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HomeMy WebLinkAbout0033 PIN OAKS DRIVE - Health 33',PIN'GAKS DRIVE,BARNSTABLE A 279:062 �F u r. 29 TILLAGE LN,W. BARNSTABLE , A= 136-003 a o L f i a ° P ° ;r 1 P TOWN OF BARNSTABLE LOCATION 3-3 Pity 6#k5 SEWAGE # t9.S—C VZ VILLAGE �1�(df1,t��i�� ASSESSOR'S MAP & LOT 271 INSTALLER'S NAME&PHONE NO. 6AW SEPTIC TANK CAPACITY 1626 IJ LEACHING FACILITY: (type) (size) A,3 Xa NO.OF BEDROOMS BUILDER OR OWNER _[�uf rr(ifjlZf/�tD PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I 7 Z 6° D�ef �l 43 3-Soo L4AJY 04WW6 _ , _ . No. 13FO Fee a COMMONWEALTH OF MASSACtiUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es Application for �Bigonl �§p!tem Construction permit Application for a Permit to Construct O Repair(.grade O Abandon O ❑ Complete System ❑Individual Components Location A40ress or Lot No. �a ' �,o A Owner's Name,Address,and Tel.No. , 3 ?,,-, ©/1�S L l ram ' l�ct3e�2`7 —i✓.�Ju2l.✓r� Assessor's Map/Parcel 2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. . A/LCN Cp11171 1Or > 73,36;L 77 8.36 ts�� Type of Building: ,. Dwelling No.of Bedrooms &X,S% Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H tk. S' ne Date Application Approved by Date Application Disapproved by: Date for the following reaso Permit No. rP o Date Issued 47 1711 AFO ;No.. r-� t� 1 �y . Fee 6 �. �, W COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALT�I,['II�ISION - TOWN OF BARNSTABLE, MASSACHUSETTS. Yes Zipplication for �Bizpozal 44p$tem CCon5truction Permit Application for a Permit to Construct( ) Repair(,pgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. /�i)/1.r/. Owner's Name,Address,and Tel.No. 3 �d-3cQ7 �rIiAGL/ nio r' Assessor's Map/Parcel 2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /a/LGr► �v.r 5�` Type of Building: Dwelling No.of Bedrooms T .9 X,S% Lot Size sq. ft. Garbage Grinder ( ) Other ` Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design+Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil �✓ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea th. ` Si ne Date Application Approved by j Date !� Application Disapproved by: Date for the following reasons ------.._ Permit No. A -",/ Date Issued 7 !O THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by 2 at _3 3 s4 A' S' v F �has been constructed in accordance l `� with the provisions of Title 5 and the for Disposal System Construction Permit No. 6 —39 / 0 r dated / 7/ Installer rA � C 1-, Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be/c�onsstruued as a guarantee that the system will funs cti as is g Date lola-"Jl t o inspector No. cp_C6 D 3 <0 _ Fee tC THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ligont *pgtem. Cowgtructton Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at :3 3 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: Construction/must be completed within three years of the dateCb perm Date � � 7/ Approved _ No. . //C7� Fee to THE COMMC)NWEALTH OF MASSACHUSETTS Entered in computer:PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �s� ZIpplic tion for Di5po5al *pztem Cow9traction VCrmtt Application for a Permit to Construct( ) Repair V) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 3 3 /0/A d,11�_5 9 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. � tc,oR�5 6PY&077r_- 'kM6MV CA MA 4,�T 6kj 1_s311 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 3,10 Z/ — sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `l'�y gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envj?6n'TVntal C and not to place the system in operation until a Certificate of Compliance has been issued by this ar of He h. Signed � Date "7-� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued _--- No. c� .-�:� Fee 109 ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPlicat •on for Mi-gpo!gal *p5tem Con5tructiou Permit Application for a Permit to Construct( ) Repair(4�Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. �j 3 Pl Al ofi�-,j QM A Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a 7Gt - 6d r Installer's Name,Address,and Tel.No. W_0-q q9 Designer's Name,Address and Tel.No. K. UX)Ok 5 �R�A��Jto7TE ao T CLTa crR. M,rA 49, 4/E57 6.,0 Type of Building: Dwelling No.of Bedrooms 3 Lot Size (R. 6/y sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers(✓) Cafeteria( ) Other Fixtures //LLLL//�� Design Flow(min,required 40 gpd Design flow provided gpd Plan Date 9-.2-o Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ' Date last inspected: Agreement: The undersigned agrees to ensure the construct and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envi>on tal Cod nd not to place the system in operation until a Certificate of .Compliance has been issued by this B rd f Hea t�i. Signed 5 /) Date Application Approved by Pik .� ,�/ i Date ViWi v v ✓ v Application Disapproved by: V 7 Date for the following reasons Permit No. �( �— Date Issued v - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by LRl�/y /9Y07TC at 33 Pm/ 01615 L1_/1 M&V, has een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. l_L2 dated r•7'''�� Installer Designer #bedrooms 3 Approved design flow .5 O - gpd The issuance of this permit shall not be construed as a guarantee that the system will fund'o as designed."nr�,,, Date ""' Inspector ----_ -- — -------- — ----- p No. �/ � _ r�/ Fee " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mi5po.gat llbp5temY Con5tructiom Permit Permission is hereby granted to Construct ( ) Repair ( v J Upgrade ( ) Abandon ( ) System located at 33 /%Y QiYU 949 &W Or— and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this(emit Date « Approved b PP Y �/ 9116/03 Notice: This Forifi�b Tb Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, tC ►� i <<�V\ 'tereby certify that the engineered plan sib by tie dated 2 2 r,concerning the property located at r` Oaks Dom' , �a�r,meets all of the following criteria: • This Med system is connected to a residential dwelling only. There are.no commercial or - business uses associated with the dwelling. • The,soil is classified as.CLASS I and the percolation rate is less than or equal to S minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • 'There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Z"9 v_-L ,-Please - Please complete the following: � l O �� s A) 'Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation 12`� +adjustment for high G.W. Ik D1FERENCE BETWEEN A and B S ' 3 SIGNNF,D : DATE: �sl� - - NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASe c*=e=W.doc 4• Town of Barnstable Regulatory Services Thomas Fa Geller,Director was Public Health Division Thomas McKean,Director �-- - 200 Main Street,!Hyannis,NA 02601 Office: 508-862-4644 Fax: SO$•74o-630A 1UW W&c Desi per„ �icatio r� t�ILI C)✓�� IQIZ Z 7!Date: G6- Sewage Permit# Assessors Msp\Parcel_ Designer: ' i �� -e-2 Instiller: �s(c�v� 42. Address: I Z-W r� � _�___ Address: Z� C'rt_'l On was issued a permit to install a (date) (installer) septic system at 3 ?�;✓L oAs D� a�t'n S `�'� based on a design drawn by. (address) 1►tiee _V-Wa/ � dated D Z Z G S (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank: I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Alan revision or certified as-built by designer to follow. R T�It T. y 1Wt�ITEE (Installer' lure) 01Y L (Designer's Signature) (Affix Designer's Starnp here) EUASL JUM TO ARNSTABLE TH laavmse®N. Q atriraL&rX -tom �oMrLl�. ..�i'.iNQY BE IJSLEp UDJJJ . WIN THL FOtM ANoe,�. �iFa�i 1vE®ay T sa�rosT ust.tc�Dtvt_SQ& I.H&SK xoU. Q.HcWtWStptWDesjVa Ctrti4ication Farm 3-26.04.doc l�11�►'31 n �a G� J `9 . _ a Sp r tywot eA OF BARMS FABLE ZO05 DEC 5 ' tf920 J 1 �l t Y� f , 4.2 TROY WILLIAMS f9 SEPTIC INSPECTIONS ,� '�r„►� 8 1999 , Certified by MA Department of Environmental Protection 1 (508) 385-1300 19 Hummel Drive E South Dennis, MA 02660 • C� o0p� • _ = COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 3 3 (3 i ) f' H 0cx k S f]r. CERTIFICATION / c. Property Address OY G28 58 M a k .Si-, Name of Owner L-Gav0 1 `S" �Q t30.rv;S 4r- Address of Owner: 93 3 S.,It N 6a,, 0.. Date of Inspection: 3 /7 /1 Name of Inspector:(Please Print) Troy Williams 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Troy Williams Se tic Inspections Mailing Address: 19 Hummel Drive, Sox Dennis MA 02660 Telephone Number: (508) 385-1300 CERTIFICATION STATEMENT I certify that 1 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 inspection. The inspection was performed based on my training and experience In the-proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: �.�:� � Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to ttte system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. rev is �, ry SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (contirx ) Property Address: Owner: 33 Pin Oaks Drive, Barnstable,MA Date of Inspection: Carolyn Savage March 9, 1999 INSPECTION SUMMARY: Check A, B, C, or D: A.- /SYSTEM PASSES: I V I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. An failur criteria not evaluated are indicated below. y e COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes,no,or,not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed c distribution box is levelled or replaced The system required pumping more than four 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 revised 9/2/98 Puge2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop"Address: 33 Pin Oaks Drive, Barnstable,MA Owner: Carolyn Savage Date of Inspection: March 9, 1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A///9 ' Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 11 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water ' Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING W A MANNER THAT PROTECTS THE PUBLIC HEALTH AND 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 supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and.the SAS is less.than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 rdKe 3orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 33 Pin Oaks Drive, Barnstable,MA Property Address: Carolyn Savage Owner: March 9, 1999 Date of Inspection: D. SYSTEM FAILS: A///j You must indicate either 'Yes" or "No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due town 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: JV119 You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 _x _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone If of a public water supply well)* The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 1v5.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Pone 4of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 Pin Oaks Drive, Barnstable,MA Owner: Carolyn Savage Date of Irup-,6—: March 9, 1999 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: 1'eg No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped-for-at least two weeks and-the system has been receiving rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. /V1/a As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. JL/ _ The system does not receive non-sanitary or industrial waste flow. JL/ _ The site was inspected for signs of breakout. J� _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: 3L _ Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at'issue,approximation of distance is unacce table / [15.302(3)(b)) P 1 The facility owner(and occupants,if different from owner) were.provided with information 11 on the. SubSurface Disposal Systems. prnpermaintenance�f s . revised 9/2/98 Page 5ofII SUBSURFACESE WAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: owner: 33 Pin Oaks Drive, Barnstable,MA Date of Inspection: Carolyn Savage March 9, 1999 RESIDENTIAL: FLOW CONDITIONS Design flow: //0 g.p.d./bedroom. Number of bedrooms (design): 3 Number of bedrooms(actual): 3 Total DESIGN flow 330 — Number of current residents. O Garbage grinder(yes or no):-Y-S Laundry(separate system) (yes or no):,Vd ; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no):YES Water meter readings,if available(last two year's usage(gpd): 98 = b y (/c, Sump Pump(yes or no): UUCI_ /0 S " 7y 00 u Last date of occupancy: d-+. 9 S COMMERCIAL/INDUSTRIAL: A///g Type of establishment: Design flow: gpd (Based on 15.203) Basis of design flow Grease trap present:(yes 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION, PUMPING RECORDS and source of Information: 1 / ►-�4� fp/wti�. System pumped as part of inspection: (yes or no) NO If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/di&�.f;eu/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) 1/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed d W known) and source of nr0 . ;HIV CA,U 4. 1 Sewage odors detected when arriving at the site: (yes or no) /VO revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirxred) Property Address: Owner: 33 Pin Oaks Drive, Barnstable, MA Date of Inspeco : Carolyn Savage BUILDING SEWER: March 9, 1999 (Locate on site plan) Depth below grade:of Material of construction:_cast iron Z/40 PVC other(explain) � ,G� � •�;�� Puy stiff a�•S Slz �.rw S D✓r9 Distance fror{private watW supply well or suction line /VM Diameter y.•• Comments: (condition of joints, venting,(evidence of leakage,etc.) S r., G cA I,'., S 77 O 7r' r L GA/ Gt SEPTIC TANK. (locate on site plan) ri H'�S Depth below grade: I8 e^•Scr5 Material of construction: ✓concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: S X 9 X 6 /6 6 p I -Po Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: o? ,& Scum thickness: 6 Distance from top of scum to top of outlet tee or baffle: b /r Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: o,-b L c , _Comments: (recommendation for pumpin�S15 condition of inlet and outlet as or baffles,depth of liquid level in relation to outlet invv rt,structur"tegiity, evidence of leakage,etc.) (rohc-r ->t�L' e./. �✓i GC c...c•` J .c c.yJ✓rc.. ( �v�-i o- O✓ c�c, v GREASE TRAP:�L,c/ c � ✓ � � v /o r �.,5���� o c-, . r, (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: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised .9/2/98 Page,of II I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 33 Pin Oaks Drive, Barnstable,MA Date of Inspection: Carolyn Savage March 9, 1999// TIGHT OR HOLDING TANK:�y9(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(ezplain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:_N/,- (locate on site plan) Depth of liquid level above outlet invert: Comments: ( ote.if level and distribution is equal,evidence.of solids carryover, deuce of leakage into or out of box; etc.) : h a s a'c�c,�.. , � W � � �.J J—.�a r rt_.-dL '.ors.s �-.►.�I-, �c- c.K PUMP CHAMBER:[/4 (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.) r revised, 9/2/98 Page 8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 33 Pin Oaks Drive, Barnstable, MA Date of lnspection: Carolyn Savage March 9, 1999 SOIL ABSORPTION SYSTEM(SAS):v (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If notlocated, explain: ' r uSt D 7` Goh✓ter. �on n f' I'hGd`h S cs.6&4- A dcJ—ate �,r r ✓w Type +y cc� W u I&A leaching pits, number: d"'1, /000� //o-� pi GSSu+�-rcdl `vcz�1_/ Jo, j leaching chambers,number:_ / t/ U t�o1 o"I"P,4- y j�- f �d leaching galleries,number:_ /L • A 6 leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: , (n to condition of soil signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, c.) YO C—k et _ c o� S rn o✓ ~ _ I1Lj �'�'�✓� CESSPOOLS:/1,9 (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(cesspool must be pumped as part of inspection) r Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:N//9 (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 33 Pin Oaks Drive, Barnstable,MA Date of.Inspection: Carolyn Savage March 9, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 1 y-. } .^ 6� 10 6 IL r' �vvu yk l(•, 75 f o w.adk , /odd pot e"N Lcc. l- f7, . revised 9/2/98 Page 10 or 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 33 Pin Oaks Drive, Barnstable,MA Date of Inspection: Carolyn Savage March 9, 1999 NRCS Report name A/�+9 Soil Type_ _ Typical depth to groundwater USGS Date website visited D'I o?L/. Observation Wells checked -Laiy5 3 3. 7 Groundwater depth: Shallow Moderate Deep SITE EXAM Slope V Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 1 -0 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record / y Observed Site JAbutting property,observation hole, basement sump etc.) JDetermined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) S w c.t rJ`o h cr✓s- 7 z b`!°` e.1 !J jo cJ 411.0 0�Q 4- - / ti 3 i S SvY41-4 1 J PC ✓ �� s4� w 'rl _ �S aU 1 I t h ✓LV v�I/� W f LY /GJ-.C.- f' revised 9/2/98 Page II of II v A R AP 19t61996 � _ TROY WILLIAMS e e"M-M eL SEPTIC INSPECTIONS of BARNS Certified by MA Department of Environmental Protection (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William Go mm F.Weld Trudy Coxe Arpw Paul Gilucai u.Governor David IL Struhs Comrniwloner /1O '93 o E SEWAGE DISPOSAL PART SYSTEMINSPECTION FORM 3 t l°1�,j ]&A/ S L/r, Ji CERTIFICATION Property Address: .2 s 8 ,/'1 ,Hare^5)z, L ) Address of Owner. L /f/] Date of Inspection: -;4;2S/9 6 (If different)r. aci y PO 3 2 Name of Inspecto ��rOv� >x 3 Company Name,Address d Telephone Number. tau i.n) z lj � M ti. 1114 CERTIFICATION STATEMENT /3"� `'�"� 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Vse Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspectors Signature: Date: The System Inspector shall submit a cop of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A B, C, or D: A] SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failum criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: I✓11/j One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes. no, or not determined (Y, N, or ND). Descnbe basis inrt of determination in all ances If"not determined', explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or enfiltration, or tank failum is imminent The system will pass Inspection if the existing septic tank LE replaced with a ponforming septic tank as approved bt• the Board of Health (,e—seC 11/03/95) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontlnued) Property Addrem Pi Owner. y Date of Inspection: 3 /ems- /y� B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pips(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /A//-I Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is Gee Gom pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Addresx 31 `, Q w k s Owner. Date of Inspection: teas/y6 D1 SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. — Any portion of a 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 I of a public well. — Any portion of a cesspool or privy is within 50 feet of a private water supply well. — Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: n////7 The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: — the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply — the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone Il of a public water supply well) The owner or operator of any such system shall b ring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00 Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: h a w kS Owner. Al Date of Inspection: 3 42 5- ` Check if the following have been done: Pumping information was requested of the owner, occupant,and Board of Health. /None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. NL As built plans have been obtained and examined. Note if they are not available with N/A. ZThe facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. ZAll system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of bafIles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. s (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 3/ /°�i, U,I k s Owner. M Date of Inspeotion: ✓'r 3/as/96 RESIDENTIAL: FLOW CONDITIONS Design flow: Ions Number of bedroom,: Number of current residents: o Garbage grinder(yes or no):�S Laundry connected to system(yes or no):_Z�F S Seasonal use(yea or no):�E S Water meter readingo, if available: .coo Last date of occupancy:_ 9 S w'; u c Q .S. o w l�_ c COMMERCIAL/INDUSTRIAL• Type of establishment: Design flow:_icallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPI•N/G /RECORDS and source of information: (� JV J /'" ✓M }} LL b • T yC.f C,✓ !U o � A �. �i 4� Ar System pumped as part of Inspection: (yes or no) ,�,/O If yes, volume Pumped: gallons Reason for pumping: TYPE/OF SYSTEM �L Septic tank/d-kr4e6iQe.bex/soil absorption system Single cesspool Overflow ceaspoo) Privy Shared system (yes or no) (if yea, attach previous inspection records, if any) Other(explain) ! APPROXIMATE AGE of all components, date installed (if known) and source of information: or s •, 4 , -Ab tit) I� Sewage odors detected when arriving at the site (yes or no) /V0 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: j� /°i h D o-�( s Owner. Date of Inspection: SEPTIC TANK (locate on site plan) Depth below grade. Material of construction: ✓oonerete metal_FRP—other(explain) Dimensions:_ 5 ' )' 5 'X G /a u cc//o A- Sludge depth. Distance from top of sludge to bottom of outlet tee or baffle: a' Scum thickness: _3/, Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) 4'e � -24-P f- ice, o- -f'1t 4- � -1✓� LJ u :/�F. . h C9. u .r�G/- ��o S i SY h ) o r—' /e- c i vr1? " 5 �4 N si.cJ C r GREASE TRAP./14 (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP—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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 h U a k S Owner. M u �H Date of Inspection: AA TIGHT OR HOLDING TANK LV/i9 (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) - Dimensions: Capacity:- eallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:/�1j9 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER/! (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3/ Owner. Date of Inspection: SOIL ABSORPTION SYSTEM (SAsr (locate an site plan,if pos&ible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pit&, number:_ leeching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: O 1?L t^', jc; f. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.)_ Sa. ( '41j ,( ,}T-2 b �' 6 t� tJ i O�J L� G G- ✓c✓t'i CESSPOOLS:�/� (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: MO-(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continuecl) Property Address: -j t e, Du hS fir. Owner' M A w Date of Inspection; y 3 /a.s-1 �'6 SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 3J' y6 � ,5 '6 �� p G 0 J cr Yr�o•J P-�-, _ DEPTH TO GROUNDWATER Depth to groundwater: ' feet adjusted high groundwater level method of determination or approximation: 0 c cA 4 c d o L-, /,, /l W I A V; ✓o ) V b I G / 9 TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, UA 2660 COMMONWEALTH OF MASSACHUSET'I'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE s OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 33 Pin Oaks Drive Barnstable,MA Owner's Namc: Peter Anstey/12 ?? f Owner's Addres.: Fairville Inn, 506 Kennett Park or PO 3„k 115� Caddsford,PA 19317 w "�+;�� +�•�, �'4 .. t e s o Date of Inspection: February 28,2001 Name of Inspector-'P Troy M. Williams Company Name: Troy Williams Septic Inspections O Mailing Address: 19 Hummel Drive Telephone Number: South Dennis,MA 02660 (508)385-1300 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The svctcm Passes Conditionally Passes Needs further [:valuation b) the Local Approving Authunt) Fails Inspector's Signature: �.J�CQ� Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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 off-ice 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 Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. •""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 saute or different conditions of use. Title 5 Inspection Form 6/15/2000 vaee I Page 2 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 33 Pin Oaks Drive Property Address: Barnstable,MA Peter Anstey Owner: February 29, 2001 Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: V1 have not found any information which indicates that any of the failure criteria described in 310 CNIR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/1i One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes. no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is'metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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 indicatine 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 .r ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 33 Pin Oaks Drive Barnstable,MA Owner: Peter Anstey Date of igspection: February 28, 2001 C. Further Evaluation is Required by the Board of Health:/u//-) Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface %kater supple or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 •Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 33 Pin Oaks Drive Property Address: Barnstable,MA Peter Anstey Owner: February 28,2001 Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool h'/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool rwlf 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. ALq Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ 1%,114 Any portion of a cesspool or privy is within a Zone I of a public well. n/9 Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/g 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. IThis 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 forma /vo (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N//-I To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 1I of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 Pin Oaks Drive _ Barnstable,MA Owner: Peter Anstey Date of Inspection: February 28,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No I'._;r,ping information was provided by the owner. occupant. or Board of I lealth 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? A116 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 V _ 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. ( E,f ,,�� � ), a—j S. z, . _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 33 Pin Oaks Drive Barnstable,MA Owner: Peter Anstey Date of inspection: February 28, 2001 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): 3 3 6 Number of current residents: O Does residence have a garbage grinder(yes or no):_YES Is laundn on a separate sewage system (yes o: no):Nu [if yes separate inspection required] Laundry system inspected(yes or no):_&4 Seasonal use: (yes or no):YL-5 Water meter readings, if available(last 2 yearsltsage(gpd)): 29 78,u03,����.,s y8/yy 6z „„s Sump pump(yes or no):olio Last date of occupancy: QO COMM ERCIALANDUSTRIAL N14 Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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: �., t •h M�r� rj__ c Was system pumped as part of the inspection(yes or no): ,v,> If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM v/Septic tank,distFibution bait,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: 1+ -max . I9?A A10 �� �a a✓. l �b1t Were sewage odors detected when arriving at the site(yes or no):Luu 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Pin Oaks Drive Barnstable,MA Owner: Peter Anstey Date of Inspection: February 28, 2001 BUILDING SEWER(locate on site plan) Depth below grade: o?"-I Materials of construction:_cast iron _Z40 PVC other(explain): ,u , ;pvc- Distance fron-, private water supply well or suction line: ,y/,9 Comments(on condition of joints,venting, evidence of leakage, etc.): h e-S t.J c-f a v n cA c I e...r a f 'f't,e +i SEPTIC TANK: (locate on site plan) Depth below grade: �_ w► > r s. Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 02 Scum thickness: G, Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or baffle: �y „ How were dimensions determined: ?"L c . _ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): p ✓i [,r�..l"t t�S .W�-✓.''-_.� u�.et .'.0n_ "'&'/+.t�l.l. /�e✓ Ckc . K S 1 .F W t -�✓�..R �o G u !�c►-c,`./ I'Yi�ci��t..J Y� h'+y �-+.✓+ ►t W c�--S /TC.V.�c l -------------- GREASE TRAP:��/�(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: 1 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.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Pin Oaks Drive Barnstable,MA Owner: Peter Anstey Date of Inspection: February 28, 2001 TIGHT or HOLDING TANK: N(g (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_Polyethylene other(explain): Dimensions: Capacity: gallons Design Flo\�: 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/9 (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.): LL //^�, I h k L:/� • ti+- 1 I L[.� In G W,� A,U d— U(.%; TOV N a k '✓2 &t w T ti S L 4"'4w.. PUMP CHAMBER: lv/,,) (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.): 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Pin Oaks Drive Barnstable,MA Owner: Peter Ansley Date of Inspection: February 28, 2001 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: AF�tr ✓S� o� �u/� 1e� 4.;�r.\ iS e-s'H e—•1-.J ey ��,t.,/,�b rta �K�y✓�h'o � .�f ... +� vIJl b; fL4u rs e( }U 10G��t 4Cc.cf �oc "fi'oM �ar�6ab�� �it �c /F a�'�;�- E�. �:�✓ Type leaching pits,number: I - /000r'Xlh' P 4- 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.): 5oi1 arws S�. J y aid\ ro/ Fty /tlo au J c. . n� [ � L �� �. 1„ c o fi {� 12 w-k-S u rL 4i'ry, o X' i o,-.-.A, • G-J, c ►-✓i- 47N 0 jn arJr t s�/0.5 l i ti lJl. a-G.�'�. y i-ai•+-'i'e✓ �c•e( Lf a f �u h/u � �.c f7✓y t p sue.In S .s.c,,�• �.� rLµ.0 h' S b.1 t✓t- c...J- 'r�,.. %/n'1.� /h J t`�Ue. O/\ W i'I1 N c 4.�.L / r •r h.t.K 'n.` CESSPOOLS:At j&(cesspool must be pumped as part of inspection)(Late on site plan) S r A 3oyf r la Number and configuration: °" f1 ,�;,,,� �,;,t`•rf �o�..t:li oK s 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:N13_(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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 33 Pin Oaks Drive Property Address: Barnstable,MA Peter Anstey Owner: February 28, 2001 Date of Inspection: I 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. ro.t+ ti y 50 J g � A�oprux. /ocJw�-ub, L Y;4-. 10 Page I I of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Pin Oaks Drive Barnstable,MA Owner: Peter Anstey Date of Inspection: February 28,2001 SITE EXAM Slope - Surface water Check cellar Shallow wells Estimated depth to ground water c204 feet Adjusted high ground water elevation feet Please indicate(check)all methods used to determine the high ground �%ater 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'1must describe how you established the high ground water elevation: k9 iM- j 1 /o c c 4 c.k o,, s I o ice.. 6T' G o.J „L -.�- II i ry Benchmark set , ;ti- . '�, t C"ti J Matthias q -&eft cor. bot. step r '2 7,d o . Lo �+ a El.=14.3:98-�(-,assumed) -- C x a . Route 6A _ i � S 85*07 20 E �` -- _ / o cv LOCUS JT .�r-.gin �4 �.a G t�1i .N j F 205,57 -: ;� �,, ( 3/, 1 N d Q r • .M �4 ' ; (n. ROUTE 6 c Tl j __.,_. f YP.) r I LOT 1 TBACK ( 23,6 9 4f $,F. BLDG. SSE 4 1 0.54f AC. LOCUS MAP N.T.S. Map 279 1 �K ...._._,..... ...._._. ._. ...., i'��``��( � ��'j.�l �� 1\P � 30, / LEGEND -- _ arce/ 62 / l ii it( (I �1 f- `�-ti /r ^ N 78 PROPOSED CONTOUR Lo . �� r; r� r0 al i 3` PROPOSED SPOT GRADE 5 TING ` � .`_ i41, >` ,y r"+i �..'� 5 ,r , if? ��'.. `` II N. 1 o EXISTING CONTOUR DWELLING (/#WJK asL E.vE¢Ar vss�NG \��t�J x_��__� �� 1 „1� ,W�i. � TEST PIT Ch I 112.0 III/ `� —W— PROPOSED WATER SERVICE �o N } TO 143. 47 �� d I l ° {` ' P 00 1 . 1 / / `7► —W— EXISTING WATER SERVICE N Il (A sum ed)z ' /' .' — U— EXISTING UNDERGROUND UTIUTI , �J f / _38 PROP. , / / / G— EXISTING GAS SERVICE ' SEPTIC BENCHMARK �_ j 6, / ,�/ � � $ -- f p s : . \ \ ._ _.-.._. I l ... PROP- FUTURE , U �-- �.� W .•� ,� GAAGE 1 1 / / V 11 1 i 9 (Jtilities 1 i 7"--� A.S�,} 1i, f ECG ��Ab 'TP p icy u y w 0 I / SOIL LOG 3,3 5 ,; - -�-` -- a .`B�oO S� f ,.� TAK DATE: OCTOBER 25, 2005 /V76.4 S SOIL EVALUATOR: PETER Mt.ENTEE P.E., (.5:E. 9 30,. ...�,_ - w _ I / �,r 1 1 o PETER T, INSPECTOR: NOT WITNESSED-REPAIR/CLASS 1 SOILS t W + ` ,I �` .., ' i, Y / / / McENTEE P- 1 TP-2 201.95 '1:Cr} v CIVIL Elev.- T De th Elev. Ue th ~` µ " v '}' / / No. 35109 EXISTING SEPTIC TANK -� /°1_` �FCI0E �, 141.8 0" 142.2 0" a A SANDY LOAM A SANDY LOAM TO BE PUMPED, RUPTURED y 10YR 3/3 10YR 3/3 AND FILLED WITH SAND / 140.8 12" 141.2 B 12" EXISTING S.A.S '' �.- �' � L ~�'41 B SANDY LOAM SANDY LOAM TO BE PUMPED, FILLED W/ U 10YR 4/6 139.2 10YR 4/6 36" SAND, AND ABANDONED 137.8 C1 48C1 MED, SAND SILT LOAM 10YR6/8 PER° 2.5Y a/a 136.2 PROPOSED SEPTIC SYSTEM UPGRADE 135.8 C2 72" C2 72s'LTLOAM 33 PIN OAKS DRIVE, PER° 2.5Y 4/4 BAR NSTAB LE, MA MED. SAND 134.2 0-', MED. SAND s� 2.5Y 5/4 Prepared for: Robert Guarino, 33 Pin Oaks Dr, W. Barnstable, MA 131.8 120" 130.2 144" 2.5Y 5/4 Engineering by: Surveying by: SCALE DRAWN JOB. NO. Eng1needngA?rkr Warner Surveying 1 -20 • P.T.M. 229-05 PERC RATE <2 MIN/IN. (MED. SAND) ZONING CLASSIFICATION: ZONE RF-2 12 West Crossfield Road 22 Long Road NO G.W. ENCOUNTERED SETBACKS: FRONT YARD=30', SIDE/REAR=15' Forestdole, Mfg_ 02644 Harwich, MA 02645 DATE CHECKED SHEET N0, (508) 477"=5313 (508) 432-8309 1 2/2/05 P.T.M. 1 of 2 f NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH TOF E F.G. EL: 142.0t FOR A DISTDAN EH OLF 15''TAROUND T�HEg 0 f (EXISTING) F.G. EL:142.0t PERIMETER OF THE S.A.S. EXISTING F.G. EL: 141.8t(EXISTING) MAINTAIN 2% MIN SLOPE OVER S.A.S. 36" MAX. COVER OVER S.A.S. INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO 3-50 GALLON LEACHING CHAMBERS INSTALL RISER OVER CHAMBER/S Q- SHOWN ON PLAN AND SET COVER/S TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDES WITHIN 6" OF FINISH GRADE . L =9, 4" SCH 40 PVC L=23' 4" SCH 40 PVC 4" SCH 40 PVC �- -2" LAYER OF 1/8" TO 1/2" e ® S= 2% (MIN.) 10 DOUBLE WASHED STONE la^ ® S= 1% (MIN.) B" 0 S= 1% (MIN.) ®�® ®®® 48' UQuiD INV. ELEV.=139.00 2' EFF. DEPTH 12821®I® LEVEL INV, ELEV.=139.17 4' 5.2' 4' 3/4"-1 1/2"qg DOUBLE WASHED INV.EL: 139.75 BAFFLE pR POS D-BOX STONE EFFECTIVE WIDTH - 13.2' ESO�SED 1500 GALLON SEPTIC TANK INV.EL: 139.50 INV. ELEV.=138.50 -BREAKOUT ELEV:=139.0 INV. ELEV.=138.50 12 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TIE IN TO 4' SEWER AT PIPE INVERTS PRIOR TO CONSTRUCTION. BOTTOM ELEV.=136.50 INLET END OF EXIST, TANK 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL 4' 3 x'8.5' = 25.5' 4' INV.EL: 140.10 AND TRUE TO GRADE ON A MECHANICALLY COMPACTED 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 33:5' SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN T.P. EXCAVATION OR G.W. 310 CMR 15.221(2). LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W. ENCOUNTERED y>�P 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP EL; 130.2 02 PETER T. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL, McENTEE "v CIVIL (3) 5" DIA.OUTLETS No. 35109 SEPTIC SYSTEM PROFILE .. � N.T.S. r.. �-- r :, DESIGN CRITERIA T t H-10 LOADING 2' - NUMBER .OF BEDROOMS: 3 BEDROOMS Q-BOX GENERAL NOTES: EXlS17NG SOIL TYPE: CLASS I � DESIGN PERCOLATION RATE: 2 MIN./IN. 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ' DWELLING (#33) :BOARD OF HEALTH AND THE DESIGN ENGINEER. TOF=143.47 DAILY FLOW: 440 G.P.D. DESIGN FLOW: 440 G.P.D. (FUTURE EXPANSION) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS (Assumed) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE GARBAGE GRINDER: NO en, LOCAL, RULES AND REGULATIONS. _ LEACHING AREA REQUIRED: (440) = 594.6 S.F. K ®®®® ® ®®®ER 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR .74 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 0®®®ff3®IRE3®®® 33" DESIGN ENGINEER. PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY N E3E3®®®®®E3E@E3 E3 E3L7W®®®I4®®®® 4, ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 6 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN I M 6g. USE 3-50Q GALLON LEACHING CHAMBERS IN SERIES ENGINEER BEFORE CONSTRUCTION CONTINUES. 102 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. SIDEWALL AREA: 2(13.2' + 33.5') X 2 = 186.8 S.F. -17 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF j r iV 1� BOTTOM AREA; 13.2' x 33.5' = 442.2 S.F. 4" KNOCKOUT THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF y I �' TOTAL AREA = 629.0 S.F. TOTAL AREA: 20" CIA. COVER HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. I Q I y I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. i q DESIGN FLOW PROVIDED: 0.74(629.0) = 465.5 G.P.D. 4" KNOCKOUT O�4:1 KNOCKOUT 62" 1 L� 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. O 4" KNOCKOUT 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PROPOSED SEPTIC SYSTEM UPGRADE TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR, i 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE L_-- 33 PIN OAKS DRIVE, WEST BARNSTABLE, MA THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING -732 4-4 Prepared for: Robert Guarino, 33 Pin Oaks Dr, W. Barnstable, MA 500 GALLON CAPACITY, H-10 LOADING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS S.A.S. LAYOUT Engineering by: Surveying by: SCALE DRAWN JOB. NO. CHAMBERS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. EnglneeringXbrkr Warner Surveying NTS P.T.M. 229-05 N.r.% AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 12 West CrossField Road 22 Long Road Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. (508) 477-5313 (508) 432-8309 12/2/05 P.T.M. 2 of 2 I p r ' ; 31 10 Ja Matt nlas2 oBen ch m ark s La "f cor. bot $#e ' El.= 9438 ssum `j G N "s J }t i'1`5 r �i r,�0— Route 6A c� 42, `.., S 85 07 20 m . ° LOCUS ` - 20557' 1A t l LOT 1 ---'" ---=SETS (tYp 23,614f S.F. -- ,-�- BLDG.' r 1 0.54f• AC. p Locus N.T.s. r! r 1 a t '� i 1 yJ 4 C)c : ...�. ...�.....,.�.......—� ;.A?', t �� Y., t€ � �.. '� l QP / � I LEGEND i,, l { `Parcel 62 / .30' PROPOSED CONTOUR E IS TING i4iR' 1 `: ��a a +y ®ry;v � {" - � t i ri �` ... Qj "6 a J` 79 PROPOSED SPOT GRADE Lu ;' S '` t l ;1 41, t� l `., N o EXISTING CONTOUR DWELLING � `3 � . �t`e� - �� po,f: .�f _- - — ROUTE 1 �`` TEST PIT I / I . / �� —W PROPOSED WATER SERVICE N (A st fined) , °� i 'F =! A/ / W- EXISTING WATER SERVICE U EXISTING UNDERGROUND UTILITI I / "" G— EXISTING GAS SERVICE .41 / / O BENCHMARK t dl/ W 611/ / v J S y \ U�d ���� 19p PROPOSED 1 Q`1 s9� l� 9 hies _ 11' ►� 6AIRAGE i ' / / / l �. o� PETER I ��✓ a_�:. — (1ti1_ � -L — c`" ` �: T.O.F-=142.5 �� Q TEE 1� - U �. 1' 3 MIEN ' 141.5 f CIVILi TO. 351 0. 9zt 7 co 7,6 2 h / j ° ' / ; � . / of , . �.. " MAg�_ TERRY WAAN RNER `p �- " ,�a is *1 No.38721 ` PROPOSED GARAGE / ZONING CLASSIFICATION: ZONE RF-2 33 PIN OAKS DRIVE, WEST BARNSTABLE, MA 3 /0 SETBACKS: FRONT YARD=30', SIDE/REAR=15' �r E Prepared for: Robert Guarino, 33 Pin Oaks Dr, W. Barnstable, MA NOTE: LOCATIONS SHOWN OF EXISTING UTILITIES ARE APPROXIMATE ONLY. IT Engineering by: Surveying by. SCALE DRAWN JOB. NO. SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SV )r*nbr N"arner Surveying 1"=20- P.T.M. 229-05 LOCATION OF ALL UNDERGROUND UTIL+TIES'PRIOR TO THE START OF i 1.2 1jlest Crossfield Road 22 Long Road CONSTRUCTION AND RELOCATE AS REQUIRED. 4 Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. f (508) 477-5313 (508) 432-8309 . .6/24/06 P.T.M. 1 Of 1 4 , f ,