!> 4 TTAL VcslGK3 = 4Z5- o- F- D. To-rAL c>A%t_Y F-LoW = 33o GP,t7. T t -RCoCA t to tJ RATE 1 iti 2 MAN, oQ, MESS v UN �tiP�tti of q _ 9�yP. fu� R. :. PETER ; 9�•-7/ SULLIVANA } -4 t -� RICHARD a. No.29733 s �.. . A. BAx rER No.240484 7, STh�G�.E y may r• _._.; :.:_- �--�.__..� -. _.` :. � . /Qw /non Z •• /w. BOX /rV✓.. ..-i._G<dL..:..°_ /�... . . �.`..� CrR C. .mod �' '• P•T PGOT f�2 vp nSc�� k V,GA C.t:__�Qi2 it l Aiz 77W. rIZA. tL Tf/QT TNE' W//7/Tf/E .S/d�'�;/ivE - :. _ BdXT�.2 'ow /�vG -____;._.... _ CO G�—_"r-.,,,•_. T!/:!S�L.•�if/ /.f /�oT`f3.4SE0 fin/.4�t//iY.�^T,�— ------------------------------- Sh�?Gf�N.yE.e�GN;;S.�al/Gp iS/�T.p,E USEp THE FOLLOWING DOCUMENTS WERE OF' POOR QUALITY IM /\GL� C DATA No..............._....... F ......................... THE COMMONWEALTH OF MASSACHUSETTS �WO BOARD OF HEALTH 91 ............................. A'1e S L O F............. ,gyp lirttiioU. for Disposal Works Tonsirixr#ion 1rrutif Application is hereby made for a Permit to Construct (-L/) or Repair ( ) an Individual Sewage Disposal System at• M � .. ._.. .. TLora' n• dress n ....... ..•--• �L!.! ,v l�-- pr_Lot N� ........_ .......:.............`�.�K-................�..................... .-.-/�#a....�..� -•••---: _..1�1....1r................ - •.......:...........•^ •-. L ddres ... .. A s ........................... ?.L_L ... Installer U Type of Build Address ing Size Lot... �2.;e feet Dwelling lL No. of Bedrooms............................................Expansion Attic ,( ) Garbage Grinder (.jQ) a Other—Type of Building ---------------------------- No. of ersons............._.__...._...... Showers ( ) — Cafeteria ( ) < Other fixture� . ................allo.•...pe... ------ W Design Flow................:...........................gallons per person per day. Total daily flow.............. .._............................gallons. W Septic Tank—Liquid*capacity.` agallons Length.$'..V.--- Width.....! `.`_ Diameter.- -----•--•••-• Depth.S!-V•---- x Disposal Trench—No......_.. ...._ Width.................... Total Length.....__...----_.__.. Total leaching area...................sq. ft. Seepage Pit No........I........... Diameter............... Depth below inlet.....G. ..._. Total leaching area...u?.—.sq. ft. ZOther Distribution box Dosing tank ( ) Percolation Test Results Performed b P &.V�u.U _.-.-_ �b Py� ►4 Y = .... Date...._.. .-... _.. Test Pit No. 1_.L-------....minutes per inch Depth of Test Pit......1.3......... Depth to grottr,a ...a(S+ Test Pit No. 2................minutes per inch Depth of Test Pit................ T' Gd ........... ---•----•----••-----:.. Description of Soil....................L........ gAll— V -.-------- ------- ------•--•-•---•---- W V Nature of,Repairs or Alter; ..•.............................•- Agreement: The undersigned agree: the provisions of TITL1. $( ith operation until a Certificate of in Application Approved By.,....... Application Disapproved for the ........................................................ Permit Nax. Date _f-1=_C6MMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH .::RIZ7v.!..........................OF...........C'�. .N...�t- .................... 01rdif irate of (Coutplittnrr THIS IS TO CERTIFY, Th t the Ind'XidSewage. Disposal System constructed (�orRepaired•----•--- -----•------ ....`.........`.... �.Lc�j Install V(' �� ..........at �' S� ....._. t.N_L _....- ......... ---•••-•.............••---...... has been installed in accordance with the provisions of fi 5 of h tate Sanitary od dated as ribed in the application for Disposal Works Construction Permit No.- >-.- .- " THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE -SYSTEM WILL FUNCTION SATISFACTORY. DATE................ .'......7 -• Inspector......................... . ....._........_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .��................OF......-....-. 1.�, N.��. •-p't1 . ., N6 D..... .. ........ ........................... FEZ ... Disposal Works Tunstrio .rruti Permission is ereby granted........I ' _.r_�..._.T`o-?--�.—� to Construct ( or Repair ( ) an Individual Sewage Disposal Si_ at No. �-`� S..- 1h�..!........ .1 .L5�..._....: >r .:. G AlF 1 V v t Street ........................... 94 as shown on the application for Disposal Works Construction Permi No :. 'Dated.... Q �. :...._...... ............. .. .._. .. ............................................ DATE Board of Hea FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r f I FIT •LLLjILL I �h.�E• y ,I i4 l `7KI i �+ MI L l.1ESIGNW RESI LOCATIM - - -- i i rt . 1 - - TM LID L-Ji , - MICHAEL J. OLINSKI ITIAL DESIGNER _ - r .... .:::. _..:;. ., : .: ,,.:.:. . ... . CG a � 7 TAKt. A..7 1vE:2[FY. _. - cost a - '-y'' 2 10 _ yNH B`1 �— - - -- - -- --- - - -- -�- - - - -1 I -l0 4--- - --- - -- - - - to I i j I -4 GeNL riLLED L.kLL'� /L I I i j 10.y 13 0 lo-y /aEAIM!,P�kET I T T y 00 i T 10 to C '' L l J -- — _ -- s ...:.. �iME �r� �. �;'� ( ! 10 - N ipp' � I i I pj -N O LfE LfC io i ---- -------- ivEW MICHAEL J. OLINSKI i : p Z _ RESIDENTIAL DESIGNER 10-5 x" - -- ---—----- � U1-1CJ ��t.► - r'L/' F,� CWTOW o,�,►a,EE ,1.Me A��aeeo LMAM of r11 N aerll SoY •r NJ , I M .. .. n ti I v uGtiJ�wo 7 _ s • PJI GEll.l{,Iu JolstSs �, 3 EAKF�,sr PeIME A1r1091?iDeer p i d I 11 j it10 `IIuy Koor'I lip I ; j RESM I o p 30 C&D i I - — 6s I e,� Z .. . 4 -set L �3ATlj✓v° "' S'o `il l�� 4�In CIoSe+ �3 ,1 —� u 17— D 'u'r Ir - r e L z ties �LoorL i zo s� Po E;�N I?d S F CA - MICHAEL J;OLINSKI !� I �'��. •p . LIGNElt . Z Z EM'twL DF...,. 86aj3s3.8SB -� 5 r ASSESSORS WEST HYANNISPORT 4 BENCHMARK MAP 24 7-115-T 4Pp 1 TOP OF SPINDLE ON HYDRANT C. O.M.M. FIRE DISTRICT ELEV.=106.1' (ASSUMED) y a o� ASSESSORS o MAP 247-161 CB/DH S86°0,244'E' '128.85' � LOCUS yYo 104 103 0'4 CB/DH 101 �o0 1 � PINE pAD - ASSESSORS I PRIVEwAY MAP 247-125-5 LOCUS MAP D LOT 5 12,732 4. S.F.-- --- PLT 4 0: 50, 99 I PLAN REF 391—49 10,2 I s o" BULKHEAD h EXISTING ASSESSOR'S MAP. ,247-125-5 i • I ° j' ... ......• ZONING. ..RB» 3-BEDROOM q 495 . SEPTIC SYSTEM �.1 SETBACKS. 20'-10'-10' 1 `� DEED REF 9316-287 I (PER TIE CARDf o � �I I 1 I / •r q d ................ ........ ti � FLOOD ZONE. ,.C,. �I I 8 Z I 19.0 g 24 0' �I O O O PJ40POSE �� " % "' ► S AN OF LA :3�BED�OM :: 44 LOCATED AT W �::::; T.OAEL=101.5' 9 ° 73 PINECREST ROAD off :: WEST HYANNISPORT, MA. .. .................Y: / I 43.1' •• o PREPARED FOR.- ELECTRIC I [� .... MHCO I 100 _ 41.3 �hr 7 l�Ja-• �S/ O I I � 1 � yj /BUILDIN ENf�ELO NAILS I ZO g9 9$ PEJ SCALE: 1"=20' y / N86°p2'44 "W / SEPTEMBER 23, 2005 125. 87' ELECTRIC STAKE REV.• \ TRANSFORMER \ PAD �a a®a,s� REV \ ASSESSORS REV p�°` o�r uss ®�� \ MAP 047-125—4 YANKEE LAND SURVEYORS a S J. -A\\ LOT 4 DpYLE & CONSULTANTS 137559 P.O. 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