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0316 ELLIOTT ROAD - Health
3.16 ELLIOTT ROAD',', Centerville ` A = 227= 086 M I I it 15MEAD No.Z-I NLOR UPC 12M snwwd�om • us&in U" IWtpOM1r/WAQW SDI �LiraOOQAY tea R t«no�a �tt1E Tp� Town of Barnstable Barnstable AN caCft ' BAR.MASS1T3fAB Public Health Division 1 ' 1► 639. ,0� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 June 30, 20.14 Russell E. Haddleton, HADDLETON & ASSOCIATES, P.C. 251 South Street P.O. Box 1298 Hyannis, MA 02601 RE. 3'16:Ellott Road, Centery le Dear Mr. Haddleton, I am in receipt of your letter dated June 19, 2014 requesting the Health Division to change the bedroom count designation in our records for the above-referenced property. Mr. David D. Coughanowr, R.S. of ECO-TECH, West Chatham, recently informed us that the septic system is more than adequate for three bedrooms. In addition, to the best of his knowledge, this home has always been a three bedroom dwelling. A floor plan clearly showing three existing bedrooms was attached to his cover letter dated June 19, 2014. This property is located outside of any State of Massachusetts designated ZONE II's, outside of any Town designated well protection districts, as well as outside of any groundwater protection districts. Although it is located within a Saltwater Estuary Protection District; three bedrooms are allowed within this district. Based upon the above information, the Health Division has no objections to maintaining three (3) bedrooms at the above referenced address. Although the original disposal works construction permit dated March 30, 1979 listed this property as only having two bedrooms, our files will now reflect a three (3) bedroom designation. A copy of this letter will maintained within the Health Division file for this address. Sincerely, u Thomas McKean, C.H.O. Oe4�lAh M A Commonwealth of Massachusetts --- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments « - 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17 2014 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 -- on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, IRS � use the return Name of Inspector key. Eco-Tech Environmental ,LA� Company Name P.O. Box 1265 Company Address West Chatham MA 02669 Cityrrown State Zip Code 508 364-0894 1328 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 ��yZHOFMAssc ❑ Conditionally Passes ❑ Fails o� DAVID yes ❑ Needs O�vu�1� a Local Approving Authority N .1 28 S• Ap E O¢ !�S REVISED JULY 1, 2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. L15,ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 or 17 Commonwealth of Massachusetts - =Mev Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments < 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 _ Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 _ 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: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. REVISION July 1, 2014 - Pg 6- Number of Bedrooms (Design) was changed from 2 to 3 at buyer's request. 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. r *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 yefarspld is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 316 Elliott Road- Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17,2014 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name _~�~ information is required for every Centerville MA 02632 June 17, 2014 --- page. Cityrrown 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 El ® 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 Yz day flow t5ins•1113 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 w.. 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 page. Cityfrown 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. f ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official tnspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts q9_= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Elliott Road - Assessor's Map 227 Parcel 86 _REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) © ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 -- - DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 gpd 15ins•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �w 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville, MA 02632 June 17, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: System was installed by Arch Construction in 1979. `Although a 2 bedrooms house was specified on the design plan, the leaching pit was sized for 425 gallons per day flow, which was sufficient to handle the 330 gallons per day that a 3 bedroom dwelling would have required according to the version of Title 5 in effect at the time. Assessors records indicate a three bedroom dwelling. 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 ears usage 108 gpd 9 ( Y 9 (gpd)) Detail: 2012: 45,000 gallons 2013: 34,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: not determined 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/personslsq.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 Inspeclion Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts n= = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Elliott Road - Assessor's Map 227 Parcel 86 _REVISED JULY 1, 2014 _ Property Address Lorraine M. Jenkins Owner Owner's Name information is Centerville MA 02632 June 17, 2014 required for every �. --------- page. Cityfrown 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: owner's agent Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? -- — —— - Reason for pumping: -- ----- Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Elliott Road - Assessor's Ma<•` _ p 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 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: 34+ years. Certificate of Compliance for original system issued 7/17/1979 (Permit#79-178). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 3 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.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank (locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: ye years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 x 5 x 6-1000 gallon `— Sludge depth: 12 in _ t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 316 Elliott Road- Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 page. Cityfrown 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 22 in Scum thickness 1 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design plan Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended at this time. Maintenance pumping is recommended every 2-4 years thereafter with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Liquid level is above outlet invert likely due to component settling. However, a bucket of water poured in to the outlet end of the septic tank was observed to flow through to the distribution box. Flow through to the leaching pit appers normal. 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•3113 Title 6 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 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name Y _ information is Centerville _MA 02632 June 17 2014 required for every _ .__ � _ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i _ Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 316 Elliott Road- Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is 17 MA 02632 June une , required for every 2014 page. Cityfrown 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 at outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box appears structurally sound with no evidence of leakage in or out. Liquid level at outlet invert. 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-3113 Title 5 Official inspection Forth:Subsurface Sewage Disposal System•Pape 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014_ Property Address Lorraine M. Jenkins _ Owner Owner's Name information is Centerville MA 02632 June 17, 2014 required for every ._., page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: - ❑ leaching galleries number: ❑ leaching trenches number, length: -- ❑ leaching fields number, dimensions: ❑ overflow cesspool number: �- - ❑ innovative/alternative system Type/name of technology: -- — ---- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pit appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Leaching pit was uncovered and found to contain about 3 feet of effluent with no effluent.contact staining observed in the cover or cover interface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth -top of liquid to inlet invert Depth of solids layer -- Depth of scum layer Dimensions of cesspool Materials of construction — - Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts FTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 316 Elliott Road- Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 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.): tSins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately L OO C A TOOo nNS -OF SEPTIC COMPONENTS -DISTANCES IN DECIMAL FEET A 8 1 15 45 2 20.5 43.5 3 26 42.5 4 34.5 27.5 DWELLLNG 0 316 THIS SKETCH IS B BEST VIEWED IN _IrA COLOR FORMAT LEACH I 1000 GALLON } PIT Q SEPTIC TANK 2 4 2 o p 3 ODISTRIBUTION BOX ' W Q a EL UOTT ROAD 508 364-0894 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 316 Elliott Road- Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17, 2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 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: 3/30/1979 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: Barnstable GIS Department You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 4 feet above the bottom of a witnessed test pit in which no groundwater was encountered. Town of Barnstable GIS Department records indicate that the property is 20 feet above nearby surface water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 l Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 316 Elliott Road - Assessor's Map 227 Parcel 86 REVISED JULY 1, 2014 Property Address Lorraine M. Jenkins Owner Owner's Name information is required for every Centerville MA 02632 June 17 2014 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 GEOHYDROLOGICAL PROFILE - NOT TO SCALE z Q a PRECAST �• 2 LEACH �► ]CON PIT� o BOTTOM OF a LEACHING PER DESIGN PLAN LEACHING IS ABOVE HIGH OROUNDWATER 41 v GROUNDWATER NO ELEVA TION GROUNDWATER PER GIS MAPS ENCOUNTERED l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Message Page 1 of 1 Crocker, Sharon Subject: FW: Revised Title 5 Report -----Original Message----- From: David [mailto:davidcou@hotmail.com] Sent: Tuesday, July 01, 2014 4:14 PM To: Crocker, Sharon; me Subject: RE: Revised Title 5 Report Hi - And I was thinking that since this is a revision within the 30 day time period, that the fee submitted with the first one might extend to cover the revision as well... But let me know if this thinking might be in error... D Subject: FW: Revised Title 5 Report Date: Tue, 1 Jul 2014 13:27:54-0400 From: sharon.crocker@town.barnstable.ma.us To: davidcou@hotmail.com Hi there, What were your thoughts on getting us the filing fee for Title V? Thanks, Sharon -----Original Message----- From: David [mailto:davidcou@hotmail.com] Sent: Tuesday, July 01, 2014 12:31 PM To: Crocker, Sharon Subject: Revised Title 5 Report Hi -would you mind printing this out and putting it in the folder? any questions call 508 364-0894. Thanks, D 7/1/2014 06/19/2014 10:01 5087903760 HADDLETON AND ASSOC PAGE 01102 HA DDEETON & ASSOCIATES, PC. Attorneys and Counsellors at Cow 251 South Street P.Q.Box 1298 Hyannis,MA 0Z601 RUSSELL F. .RADDLLTON* (508)771-3132 Branch office Email:rhaddleton@httddl.etonlaw.corn Fax(508)790-3760 KIMBERLYA.HOGAN wu'w.ha.ddletantaw.cotn 47 George Ryder Road Email!kimherly@haddletonhw.com Chatham,MA 02633 JC)YCE M. COLLINS . (50R)4h5-19—s5 Ernail!,jmq,i.ns r�i haddletonlaw.cxm Ry!t��az�r�mev�t 'YAdmrW In M11&FL June 1 9,2014 Thomas A, McKean,Director Barnstable Board of Health By fax to 508-790-6304 Re: 316 Elliott Street, Centerville, MA Dear Mr.McKean: I am the personal representative (formerly called "executoe') of the estate of Lori. Jenkins, The estate owns the residence at 31.6 Eliott Street, Centerville. This property was built in 1.979, with a septic system that was suitable for a three- bedroom home. The Town of Barnstable has, for the past 37 years, considered the home to be a three-bedroom home and, has assessed a real estate tax based upon a three-bedroom home, and Mrs. Jenkins paid a real estate tax based upon a three-bedroom home. It appears that the installer of the septic system., through inadvertence, � failed to specify that the system was for a. three-bedroom house, and that for that reason the Board of Health. has the property listed as a two-bedroom house. This listing causes the market value of the house to be less than, it would be if the house were correctly listed as a three-bedroom house, as indeed the assessors have considered it to be for almost four decades. I would ask that the Board of Health change the designation of the house on its records from a two-bedroom to a three-bedroom, house, r 06/19/2014 10:01 5087903760 HADDLETON AND ASSOC PAGE 02/02 Yours truly, REH/ms Russell E. Haddleton 2 s - ' ECOJECH Environmental P.O. Box 1265 West Chatham, MA 02669 (508) 364-0894 June 19, 2014 Re: Clarification Letter 316 Elliott Road Centerville Q Barnstable Health Division " � = Barnstable, MA To Whom it May Concern While completing the paperwork for a Title 5 Real Estate Transfer Ins ection at they p g pap p above referenced property, I noticed a discrepancy in the bedroom count. , The original Design Plan for the dwelling, dated 10/26/98 calls for a 2 bedroom dwelling, but then specifies a septic system which is more than adequate for three bedrooms. Furthermore,the property is listed with the Assessor's Department as a 3 bedroom dwelling. One June 18, I inspected the house and have drawn up a floor plan confirming the 3 bedroom count. I have been informed that Lorraine M. Jenkins, who owned the property since 1978, is deceased with no surviving family. I am also told that the property is being sold and the proceeds given to charity. Based on my observations of the home, I conclude that the original 2 bedroom designation noted on the original Design Plan is in error and that to the best of my knowledge this has always been a three bedroom dwelling. Please call me if you have any further questions. OF Mgss�c DAVID D. Sin XjOUG ANOWR N No. 1,09 0 G sANITAR\PN r David D. owr, R.S. BED BED ROOM . ROOM DINING LIVING BA TH ROOM ROOM BED' _ ROOM W U ct cr- KITCHEN U GARAGEZ41 ' BATH MAIN . FL OOR - ,i z. UNFINISHED BASEMENT C. FLOOD P L A N BASED ON CONDITIONS OBSERVED ON JUNE 18, 2014 NOT TO SCALE - �0\ OF M4SS9 WEST ,ygiq, DAVID Sr9FF - D. EXISTING sTAEET r COUGHANOWR N PINE No. 109s - FLOOR PLAN ESTATE OF o "PFG/srE��° LORRAINE M. JENKINS , OWNER(S) OF RECORD ELLIOTT Q` - — - Focus T° 316 ELLOITT ROAD scALE CENTERVILLE. MA P.O. BOX 1265 PROPERTY ADDRESS CENTERVILLE. MA WEST CHATHAM. MA -- - 02669 DATE.• JUNE 19. 2014 L O C U S M A P 1508 364-0894 PCa.1/1 1 .w: ETE-3838 6/19/,14 237 AN Town of,Barnstable.Geographic Information TO System ,,, , zTA New Search; IHome ;J Help Parcel Viewer 1:ust6m-M4--, Abutters "Map.'SEze,�„ : Zoom Out fl r■ Rr �Q�V 1%y PIN ; ' ! �EPTum map�tayer5 on/pff by_ �` Refresh - -� I selectin g check boxes below Unpaved Paveds •� ��` 'f` fs'o "� ,F� r�, � �� y � �Unpaved El Topography }: , • . • � � Topo SpotElevation �• : •' .. . zr � �� k 5� s(NAVD 88) '. '.. J Topo:Major Contours(NAV.D88) Topo Minor,ConEours(NAV088) °fir ❑ Zoning&Groundwater Protection t ' """" p (] Zoning ov,erlay Districts 4 ' , (Medical marijuana It U se �i ,®. k f � Doc &Piers Ground Mounted Solar Photovoltaic .� • '(DIMedical;Services •. :� � Planned Unit Development ............. N = ° ;�APOD; Resource Protection '.. E7 :i4*r: r'r ;Senior Contlnuing Care Retirement Community iM SFioppRelayeSheilfish Dock&Pier � �• saltwater Estuary Protection - — . ....... ..... ....... W. •� � � { �O�n. Distr j Town Designated Zones of Contribution Y ®GP �. :. ' -Groundwater Protection District • •;:n icc: •:... ;• •:. ::::::• .:::::••::::::::::::::::::::::: ... �WP-Wellhead Protection Distr'Ict ............. - - � • • iii:i::•• State ApproVed1Zi7rte IIs+° — • sic , IC 0 nan.ce -- a ; 2000 R.Buffer Zones arou.nd'Child Service Facilities Facilities that Provide Services to Children 400 Aerial Photos MAP DSSCWMER r ,. _ •_ili _ ,_ _. „. _• htfntMmanC.tnwnnfh0.mctaitiPuc7aii•imc/annnpnannhtSan aenY7mmnartv1(7_777nRl.RimannarF-r4_777nRA P;inp1 of Maximum Wastewater Discharge Allowed Based Upon Lot Size *if one parcel is within multiple zones, rs?ttejr o'Wricul mitation for parcel (bolded below) tg , rStatcl 't 1+ i/3 1+2/3 �t 1 !;;` 1 7U'n, 31 °Defined True Acres Acres 2 Acres Acre Acre 10,000 13,333 20,000 30,000 33,334 40,000 =43,560 50,000 58,080 60,000 =72,599 80,000 =87,120 S.F. S.F. S.F. S.F. S.F. ;_� S F: .�:w SY S.F. S.F. S.F. S.F. S.F. S.F. STATE. DI V 1 `('I'1 Red Title V 310 Diag. CMR 15.214 .' 110 110 220 330. 330 440 440 550 550 660 770 880 880 Lines *applicant can apply for a variance. STATE Red With I/A Diag. Technolo Lines �` ]l0 220. 330 440 550 660 660 770 880 990 1100 1320 1.430 [I/A-with 660/acre Credit] (+not in town ordinance) TOWN ORDINANCE Green Regulation of 330 336 330 330 330 330 330 330 440. 440 550 550 660 +Red Wastewater Zones Discharge *can not apply for variance and doesn't allow I/A. BOH-Interim Blue Salhvater Estuary 330 330 330 33.0 330 440 440 550 550 660 77.0 8.80. 880 Protection Regulation *can apply for - variance, but doesn't allow I/A C:1Use.rs\AdministratorlDrapbox%CltartTable ListingWWDISCHARGE MAXIMUMS3.doc No,�17 Ff-. Fi$............................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH M P ....... .. ...................--.---......OF.......................................----.....------..........----...................... ���`� 7 Appliratilan for Disposal Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: ......... ......................................J.;. ......-------•-•--.........---------•..........---- Location-Address or Lot No. ...........0C171.�.C,.7�......a �'.,t_�'%C iw - 31 ._..�RZt2 i.Ply.�te4 t?...PtZ......C-c.e<.✓.Z.4; ✓.fir.t L� y/ Owner Address . J..1. C.C3.AV.5.:t-.t�°c�G:T1.fti. .................... .... E,�+'` `� r_....1. ... Installer Address d Type of Buildi�n ` Size LoteZkA_L_�-�........Sq. feet U Dwelling2 No. of Bedrooms.........;iL..............................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .........--•--- -•.............•---••-••-•-•••-••---•----•-••••-•-----------------...._........-•--------•-••---=-................................. WDesign Flow.................i�`5__...............gal lons per person per day. Total daily flow------- ...........:.........gallons. 9 Septic Tank-� Liquid capacity/.gallons Length................ Width._..._.___..... Diameter................ Depth................ Disposal Trench—No_ ___________________ Width...._._._._.. Total Length...... Total leaching area....A.Q.... __sq. ft. Seepage Pit No............. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...�3�. , ... �_.../ljy�........................ Date_...=E_-._J.�:'.7.5�__.__.... �Test Pit No. 1...... '_.minutes per inch Depth of Test Pit.................... Depth to ground water.................... �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil Q_-._._��.a........ .......4._�� --•- ..... � ........ 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 TITL rZ 5 of the State'Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sied............•--••-•..........--•-••------•-------••.................•-•-•••-.••-- Application Approved B D to Date Application Disapproved for the following reasons----------------••-• ----•---------------------------------------------•-----------------......---•••. .............................................. .........................................................._..........•--••-----------------••---•••--................................................... Date PermitNo......................................................... Issued..... .................. Date 7� f 7 �- •�►`'' _ � � Fps..............' w-�'-� No......................... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F.......................................---------------......._------...._................. Allp iration for Disposal Works Tomitrurtiun thrmit Application is hereby made for a Permit to Construct (4 or Repair ( ) an Individual Sewage Disposal System at: ...........•........ ..................................... .I. Location-Addres s or Lot No. .......�� b f �9_ r_....:.mow}.... .v�•4ep. ' �_ 5_... ..'31J.'x. 9t.t?.XZZf&;.&AM UsI ..C-4..a.T5..�t�e��:.� Owner Address' W t` .--- fi ` .1 .... . t...AI ................... :_� Installer Address UType of Building, Size LotA_&e.->_k.q.......Sq. feet Dwelling 9 No. of Bedrooms.........Z...............................Expansion Attic ( ) Garbage Grinder (#a) a`4 Other—T e of Building ...__..... No. of persons............................ Showers Other—Type g --------•--------- P ( ) — Cafeteria ( ) Otherfixtures -----------•--- __-- .........=.......................................................... W Design Flow..................�_�.5_................gallons per person per day. Total daily flow.......... ..............................gallons. 9 Septic Tank-,L Liquid capacityf�_,j.gallons Length................ Width................ Diameter----------------- Depth................. Width_.....:........ Total Length --------- Total leaching area ft. W Disposal Trench—No.,.............. g g q• Seepage Pit No.----_---. ____-. Diameter......:............. Depth below inlet................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed .....................•. Date....., "._.' .::.. . ........ 0-4 Test Pit No. 1......Z x'..minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pdr......t......• j •..............• .._•----............. ...:•-•- D Description of Soil ' . ..... � ! U . -•----••-••-•-••-••••---•••••••-••-••....................................•••-•-•-•-........---•-••--•-....•-••-•••••--••-••••••---•••...•••••---•-••-••••---•-•-......••• •--_.. ...._ . ... .. . ,... . ... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ U Nature of Repairs or Alterations—Answer when.applicable.......................................................................7...................\_. . -------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL u 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. -I S61 i ,fied7141, : . /� ------------------------------------------------------------- ---•--.................... 1 / �r� 2 , Da� r Application Approved By .._.. ,� e ..:.. ............. `� `" Date Application Disapproved for the following reasons:...................... . •-•--••••-••-•--••-••••--•-•--•--•-•••----••-••-----•-•-••.................. ............................•------------•--•--.....---------•------.........--------•-----•---------•------------------------------------------...--------------------...••-•••--•--•---••••-----...... Date --------------------------•-------. Issued----7`l•7 Permit No......................................................... -.--.�................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF �EALTH ... .....OF.. . ..............Z'...�.................... Tntifiratr of TompliFanrr THI -IS TO CER Y, T t) Individual Sewage Disposal System constructed ( o Repaired ( ) by - t �°`=x: ��•-�?......._.. -------•-. ._. • -' f� ,n� a J ' at••-•-•• l,-i�?�.��g_! .....�/_. �1_!cx� .4<+:^yd = � - `_ 1.......:� a�.'..- .................................................� has been installed in accordanckwith the provisions of T 5 of Tle State Sanitary Cade as describ d in the Lr"` application for Disposal Works Construction Permit No.....................�........_....... da.ted_ --u__4.'�u " � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ 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