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0014 ELLAS LANE - Health
14 Elias Way A= 189— 163 Centerville SMEAD No.2.153LOR UPC 12534 d.eom • Made In USA fdltl�NMSRgOUC�INE OFTWSAMUM SFI c¢Rnc�o souaa� wwwsroraoGRnµoaG i No. ZV Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in corn ter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes \� I 01ppYILatIOtt for ;O ) 'Upgrade S08AY 6p8tC111 Construction �PrIYCit J Application for a Permit to Construct( ) Repair ( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 14 El to e . Owner's Name,Address,and Tel.No. P,e Assessor's Map/Parcel rv�p" talou ei Lnuith Installer's Name,Address,and Tel.No. S Designer's Name,Address,and Tel.No. sag Type of Building: Dwelling No.of Bedrooms Lot Size M00L sq.ft. Garbage Grinder( ) Other Type of Building Q?SiClf'�'j4 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) C.i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code ao, not to place the system in operation until a Certificate of Compliance has been issue this Board of .eal'f ✓ ` Si // © Date Application Approved byLrleyj�/ Date Application Disapproved by Date for the following reasons Permit No. Date Issued f .ram No. _ i•'' ^.wz V ... >J# t I r Fee r Entered in computer: ; 4 THE COMMONWEALTH OF MASSACHUSETTS , _PUBLIC HEALTH DIVISION - TOWN`--'OF BARNSTABLE, MASSACHUSETTS YES` 2pplitatlon for ;Disposal *pstpm (tonstruttion Permit Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) •❑Complete System k2 ndtvidual Components Location Address or Lot No. +y � Y1 Owner's Name,Address,arid Tel.No. Assessor's Map/Parcel t ,��1 ti� P A L.CuAki P :5- j Installer's Name,Address,and Tel.No. SQ b' Designer's Name,Address,and Tel.No. lRoAs El<cav4+i*q c Eco - ,ecl So Type of Building: //,,`� Dwelling No.of Bedrooms Lot Size ad kJ sq.ft. Garbage Grinder( ) Other Type of Building C�Z(�Kt' F+g► �' 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 •'� a Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: d 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 not to place the system in operation until a Certificate of Compliance has been issue this Board o s> / --/7 Datel \� Application Approved by l Date Application Disapproved by Date 7 for the following reasons Permit No. Date Issued y,. .. . . ------- ------------------------------------------- --------------------•---------------- - -------------------------_---------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compriante THIS IS TO CERTIFY,that the On-site Sewage Disposal system'Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by (,VI�q �_X ea L4 Ti fIq _ LA C at El 1 � `OR�e J has been copstructed inn adc5Id2k e with the provisions of Title 5 and the for Disposal System Construction Permit No. dated I T—, (� Installer �[�('�S ExGr2 Designer 97-co ^—FPC_(/A #bedrooms t Approved desig A�ow ` gpd The issuance of this it hall not be construed as a guarantee that the system will nct'oh�a d sign Date 4� Inspector / --------- �� - --- - ------------------`------------- ------- ----------------------------------- --- ---------------------=%�_ No. �../ Feed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) ,Repair( ) Upgrade( b�andon,7(�)rf� System located at 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:Construct''o must dco feted within three years of the date of this permit. Date / Approved by _- J Town of Barnstable `HE �. .�'O'ytio Regulatory Services Richard V. Scali, Interim Director mmsrnst.e. = 6'�: �0$ Public Health Division �: A�fDMAta Thomas McKean,Director �— 200 Main Street,Hyannis,MA 02601 Office: 5..08-862-4644 Fax: 508-790-6304 ( Installer& Designer Certification Form Date: Sewage Permit# b/S' /3Assessor's Map\Parcel 189/163 Designer: David Coughanowr Installer• ZIAlyn &brA,( 155 George Ryder Rd South 1 Address: , Y Address: Ad�'S �X rl�1/ A_ Chatham, MA 02633 i Qzt�r On /S '- 1 ` fY'�ULZII�was issued a permit to install a date (installer) t septic system at 14 Ellas Lane based on a design drawn by (address) David D. Coughanowr, RS dated November 7, 2015 , (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. Strip out (if required) was inspected and the soils were found satisfactory. X 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. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructe cc with the terms o4the I\A ap al letters(if applicable) "gsSq DAVID � yG s� D: .. COUGHANOWR (Installer's Signature) No. 1093. o Zo-ty). S S�NITARtP� ..............2 (Designer's Signature) (Affix Design amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc IV, VARIA"!CE REQU Sr<_ TED Q5 too.00 ft V, 8E p�ANTED.IMMEDIATELY BY. HEALTH AGENT OR HEAL TII INSPECTOR. -,� 310.CMA l5:221D) - COMOONEW DEPTH TO`FINISH GRADE. REFER TO INSTALLER'S 36 In,MAX REOUIRED-�IARIANCE TO 72 In �...�- AS BOIL T CARD FOR OF COVER REOUEPO- _ �-^ LOCATIONS OF SEPTIC COMPONENTS i n (�p� q� �q IL- L� V.� ll §ONS i ELEVATIONS SPECIFIED ARE.INVERT ELEVATIONS Y (BOTTOM OF PIPE) EXPRESSED IN DECIMAL FEET 1 SEPTIC TANK OUT 38.70 1 1 1 D-BOX IN 38,06 p D-BOX OUT 37,89 p LEACHING SYSTEM IN 37.70 \ BOTTOM OF LEACHING 35.70 TOP OF LEACHING' 38.70 GROUNDWATER PER GIS 15.00 ,w 1 .o 1 1 1^• SOIL ABSORPTION SYSTEM 1 p3 10 1 jj < iNQ V � o f Q� F LOT 29 re ARt 20162 sf+- LAND C URT PLAN .35548-D 1 c� ASSR AP 189 PCL 163 .TEST PI T `3 NOVEMBER 23 2013 1 UNWITNESSED HAND ` l A N AUGURED TEST 'PIT \ �• A� SCALE:. I in = 20 ft ELEVATION PAPER FORnPROPER (SCALE. 35.70 \ �b k DOFI,uss'� pI L(tt 01 tiysf�y i 2&00 .z 1^ � ' ADVib yGJ; DAVID q a NO GROUNDWATER ` a COUGHANOWR �„ GC3l1G A�OtNr? e `No. }093 vo. A61 WAS OBSERVED' TO A DEPTH OF 6.3_ ft. BELOW SAS BOTTOM. CENTERVILLE. MA ROAD .-- F APLITE 28:oko EALM9UT" Q` SEWAGE; DISPOSAL t SYSTEM PLAN :LOCUS ROAD.', 0 -TO SERVE EXISTING DWELLING ��.�� � o , �� '• �. JEAN L. - LOWTHER OIN1dER/S) OF RECORD NOT TOE k4r °N 14 ELLAS LANE SUt a BUNtPS RIVER 9w 155 Geo Ryder Rd S PRoERTY NTEADDRESS E, MA a \ Chatham. MA 02633 DATE: NOVEMPBER 24. 2015 LO Dovidcou®Hotm6iLcomM ETE-4001 TOWN OF BARNSTABLE LOCATION E �(� �p,�,� SEWAGE#-4 ,r, VILLAGE rp -' — ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Logo LEACHING FACILITY. (type) (size) NO.OF BEDROOMS OWNER }' PERMIT 1/ . a 7 -i,I;— COMPLIANCE.DATE: i Separation Distance Between the: Maximum Adjusted,Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)', Feet FURNISHED BY .,� ga. r Town of Barnstable Barnstable .�. Regulatory Services Department ABA, 1 1 9 ��' Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office:508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7156 November 10, 2015 Jean L. Lowther PO Box 2652 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 14 Ellas Lane, Centerville,MA was last inspected on June 23,2015,by Michael DiBuono, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER O R OF T E BOARD OF HEALTH C Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL 47006 2150 0002 1041 7514 QALetters Septic Inspection or Furture Ev1\14 Ellas Ln Cent Nov 2015 Parcel Detail Page 1 of 6 3 (� g BAAK5 ASs. a: yQ li Logged In As: Parcel Detail Tuesday,November 10 2015 Parcel Lookup Parcel Info Parcel ID 189-163 I Developer Loot LOT 29 Location 14 ELLAS LANE I Pri Frontage 20 Sec Road Sec Frontage Village CENTERVILLE Fire District C-O-MM Town sewer exists at this address NO I Road Index 0514 I Interactive K "y Map Owner Info Owner LOWTHER,JEAN L � l Co-owner %FOUR HUNDRED MAIN REALTY LLC Streets PO BOX 2652 Street2 I City HYANNIS State MA I zip r0_26011 Country Land Info Acres 0.46 Use Single Fam MDL-01 zoning IRC � Nghbd 0106 --I Topography Level Road I Paved I Utilities Public Water,Gas,Septic ( Location Construction Info Building 1 of 1 Year 1982 I Roof ,Gable/Hip Ext Wood Shingle Built Struct Wall Living 1348I Roof Asph/F GIs/Cmp I AC None 7s Area Cover Type 13 FEP.13 style Ranch I Int 'D rywall # I Bed 2 Bedrooms I Wall Rooms Model Residential I I Floor or Carpet I Bath 11 Full-1 Half I - Rooms 4 GAR 2 �BAS g. Heat Total•6Roo .......... .. � ' Grade IAverage Hot Air ms Type Rooms Stories Fuel ation 1 Story I Heat Gas "—" ""—I Found- , Poured Conc. Gross 3 Area019 Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13 086 11/10/2015 Parcel Detail Page 2 of 6 Issue Date Purpose Permit# Amount Insp Date Comments 4/18/2008 New Roof 200802071 6/30/2008 REROOF STRP OLD 12:00:00 AM SHINGLES 3/1/1992 Addition B34904 $16,000 1/15/1993 CE ADD'N 12:00:00 AM 9/1/1985 Addition B28422 $2,500 1/15/1986 CE ADD'N 12:00:00 AM Visit History Date Who Purpose 10/13/2015 12:00:00 AM Susan Ricci Cycl Insp Comp 9/26/2014 12:00:00 AM Lisa Henderson In Office Review 10/10/2013 12:00:00 AM Lisa Henderson In Office Review 7/20/2012 12:00:00 AM Geraldine Clark In Office Review 7/19/2012 12:00:00 AM Lisa Henderson In Office Review 5/24/2012 12:00:00 AM Denise Radley In Office Review 5/17/2012 12:00:00 AM Pamela Taylor In Office Review 5/17/2012 12:00:00 AM Pamela Taylor In Office Review 10/18/2011 12:00:00 AM Pamela Taylor In Office Review 10/25/2010 12:00:00 AM Michele Arigo In Office Review 10/14/2009 12:00:00 AM Karen Perry In Office Review 12/23/2008 12:00:00 AM Paul Talbot Cyclical Inspection 10/10/2008 12:00:00 AM Karen Perry In Office Review 7/11/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 5/15/1993 12:00:00 AM ML Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 7/14/2011 LOWTHER,JEAN L #BA11P0311EA $0 2 8/2/1996 LOWTHER, GERARD J #D672668 $0 3 5/4/1990 LOWTHER, GERARD J &MARIE D C120424 $1 4 2/11/1983 LOWTHER, GERARD J C90917 $67,900 5 5/17/1982 SMITH,JAMES K TR C89660 $120,000 6 11/6/2015 FOUR HUNDRED MAIN REALTY LLC IC207877 1 $255,000 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2015 $101,400 . $44,900 $0 $136,200 $282,500 2 2014 $101,400 $44,900 $0 $136,200 $282,500 3 2013 $101,400 $44,900 $0 $141,700 $288,000 4 2012 $101,400 $43,300 $0 $168,900 $313,600 5 2011 $139,700 $3,300 $0 $168,900 $311,900 6 2010 $139,600 $3,300 $0 $163,500 $306,400 7 2009 $134,700 $2,700 $0 $175,200 $312,600 8 2008 $160,900 $2,700 $0 $191,700 $355,300 10 2007 $160,200 $2,700 $0 $191,700 $354,600 11 2006 $143,000 $2,700 $0 $157,200 $302,900 12 2005 $134,100 $2,700 $0 $178,500 $315,300 13 2004 $108,800 $2,700 $0 $142,800 $254,300 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13086 _ 11/10/2015 Y1 - 1 CAA OT Alve- 4L 4 -ear T� —Lt �r�cc-D Commonwealth of Massachusetts 199 W Title 5 Official Ins-peeti®;n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Elia's Ln — ----- --_---- =-- - Property Address Jean Lowther_ OwnerOwner's Name -- -------------------------,---._---------------- --__...--------------- information is required for every Centerville _ Ma 02632 6/23/15 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms ` on the computer, use only the tab 1. Inspector: 4 �L) Key io glove your cursor-do not Michael DiBuono use the return --- ------- --- -- --------._...--- ...-- ----- - — key. Name of Inspector --- ------- DiBuono Sewer and Drain .__. __-_ - .-. gb Company Name 8 Johns path emm Company Address - S Yarmouth MA 02664 City/Town State Zip Code 508'364-9587 S11'3522 Telephone Number License.Number .. . B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true„accurate and complete,as,of the time of the inspection. The inspection was performed based on my training.,and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation b kcal Approving Authority 6/25/15 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 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. V v (Sins•3/1.3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 - �- - r��� �� �.�,�.� � �� � � � �� �� r t ^ _ � ��`� Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Ella's Ln Property Address Jean Lowther Owner Owner's Name information is Centerville _ Ma 02632 6/23/1_5__ required for every _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A)_. System Passes: ❑ I have not found any infprmation whir.h 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: _ The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. Tank is 6ft below grade. Staining in the risers indicates hydrualic failure. As well as in the Dbox. The laundry is--upstairs:, - B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Ella's Ln Property Address Jean Lowther Owner Owner's Name information is Centerville Ma 02632 6/23/15 required for every __- page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally"Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 14 Ella's Ln Property Address Jean Lowther Owner ------- -------- ------------- Owner's Name information is required for every Centerville _ Ma _ 02632''' 6/23/15` page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters ❑ ® due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool.is less than 6" below invert or available volume is less than '/2 day flow .t51ns•3/13 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 14 Ella's Ln _ Property Address Jean Lowther Owner Owner's Name information is Centerville _Ma _ 02632 6/23/15 . required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4 time.s..in.the.last year NOT due,.to clogged or E] ® 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 l 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 11 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 14 Ella's Ln Property Address Jean Lowther Owner Owner's Name information is required for every Centerville _ _ Ma 02632 6/23/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"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): , 3 Number of bedrooms (actual): 3 -------- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 _ 15ins•3/13 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 14 Ella's Ln Property Address ----- — - — - Jean Lowther Owner Owner's Name -- information is required for every Centerville -__ Ma 02632 6/23/15 _ page. City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. Tank is 6ft below grade. Staining in the risers indicates hydrualic failure. As.well as in the Dbox. The laundry is upstairs. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): 118 Gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 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•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 14 Ella's Ln _ Property Address ---- Jean Lowther Owner Owner's Name ---- -- --- ------ --- ------ information is required for every Centerville _ Ma 02632 6/23/15 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date -- Other(describe below): General Information Pumping Records: Source of information: -- —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): t51ns-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 14 Ella's Ln Property Address Jean Lowther Owner Owner's Name information is Centerville Ma 02632 6/23/15 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 32 years .. Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer (locate on site plan): Depth below grade: 6 ft 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.): System is vented throught the roof. Septic Tank (locate on site plan): Depth below grade: Eftfeet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Gallon Dimensions: 1000 Sludge depth: 3" - — -- 15ins•3113 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 14 Elia's Ln Property Address Jean Lowther _ Owner ---- ------------------------- Owner's Name information is Centerville _ _ Ma 02632 6123/15 required for every _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top-of sludge to bottom of outlet tee or baffle 24 --- --- Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42 -- Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick — How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is at normal level Risers and D box showing signs of Grease Trap (locate on site plan): Depth below grade: NA 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 -- 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title -5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Ella's Ln Property Address Jean Lowther Owner Owner's Name information is Centerville Ma 02632 6/23/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. 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 t51ns•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Im Subsurface.Sewage Disposal System Form - Not for Voluntary Assessments e 14 Ell.a's Ln Property Address Jean Lowther Owner Owner's Name information is Centerville Ma 02632 6/23/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Shows.signs of backup, . Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakaae into or out of box, etc.): signs of carry over and decay. 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:Subsuriace Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Ella's Ln Property Address - ------- ---- ---- - -------- - --- Jean Lowther Owner Owner's Name —— information is required for every Centerville Ma 02632 6/23/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: Z 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.): No pondinq or break out. — 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 of construction - - ---- _-. Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 14 Elia's Ln _ Property Address Jean Lowther Owner Owner's Name information is required for every Centerville Ma 02632 6/23/15 _. _ _— page. CityFFown 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.): No signs of onding . 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.): 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments a 14 Ella's Ln Property Address ------ - ------- -------- — Jean Lowther Owner Owner's Name ---. ----- — — ---- ---------- ------ required for every information is Centerville' Ma 02632 6/23/15 _ require page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t S`4 vA v` /Jd f 21 \ 0 O 151ns•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form lS Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Ella's Ln Property Address --- Jean Lowther _ Owner Owner's Name information is required for every Centerville _ Ma -02632 6/23/15 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: Ground water to be established by engineer during up coming perk test. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 16 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Ella's Ln _ Property Address Jean Lowther Owner Owner's Name information is required for every Centerville _ Ma. 02632 6/23/15 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 Town of Barnstable P# oFV� Department of Regulatory Services mumur,BtA : Public Health Division Date �{, 2- is 200 Main Street,Hyannis MA 02601 • �AfEll fdld� Date Scheduled Time Fee,Pd._ b / Ck At ;2/3� Soil Suitability Assessment for Sew e isposal Performed By:�f1 Vi N D co 614 dW� Witnessed By: , n n LOCATION&.GENERAL INFORMATION Location Address 14 i(A 5 LA4` Owner's Name Lowl h a r CCikkr1/1 lie Address Vit 1(qs YC17, '(,T V Assessor's Map/Parcel: - 1 V/ t 6 3 Engineer's Name IN tl,A C0 11,6-h or N 0 4 Y NEW CONSTRUCTION j REPAIR Telephone# 1!j0$ Land Use @�/�p ( 1 I Slopes(%) Surface Stones W h f Distances from: Open Water Body too ft Possible Wet Area `_ p6 ft Drinking Water Well O(/ ft Drainage Way ,� f ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) N • �4 ---------------------- ��PrS tzZ.Z� t . L0N� Parent material(geologic) 1�ra�l q6i G1 ✓V�W ,5 h Depth t0 Bedrock Ul 0 n V Depth to Groundwater. Standing Water in Hole: Q Weeping 4r0111 Pit FACe 0 h E Estimated Seasonal High Groundwater 20 �t DETEPAIINATION FOR SEASONAL HIGH WATER TABLE Method Used: _Mot� (f ny �0ne �t l�� Depth Observed standing in obs.hole: In, Depth to soil mottles: in. Depth to weeping from side of obs.hole: __ In, Groundwater Adjustment fr. index Well- Reading Date: Index Well level Adj,factor AcU,Groundwater Level, m PERCOLATION TEST Date Uuv Observation ` Hole# Time at 9" h / I Depth of Per Time at 6" 4 L c, Start Pre-soak Time® 0-00 Time(91141) End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) �j 0 Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. ' J 1 Q:ISEPTICkPERCFORM.DOC r y. DEEP-OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,,Boulders. ottsi tenay %Oravell Scidy. C©tim 10 R312 `None �� � �Ip DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency.% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ' Consistency. e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes. „ Within 100 year flood boundary No.* Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �P_r__5 If not,what is the depth of naturally occurring pervious material? Certification l I certify that on �� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the requirWraining,expertise and experience described in 10 CMR 15.017. �jN OF MAs �} D✓ ?U 1 DAVID S �� Signature Date o� D. " COUGHANOWR • sp �/CENSEO pQ' Q:\.S.EFTIC\PERCFORM.DOC '� t;6 N L P1\ I Town of Barnstable P# Departinent of Regulatory Services i I Public Health Division Dato 0:-t 141 2 1 >rARS 200 Maio Street,Hyannis MA 0=1.sip. . Date Scheduled The Tree Pd.-- 0 ` Cl! Sail Suitability Assessment for Sew • e isposal Perform«i Dy.Vkyt(� 0 • CnV Gt u ewf tt %FItneasaf LOCATION&.GBNERA.L INFORMATION Lmdon Address �(� E 5 Ik a Owner's Name P�N L,00 CeR f Crib lie Address l'� 0:1�9s Wtt�t V Anessor's Msp/Parcet; , `d j/ t 6.3 V1 Lrngina es Nerna I)q tt,i{ cept'�j liar N "�r NEWCONSIMUCRON 1 REPAIR Tletepltbne6 SCE% band Use �' sq 0 h ( r Stapes(96) Burfaae&tons ilk i b1 e Distances from: Open Water Body r I! Pnnlbte Wet,Arw R Ddnking Water Well--LW-f ft Drainage Way R Property Line {R Other Q SI +'TCH:(Street name.dimensions of lesk exact locations or test holes&pare tests,locate wetlands to proximity,to holes) �TP-r • rp2 ' o Q� t7 4 I4 (A NE Porent nmlerial(geologic) PrU 41 l RG�H 1 i-/V+tiy�Gl S Depth to Bedrock N 0 n Q Depth to Groundwater. Standing Wafer to Hole: h 0 h P Weeping Aftom Pit Agee 1✓<0 h e Bstintated seasonal high Omundwater 2.O Pt DETAAMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 1Y Otf Ir n1e h4ae t I44 Depth Observed standing in obi.link: In. Depth to soil molder In. Dg11h to weaving from side of obs.Mote: In, Ordttndwaler Adjuatmant Is. bides WeIFd heading Data tadea Welt lfvol • Aql,thelor Atg.Groundwater•level— PERCOLATION TEST Dalo U,.°�°�Itao Lm Observation Holed lime at 9" Depth of Pere (r Time At 6" tr` Start Presoak Tama® �:�1L 7yrna(9"•6") °I End Pre-soak "� 1 Rate MInJbtch Y11 r Site Sul lability Assessment: she passca Site pallet; Addltional'fesdag Needed(Y/M �j o Original: Public Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted wittdn 100'of Wetland,you must first notify the Barnstable Conservation Division at least one(1)Week prior to beginning. Q:%SI!MCU.IIRCMRM.DOC 1 D r 1 P.OBSERVATION HOLE LOG HoI9# I Depth from Soil harken Soil Texlure Sall Color soil• • - other Surface on.) (USDA) (Marudo Mottling (Stmretum Stonef;nouldeo. �{, r / 1 CMMhjW&XQMnD O_� ScI7a CA rn 10li l Z 'V �n4 —3 AM S11ad (0` P_ 6/4 Loose DEEP OBSERVATION HOLL LOG Hole# 2 Depth from Soil horizon SollTexture Soil Color son other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slow,flouldcrs. fiLaeY.%UMVEII -G tog nl kOi(R3/Z �JonP Fi►ablp t44M #W fflqb( 36-144 r R4(*jvnSq4 OAR _ Lodse . DEEP OBSERVATION IiOLE LOG Hole# Depth froai Soil Ilodzon Soil Texture Soil Color Soil Otlrer Surface(la.) (USDA) (Munselo Mottling. (Structure,Stone,Uouhlers. DEEP OBSERVATION HOLE LOG Hole# Depth fmm Soil 1(odmn Solt Texture Solt Dolor sell Othcr Surface(In.) (USDA) (Munsall) Mottling (Structure,Stones'Boulder. Flood Insurance Rate Man: Above S00 year POW boundary No— Yes withlo 500 ymrboundzry No '� Yes ' Within 100 ypr flood boundary No Yes Aanth of Mntnrnliv Occtt rine Pervious Notarial Does at least fourrcato[naturally occurring pervious malarial exist in all areas observed throughout the area proposed for Ilia soil absorpdon system? -MO-S jr not,what is the depth of naturally occurring pervious malarial?_.._...__...r. Col:'tltica on i 1 a J I certify that on lv (datc)I have passed the soil evaluator mmmination approved by Ilia Department of Environmental Protection and that the, above analysis was pedonned by me consistent wit • the required ng, xpardse and experience described In�10 CMR 15.017. tN tin r,u��r� UDate d+ ?V I S o� DAVID . I Signature t, D �= COUG.NAN010111 QAspi rimpIMCFORM.DOC �� EVAt.dp� (� Qq \ t`,;o Q C I V Lo Zzz l z C� � i NX........�� Fims.1/................. I4THE COMMONWEALTH OF MASSACHUSETTS � BOAR® OF HEALTH ................oF....... C�vfl..c� ---_...............0 .. ................................... ......... ,ApplirFatiun for Uiipuiiat Works Touiitrurtion Frrmit Application is hereby made for a Permit to Construct (t,,T or Repair ( ) an Individual Sewage Disposal System at: --•-- __________c tron-Addr, ---•-_... ........_.. \ p � � Owner "re •---._.._..- ,i . .. .�CC7.1. ..._......-•---... S-------•----••--- --•---- ���-: .....----•...............................•--- Installer Address - Type of Building Size Lot_........ .................Sq. feet Dwelling—No. of Bedrooms_________________________________._..__Expansion Attic ( ) Garbage Grinder (tJQ aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures __________________________________ ______ W Design Flow............\.�®......................gallons per person per day. Total daily flow.___._.__._____- !................gallons. WSeptic Tank—Liquid ca.pacity.I000.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by " .............. Date______��_'_ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-••---•----•-------•---•-----••-----•------•-•---•------------------------•--•-.__-•------•--•------------------------------------------------------------- O Description of Soil....... ............,-�--��`r'==............4.-----------�Q 6 C).... ............................................................ AAA x .._..•••-----••-•--••••-----...••-•••--� ............... ............��� = - ----------------•-•-------........................................... W --------------------------------------i—.O- .------------------------� :cAn.--,A.-•----------------------•---------------•-------------•--•-----..... UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•----------------------------------•--...------••-•••-•-•----•-•-_•-•-•-•-•------•••---------•------••--•-•-----•--•••-----•••--------••-••-•-••-----•----•----•-••-•--•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'ILZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of/Complianas been issued by the board of health. ( D Application Approved By. -----------------------•----•----•-••----------------------------- l �� Date Application Disapproved r teasons---------------------------------------------------------------•---------------------------------._._....._••--•- ..-------••---•-----•-•---------------•-----•------•-----•---------------•-••-----------...--•-----------._..._..----•--••-••----••••------••-_._...---•-•--•-••-•-•-•••-•--.•-------•-•••••--••--•....._ Date PermitNo......................................................... Issued_..................... Date A L . No.._.`.................« FES............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. -. ........ .. �. .............OF..............CJ.. Appliration for Ili-spas al 10orkii Tonitrnrtion umit Application is hereby made for a Permit to Construct (l4 or Repair ( ) an Individual Sewage Disposal System at: .. L.IX.��.. .......... �'.�� E•-•----•-•-./Z v-----•.. ............................. .......................................................... L cation-Address r t N \ , ......--••••..........••••••••--....-••....•-•---••............•-••............•. Owner ... .... Installer Address Type of Building Size Lot_.P ,., ......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (01,y aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .----•----•--•---•--•--•-•-----•----------------------•---••••••••------------•---•-----.............._......---•••••••--•-----.................---- W Design Flow..........._.\.��......................gallons per person per day. Total daily flow.............:s�`..0._.._............gallons. WSeptic Tank—Liquid capacity.QQ9.gallons Length................ Width................ Diameter____._..._....__ Depth..........._._.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------_---- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ~� '~ Percolation Test Results Performed by._... -<. �- _�F'^......._e--.._..JN..__ ....._ Date-, � S�`�S2 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----------•............. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... P4 .---•-•---------•-------------•-•----••-•-••............-•--•-•.........--- ..................-......................................................... D Description of Soil......` M ''............�, ' '' IT' �> _S_c .......----•- c.� - = 1---•-----.. ...k........................................................................ -----•-•-------------------------------...�?----°--_......_..---...� .`...C._..-------•-------•----. _CA n,_-V.....---•-----•-•--------------•---..................•........--•--- U Nature of Repairs or Alterations—Answer when applicable._.._........................................................................................... --------------------------------•--••-------------------------------------------------........••-•-•--•---•--••--•-•---•-•-••...-----•••----•-----••-•••----•-•-••--•--•---•-----•----...........•----- Agreement: The undersigned agrees to install' the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed------- ' _!'t^( _a '� s i" ....:f'1 -------------------------••-• ----••......-- -•-••---• ..................... Dat / e Application Approved BY --`---//•-----------------------------------------------•-..---••-----•--•-------------------- f-- •••-•-••---•-- .............•--•---- -• / Date Application Disapproved for the following reasons---------------------------------------------------------------•----------------•-------------------------------- ........••••--•------•-•----•-----•--••-....-•-•••-•-----•--•••-•--•-•-•--•--•--••---....-••••-•-•........__....-•••-•••••---•---•-••--•-•-•-----•--••----•-----•••---•----•---••-----•.•--••-•••----. Date- PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH QA,.,O' A"S..............OF...............ti K_", V Ci;�� Trrfif irtttr of fuumplianrr - THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) byv C=_. =.t.�\ ,a-------------a`�{:'::?....................----------------------------------------------•----.-. .........--- ----------------------------- Installe has been installed in accordance with the provisions of TITER 5 of The State Sanitary Code,a described in the application for Disposal Works Construction Permit No____________________I.i'__`1..._....... dated_._...._ %' /:..._-�..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..............ca . :......... F /........... ................ EE........................ Biolmo l orks Tonotnir#ion Vamit Permission is hereby granted.....,... _ _.1,,' _'. . --••--•--.-- ••-•-•.` -------=------•-------------------.......--•-•-•-••----.............------. to Construct (L,-'or Repair ( ) an Individual Sewage Disposal System —, 1 at No....... 1" •-•- :.. .... -� _ C c t.. .. =Jam .............. Street as shown on the application for Disposal Works Construction Permit No.................- Dated.......................................... •2 ,,.. X Board of Health DATE................................................................................ i FORM 1255 HOBBS & WARREN. INC., PUBLISHERS psF• SIGLI pATA - - SINGS FAMILY - � BEORQoM ►.Io�GA1ZBA►GE �j¢IM��cz• P^ILY F%.OW s I10 x 3 = a3o G.P.o ic7o no 5EPTIG -rAwK =• 330x15c),% =.4956.P. P. u5E 1000 GAl.. r 0%5P0 E5AL PIT V5 I o oD GAL• r ,Exp. D4YJA�L AREA o I Jo S.q Ir PR 5 L i5o S.F X 3?5 6RD. N P' BOTTOM AQE.Az . lYc 4F. 5p S.F.• x I• o = •5•0 G.P OF '7oTA%- C E516N * 4215 6-PO. �Lg I . 'TOTAL DA I L-"? F1-o1r! = 330 G•Po N PE2GOLATIoN RATE] I"iN VAIN OVLLE55• I -� 1I rN�•:,c� '-7 1 ALAN jk j '4 /1X 14►Z �;: JONES No. 25100 -TE=5T �'-/33/ To P FNfl f 48 - NoLE 6-2G 82 �y EGL 4� a Fi 4'� ^ I�•'4G. . I7AIR i LOAM ►ooa INV. , SvRso�L INS' ScvT►G ys'� INV: Bo?c 45•G TANK ' 64AJD1 4, LEAC14 PIT INV. INY. wlTu 45*7- 4S'4 YL ' WAc WGD 1. 6TvN6 SAND. (� � 1• j GERTIFIGo Pt-oT PL.AtJ I _ PRoFILG 1.o C A't►c N CEI.TTER�JI Lu=- 3S /z No SGALE 5 GALE ��; e c 'PATE lla W4 MM P L.A,W RE P Gzew GE 1 CS I TIFY THAT 'T1+f-- FouwAT►01J 5"OWW NEREoN GOM?U?5 WITH-T V4 SIDELINE --�-cu- A►.JW SETQAGK R.6QV1R-EMENT'> �01-r -TNE' -TOWN OF �A21�iTA-13t:.6 AMD IS I LOCATED WITNI T 6 F1..00p P a1N Couvr 3�54•� Dl1►TE s^VL+G1Ze NvE INC. Tu15 PLe.r.l Ili No'T �t�s�p > d AN o6TE2.vILLE- • MASS• i Iu5TR.uMEN-' SuQVGY THE OFF5E75 5uout,� r•-rr_v_Mi"r- L_.n'c- L_I!J17-�� AP.Pl. 1�A►-IT � ,��LS (� , SMI'I A APPLICATION FOR PLRCOLA`ION `I'ES'I AND Of L;ERVA110iv PI' S LOCATION a NO. P-f3 3 j VILLAGE \rt DATE APPLICANT --ac(\e-, K,r 1 Mn FEE__ ADDRESS S TELEPHONE N0:1I�y1�S (Non-refundable) _ENGINEER � � �� ",e, TELEPHONE NO.� DATE SCHEDULED (Applicant' s signature) • • • • • • O O O O O O • O • O O O O O • O O • • • • O O O • O • • • • • • • • O • • • • • • • O • • • • O • • • • • • • • • O • Y • • • O • • O • • • • • . SOIL LOG ,ISUB-DIVISION NAME Gq kg&22fL— DATE_ TIME EXPANSION AREA: YES NO XT-OL $ '.I+�a � ply ENGINEER_:,ii TOWN WATER PRIVATE WELL BOARD OF HEALTH k EXCAVATOR ;,.SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and ' ` . percolation tests, locate wetlands in proximity to test holes) i NOTES : 10 14- z 1 Vl\ Ii 11 I C Yl. �°RtYr i ^PERCOLATION RATE: TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: �1. 2 :� 1 n 2 I� 3 3 4 I 5 5 8 � 8 . _a t 10 Sin, 10 11 11 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB—SURFACE SEWAGE : LEACHING FIELD _LEACHING PITS__ LEACHING TRENCHES UNSUITABLE FOR SUBSURFACE SEWAGE. REASONS: , NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC VOPF PLICATION FORIGINAL: COMPLETED IN ENTIRETY BY P . AND RETURNED TO B HEALTH COPY: RETAINED BY APPLICANTP 4 F, -,163 (Y Da ,7r& Lb'CATION SEWAGE PERMIT NO. © 4 :;,2 L L VILLAGE INSTALLER'S NAME i ADDRESS 6UIL0E111 OR OWNER J si 4/r/y DALE PERMIT IS-SUE-0 _ D-AT E COMPLIANCE IS=SUED- . } ��� �}� � c r� . ;, ,,�: s.d._ - �., � � <.i ��.��,� , . �� 3 TEST DATE: 14882 ER b, 2015 7SOILABSORBTION GN CALCULATIOO S�0 L uES u �0� PERC# 14882SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE #461 LOW: 3 BEDROOMS X 110 GPD = 330 GPDWITNESSED BY: DAVID STANTON, HEALTH DEPT. NO GROUNDWATER ENCOUNTERED NK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT PERC AT 68 in - 2 MIN/INCH IN C SOILS TING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHERTRUCTURAL CONDITION. IF NOT, INSTALL INCHES HORIZON TEXTURE (MUNSELL) . MOTTLES 0 GALLON SEPTIC TANK. 43.70 0-8 Ap SANDY LOAM 10 YR 3/2 NONE FRIABLE ON BOX: INSTALL UNIT DEPICTED BELOW. 40.53 B-38 Bw LOAMY SAND 10 YR 5/6 NONE LOOSE RBTION SYSTEM: 38-123 C MEDIUM SAND 10 YR 6/4 NONE LOOSE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 33:45 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES NO GROUNDWATER ENCOUNTERED PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. 11 TEST PIT 2 THE 24 ft x 12.5 ft :x 2 ft LEACHING.GALLERY ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DEPICTED BELOW CAN LEACH: INCHES HORIZON TEXTURE (MUNSELL) MOTTLES BOTTOM AREA = (24 x 12.5) = 300 sq. ft. 43.65 0-6 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE SIDEWALL AREA (24+24+12.5+12.5)x2 = 146 so. ft. 40.65 6-36 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE TOTAL -AREA = 446 sq. ft. . 31.65 36-144 C MEDIUM SAND 10 YR 5/4 NONE LOOSE FLOW CAPACITY = 0.74 x 446 = 330.04 goal/day INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED BELOW. FLOW CAPACITY = 330.04 gol/dog WHICH EXCEEDS c' THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN. 1000e GALLON SEPTIC TANK TANK TO BE PUMPED DRY AT TIME OF INSTALLATIONAND FOR S O L A S R h T I O I\l INSTALL NEW PVCMINED OUTLET EET RUCTURAL EQUIPPED WITH AITY.GAS BAFFLE. S Y S T E ll/I ® ' REPLACE WITH A NEW o• •• •e e I in 1500 GALLON TANK -- - - _- D TAPER IF CRACKED, ROTTED UNIT ELL 24.0 ft OR OTHERWISE COMPROMISED. co ri 4, o S o I NOT CN - N . 4.. TO Ilk-':: . LoSCALE "NO STONE 3.5 ft 8.5 ft 8.5 ft 3.5 ft -- - -- - 8 ft-( -- - - 500 GALLON DRYWELL INLET OUTLET k DIMENSIONS & DETAIL CO VER CO VER INSTALL ONE INSPECTION RISER TO WITHIN THREE i INCHES OF FINAL GRADE 3 /N DROP USE & INDICATE LOCATION —� FLOW LINE H-10 ON AS-BUILT FROM = UNI T BUILDING 10 in = 14 TO 1^ D—BOX pD. 33 I . 48 /n oc�,olC, opp In AS .,� ool�gld!Q E V ELr `8;4 FF'L E - IC, tna '0 2 b in STONE BASE IF NEW SEPARATION BETWEEN INLET & OUTLET CROSS' SECTION VIEW / TEES, NO LESS THAN rLIQUIDD DEPTTH INSTALL AN APPROVED GEOTEXTILE CRASS SEC T l DI V VIEW FABRIC OVER STONE V •' 3/4 in TO ■ 24 in v 3/4 in TO 28 1-1/2 GRAVEL EFFECTIVE®' 1-1/2 in GRAVEL • ► ;e o in DEPTH a 46. 1 n 58 in 46 in 150 in 12 in - MIN FROM S � � -INSTALLER TO OBTAIN DISPOSAL WORKS. PERMIT BEFORE n1 TANK y TO N STARTING WORK: p ^ SAS -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM O O REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 6 in STONE BASE -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND 21 in 2� \ CROSS SECTION VIEW UTILITIES BEFORE EXCAVATING FOR SYSTEM. -ECO-TECH RECOMMENDS THE INSTALLATION OF LOW - - FLOW FIXTURES AND. APPLIANCES, AND PERIODIC PUMPING OF THE SEPTIC TANK. S -SYSTEM NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. t O W p O L C TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE SCH. 40 PVC - EL = 46.75 +- 6 in OF FINAL GRADE AND TO PITCH AT 178 in/ft MIN 44.0 -B0 3 USE H-20 _, _ __ - MAX EXDSTH3 41.00 EXISTING 1000 GALLOON aa000aooa000 011 0.0 0 p0000p000000a PRECAST o0000 00� �Cp��C� T���C 42.15 00 0�0000�°0o DRYWELL :0000�o aa� 40.38 000 0000o UD`O0 in aaoo 42.40 REFER TO DETAIL BOX STONE SOL ABSORPTION 40.55 5 EXISTING 6 In STONE BASE /F NEW BASE 40.2 65 ft 5-12 5 SYSTEM -REFER TO 4- DETAIL BOX q 38.25 NO GROUNDWATER Ln BELOW NO OBSERVED _ 31.65 SEWAGE DISPOSAL SYSTEM PLAN 14 ELLAS LANE CENTERVILLE, MA NOVEMBER 7, 2015 ETE-4001 PG 2/2 CENTERVILLE, MA 0 oko FALMOUTH ROAD �'E'�P �� 0CyU�S FOR ROUTE 28 � Ov _ (�O �� �(r n/�O� TI �UVu� LOCUS ROAD D n� �NSSA6LE GIS DgjU Q �Q m IlV m EL E V A T I O N NOT�q BROOK�, TO R° �F9s N O SCALE �TSpOT ON S�Ee, UMPS RIVER 90 V U §L�Q'r§ES B 9� THISISA WATER LINE L ® CUS MAGI ��� 0 R � GAS LINE - PLAN GAS GATE O USE COLOR PLAN ONLY OVERHEAD WIRE off FOR INSTALLATION UTILITY FULL DETAIL IS BEST POLE VIEWED IN 100 j FULL COLOR 44 p n 00 LOT f OT 2� I AREA = .20162 sf+— LAND COURT PLAN 35548-D EL E V n T§O S ASSR MAP 189 PCL063 ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS (BOTTOM OF PIPE) EXPRESSED IN DECIMAL FEET SEWER LINE OUT EXISTING SEPTIC TANK IN 42.40 SEPTIC TANK OUT 42.15 43 \ e MINIMAL D-BOX IN 40.55 PROPOSED SOIL�o PGRADING ROPOSED D-BOX OUT 40.38 ABSORPTION o LEACHING SYSTEM IN 40.25 SYSTEM BOTTOM OF LEACHING 38.25 / V" fe -SEE DETAIL / ® ON BACK Z / ® /\LI 2 �} D f ND ONENTS f« A STINGCH PIT/ SSPOOL BOX© � . TEST PIT IMI g� GARB GR \ 1 WE 1 OWED O 0 / 46 t / 43 - / �N yr M4SSq ��H OF MASS 44 122.26 ft e _ _ DAVID �yG� o�P DAVID 9�yGs 4 5 D. D. w� 46COUGHANOWR n o COUGHANOWR No. 1093 No. 461 �PF �p C PLAN GIST gPPRO EO " 1n � S � 0/l SCALE: 1 in = 20 ft �1 O 20 40 0 10 20 PRINT ON 11 x 17 in PAPER FOR PROPER SCALE - SEWAGE DISPOSAL ' SYSTEM PLAN -TO SERVE EXISTING DWELLING JEAN L. LOWTHER "`. 1995 J OWNER(S) OF RECORD 14 ELLAS LANE c V CENTERVILLE. MA THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM 155 Geo Ryder Rd S PROPERTY ADDRESS DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING Chatham, MA 02633 PLACEMENT OF ADDITIONS• SHEDS. FENCES OR SWIMMING POOLS, OWNER Dovidcou®HotmoiLcom IDATE. NOVEMBER 7, 2015 SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. 1 508 364-0894 PG 1/2 JOB+ ETE-4001