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4340 FALMOUTH ROAD/RTE 28 - Health
4340 Falmouth Road ; Cotuit A= 024-027 1 TOWN OF BARNSTABLE L(�ATION 43 40 F,,A rn oojti, QJ 4c 2$SEWAGE# Q 019 - Z`73 VILLAGE (20Au; J ASSESSOR'S MAP&PARCEL Z -1. 2`1 INSTALLER'S NAME&PHONE NO. Q EXcayo�A i o.n ye)')— DGS3 SEPTIC TANK CAPACITY /QpQge,, LEACHING FACILITY:(type)'Trc no 5 (Z) (size) Z NO.OF BEDROOMS 3 OWNER PERMIT DATE: s]-2(,-0 9 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 Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY y . Al- Z4"4 '' AV Zq' 3" $2' 49.E 3 A3' GZ A f3 No. ✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ltlfltation for Bispo8af *pstrm Construction VermIt Application for a Permit to Construct( ) Repair(✓Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. bwner's Name,Address,and Tel.No. Grryor.{ 41a4c1,��+ Assessor'sMap/Parcel 7 q g340 Fo-lrv% Ra( Ca4u;4 Installer's Name,Address,an Tel.No.B 1y,$ E(em�-j j o^ Designer's Name,Address,and Tel.No.�' c4 4 EA ;orM[,n ty Tcc�Scrr� t.uJ Foccsiolalc 41'1. OLS3 fo.Box 331 I-(o rw�ch wt A Type of Building: VJ 1 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) 130 gpd Design flow provided 339 gpd Plan Date "]-2 Z — 19 Number of sheets `� Revision Date Title Size of Septic Tank .000 Type of S.A.S. r-rr Achc.S Description of Soil Nature of Repairs or Alterations(Answer when applicable) 14 20 D B OX- 2 x 3 x 33 u5;n9 ,pr_W f,ac Surronolco( hu W!aSAc.t 540Y%L 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 Date77/7-4-119 Application Approved by WL Date 'f Application Disapproved by Date for the following reasons Permit No. _ a0) 7 J Date Issued �� 911 lyi No. Fee CV I of THE COMMONiIV AL-AL O0 MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �pfitation for is osaY 6pstetn 'oustruttion Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. V�1 Grc�ory Kc�lc t,,c n ; Assessor'sMap/Parcel 143yo F0.1.r, Rat Co4u;4 Installer's Name,Address,and Tel.No.B 4,B t<XCa J,,,7 i 0/� Designer's Name,Address ane. o. � � d Tel.N F1aihtr4y Gnv;ornlZnl 1�1 'T�aScr 411 06S3 PO 30 x 331 Ha rL.�«M• M A Type of Building: / Dwelling No.of Bedrooms Lot Size �/ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures .. . t Design Flow(min.required) gpd gpd Design flow provided �•Q � gpd Plan . Date—77- Z Z . 1 9 Number of sheets Revision Date Title J - Size of Septic Tank Type of S.A.S.- Description of Soil. Nature of Repairs or Alterations(Answer when applicable)�14 zo nax, ?_ 'fr=n c h s s 2 x 3 >< 3 3 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 T ��X `) Date Application Approved by Date -It Application Disapproved by Date for the following reasons Permit No.3 oil Date Issued 771 a/010 --------------------------------------------------------------------------------\----- -------------------------------------------- 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 L)n•1. O at Q 3 q O r ,r,n'�-� �Q has been constructed in accordance With the provisions of Title 5 and the for Disposal System Construction Permit Noaadated 7) L( Installer .3 i- B E)ec-a ua A 1 n a Designer ��� Fla I.e r-►u #bedrooms 3 Approved design flow and The issuance of this p it s all not be construed as a guarantee that the system will ctio as signed. n Date In Inspector ---------------------------- - ------ -- -- - ---- -------------------- ----------------- ----------- ----- -------------------- i3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal Opstem Construction Permit Permission<is hereby granted to Construct( ) Repair(,/f Upgrade( ) Abandon System located at U3!4 O r"„ )0n0,0 k 194 , 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:Construction must be completed within three years of the date of this permit. Date Approved by 11, I Town of Barnstable IHiE ro�L regulatory Services Thomas:F. Geil:er, Director BARNSTABLE, = Public Health Division MASS. g Fo5.tA`� Thomas McKean, Director '200 Main Street, Hyannis, MA 02601 Office: 508-862-4644. Fax: 50S-710-6304 Date: R- 1q - 19 Sewage:Permit# Z019 - na Assessor's Map/Parcel 2 - Z Installer & Desianer Certification Form Designer: Installer: Address: -O. ay Address: ,y T'c0. e 5erse Lwj o.c- i c.ln �o ccs�o�o.lc_ On '7=? �.__ ExCraV<%,A►oN was issued a Uennit to install a. (date) (installer) septic system at 43 y0 _Qj s,K)jl,. Rj C0Av,k based on a,design drawn by (address) dated '(-27.- 19 �— (deSlgneT� X 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 distr14ution box andlor septic tank. Stripout (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. Stripout (if required) was inspected and the soils were found satisfactory. Of 7)AVIID 7A-Ch staIIcr s SSigrnah e) LAHERTY4.1 � y (Designer S.Signatur )` R . (Affix Desig mp Here) PLEASE RETURN TO�,BARN STABLE 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. q:\office forms\desionercertificauon rorm.doc Y. r Town of Barnstable Barnstable Inspectional Services Department. 11111.1 BARNSTABLF.: � b . Public Health Division ATF°"1A�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 7589 L144e.,r not S4,igtj Q/ KETCHEN ASSOCIATES LLC 45 CHESAPEAKE BAY ROAD OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 4340 Falmouth Road, Cotuit, MA was inspected on 07/01/2019 by Brett Hickey, 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 Q 10 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH Thomas McKean, R.S., CHO" Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\4340 Falmouth Road Cotuit.doc Town of Barnstable • BARNSTABLE, A 6 q Inspectional Services Department TfD MA'S� Public Health Division 200 Main Street; Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 1 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 o 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) Veachin'g facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: 9:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 4340 Falmouth Road .; Property Address Gregory Ketchen Assoc. LLC { Owner Owner's N me information is c required for every Cotuit Ma 02635 7-1-19 0 page. City/Town State Zip Code Date of Inspection r r1 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 A. Inspector Information S� 9 filling out forms # l 3^B on the computer, Brett Hickey use only the tab y key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 QCompany Address Sandwich Ma 02563 City/Town State Zip Code 508 477-0653 S113747 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 Brett Hickey °re"�""e�tr e�°"'�" 7-1-19 °":m_9�"mow.o.o...m.�,..,w�,..e,..®..�.�,.�� ''..Dam:]1119.W.9210Affi MOO Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of,Massachusetts 1 ,p Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19.. required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i% Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road u Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑.ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 J c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road u Property Address Gregory Ketchen Assoc.LLC Owner Owner's Name information is required for every Cotuit Ma 02635 7-1-19 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 colifor'm 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 ❑ O Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 4340 Falmouth Road Property Address Gregory Ketchen Assoc.LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 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 day flow ❑ a Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ E] Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. E] ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 44 Commonwealth of Massachusetts r� Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name nformation is Cotuit Ma 02635 7-1-19 -equired for every 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 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 0 ❑ 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? El ❑ Has the system received normal flows in the previous two week period? ❑ a Have large volumes of water been introduced to the system recently or as part of this inspection? O ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? ID ❑ 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: ❑ El Existing information. For example, a plan at the Board of Health. 0 ❑ 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road V� Property Address Gregory Ketchen Assoc.LLC Owner Owners Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: No design plans 3 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NA Description: No design plans were available for this property at local Board of Health Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes E 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 0 No Seasonal use? ❑ Yes 0 No Water meter readings, if available (last 2 years usage(gpd)): See below Detail: ***2017- 51,000gallons 2018- 78,000gallons*** Sump pump? ❑ Yes ❑■ No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 L a c Commonwealth of Massachusetts �m Title 5 Official Inspection Form it (/ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road v Property Address Gregory Ketchen Assoc. LLC ,Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont,) 2. Commercial/Industrial Flow Conditions: NA 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? No ❑ Yes ❑ Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 3 years ago Was system pumped as part of the inspection? ❑ Yes M No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road u= Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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: 1988 per asbuilt Were sewage odors detected when arriving at the site? ❑ Yes X No 5. Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town waterfeet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 li Commonwealth of Massachusetts �n Title 5 Official Inspection Form io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' 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 1 Dimensions: 000gallons 1211 Sludge depth: 2419 Distance from top of sludge to bottom of outlet tee or baffle 6" Scum thickness 511 Distance from top of scum to top of outlet tee or baffle 1311 Distance from bottom of scum to bottom of outlet tee or baffle measured 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.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c Commonwealth of Massachusetts id,m ,tp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ( r u— 4340 Falmouth Road Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name irformation is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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.): The d-box was in poor condition at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l 4340 Falmouth Road V Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA 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: El leaching pits number: (1) 6'x6' pit ❑ 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 c Commonwealth of Massachusetts V �n Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 4340 Falmouth Road Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every 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.): The SAS was in hydraulic failure at the time of inspection. Pit was full to inlet invert when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 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 l 4340 Falmouth Road Property Address Gregory Ketchen Assoc. LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 l_ c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road u Property Address Gregory Ketchen Assoc.LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town 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 1-1O N rxa= 13n`tzratir i.r, VIT-LAb ' AS�L4 t){i,• .At15'I' 6z t;CJ C . , tip __ ---- _yam IN51.'i,LLk?R > 3dlf ktt-fsz \N5L NC>- OP t)Fi�tt'C,7C�MS ..- .:- YRIv-&-r✓ W <>R rU131 1C W&TER, I�:AT13.$�:E?RL37,T.2S'fitt�ll=J_ j G✓ •..•. m��'""��' „�._:__ �.�.� V:A til,r M—_U- G'R t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r ; Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I; 4340 Falmouth Road Property Address Gregory Ketchen Assoc.LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope ❑■ Surface water Check cellar Shallow wells Estimated depth to high ground water: undetermined system in failurefeet 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: 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 C Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road v Property Address Gregory Ketchen Assoc.LLC Owner Owner's Name information is Cotuit Ma 02635 7-1-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist f Complete all applicable sections o 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 I m drawn on . 16 or attached For 14: Sketch of Sewage Disposal System pg For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.M612018 Title 5 Offidal Inspection For n:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. City/Town 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 formA. General Information s on the computer, use only the tab 1 Inspector: key to move your cursor-do not Ricky L. Wright use the return key. Name of Inspector B & B Excavation, Inc. Company Name 14 Teaberry Lane Company Address Sandwich MA 02563 City/Town State Zip Code 508-477-0653 S14595 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to.Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Appro ' Authority 2/17/11 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the_inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving.authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 1 t5ins•09/08 Tb' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 l f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotult Ma 02635 2/17/11 page. Citylrown State `Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y °❑' N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ `N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ` ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is Cotuit Ma 02635 2/17/11 required for every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve aJfacility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ - ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well s If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 f , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is Cotuit Ma 02635 2/17/11 required for every - page. Cityrrown State Zip Code Date of Inspection C.�Checklist Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number`of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readin s, if available last 2 ears usage d n/a 9 ( y 9 (gP ))� Detail: Sump pump? - ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: ` Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No . Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of.information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: A ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy s < ❑ 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. r ❑ Other(describe): t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1988 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: , 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good shape no signs of leakage or blockage Septic Tank(locate on site plan): ,. Depth below grade: 16 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: 5.2x5.2x8.6 Sludge depth: 3„ t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle ' 37" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 12" - How were dimensions determined? scour 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.): At time of inspection tank appeared to be in good condition no sign of backup, tees present. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins 09/08: Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑.Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert no d-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.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17111 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appeared to be in good shape no sign of staining or hydraulic failure.Pit was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer _ Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every, Cotuit Ma 02635 2/17/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments , 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 . 2/17/11 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate:all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 13 V , A2= 5V `BI 3q ' t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ®' Shallow wells >12 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation.- El Obtained from system design plans on record If checked, date of design plan reviewed: pate ® 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: Hand auger hole threw dry leach pit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I ° Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4340 Falmouth Road Property Address Household Finance Corp II Owner Owner's Name information is required for every Cotuit Ma 02635 2/17/11 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I. WN Of, B RNSTABI.E '"Maia--w-1 — SE1"s'1�GE # 00 -CQ VII,L ACE_CD-tj,�A_ __ ASSESSOR'S MAP & LOT � NSTALLER'S 1 1iHF, & PHONr NO, �I � SEPTIC ViNK CAPACITY_ ( LI:r1GUi_IVC; (size)WAT NO. QP BF-FDROOMS a__PRIVATE W ' OR PUBLIC ----- _- BUILDER OR OWNER &i,� 0 DATE IERMI.T I.SSLIED: DAT 3 COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes _MNo y`� e J k �� • � � i ��� ����� +� THEBCO AORN®ACTH oF�SALT ETTS C , Application for Uh4p a al Vorkg Tnnitrnrtiun Famit �i Application is hereby made for a Permit t Construct ( ) or Repair an Individual Sewage Disposal System at: q ..... ....................Ro. ........................................... ..................... . ....... Location-Ad ess Lot -o- _--- ---•-- -1:c,..-------- ----- ------ - ----------------._... S--- ----- -- \ �O^wner ���- 1CAddress W �? '� -4..---�•--�.=Sic... .....__._. — 5-------- -------- k-- _.a VV :. Installer Address U Type of Building Z Size Lot___________________________Sq_ feet Dwelling—No. of Bedrooms___________ ________________________Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures ...................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W 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........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_-_____________________- �T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water________________________ a --•-------•-----•••••••--•••----•-•-••••--•--•-••-•••••••................................................................................................... 0 Description of Soil--------------------------------- --- x W -------- --- - - ------------ •-• --•--• �. UNature of Repairs or Alteratio s—Answer when applicable.__________ =S_ - _. .(-___-�__�__. ------------------------------•.----------------------------------------•----.-•-------•--•--.--.•••-•••--•-••....._____--.••- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with LET�'1•^ the provisions of :T i t 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued the board�of health. Signed \ &Ne��a_ ' Date Application Approved By.....-•---•--- — ----------- G - —ya Date Application Disapproved for the following reasons_---_.......................................................................................................... _ -•------------------•------•--------------------------------...------------------------------------------•----------------••--•-•-------•••-•---------••••-•-----•--••-•--••-----•---•------------------ to_ Date Permit No...... - Y ____________________ Issued..�. .................-� d 'b THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) MS L DATA No..... :/�`?i`yy FEs.1a 0.-_t9" THE COMMONWEALTH OF MASSACHUSETTS G ��----� BOA R D-JC H E A LT IJ - -- -- Appltration for UhipagFal Works Towitrurtiutt U.rrtttit Application is hereby made for a Permit to Construct ( ) or Repair Qom`an Individual Sewage Disposal System at: Location-Address Lot Ivo. rl _ .. ✓..w C_ `� ��� ..............................-c (..`L 11 r.'...... ... `^—�L----------------------- --•----•— I (( + Owner __A,ddress I _._.,_ ....... ......... ....... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms...•.._......._ _.__.Ex anion Attic a g— ....-----•-----------•-- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------••------------......---------------•-- W Design Flow............................................gallons per person per day. Total daily flow......:.....................................gallons. WSeptic 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_---..----_-___-___.-. Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ........................................................ ` ............................................................................... ODescription of Soil...................................... :_-----_------..................------......------..................------.... U ' -------------------------------------------------------------------------------------•------------------------...........---------------•••... •--•-----•-•----•---•--- Ux Nature of Repairs or Alteratio s—Answer when applicable-------------- S � ',.i' _ P ------ t -------I_ •-•---••-•-•--------•------------`"`�..=�---`---_................•-••--------------- ----------------- --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T .a�. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued b the board of health. , j Signed `yam -- .. . .... L� Date Application Approved By............... '= '•�"tl ..c.4:7��-=- , -•----------� '...�-_.... Date Application Disapproved for the following reasons______________________________________............•.••..•--•.............................•-- -__--________ ......----•-----•...................•••------•--•----•-•------------•••--------••-....--•.....-------•••--•--•--••-•••••---•--------•--•-----•-•-----------••--•--•-------•---•-•-••----•-•••----....--- Permit No. .:..r_ ,(_°� -----_. Issued /- �' r' -au T_._...._•----__-__ L --. •------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rr .......... ... ..t-,-?.`^.......OF............. .��. :.�~.�'..... " `,� . ..................... kTrdif tratr of Toutplittttrr THIS IS T01-&,ERTIFY, That the Ind ideal Sewage Disposa� System constructed ( ) or Repaired by-------------------------- "•:.. - __---•------••-----•-------•-------•f-------•------------------- - ---------------------------------•------------- j � ` 1 Installer �I(1 at--••---•••-.......----•--�......-:�..._ . V _ -..__l._��U �.-. �'--� has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as descri_bo�_n the application for Disposal Works Construction Permit No..........3.,K=_.___ _V_....... dated-------1_._. r. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAJI,!gACTORY. DATE.......... .. -----�....0.............................. Inspector...................... --- THE COMMONWEALTH OF MASSACHUSETTS BOARD Q.I;_ HEALTH i No......................... FEE--.... -- l.. Permission is hereby granted............. .. {_.._'_ '�.`-'...__________.. v.3 _.Z --,_. _ .........•-- ••-•-••--•--•----._.•-• . .. .. ....••........................... to Construct ( ) or Repair ( an Individu Sewage Disposal "stem at No..................-------•------- -- k--r.� 1 \� CD ' -r� ... ,---•-••---------------•----•-----....................................................................--......... SEree e as shown on the application for Disposal Works Construction Permit tNo.g�.6/y/.. Dated.......1n.._--L �_.`.U.6j Board of Health DATE...... �')� -- .....;0............. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS : y TOWN OI' D RNSTABL ? t� LOCATION (� i --rEWAGE # OQ : YILL OE� ` j.. - I ASSESSOR'S MAP &.LOT v I_NSTr.LLER'S lUt HE. ICi PHONJi NO. SEPTIC TANK CAPACITY _Q00_ LTACI ING FACILITY:(t➢pe-) P.i' (slze) l c ��1 s. NO. OF LF:IaROOMS �_-PRIVATE w : OR PUBLIC WATER �_. BUILDER OR.OWNER O DATE 'ERMIT DATE, C:t?t1I'LIAPacE ISsul±n• f C) � .. VALIANCE GRANTED: Yes No a, D e a � � y� v� ®--%AA i� TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE BROUGHT O WITHIN 6"OF FINAL GRADE Flaherty Environmental Services EL. 100.0' EL. 98.0' (not to scale) INSP. PORT W I 3" OF GRADE P.O. Box 331 2" PEASTONE OR EL.98.0'f CLEAN SAND Harwich, MA 02645 GEOTE4"CAST IRON or EQUIVALENT FILTER AB 774.994.1166 MIN. PITCH i 4" PER FOOT FILTER FABRIC VENT (IF REQUIRED) 4"SCHEDULE 40 PVC PIPE " 4 SCHEDULE 40 PVC PIPE FLOW LINE (firetZtobelevel) ; 5' 3.6% _� EL. 95.9' •,;,•.; L.EXISTING —� ---�" 14" EL,EXIS G EL.95.4' —� —� 2' ' EL.94.33' EL.92.0 GAS BAFFLE EL.94.5' 94 3, (0 005%SLOPESW . CLEAN, DOUBLE- ':-:� H-20DBOX 6"CRUSHED STONE OR SOIL ABSORPTION SYSTEM MECHANICALLY COMPACTED L WASHED 3i TO 1 ° STONE (2) TRENCHES 3 W X 33 X 2 D USING S.0 =— PERFORATED PIPE AND SURROUNDED 1000 GALLON SEPTIC TANK BY DOUBLE-WASHED J" TO 1 z" STONE (DATUM: ASSUMED) (EXISTING) EL. 87.0' BOTTOM OF TEST HOLE EL. 87.0' 55.2725 USGS ADJUSTMENT: N/A LOCATION MAP GROUNDWATER ELEV: N/A N TH � o SHED TH-1 .H-2 14.9708 98 98 k c LOCUS EXIST. L.P.© � ,p 50.6135 \\ 0 EXIST. S.T. O DRIVEWAY \ DECK \\ NTS EXISTING I \ 98 3 BR i \ `� OF DWELLING N \ 96 BENCHMARK: .1 TOP OF FNDN LOT E"100.0' op,0 DATE.'712ZW 19 REVISED. � V f F ' SITE AND SEWAGE PLAN FOR B & B EXCAVATION INC./ 96 i GREGORY KETCHEN 14340 FALMOUTH ROAD SCALE : 1�� 40' BARNSTABLE (COTUIT), MA REF:DB 25302 PG 273 PAGE 1 OF2 ............................................... ..... . ...... ........ .............. .... . .... ... ...... ... .. ........ ...... ......... .... .. ...... ..................... .... ....................... ........................... .............. . ............................. ..................................... ........................................ .................................. .... ......... ............... . .......... . ........ ........ .. ...... ........ .. .. ................... ...... .. ..... ....... ...... GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services P. 0 . Box 331 1, ALL PRECAST COMPONENTS TO BE H-1 0 Harwich, MA 02645 RATED, ALL COMPONENTS WITH ANY NUMBER OFACTUAL BEDROOMS 3 774.994.1166 ANTICIPATED VEHICULAR TRAFFIC TO BE [IDS. PORT H-20 RATED. GARBAGE DISPOSAL UNIT NO ❑ 3/ 2. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE TOTAL ESTIMATED FLOW (110 GALIBRIDA YX 3 BR) 330 GAL./DAY GRINDER. 6, 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 4. ALL CONSTRUCTION TO CONFORM WITH 177-777 L: 7-7777= 310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) APPLICABLE LOCAL, STATE AND FEDERAL CODES AND REGULATIONS. SOIL CLASSIFICATION 1 33' 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <5 MIN./INCH VERIFY ALL ELEVATIONS AND DETAILS AND REPORT ANY DISCREPANCIES TO EFFLUENT LOADING RATE 0.74 GAL./DAY/FTC DESIGNER PRIOR TO CONSTRUCTION OR ASSUME ALL RESPONSIBILITY, LEACHING AREA 6. INSTALLER/CONTRACTOR IS BOTTOM: (YX33)X2= 198 FT2 9' MIN. OF SOIL RESPONSIBLE FOR MAINTAINING SAFE SIDES: 2' PEASTONE OR FILTER FABRIC WORK AREA, VERIFYING ALL UTILITIES [(2'X33)X2+(2'X3)X2]X2= 248688 FT' TOTAL 2 AND NOTIFYING "DIG SAFE" (1-888-344-7233) 72 HOURS PRIOR TO X 0.74= 359 GAUDA Y 1 CONSTRUCTION. 2 7. ANY CHANGES TO OR DEVIATIONS FROM USE(2)TRENCHES OF PERFORATED PIPE SURROUNDED BY THIS PLAN MUST BEAPPROVED IN TO I J'STONE,EACH TRENCH CONFIGURED AS WRITING BY FLAHERTY ENVIRONMENTAL YWIDE X 33'LONG AND 2'DEEP SERVICES AND LOCAL BOARD OF HEALTH. RESERVE LEACHING CAPACITY NIA 8, FINISH COVER OVER COMPONENTS IS TRENCH END VIEW NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND FILLED WITH CLEAN SAND OR REMOVED SOIL EVAL UA TION AND REPLACED WITH CLEAN SAND. TESTHOLE#1 TPT#19-69 TESTHOLE#2 TPT#19-89 10.ALL COMPONENTS TO BE PROVIDED Evaluator: David D.Flaherty Jr.,RS,REHS Evaluator- David D.Flaherty Jr.,RS,REHS WITH WA TER TIGHT ACCESS PORTS SE#2755 SE#2755. %k OF WITHIN 6"OF FINISH GRADE. BOH Witness. David Stanton,RS BOHWitness: DavidStanton,RS Date. July 18,2019 Dater July 16,2019 11.ALL SEPTIC TANKS, DISTRIBUTION C.) DAV BOXES AND PIPING TO BE INSTALLED TH-I ELEV.98.0' F ' j Cft TH-2 ELEV 98.0'j E WATERTIGHT. 12.NO KNOWN WETLANDS OR WELLS 0'-7- A LS I0YR312 0'-7" A LS I0YR312 WITHIN 100 FEET OF PROPOSED 516 7 -25" B LS 10YR 7 -25" B LS IOYR516 GiSTE LEACHING. y. MIA 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR 25"-132" C 'MCS2.5Y614 pe" 25"-120" C MS 2.5Y614 BUILDING PURPOSES. 51) SITE AND SEWAGE PLAN FOR 14.LOT IS SHOWN AS ASSESSOR'S MAP 24 7 certify that on November 12,2002,l have passed 8 & B EXCA VA TZON INC./ PARCEL 27. the examination approved by the Department of 15. LOCUS Environmental Protection and that the above analysis GREGORY KETCHEN PROPERTY'S PROPOSED SYSTEM has been performed by me consistent with the 4340 FALMOUTH ROAD APPEARS TO BE WITHIN AN AQUIFER G.W.ELEV.NIA v G.W.ELEV.NIA required training,expertise and experience described PROTECTION DISTRICT(ZONE 11). In 310 CMR 15.018(2). BARNSTABLE (COTUIT), MA BOTTOM TH-1 ELEV. 87.0' BOTTOM TH-2 ELEV. 88.0'- -PAGE 20F2 DATE.7 12212019 .......................................... .............................................................................................................................................................................................. ................................................................................................... ...................................................................................................................... ................................................................................................................................................................................................................................ ....................................... ...........