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Home My WebLink About0056 ELIJAH CHILDS LANE - Health 56 Elijah Childs Lane, Centerville A= 288 — 154 UP N 534 ` ++4SsiaGS,�H I pe _ Cape Cod's WdP.O.Box 10 • Orleans,Massachusetts 02653-0010'• (508)240-0555 Community Bank Member F.D.I.C. ® Since 18J�J� THE CAPE COD FIVE CENTS SAVINGS BANK:. i .,. .. •ram ; ,r- , y si a Mr. Thomas A. Mckean;R.S, CHO { Board of Health Director Town of Barnstable, Regulatory Services Dept.,, Public Health Division 200 Main Street Hyannis MA 02601 ,Mr. Mckean, I am-,writing today to let you know that we are moving ahead as fast as possible with the repairs to the existing system that failed at 1520.Iyannough Road. As part-of.the sale that took place on February 3,2014, the Bank has taken on this responsibility from the prior owner,to whom your letter of January 27 was addressed (see attached). The bank has engaged Baxter Nye Engineering and Surveying to design and permit this work, and they have already scheduled a perc test March 13th. Weather permitting we are very hopeful that we can still be very close to the 60 day window given. We will be sure to let you know as soon as we have additional design information and target dates for installation. Below is my complete contact information should you wish to discuss. N Sincerely, 0 �ry Uj v � , Christopher W. Raber , S.V.P./Chief Real Estate Officer The Cape Cod Five Cents Savings Bank P.O. Box 10 19 West Road Orleans, MA 02653 Office: 508-247-2216 Cell: 774-722-1334 Fax: 508-240-3510 (cc) Matthew Eddy, P.E. —Baxter Nye Engineering & Surveying (via email) Town of Barnstable BarPstable I kEftid Regulatory Services Department DAR.NwrAnix, MASS. 1639. VOlic Hehlfl W i Mvoti 200 M-a' in Sireet,,HyannisNMA 02601 21007 Office: 508-862,-4614 Richard Scafi,Interim Director 1.AX: 508-790-6304 Thomas A.McKean,C HO CERTIFIF-11D MAIL# 7012 10-1.0 0000 2851 J920 January 27, 2014 D&C Investment Cbr.p., %David Blotnick PO llo-,N, 1827 Palm City, FL 34991, ORDER TO COMPLY WITH STATE E NVIRONME NTAL CODS, TITLE 5 The septic system.located.at.1520, Iyannough -Road/Wel.32, Barnstable, MA was last inspected oil 1/9//2014, by Joseph R, Smith, a certified septic inspector for the State of Massachusetts. The inspection of the septit system showed thaf1he syslen'l "Fails" under the guidelines of 1995 TITLE 5 (3 10 CMR 15,00.) due to the following:. * System is ill.hydlraulic failure * Distributimi box inust be replaced You are ordered to r6p6i*or rel lace t1i.p, septic system within Sixty (60) days from the date you receive this notification; Failure to repair/replace the septic system N�Iith in the deadline period Nvill result in:future enforcenlent action, R ORD-E—R,OF.".PH.E BOARD OF, 1-1 EALTH' 1-110ilicis .6k6an, R.S. C-1-10 Age.lit of the Board of Health. 0:'1SEPT:1bLcH.c.rs Septic Inspection F19itures-or Future Evak]520[yalmough Rd Ric 13 1 2 Barn 2014.doc `,err-��a=�t.�- � ,, •' `otHe: Town of Barnstable `9 c- I'.5.r< 's. E., F,Th:'c` Gn.,r �'--f s' 4• lam. Public Health Division i _ 200 Main Street FOMPti>. Hyannis,NL4-0260:1 7012 1010 .0000 2851 1920 D&C Investment Corp. %D'avid Blotnick PO. Box 1827 Palm City, FL 34991 v GVl�Ck (MCP Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms the I q computer, r,use 1. Inspector: f only the tab key to move your Scott Campbell cursor-do not Name of Inspector use the return key. Cardinal Construction Company Name 32 Ridgetop Rd. Company Address Cr Ma 02635 City/tyrToown State Zip Code 508-420-1295 S1388 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs rthFEvion by the Local Approving Authority 3/27/14 InsActol-rpmipi§ntre Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection W.rm .bs.rf.,.Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owners Name information is required for Centerville Ma 02632 3/27/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Installed new H-10 3,hole distribution box. Permit#2014-084 B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No I ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® 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/day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out In the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: 2014 Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y �0 56 Elijah Childs Ln. M Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1 Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle n/a Scum thickness n/a Distance from top of scum to top of outlet tee or baffle n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a How were dimensions determined? Visual inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): System was pumped directly after septic inspection was complete. Both tees in place at time of inspection. Structural integrity of tank was good. Liquid level at proper working height at time of inspection. No evidence of leakage into or out of tank. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner owner's Name information is required for Centerville Ma 02632 3127/14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): New distribution box installed and inspected by health agent. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , ' 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owners Name information is required for Centerville Ma 02632 3/27/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Dry course gravel. No signs of hydraulic failure, no ponding,normal vegetation. (grass) II I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 00 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids li s Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3� t5ins•3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar _ ® Shallow wells Estimated depth to high ground water: 12+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Excavation at time of distribution box replacement. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Elijah Childs Ln. Property Address Julius Pasys Owner Owner's Name information is required for Centerville Ma 02632 3/27/14 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 NO. Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in co uteri PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Disposal 6pstru Construction Pf mit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or L t No. � �c: f JQ wner's Name,Address,and Tel.No j0S /As1es�dr's 1 Installer's Name,Address,and Tel.No .}� Designer's Name,Address,and Tel.No. Type of Building: &4/OF- 81`51L5 1K_ �D7 Dwelling No.of Bedrooms 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 t e vir e al Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar H alt . , n 0- Date Application Approved by ® Date Application Disapproved by Date for the following reasons Permit No. Date Issued o. Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in cjoute( Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Z iplication for'Disposal stem (Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Ljbt No. Owner's Name,Address,and Tel.No. Installer's Name,Address,and Tel.No:�Cr;�� ;�f Designer's Name,Address,and Tel.No. Typp of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building V 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 V` O O ,r Nature of Repairs or Alterations(Answer when applicable) 1 r 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 viromnental C'bde and not to place the system in operation until a Certificate of Compliance has been issued by this Boar 6 'H alth.w jo Date f Application Approved by i � (�' i" � f Date Application Disapproved by V Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS j BARNSTABLE,MASSACHUSETTS Certificate of Compliance T IS TO CERTIFY,that he On-site Sewage Disposal system Constructe ( ) Repaired(Vl< Upgraded( ) Abandoned(, )by�c '� � 1�—�=�`Q / D✓l f� .GrtJ at 6 /`LJ_I///1 ��i /O S has been constructed in accord ce with the provisions of 'tle 5 and the for Disposal System Construction Permit No ated t' Installer / ys Designer #bedrooms Approved design flow / gpd The.issuance of 's pe t sh 11 not be construed as a_guaranfee that the system wTljl :n?)O�adesigned. %} Date Inspector 1 s�, ------------------------------- --- ------ - - - --- — No. g Fee O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(✓< /Upgrade( ) Abandon( ) System located at s b � �.�� cd, ,,q</ eel(,%�Q V, f 6, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be )mp 4ted within three years of the date of this permit. Date Approved by P �� ) No. 41� Fee %_1 8— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_ • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS apphLatIOIT for M18p0saY 6pStPITI COITBtCULttOtt VPC1111t Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No i` �/� /'Y Owner's;Nao,,e,Address,and Tel.No. Assessor's Map/Parcel Inst ller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 'D' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided O gpd Plan Date 3d^--/' Number of sheets Revision Date Title Size of Septic Tank ��G'� ��®p• sal Type of S.A.S. XG1,40 �i'��' 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 Health. �r Sign. O C Date '� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued t � _ 1 � sk Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for ]Disposal Stem QC0rt5trutti0n Permit Application for a Permit to Construct( ) Repair(J�I`Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No>_17,A ,gam 44*/f Owner's Nape,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L�t�rQs'ca+f , .7,,� ®>C�> -0�i/,�'� 3� ./7! '' `!' Type of Building: 21 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildings�, 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 /L'G ,r /�`G►O. l 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 Health. Sign d �' Date Application Approved by _ /f Date Application Disapproved by V Date for the following reasons Permit No. )/ Date Issued --------- -------- -- T1i F�COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( �_ Repaired( ) Upgraded Abandoned( .)by ��//� � .� dG /�-' _P d-�c at .�S` G,�gl,��,°¢ ,e' ra+ . C d,A-•T' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ® uAted Installer f�.OW GGr�Oc4`G,�r ,j' p rc ,/+s+C.Designer iqi ,s J'® ?J #bedrooms ? Approved design flow �' +�f gpd The issuance ofh/is permit hall of be construed as a guarantee that the system w' fimcti a designe '� 0 Date L�'J Inspector do l y ..- _ ._. - --- ----- - ------ - -----I-----,----=-- -------- d --- ---------- -- -- i No. / I/"7 Feet THE COMMONWEALTH OF MASSACHUSETTS k: PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS BispoSar 6pstPm ConstrUttion VPrmlt Permission is hereby granted to Construct(je_� Repair( w) Upgrade(141 Abandon( ) System located at 26e '" �/ d/✓�' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio Date Approved by on must be completed within three years of the date of this permit. ` ! �� j �l�' ��y , - Apr 0214 07:37p Colleen Mason 508-833-2177 p.1 t Town of Barnstable Regulatory Services o� Richard V. Scali,Interim Director Public Health Division Thomas McKean, Director i 200 Main Street,Hyannis,INIA 02,601 Office: 508-862-4844 Fad: 503-?90-5304 i tl 1 Installer& Designer Cent fleation Form 1 1 Date: 3 ZG Sewage Permit, Assessor's Map\Parcel Designer: �yl - �DUI.P Installer: WH �� 5 Address: 1 � � Address: _ was issued a permit to ir_stall a Cn . (daze). Installer) septic system at 7�44A ' • � based on a desi gn drawn by (address) Y1 yv[W ,1 v�dated (resigner) B VI tifv that toe septic system referenced hove was in�ta ied .substantially accordina I cer to the design, winch may inciude minor approved changes such as lateral relocation of the dis-tr'ibstion box and/or septic tank. Strip ,out (: regai:ed) was inspected and the soils ^ were found satisfactory. I cerd � that ts'�e septic sysie xeferenceL 'above ,xas i:�stalled tivitn major changes greater than 10' latera_ relocation of the SAS or any vertical relocation of any component 0-:'the septic system) but in accordance �,7th State &Local Reg�iiations. Pion revisicn oz certified as-built by desla"7i eI o follow. Strip out (if required) was inspected a rd the soils were found satsfactory. I certify that the system referenced above was z=sttn:cted in com, fiance with-se Terms of the PA approval letters (if appL'cabie) ,� F ' DAViD (L-istal eI's Si r-at�.r ;1ASul c � iST- (Designer's Sianatt: e) (Afx Desi }�Here) PLEASE RETURN TO BA.RNST.ABLE PI.BLIC UEALTH DIVISION. CERTIFICATE. OF CO LI_kN'CE NVnL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEI-YED BY THE B_ARtNSTABLE PUBLIC HE.-�-L'IH DIiaa§10N. T ce-YOZ. Q kSeptic0es;;ner C&dfication Form Rev 8-14-13.dec i i COMPUTE • ■ Complete items 1,2,and 3.Also complete A. Signature item 4.if Restricted Delivery is desired. X .-a/— ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the Card to you. B. Received by(Printed Name) 0 to of KielKry ■ Attach this card to the back of the mailpiece, or on the front if space permits. ;3 D. Is delivery address different from Rem ? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No JJA 5 lb I, ?� 911 3. Sery&lype Certified Mall ❑ ress Mail 0 1/3 ❑Registered etum Receipt for Momhandise d`� ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) O Yes 2. Article Number, , i :i i i F c j R" j __ rr � k 7 r r (fransfer from service label) 7006 2150 0002 1042 083=5 Q PS Form 3811,February 2004 Domestic Return Receipt 102595-024&1640 UNITED STATE 06 �' L'&PAE t-% 11Q'S m o ° Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable I Health Division 200 Main Street Hyannis, MA 02661 7 02 :iliitt4�i111l1:1tlit3!! l1#11��ttt#�ittlllllJ!!i�!!t!1#�# ._. CGaVkETE THIS SECTION COMPLETE THIS SECTION DELIVERY iiEN I ■ Complete items 1,2,and 3.Also complete A. Signature I Item 4 if Restricted Delivery Is desired. X ❑Agent ■ Print your name and address on the reverse 4 Addressee so that we can return the card to you. B. Received by( rinted Name) lat of Deli ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? Yes 1. Article Addressed to: - , If YES,enter delivery address below: U No ® ��I��Gtitww c^ e a 1 3. S Type C� LJ Certified Mail ❑Fwress Mail ❑Registered ( etum Receipt for Merchantlsg ❑Insured Mail ❑:C.O.D '° 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 215'0 0 0' 2' 10 4 2 -'0 5 7 6i � (transfer from service labi:. ozsss o2 nn teg PS Form 3811 February 2004 Domestic Return Receipt to' UNITED STATES POSTAL SF, VI ai CS '14'��waN�yttk ' • Sender: Please print your name, address, and ZIP+4 in this box • I I I Town of Barnstable � 4 Health Division ;:: S� 200 Main Street c�-3 c i -Hyannis,MA 02601 I I r,� I f( J(Ji jjjj f i j � J�� .»..1�L�i JJJJ7JJJJJ�1��lt�JJJJJ JJdIJ1JJ1J3.lJ1lJlJlJJ/Ji-��JJ��JJJJJI�J1 Heah Master Detail Page 1 of 1 i g�-,A eg"us.-x�Ti• ?s :.Ya �-,y1f.: __.°may ,?a• V'3 F _' ,....;C3.;ed S'. I i` .,.;I3 g ! '..I s. 's :'i 1 &.»use.. .. m. 8.ro..i 1 ( 'i Parcel Septic ._. _. rc �mm 'Weil F veI Tark Parcel: 171-2 4 Location: SE EL.IJAH CHILDS LANE, C:E °TERVILLE Owner: PA Y , 3ULIUS LUKAS Business name:F Business hone Rental property: Deed restricted: r7 Number of bedrooms Contaminant released: Fuel storage tank permit: : SauexFarcel Changes r ' Return to Lookup Parcel I fo Parcel ID: 171.-254 Developer lot:t...OT 56 Location:56 ELIJAI-i cHALD5' LANE Primary frontage: 110 Secondary road: Secondary frontage: Village:C;EN r ERVILLE Fire district:G O MM Sewer acct: 7 1 Road index 0488 "I 6 Asbuilt Septic Scan: ?,7 1254_1 Interactive map f0 Town zone of contribution:GP (L ri>tindw, ,c_r Protection Overlay District) State zone of contribution:ilk Owner Infra Owner: PASYS, IjULIUS LUKAS & Co-Owner:PALAIMAI I E LAG Street1:220 MEGAN RD Street2: City:HYANNIS State:MA Zip: 02601 Deed date:9/8/2006 Sd o r° Deed reference:21333/192 Land Info Acres: 0,60 Use: Single Farn MDL-01. 650W Zoning:RC Neighborhood: Topography: l._eve€ Road:Paved Utilities:S€ptic,Gas,Public Water Location: Construction Infra -:i'<:af3E?:`.i..,;<nm's Bath rY3nms 1 11981 1761 2 Bedrooms2 Full Buildings value:$141,200.00 Extra features: '$2,500.00 Land value: $142,400.00 I http://issq 1/Intranet/healthMasteriHealthMasterDetail.aspx?ID=171254 8/22/2008 Town of Barnstable THE Regulatory Services. k ti�P� ti� Thomas F. Geiler, Director ; + Public Health.Division * BARNSPABLE, + Thomas McKean, Director 200 Main Street 2,007 Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 23, 2008 Julius Pasys 56 Elijah Childs Lane Centerville, Ma 02632 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable " Health Division. According to our records, you own the rental property a 56 Elijah Childs Lane, Centerville Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2008 fees included. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Timothy B. O'Connell Health Inspector Health Division Direct #508-862-4646 Health Master DGetail Page 1 of 1 ea ftg •� 5Z �.., Detail I I t e Dzz'- eI .17;.kip selection t'e 's arce4 elata rrt' sl Parcel: 327-012 Location: 8 NORTH STREET, HYANNIS Owner: MONAG AN, LIAM P TR Business name: Business phone Rental property: h Deed restricted: ( T. Number of bedrooms 0 Contaminant released: - Fuel storage tank permit: Save Parcel Gh riges., Return to Lookup- Parcel Info Parcel ID: 327-012. Developer lot: I...OT F Location:3 NOR1 N S I RFE I Primary frontage: 57 Secondary road: Secondary frontage: Village: HYANNIS Fire district: HYANNIS Sewer acct: 1442 Road index: 1100 Interactive map ' ' AP (Aquifer Protection Overlay Town zone of contribution: Co— 6 f p� State zone of contribution:OUTDistrict) Owner Info Owner: MONAGHAN, I...IAM P TR Co-Owner:TRUST AE3LF ROAD R�ALI TRUST Streetl: 100 WES..I.. MAIN S I UNI1' 6 Street2: City:HYANNIS State: MA Zip: 02601 Country: Deed date:3/1.6/2000 Deed reference:C1.56917 Land info Acres: 0,12 Use: Single: Fam MDL-01 Zoning: I IVB Neighborhood: 0104 Topography: Level Road: Pave Utilities:All Public: Location: Construction Info��.,:4 : °�, � �roc 1 1800 11188 Bedroom 1 Full + SH Buildings value:,$109,600.00 Extra features: $2,400.00 Land value: $105,000.00 ,. q6 6 ( 7- 595- 3* ' http://Issgl/Intranet/healthMaster/HealthMasterDetall.aspx?ID=327012 8/21/2008 Town of Barnstable �f1HE T Regulatory Services o Thomas F. Geiler, Directory° � " Public Health Division * * BARNSTABLE, MASS. �, Thomas McKean, Director 1639. �0� 20ttr"'200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 17, 2008 Liam Monaghan 100 West Main Street Unit # 6 Hyannis, MA 02601 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with -the Town of Barnstable Health Division. According to our records, you own the rental property at 8 North Street, Hyannis. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at wxN�N,,.towii.bai-nstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2008 fees included. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Timothy B. O Connell Health Inspector Health Division Direct #508-862-4646 O Fizic THE COMMONWEALTH OF MASSACHUSETTS BOAR® F I�AO�S�...............OF, .............................. Appliration for DWpaant Works Toutitrurtion thrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal ...yS..s.t.!.._.. a --� .5............. ...L.....(.qk..�..�.. . ........... ........................%.�.. . ................................... Loycion-Address or I _0...................... .. -9 0 -A... .... ............... ..... ... ... ............................... ...... .......... ....... Address ............Soo... .... ............ ..... ..... ....................................................... Installer Address Type of Building Size Lot../_CO-------.Sq. feet U Dwelling—No. of Bedrooms.._ ........................Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( Other fixtures .....................---------------------------------------------------------------------------- ------------ Design Flow..........�L. ._.gallons per person per day. Total daily flow.___.._... ._.._:5.......................gallons. 9 Septic Tank—Liquid'c�'Pacit"/ gallons Length................ Width................ Diameter------------_.. Depth................ W y Disposal Trench—No..................... Width.....__......__.._.. Total Length_.__................ Total leaching area....................sq. ft. Seepage Pit No.... ... Diameter....._......._...... Depth below inlet......_............. Total leaching area..................sq. f t. r----------- Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. I................minutes per inch Depth of Test Pit._.__......_......_. Depth to ground water..___...__.._........_.. Test Pit No. 2................minutes,per inch epth of Test Pit.................... Depth to ground water.________....._......__. ------------------------------------- -------------------- --- ------------------------------ -------- --------- 0 Description of Soil. ---/07: ------ ... ... .... U ....................................................................................................................................................................................................... ....................................................................................................................................................................................................... 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"IMIL4 5 of the State Sanitary Code— The undersig t!d further agrees not to place tl�e syste in p, operation until a Certificate of Compliance has bee s d..bby the b ardIf health. place e syste i,........ ... ............ ...Sign .. ............................... .... ----------------------------------------- ---I........D e-------—---- 2_ Application Approved B ----- .................................................................... ................................... Date 1p Application Disap v or e following reasons:................................................................................................................ ........................ ................................ ... ............................................................................................................................................................... Date PermitNo......................................................... Issued-....................................................... Date _ 1A .Y ^ No...g�.......'? � FimB............... r ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF................................................................................_.......-_ ApplirFation for Uiipusal Workii Tonstrnrtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --......-•-•--.._..............................•-...--•-•-••---..........._•--•--•---•-••-••-_... _........._......._..--•............••---••--••-•--•••-•--•-••--••-•--------•--•-•---.........---• Location-Address or Lot No. ......................--........................................................................ ..........--...................................................................................... Owner Address W --•..................... .•-•-•-...•---•-•....---...-•--•••---•••.._. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.___._ ______________________________Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons____________________________ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures ------------------------••--•-- • W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. Test Pit No. 2................minutes per inch epth of Test Pit.................... Depth to ground water........................ o :.j............... Description of So>1 ,: ,:<� x v �p r -----------------------------------------------------------------------------------------/---------------------------------------------------------------------------------------------------- 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 T.i:LL 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. r!� Sign ----------------------------------------------------------•----•-------•---•-----•--- ............ z.1. ---...---•-•-•---••............... �__...._....APPlication Approved B Date Application Disapp veld 'or a following reasons:--•---------------------------------------•--------•------------------•-------------------•---------------.._._. ....--•--------•-•--•--••--• ---- --- -•-----•-----------•-••-•••--•-•••-••--------•----•-------•------------------•-----•-•-•--•--•-•-•----••••---•-••---•-----•••---------•-- ••------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS -- - BOAR,9 OF zr... LT ...... ............................OF........ .... .. .............................._.........._... Trrtifiratr of Tomplianrr TL�S CERTIFY, That the Individual Sewage Disposal System constructed (I/) or Repaired ( ) by �[ -• = ------------------------------------ ----- ----- - - :'`` 11er - has been installed in accordance ith the provisions Of TIT r 5 of '�kte State Sanitary Code s d cr•bed in the application for Disposal Worlfis- onstruction Permit No _______________ dated-...% ..iv THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �i DATE.................................................... c ° Inspector...... _X-.�`_-..._...------.............----------•------•-•--- THE COMMONWEALTH OF MASSACHUSETTS �--` BOAR"F HEA T _./ W/ z } r'. ...-....1.....................OF............--.....��......__......_ti.................................... �. No......................... FEE_. � ........... n, kil nnil ilan Vamit Permission is reb ranted. Ilti Y g to Construct r ansInrli Hualewag as b 'stem Street as shown on the application for Disposal Works Construction Permit No�!_�_�S�Dated.._�y___1�.__�l.____._.... ................................1P--- l/-----------•---------------------------- / l �Q Board of Health DATE. ------------'Y.-d1 FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r _ . . . . r - �1�1.�• �l�J1i11 L?� - ,'3:131=��;ODNL _ I t uo _ G;AfZT�AGE l USA'. . lOOcl .i6.4L # r ft -17 1J W G t i t 1 � �. ' Poa,t�.1�' �P►T � T!• t F rat -t, J , � :.a , ;.��a�.,..1`r�r F.-A:. L'.ltj0 J C.�'a•. �•` - .- . .. r i �ti_1.` ,.'y. ...f�..S,. ,� 1 f� i j '.,.,. " :Ic�p SF ,� r .2..5.• 3 1 ;- 5 .G P,T�: 1, ;, MA rPC �, . , 1, CEO: l I , - s+�'. ► o MO, yU ► T r� 'roTAL U4=SIGI.t F .4 . G � . �, teat t_ f 4. tSLGDl.4T1Ot.J: Q�TF.. .- :t l� ;G. 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Z .i + j 1 k t f '..,litF.i •htt j..�. r.r. .1 }''. 1 t ilt, A lU4./ tT t ..:. .' rah t A it J;' t ' i tr� f't ►�.1 i 'R F'icV_ I :1 DU4 ..tw 54aclJu .r t ��I Sit.. � C ; E ti.l t? lr'iI;X Gc),AAvLvS v./i-rA" TNT _5I DEl.,X; A6.lba 5C't't;,ACK� U`lQENc.c"Tr o = Towc.� o� 13A �iTQal t , : ►.1� �._ 4 E. w►I-vA 11,4 -r oor ' ( 1 , c fi [3/-L'RT r -. - _. t2CGtSlt t.5 ht_A1_t 15 1,OT Lo.Sc� V�� At`J OSTE�'�%1l.tL o MrLSS� IIJS't-CUM�'l.t� �,vc,.il .�! �• TI-t[:. c��c,�.T'�. �1-icwt� AF�PLt Gn.ti.1T F•t>r c,c U. ru n a:j*C. .t l w LnT -�_I w •� -- �A� � [.t. � ..- �= . CATION SEWAGE PERMIT NO. lot 6 81-755 VILLAfrE Elijah Childs Ln. Centervi le, NIA.. 1NSTA LLER'S NAME i AD.D.RESS Robert Our Co. Harwich, MA. 02645 B U I L DEAR ! OR OWNER �. Alan E. Small , Inc. Box 536 CentPrvill P, NIA. D A T E P,E R M 1 T I S,S U E D 12/22/81 01MPLIANCE ISSUED DATE C c /- 1a -81. /171 , I i i I ASSESSORS MAP : PARCEL : TEST HOLE LOGS �` (��' - - l) Tile installation shall caul.., with 'l'itle V aiid 'Town ul$�ep uard ot. FLOOD ZONE: Ilealtlt Regulations. � �'/�' SO I L EVALUATOR :�41.D wr :_ REFERENCE . f WITNESS : cID� a[�> J� / � 2) The installer shall verily the location of utilities, sewer urvcrts and septic °- � DATE : Z components prior to installation and setting base elevations. G ;2r7r / 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first _e•�� e PERCOLATION RATE: t�Gl 1 two feet out of the d-box to the leaching shall be level. �. � 4) "fliis plan is not to be utilized for property line determination nor any other TH- 1 I TH-2 purpose other than the proposed system installation. P P LA �D 5) All septic components must meet"Title V specifications. 6) Parking shall not be constructed over I110 septic components. 7) The property is bounded by property corners and property lines. LOCATION MAP 8) The property owner shall review design considerations to approve of total I design flow and number of bedrooms to be considered for design. Receipt 1 of payment for the plan and installation based on the plan shall be deemed / approval of the design flow by the owner. it 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall ttrL - be removed along with contaminated soil and replaced with clean sand per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the - - - - - � water line shall be sleeved with 4 inch SC[[ 40 ['VC with ends grouted if ' ' ', ✓ � applicable. The proposed SAS is being installed below the water service . - r - line. The line is to be sleeved as aforementioned and maintained in place. i SEPTIC' S Y S T E M I D E S G N 11) if a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such FLOW ESTIMATE exists. I 13)The installer sliall verify the location, quantity and elevation of the sewer f3EDR00MS ►T ` GAL/DAY/BEDROOM - �AL/DAY lines exiting the dwelling prior to the installation. ' 14)This plan is representative only that a system can fit on a property meeting SEPTIC ,TANK Title V requirements. GAL/DAY x 7 QAYS - GAL �9 lot USE IL� AI:LON SERT I C TANGO c r 1 0 r .. , � IL� ABO 49 r spry �. . } • SIDE DE AR Z K r I t - No X X o i �37E BOTTOM � cQ ARE �/,gyp •I' '` r � SEPT .I C SYSTEM SECTION � D11 *p � --- - \\,, _ U ' Wn - of -f�-, -An B _ M Ll GAL __ ►�(�'Z. 1�.� . 3 � you � / 2 SEPTIC TANK �( : a • 3 : Z�� E PLAN LOCATION PREPARED FOR : �J l Vv� l 4 M 1� V� SCALE: 0 DAV I D B . MASON75 DATE: u Z t) DBC ENVIRONMENTAL DESIGNS Z DATE HEALTH AGENT EAST SANDWICH . MA ( 508 ) 833- 2177 t