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HomeMy WebLinkAbout0099 BACON ROAD - Health 99 BACON ROAD HYANNIS A= 309 -035 I n -�� �� � l (p,^� �� '/ � �—��� fj��1 c:,�ssP�t�(� � � N r G��4 ��� _ �� �� Cr.,��t TOWN OF BARNSTABLE LOCATION Ci 9 .&Xeor,, SEWAGE# ZoZO. 11,5 VILLAGE ASSESSOR'S MAP&PARCEL3O9-35 INSTALLER'S NAME&PHONE NO. Q 4,5 EXQg_QoA;O `le)- O GS3 SEPTIC TANK CAPACITY /SOO LEACHING FACILITY:(type)—T'nncke S C7-) (size) 2X3 x 33 NO.OF BEDROOMS 3 OWNER Lous c-- ',r a^A ric PERMIT DATE: t4-1(, - 7-0 COMPLIANCE DATE: "1 )-3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 3l _ ZS� AV yz'3' A3' b l" P.EA 33. 5 6'G' q a M O (3q u 1 No. � Fee Ova THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Misposal *pstpm Construction permit Application for a Permit to Construct(�) Repair(,� Upgrade( ) Abandon( ) [✓,Complete System ❑Individual Components Location Address or Lot No.99. &k co n 94. 9yannv S Owner's Name,Address,and Tel.No. Lou*1sz K:r lc poi6 Ck. Assessor'sMap/Parcel 509 1 3S 9q 4000.on Road nn;s Installer's Name,Address,and Tel.No.(Ij3 Q J,Y cayat�o. Inc• Designer's Name,Address,and Tel.No. F 1 al,eri-, crW tomQ„�ai 3111 f%ou+e 130 5Q-dw4 , N1a. PO 60V 331 Mo, ozugs Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ftt Garbage Grinder(No) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �)3 0 gpd Design flow provided 3 S 9 gpd Plan Date y 121 ZO Zo Number of sheets 2 Revision Date Title Size of Septic Tank I To Type of S.A.S. Z_tP_o,0%,no, --rcncl,.t.4 Description of Soil Se¢, plans Nature of Repairs or Alterations(Answer when applicable) Ref)koxe, - 0•k¢d Q SS p001�S I U llon -6tr%k , d- box and (-L) It0,6i,no, �rencbts Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date q I H 202.0 Application Approved by Date 1b '2e, V Application Disapproved by Date for the following reasons Permit No. ZO-Z 0 "']�� Date Issued zo -o No. 0 0'"' �I.� Fee l 400 /+ . f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: E/ �": PUBLIC HEALTH DIVISION -:-TQiiN4,OF BARNSTABLE, MASSACHUSETTS Yes ftplitatlon for Disposal 6pstem Construction permit Application for a Permit to Construct(f) Repair( Upgrade( ) Abandon( Complete System ❑Individual Components Location Address or Lot No. `h ('�o,co N-\ky r,n+5 Owner's Name,Address,and Tel.No. L o w s e K• k,f,�i c 1c Assessor's Map/Parcel 9 3 S �1 Q o c c n Ron(' Installer's Name,Address,and Tel.No.(j Q v rc..u'i,;, i nc. Designer's Name,Address,and Tel.No. ;6uk` S�SU Jcc t:f,riGt� �'`� i I�ov ^,�� Hrx(L. (\, /Acr 01(o11S M Type of Building: x Dwelling No.of Bedrooms Lot Size 19,'q b sq.ft.*- Garbage Grinder(w) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 6 gpd Design flow provided 'S 5 C, gpd Plan Date y l 12( Zo Zo Number of sheets �� Revision Date Title Size of Septic Tank 1 TO o Type of S.A.S. Description of Soil See t�l ca ns Nature of Repairs or Alterations(Answerwhenapplicable)'.,RQg6re, CcSSpO!sf> I�_,00 `C'`- C. boy (�\r,ck oc'-,,(Nck` �rCnClne, �J Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed <. __, Date H jZozo Application Approved by Date `?/ il� {202-0 Application Disapproved by ,dam !e Date 1 for the following reasons Permit No. Date Issued LJ (��� Z07-o ------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) Abandoned( )by u cJ. o- k,i c. at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7—OZO—j1 dated �t`, 1, /7,02-" Installer U kK)r. Designer gknY,H: n i,(nlhnF,ln #bedrooms Approved de sigff fl'ow­�: ,. 3 C:) gpd The issuance of this pe rrm',it4all not b5konstrued as a guarantee that the system w\ill function ias ld��y ed Date / f �� 3 �^x Inspector `�,,.N �A�,;t. d�`�/. 3 ,.�.,.. _.__1 P - ' No. Z02-0 I t 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pstem, Construction Permit Permission is hereby granted to Construct Repair( Upgrade( ) Abandon( ) System located at 9 q I>Q[O n K na r1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: onstruccttion must be completed within three years of the date of this permit. DateGC��.(� Approved by ..- ----'` Town of Barnstable Inspectional Services • Public Health Division a • ■ARN6CABLC. M^3 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: _ •23- Z0 Sewage Permit# 2oZo• I1-T Assessor's MapRarcel ?o4.3S Designer: Installer: Q S3 Excravo ;ors Address: Q o 13ox 331 - Address: J Lk'T'c._S crr!{ 1✓a Fo rr- A On 4-IL-ZO Q A,Q EXc9 ,L7o_A10r�, was issued a permit to install a (date) (installer) septic system at qq aogeor\ based on a design drawn by (address) _L1,.uc F1o��c ra y dated LA-12- ZO (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils. were found satisfactory. I certify that the septic system referenced above was .installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i cdi�nace with the to rms of the I\A.approval letters (if applicable) ssq DAVID oyG� D. FLAHERTY,JR. co (I taller's nat No. 1211 0 �cISTERE SgN1TW NN esigner's Signatur (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoaldeptAHEALTMSEWER connecASEPTICOesigner Certification Form Rev&14-13.DOC ra CIO ". - c0 Certified Mail Fee 3 ' y-•\ )T $ Extra Services&Fees(check bar,add fee as appropriate) ❑Return Receipt(hardcopy) $ N`SS�A O ❑Return Receipt(electronic) $ ostmark O ❑Certfied Mail Restricted Delivery $ !}� Here O ❑Adult Signature Required Adult Signature Restricted Delivery$_ _ -.Oo13 O m \ �g,p0 ,,a rq KIRKPATRICK, LOUISE.J'. � 99 BACON ROAD. E3 HYANNIS, MA 02601 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail IN A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this_ delivery. USPS®-postmarked Certified Mail receipt to the' ■A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period, delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the e You may purchase Certified Mail service with Y P signee to be at least 21 years of age(not .x. First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agentl with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the a To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear aT certain Priority Mail items. USPS postmark.If you would like a postmark on n u For an additional fee,and with.a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail Item at a Post Office'for f.� the following services: postmarking.If you don't heed a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion a of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.r. electronic version.For a hardcopy return receipt, complete PS Form 3811,bomefic Retum Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps For,380%April 2015(Reverse)PSN 7530-02-000.9047 • • ON ON DELIVERY ■ Coifip`iefe items 1,2,and 3. - � g ture ■ Print your name and address on the reverse. -,, 'r. . A e so that we can return the card to you. s ■ Attach this card to the back of the mailpiece, B. Received by(Print e a e) Date of Delivery or on the front if space permits. —I.—Article-Addressed-to. t-tQ delivery address different from item 17 ❑Yes 4ter delivery address below: ❑No 'KIRKPATRICK, LOUISE J t 99 BACON ROAD HYANNIS, MA 02601 I --. .T,pie ❑Priority Mail Express® �II11111�I II III I IIIIIII IIIIIII111 I II I II II I III _❑AdultU fe 9M tur Restricted Delivery ❑R�Veryred Mail Restrlcted 9590 9402 5357 9189 1974 17 certified Mail Rued Delivery etum Receipt for ❑Collect on Delivery Merchandise p n+; a n�.. ,ho._[ir�ncfc._f.,..�o❑ifcA rahan__ _ _ - 0 Collect on Delivery Restricted Delivery Signature ConfirmationT"' iil ❑Signature Confirmation 7 015;R17 3 0 0 01 >4 9 8 8; 13 6,4: `;iil Restricted Delivery Restricted Delivery k PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt i e - First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 5357 9189 1974 17 I United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service 4 Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 I I I �tT Town of Barnstable ti Inspectional Services Department anrtx�rrata>.� 6'9. ,� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1364 December 9, 2019 KIRKPATRICK, LOUISE J 99 BACON ROAD HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 99 Bacon Road, Hyannis, MA was inspected on 11/15/2019 by James D. Sears, 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: • The system consists of three block cesspools. Main piping to cesspool #2 is blocked and falling apart. Block cesspool is old; blocks are not solid enough to do a line change. • The state inspector marked "failure" due to backup of sewage on the inspection report. 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. PER ORDER OF THE BOARD OF HEALTH 0 /�rl omas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\99 Bacon Road Hyannis.doc Town of Barnstable 3 BA%NSrABLE, MASS �A 039. Inspectional Services Department rED MA'f A 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 above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool 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) Veaching 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 ao y Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis. f/ MA 02601 11-15-19 page. CitylTown 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. \`, g1110Ftilupz���' Important:When i filling out forms A. Inspector Information AR on the computer, a DAMES use only the tab James D.Sears key to move your Name of Inspector cursor-do not use the return Capewide Enterprises s��•,c+� ��o .��a key. Company Name 4�y����•. ,.G4�.� 153 Commercial Streetv,,n —IC'11 Company Address uiulnu Mashpee MA 02649 City/Town State Zip Code reaoo 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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 11-15-19 Spector'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. 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. 151nsp.doc•rev.7MI2018 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 1 of t8 6 abed xed dH LEU 660E 66 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 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: ❑ 1 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: Failed - Pipeing + Blocks.The system is three old block cesspools. 2) 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. r 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 extiiltration 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 ❑. NO (Explain below): t5nsp.doc-rev.7/26f2018 Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 2 of 18 Z a6ed YU dH LZU 6V 66 AON i Commonwealth of Massachusetts Title 5 official Inspection Form P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Mf . � 99 Bacon Road Property Address Louise Kirkpatrick Owner Owners Name information is required for every Hyannis MA 02601 11-15-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): f ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (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: Wnsp.doc•rev.7128/2018 ntfe 5 Official nspection Form:Subsurface Sewage Disposal System-Page 3 of 18 £ abed xed did LZ:U 660Z 6l, AON Commonwealth of Massachusetts Title 5 official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -�' 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 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.7l2fi12018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 abed xeJ dH LUZ 660Z El, AON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f� f 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 page. City/Town 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 NA or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 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. Q ® 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 T ❑ ❑ 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— IW PA. )or a mapped Zone II of a public water supply well t5insp.doc•rev.7!2612018 Title 5 Official nspactlon Forth:Subsurface Sewage Disposal System•Page 5 of 18 5 abed xed did LZU 6XZ 66 AON Commonwealth of Massachusetts 6P Title 5 Official Inspection Form kt��"-44 I(i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 page. City/Town 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 r 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 a/!inspections: Yes No ❑ ® Pumping information was provided by the owner,occupant,or Board of Health El ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week per ❑ ® 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 15202(5)) 15insp.doc•rev.712SI2018 Title 5 Official nspection form:Subsurface sewage Disposal System•Page 6 of 18 9 a6ed xed dH LZ:£Z 660Z El, AoN c � Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 page. City/Town State Zip.Code Date of inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Three Block Pool's. Number of current residents: 1 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2017-34,000Gals g ( y g (gpd))' 2018-24,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date 15insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 L a6ed xed dH LUZ 660Z 66 AoN f y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name Information is required for every Hyannis MA 02601 11-15-19 Paw. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commerclalnndustrial 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: NA Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 800 gallons How was quantity pumped determined? Gage on Pump Truck Reason for pumping: Part of Inspection tSinsp.doc•rev.V262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Pag e 8 of 18 9 abed xed dH 8UZ 660Z 66 ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form ( Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 page. City(Town 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: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1 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.): Line main to pool #2 Blocked and falling apart. Block not solid enough to do line change. 15lnsp.doc•rev.7126f2018 Title 5 Vidal Inspedon Form:Subsurface Sewage Dlspaaal System•Page got 18 6 a6ed xeJ dH BUZ 660E 66 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v. 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 per. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan); Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 — How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 ol, abed xeJ dH KU 660Z 66 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form vw-rr Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 11-15-19 required for every page. CitylTown 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.7126)2018 Tiue 5 Official Inspection Form:Subsueace Sewage Disposal System•Page 11 of 18 66 a5ed YU dH 6ZU 660Z 66 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 page. City/Town State Zip Cade Date of Inspection D. System Information (cost.) 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 No Box 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.00c•rev.T12812018 Title 5 Official nspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Z i, abed xed dH 6ZU 6 60Z 6 6 AON Commonwealth of Massachusetts Tw Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Bacon Road " Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 _ page. City/Town State Zip Code Date of InGpection 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: Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ® overflow cesspool number: 2 ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Dlsposal System Page 13 of 18 6� a6ed xed dH 6ZU 660Z 61, AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 page, C'Ity/Town State Zip Code Date of Inspection D. System Information (cunt.) 11. Soil Absorption System(SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Over flow's are two Block Pool's. #1 is 6-6"w/cover at 16" I'water w/outlet sweep. #2 is T deep w/cover at 20"dryw/no sign of over loading. Note: Pool#2 Block's are old not solid enoug1n to be worked on. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert i3 Depth of solids layer 4 Depth of scum layer 2" Dimensions of cesspool 6'Deep Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Main pool is 6'deep block w/cover at 4". Pool full W/orange burge sweep . Line to pool #2 in Bad shape Falling apart. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 b 6 a6ed xeJ dH 6HZ 6 60Z 6l, AON Commonwealth of Massachusetts Title 5 Official Inspection Form �4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �t've 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name Information is required for every Hyannis MA 02601 11-15-19 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate an 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.): 151nsp.doc•rev.7t26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 56 96ed xed dH 6UZ 660E 61• AON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 99 Bacon Road L Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 11-15-19 requirediorevery page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 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 r f AR A A I J A .3_ s8 1 Q � 3 kl 1 , I,Wwdo$ row pAB4019 ru S Orrcp LWO M Pam szwfta 60.8 ra0'WO&C flat"• .00116 g t abed xed dH 6Z:£Z 6 60Z 6 6 ^oN i - Commonwealth of Massachusetts in Title 5 Official Inspection Form 'e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �V 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15, Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N° L 12' Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 15C 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: Auger T.H. 12'no G.W.. Bottom of pool#3 at 10' below grade. Bottom of pool#3 at 2'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.Wc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 �� abed xed dH 6Z:£Z 660Z 6l, AON c Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is required for every Hyannis MA 02601 11-15-19 - page, Chy/Town 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 GLADE 71" o' poop �, 0 t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page la of 18 91, @fed xed dH 6Z:EZ 61.0E 61, ^oN Aug 01, 2018 1629 HP Fax page 19 3a9- D%__ Commonwealth of Massachusetts Title 5 Official Inspection Form ' t' Subsurface Sewage Disposal System Form Not for Voluntary Assessments r��l P F 1 v � 99 Bacon Road Property Address A. Louise Kirkpatrick Owner Owner's Name / information isreq Hyannis �/ MA 02601 7-27-18 page. for every City/Town State Zip Code Bate 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. �at�d�u10F 1110', Important:When A. Inspector Information filling out forms �� '``p��', .. ..... .,''4CyG on the computer, James DSears = JAMES n use only the fob a SEAS_ key to move your Name of Inspector v cursor-do not Capewide Enterprises �'•-o�c- use the return Company Name �$ '' �'' key. 153 Commercial Street �V uutuu Company Address Mashpee MA 02649 Cityrrown State Zip Code raYro 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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 0"'� 7-31-18 pector'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 god 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. 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. 151nap.coc•rev.712&2018 Title 5 Official Inspe0on Form:Subsurface Sewage Dieposel System-Page 1 of 18 .LDG G�r�VS�i Aug 01 2018 16:30 HP Fax page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 7-27-18 required for every State Zip Code Date of inspection page. Cityrrown 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: The system is three old Block pool's 2) 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): t5insp.doc-rev.712612018 Title 5 Officlal Inspection Form:Subsurface Sewage Disposal system Page 2 of 18 Aug 01 2018 16:30 HP Fax page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owners Name intormation is required for every Hyannis MA 02601 7-27-18 page. City/rown State Zip Code Date of Inspection C. Inspection Summary (cunt.) 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): ❑ 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: t5lrtsp.0oc•rev.7(2&2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 3 d 16 Aug 01 2018 16,30 HP Fax page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form `] Subsurface Sewage Disposal System form -Not for Voluntary Assessments p 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is H annis MA 02601 7-27-18 required forevery y 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 61n5p.doc•rev.7126/201 a Title 5 ofricial Inspection fcrm:Subsurface Sewage Disposal System-Page 4 of 18 Aug 01 2018 16,31 HP Fax page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,% 99 Bacon Road " Property Address Louise Kirkpatrick Owner Owners Name information is Hyannis MA 02601 7-27-18 required for every State Zip Cade Date of Inspection page. citylTown C. Inspection Summary (cont.) 4) System Failure Criterla Applicable to All Systems: (cont.) Yes No N A❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z 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. 6) 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.712612010 Titla 5 Official Inspection Form Subsurface Sewage Disposal System-Page 5 of 16 Aug 01 2018 16:31 HP Fax page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owners Name information is Hyannis MA 02601 7-27-18 required for every — Slate Zip Code Date of Inspt:ction page. City/Town 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 all 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 NIA) ® ❑ 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? Cl ® 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)] t5insp.doc rev.7126f201 8 Title 5 Offlciel Inspection Form:Subsurface Sewage 6403al System•Page a of le Aug 01 2018 16:32 HP Fax page 25 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 7-27-18 required for every State Zip Code Date of Inspection page City/Town D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Three Block Pool's 1 Number of current residents: Does residence have a garbage grinder? 0 Yes ® No Does residence have a water treatment unit? 0 Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection LD Yes ®' No information in this report.) Laundry system inspected? 0 Yes ® No Seasonaluse? Yes ® No na Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? [] Yes ® No Present Last date of occupancy: bate t8in6p.doc-ray.7/26/2058 Title s ofriolal Inspection For:Subsurface Sewage Disposal System-Page 7 of 18 f Aug 01 2018 16:32 HP Fax page 26 Commonwealth of Massachusetts :. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information Is Hyannis MA 02601 7-27-18 required for every 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(seatslpersons/sq.ft., etc.): Grease trap pr esent? ❑ 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 occupancyluse: Date Other(describe below): 3. Pumping Records: NA Source of information: Was system pumped as part of the inspection? ® Yes ❑ No: 700 If yes, volume pumped: gallons How was quantity pumped determined? Gage on Pump Truck Part of Inspection Reason for pumping: Onsp.doc-rev.712WOiB Tiue 5 official Inspection Form:Subsurface sewage Disposal System'-Page 8 of 18 Aug 01 2018 16:33 HP Fax page 27 Commonwealth of Massachusetts Title 5 official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 7-27-18 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 4. Type of System: ❑ Septic tank, distribution box, soil absorption system ® ®in 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 11A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. Cl Other(describe): Approximate age of all components,date installed (if known)and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑cast iron ❑ 40 PVC ® other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Orange Burge t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Fcrm:Subsurface Sewage Disposal System Page 9 of 18 Aug 01 2018 16:33 HP Fax page 28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F., 99 Bacon Road Property Address Louise Kirkpatrick Owner Owners Name information is Hyannis MA 02601 7-27-18 required for every State Zip Code Date of Inspection page. CitylTown D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth. Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): l5nsp.00c•rev.7/2&2018 TiUe 5 Official tnspection Form:Stsurface sewage Disposal System•Page 10 of 18 Aug 01 2018 16:33 HP Fax page 29 Commonwealth of Massachusetts 6z Title 5 Official Inspection Form Subsurface Sewage Disposal Systern Form- Not for Voluntary Assessments .� 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 7-27-18 required for every State Zip Code Date of Inspection page Cilyrrown 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 t5lnsp.doc•rev.7MM18 Title b oftial Inspection Fcrm:Subsurface Sewage Disposal System Page 11 of 18 Aug 01 2018 16:34 HP Fax page 30 commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner owner's Name information is Hyannis MA 02601 7-27-18 required for every page CifyfTown State Zip Code Date of Inspection D. System Information (cont.) 6. 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): No Box Depth of liquid level above 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.): 15insP.da'ray.71261201e Title 5 officlel Inspection Form:Subsurface Sewage Disposal System Page 12 of 18 Aug 01 2018 16:34 HP Fax page 31 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 7-27-18 required for every page City/Town State Zip Code Date of Inspection D. System Information (cons.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes 0 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: Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: 2 ® overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 15insp.doc-rev.712612016 Title 5Official Inspection fcrm:Subsurface Sewage Disposal System'-Page 13 of 15 Aug 01 2018 16:34 HP Fax page 32 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information Is -Hyannis MA 02601 7-27-18 required for every nis state Zip Code Date of Inspection page cityfrown 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.): Over Flow's are two Block Pool's. #1 is 6-T wlcover at 16" 3'water w/outlet sweep. #2 is 7' deep wlcover at 20"dry w/no sign of over loading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): 1 Number and configuration 8" Depth—top of liquid to inlet invert 4" Depth of solids layer 2" Depth of scum layer 6' Deep Dimensions of cesspool Block 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.): Main pool is 6'deep blockw/cover at 4" Pool at working level wloutlet sweep. t5insp.doc•rev.7/2612DIB Title s official inspection Form:Subsurface sewage Disposal system'-Page 14 of 18 Aug 01 2018 16:34 HP Fax page 33 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 7-27-18 required for every Page CitylTown 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.): 15insp.doc•rev.71282018 Title 5 Official Inspection Form:SubsuAace Sewage Disposal System-page 15 of 18 Aug 91 2018 16:35 HP Fax page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form l' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is _ity/town Hyannis MA 02601 7-27-18 required for every paw C 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 ,4R a a 0 t � a 0 3 t5irep.00c•rev.712612016 Tit.e 5 Official in"clion Form:Subsurface Sewage Disposal system•Page 16 of 18 Aug 01 2018 16:35 HP Fax page 35 If"\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments uy 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA D2601 7-27-18 n gered for every CityRown State Zip Code Date of Inspedion D. System Information (cost.) 15. Slte Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No 12' Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Auger T.H. 12' no G.W.. Bottomof pool #3 at 10' below grade. Bottom of pool#3 at 2' above T.H. Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. ISfnsp.doc-ray.7I26f201 9 TiUe 5 Official Inspection Form:Subsurfam Sewage Disposal System-Page 17 of 18 Aug Q1 2018 16:35 HP Fax page 36 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments f 99 Bacon Road Property Address Louise Kirkpatrick Owner Owner's Name information is Hyannis MA 02601 7-27-18 required for every CifylTown State Zip Code Date of Inspection age 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.726W18 Title 5 official inspection Form:SubWace Sewage Disposal System•Page 16 of 16 Par CeI'309-63S' q9 OcLco n Rna.d Hyclnnla, MA oa�m Dining Room V;Leh en 8af�ro©m AL Hallway n +- s o�� m Room U 'Beck ro o M A3 Garag En�-r� e -Frant-door Bedroom la Dirrie.nsi©n� x 8ectrOOM tea. s: 3o-�a1 sq. k 1a44- Bedroom A I � _ y , �x i0jS i!, Pre rya by: 3edroorn �3 ID 9"Y, 16 '7„ Lnuis& Tgirkpa+rick May a8_ao 19 COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services P.o. Box 331 TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE EL. 102.0' EL. 100.0' (not to scale) PORT W I 3" OF GRADE Harwich, MA 02645 INSP. 2" PEASTONE OR 774.994. 1166 GEOTEXTILE EL. 100.0' CLEAN SAND FILTER FABRIC 4" CAST IRON or EQUIVALENT ENT (IF RE ) MIN. PITCH 1 4" PER FOOT 4" SCHEDULE 40 PVC PIPE — 4"SCHEDULE 40 PVC PIPE , FLOW LINE (first 2'to be level) _� 30'(1.0%) i f-- 5' 1% --► EL. 97.2' •,;.••; L. EXIST. -� -� 1 14" • EL EXIST. � 2' EL.97.0 L.96.53' EL.94.5' :L.9 96.5 LO 005%SLOPE' E H 20 Deox SOIL ABSORPTION SYSTEM CLEAN, y DOUBLE- (2) TRENCHES 3'W X 33'L X 2'D USING 5.0' .•i. '• '' 6"CRUSHED STONE OR WASHED " " PERFORATED PIPE AND SURROUNDED MECHANICALLY COMPACTED s TO 1 2" (DATUM:ASSUMED) 1500 GALLON SEPTIC TANK BY DOUBLE-WASHED J" TO 1 " STONE EL. 89.5' (PROPOSED) \ BOTTOM OF TEST HOLE EL. 89.5' USGS ADJUSTMENT: N/A LOCATION MAP GROUNDWATER ELEV: N/A N TH Bum us Rd. BENCHMARK: / TOP OF FNDN EL. 10a 0' DRIVEWAY/ 0 - LOCUS 3 / / \ 7► m a N GARAGE ` �O C tnu O �929 00 � O EXISTING 3 BR 98 NTS 38.9' ® PROP. S.T. DWELLING EXIST. C.P.'S 58.C p f11.3' 1 /STERN 98 X a'�AItTAR►t► lA 38.8' DATE.•41IZ2020 REV1 ED: o LOT 110 19,928 SFt MAP 309 SITE AND SEWAGE PLAN FOR LEGEND LOT 35 B III B EXCAVATION INC./ 6 6 6 6 GAS LINE LOUISE KIRKPATRICK W W W W WATER LINE 99 BACON ROAD -e E E E E EXIST. ELECTRIC i 99 EXIST. CONTOURS SCALE : 1 " = 3 0' (HYANNIS) BARNSTABLE, MA 99 PROP. CONTOURS 6Nrt u.,c ws UNDERGROUND UTIL. REF.-LCP 18327-F PAGE 1 OF2 ....... ....................... . . ...... ......... .............. ......... ...................... ....... ......... ........ ......... ........... _... . ......._ ........................................ ......... .. ...__. ......... GENERAL NOTES DESIGN CALCULATIONS Flaherty Environmental Services P. 0 . Box 331 1, ALL PRECAST COMPONENTS TO BE H-10 SYSTEM DETAIL--'*' Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED, "1VUMBER OFACTUAL BEDROOMS 3 774-994. 1166 ALL COMPONENTS WITH ANY ANTICIPATED VEHICULAR TRAFFIC TO BE H-20 RATED. GARBAGE DISPOSAL UNIT NO ❑BS, PORT 2. THE DESIGN OF THIS SYSTEM DOES NOT ' 3 ALLOW FOR THE USE OF GARBAGE TOTAL EST/MATED FLOW t 1, GRINDER, (110 GAL/BR/DAYX 3 BR) 330 GAL./DAY .777 - 3, MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 4. ALL CONSTRUCTION TO CONFORM WITH 330 GPD X 2= 660 GAL. 6 310 CMR 15.000 AND ALL OTHER RESERVE APPLICABLE LOCAL, STATE AND FEDERAL SIZE OF SEPTIC TANK 1900 GAL. CODES AND REGULATIONS. 5. INSTALLER/CONTRACTOR TO REVIEW& SOIL CLASSIFICATION 1 33' VERIFY ALL ELEVATIONS AND DETAILS AND DESIGN PERCOLATION RATE <2 MIN./INCH REPORT ANY DISCREPANCIES TO — DESIGNER PRIOR TO CONSTRUCTION OR EFFLUENT LOADING RATE 0.74 GAL./DAY/FTZ ASSUME ALL RESPONSIBILITY. 6. INSTALLER/CONTRACTOR IS RESPONSIBLE LEACHINGAREA r 9' MIN, OF S❑IL FOR MAINTAINING SAFE WORK AREA, BOTTOM: (3'X 33)X2= 198 FTZ 2' PEAST❑NE OR FILTER FABRIC 2' VERIFYING ALL UTILITIES AND NOTIFYING SIDES: "DIG SAFE" (1-888-344-7233) 72 HOURS [(2'X33)X2+(2'X3)X21X2= 288FT2 j PRIOR TO CONSTRUCTION. TOTAL = 486 FTZ 7, ANY CHANGES TO OR DEVIATIONS FROM X 0.74= 359 GAL/DAY 3' THIS PLAN MUST BE APPROVED IN TRENCH END VIEW WRITING BY FLAHERTY ENVIRONMENTAL USE(2) TRENCHES OF PERFORATED PIPE SURROUNDED BY SERVICES AND LOCAL BOARD OF HEALTH, a"TO 14"STONE, EACH TRENCH CONFIGUREDAS 8. FINISH COVER OVER COMPONENTS IS NOT X WIDE X 44'LONGAND 2'DEEP TO EXCEED 3'PER 310 CMR 15.000 UNLESS SHOWN PER PLAN, RESERVE LEACHING CAPACITY N/A 9. ALL ABANDONED SEPTIC SYSTEM (NTS) COMPONENTS TO BE PUMPED DRY AND FILLED WITH CLEAN SAND OR REMOVED AND REPLACED WITH CLEAN SAND. 10,ALL COMPONENTS TO BE PROVIDED WITH SAIL EVALUATION OF WATERTIGHT ACCESS PORTS WITHIN 6" OF �yzN FINISH GRADE, fl !� 11.ALL SEPTIC TANKS, DISTRIBUTION BOXES AND PIPING TO BE INSTALLED TEST HOLE#1 TPr#20-54 TESTHOLE#2 TPT#20.54 "l certify that on November 12,2002,1 have passed - Evaluator., David D.FlaherlyJr.,RS,REHS Evaluator., David D.Flaherty Jr.,RS,REHS the examination approved by the Department of WATERTIGHT, SE#2755 SE#2755 Environmental Protection and that the above analysis fir' BOH witness: David Dtanton,RS BOH witness: David Dtanton,RS has been performed by me consistant with the 12,NO KNOWN WETLANDS OR WELLS WITHIN Date: April 1,2020 Date: April 1,2020 required training,expertise,and experience described 150 FEET OF PROPOSED LEACHING. in 310 CMR 15.018(2)." 13.THIS IS NOT A CERTIFIED PLOT PLAN AND TH-1 ELEV.100.0' TH-2 ELEV 100.0' .� UNDER NO CIRCUMSTANCES IS THIS PLAN o°-n° oiA cs +ora2i2 0°-11° oiA Ls 10YR212 TO BE USED FOR ZONING OR BUILDING ++" �' a Ls mYRsrs ++°-2s B LS foYRsrs PURPOSES, 14.LOT IS SHOWN AS ASSESSOR'S MAP 309 zs 126° c MCS 2.5Y616 26°-126" C MOS 25Y6/6 PARCEL 35. PERC AT 38' 15. LOCUS PROPERTY'S PROPOSED SYSTEM SITE AND SEWAGE PLAN FOR APPEARS NOT TO BE WITHIN AN AQUIFER B & B EXCAVATION INC./ PROTECTION DISTRICT(ZONE II), G.W.ELEV.N/A G.W.ELEV.N/A LOUISE KIRKPATRICK 99 BACON ROAD BOTTOM TH-+ELEV.89.5'1 BOTTOM TH-2 ELEV.90.0' (HYANNIS) BARNSTABLE, MA PAGE 2 OF 2 DATE:411212020 P