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Home My WebLink About0163 ELLIOTT ROAD - Health 163 ELLIOTT ROAD CENTERVILLE A=228-200 5 M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR FORESTRY lE MIN,RECYCLED INITIATIVE CONTENTIO°k Ce6fiedFbetscurcing POST-CONSUMERIS wwwxnpmammorg S M1290 MADEWUSA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE LOCATION 63 SEWAGE# ,2D A9 9 VILLAGE e-",Ve ASSESSOR'S MAP&PARCEL;22$-,200 INSTALLER'S NAME&PHONE NO. CoNs:cc' 50e 64&-99Zb SEPTIC TANK CAPACITY 8 0 LEACHING FACILITY:(type) S Jr-y (size) LJ K a2 5. NO.OF BEDROOMS- OWNER C, PERMIT DATE: COMPLIANCE DATE: L,� 3 t V Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Seet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) eet Edge of Wetland and Leaching Facility(If any wetlands exist within 100 feet of leaching facility) Feet FURNISHED BY qb ;.9 `3 a� 9 Z 0 ' ' U.S.PbSTAGE>>RTNEY BOWES DF�"E*mow Town of Barnstable Public Health Division 200 Main Street A 0 Hyannis,MA02601 SEA' ��&�� Fa' 02 41N6014$5��6.9�0 I ` y7015 +1730�0001-4987 ` 7954 0000 �s1 y V r < DREW, ERIC 1111 r! „ ---� ` 163 ELLIOTT ROAD ,_C:FNTFRVII_I_F .Me.n�a10 �- 9 O-IT FIFE I 826C000glIa/ze, 00 NOTIFY SENDER OF NEW ADDRESS �a,� 0g�209 f�{•t� DREW i178 .1JJY13� J }, 1�Atrl ^., . W 8A,RI"S TAB LE NIA 02668-11.66 � 11yn ,. 9400:9'Z2� -,� a 8C: 02668116690 *1.52Z-00981-14—.44 '� �ZX XAj PI \1 m r- SENDERCOMPLETE THIS SECTION ON DELIVERY z, I ■ Complete items 1,2,and 3. A. Signature C ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. I r- -- -- address different from item 1? ❑Yes ! er delivery address below: ❑ No I I I DREW, ERIC .163 ELLIOTT ROAD "= CENTERVILLE, MA 02632 j �'- - - -"`� - -`��' u.Tuc,via.c•rypd ❑Priority Mail Express@ II I IIIIII III III I III II III I I III I I I IIIIII II I I ❑Adult Signature ❑Registered Mail r '❑�Pdull Signature Restricted Delivery ❑Registered Mail Restricted! % ertified Mail@ :livery } / l 9590 9402 5849 0038 3917 23 LLL��jjJ��Certified Mail Restricted Delivery :turn Receipt for ❑Collect on Delivery flignature erchandise ^ i I n - - n Delivery ConfirmationTM2. Article Number_(Transfer fromserv,ca_,��--- �- �Delive Restricted DeliveI -- lail ❑Signature Confirmation 7 015 17 3 0 0001 4 9 87 7 9 5 4 500ji1 Restricted Delivery Restricted Delivery I i»- i i !; PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt �.. Town of Barnstable Inspectional Services Department RAPNnABLL MASS. $ Public Health Division i63p. tee' 1639. 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 79 September 15, 2020 DREW, ERIC 163 ELLIOTT ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 163 Elliott Road, Centerville, MA was inspected on 08/19/2020 by Thomas Roux, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PE ER OF THE BOARD OF HEALTH vJ� Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\163 Elliott Road Centerville.doc �tr Town of Barnstable Inspectional Services Department BARNSTABLE,SS.MARS. Public Health Division M 39. 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 79 September 15, 2020 DREW, ERIC 163 ELLIOTT ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 163 Elliott Road, Centerville, MA was inspected on 08/19/2020 by Thomas Roux, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PE ER OF THE BOARD OF HEALTH Thomas McKean, Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\163 Elliott Road Centerville.doc Town of Barnstable BARNSrABM 63 ,�� Inspectional Services Department �tFD MA'S s Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A. McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts o?au- Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a � 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information isequired or every Ceeille Ma. 02632 August 19, 2020 page. Citylrown 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. Inspector Information #- 11+�OI on the computer, use only the tab Thomas Roux key to move your Name of Inspector cursor-do not use the return Company Name key. 89 Mayflower Lane Company Address East Wareham Ma. 02538 Cityfrown State Zip Code +� 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of,Title 5 _(310 CMR 15.000);l have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails AU4 ZO 20 20 Insp ctor'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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. .,j Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 f c Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 � 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"ConditionalPass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every g page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): El 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Titles Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every g page. City town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19 2020 required for every 9 , page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every g page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for aH inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 cam; Commonwealth of Massachusetts �n = Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19 2020 required for every g page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): No design Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): +330 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: June 2020 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19 2020 required for every 9 , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 35 years, house was built in 1985. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5'feet Material of construction: ❑ cast iron ❑40 PVC SCH-20 PVC ® other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5' 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: 8'L x 5.67'W x 5.67'H Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 24" Distance from bottom of scum to bottom of outlet tee or baffle 0" 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.): The septic tank was pumped out about 2 months ago. The house has had very little use since then. The septic tank was only about half full at the time of the inspection. The outlet concrete baffle was partially broken. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts t9 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 P Y rY 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts r 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: The pit was dug up and inspected. The pit had no water in it. It did have significant rust line and staining near the top of the structure. This indicates that the structure has been filled to the top for long periods of time. Solids were visible in the holes of the inside of the structure. Hydraulic failure. Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19 2020 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The pit was dug up and inspected. The pit had no water in it. It did have significant rust line and staining near the top of the structure. This indicates that the structure has been filled to the top for long periods of time. Solids were visible in the holes of the inside of the structure. Hydraulic failure. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 i 23- A � _ I, = 3� . 2 g4Do t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19 2020 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 +/ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A test hole would have to be dug to determine the actual groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 163 Elliot Rd. Property Address Eric Drew Owner Owner's Name information is Centerville Ma. 02632 August 19, 2020 required for every 9 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 '•F No.._.��...._ �. Ficil.,..,�.... ............' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .....----/ .........OF............... n....................................... .... -------- Applira#iuu for Disposal Workii (foustrurtiurt ramit Application is hereby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: .......:........_.. .... ---------..........---------------------••------------------...._.....----.....-•- catio Lo No �'f 'wrygr_ n�j® ��}-A Address ...�;, .� Installer !Address If d Type of Building Size Lot .... ..... ..12T...Sq. feet Dwelling—No. of Bedrooms............... ..........................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building4 -.670AV No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- -- w Design Flow............................................gallons per person per day. Total daily flow.._....._.__.5��......._........._gallons. WSeptic Tank—Liquid capacity./C"..gallons Length................ Width................ Diameter------------_--- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....�&Cv----sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.._zVL-b.k...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '_4 Percolation Test Results Performed by_______________ d by �T!f R Date.......... . `4 Test Pit No. 1 ? minutes per inch Depth of Test Pit.................... Depth to ground water____- a �;--� P P P 1�' s�f�Jre----- (i, Test Pit No. .......minutes per inch Depth of Test Pit.................... Depth to ground water..........._........... a ................................... . .............. -•..................................•------.-.------•-------•-------------------•-------------- O Description of Soil........................................................... --------------------------------------------•--------------------------•••-----------•• x w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------•----------------........----•-------------..._..._...--•-------------•-•--...-•----------------------------------------------........................................................... Agreement: The undersigned agrees. to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT Z- 5 of the State Sanitary Code—The undersigned further a rees not to place the system in operation until a Certificate of Compliance has'been issue by the boa ., Signed............ -••--•--- ... ..... s/ 1th . ----....: - (� � j Date Application Approved BY__._____ :�_-� -:---•_------__._......... .. Date Application Disapproved for the following reasons:................................................................... •---•••-•---•-•--•. ...................... .........-•------•-•----------•-•----•---••--•-••--------••••••-•-•-------••----••••.................•--•---------------------•--•-••-•---...---••••-•---••----••--•---•-••••••--------•-•--•......---•- - \K [ / 6, Date PermitNo..... -•-------•--•--•------------------------- Issued-....................................................... Date ------- -- -- = --- - - -------------- No....§..� ..... FEB.�'.............�=a.*.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA11 �� ........0 F............... ..---------.........._......._..__................... Appliration for Disposal Works Tonstrnr#inn Prrmit Application is hereby made for a Permit to Construct �) or Repair ( ) an Individual Sewage Disposal System at: ........ - ��- .................... �� ................. ..... ...... Loc ion;Addr-s .... -. ....- Owner ./ Address ' a .... .. / --- ..... .........!=...... .�......... ... .-.---------•--•-•--•- Installer Addressr Type of Building Size Lot..../07 .Sq. feet Dwelling—No. of Bedrooms...... ..........q__ .......Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building 44-" t of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures .............................. ----••------------.....----------------------------------------•------------------------ W Design Flow............................................gallons per person per day. Total daily flow__._.__..............��_ _____._....gallons. WSeptic Tank—Liquid capacity.:/Olgallons Length................ Width................ Diameter.....•.......... Depth.._............. W Disposal Trench—No. .................... Width.................... Total Length..... Total leaching area ��-I_.sq. ft. 3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area... ?kh.sq. ft. Z Other Distribution box ( ) Dosing ;an��k ) /�V� f Percolation Test Results Performed by. ,.__.._._ .........( Date....._2ter ____. ._ ..� ._. Test Pit No. 1 ,,��,,{{ /�_�minutes per inch Depth of Tes Pit____________________ Depth to ground ____....__.._.__..._.._. 44 Test Pit No. ,"..minutes per inch Depth of Test Pit..................•. Depth to ground water........................ P ---------------------------•-•----•----------------------------- ---•------ ......------------------- ----.... 0 Description of Soil........................................................... U .-•.•-•--•-•-•-•-••.............•-•-••-••--••----•---.•.•-•-----•-••...-••---------....... �----Y--; ................................................ W ---••-------•---------------------------------------------------------------------------------------------------------------------------------------•--------------•-------•---•-•-•-•-•-•--•---•---•-- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------------•----------•-------------------•••-•--•-----•---••-•---•-••---•-••---••--•-•--•---•------•...:..---------------.......----••-------•----•---•-••-•••......-----•......---•-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place_jjje system in operation until a Certificate of Compliance has been issued by the board of he Signed................ ..... �.. ...e _�— Application Approved By. ---- ------------ -.--- - '- Date Application Disapproved for the following reasons:................................................................................................................ ........----•••.................•-••••••...•-•-•--•-••-••--•--•-........•-------.....__......••••--....•.-•........-•-•-•--•---•--•-------••---••--------••--•---•------•--•••-•----•-•---•-••-----••••- �/ 6j Date PermitNo._.. ......•...............................•----•• Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH w•••.•••�004,09P.7.....OF....... .. _ Tntif irab of f omplianrr THIS IS TO CE_$TIFY, hat the I dividual cage D' al System constructed �) or Repaired ( ) G nstaller at ---------•---••----------------------------------------------------•••----••-----••••- has been installed'in accordance with the provisions of TITLE 5 of The State Sanitary Cod as, described in the application for Disposal Works Construction Permit No---�'r, ._`_� .6-f........._.. dated---.j' ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................a-- --• -----1�3•-•-•-......_..-•-•••....._. Inspector............... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH vw//a ..................... ...... .........OF.........../w+ . � �.?................No. . ...............•-•--• FEE4.7.A............. Dis pos tl Works Tonstrnrt n rrmit Permission is hereby granted------. _ t/......... N--------'----------------- --------------•-•-------•-------•---••--------•-•-•--- to Construct A) or epair ( ) an Individual Sew?,e Disposal 5ystem at No._. .. ................................ Street as shown on the application for Disposal Works Construction Permit No "/�.�__ Dated.._12 --.r—If............ .......................... Boa .......................................... rd of He DATE---...��-:..-_��._'..--- � FORM 1255 A. M. SULKIN, INC., BOSTON t .d � o � J L-DT b, Al 66 iJ` /v a• �O a 77 In t 2-6 7` 7 _ IV N 20 IV N IV �i• i � VDU iY/pTf/ 99 O . S6-77,9Acis' 99 n/C>TE ASSuME`/� Z.07- T �7 PR a ion/ Pc:e fi RT� Sec7,,ZD, 4E. To t.✓w 6 YGst ws q7: y ROSERT <�✓ 'Y;7' ALBERT s ELDRcDCiE �> ~� Pic. 19�67 tnni?SE '+I 'LEGE�J® ' L ISTING SPOT ` ELEYATION OAO ISTIN9. CONTOUR --.... CERTIFIED PLOT PLAN Ifsl►MIbO :SPOT: ELI�Yf�TION IRR ® ,C 0 N T 0 U R ® , Z-OT / LL. TT lc.n1+10. . l�catio-1, of a �� exz;ssn under�a� ol.nd s1.awer�e.h�.. g — _ ,. - - ---- �}a, or. other.:utiIiti :-on this "p ll is approx- 'only as,determin@d from`rergrds and/or verbal or�a on, <.The.'contractor s:;.responsible for the t' A n h S 7A t�� ,tion';pf. tre.,a�c,1,s.�ing,'Jpcations. in";the field. BCALEl /�— 40 ' DATE 1 /"/ /S 85 �RL�®GE s�'NG/NEEA'1N8'C4�°IN Af IC—k v.4►.S. CI.IENT...q,., I CERTIFY THAT THE PROPOSED hCISTEIrdE • , REaIlTEJtEO �� i 3 6 C0V11. r J��..�10. 'J�� BUILDING SHOWN ON THIS PLAN gay; {LAND w" � �ONFOAhIS TO THE ZONING R OR�R.Y+ '4` LAWS OF BARNSTABL E MA S J. ': ?12 :'AApI:N 3.TREET F CN. By R 6.f5�- BHEET.L Oi Z WA E ik + REG. LAND SURVEYOR 2p FT MIN ,�a1'O?E /F EITHER 7`HC SFPT/C TAIVIC OR •j !� ��G/dlivC, P/T ARE MORE T,H/i;V /2� BEL®i�V r� -:r;�ADE� A 24"L7/AM ETER COiy�'RETE C'OVE� ! SJ/ALL 8E ,BROUGHT TO GJgA!>E.�.-il✓ EXTR CONCRCTE 4`'LNG' PJPE i`�E 4✓Y CA ST //?O/Y L 13E USELo L a, COi�ERS - M/N. o /a Y8 r r.Z 7 CONCRETE j�I;.�•.i G`AOE CO ►�ER CLEAN SANS �� SCNED�LCb4� 2'LAYER AY.C. P/PE c 4000 O GAC D f o • o o GF 1�8 3/8" . ° 0 1 • r • . • • r 4 WA 5HFD STYJNE %4"Rem .T. SEPTIC rANJK D OST, � a � . I • � • • • • • • • �•n e a� � 1 1 •� j� • r I • ► a o o t Ir /4 • • + � " i ► � , , � •efF�cr/vim � �.�,.�c•. �� .ti. � ::: •.:.,: - � o t � : ► • • pEPTt! • • • •�s � o y✓ASHED STaNE i t r • •, • • • • • 11; c o o 79 )c !.O — 70_- a. e • a�. e s • • • •' Dpa v PRE445TSFEPAGE 4 INVER? ELEYAT/OHS P/T C�9Pf1 c.1Ty 54�3 G'�L-�v4y ° ► �� ' • 1 s1 • o. s • • • ' n 'o, P/T OR EQU/V. AD E /NYERT AT B!//L.DlNG 7.a FT. ,'INLET SEPTIC TANK 96.6 FT !o .FT p/A/y C SEE TABULATJON> r� Ot/TLET SEPTIC TANK 96.+ FT. . 8 G Ov V O PV, TE/Y TABLE INLET D/STR/BUS''/ON BOX 25 FT. 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