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Home My WebLink About0228 BEARSE'S WAY - Health `,BE-ARSE :WAY ,HYANNIS - -- �A ° I ° I i I ° ° 4 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 228 Bearses Way ,a Property Address r ii MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name/ information is H annis V MA 02601 5/20/2020 required for every Y 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 forms A. Inspector Information Iy,5y0 one the computer, M. Cam us only the tab -Anthony ano P key to move your Name of Inspector cursor-do not Campano Title V Inspections use the return Company Name key. Elm Company � Company Address Pepperell MA 01463 CityMwn State Zip Code 978-433-2212 12780 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); I 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 05/25/2020 I ect 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 i ry. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every .Hyannis._ _ ._ .. ___.. _ MA 02601 5/20/2020 page. City/Town—`--—'—"`— " -- State Zip Code -Date oflnspection 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 repiaced 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 S 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed '❑ Y ❑ N -❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 pipes)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M (� 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. CityrTown State Zip Code Date of Inspection C. Inspection Summary-(cost:) ❑ 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: I **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 'Sy"stem.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 ❑ 0 Discharge or ponding of effluent to the surtace of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owners Name information is required for every Hyannis MA 02601 5/20/2020 page. Cityrrown State Zip Code Date of Inspection -C. Inspection Summary-(cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded .or-clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis -and chain of custody must-be"attached-to-this-form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 1.0,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments tl 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 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 ❑ ® Pumping information was provided by the owner, occupant, or Board of Health -❑ _0 "Were any of the system components pumped out in-the previous Iwo 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? 0 -❑ 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)j310 CMR"15.302'(5)] t5insp.doc-rev.7/26/2018. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is Hyannis MA 02601 5/20/2020 required for every Y page. Cityfrown State Zip Code Date of Inspection D. System Information 1. 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 'Description: See attached permit dated 2/10/2000, showing a 3 bedroom house with 1500 gallon septic tank with 4 high capacity infiltrators. Number of current residents: unoccupied Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes .® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 60.4 gpd 9 ( Y 9 (gpd)): Detail: See attached,-usage report-showing 51-883-x 7:48-cf/728-days=-60:4 gpd --Sump�pump? ❑ -Yes °� No Last date of occupancy: not known Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts r - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. City/Town State Zip Code Date of Inspection _._D._.S_ystem Information.(cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design-flow-(seats/persons/sq:ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): { 3. Pumping Records: -Source-of--information: not known Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is Hyannis _ _ ___ __ _ _ __ __. _ MA 02601 5/20/2020 required for every , .y page. _ _ Cltyrrown State Zip Code Date of°Inspectio`n. -D..-SystemAnformation-(cunt.) 4. Type of System: ® Septic tank, distribution box, soil_absorption.system -Single:cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) '❑ 'Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. -❑ -Other"(describe): Approximate age of all components, date installed (if known)and source of information: Attached septic permit dated 2/10/2000. Were sewage odors detected when arriving at-the site? ❑ Yes''0 'No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments(on condition of joints, venting, evidence of leakage, etc.): 'All-exposed joints-and-pipes-are in-good-condition with-no evidence-of leakage-or venting-problems. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 22"feet Material-of•construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) There are 2 inlet baffles one for the kitchen sink and washer and another baffle is for the.rest of the home. Both inlet baffles and outlet baffle were in good condition and composed of pvc. The tank liquid level was normal at the oulet pipe invert. The inlet cover is on a 9" riser.(See attached photo) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10' L 6'W 5'D Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 14" .How were,dimensions_determined? graduated dip pole Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be pumped every 2 to 3 years. Both inlet baffles and oultet baffle were in place and composed of pvc. The liquid level was normal and at the outlet pipe invert. The tank did not appear Jo be leaking. (See attached photos) 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 M (� 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. Cityrrown State Zip Code Date of Inspection D System Information#ont..) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: -❑ concrete -❑ metal El-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. Tightor-Holding Tank-(tank-must-be-pumped at-time of•inspection)-flocate-on-site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons -Design-Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d box was level. There was no evidence of solids carryover or leakage into or out of the box. The'box showed some signs of decomposition above`the waterline. The d box was Z below grade. (See attached photos) t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 118 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is Hyannis MA 02601 5/20/2020 required for every ..�y_ -- ------- -- - page. Cltylrowri -State-- • Zip Code— Date of Inspection` — -.D..-SystemInformation-(cunt:) 10. Pump Chamber(locate on site plan): Pumps in-working order:. ❑ Yes ❑ No* -Alarms-in-working-order: -❑ Yes -❑ -No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass, 11. Soil Absorption-System,-(SAS)-(locate on-site-plan;-excavation_not.required): If SAS not located,explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 4 high capacity Infiltrators ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. Cityrrown State Zip Code Date of Inspection -D. SystemAnformation-(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.): Soil was dry with no signs of hydraulic failure, ponding or damp soil. Vegetation above the leach field -is-mowed-lawn-with a-small-flower-garden: 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert- "Depth of solids-layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwaterinflow 'EJ 'Yes 1:1 -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 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M (� 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. Citylrown State Zip Code Date of Inspection D. S_ystem Information,(cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions "Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form `i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 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: E -hand-sketch-in-the area-below ® drawing attached separately t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts UV� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 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: 14 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: Attached is a copy of the septic permit showing the soil description and calculation on ground water. Checked with local excavators, installers-(attach documentation) ' ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: See attached copy of the septic certification with soil descrition dated 02/10/2000. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . (� 228 Bearses Way Property Address MTGLQ Investors, L.P., A Delaware Limited Partnership Owner Owner's Name information is required for every Hyannis MA 02601 5/20/2020 page. Cityrrown State Zip Code Date of Inspection -E.-Repor-t-Completeness-C-heeklist 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'l n-formatiom. For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached -For 1-.5 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 No. Zq0 U —�Q .-� Fee D, / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,MASSACHUSETTS Yes 2pplicatton for )Btopooat bpgtem Conotructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade(VIAbandon( ) `Complete System O Individual Components Location Address or Lot No. ,r&cp.S << ► Owner's Name,Address and Tel.No. Assessor's Map/Parcel '310 _o 33 , E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. vv Q'-(of--p-94-p C I C is lct�l c c Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow er C7 gallons per day. Calculated daily flow 3yc! gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank CSLIZ> 9 A Type of S.A.S. �i ��<<c i �tfT��• Description of Soil Nature of Repairs or Alterations(Answer when applicable) K - 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 Environ ode and not to place the system in operation until a Certifi- cate of Compliance has b and h. t> Signed Date cw�0 Application Approved by - Date "/G-?AV-a Application Disapproved for the following reasons Permit No. 2-ow rq E Date Issued ----------------------- ----------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(L--)^ Abandoned( }by : VX*% -C A 0 i`. 1=r0 L at. has n constructed in accordance with the prQvisi- s of Title 5 and the for Disposal System Construction Permit No. _�O- b dated z -/U- ZdV Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date '` ' �')! Inspector i J.---------------- No ow- i r �5P ' 47 lyM i-A Wlylne r O Tn f " —`— 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) ,hereby certify that the application for disposal works construction permit signed b me dated �—��a P gn Y , concerning the h property located at aszy�� t� �h- . .�: w meets all of the following criteria: i This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. E (!/There are no wetlands within 100 feet of the proposed septic system I ,P' There are no private wells within 150 feet of the proposed septic system i There is no increase in flow and/or change in use proposed i �, I here are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when �plicable) • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: ii y� (� A) Top of Ground Surface Elevation(using GIS information)B) G.W.Elevation ZiO +the MAX.High G.W.Adjustment2--( _ �?`6 7t DIFFERENCE BETWEEN A and B + (� SIGNED: DATE: o� `to`� f [Please Sketch p ed plan of on back]. i' NOTICE I+� Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder.cert i 5/20/2020 ShowAsbuilt(1700x2800) 4 V 0 li f LOCATION_.-�Z� d%fU�)f�liS - SEWAGEY�`,�-/f An VILLAGE /iiA N%f IT--'V ASSESSOR'S MAP&lDT /d� -6.3'� INSTALLER'S NAME&PHONE NO. Wti7rA. a re wf`-ir ` 71 SEPT[C TANK CAPACI'!Y,_f, )-go .. LEACmwGFAClLrY:(type) 14/6/TAR TORS' NO.OF BEDROOMS BUILDER OR OWNER PERMITDAT& 1-16.3,eoa COMPLLANCE DATE-- Separation Di=cc Between the h .� Maxlmttm Adjusted Groundwater Table and Bottom of Leeching Facility E1w III Private Water Supply Well and Leaching FacIty(If any wells exist on site or within 2W fee[of leeching WcILity) Felt j Edge of Wetland and I cubicg Facility(If any wetlands exist Within 3W feet of leaching faeitity) Felt II Punished by fi U } I a !` A '.i l� �t dt t{{� 'S it I' 1 • o �� i 9 Y i i N li i� 5 •I i ;•i 1 4 ' 11 II lti 'f Ij i { 4� �t fJJi I l' 1 i,} I V r; �t I� SI 5/22/2020 20200520_131436_HDR.jpg Date: 5/22/2020 Meter Reading History Page 1 of 2 Customer# 605392-1 _ L �' J� 9 �/ /�Z� P v Premise#605392 U C,� �T 2 / Service:Water-Regular Metered METER READING TRANSACTION INFO Read Date Sequence# Meter# Face Sort # Read Code Reading Consumption Skip Count Type Code Status Bill Period Trans Date 05/18/2020 01 94109885 0 27010500 PND 761.00 0.00 0 REG A R 01/01/1900 02/18/2020 01 94109885 0 27010500 1 761.00 4.00 0 REG A R 202001 02/24/2020 11/19/2019 01 94109885 0 27010500 1 757.00 11.00 0 REG A R 201904 11/25/2019 08/19/2019 01 94109885 0 27010500 1 746.00 14.00 0 REG A R 201903 08/26/2019 05/14/2019 01 94109885 0 27010500 1 732.00 8.00 0 REG A R 201902 05/20/2019 02/19/2019 01 94109885 0 27010500 1 724.00 11.00 0 REG A R 201901 02/25/2019 11/19/2018 01 94109885 0 27010500 1 713.00 24.00 0 REG A R 201804 11/27/2018 /1 08/13/2018 01 94109885 0 27010500 1 689.00 33.00 0 REG A R 201803 08/19/2018 J �VJ, 05/01/2018 01 94109885 0 27010500 1 656.00 13.00 0 REG A R 201802 05/16/2018 02/06/2018 01 94109885 0 27010500 1 643.00 14.00 0 REG A R 201801 02/19/2018 11/06/2017 01 94109885 0 27010500 1 629.00 14.00 0 REG A R 201704 11/21/2017 08/11/2017 01 94109885 0 27010500 1 615.00 17.00 0 REG A R 201703 08/17/2017 05/08/2017 01 94109885 0 27010500 1 598.00 14.00 0 REG A R 201702 05/23/2017 02/06/2017 01 94109885 0 27010500 1 584.00 19.00 0 REG A R 201701 02/22/2017 11/07/2016 01 94109885 0 27010500 1 565.00 18.00 0 REG A R 201604 11/21/2016 08/08/2016 01 94109885 0 27010500 1 547.00 18.00 0 REG A R 201603 08/17/2016 05/09/2016 01 94109885 0 27010500 1 529.00 15.00 0 REG A R 201602 05/19/2016 02/09/2016 01 94109885 0 27010500 1 514.00 25.00 0 REG A R 201601 02/22/2016 11/09/2015 01 94109885 0 27010500 1 489.00 59.00 0 REG A R 201504 11/19/2015 08/11/2015 01 94109885 0 27010500 1 430.00 63.00 0 REG A R 201503 08/24/2015 05/11/2015 01 94109885 0 27010500 1 347.00 54.00 0 REG A R 201502 05/19/2015 02/04/2015 01 94109885 0 27010500 1 293.00 54.00 0 REG A R 201501 02/12/2015 11/10/2014 01 94109885 0 27010500 1 239.00 103.00 0 REG A R 201404 11/16/2014 08/15/2014 01 94109885 0 27010500 1 136.00 94.00 0 REG A R 201403 09/03/2014 05/12/2014 01 94109885 0 27010500 1 42.00 42.00 0 REG A R 201402 05/15/2014 03/21/2014 01 62003468 0 27010500 1 2,285.00 95.00 0 REG A O 201402 03/21/2014 03/21/2014 01 94109885 0 27010500 1 0.00 0.00 0 REG A S 201402 03/21/2014 02/12/2014 01 62003468 0 27010500 1 2,190.00 367.00 0 REG A R 201401 02/19/2014 11/19/2013 01 62003468 0 27010500 1 1,823.00 260.00 0 REG A R 201304 11/21/2013 08/15/2013 01 62003468 0 27010500 3 1,563.00 30.00 0 REG E R 201303 08/23/2013 05/09/2013 01 62003468 0 27010500 1 1,533.00 118.00 0 REG A R 201302 05/13/2013 02/15/2013 01 62003468 0 27010500 1 1,415.00 91.00 0 REG A R 201301 02/20/2013 11/15/2012 01 62003468 0 27010500 1 1,324.00 33.00 0 REG A R 201204 11/25/2012 08/15/2012 01 62003468 0 27010500 1 1,291.00 28.00 0 REG A R 201203 08/21/2012 05/15/2012 01 62003468 0 27010500 1 1,263.00 22.00 0 REG A R 201202 05/24/2012 https://maii.google.com/mail/u/O/?tab=rm&ogbl#inbox?projector=l 2/2 5/22/2020 20200520_122419.jpg Date: 5/22/2020 Meter Reading History Page 2 of 2 Customer# 605392-1 Premise#605392 Service:Water-Regular Metered METER READING TRANSACTION INFO Read Date Sequence# Meter# Face Sort # Read Code Reading Consumption Skip Count Type Code Status Bill Period Trans Date 02/14/2012 01 62003468 0 27010500 1 1,241.00 24.00 0 REG A R 201201 ' 02/23/2012 11/08/2011 01 62003468 0 27010500 1 1,217.00 22.00 0 REG A R 201104 11/22/2011 08/15/2011 01 62003468 0 27010500 1 1,195.00 33.00 0 REG A R 201103 08/23/2011 05/17/2011 01 62003468 0 27010500 1 1,162.00 29.00 0 REG . A R 201102 06/02/2011 02/15/2011 01 62003468 0 27010500 1 1,133.00 32.00 0 REG A R 201101 02/28/2011 11/10/2010 01 62003468 0 27010500 1 1,101.00 29.00 0 REG A R 201004 11/22/2010 08/19/2010 01 62003468 0 27010500 1 1,072.00 30.00 0 REG A R 201003 09/02/2010 05/18/2010 01 62003468 0 27010500 1 1,042.00 39.00 0 REG A R 201002 05/27/2010 02/19/2010 01 62003468 0 27010500 1 1,003.00 32.00 0 REG A R 201001 02/24/2010 11/17/2009 01 62003468 0 27010500 1 971.00 27.00 0 REG A R 200904 11/24/2009 08/21/2009 01 62003468 0 27010500 1 944.00 27.00 0 REG A R 200903 09/03/2009 05/21/2009 01 62003468 0 27010500 1 917.00 56.00 0 REG A R 200902 06/29/2009 02/18/2009 01 62003468 0 27010500 1 861.00 74.00 0 REG A R 200901 02/18/2009 11/18/2008 01 62003468 0 27010500 1 787.00 47.00 0 REG A R 200804 11/18/2008 08/20/2008 01 62003468 0 27010500 1 740.00 58.00 0 REG A R 200803 08/20/2008 05/19/2008 01 62003468 0 27010500 1 682.00 28.00 0 REG A R 200802 05/19/2008 02/20/2008 01 62003468 0 27010500 1 654.00 32.00 0 REG A R 200801 02/20/2008 11/16/2007 01 62003468. 0 27010500 1 622.00 31.00 0 REG A R 200704 11/16/2007 08/1412007 01 62003468 0 27010500 1 591.00 32.00 0 REG A R 200703 08/14/2007 05/22/2007 01 62003468 0 27010500 1 559.00 44.00 0 REG A R 200702 05/22/2007 02/12/2007 01 62003468 0 27010500 1 515.00 62.00 0 REG' A R 200701 02/12/2007 11/15/2006 01 62003468 0 27010500 1 453.00 47.00 0 REG A R 200604 1.1/15/2006 08/14/2006 01 62003468 0 27010500 1 406.00 33.00 0 REG A R 200603 08/14/2006 05/15/2006 01 62003468 0 27010500 1 373.00 0.00 0 REG A R 200602 05/15/2006 02/15/2006 01 62003468 0 27010500 1 343.00 0100 0 REG A R 200601 02/15/2006 https://mail.google.com/mail/u/O/?tab=rm&ogbl#inbox?projector=l 2/2 5/2142020 20200520_122433.jpg A � 417 Ile 4 Al 3, .r ., � •� �� fie. 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P '� :� �'� .fir sus` _ v '",�' _aca a'�,r�+`.,s•.^�y;�'�"w�, �.'�i � �;. ,c w» F .t... ..•" „� Yww-�� z � � s ^s j �^c��'ut' '�" ��.ma:" rY Cl �- �c a t� Ft by fJ�^,.Y a •.� � _ t�t �Fi nr � 4;�� .t wp.�.-t$' ,..�',�� ^Y. •ice `` . . •ty b.YR� t� 1b f i a r�, �aC { �� k•": ,: � � �� .,t'' �v� jk e d d n..""*3� .' Jy a.r':T f i d 1h ? ...2;anf.e ,Ss ,• �, k+� r „ + - _fy'. _} d,yi Id brjk.� ..'C"ty ,y``ik y 't4'�� ♦ � ,. <.; 4i'1 - -. Rt, _#.L �.•yet ..; 'f l b i•i.W`: i �— h• •r ® !E 'r{ I •• ,IR 1 11 1 1 1 WI�OF BARNSTABLE �.C, LOCA'IION /r! SEWAGE #ei ;2 m--jL8rs1 VILLAGE J (A q/N/-' ASSESSOR'S MAP & LOT 3 16 - 63-� INSTALLER'S NAME&PHONE NO. In/h cAge Se tz C SEPTIC TANK CAPACITY S��0 LEACHING FACILITY: (type) l All I rAA FRS' (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 2- — le - Cori COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i Q N' I d wtz J No. �� °r .• Fee l / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for Mitpont *p$tem Cow6trurtton Permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) `Complete System ❑Individual Components Location Address or Lot No. p,a� � bcca�5 Q-►,, Owner's Name,Address and Tel.No. Assessor's Map/Parcel —W ._o-Y3, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. • IMZ p— �-e(�t�C.. I"S kc)Is-CT, Ltv Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( Other Fixtures Design Flow 72�a gallons per day. Calculated daily flow 3 � gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ► fc��Cc��4 e i�Htt�l�� Description of Soil OLQ�S 39kz Nature of Repairs or Alterations(Answer when applicable) 1 �/'U S� ( . 1 �✓_ t 'T✓C ZTi%,Z t STo-� aav 1 r2-Z=J Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the EnvironrUmIaLf ode and not to place the system in operation until a Certifi- cate of Compliance has b and Signed Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued � �__�_-- _ -- - -- - ——— m ,�x/"jra�..r-v..r--••f•--7.;_ �,,_:,yS-�F,,`'►rt;,v �^s."i+: :f'�-s=.t�--•->.n- :�c�-.:._.��:1:.-' �.r, -a:^•��t =M-...�v-:,�'�r:7s`:�tw.�`�`:r---,.+�-r—=�;:- ,. .:�_,- Z _ -_ _ No. d d CJ Fee THE COMMONWEALTH,I OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplication for Mi.5pozar *pe;tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) `fComplete System ❑Individual Components Location Address or Lot No. of �i SoS C l Y Owner's Name,Address and Tel.No. t��.4•�u_�S Assessor's Map/Parcel - O —Q-2, 'r V N c Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. V\K� O-GV9(2p S'e 0 i T lw,:s.,CT 1-G Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( )- Cafeteria( ) Other Fixtures N Design Flow gallons per day. Calculated daily flow 3�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank i S Oa S A-\ V_ Type of S.A.S. �A_Cct ®4 C Description of Soil S Nature of Repairs or Alterations(Answer when applicable) 1 \ S, ru ��C f- (_-TV�.T�i�S c,c�I �( t S'T _ aav Sim ! Date last inspected: Agreement: The undersigned agrees to ensure the construction and-maintenance of the afore described on-site sewage .. 0,sal system ¢ _--In accordance with the provisions of Title 5 of the En,vviirro-nme�ta ode and not to place the system in operation une'l,Certifi- cateof Compliance has bgen4asued-by-dii oard 6t-ki - A Signed p` Date C Application Approved by - Date 2'/b-2-6"D Application Disapproved for the following reasons Permit No. ZO'UO-e Date Issued w Z -I O-7fao THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( ti.)Upgraded(1.-' Abandoned '),`by, Il\i -C'A p C_ F: 1 L at 8.. e5 c, has be n constructed in accordance with the p� ' ' s of Title 5 and the for,Disposal System Construction Permit No. ?.OyO Mated Z- -/U- ?e00. Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 - - DLL Inspector Q\ - c - --------------------------------------- No. O _ Fei THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=igo.5a1 bp$tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(Vf Abandon( ) System located at a and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to << comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years bf the date of this- ermit. ' Date: Z�d�'�� Approved by �j kaflri- 1/6/99 NOTICE: This Form Is To Be_Used For.the Repair Of Failed Septic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated p52—ld j7V , concerning the property located at µ if meets all of the following criteria:. This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. (wl"There are no wetlands within 100 feet of the proposed septic system ,P' There are no private wells within 150 feet of the proposed septic system 'There is no increase in flow and/or change in use proposed There are no variances requested or needed. Arhe bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when �plicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ��f B) G.W.Elevation ,01C) +the MAX.High G.W.Adjustment. '(0 = off, DIFFERENCE BETWEEN A and B 1 q SIGNED D . DATE: _ a [Please Sketch p ed plan of on back]. I NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert i r �, - r