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HomeMy WebLinkAbout0129 ELLIOTT ROAD - Health - 12� Elliott Road ; Centerville P 248 313 r' t No. 4210 1/3 ORA 001 EmMaKo 10 0 . 0 0 0 � i � ��. �� �. t �, � e _�� op C-11� V �S � 7 75 >,5"O E f ..r k' E- S' k' i.: is f ti- yr t- 313 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name ! information is Centerville ✓ Ma. 02632 8/30/2018 : required for every a'! page. City/Town State Zip Code Date of Inspection J1 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 forms A. General Information S'�} �-- on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection 11110`4-�l Company Name 74 Beldan Lane Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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 by the Local Approving Authority 8/30/2018 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 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.doc•rev,6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Road Property Address Franko &Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 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: The dwelling located at 129 Elliott Rd Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 precast leach pits. The system was found to be in proper working condition at the time of inspection. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 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. I. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 129 Elliott Road Property Address Franko &Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 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 Y day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. Cityrrown 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 CM 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.doc•rev.6/16 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 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. Cityrrown 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? ❑ Z 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 gpd t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts �n Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Road Property Address Franko &Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. City/Town 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 Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8/2018 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. Cityrrown 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): Lt5ins.doc•rev.6/16 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 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 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: Original system installed 1988 with a new pit added, date unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3.5 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.): Joints ok, no leaks , vented through roof Septic Tank(locate on site plan): Depth below grade: 3 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: 1000 gallons Sludge depth: 6" t5ins.doc•rev.6/16 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 129 Elliott Road Property Address Franko &Toni Ivers Owner Owner's Name information is required.for every Centerville Ma. 02632 8/30/2018 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 3' Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet cover is on a riser. 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.doc•rev.6116 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 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. Cityrrown 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts is Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 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 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.): Distribution box was video inspected and found in good condition, no rot, water level was even with outlet inverts. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts 1, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2x1000 gals ❑ 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.): Leach pit#3 on as-built was found to have 2' standing water with a stain line 6" higher. Leach pit#4 on as-built was found dry with a stain line 2'from bottom. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration �h 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 l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form l' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 4 rti t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Road Property Address Franko &Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. Cityrrown 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 l F 1z /0 AZT A3 33 ,AY 276 3 L/ yg L' t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 115 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Elliott Road Property Address Franko&Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 page. Cityrrown 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 groundwater elevation: 1 Groundwater elevation was determined by accessing`Town of Barnstable groundwater contour map. It f Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 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 4� 129 Elliott Road Property Address Franko &Toni Ivers Owner Owner's Name information is required for every Centerville Ma. 02632 8/30/2018 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 ~4 �J t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ,Barnstable Board of Health 200 Main St, Hyannis, MA 02601 Agenda topic for,8/28/18 I am writing out of concern with regard to increasing the number of bedrooms located at 129 Elliott Rd, Centerville;MA. The lot next door 109 Elliott Rd, Centerville, MA map/parcel: 248-314 is for sale and adjacent to my property and we are currently looking into the possibility of purchasing the lot. Since 109 Elliott Rd is zoned for 3 bedrooms, I would merge the 2 lots to one to possible increase my house to a 6 bedroom. Currently,the size of the septic at 129 Elliott Rd is for a 5 bedroom with 2 leach fields. Our house, at 129 Elliott Rd, sold in 2008 and 2013 already twice as a 5 bedroom. See listing sheets, assessing field card, and the Title V Septic attached. However,the town would not let 129 Elliott be sold to us as a 5 bedroom in 2016, but allowed the sale to proceed as a 3 bedroom. Also, not far down Elliot Rd,there are properties with more than 3 bedrooms:, • 290 Elliott has 4 bedroom • 443 Elliott has 5 bedrooms • 439 Elliott has 4 bedrooms- • 494 Elliott has 6 bedrooms When I spoke with the Health Inspector Don Demaris on July 23, 2018; Mr. Demaris informed me that 129 Elliott had .39 acres and 109 Elliott Rd has .82 acres for a combined acreage of 1.21 and that doesn't provide enough land fora 4 bedroom since 1.33 acres is needed for a 4 bedroom. So it's short .12 acres. This doesn't make sense to me. I am troubled and alarmed that Barnstable Town would not stand behind their permit. This is evidenced by permitted a 5 bedroom, an enlarged septic,then took it back later. My fear is I could purchase the neighbors lot, approve my house as a 6 bedroom,then turn around and rescind by saying no after I've spent a lot of money and purchased the land. Rendering me with more land and not able to proceed. Kindly review all of the documents I've incorporated within this package, and I hope you can understand and be considerate of every effort I've raised and made to take into deliberation all factors of my case. I look forward to discussing this matter with you at the August 28, 2018 Board Meeting. Toni Ivers 129 Elliott Rd, Centerville, MA 02632 _ F v f p He;Sc�iF y� a*�i"'v Lp N 3- �i�' Attachments 08/06/2018 f P i Coiiim6nvirealth of Matssachuseits Tile 5. Official Inspection Form Subsurface vewa.ge:Jlsposatl; yst.om Form_Not for Voluntary.Ass menis - l 129 Elliott Rii. { Piopedy Address I SANTANDER BANK NA tJildner Owner.Name re iqu ired fore!lery nformation.re Centerville _ MA: 02632 10115114 - , page. CitydTown state Zip Ooi#d Irate of l iliectiort l C. Chledkil'st Check.if the following have been done. Yov trust indicate"yes°or°no"as to each of the'fcrllowing-. Yes No � Pumping i0fo nation was prowicted 4y the.c0ner,occupant,or Board of Healthw Q Were;any'of the.system componertts pumped out in ft prev'ious two weeks' 0 Has the systern.received normal flows in the previous two,wee period? F H4Ve large_iirilumes of Water been introduced to-the system recently or as part of tits inspection?- Were as built plans.of the system obtained and e�camined?(If they Were i,ot. available note.as_N/A) [� was the faciiity or dwelling inspected for signs'of s0age back u?. Was the site:inspected for signs bf'bM.'A-.otv. Were.all system cor'nponents,.excluding the SAS,locates#brr site? Were the septic tank iman'M'es.unc.pyered;opened,.and`fhe#teribr of the tank inspected for the condition of the.raffles or tees, material of construction,- . darriensaansT.depth af.1inuid,depth cf sludge.grid depth a#scum? . Was the facility owner rand occupants ff differentfirom o�itier)pro�rid witll Q- information.on the proper maintenance of subsurface sewage disposal systems? The size.and 4od.a#Iran of the.S.00 Absarptir n Syrstem. ($.A$)on the site has been dIeterrrfinedlbaso.-qn>. ❑ Existing Hdrmatioh.For ekarriple a plafi`atthe'Board of'Health: © Determiined ill fhe field(ffi any of the failure criteria related to Part C is at Issue apptaXiiriation of istanoe.is unancept blei 7b:. it'll .i5.302(3)j D. System Information Residential Flow Conditioiw: �. 5 Nut tber-bf bedrooms(desigfi) _l` fter of bedrooms(acts aly. DEStGN flaw based..an 31:0.CMk f".7tt3 0pr•'exarnple;11t1 gpd.x#.ai I$droorr►s): tsq;p=3N3. Tilt S'Oitldw InvatlI64 r-0m.sut surface S&*wa bip"it-%li y,P"a s of i3 Commonwealth of Mass chusletts :-- title a Official Inspection I=or�n Subsurface Sewage Disposal System Form-Not for Voluritary Assess rents I t 129 Elliott Rd. Property Address SANTANDER BANK FAA information is tJiVners Name ieoliad nor every Cente it#e MA.:_:�... 026 2......_ 10115114 Poe. ditynrown slate, dip code Date of Inspection Inspection results must be submitted on this forma.Inspectio forms may not be aiteied in any. way,Please see completeness.chec#ttist at.the end of the form, Irft outif ms n A. Genielral nforcrtaition r}iltng avt mama on ihp eomput,±t, - - . uso.only Ow..tali g, inspector. k< y io rai a yat }� i3Utbar :do l Ft Robert lyaolini . ' UsettWrktUM .._.,....�..�..:.._..._..._.J.—�__._.._ .........._._..._...___....... liey. Name of lnsptoor Robert Pool irl Septiq Service Company Name _ .__. .... ..... -....... 17 P rog and Lard _....__._. Gampatry Addresa �" - a:� Varmouthpo 4 MA 02675 CityYTown State Zip CodC 508 362-5555 S*$4 Tctephone Number Llcahse Nurrib:er a: Ceti e'ation l cerlify that I have personally inspected.the sewage disposal systern at thts:Address and that th.e. information.reported below is true,accurate and complete as of the lime of the inspection.The inspection was performed bese'd oft . tratnrrtg and' perience iA the proper function and*Maintenance.of on site sewage disposal systems. t ain a DEp approved systern inspector pursuant io Section 15.340 of Title S.(.39C1 CIVIR 15.660).The system: Passes El. Conditionally Passes El Fails 3. Needs Further Fwal.vation by the Locei Approving Authority Inspec4at"s SlgnaWre Da"te The system thspecior shall submit a copy of this inspection report to the Approving Authpnty:.(B'dar€! of Health Or.DEP).within.30 days of c6mpleling this irispecliuri.if the sys#tire is a shared syste n or has a design flow or 1 t},OOa gptf nr:greaier,the inspector and the system owner shall scibmi3 thee. report to the aporopriate regional office of the ljEP.Thie original should,be sent to the system owner a6d copies sent to the buyer,:if applicable,ant(the approving authority: #'.**This report only describes conditlons at the time of,inspection and cruder the conditions of use At that time This Inspection does not atloress how the system iastitt perfarrn in the future under tt e.same or dlffexerit.cor ditions Of:U.So. Ana•a?3� Yde�dffuraf bnp.c5an Eqmi$u4au�acc Sei..lti l)iat,a501 sYSCi+F.ygs�t g"12 i;emtnnwaath of 1VCassachltsetl„s Title 5 Official Inspection Form Subsurface Sewage Disposal_System Farm-Not for Voluntary Assessrr►arii -- 129 El(iattRd. Property.Address SANTANDER BANK NA i Owner' ownees Larne infrarFna[ sn is. Centerville _: required for every. _.. __.. page. Cityfra" state Zip Code Date of inspection S. Certification ('Cont) © Pump Chamber pumps/Warms not operational.System will.pass with.Board of Health approval if pumpstalarms are:repaired. S) System Conditionally Passes(cant.): Observation of sewage backup or break out or high static Heater level in the distdbut(ori box diie to broken or.obstructed pipe(s)or due to a.broken,settled or_urieven distributioti.box..Sy'tern will pass.inspection if(with approval of Board.of Health); n. broken pipes)are replaoed Y ] N ❑ NO(IExplain below); obstruction is removed D Y 0.N D IND(Explain belowy, distribution box is leveled or replaced 0 l' Q O(Explain below); ,I II 0 The system required pumping more than A times a year Clue to broken orobstructed pi'e(s).the system will pass inspection if(Hrlth approval of the Board of Health). broken pipe(s)are.replaced El Y 1 N Q Nb(Explain below)... obstrucfioti is removed 1 , Y N NC(Explain below): C} Further i=valuatiort`is Required by the Berard of Health.. 0 Conditions exls#.0tGh require.furfher.evaluation by the Board of 1-1 alth in order to determine if. the Systeiu is failing to protect public health,safety rarthe.environment.. 1. Sys(ein rtvill pass tan:less;l3oard cif Health determines inaccordance vie#la 31.0 GIVlR 15.3.03(1)(b)alert the system is n-ot functioning in a mariner which will protect public healil:4, safety and the environmobt, Gesspool or-privy its wi.M 50 foe€.6fa:surface water cesspool or privy Is.within 50 feet of a bordering vegetated wetland or a.sail marmh ($ 4 3FS TiVe 5 MOW kiVealw Foam Subsurtece SwAm a Disposal System•Berge 3 or:E7 t i Commorlweath of Mass; ohuetts Title 5 Official inspection r r Subsurface Sewaga Disposal>Sys'tern Form-Not for Voluntary AssessrrtenW f 129 Elliott Rid, P(dps�rty Add,,o SANTANDI~R BANK N Owner Ownees Name re Information Is Centerville IAA 02632 10115114 re for gory page, CCalLown state. Zip Code Oaie of 1r ipeciion j B.Certification (cont.) Inspection Sunmrnary::Cbeck A,B;C I�or E!a/atiiays i orrtpleta etl df SeCtigtl.p A) System Passes: I have not fourth any Information which indicates that any of the failure criteria described. in.310 CMR 15.303 or In 310 CMR 15.304 exist.Any.fa lure criteria riot evaluates a€e: indicated:below:: Comments: The septic system is in ro er workincZcrrder at the present tir»e 8) System Conditionally Passes: . One.or more system components as described in the"Conditional Pass".section Reed to be replaced or repaired The systems upfln completjQn of the replacement.or repair,as approved by the Board of Health,will pass. Check the boo for".yes";"no°or"not deterrnimeT(Y. , N;ND)for the following stateritirl.rtits.Ih"rtot . de#erininect;"pease.e5tplain. The septic tank is metal and over:2Q.years old*or.the se.pilplank(whether metal or not)is structurally unsol d;exhibits substantial infiltration or exfiitration or tank fal.vre:is imminent.System wit!pass Inspection if the exist ng tame is replaced with a i o.mplyiing septic tank'as approved 6y the Board of Health. *A rtietal septic tank will pass inspection wif:it is structuraily.sound,not leaking and if,a:Ce.rMcate of Co pliance ndicaong that the tank Mess than 20 years old.Is ay.allabl'. FI: Y ON N.D.,(Explain below): 156re+; TfU*5 Offit 1 lmpedi*n F•am;$0b*t0erft Sewage 0%PQW J Sya*+n- g q d?. Commonwealth of Massachusetts Title 5 Official Inspection Fob Subsurface Sees age Disposal System Form-loot forUOlttrrtary Assessmeas 129 Elliott Rd. I f'ropety Aifdiess ___. SANTANDER BANKCIA Owner Owners Name _ injortnatbo,16, Centerville 11tiA Q2 ��MS "utred for every PRO. cit,rpwn � State Zip Cade Oste of Inspecilon. B. Certification (colic) Pump Chamber pumpslala s not aperatior al.system will:pass with:Board of Health appri�Vai If purripslalwms are,repaired. B) System Conditlorially Passes(coat.): 'Observation of sewage backup or break out or NO static watef levW in the distribution box diia 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); 0 broken pipes)are replaced ld tilD(`Explain below): obstruction is removed YY E.N d ND(Explain below):: distribution box is leveled or replaced N. 0 ND(Explain below); 0: The system required pumping more than A trines a year due to broken or obstructed pipe(s) Tlie .system will pass inspection if:(+.;with approval of the Board of Health).: broken pipes)are replaced [I Y E) 1W Q Nb(Explain below)',. obstruction is reriioved , Y [t N F1 NIA(Explain betoiiV) C) Further Evaluation. U fletlt r€d by the.Board of Health, r Conditions exist which requiise,further evaluation by the Board of Health in order to determine If. .. (he:sys#slit is fail rtg to oEect:public boalth.,sate3y grtl�.e.e ivirczriment., . Sys#e>i rivrll pass tanl:sss B and of ii:ealth dstr rrriihea iri acc-a�rxlance w�flt 31 CIViR 46.3.i3(11)(b)that the system.Is not furictioning in a manner Which gilt protect public heall:4, safety and the enviroamgnt Cesspool or privy is within 5D..:feet of a sgrface_water [( Cesspool or pdvy.is,wiHn 50 feet of a bordering vegetated Wetland or a Salt Marsh . L".4`3Fi`S T1He 5 tktKial.ih pedion FMf SuLautfa4e Semp 013posel SywPin-F»ge 3 Lf.V* i Gotnmonweatth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-tJot fo€Voluntary Assess fonts IN Elliott Rd. __ + Property Address SANTANDER BANK NA._.—..._... ._ Owner Owner's Nome inrannsunn 0 Centerville. MA 01632 1061.14 required iorevsry Page. CitylTowEi Stale zip Code Date oflnsped'ion B. Certification (Pont..) 2. Sy*.tem will tail unless the.Board I H$a..lth. . d Public Water.Supplier,If any) Werfillnes thatthe system is functioning in a rnantler th4t. rotects the p'u.blic health safky and envlronrnentt t3.The systern has a.septic.tank and soil absorption system(SAS)afid the SAS Is vs+ithin 100#eet of'a surface water supply or tributary to a:surface water supply_. El The system has a septic tank and SAS and the SAS.is within a zone 1 of a ptiblrow�fel supply. i. 0 The system flan a septic tank and SAS and the SAS is vA hin 50 feet of a private mrater supply well.. © The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet Or more frorn;a.private water supply well Method Used to determine distance: This:system passes if the.well water analysis;performed at a DEp certified l9borat6ty,for fecal rolifon-n.bacteria indicates absent and the:presence of ammonia,nitrogen and nitrate nitrogen Is equal I to or less than 5 ppr,,provided that no other failure criteria are triggered.A copy of the analysis trust be attached to this fort,. 3, Other; D) System Fa lure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for aft inspectiops. Yes No 6acktip.ol'sewage into facility or system component:due.to ove.do.aded-or clogged SAS or cesspool Discharge or pandi,g.qi effluent to the surface of.the grour�d:or surface waters. due to.an overloaded or cragged SAS or.cesspool Static fiquld revel in the:distribution box above outlt=t invert due to an overloaded, or clogged SAS or cesspool U4Wd depth in cesspnpl is less tharl 6"below Invert.ar avallable Volume is less than 4/2 day flow ISl rr:'. 7 s 7HIe 5 OIBcii1 inapgda+`oMr,6Vbx sfece Sewage olip08»C Sy*Am•Pago 4 or 17 ' r i . Cortimonwealth of Massachusetts Title 5 Official inspe�ctcn `crm subsurface Sewage Disposal Sj stdm Fonts-Not for Voluntary Assessme s 420 Elliott Rd. _......_...__. Property Adddrens SANTANDER.BANK MA Cwurter: owner's Name tnforrriatian is Centerville MA: 02632 10f15f1d required for`ever'f _ — _ pane: City/Town ._ State zip Code Date of t rspection B. Genii daftoll (cant j I yet NO Required purnping more than 4 xirrtes in the last year Nor due to alt7gged'cir I 06structg4 pipes) Wrriber dtlmes pumped.. (Q Any portion of the SAS,cesspool ar'privy is below high groundwatereleva ion:. I Q ;Any portion of ciwsspool or pnuy is within 100 feet of a,surface water supply or tributary to a surface water supply. MY portion of a cesspooT or privy is within a pine 4.of a public virelL { Any portion of a cesspopl or:privy is within 50 feet of a.private waker setppTy well. .Any portion of a.cesspool or privy is less than 1`00 feet but greater than 50 feet from a private water.supply.well with no acceptable water quality analysis.[Thus system passes.If the well water analysis,.peirforrined at a DEP certified laboratory,for fecal colifoirn bacteria indicates absent and the presence of ammonia:nitrogen and nitrate nitrogen is squa.l to or less thari 5 pp'TR provided that.no.ott r failure criteria ere triggered,.A copy of the analysie i and chain of atrstody must be attached to this form'] The systems is a cesspbal serving.a facillity41th a cfesigri flow of 200©gpd .10.000gptl. The system fails,l have deterniitted that orie or more of the above failure criteria exist.as described€n 310 CMR 15..303:;therefore the system fails.7'tie system owner should.contact the Board of Health to detwM.lne what WM be necessary to correct.thefailure. E.arge Sjrsl arris� To be conslrlered.a lame system the system must serve a facility wilt a. rieslgti flow of'14,pillt gpd Eo 1.5,OQ0:gpd.. Ppr iarge$ystenls;you must:indicate either yes°or"no"to each of the fol owing,.in addtfiorr io:the questions in Section D. yes. No 0 .0. the system is within 400 feet of.a surface drinking water supply a .: the system is Within 2t10 feet of a kibutary to a surfiade orinIdn*g water sicppiy the.system is located.In a.nitrogen sensitive area(Interim Welfbpli d Protecttoxt Area.--Itf11PA).qi a mspprd Zone it of a p>ikitic eater srapply well If you have answered"yes"to any quostioft in Section Ethe system is considered a,stgnMoarat t4r'dot* or answered"yes"in Section .above the large system has failed.The owner or operator of`ariy 1arg4 system cons a ignifiaarrt threat'urtder.Sectron. .or,failed under Section D shall upgrade the system in-accordance with 310 CMR 15.304,The systam owner she vtd contact the.appropriate teglonal office,of the DOpartmeht. i Ff•:1? !.1ft 5 olroni:bi�clian PaIN 5 d T:. Commonwealth of Massachusetts Title 5 Official #ns .sect on form Subsurface Sewage Disposal System.Form Not for Voluntary Assessments 120 Elliott R& Property Address _ - -- SANTANDER.BANK NA. Owner 04mer i Name irrtorma to Centem1W MA 02632. 1.0M W14 ,are For every page. cityfrrn 5tteI ...... D. Syst6m Inkmatilon bescription NA Aiurnber of current residents: • ----�_ Does residence have a garbage gr nrIsr Yes .o Is.laundry on a separate sewage system?(include lauh-dry system Inspection information in this [ Yes Na, Laundry systern inspected? 0 Yes-0 No Seasonal use? Yes.El No Water teeter readings;lf.avalatile(last:2 years usags(gpd)) Detd- i i surnp.puirtp7 -yes 0 N"O Last date:of odCupatidy: NA. Dale , Commerciallindustrial Flow Condi'tlons: Type.of tstaOishment lies gtt flaw(based on 3'(0 aMik.16." t Gatbns per day.Lq d} Basis of design flows <seets/persorislsq::lf.,efc:X ;grease trap prese€lt? 0 `Yes NO indclstr►aJ waste t}oisfirtg tank present? I`Y s. 0 Non-saniterywaste ditcharged.to.the Title 5 system? 0 yes M Nd : Water.rrtete'r readi* if available. �,,rn.�+sj�� 7iltt 5 OfYrtiul�ispae[ioit�errq:3ub�ilaee:Sevla�7v.Olsposat 5yslam•Pape T at 3T { Co.M.Monwea#th of Massachusa t 1 WORM Title 5 Official Inspection Form Subsurface Sewt ge.Dlsposal System Form-Not for Voluntary Assisssti e. yo Elliott Rd. Property Address SANTANDER BANK RA Owner {apt�`ie Owner's Nam required ror every. Centerville MA 026t2 'liI V.14 pp.06 CIIY1Tawyt state :Zip Code; . Date of IrispedWn U. Syst. Inf rtl<latioin (cant) Last date of occu.pancyltase - Date Other.(describe below); i General Information Pumping Pocords; $aurce.o# fosrrtaf tor}; Robert Paolini Sgpfic:Servlce Was system pumlae4 as part:of the nspectiort d 1'es 0 No if yes,volume.punpert ,qaltons How was quantity pumped determinW — Reason for pumping: Type of System,. (�# Septic tank,distribution box,so]]absorolon system El Single cesspool 0 Overflow cesspool Privy- Shared system.(yes:or no {if yes,-attach pfev-idus in'specWn fecords,i any) tnnovat]vOAlternave techrialogy,;Attach a;copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the IAA system by system operator tinder corttrabt Q right tank..Attach a popy df the IEP apprpvaf.. . Other(desaJb6)..' iSrsia atfa. rids 5 0fridal h spec- Form:subswfies,o.5ew i j UispasW System i Paov 6 0.1 If .. F i ' E Commonwealth of Massachusetts r : .-IBMTitle Official Inspec n Fo� i Subsurface Sewage Disposal System Form-Notfor VoiunWr.y ASsessir3eti f 129 Elliott fed ....' Prattetty Address SANTANDEER BANK NA ovAer Owner's Name requmalfanrs Centerville MA 0.207 1{llt��_14 required for every _ Page.: CU/Town swke, Zap Code bat&jof Ins0criiih D. System W6010tion (cone.) . 1 A:ppfd.*Imate age of all components,date installed(if known)and source of inf6irnati6h!. i Were sewage odors detected.when arriving at the siiel Wes tdo i suitdlrto Sewer(locate on site plan): bepth below gfadlik Ir feet Material of construction; cast trbn M 40 PVC'. E-1 either(explain}:: _._.._ Distance from private water supply well or suction Me: V+ --- . feet: Comments(on condltion of joints,yarning,evidence of leakage;etc.): Joints appear tIOLNo evidence.of leakage. ystem vented through the build`{rtg vertu: Septic Tank(locate on site plan); Depth below grade.,grade., feeteel Mate,rial of construc:11on: concreti Q.metal (]fiberglass b.pofyethylelte tither(eia{r) I€ i Is..metal,.list years Is age:con'firme#ay a Certificate of.Compliance?.(attach a...popy of cent fIcate) D Yes 0 lva' ooa q i Omens.ions: 1. __.. Sludge depth. f81tm 3T73 Tft 5'ofr'M Wdpsaf n Eam..SubsWfwe Sewage la?spoeal sysiem•-os 9'61 17 r Commonwealth of Massachusetts 1 R - Y Title 5 Official Inspecilion FOM t Subsurface SeWage Disposal system Fortn-blot for voluntary Assessments 129,Elfttitt.11d. � Frropeify+4ddn:ss. SA14TANDER B-ANKN4. f WOW. .. owners Maino I Information I§ Centerville M� 02ta32 tegtthed for every' state. Zip Code Date aF Rie'eatintt e Gi:}Ta+vr ; CP. S:YsteM* fnfbftal O (cant) Septic Tank(pont). 31" Dtstarice from top of sludge to bottom of outlet tee or baffle scum thickness I]istance from top of scam to lop of ouHet.tee:or baffle — - Distance 1rdm bottoi n of scur;n to bottom of outlet tee of bafifte 12" - 'Measured How' were dlmenslons determined? Comments..{on pumping recotnmentfatigns,inlet and outlet toe or baffle coed uons structural irtitegrity, liquid levels as related to outlet invert,evfdence of leakage,etc.): pump tame every 2 years inlet and nutlet tees are in,plOce, P evidence of Ieakage,Tarik..appears' structurally sound -- Grease.Tcap(locate.on site 1,1e0�. Deod1.below tlMO•'' test Metartai of construction:. ' cor rete Q MOO fiberglass [Ipoloetli}+I..eite CI oifi x�itairi): l�llriettisicii"ts: Scum thickness Q stance from topsof scum to top_of nutlet tse or baffle Distance trot bottom.of sFum to boflorn of ouVet.tee or WOO, Cate of last puimp'Ing: Date t5tns-3lf3 TNe S QRIC1al 1r5gecT+.Pn FgrtL 5abaurtaze 8esvage0lspusal 6Ye O%�payo'40 at.TT k 3 a l Commonwealth of Massachusetts e Tine 1fl�ci 1Iris 1`6 Fa rr . _ Subsurface 5eWoge Disposal System Form'-Not for Voluntary Assessments. f 12.9 Elliott Rd. I Propertx Address: SANTANDER BANK NA Owner" ... owiiar s Name -._ at�rrn d Centerville <AA 0. 632". -10/15/14 ragsi r'=d fo fa�i sooty _._.. t__. page. CRY/Town State: ZIp.Code Data.of IhSP6 tian D. SyStem In#orrlr abon (con..) Cornments.(ort pumping recommendations,iriiet and outlet tee or bale condition,structural.iit y liquid. levels as related to outlet invert,evidence of leakage.;etc): Tight or Holding Tank(tank must be pumped at tune Afi'inspection)(locate cs site pPan): De th below ode ----- -- p. g? MateNal'of constractith, 0,caricrete metes. Q fiberglass [3 polyethylene Q other(explain): 'C3'rcnerYsiirns; Capacty:: gallons 17e5igtt 1=1C 1tiE gallons per day Alarms present: El Yee; .© No Alarlrl level: Alarm tinwarkirtn order. 0 Yes 0 No [date,of:last pumpinglz __.. Date Comments,(condition of alarm and float switches,etc. :. `.Attach copy of current pure ng.contract(required);is cz%p adacl'tad? Yes .No wm;310 -rifW S 4f6cW In%mcgM Form:Subsuiiace uO.P. pisposal sy-aWM Rugs 11017 I 1 Commonw ealth of I' assachusetts Title 5 Official Inspection Form, subsurface Sewage Disposal System For -Not for Voluntary Assessrl.ents t I 129 Elliott.;Rd. Property Agdias' -- SANTANbER BANK NA owner owner's Name rnraiirlat�on ie required rwbwry Cent#entilfe MA 02632 - ttSli 5t1 page: Cttyrrowrr Stale Zip code hate of.lnspedf on D: Systems Information (grant.) Distribution Box(jf present must be opened)gogate on site plan): No i Dept#i of liquid.level above nutlet invert.' i Comments(note tf.tipx IS tevel.artd.distribution to oUtfets equal,any evidence'of solids carryover,.arly evidence of leakage into or out of box,etc.): Box is level.toxflas two ouilet.laterals.No evidence of.solids:carryover.No evidence of feakag Pump Chamber(locate on site plat)* Pumps In working ordet': El 'Yes El. IV Alarms in working order. . Yes M1Yo'` Comments(rfgte condition.of pump chamber,condition of pumps and.appurtenances,etc.): *if..purnps Qr alarrris.are tiot.in v+rorking orcfet,system s a conditional pass.. Sail Absorption System{SAS)(locate on site plan, excavakion not required}; If SAS not located,.explain Why tsht!Vt4 Tile 5offi"l5PW;0n Famw Subsurface Ss+vage nYsposa%tie'a-ftge420r 47 i Commonwealth of Massachusatts w -- Tale 5 Official Insectio Form Subsurfatce Sewage Disposal System Form foot for Voluntary Assesst�ertts 129 Elliott Rd, Prppe1yAddress --- -- SANTANDER BANK IVA Owner trtkt7nialton€s. S3wner's dame ei qss red ror+v y Centery ill lU{A 0263.E. 1611:uI4 page. Clyl7ovtn State. Zip Code Date orinspeciton D. System Information (gor►t.) Type. 2 6:,xV WiWithZ leanhitg pits: number, stone' 13 leaching chambers r�uer _ _— — leaching ga1t nurfiberr [ le ichil'tg trench number,Length:. leaching tiels. nurnligr,climerisions; --- — overf bw Cesspool nurnber — Q innova6elaltemative.systern Typetname df tectaht tn4y; — -- _ Comments(notel condition of soil,sgns of hj draulic failure,level of pond hg,damp soil,condition of vegetation,eto.): Sandy soli No signs of hypracllic failure Leaching was dry at time of inspection;LP#1:stain line observed 34"oelow nvert.Ll7#2 stalrt line IT below invert:,____._._.. Cesspod1i(cesspoo)rhusE.be pumped as.parfo'f I isped6oh)Qocate on site.piano; Number:and.configura11''Depth'-top.of l3nuUtg inlet:lnutw:t( Depth ofro3sef. T _. Depth gf:scitrr[Payer . Dimensions of cesspool Materials ottmtruction inification of groundvtaterfni`rovr: 0 Yes 0140. tSMS+ Cori Sti6snF(aee Sewage dt"sB at SYsiem•Pa+3a 9 of{; i (.gmmonwealth..of MaSSA;.b.U!Wts T�tt� t� cia tnsPection Form Suhsutface Sewage Disposal S�fstem rrt Not forVolurttary Assessment 19: Fifiiott R.d ProperiY_Adifress SAtUTA�lt?ER>�A�IK 1�R. - bwneP . C>4vrae{s Naiiia tnformatton is MA 026� 10i15l14 aired for every Getet�liiie req. r10 code Date'ot irtis ectign page; CitylTown: .. , D. p 6r6 tnf grm.�tion (cant:} y etaton, nimeitts.irtote:condit on of oil;stgi s of hydrau[ic failuro,)ejai of pontli!?g condition` .v..�g. F V.y(locate on,site plan):. TStiateriais of construction.. Dimensions Depth of solids : . CdtTiments(note condition of soli.,signs of hydraulic failure;levet.ofi.poriding,candi on of vegetation, ): I i i a i "ri41C.�r3fr'�a Uxi(er1iR��w,tl;SuDewrate Sewage Ai;PQs�l.5y5�ener Pmpe to of 47 tSic.>.31J3 j I Corrtilnd0wealth of Mas.sachi soft Title 5 Official '!n.s pect on Forme Subsurface.Sewage Msposai Sjrs m Form_Not for Voluntary A.ssessmierAs `t2g EllfotlRd. 016pe4 Address" ! SANTANDER BANK NA ► Qiviter. i?vKtei'i Namf' In[ortna5orris. requaediorevery Centerville MA 22632. 1015114... i p&ge t>tiy/Town" State. zip bode . Pats.otIIn0*0on. i D. System.Information (cone) Sketch Of Sewago[Yisposal.System:Provide a view of the sewage 0isposai,system,including ties to. at least two pemfanant refer rtce landitiarks ar[ rsc friarks Locate elfWalls Wil4j.h.1QQ feet I:ocate wher6 pL is water 3upoy enters the tiufldin,g.Chock one of the'boxes b6id t+. 13 hand-sketch in the area below rfcawing attactred s$pai�tety- i . • i I I I 1. I I 1 I I 1 teaiv�►w+,�o�rnd4arnst ateuarASSHssing"Mds 112, f care•'rtA fw s; Imp.r n F ft:Sij faoe SwnQ�tTnpb9i!S i7iM1- �.lSot 1'7• j I t commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal Systern Form-Not for Voluntary Assessments 129: Elliott Rd. .- Property Address SANTANOER BAN_ KNA — Owner :Owners Name informationts Centerville ty�A. 02fi32 1p11�I14 ___ ragsiired fai every — page; C lroiiun State Zip Code Data.&inspection A* S�ystetin Inforrh"on (cont..) Site many: Check Slope .Surface.water Check ceIW shopw wiellS. Bottom of teaching 9' E 2timpted depth to:high ground water; teat Please indicate all methods used to determine the high ground water.elevation: ❑ Obtained from system design plans on record It etiedceti,date of design plan reviewed; bate w -- - Q observad site(abutting property/observation hole within.1 So feet of SAS) Checked with local Board of Health-gxplain:.. As-Built - ]. Checked with local excavators,.installers-.{attach documentation) Accessed USES database-explain: You must desc6be haw you.established tl+,e high ground water elevati n; USEUr SCS observaticirt well data.U'SED:Technical bulletin 92.0001 ahnual'.re-nges of 9rpp water elevations. $efars filing this Cttspettion Report,please see Report Completeness Checklist dih next page. ISMS•wig `me S OI6tiE1 k£apeaiw Faint:Sub adaee SM89a D3ry0sBt Syf£etn-Psge t6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c.M 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is Centerville MA 02632 5/25/15 required for 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 7/13/2018 Assessing As-Built Cards r TOWN OF BB STABLE LOCATION l aq JC I I OT iC. SEWAGE 11 VIILAG6 `FBhI�t� ASSESSOR'S WI-&Lor2 y INSTAUEERR'S NAME&PHONE NO. SEPTIC TANK CAPACITY ^ LEACHING FACLITY:(type) �•1.S GX� (size) /� <-NO._OF.-BEDROOMS S- —S .,JUILDER OR OWNER MOO/G thin DATE: COMPLIANCE DATE: ' Separation Distance Between tlx: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Fat Private Water Supply Well=##aching 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 fact of leaching f ity) Feet Furnished by rixoe= —37 roe QA(I- e, A � a 1 10 el J3 to y Ire �o http:l/www.townotbamstable.us/Assessing/HMdisplay.asp?mappar-248313&seq=1 1/2 290 Elliott Rd, Centerville, MA 02632 - realtor.=O https:?Pv%h,,.tt.rea.itor.com> Nlassachusetts> Barnstable County> C-enterville> Elliott Rd F-t, 1' 2 01? View 1 photos for 200 EIIlott Rd,Centerville .MA 02632 a 4 bed, ...The $444,500 estimated value is 21 38% less than the median tisunq price of S560.000 for the Craigville area. .... Sirn lar Hornes For Sale ;gear Centerville, NIA. 443 Elliott Rd, Centerville, MA 02632 MLS #72349684 1 Ziilow ntt y.r;���t nfi zillcr�v cam > Massachusetts> Barnstable>02632> Centerville 443 ELLIOTT RQ CEfl T ERVIL-LE. MA 0 632-3666 is a single-family home listed for-sale at$1350000 'waterfront Pre>perty located on the Centerville River in Oyster Bay,featuring 5 bedroorns.... shaded area, benches, small boat landing and absohrtely breathtaking.•iews for resiclents only. . . $0361084 bds>t ba325`'s qft 4439 Elliott Rd, Centerville, MA 02632 - realtor.co'10 https:lhnr A(.realtor.com > Massachusetts= Barnstable County> Centerville.) Elliott Rd Felt- 13 .012 .."<,<iewr 22 photos f&r 439 Elliott Rd. Centerville, MA 02632 a 4 bed;4 bath; 2761 Sq Ft. Ploperty Ove iow .1 Overlooking the Centerville Ri+.er, sits this court, paddle court, plaiground and small boat kayak iaunchino area, 494 Elliott 'Road,.Centerville., MA 02632 HotPads https rthotpads,com> MA> Barnstable Homes Home for Sale at 494 E:llicrit Road: 6 beds, S1'.6rn. .::. Located at the very end of Elliott Rd affording the ultirnate in privacy and encompassing......An expansive open floor plan includes a large 'Kitchen area vith granite ... Showing 3 of 4 schools. •L s .a,�,ar f, Wag Lyame: State Use:1010: ■ ■ ■ N■ Vision ID: 17$84 Account f# Bidg#: 1 of 1 See#: I of 1 Card l of 1. Print Date:Q8/03l21�� ■� �. / ■ ■ ■ ■: ELLAIND,.Rp137e�Y-It ET AL 1`i eve] ,:. Pa6helVater aved .-Descripl¢orr -:-� Cadz-��l rniszd°b'aluz 9'aS�iVlr�NDER S-�t1K�111. '�. 444 .i10RT11 11 ARIsT STREET _ o_. _ 4 _, 1 SIbiYI L: :<- 1010 - SLATE 100 : phe I . .,.. ESL SND 1070 165,400 165,30 17015 I�YIL�IINCTOi'i,DE 19801 3tE51DVTL 2070 1,a00 ABLE- �aaitioQar ne sUPPLEeItTALDATA - - la N..... o� rs =. } Plan-Ref'. 387197 Split Zoning Land C19 :[. p... I eT.Prop, xSR Q,ONY�I . .._ -.:. _., ..__ ...,- Fs ate - - . ... ...__ . _ DL I::. - _ - w Motes =- _ _ LOT J _ _ -- - ��_ 7SID; 1788i -._. ASS0CPll3e._ __.. .. RECORD OF;OWNERS'HIE , Bg=Y01JP� E�.SALE AATE- u Yr S�IL�a�ltl4� 1! - t._.. ,. _ .:.:329,300 _. I C PREVIt?US .SSESst1lE1V7S STOR`}� ELLANDHR BANK i IE __.. 230931 77 04/1712014; U ' I r 318,000f IL }r. Cade Assessed Value Yr_ Code .------ Id dalue Yr_ Code Assessed I atue m' �ELLA�t�,R08Y�1 R ET AL I 4637/159 03n 1n00S Q I 480 0tt0 00' 014 1010 262f100 R.].`,LL,.NTNDY►[.': =:: . I1Z60/� t_ ... .::. ._ _ 013e 1010 _�62:0D Ol?..1010., - ;CO..- -U.. ..:.- 104. 1998:L 1 1 L ,:. _.. _:,_.- - �.... .. .. _ ,• 1 f.:.1010_. 16aUOR Q13, ., ... .. oo..:. tf[_t<HA1EL._C 81'E�tDy�,I, - 9�78k?a3 --- — _ ._: __ _L010 ____ =113 .00: —. —=- - fl6!}511994._ r. . i 00-::- _:rI _ - �.._•- --- -- r.Q:.. 2i1f4 ]OIO a _. . •. _:_:.- -.._ 1500 013.•.1010- _ 1CBRIDE'aLS71N.G 3c`D �1E -.: ;._. 67? _. -- .. b00 . - - --0/329 _- --.051ht_1989 Q -1:- 2�8;360- = - I_C.Kt!la1S,L_aRRY"D. 148 - br67 ' Torat: 429 400 Tara! EXEMPHOArS OTHER ASSESSMENTS 7Ttrs stgntrntre acknowledges a►as f Gy o Daiv Collec;o�.os 43 lssesso K.. I Ysm T ae De cr' tiara 4mount.. Code Desc�J Iran -... 'Jtanber. =-atmotenJ:::: :. Car.+aa1 lnt . 201a VSC O RESIDENTi IAL EK-E�IPTlON 0 OQ TO Appraised Bldg;Value(Card) 210,000 AS'SESSINCsNEIGBBORHOO " Appraised XF. Value(Bldg).NBHD/5'UB NB ND Name PP B) ( e 52,=1fl0 Sheer Index Name Tracing Batch O1Q�/A ( CEwiL Appraised OB(L)Value(Bldg) I Appraised Land Value(Bldg) 163, 60 NOTES..... . P e 1 Special Land Value 0, Total Appraised Parcel Value 129,300 Valuation Method: C Adjustment: 0 Net e Total Appraised Parcel Value � 479,30 i t'LS�T%EI�r?tY(�E"=TO1fY : • .: i PermiJ ID Issue Date T a escrr rian Amount I In. .Dale %Co Date Co - atxments Date T IS ID Cd P ase/Rzsult F 201101536 03/29/2011 LN elation 5,000 100 1VEATHERIZ-E-L�iSULi f11Date v B37463 03/O1/1995 AD dditfan 985 01/15/1996 100 I RB' 16 Of re Review CE FL.NBAS ?3n4n0D8 03 1332790 0•I/01/1989 AD ddition 25,000 OLl15f1990 Ifl0 SCE ADD'N IsI P 16 n Oflice Review 831093. 08i0U1987 DlY e12irFg '65,000 OVIM988 100 08/17n007 03 JK 16 In Office Review E 112 S 1Dn5r_ofl5 04 JS 4-4 rive by inspeetian only IQ/t�n001 01 LPT 00 leac/Usted-IoteriorAct[ :. .:...... TI I SCTIl1Y ..- Use Use Unit L Acre L � Cade Dzs�71prfl n Zone D Front Depth Units Price Facmr S eera/Priem S.Idj S;L Disc Factor lar q Notldt S c Use S c Calc Fact d'. Unit Pr Land d'atue 1 1010 ingie Fam l�IDl,-tll RB 3 0-39 AC 124,000.00 21063 S 1.0000 .1.00 0107 1 aS 1.00 163,401, t i m m Total Card Laod Units: 039 AC Parcel Total Land Area:p 39 AC m Total Land Value:( 163,400 A ---- ----•-• - _ .. .:6......ic.. JrafE USe•IUIU Vision ID:17884 Bldg!#: l of] See#: 1 of 1 Card 1 of 1 Print Date:OSl02l2418 14:44 CONSTRUCTION DETAIL CONSTRUCTION DETAIL QiN Ti EVUED Element.- Cd' Ch. Dzscii�rion "`Eletrent Cd" Cn Discir uen .yle _= 3 Cotamak- — - - fodel oiand- ton. 01 . aured Conc � . N rode CAverage 6tonzs.. - ff -pirt 0 _ .. - Ba :S l3.Full= _I s' jVMD USE CO �ExteriorWall 14 ''oodsl3insle t Code Description Percent -ae... : 14 - _. ztenoc Nall ...,.. 10I0.. mole Fam ti1DL O1 l00 - _ oofStntctorz ... :. __...GablelHt - =- - -� _ - - - p - BAS . oof Cover J A�pb/F GIs/Cmp _..._ . ..... - - - . -- - tenor Wall I . Isstered _. _ �-- P 1 Z _._.._._ _ - 70 � 0 tenorNllalt2 -.' - 1 "all "' -'COST/hi.1I�SETVUATIOIY - terioi Flow l 4 Carpel t'.dj Base Rate 9 7.77 r 19. m 2 14 lzterigr Floor 2_:_; 2.... _ ardwood _: :. _._ ... •_ =- ---- =-'- -�,926 : .:: _ 28," _ LlttOttter:Ad W... _„ --Meat FueF== _ el _�•.- J P O.O - �= of - — -- _ -_ 8 Yp sCT ne 2002 BAS N draoms-r= 5 _Bedrooms- .-- � ep Code FHS 2 BMT N FUS ull Baths ` Remodel Rating . 26 GAR 0 2 BAS ... 1]a1f Baths 0. - ear Remedelzd;_ _-.._ - - -= 2 - - Extra Fixtures _. Bb97 _ '3 8 ` 3 �oa .- ... 1 OP ?atal Rooms 10 10 Rooms Functional Obslnc t atllStylexterna101rslns....- - Kitchen Sryt„ ast Trend Factor ondition 28 /o Complete r arall%Cond 9 Apprais Val r �' I Yam' ep Ovr Comment; Misc Imp Ovr �Iisr,Imp Ovr Coovrtent y_�'ss';az_�s��� �=�'-_ ��." _ _ �.�, -� t _�•'#+�� �•:`' = s eau ass -�. Accessory Apt lCwt to C3ae Ovr .?�:,-..s �•��,• _ _ -t 'Cast to Cure Ovr OB-OUTBUILDING.1z YARD ITE�]I�S(L)/XF-BUILDING�A FEA7'URES(B) Ccdz Desert rioxi Sub Svb Desch i L� Units Unit Price Yr Gde 4t Cnd o�Cnd Ayr Yalue ,PAT] Patio-Aierage 88 7.05 000 00 QUO L2 Fireplace 1.5 st 4,575.00 002 00 ;100 RR smt Rec Rm-! 00 '7.40 002 0o ,600 :;-"_ ..... OP (Open Porch-ro. 2 44.00 002 l 00 800 GAR Ikttacbed Gara = '• : s b©.00 002 c` oo' 6,zo© �MTi• Basement-Uali: ,056 23.00 002 1 100, 21,700 BVZLDEYG SUBARAA SUd13fARYSECT3UN Cede Desert Lion Living Area Gross Area L _Area Unit Covt lode rec. VratueRAS - - - irst Floor 1,348 1,348 1,348 87.77 118,314 i,Wf asement Area 0 1,056 0 0.00 0 S AfStory 4" 888 444 43.89 38,970 P pen Poreb 0 32 0 0.00 0 " '."` -0 IFUS Peer Story 896 896 896 87.77 78,642 ,�. GAR 4ttached Garage 0 728 0 0.00 0 Vr7 O afio 0 288 0 0.0D 0 <l m Csrom LiIvLe 2,688 5 2 6 2,688 233.926 p 5/18/2015 ccimis.rapmis.corr iscripts/mg rq ispi All • 11�It11tRAY* Yn LV.S_ ... .. , s Q rlrr __ f � •t P` a a 129 Elliott Rd Centerville,MA 02632-3658 LP$599,000 This very private 5 bedroom,3 bathroom home is situated amongst stone walls,large mature trees and natural surroundings.The 2,800 s.f. home has a formal living room with a fireplace and built-ins,family room with a 2nd fireplace,library with built-ins,hardwood and tile flooring,finished basement,attached 1.5 car garage.Second floor has.5.bedrooms,2 baths,and laundry area.There is a separate, abutting.82 acre lot that is also available for purchase.The buildability of this.82 acre lot must be determined by buyer. Listing Number 204012.39 Year Built 1988/Approximate Style Colonial/ P rope rtyType Single Family _�_ � Subdivision Rooms 10 �ms--5 Baths F/H 3/ Presented B . Bonnie J Chase Coldwell Banker Murray R E Primary: 774-209-9954 490 Main St., Rte 28 Secondary: 508.432-6600 Harwich Port, MA 02646 Other. 508.432-6600 Fax: 508-432-3139 E-mail: bonniechase77@yahoo.com Web Page:hftp://bonnie.chase@coldwellbanliL-r.com Printed by Coldwell Banker Murray R E on 05118/15 at 4:30pm Information has not been verified,is not guaranteed,and is subject to change.Copyright 2015 Cape Cod&Islands Multiple Listing Service,Inc.All rights reserved Copyright©2015 Rapattoni Corporation.All rights reserved. U.S. Patent 6,910,045(Residential Flyer w-Addl Pics) 16isting Pfint Page http://www.mispropertytinder.com/print/detail_pt:asp?listingid=214... �i _._____- .-----------.--.-.___---------.,----------_-------------._-._.-_--..._...----_._.____.__.._..-..____.- .--__...-_--._.__._......._........__......... ._., PROPERTY LISTING BARNSTABLE: CENTERVILLE, MA 02632 sr 129 Elliott Rd { County: Barnstable Listing Price: $334,500 H Status: Active Total Rooms: 9 Total Bathrooms: 4 Full Bathrooms: 4 Total Levels: 2 Style: Colonial Square Footage: 2,688 Square Footage Source: Assessors Records Year Round: Yes Year Built: 1988 Year Built Desc.: Actual PropertyType: Single Family Listing Number. 21410046 Remarks: Bank owned 5 bedroom 3+bath Colonial in great Centerville neighborhood.Needs TLC and new roof,septic passed. INTERIOR EXTERIOR TAX Basement: Yes _______.__..._..._.. Acres: 0.39 Annual Tax: 3 836 fBasemnt_Descxption__Bulkhead Access,Finished , Lot Square_Footages 16,988__. Tax Year: 2013 - - -'--.... .. -.... - - .. ._... Floors _. __. Hardwood�Vmy_I__ Lot Size Source _ Field Card _..._._,- Total Assessments: Yes TgM_raphy Desc: __-Interior,Level- - Land Asmnts: $173,900__._ HeatmgfCoolirx .____Oil,_Hot Water.-_^-_ Foundations Concrete Im _ovement Asmnts: 210 000 Hot Water: Electric Flood Zone: Unknown To Be Assessed: No Separate L'nriN Qtrs_No _.. Water/Sewer/Utility: Septic,Town Sewer Subdivision:„ - M Spring Meadow Roof DescrJptlon:. _ Asphalt.Pitched Zoning_ residential SidingDescrtptrom Shingle._ Association: Unknown Street_Descr ron Cul-De Sac,Paved Assoc.,Fee_Year 0 Number of Cars: - 2 Garage:.' Yes ----- _-.------_.._.._....- Gara4D—es SCHOOLS - ro : --..------._ Pool: No Water Access: Sound BEACH Waterfrontt No _- _...... Beady Description: Ocean Water View: No Miles to Beach: 2 Plus_ ._.-.._........_-. _. _.__.._..._...__...__._...._._.___..._....__-..--._. ._.. Dodd.-----_...___-----No Beach Ownership: Public --.----- ADDITIONAL Exterior-Features_ _-, , Yard Convenient To: Golf Course,House of,Worship,.Medical Facility,School,Shopping__... Amu pi _ eJ ' I �YY11 i 1 � V U 1 of 3 V `�� V C= 3%23/2015 10:32 AM v\ �. . .. ,. laNO `n-o>rar �� ,SWISS ..3 �. �,,, t om 3✓f`S :r-,e.� t�w-c"'rg'4'S z �..- Ego -�-�: � : y to p- . "�'.� .ram` ` r F ,ey�,�, z %_� ' no MINE AN MR - ' "-'` .�' 's'" ..tom ....,..L „�?- h-:.., 1 ,„Y.,r,_.,'�ry3oil, TIT i"3^v " z J y ap...3r f Ie 711 � 3 s - NA � J,a r 'ck'i5`w� � uatti,�Ky.S- rM nr a'.' , fie^ 1' S YAW d bx `'vr�; ,�, RED SWERRIT can tl f nr 14 r)lei r IMI I RIS Nil. r r ..y.; � ea �� _ = r 1. � �::n ��,,,,E r rt � a C t '. .,�hi•g,.`" r sAp �K t 3 f zz � L Mt �VQF 1� s � k 51 k } ` r r It AZ ,43M MAN TMM Rn j - go -- .` '" ,76 gz Rl me a � roar ?a" �,, g=� '•� -#� � .^ ;�' :r; v��,.'f .. - s k xY. �� is r :11 ••:1 • . • . .. • • rrr . . .- r � � a 1 � � • 1 o.r • \mac,,; ,,` 9 16( y O 4�;I 9 fi , •,. . • � �+�0 CERTIFY THAT THE SHOWN OIl9..TI'Ila PLAN IS. ,"p��Ka��� k{,r¢; k� LOCATED ON:THE GROUND PAUL A N AS III®Q CATEO u LEVY P NO. 10617 ' I _ eyy DA R GIST LAND S RV- OR LEVY 'VE-LDREDGE AS80CIATES,INC. CLIENT �x� _ � Off"° ! �, . eoo .ham �, ENGINEERS — LANDSCAPE ARCHITECTS : JOB WO," �l`�I PLANNERS— LAND SURVEYORS OT` �O�•() OF DR, '.�,.-.,,,,o,�.,�,..., s' ,. 8ff9 1dY5T .MAID STREET CI . Ytr,....�, Lt a TOWN OF BARNSTABLE. LOCATION I I 1 (2 SEWAGE # V LLAGE CeA o f V,I t ASSESSOR'S MAP & LOTay�� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) A r J GX(11 (size) /0" NO.OF BEDROOMS S "C BUII,DER OR OWNER ;PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet . Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching,facility) ��— Feet Furnished by Spe Cis tgAlk . A � f 10 y/ 3 S a fa ys 3 10 n,r I �tNe tpp�, Town of Barnstable Barnstable MA s..xtvsrna>rF, + . g Board of Health rfc3�s 200 Main Street, Hyannis MA 02601 2067 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi RE: 129 Eliott Rd. Centerville 6/16/2015 To Whom It May Concern: The above referenced property was found to have 5 bedrooms. The property is in what is called a Zone 2, which is a well recharge area which supplies our drinking water. This property was permitted to have only 3 bedrooms. Two bedrooms were added without permits. We will allow transfer of said property with the stipulation that the new owners will alleviate the discrepancy within six (6) months of purchase. I require that we be notified of the closing date. Any deviation will be met with $100 per day tickets issued by the Board of Health. The new owners can feel free to contact me for consultation at no charge. Donald Desmarais R.S. Health Inspector Town of Barnstable 508-862-4740 donald.d.esmaraiska,town.barnstable.ma.us Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\68 Sturbridge Dr.Dec2012.doc 71 v"�ab - -- -- - ----( &a -te- v u-tu't, t-�-ym' 6-o z 51 -3ggo -- -- - - -_Lln�`�@ o�►'v`� C ��bY►�-J _ rn Q,r�a C� G�, � . C fY� _ ._ i i 5/11/2015 Joly,McAbee&Weinert Real Estate 129 Elliott Rd, Centerville, Barnstable, MA 02632 LISTING # 21410046 Bank owned 5 bedroom 3+bath Colonial in great ❑■ Centerville neighborhood. Needs TLC and new roof,septic passed. E ,PROPERTY SUMMARY List Price: $334,500 City: Barnstable Village: Centerville h. W7 County: Barnstable 13 Property Type: Single Family Bedrooms: 5 a Full Baths: 4 r Fireplace: No Garage Type: Attached Basement Type: Bulkhead Access, Finished 101 Miles to Beach: 2 PlusAssociation: UnknownYear Built: 1988 Style: Colonialoil Living Space: 2,688 sgft Acres: 0.39 Zoning: residential Tax Year: 2013 a Taxes: $3,836 i Total Assessment: $383,900 r Living Room Area: 0 Living Room Dimensions: 0 x 0 `'°'— y Dining Room Area: 0 Dining Room Dimensions: 0 x 0 Kitchen Area: 0' Kitchen Dimensions: 0 x 0 Master Bedroom Area: 0 Master Bedroom 0 x 0 Dimensions: Bedroom 2 Area: 0 } Bedroom 2 Dimensions: 0 x 0 Bedroom 3 Area: 0 Bedroom 3 Dimensions: 0 x 0 Family Room Area: 0 Family Room Dimensions: 0 x 0 Foundation: Concrete Roofing: Asphalt, Pitched Exterior Features: Yard Heating/Cooling: Oil, Hot Water LISTING AGENT httpJ/www.capecodjmw.com/propertiesAisbrig_sheet/22208147 �,,,,_ 1/2 5/11/2015 Joly,McAbee&Weinert Real Estate Agent: John Weld Cell: 508-280- iohnweldCaDcapecodimw.com 4414 ' t a lo, I' l e 1) Disclaimer: Courtesy of Joly, McAbee&Weinert. Disclaimer:All data relating to real estate for sale on this page comes from the Broker Reciprocity(BR)of the Cape Cod & Islands Multiple Listing Service, Inc. Detailed information about real estate listings held by brokerage firms other than Joly, McAbee & Weinert Real Estate include the name of the listing company. Neither the listing company nor Joly, McAbee &Weinert Real Estate shall be responsible for any typographical errors, misinformation, or misprints and shall be held totally harmless. The Broker providing this data believes it to be correct, but advises interested parties to confirm any item before relying on it in a purchase decision. Copyright 2015©Cape Cod & Islands Multiple Listing Service, Inc.All rights reserved. �Sb�erg�l�ts�s Onlln¢_ t httpJ/www.capecodjmw.com/properties/listing_§heeV222208147 2/2 Postal CERTIFIED IVIAILj � RECEIPT .. . Coverage n' . m ra OFFICIAL USLrl Q Postage $ NN IS M Certified Fee �O r� 0 ReturnReceipt Fee �,_Postmark �J p (Endorsement Required) ere O / v O Restricted Delivery Fee 15 (Endorsement Required) O W Total Postage&Fees Ns ps P� o Santander Bank NA P- 824 North Market Street Wilimington, DE 19801 Certified Mail Provides: ■ A mailing receipt F ■ A unique identifier for your mailpiece ■ A record of delivery kept by theFPostal Sewice for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt maybe requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. " PS Forth 3800,August 2006(Reverse)PSN 7530-02-000-9047 _ UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box* r Town of Barnstable i Public Health Division j 200 Main Street Hyannis, MA 02601 F_a �rti�r}lillitr�;�Ili�j ,,i3+ll'1��(��la�lll!l1t11li9�iil1�Flliiil SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. S' attire item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that We can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ 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: 1 `'i If YES,enter delivery address bi 1. tEl No lk Santander Bank NA �!,v 824E=North Market Street Wilifimington, DE 19801 3. Service Type ❑Certified Mail® ❑Priority Mail Express- ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service labeq Ps Form 3811,July 2013 Domestic Return Receipt r e� ' l 4 Town of Barnstable Barnstable Regulatory Services Department RAMSTASM Public Health Division I 63��,+ 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Riochard V. Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7014 1200 0001 0358 3995 June 18, 2013 Santander Bank NA 824 North Market Street Wilimington, DE 19801 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 RE: 129 Elliott Road, Centerville, MA The septic system located at 129 Elliott Road, Centerville, MA was last inspected on 5/25/2015 by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Passed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00). Although the septic system at 129 Elliott Road technically "passed" inspection on 5/25/2015, it was determined that there are too many bedrooms in the home. Four bedrooms were observed, where as only three bedrooms are permitted for this property located within a nitrogen sensitive area. Please contact this Office within twenty (20) days to inform us how this situation will be rectified. Telephone (508) 862 4644 Pmas ER OF T E BOARD OF HEALTH cKean, R.S. CHO Agent of the Board of Health c Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\129 Elliott Rd Cent Jun 2015.doc l VKWE Town of Barnstable Barnstable Public Health Division ""mu`c'C"" MRNSeast.e. I 9MASS. 200 Main Street, Hyannis MA 02601 2007 fp µp'l Office: 508-8624644 FAX: 508-790-6304 OPTIONS FOR RESOLVING YOUR BEDROOM COUNT ISSUE Are you being told that your application for permit consists of too many bedrooms or other rooms that are considered "bedrooms?" Here are various options for rectifying this issue: A. Eliminate Privacy - Provide a minimum five (5) feet opening for new construction (see back of page for more details); B. Record a Deed Restriction (see back of page for more details); C. Submit a Neatly Drawn Full House Sketch Plan and Submit an Affadavit; this is for pre-existing dwellings only. (see back of page for more details); D. Construct a Secondary Treatment Unit (see back of page for more details); E. Offer Aggregate Land (see back of page for more details); F. Schedule a Hearing Before the Board of Health (see back of page for more details. I NOTE: Assessor's records have no bearing in regards to the number of bedrooms at a dwelling. r MUTIPLE OPTIONS AVAILABLE FOR RESOLVING YOUR BEDROOM COUNT ISSUE A. Provide a five feet opening a minimum four feet opening is required for pre-existing construction where five feet is not possible for example due to existing width of hallway where subject doorway is located) without any obstructions to eliminate or reduce "privacy" to a room which would otherwise be considered as a "bedroom." No glass doors, blinds, hanging beads, shower nor an other obstructions shall be installed within the five feet or four feet opening. curtains, o y Please submit full house plans with labeling each room within each level of the dwelling including within the basement, finished attic, and any outbuildings. Also include measurements of openings. B. Provide a Deed Restiction- The applicant may seek approval for a smaller number of bedrooms than are presumed in the "bedroom" definition by granting the Health Division a deed restriction limiting the number of bedrooms to the smaller allowable number. C. Provide a House Plan and Provide an Affadavit- Pre-existing Dwellings with additional bedrooms or other rooms which are considered "bedrooms," please submit full house plans with dimensions of openings to/from rooms and include labeling of the existing use of each room within each level of the dwelling. Include all rooms within the basement, finished attic, and any outbuildings. Also if this option is chosen, an affidavit shall be submitted from the owner or previous owner of the home clearly indicating what was/is the actual number of bedrooms in existence at the property since a specified date before 1986 if located within a zone of contribution to public water supply wells (Zone 11, GP, or WP Districts, private wells), or a specified date before July 2008 if the property is located o*within a saltwater estuary district D. Construct a Secondary Treatment Unit- There is a provision within Title 5 which allows for additional wastewater discharge flows if the subject property is located within a State designated Zone II and a secondary treatment unit is installed. For example on a 20,000 square feet parcel, it may be possible to obtain a permit for three(3)bedrooms if the proper secondary treatment unit is selected and installed. This option is not applicable for requests of four bedrooms or more. This option requires a hearing before the Board of Health for approval of the monitoring plan. E. Offer Aggregate Land - Schedule an Informal Discussion before the Board of Health first to discuss this option. Provide information relative to the proposed credit land (i.e. location, what is currently constructed there) and details regarding your proposal (i.e. number of bedrooms requested). , F. Schedule a Hearing Before the Board of Health-You have the option of requesting an informal discussion before the Board free of charge. Four copies of such your request(i.e. written letter of request, full house plans) shall be submitted at least fifteen (15) days before the next scheduled meeting date. The Board meets monthly usually on the second Tuesday of each month. If instead you seek a variance, there is a required fee of$95. Please be aware that there aren't any variance provisions within the Town of Barnstable Code relative to groundwater protection (GP) and well protection (WP) districts; therefore the Board does not have the ability nor the authority to grant variances in regards to the specific Town Ordinance which limits wastewater discharge flows to 330 gallons per acre per day within GP and WP Districts. There is however, a variance provision provided within the Saltwater Estuary Protection Regulation. Imo.... F• _.e7// 4d� 1 t © UJ2 G tS ) ZCI L,7Ii 0 4 ��L�c�2 — o -- I j ` I IT �I • Ji � � I 1 f •f I I� yy � I�f III �1 _.l r 6/9/2015 Parcel Detail w k1AS5, Logged In As: Parcel Detail ruesday, -June 9 2015 Parcel Lookup Parcel Info Parcel ID 248-313 l Developer Lot LOT4 Location 129 ELLIOTT ROAD ' Pri Frontage l Sec Road Sec Frontage l Village CENTERVILLE Fire District C-O-MM Town sewer exists at this address No Road Index 0492 l Asbuilt Septic Scan: ry Interactive Map 248313_1 m Owner Info CO- Owner SANTANDER BANK NA Owner r Streeti 824 NORTH MARKET ST street2 SUITE 100 city WILMINGTON State DE (zip 19801 l country Land Info Acres 0.39 use Single Fam MDL-01 ( zoning RB Nghbd 0107 Topography Level Road Paved Utilities Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1988 Root Gable/Hip Ext Wood Shingle J Built . Struct .. Wall Living 2688 Roof Asph/F GIs/Cmp AC None Area Cover Type style Colonial Wall Plastered Rooms nt Bed 5 Bedrooms Model Residential Int Carpet Bath 3 Full-0 Half Floor Rooms Grade Average Type Hot Water Roomotasl 10 Room Stories 2 Stories Heat Oil Found poured Conc. Fuel ® ation Gross 5236 Area Permit History Issue Date Purpose Permit# Amount Insp Date Comments 3/29/2011 Insulation 201101536 $5,000 WEATHERIZE- INSULATE 3/1/1995 Addition B37465 $985 12 CE FINBAS 1 :00:00 AM:00 http:/fissq l2/i ntranet/propdata/Parcel Detai l.aspC?ID=17884 1/3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface_Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is JCentervilrequired for every le MA 02632 5/25/15 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 forms A. General Information �O 2 on the computer, �� I0 use only the tab 1. Inspector: I key to move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service ICI Company Name 17 Playground Lane Company Address Yarmouthport MA 02675 City/Town State Zip Code 508 362-3555 S14454 I',H C_ HLf 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 by the Local Approving Authority ice• 5/25/15 Inspector's ignature 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 L Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 page. CitylTown 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: System is within Zone 11 permited for 3 bedrooms 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 Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 page. Citylrown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cunt.): ❑ 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 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 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 ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•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 "t 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 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: ❑ . ❑x Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑x Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ O Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑x 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•3/13 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 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name required for e information isvery Centerville MA 02632 5/25/15 page. Cityrrown 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 C] ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑x Were any of the system components pumped out in the previous two weeks? ❑ ❑x Has the system received normal flows in the previous two week period? ❑ ❑x Have large volumes of water been introduced to the system recently or as part of this inspection? ❑x ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) M ❑ Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? n ❑ Were all system components, excluding the SAS, located on site? ❑x ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? 0 ❑ -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: 0 ❑ 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): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 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 129 Elliott Rd. Property Address SANTANDER BANK NA. Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ❑x No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑x No information in this report.) Laundry system inspected? ❑x Yes ❑ No Seasonal use? 0 Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): na Detail: Sump pump? ❑ Yes ❑x No Last date of occupancy: NA 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 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Robert Paolini Septic Service 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5125/15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑x No Building Sewer(locate on site plan): Depth below grade: 1' feet Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints spear tight.No evidence of leakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 18" feet Material of construction: 0 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: 1000 gl Sludge depth: 5" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for-everyCenterville MA 02632 5/25/15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 211 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or.baffle 12" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 129 Elliott Rd. Property Address SANTANDER BANK NA Owner owners Name information is required for every Centerville MA 02632 5/25/15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has two outlet Iaterals.No evidence of solids carryover.No evidence of leakage. 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 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owners Name information is required for every Centerville MA 02632 5/25/15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑O leaching pits number: 2 6'x 6'with 2' stone ❑ 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.): . Sandy soil.No signs of hydraulic failure. Leaching was dry at time of inspection.LP#1 stain line observed 34"below invert.LP#2 stain line 13"below invert. 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 Forth:Subsurface Sewage Disposal System•Page 13 of 17 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is MA 02632 5/25/15 required for every Centerville 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 . 4 B A, � Ia 4/ 3 . a ra yS � . 3 10 y Ira �o � a7 y8 httplhnww.towrdbar staWaus/AssessingMMdsOayasp?mapper=240136W1 w. _ � To 5 Mini kapedw Form:Subsuftw Sew&P olaposN System•Pape 15 0117 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 page. Cityfrown 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129. Elliott Rd. Property Address SANTANDER BANK NA Owner Owner's Name information is required for every Centerville MA 02632 5/25/15 page. Cityrrown 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: Bottom of leaching 9' 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: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. 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 ,•"v 129 Elliott Rd. Property Address SANTANDER BANK NA Owner owner's Name information is required for every Centerville MA 02632 5/25/15 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑x 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 0 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 Page 1 of 1 R, Desmarais, Donald From: Franko Ivers [f ivers 1 @yahoo.com] Sent: Wednesday, September 02, 2015 8:38 AM To: Desmarais, Donald Subject: 129 Elliot Rd, Centerville, MA Dear Inspector Desmarias, RE: 129 Elliot Rd Centerville, MA We have completed the 5 foot opening as you've required. There are photos attached to show you how it came out. Therefore, we are asking you to kindly release the septic title v cert to us and have provided our Post Office Box. Please, let us know if you need additional information. We appreciate your assistance in this matter. Sincerely, Toni and Franko Ivers PO Box 1171 Framingham, MA 01701 508/314-3990 6/14/M 16 r AMOM -THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH TOWN OF BARN TABLE � S App iration for Di►ipasal W,arkB Tomitrurtiun Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( an' Individual Sewage Disposal System at: �-�. �, _L�_v ---...�.......-•--_.... -•----•----•----------------------•--.....-------------•--•------•••••------•---•---...------..... • - -.-.. .... ---- n oration-Add less or Lot No. t f {r'F1Wi'� Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.....�----------------------------------Expansion Attic ( ) Garbage Grinder ( ) 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 I i�iu �.��gallons Length....-.---- Width-. .......... Diameter................ Depth................ x Disposal Trench--No. .................... Width.............--..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------,--------.- Diameter-----/.0."...... Depth below inlet----6. ......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►.-t Percolation Test Results Performed by-------- ------- ......................................................... Date........................................ 1 Test Pit No. I................minutes per inch Depth of Test Pit---.-..---.--------- Depth to ground water.....................--. G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C ---------------•-------------------------------------------•------. ------------•---........-•----........................................................... 0 Description of Soil........................................................................................................................................................................ ----••---------------------------------------------------------------------------------------------------------------•-----------...------. ............... U Nature of Rep irs or Al erations—Answer when a plicable.-------- '(/�- ([.�.....�. ------/ ................ --------•---- �.�� - - -...._. = ------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com alT s b�21 is ued rd health. v c Signed ..-.:.... .. ................. ` . .7' Dace Application Approved By .......... J U....� .. �...-...9.-..Q..S�r. 1e Application Disapproved for the following reasons: ....................... ....................... . ........................................................ . ............................................................. q� Dare 7 Permit No. ,F..4.. 3....e- ---------------- Issued .........................................................ia ...... Dare h3..,rv"Y:r"*+,t,�Y'"'•yi.--...�ro�.ao`.�,f....-,.....e.:«t—'tc;�;u •r..:�ea.x �.�" "'t.'�N�rn..�;�+wr�,.„;+.�..Y,���A��,sr^��a`:;.ie::++5."`c+'i}„''v'..,,,�,:ag.q,.,;,..,....,y.n��� �.�.•,..�,..... �...�":w:if'�,N,.,v , r r No.. FIn$.....: ��zi.......`. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T .TOWN OF BARNSTABLE Appliration fur Dirip t ial World ( omitrurtion rrmit Application is hereby made for a Permit to Consilruct ( ) or Repair (t,41'an Individual Sewage Disposal System at: s Location-:Address or Lot No. R: n( ..+----"-7-"--- •--------------------------- -----------•------- I r --•---..•.................................................... Owner Address /� Installer Address Type of Building Size Lot............................Sq. 'feet Dwelling— No. of Bedrooms----- _----------------------------------Expansion Attic ( ) Garbage Grinder ( ) a4 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... . . W Design Flow.......?5-:�------------------------gallons per person per day. Total daily flow...... t'_:�....................gallons. 1:4 Septic Tank J I: d�catpacity_, gallons Length__�i_.:.:._ Width-�.......... Diameter................ Depth................ Disposal Trench--No. .................... Width........_..._._.. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------.I----------- Diameter-----1.1.!...... Depth below inlet....6._f......... Total leaching area..................sq. ft. Z Other Distribution box (: ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date....------------.....---............--- ,� Test Pit No. I................minutes per inch Depth of Test Pit._._--___-___---_-- Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit__.----_----_____._. Depth to ground water........................ P4 --••-•--•------•••---•-••....-----•••••-••••••••-••••••--•-•---••--•-••••-•-••--•----....••.................•---•-•----•...-••----••...........--------...... 0 Description of Soil........................................................................................................................................................................ W U .............................................................. --•-------•-----•-•---•---------•----••-•-•--•-------••-----•••-•••---•-•-•----•-•--•-•••••-••----•--....•---...............--------_••--- W UNature of Repairs or Alterations—Answer when applicable............ " ... 15:.(__�-_-._?�h--'................ >............................................ -------------- -n�1., = .,.r. R:_.....---cti J -- +5't i ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of,the.State Environmental Code—The undersigned further agrees not to place the 1 system in operation until a Certificate of Complia.ace-has been is ued by-the�,d of�ea . Signe . _..... /..."? .�. ....... . ......... .......�� ..... r Dare Application Approved BY ............................. ............................:ti._........_.............._.... ....... C �. Application .......................................................... 11 ��...-...-�:-..rC..c.r. Disapproved for the following reasons: ...................................................................................................................................`. ... ......................................................................... . ............................................................. ................,,............................ .......................... . ----- Permit No. .. .. ....�.!/........... ................... Issued ........................ ' Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE kCPxtifirate of (Clomplian e THIS IS TO CERTIFY, That-the Individual Sewage Disposal System constructed ( ) or Repaired at .. ........ �.. .. � ` r. �" �.c s!�...►...........................C. .!:....(. ........... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...?_'I..-... .. _�..._... dated .................................__......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A{GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 6DATE...................... -......._. ...... �` . _... ....................._ Inspect r .... ................. '2% ' --........._...... ..._...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE........... ... �i g ttl �rla Tonotrurtivn Vrrmit 11/ i 7__.l._4�1 .1 _.--Yi�•A r C_ Permission is hereby granted---------------------------------•--•---•k2(:- -••-• v to Construct ( ) or Repair ( Lj_an'Individual Sewage Disposal System ....................................................... Street as shown on the application for Disposal Works Construction Permit No.. y.-30. Dated... t ...................................................... -•----•--•--••----•-•--•---------•-----•-•---••--- U � Board of Health DATE.,..................... � ..----•-•(-- .......................� FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION ��-� Yl� P)T_ f4-P0 0 SEWAGE # "7 V-307 VILLAGE_ ASSESSOR'S MAP & LOT;?#g'- �43 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY tee'r--o S T-✓\ `LEACHING FACILITYAtype) �(.e�-C�+�SQ' �� J (size) ,NO. OF BEDROOMS PRIVATE WELL O IC WATE BUILDER OR OWNER DATE PERMIT ISSUED: .- -� DATE COMPLIANCE ISSUED: �" VARIANCE GRANTED: Yes No (� 0 a No..................3... Fic$....................`......... `�, THE COMMONWEALTH OF MASSACHUSETTS BOARD O F H LT H ........:.........OF..................... ..... ......... --------....._-----------_. .. ..... . ppliratiou for Elisposal Works (filuarurtiun Famit Application is hereby made for a Permit to Const�- or Repair ( ) an Individual Sewage Disposal System ....... . ...... ... . ......... -. --. . Location-Ad ss r Logo. c��-.� � C,rr / .......................................... rr a Ownerr Address✓.-. t ....... �.�^.__..... '---------------------------- -----•---- Installer Address Type of Building Size L Sq.:'feet v �� '6 Dwelling—No. of Bedrooms................ ..___....._.......Expansion Attic ( ) arbage Grinder' ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtu es ..._.__..... W Design Flow.............z- ...__. ...............gallons per person per day. Total daily flow................__.._ _ .........gallons. 9 Septic Tank—Liquid capacity/Wlkallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area____-_-_-•_•------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area.................. -t. Z Other Distribution box ( ) Dosing tank ~' Percolation Test Results Performed by........... ....,�� 7epth .... Date_._. �14Test Pit No. 1, .. . .....minutes per inch Depth of lest Pit.................... to ground water---__-_ � 4 Test Pit No. _._minutes per inch Depth of Test Pit.................... Depth to ground water........................... Descriptionof Soil ---------- ............................................................... ---..........G- -C U ............................................................:S .......... ----------------------- ................................................................... -----------------------------------------------------------------------------------•------------------------------------------------.... .............................................................. 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 i T �. p S of the State Sanitary Code—The tin ign 1 er agr snot to place the syst in operation until a Certificate of Compliance has been issue b bo of h th. Signed...• ----- -•--•----•-•-- •• ••....... . . ......................... •• .... --- ---------Application Approved B / Date PP PP Y I f- Date Application Disapproved for the f oll ng reasons:................................................................................................................ ------•-----•-•-•-•--------•-•---....-•--•••....•-/•---•-•---------•---•--•---------------••..............................--•--•------._..._._....••---•-••--------•-•-•-••--•-------•••----•••------• � •'-----'--'Date PermitNo.---'-........................................... Issued-------------•---•......••---- -'--'------ Date No.... .�J 5310 Fxs.................. ................... THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF ALTH ---- .............--------------OF................!!"....:._... ................................................... ApplirFatiun for Bi-spuual ur u Tonstrnrtion Prrutit Application is hereby made for a Permit to Cons ( ) or pair ( ) an Individual Sewage Disposal System at: . � .. _ .......................................................... h........_. --.._..... LocationleyzJ� - dress / � f d / Owner Address Installer /otr of TYP Dwellin —No. of Bedrooms________________ _________._.______..___.Ex ansion Attic Garbage Grinder feet A4 Other—Type of Building ________________��__. No. of persons............................ Showers ( . ) g Cafeteria ( ) a Other fix r _�: 0---- -------------•••---•-_•---•- W Design Flow___________________________________________gallons per person per day. Total daily flow....................... ...................gallons. 9 Septic Tank—Liquid capacit�( U.gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................s . ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet...... _________ Total leaching ar _ _-___ ft z Other Distribution box ( ) Dosing to ?r �� aPercolation Test Resul � Performed by..................._...._£ ______-_-----------------____-.a ___------ Date_-...___..____.....__ hw<_ ,-a Test Pit No. __ ______minutes per inch Depth of Test Pit____________________ Depth to ground water.- .............. fi Test Pit No. __,._minutes per inch Depth of Test Pit____________________ Depth to ground water........................ O Description of Soil____________________________________ �__�,_.,__. U ------------------ ----•---------------------- - - - - - -•••- W U Nature of Repairs or-Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of i 5 of the State Sanitary Code— The er fYe fu her ees not to piac t stem in operation until a Certificate of Compliance has been issue the b a of lth Signed_-- -- -- ... ................................................... Date Application Approved B L�----' .(i................................................................. Date Application Disapproved for the f oll ng reasons:----•---------••---------------•-----------------------------•------------------------------------•--.._.._...•- -----------------------------•----•-•------------...-----------------------------------------•_._...._.._-----•••-----•----•---•----•--•---•••••----------•---••---------•-•-•--•-----------••••---•---- ,.. Date PermitNo....... -i...................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................O F....... ..,r. ........................ TrdifirFati of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructect or Repaired ( ) by............ - f •, - --------- --------------- ----- _____------------------------------- -- L� t _. at.................. ----•--------........... ------ = ----------•- � has been installed in accordance with the provisions of T�hjii+ 5 of The State Sanitary Code as esc ibed in the application for Disposal Works Constriction Permit No.._ _._�__._____3�_______________ dated_-_._- _ -'._ ._ ____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARA E THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. / DATE........................�1.�._��...... _7............................ Inspector......... - -.�---------... .. • THE COMMONWEALTH OF MASSACHUSETTS J BOARQ OF HEALTH � � �� IVrO.+ ---------------•--... FEE.__.............-....... Mu70ofital o Ca�nurion prutit Permission 's hereby granted__________________ 1/ '-. ...........•--•---•-•••••---•----•---•--••--•-•-••••-••••-----------•-.._..•--•-_..._....•--...... to Con ruct ( ) o Repair ( an dividual Sever a Dispo S stem " atTo. - '- -. :. - .C -•-••-----.--.•••-.--.-_-_• •---.-•-..•.•.......- -- ---- -------- Street as shown on the application for Disposal Works Construction Per it No�"�S.� Dated__._ ...__l.___'_.)�_:....__. . � -_--------------------------------------- Board of Health DATE.. 't -=-.e.. FORA 1255 OBB & WARREN, INC., PUBLISHERS PAP /� 775 1�� �o-cJSQ J S lX�r' �D 7J yAq LOCATION Lmt y 0 DaAkSEWAGE # 5 7- 5-3 VILLAGE ASSESSOR'S MAP 6z LOT Jc4 INSTALLER'S NAME & PHONE NO. r,l. �yg=5 gig SEPTIC TANK CAPACITY /oar LEACHING FACILITY:(type) LeI, (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER,vh.e#f,,. A BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No L-- -- C, c o 20 FT. MIN. TOP OF FOUND. SOIL TEST EL. = 10 FT MIN. DATE OF SOIL TEST y ~� FF WITNESSED BY CONCRETE 4" SCH. 40 PAC PIPE CLEAN SAND PERCOLATION RATE MIN. INCH covERs MIN PITCH 1/8' PER FT. OBSERVATION HOLE I OBSERVt-T'ION HOLE 2 CONC RETE CO COVERS 2" LAYER OF ELEV. ELEV.= 2 4' CAST IR N PIPE (OR EQUAL, MIN. 1/8"- 1/2'' WASHED -- G i�)AM PITCH 1/4 PER FT ,arc STONE Av , Fl4L L FLOW LINE EL = MIN. EL.= 20" EL = ! — LEVEL = - Lj r.. EL= DIST EL oo a o > WATER AT • �L.= WATER AT EL.= BOX 3/4"- 1 1/2" 09° 1 o GALLON WASHED STONE i°o o ` w a 00 o TA , w ° d EL.= DESIGN CALCULATIONS SEPTIC TANK PRECAST LEACHING NUMBER OF BEDROOMS BASIN OR EQUIV. GARBAGE DISPOSAL UNIT ` <^ 6' DIAM. TOTAL ESTIMATED FLOW `'�\ SEWAGE DISPOSAL SYSTEM PROFILE I� ;, ; ( /''J GAL./BR /DAY x _ � BR.) _.� _ GAL./oAY — REQUIRED SEPTIC TANK CAPACITY `✓�°/ 15' GAL. NOT TO SCALE ACTUAL SIZE OF SEPTIC TANK GAL. ' CIO BOTTOM OF T_EST_HOLE OR USGS PROBABLE WATER TABLE EL = LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE ( / / ) EL = SIDEWALL AREA 1 v 6-AL. /S F ��. BOTTOM AREA r`d� GAL /SF j `.. LEACHING CAPACITY ( BOTTON, - S DEWALL ) _ GAL } L ` LEGEND : LP RESERVE LEACHING CAPACITY GAL L � T jA EXISTING SPOT ELEVATION OOxO EX UTING CONTOUR — — - 00— --- ��\ FINAL SPOT ELEVATION NOTES FINAL CONTOUR — 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E r f SOIL TEST LOCATION TITLE 5 AND THE TOWN OF ' RULES AND . _ f`.q/tr� - f; ' t I ' UTILITY POLE -O- 1 1 1 � 1', REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE . TCWN WATER ==`N--==--w— _ 2 ALL. COVERS TO SAN►TAki ONITS HALL BE BFiOGHT TQ CATCH BASIN ® ) WITHIN 12 OF FINISHED GRADE . I f r• a 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING a MIN FRONT SETBACK �rT SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. MIN. REAR SETBACK / 5• ANY MASONARY UNITS USED TO BRING COVERS TO GRADE LOT MIN SIDE SETBACK SHALL BE MORTARED IN PLACE.. 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH �L QT q r DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO I OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. ► 7 T APPROVED : BOARD OF HEALTH �\ GATE AGENT fir i .. i -,' � /• (� err i'M•, T , PROJECT LOCATION: C/• / 4i �• �., rFl APPLICANT: 3b PAUL I J A +, LA f p ~� s 1 c� ! E V Y f; ' AZttl- _ - - - "� °"� NV Levy, Eldredge & Wagner Associates Inc. ���. ! ��� V'v � _ ` � �, ` �� �_�� �-� -__ _ --- ___. � o En9neers Landscape Architects Planners land Surveyors _ __ __ _ ; r , 889 West Main Street LI A)F- OF AL �' 01 � ELLIOT - Centerville Mo. 02632 --L :_.... _ "� '`\ LOCATION MAP Joe No. SHEET 0F ,' I