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0358 LINCOLN ROAD - Health
35Sr .1 Coln Road _ w Ryan 271 66 N V � a P r a IP { M f n n Commonwealth of Massachusetts aW— DlO(p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 t.l Property Address I� KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road,Yarmouth Port, MA rr; Owner Owners Name information is required for every Hyannis, MA MA 02601 06/26/2019 P 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. Inspector Information on the computer, use only the tab REID C. ELLIS key to move your Name of Inspector cursor-do not ELLIS BROTHERS CONSTRUCTION use the return Company Name key. 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 Cityrrown State Zip Code r 508-362-6237 S121891 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 main nance of on-site sewage disposal systems.After conducting this inspection I have determined that the ystem: 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails V Inspector Signatu 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 �4— 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. t5insp.doc•rev.M6=18 Title 5 Official Inspection Form:Subsurface sewage Disposal System.Pagel of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form i e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name fn isregwfired or every Hyannis, MA MA 02601 06/26/2019 page. Cityrrown 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: Ael LAE 1 have not fou rdny nformation which indicatesthat any of the failure criteria described in 310 CMR 1 in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as desci abed in the"Conditional Pass"section need to be replaced or repaired. The system, upon cc mpletion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determine "(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 exfi tration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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 thar 20 years old is available. ❑ Y ❑ N ❑ ND(Explain b low): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts 1_ z Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '`• � 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name infortnation is required for every Hyannis, MA MA 02601 06/26/2019 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operation a. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out o high static water level in the distribution box due to broken or obstructed pipe(s)or due to a brc ken, settled or uneven distribution box. System will pass inspection if(with approval of Board ofHealth): ❑ 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): Y ❑ The system required pumping more than 4 tirr es 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, sE fety 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 function ng in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/2W018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Bamicale Road, Yarmouth Port, MA Owner Owners Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. Cityrrown state Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet a surface water ❑ Cesspool or privy is within 50 feet J a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of H alth (and Public Water Supplier, if any) determines that the system is functioninj in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil at sorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributar 1 to a surface water supply. ❑ The system has a septic tank and SAS nd the SAS is within a Zone 1 of a public water supply. " ❑ The system has a septic tank and SAS z nd the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS a nd 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 presei ice of ammonia nitrogen and nitrate nitrogen is equal -to or less than 5 ppm, provided that no other faili ire 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.726/2018 Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Bamicale Road, Yarmouth Port, MA Owner Owner's Name information is Hyannis, MA required for every y MA 02601 06/26/2019 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 or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %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. An portion of a cesspool y P p or privy is within 50 feet of a private water supply I 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.] ❑ M/ 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"ye;"or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400 f Bet of a surface drinking water supply El ❑ the system is within 200 1 Bet of a tributary to a surface drinking water supply ❑ the system is located in nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapp d Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I f Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 358 Lincoln Road, Hyannis, MA 02601 v Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Bamicale Road, Yarmouth Port, MA Owner Owners Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. Cityrrown State Zip Code. Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No Pumping information was provided by the owner, occupant, P Y pant, or Board of Health ❑ VWere any of the system components pumped out in the previous two weeks? ElN Has the received system y e ed normal flows in the previous two week period? ❑ N 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? Me< ❑ Was the site inspected for signs of break out? P 9 ❑ Were all system components, 4wcluding 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts ig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Bamicale Road, Yarmouth Port, MA Owner Owner's Name information is ' Hyannis, M required for every y A MA 02601 06/26/2019 page. Cityr town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 6 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): �� Description: 01V .X" . Number of currentresidents: `� Does residence have a garbage grinder? ❑ :PN7o Does residence have a water treatment unit? ❑ Yes k No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ,,,�� information in this report.) El Yes E' No Laundry system inspected? ❑ Yes VNQ Seasonal use? ❑ Yes VNo Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date ISinsp.doc•rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 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 CM 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 sys em? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: v Was system pumped as part of the inspection? /Yes ❑ No If yes, volume pumped: /t50U gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ( (P a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of ystem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records if an P � Y) ❑ Innovative/Altemative 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, 'own)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes /- No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: P cast iron ❑40 PVC ❑other(explain): 6 Distance from private water supply well or suction line: 1�e feet Comments(on condition of joints, venting, evidence of leakage, etc.): i t5insp.doc-rev.7/26/2018 Tttle 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 9 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): ,+ Depth below grade: .��� [7 c°i ./� 11 feet Material of construction: M"C'*oncrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) 711If tank tank is metal, li age: ears �,� / ./ Is age confi ed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yet u No/ Dimensions: AIVIV �t1 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 4� Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle J � How were dimensions determined? T Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): e 6ow- A.- t5insp.doc°rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Bamicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet t e or baffle, Distance from bottom of scum to bottom o outlet tee or baffle Date of last pumping:. Date Comments(on pumping recommendation , inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evi ence 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 ❑f berglass 0 polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 11 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float swi hes, etc.): *Attach copy of current pumping contract required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate o e plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of ids carryover, any evidence of leakage into or out of box, etc.): AW V aw t5insp.doc•rev.7126f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 12 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 368 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chambe , condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working ord , system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 01 Type: ❑ leaching pits number: leaching chambers number: - ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): l 1 / Al® �rZ a- - OF d 12. Cesspools (cesspool must be PUMP d as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, sig is of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t �- ,; 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. CityRown 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 ydraulic failure, level of ponding, condition of vegetation, etc.): { 15insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 15 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Bamicale Road, Yarmouth Port, MA Owner Owner's Name information isequired or every Hyannis, MA MA 02601 06l26l2019 page. Cityrrown 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 ilding. Check one of the boxes below: hand-sketch in the area below El drawing attached separately � w A `1/. 17 e � Cad2z 32 d _ '_32q r" e1 M P I t5insp.aoc•rev.M6=18 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts +� ,iq Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Barnicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope ze.e''ve Surface water /t���✓� ©, Check cellar L�J Shallow wells Estimated depth to high ground water: C;ZID t d 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: r� 1:> ,rIqe, �,�. as 15?7 You must describe how you established the high ground water elevation: 0 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 358 Lincoln Road, Hyannis, MA 02601 Property Address KAA Realty Trust, Kerry P and Ann M Ayler, 92 Bamicale Road, Yarmouth Port, MA Owner Owner's Name information is required for every Hyannis, MA MA 02601 06/26/2019 page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed [� D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE uxATION SEWAGE VILLAGE 11y*4 A1' W s 5 ASSESSOR'S MAP&PARCEL INSTALLER'S NAME:&PHONE NO. Alto-IV SEPTIC TANK CAPACITY t.3'd0 cr//O //A ✓ LEACHING FACILITY:(type)��,/).S-oo (' 4 .�_ s (size) y2 X 3 A NO.OF BEDROOMS �J n d OWNER /'�' 11s,'e CZ. PERMIT DATE:. // /to COMPLIANCE DATE 0 Separation Distance Between the: W 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 n a_ COO ,: UU� 1 l�1 Fee 40 No. ��"" THE COMMONWEALTH OF MASSACHUSETTS Entered in compute PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppIitation for ]Disposal Ops -m Construttion permit Application for a Permit to Construct( ) Repair(4-1upgrad ( ) Abandon( ) ❑Complete System ❑Individual Components Location A dress qr Lot No. f� N� Owner's Name,Address,and/Tel.No. Assessor's Map/Parcel �_ = o } Installer's Name,Address,and Tel. o. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(11411 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S •r U gpd Design flow provided �� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. i e e Date Application Approved by _ Date Application Disapproved Date for the following reasons Permit No. Date Issued y+ ` >.•+..n.iwr4n7.�^i..4.`f4¢yF,fy�'Vr� �...+.v�v�y.rrrw.,.�,«y�x•.-.,-� .,--- ..�.+.. .. «....yatb�,:.,;,;�. • No. bvo % , Fee y�' THE COMMONWEALTH,OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN'OF BARNSTABLE, MASSACHUSETTS r 'cation for bisposal 6pstetn Construction 3permit Application for a Permit to Construct( ) Repair(/Upgrade() Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /� S Owner's Name,Address,and Tel.No. ssessor's Map/Parcel Installer's Name,Address,and Tel. o. Designer's Name,Address,and Tel.No. Type of Building! aF j Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 57 _r U _ gpd Design flow provided r6 f gpd Plan Date Number of sheets Revision Date Title - Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicab a) l Date last inspected: j *w 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 oof�f Health.' Signed/��,/ G . . n Date / / /0> Application Approved by �� /v�!! J Date Application Disapproved by d \ v Date for the following reasons t-© Date Issued -""Permit No. " T` x THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(y/)` Y Upgraded( ) Abandoned( )by (12 C f7 at 3 has been const cted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. f! .ated Installer /� Designer 4- bedrooms Approved design''flow N gpd The issuance of this p rmit hall not be construed as a guarantee that the system will ncrion as designed. Date �� �� Inspector,- J1, �� �( No. Ob Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION' BARNSTABLE,MASSACHUSETTS �fsosaf �pste ,Constructio'�ertnit Permission is hereby granted to Construct( )r Repair 7 ) U grade Abandon( ) System located at -3 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. 7 Provided:Construction u191 be co/� leted within three years of the date of this permit. Date / ) Approved by AFFIDAVIT January 11, 2010 To Whom it May Concern, I, Kerry Aylmer, owner of the property at 358 Lincoln Road, am having the septic system replaced there, and it needs to accommodate the 5 bedrooms in the house. The house was originally a 3-bedroom home when it was built in the 50's, but when my parents bought it in 1984, they found it to be too small for their growing family, so they remodeled, and added 2 bedrooms downstairs. Sincerely, Kerry P. Aylmer ELIZABETH M. GATELY NOTARY PUBLIC Commonwealth of Massachusetts My Commission Expires August F, 2013 t 23 10 12:38p CSN EnginsO.Irg '-5G8-548-54-8 p.1 Town of Barnstable Regulatory Services I NON Tlwtnats M.Geber,Director : ..., Public Realth Division 'Thomas McKean,Director . 200 Main Street, Hyaneis,MA 0260t Office: 503-8624(44 tax: 508.9�0•6304 Date: ! 26 Sewage.Permit# ASSOAor's -MAWParcc! 271 — 'Ina:i�ller &. Dekient!r Ct•rtifcation Form Designer: JU v "'� [nslu►Ier 2 / 4.� S T I-I OV% Address: �` 2 Address: o x (A/ YALIT __�__ �uas is�ucd�► pern�n.u� ir"tall a (dxtc) (insratlerlQ� septic system at �1'"�`J `L based on it design drawn by (address) / vdcsigr il'rl ,�/ 1 certify that the septic system referenced above w s instxled substantially according to the design. w-Isich may include minor approved changes such as laicral relocation of the distribution cox and/or septic tank, Stripout (if required) was inspected and the soilR were found 9ehisf3ctory. 1 Certify tlt:►y(hc septic system referenced above was inst3l].d with major changes ,i.c, greater than 10' lateral relocation of the SAS or any verticrl relocation of any component of t1te septic 4y.verd) but in accord', tee with State & l,ocal Re Plan rev,isioct or certified a,-built by designer to ollow_ Snipou[(if r�quirc. x V, and the soils wort:found whifact c� P1V'0 tall u , I L}�i`Lv,l o � - e[ s S00at KC) NC.C.�Sj04 ) OVA ''(�th ig�3er Sigatatut») (Affix Uesigwr's tarttp Here) LE R C HEALTH Dl' SION. .F R A WI1. N '1' B 1RU NTIL BOTH THIS FORM AND U'BU[ ' :AR RECEIVED THIS; IJARW F. 1 J ' '1'H D VI41O THANK YOU. y:u�ikc t2u+nwtick�i�aueenl:lea:wn l:xnak'c Le LL r IL izi 16, 1 r ti 71 ` v�C �. c d i a Ot�JG` L 1 Town of Barnstable Department of Regulatory Services . � arsurarxnt:a, ; . Public Health Division Date l0 200 Main Street.Hyannis MA 02601 Date Scheduled Time—vim Fee Pd, t'0 v Soil Suitability Assessment or Se Performed By: Cd 51�� f' wage ",SWitnessed By: � 1 LO N & GENERAL INFORMATION F on Address/ f SS 1. w cpC� /� Owner's Name ,!�,e�ArW/Q, Q Vl ovl,q Address. (Z 'tXj`R Assessor's Map/Parcel: 2' Y�•� ,(� — — Engineer's Name NEW CONSTRUCTION REPP.112 1J.�2 �'TA� has 4� Telephone# Land Use t 1 ,�� Slopes(%) o Surface Stones _ Distances from: Open Water Body��.4- ft . Possible Wet. /�/ T31..T Area_----�_ft Drinking Water Well a_I�Z4ft Draihage Way /1 ft Property Line Other (40L-� 30 ' f[ SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,] «0,R"O�wrtt ands in proximity to holes) d � � 1 (, N �ol,J tw y`Y`j Parent material(geologic) - r v v4'0-r Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater y 1 IT DETE ATION FOR SEASONAL Method Used: HIGH WATER TABLE Depth Observe Landing in obs.hole: Depth to weeping Nside of obs.hole: �jrvajljiln Depth to Sol]mh Index Well# Readin GroundwnterAdJus t g IndexAdJ,factor ft. AdJ, water Level Observad PERCOLATION TEST bate 0 U�x1mn•3�o Z Hole# `H Time at 9" Depth of Pere �CV, e�]s�—�,an,. _n t' v Time at 6" Start Pre-soak Time @ 3, (1 T' 2 Time(9".6") End Pre-soak Z it Rate Min./Inch Site Suitability Assessment: Site Passed * Site Failed:_ Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed On Back----------- If percolation test is to be conducted within 100' of wetland, you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFO.RM.DOC DEEP-OBSERVATION HOLE LOG Hole# 1�' 69• Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stoner,Boulders. lVy on iste c % ,ravel 32 13 Ll !bx-bt, �,�74, u C ?7 4-AJ& Y DEEP OBSERVATION HOLE LOG Hole# l of Depth from. Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other (Munsell) Mottling (Structure,Stones,Boulders. O_ 1Z i C lU t JQQnsistency.90 Gravel) 1 - �/O ✓O LA � W .... DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA Other. ) t (Munsell) Mottling (Structure,Stones,Boulders. QPflaigtency,9' Gravel i DEEP OBSERVATION HOLE.LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil - Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten I Flood Insurance Rate Man: Above 500 year flood boundary No_. Yes Witlun300 year boundary No Yes " Within 100 year flood boundary No_ Yes . Depth of Naturally Occurrin2 Pervious Material Does at least four.feet of naturally occurring perv'0 s material exist in all areas observed throughout the area proposed for the soil absorption system? _17 QS " If not,"What is the depth of naturally occurring pervious material? Certification / I certify that on -qb (date)I have passed the soil evaluator examination approved by the Department of.Env on ental Protection and that the above analysis was performed by me consistent with the required train' exp rtise and exile ' nce escribed in 310 CMR 15.017, Signature Date / - Z2/'6� Q:\S PT1C�PERCFORM.DOC I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRO, TECTIONEIVED tICT 2 4 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 358 Lincoln Road Hyannis, MA 02601 Owner's Name: Kerry Aylmer Owner's Address: Same Date of Inspection: October 4, 2002 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Map:271 Mailing Address: P.O. Box 49 Parcel: 066 Osterville,MA 02655-0049 Lot: 66 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT . I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ - Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: October 9, 2002 The system inspector shall sub 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 358 Lincoln Road Hyannis, MA Owner: Kerry Aylmer Date of Inspection: October 4, 2002 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: 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. Answer yes,no or not determined(Y,N,ND)in the 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 i 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 358 Lincoln Road Hyannis,MA Owner: Kerry Aylmer Date of Inspection: October 4, 2002 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 ' Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 358 Lincoln Road Hyannis, MA Owner: Kerry Aylmer Date of Inspection: October 4, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h 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 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 conform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 358 Lincoln Road Hyannis, AM Owner: Kerry Aylmer Date of Inspection: October 4, 2002 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 vlocation of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ 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(3)(b)], 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 358 Lincoln Road Hyannis, MA Owner: Kerry Aylmer Date of Inspection: October 4, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no) No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAIJINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system.(Yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped approximately I month aAo-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: Qallons--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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Nov. 10184-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 Lincoln Road Hyannis, AM Owner: Kerry Aylmer Date of Inspection: October 4, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 u OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 Lincoln Road Hyannis, AMA Owner: Kerry Aylmer Date of Inspection: October 4, 2002 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 Lincoln Road Hyannis, M4 Owner: Kerry Aylmer Date of Inspection: October 4, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 6'x 6'-1000 gal. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number:, Innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The pit had approximately 2'of water on the bottom. The scum line was approximately Y up from the bottom. There were no signs of failure. The bottom to grade was approximately 9. The cover was approximately 2'below grade. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 f Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 Lincoln Road Hyannis, MA Owner: Kerry Aylmer Date of Inspection: October 4, 2002 Map:271 Parcel: 066 Lot:66 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. t`COn1 a � a 3 r OV.4 FA3.a as. 3° � y 3 a3 3� 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 358 Lincoln Road Hyannis, MA Owner: Kerry Aylmer . Date of Inspection: October 4, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30' +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours mans Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 9. Using the Barnstable topographic map and the Cape Cod Commission water contours maps, the maps were showing approximately 30'+/ to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the.system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied, relating to the system, the inspection and/or this report. 11 LOCATION SEWAGE PERMIT NO. VILLAGE Y/" �/ S INSTALLER'S NAME a ADDRESS ALor/ CoAiS I UILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED L �l I' \. I � + � � i ��y v o II,, � � "` TOWN OFnBA.RNSTABLE LOCATION 4^t0l^ "�• SEWAGE # G I O VILLAGE /�y�r1n1S ASSESSOR'S MAP & LOT a_1V D(V(o INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY f�� LEACHING FACILITY: (type) �' 6J +� (size) M CA/. NO. OF BEDROOMS BUILDER OR OWNER �C rC'4 PERMITDATE: COMPLIANCE DATE: 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 Wedand and Leaching Facility (If any wetlands exist widen 300 feet of leaching facility) Feet Furnished by Je e Ob i3A J 0 r � W r; 0 Q _ I Lo ju }f } E OD 4 . r 4 Fps... ................. THE COMMONWEALTH OF MASSACHUSETTS OAR® OF HEALTH ..........................................O F....................-.................---------------..........--------.................. Appliration for UiipugFal Workii Tonstrurti.on Frrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual.:Sewage Disposal System at: ................--•... /re .�..� - .......... ----•-------.-----•-•------........ Lo lion- .or Lot No. ' -•-------------- ----------- -............ ........... •------- Owner .............•---...--....---...Addres ............................................... ..EA................... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. ---- .. Expansion Attic ( ) Garbage Grinder ( ) PLOOther—Type of Building No. of persons............:............... Showers — Cafeteria a' Other fixtures -----------------------------•-- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity........__..gallons. Length-----------_--- Width................ Diameter-_-_____--___._. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No_____________________ Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date......................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...........•----------------------------- --------------------------------------•.......-• -------------------------------------------------- ODescription of Soil------•-----......•-------------------------------------•---------------------------------------------•-----------------•----•--•----------............................. x U --•------•-----•-••-•••--•-------•--•--•----•---•--•...-••--•----------------------------------•-•-•-......••----•----------••--------•---•••-----•------------••----•-----•--••--------•--••-----..---- W -•••--------------------••---------•--------------------------------•-----------------------••--•••-----••-•---•--•--------••-•••---------••-• -----•---•••-----.... . U Nature of Repairs or Alterations—Answer when applicable_..___ ____y7-? ___ ... d�`__..__. __... _��. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIHE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issueed-byy the board of health. / _ Signed•--- ------L ��` :... �1.._ f�...- Date ApplicationApproved By..•-•---•--••-•-•-----•----•----.= ................................... ........................................ Date Application Disapproved for the f olldwing reasons----------------------------••---•-------•---------------------•----------------------...._...._•-----.....------ ................•--•--•--------------.....•-------------•-•....-------•---•---••..........--•-----.......-•-------------------------••-•---•-•-•--...-•--••-•-•--••--•-•-•---------••-•---••------------ Date PermitNo......................................................... Issued....................................................... Date - FE$.....j.�..............._. THE COMMONWEALTH OF MASSACHUSETTS �30ARD OF HEALTdz -----•. ............................... ApplirFa#ion for Dispaii al Works Tonstrurtiun Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal ystemat..... ._ ..!2.... .._ � -- ---- ........................-- - --... . r r t.. t„ Location-Address or Lot No., ......................-......------ ='._�o Y.. --...--------------- ....................................................I y f d Address W f ! - f - , a ,.................•-•-- Installer Address UType of Building S Z'e Lot............................Sg Meet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder 0 ) a,, Other—Type of Building ............................ No. of persons............................ Showers.,'( ) — Cafeteria (; ) dOther fixtures --------------- -•-•--.....---•-•---•---------------••------------•---- ...............................:�.....----•---•-------------•....... ---W ! W Design Flow............................................gallons per person per day. Tot " daily flow......................._.....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Wi''fh.�._.__.......... Diameter................ Depth........ x Disposal Trench—,No..................... Width.................... Total Length--t................ Total leaching area.................. �ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area............. , ft. z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----------------........ GZ4 Test Pit No. 2................minutes-per inch Depth of Test Pit.................... Depth to ground water........................ a' --•••-••----•--------------------•----___.----__--------------•-----..._.._--__-•-----___----________-_-•----_____...............................---•---- 0 Description of Soil.......................... ------- •------------------------------------ •---------------------- ------ •------- •------------------------------ ------------------------- W , x ---------------------------- U Nature of Repairs or Alterations—Answer when applicable ".. 1 _..d" ...- - -%�----------------- ______________________________________________________________________________________________F__.........__._----__-.-__-•____-_--_..----_--_•__---_-----------.----_------_ -------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The and@rsigned further agrees not to place the system in operation until a Certificate of Compliance has beeg issued by the board of health. Signed)/..-------..-- ---..._ --------- /...................... Date Application Approved By............................................. _ Date Application Disapproved for the following reasons-.................................................-............................................................. ..---•.........................•-----•----•--------•----•--------•--•--•--•------------••----......-----•-•-----------•-------•------•-•--------•---•-•--•----------------•-••---------•-•--------•---•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ..........................................OF..................................................................................... Tntifiratr of ToutpliFana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................................5............................... .... ... ----z..............._--_-__-_-----------_-_____.....---_------____________---._-___-_-- at------------------------------------------------•----------.....------ . has been installed in accordance with the provisions of TITLE- 5 f The State Sanitary Code as described in the application for Disposal Works Construction Permit No--------- '' _ _ .. dated-.------------------------------------_......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................. � _�.�1 ).. Inspector....... = ' ............................................................... THE�6MMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ; ...........................................OF.............................. .. .............................................. /�~ No......................... FEE...1.1 Disposal Wear ,un#r i Itt Vamit Permission is hereby granted.................... to Construct ( ) or, i�� ) 01 an Indio' ual Se,A, e ......................��Spol_ Sys at No. ......... .--••- Street as shown on the application for Disposal Works nstruction Permit No..................... Dated........................................... Board of Health' DA .............. ....... �"mac FORM 1255 A. M. SULKIN, INC., BOSTON,;M- AV-- --- - - - TOP OF Raise °°Ie to within 6" of TION STANDARD NOTES EL 6 .5 finish grade install risers as needed Raise one cover to within 6" of finish grade install risers as needed (s0.0) i) THIS PLAN IS FOR THE AY&FAA&W6W/' REPAIR OF A SEPTIC SYSTEM Prvpwed 4 Bend (58.8) GROUND SURFACE EL__59 7 __ 2) ALL INSTALLATION ,PROCEDURES AND MATERIALS SHALL CONFORM TO 310 CMR 15.000, THE STATE ENVIRONMENTAL CODE, sw°.St.] Proposed Barnstable L'oaeotor A TITLE 5, AND THE TOWN OF-� SUBSURFACE DISPOSAL REGULATIONS. - Top COMPLIANCE 58.07 D " Box MIN z' LAYER DOUBLE WASHED MINATION HAS BEEN MADE AS TO CE OF ALE PROPERTY INFOMATION DEEDS -.._ t� 1/$'- 1/2' STONE ) NO DETERVAILAB P R WITH RECORDED.. - _ D - - MIN 2'LAYER DOUBLE WASHED MIN `2' LAYER DOUBLE WASHED 3 575 e"MIN-3"M4X vs= 1/2' STONE ve•- 1/2' STONE OR ZONING REGULATIONS. INVERT EL - 4) THIS PROPERTY IS SERVICED BY TOWN WATER 56.9 Existing i0„ 56 75) THERE ARE NO KNOWN WELLS WITHIN 100' OF THE PROPOSED SOIL ABSORPTION SYSTEM INVERT EL i4" INV EL — - — — — — 24" 133- - ,I INSTALL - — — EFFECTIVE 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE GAS_- — — — — SIDEWALL BAFFLE 56.6 e'MWX Bass __ _ 7) ALL SYSTEM COMPONENTS' SHALL REMALN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY Bo El 5Z.4 -- INV EL 51 4, 56.05 Four _ bu, w 3/4'- 1. 1/2' DOUBLE UPON OR ABOVE THE COMPONENT ACCESS" LOCATIONS, WHICH WOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION INV EL INV EL _-_-- $00 Gal Cone (H 10) i b WASHED STONE - � B`t's - Chambers with _ _4 stone all around PUMPING OR REPAIR. 3/4'- 1 1/2' DOUBLE (4-10 x 8-6 x 2-•9) al ti 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OTHER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION Proposed (H 10) WASHED STONE 54cz, .25 X EXCEPT WHEN VENTING 11AS BEEN PROVIDED .S - 0.05___ 1,500 Gal Septic Tank S 0.025 =o. BOT?YJM EL 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE SS. ._ _.01 1 BASE 12 _4' 2 TO ENSURE STABILITY AND PREVENT SETT ING. -- EL 478 Bot Test (No and rater) 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH SAS (12'-10" x 42-O) ; Pit j _ 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H 10 LOADING UNLESS THEY ARE UNDER OR WTHIN 10' —� OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED I2) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC, 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN PROVIDED. DEEP OBSERVATION DEEP OBSERVATION 14) IN THE AREAS OF EXCAVATION, EXISTING GRADES ,SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS Floor Plans HOLE LOG HOLE - LOG 15) IF SOILS ARE ENCOUNTERED DURING THE EXCAVATION OF THE SOIL ABSORPTION SYSTEM, THAT DIFFEI? NOTABLY FROM THE DEEP OBSERVATIOM HOLE LOG, CONTACT A & M LAND SERVICES AND TOWN BOH BEFORE PROCEEDING: Test Hole #1 Test Hole #2 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES PRIOR TO CONSTRUCTION i EL - 59.8 f)- (EL = 59.8 17) CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION Bdr t Bdr z Dgpt)h lev Soil Soil soil Dgpp E,lev Soil Soil soA TO A && M LAND .SERVICES AND TOWN BOH FOR REVIEW AND APPROVAL in Horizon Texture Color (in lft) Horizon 'feature Color Fero (USDA) (Munsell) (USDA) (Munsell) 18) CONTRACTOR SHALL NO.7%PY TOWN AND DESIGN ENGINEER AT LEAST Bar 4 _. 24 •-- 48 HOURS PRIOR TO INSPECTION(S). Bdr O - 8" 59.3 A Loamy Sand 1OYR4/S 0 - 12" 58.8 A Loa 2y Sand 10YR413 19) MAGNETIC TAPE TO BE PLACED OVER ALL COMPONENTS ACCESS POINTS: Poroe Beth 6" - 32" 557.1 B Loamy Sand 7 5MI 12" - 14' 57 0 B Loamy Sand 7 5YR51 32" 144" 47 8 CI Coarse Sand .5Y716 14" - 144" 478 CI Coarse Sand .5Y7/6 - IOC' Ga vel 1090 Ga vel Lir IGt zir Bdr 8 - Deep Obs Hole Date: 1114109 Deep Obs Hole Date: 1114109 DESIGN T r j� /f N(�T i + Soil Evaluator: ED STONE Soil Evaluator: ED STONE -L.•+.L� l 1 V tl 1 1 1JT1'T1TTTj Witnessed By: DAVID STANTON Witnessed By. DAVID STANTON Pero hate: < 2 MIN/IN 0 60'. Pere Rate; Parcel located within Zone IT Contribution Soil Survey Description: CARVER Soil Survey Description: CARVER Number Of Bedrooms: 1st Floor Plant Basement Plan Geologic Material• GLACIAL OU7WASH HORRAINs Geologic Material: CaAaw 011TWAsll ArORRAINB - Owner of Record Depth to Standing Water: NA Garbage Grinder: NQ F g Depth to Standing Water: NA g r Inver Depth to Weeping Water: NA Depth to Weeping Water; NA Design Flow: 550 Ker,,..�� & Ann AY Depth to Mottling(Color): NA Depth to Mottling(Color): NA 92 Barnacle Road Est Seasonal High GIN. NA Est Seasonal High GW: NA (110 Gal/BR/Day R Number of BR) ,�360 Aq�ar USGS Observation Well: NA USGS Observation Well: NA Yarmoutb Port, MA Map 271 Date of last Measurement: NA Date of Last Measurement: NA Septic Tank: 11500 Comments: Comments: Deed Reference Parcel 65 i (Minimum - Design Flow x z00%) Ga 1.i _ Leaching Area: Bk. 16,292 Pg. 43 140' _ Sidewalk Pg. 213 Bk. 16279 (z stdewalls x 42. y _ 2 ) + Plan Reference 1{opq) (2 Endxalls x12 B3 r x 2 Ft) 219. 3 SF osed 10,°9 12 10 __ Bottom: 538. 8 SF PI Bk 58 Pg 99 SAS Ohs Hole Lo t 66 .--..-- Pump, crush and Nezro�r #1 I 10,83>t x 4_2 p_Ft) 758 SF sand fill existing + , 30•oak, Pe Test Shed : g P Lon Term Acceptance Rate LIAR 0 74 cesspool i y X i 4 Proposed D-Box ........r (Sidewall Area + Bottom Area) x LTAR rLObs Hole,.2 (e°0) (°99) Leaching Area Design Capacity: 561 GPD Min .. - ._--..------` w I f6'1- GPD Provided 550 GPI? Required = 11- Reserve i o 0 I , ro'Mla._ I ASSESSORS MAP 271 LOT 66 (6 °) o Bldg #358 z o ' tg9gl i 5 Bdr s �r T T ( , ro ,., ! TCF = 60.5 � .N/F Septic c Upgra epa l*T Pl c,1.,_ - 1 d e I'i DeCastro • J ' {3 TQp °I St '0or Map 271 Parcel 61 In j ! roposed i w uu 1,500 Gal j Barnstable, MA (61 ......_.. ._ ,] ¢ (90 � pIp rs Located AL 5 i 1T,I�iiiii .!!_.... I I i 358 Lin eoln Road ------- ®., -------- _ _m -.._., _�,,..- ___ _, Hyannis ]fir ' !(°°• Water Line _ IZ a n n>7S MA I D/ 1 (�ear d G 1 CERTIFY THAT I AM CUPJWNTLY APPROVED BY THE DEPARTMENT OF AppI1Cc3 t2 t l --.,.. ENVIRONMENTAL PROTECTION PURSUANT rO 310 CMR 15,017 TO CONDUCT - - "' 0) SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED BY ME COMMTENT WITH THE REQUIRED TRAINING, EXPERTISE AND EXPERIENCE i DEaCRIBED IN 310 CMR 15,017. I FURTHER CERTIFY THAT THE RESULTS OF MY Kerry & Ann AyImer SOIL EVALUATION AS INDICATED ON THE ATTACHED SOIL EVALLIA77ON FURAS SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORAG Ba r'n a cl e Road ARE ACCURATE AN DV ACCORD 310 CMR 15.100 THROUGH 15.107 92 l Yarmouth Port, MA y �r �-r SCALE` 1" � 20' DATE.- December 10, 2009 j ,ti�SO x? I t. ED A. SYVN CERTIF7E/SOIL EVALUAF R 1 I Map 271 parcel 66 Locus Map PREPARED BY NTs A & M Land Services N OF>iigss Kc 618 Main Street f r° uNDA J. ti� West Yarmouth MA 02673 i 160 Rptlte 28 h P` �'} '� Ph, (508) 737-1777 Email.- anmland cameast.net t CIVIL CA N`F a LOCUS b + �o �No. 465:04 GRAPHIC SCALE i MacleodsrERQ���` Map 271 b 3s/oNAl ��G 20 0 to zo ao so Parcel 67 ti o 4 yarnns ( IN FEET ) main ,St. 1 inch 20 ft. Wes t Dwg. 6072.dwg