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HomeMy WebLinkAbout0817 OLD STRAWBERRY HILL ROAD - HYANNIS CONDOS 817 OLH STRAWBERRY ROAD Shallowy `> -Hyannis Pond j • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .0 .''� 817 Old Strawberry Hill Road Property Address - Shallow Pond Condo's units 1,20 A&B OD Owner Owner's Name ►+ information is Q} required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in a6p way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return Name of Inspector key. ' Ford Septic Services, LLC Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State, Zip Code 508-862-9400 S12482 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 E luation by the Local Approving Authority 2/3/16 Inspect Signature Date The sy e 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is Hyannis MA 02601 2/1/2016 required for every y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. F *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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis annis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,.if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El 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 1/2 day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a,•''y 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 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: ❑ ® 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 a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone Il of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. , t5ins•3/13 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 r 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 ` page. City/Town 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): n/a Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A,•''y 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 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: pumped on 1/2/16 Was system pumped as part of the inspection? ❑ Yes [Z No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cw„a 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 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: system installed in 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12 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: 2500 gal. H-20 Sludge depth: 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�M a 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town 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 Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measure 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.): The tees were present and there was no sign of leaksge. The tank was just pumped on 1/2/16. The inlet steel cover was to grade and recommend replacing. i Grease Trap (locate on site plan): Depth below grade: n/a 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 I5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 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): N/a 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town 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 even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was normal. 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.): n/a * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 lit Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4-2'x4'x54' Ion ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil,'signs of hydraulic failure, level.0",pond i ng, damp soil, condition of vegetation, etc.): There was no sign of failure. A camera was used to inspect. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town 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.): N/a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately sue. A P t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�•, 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 18'+/- 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: Topo and water contours map. ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above L Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 rj J O U Q �. La ri Zv 70 � O b '..•. (.� J. :SAS. Q '^ O �J' .�v, �. -d r� �? �„T� = ._ :[ .:C'? (�T t I _ 04 4 ' I 1_ L J7 v f Commonwealth of Massachusetts - /o F v Title 5 Official Inspection Form � �� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2A +ZI3 ' M 1'6 Old StrawberryHill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name forma is re Ired for every Hyannis MA 02601 2/1/2016 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return Name of Inspector key. Ford Septic Services, LLC Crab Company Name P.O. Box 49 Company Address Osterville MA 02655 Cityrrown State Zip Code 508-862-9400 S 12482 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 Fur er Evaluation by the Local Approving Authority 2/3/16 Inspe i u a s Signat Date The y tem inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heath 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. l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 v Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �f6 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B System Conditional) Passes: Y Y ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �<6 Old Strawberry Hill Road Property Address / Shallow Pond Condo's units 1,2&3 A&B Owner information is Owner's Name required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by.the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts V W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Old Strawberry Hill Road .�/ Property Address h S allow Po nd Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ , ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `�M e,•` M Old Strawberry Hill Road al�/ Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply EJ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -146"0ld StrawberryHill Road �0/J Property Address Shallow Pond Condo's units 1,2&3 A&B Owner information is Owner's Name required for.every Hyannis MA 02601 page. City/Town 2/1/2016 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): n/a Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -Old Strawberry Hill Road ell Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. Cttyfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently 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•3/13 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�s•`'�� W Old Strawberry Hill Road Q'/j Property Address l� Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 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: Pumped on 1/2/16 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts ,l Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Old Strawberry Hill Road Property Address /1 Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed in 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 12"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: 2500 gal. H-20 Sludge depth: 2 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Offic ial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4�tTlDld Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town 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 Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measure 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.): The tees were present and there was no sign of leakage.The tank was just pumped on 1/2/16. The inlet steel cover was to grade and recommend replacing. Grease Trap (locate on site plan): Depth below grade: n/a 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,20 A&B Owner Owner's Name Information is required for every Hyannis MA 02601 2/1/2016 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 r g o Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): N/a 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments .&4-6—Old Strawberry Hill Road Property Address a / Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town 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 even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was normal. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ® No* Alarms in working order: ❑ Yes ® No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments As•`�F _ Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name ' information is required for,.every Hyannis MA 02601 2/1/2016 page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4-2'x4'x54' Ion ❑ 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.): There was no sign of failure. A camera was used to inspect Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �-11j Old Strawberry Hill Road n' Property Address g Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town 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.): N/a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsur face Sewage Dis posal sposal System Form - No t of for Voluntary Assessments Old Strawberry Hill Road (� Property Address b Shallow Pond Condo's units 1,2&3 A&B Owner information is Owner's Name required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Set auk pygsg . i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Sub- surface Sewage Disposal System Form - ' 9 p y Not for Voluntary Assessments '�M e,•''� 8"16 Old Strawberry Hill Road I Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 18'+ 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: Topo and water contours map ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •0 -&16 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 1,2&3 A&B Owner Owner's Name information is required for every Hyannis MA 02601 2/1/2016 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•P g page 17 of 17 eW=QJ� S 'OWN O i lARNsTABL LOCATIOI`i:, VILLAGE ASSI.MOR'S MAP:dc LOTS INSTALLER'S NAIv1E&PHON>r NO', SEPTIC TANK CApACt'i'Y ._ .. Gz-�(.._ t.� LZACHING FACI I'I'Y: , L(� :� c-+'nr_ (size) ,►�4i ,. 13UILDER OR OWNER PERMITI3ATE: (ed Z 1, ';04 _ __ _ ...CGIv1PLUNC13 DATE: Saparatian 17istancc Sclween the-, +p.a� Maximum Adjusted Groundwater Table and.Bottoai of I.tactung Facility Feet..(ffoia Pt'ivatc Water Supply Well and Teaching Facility, (If arty wells.exlst on site or within 200 Not of leadtung facility) Feet Edge or WtUand and T caching FecWty(T,1'any wetlands exist / wi"n 3oo reet.dr leactun citity) d'li Feei, Furnished by � w C _ c 4a �3 74 r� A.- . ` � C�t f�'��('f'✓titrl `9 � ;' :s R)C -� YL11 e TOTAL P.02 COMMONWEALTH OF MASSACHUSETTS u: t H EXECUTIVEOFFI'CE OF,ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL:PROTECTION { TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION in, ' �a -Property Address: 01d Strawberry Hill Road units 1.2&3 A&B Shallow Pond Condo' rude MA 02632 Owner's Name:. Cape Cod&Islands Property Management nL Owner's Address: � �C t rs KI . Date of Inspection: A May 8, 2012 ' Name of Inspector:(Please Print) James M.Ford i Company Name: James M. Ford k-n ,-n Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (M8)862-9400 CERTIFICATION STATEMENT I.certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed P p based on my training and experience in function the proper, and maintenance of on site sewage disposal systems. Lam a DEP approved system inspector pursuant to Section M340 of Title 5(310 CMR 15.000). The system:. ✓ Passes - Conditionally Passes s Further Evaluation by the Local Approving Authority ai Inspector's Signature:P g Date: May 8;2012. The system inspector shall sub i a copy of s_inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the,report to the appropriate regional office of the DEP. The original should be sent to the.system owner and copies sent to the buyer,if applicable,and the approving :authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Shallow Pond Condo's 1.2&3A&B 816 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Management Date of Inspection: May 7, 2012 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section.D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303.or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: . B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes;no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it,is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled for uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s)'. The system will , pass inspection if(with:approval of the Board of Health): broken,pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) , Property Address: Shallow Pond Condo's 12&3A&B 816 Old Strawberry Hill Road_ Owner's Name: Cape Cod&Islands Proverty Management Date of Inspection: May 7. 2012 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or.privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS.and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other, failure criteria are triggered. A copy of the analysis must be attached to this form. t 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION (continued) Property Address: Shallow Pond Condo's 1.2&3A&B 816 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Management Date of Inspection: May 7.2012 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each,of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to.overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than Ili day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s):.Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of.a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private:water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less-than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: . To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems»in addition to the criteria above) ,Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water,supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Shallow Pond Condo's 12&3A&B 816 Old Strawberry Hill Road Owner's Name: Cane Cod&Islands Property Management Date of Inspection:. May 7.2012 f 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: Yes No ✓ Existing information: For example,a plan at the Board of.Health... ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Shallow Pond Condo's 1.2&3A&B 816 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Management Date of Inspection: May 7. 2012 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): .n1a Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): n1a Number of current residents: n1a Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system{yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes orpo): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): end Basis of design flow(seats/persons/sqft,etc.) Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2 months ago Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: sallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank;distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)"(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) . Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: installed in 1996 -per as built Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond Condo's 1.2&3A&B 816 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands PrODertv Management Date of Inspection: May 7;2012 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints;venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach.a copy of certificate) Dimensions: 2500 teal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: " Scum thickness: 1„ Distance from top of scum to top of outlet tee or baffle: Distance from bottom.of scum to bottom of outlet tee or baffle: 101, How were dimensions determined: Measur.in z stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural.integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs o leakage GREASE TRAP: None (locate on site plan) Depth below,grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or bale: Distance from bottom of scum to bottom of outlet tee or baffle: :Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond Condo's 1.2&3A&B 816 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Management Date of Inspection: Mav 7, 2012 TIGHT or HOLDING TANK: None (tank must be at time of inspection) locate on site pumped P )( to plan) Depth below grade; Material of construction: _concrete metal fiberglass _,polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: eallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert`. Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was clean. No solids were pLesent. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9.of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond Condo's 1.2&3A&B 816 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Manag eement Date of Inspection: Mav 7. 2012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ✓ Teaching fields,number,dimensions: 4-54'trenches per as built overflow cesspool,number: Innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition.of vegetation, etc.): . There did not appear to be any signs offailure A camera was used for the inspection CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site,plan) Number and configuration: Depth top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of-construction: Dimensions: Depth of solids: Comments(note condition,of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): , 9 � r Page 10 of 11 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond Condo's 12&3A&B 816 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Man —a—cement Date of Inspection: May 7. 2012 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. o 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond.Condo's 12&3A&B 816 Old Strawberry Hill Road Owner's Name: Cane Cod&Islands Propertv Manazement Date of Inspection:, May 7, 2012 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 18+1- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date.of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,:installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation:: Using Barnstable topographic and water contours maps the maps were showing approximately 18'+/ to gZ:oundwater at this. site. , i This report has been prepared only for the septic system and components described herein. This septic system has been inspected andpassed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied, relating to the septic system,-the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 SF.P-25-2002 11:51 CUBELLIS/SAIVETZ i?eie497759 P.02 l ). ��(�S�•TOWN OF BARNSTABLE LOCATION N 15AGE f VILLAGE %� A,-`� ASSMSSOR'S MAP do L4T 3 INSTALLER'S NAME&PHONE NO. \c-e.�l,L "7 ?•�,� - SF-PTIC TANK CAPACITY LEACHING FACILITY: (type) . ,Jr tom., NO, ot:BEDROOMS BUILDER OR OWNER PERMI-T DATi;:,sue I i I �- _ _-- COMPLIANCE DATE: GourEs;'p�� Saparadon Distance Between the: Q Maximum Adjusted Groundwater Table and Eottoin of i,eaching Facility tt private Water Supply Well and Leaching Facility (If any Wells eajst Feet on site or within 200 feet of leaching facility}. Edge of Wcdand and Leaching Facility(If any wetlands exist ! Feet within 300 feet of leachi ciljty) L ,, Furnishes br,�—f� L,, A4-a rIJULY -ko .0 yip l v y 74 A +n 1 s Qr�S t ti . • TOTRL P.02 Page 10.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS MENTS N TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberr Hill Road Units 4A&'B SA&B V Owner: Cane Cod&Islands Property Management Date of Inspection: December 12 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. } I /S 19 y a ;L 3g 3 a� yI s a y S3 Cove To (�rA& y A+ (� i S +R i • I � 10 1 I Y , Commonwealth of Massachusetts r2 = Title 5 Official Inspection Form In li . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . � 817 Old Strawberry Hill Road Property Address r h ' Shallow Pond Condo's units 4 A&B, 5 A&B t- Owner Owner's Name/ reformation is required for every Hy annis V MA 02601 8/26/2019 ! -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 U A. Inspector Information c4 on the computer, use only the tab James Ford key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return key. Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 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 8/30/2019 Inspec is Signature Date The s tem 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 Commonwealth of Massachusetts �. Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is Hyannis required for every MA 02601 8/26/2019 page. Cltyrrown 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 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawbegy Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 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 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts r; (P Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Wddress Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. Cltyrrown 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 ❑ E Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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 l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 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 ❑ 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? Z ❑ 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)] 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 M;V 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is Hyannis required for every y MA 02601 8/26/2019 page. CltylTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 8 Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 Description: Number of current residents: unknown 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 information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: unknown Sump pump? ❑ Yes ® No Last date of occupancy: currently Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts r- 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 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: pumped yearly 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 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawbegy Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Dec. 2016- per as built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 24° feet Material of construction: ® concrete El metal ❑ fiberglass ❑ polyethylene El 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: 2000 gal. H-20 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 23 Scum thickness 5 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 13 How were dimensions determined? measure 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 tees were present. There was no sign of leakage. steel covers were to grade. i 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 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is Hyannis required for every Y MA 02601 8/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.1/26/2o18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form S Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): N/a *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 even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The H-20 D-box was in the parking lot. speed levers were present steel cover was to grade. I 15insp.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 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is Hyannis required for every y MA 02601 8/26/2019 page. Cityrrown 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.): Both pumps and alarm were working. steel cover was to grade. 2500 gal.Two compartment pump chamber * 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: 6-500 gal.chambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: I ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. Cityrrown 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 chambers were clean. bottom had 1"of liquid. steel covers were to grade. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: N/a 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 , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments of 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � S Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 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: 20' +/- feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9/2016 design plans Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Topo and water contours map. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: The SAS is up high in the parking lot. Design plan shows no water at 12'when installed 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 Commonwealth of Massachusetts a. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5 A&B Owner Owner's Name information is required for every Hyannis MA 02601 8/26/2019 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i I �p� o \ EL=196.6 O g� \ TP STY EL=198.5 IN, G c' G OWE�� W �y M. 1 A c03 G Y 2 SF py\N �IN� FF,199.2 NIT ZA WOOD P�5 DECK CB ®. 2 STY e R=200.5 D/WE�3 G FF,198.2WOOD O NIA s DECK S R=2 p 01.6' e ? •87.3', / New Chambers (6) 0 S e � 1g�.2 y..,,, Riser & Cover m FF� To Grade (typ) 1NDO Top EI=200.4' DECK Caty � O s � PVElec .ram � Tel el Tran �ran y� -box O i Inv=199.5' -195.9' -A cn Inv=199.6' BIT R= 0\ O —A Inv=199.6' PARKING S Inv=200.0' AREA S top 2"=193.6' Sump=199.6' `"R=196.7 C Top EI=1 0' ��� Inv=200.1' i Inv=193.4' '� p t \ Inv=193.6' ;t Pipe C Septic "� , Inv=199.5' / �'.�_ - � Inv=199.6' ,9g Tan{C/ m Inv=199.6' F' Top E1=200.4' 2"PVC Riser & Cover C) Force Main y$ To Grade C' Lawn a 5IO �P�O c\ As—Built Sketch Of New Septic System For Units 4 A+B, & 5 A+B 5�y� p�0 At 817 Old Strawberry Hill Rd r10��59 Hyannis, Mass �I G Shallow Pond y Condominiums CapeSury 23 West Boy Rd, Suite G Osterville MA 02655 (508)420-3994 (508)420-3995 fox copesurv@copecod.net p 15/DEC/16 C158_2g2 1"=20' 0 5 10 15 20 30 40 FEET �Ln o .. • o a- - OFFICIAL USE cO Certified Mail FeeEr t� Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) $ E:3 ❑Return Receipt(electronic) $ `l,�,��� Pdstmark O ❑Certified Mall Restricted Delivery $ ;, a tyt 'Here t7 ❑Adult Signature Required $ l ❑Adult Signature Restricted Delivery$ O Postage ,r m �. $ .:,. � Total Postage and Fees $ / D S- To O d p /121�/�!0 UR4117_C 0 P/7� - Stre Apt No.,or PO t o3 z No. :4NQ ---------------- City,State,ZIP+�✓,/ bab S mivgw.r.mrrr•r, Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this, delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. �J7 signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent fmppriant Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). r' or Priority Mail®service. Adult signature restricted delivery service,which ■Cerlfied Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified, ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent' with Certified Mail service.However,the purchase (not available at retaig. of Certified Mail service does not change the o To ensure that your Certified Mail receipt is 1 insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.lf you would like a postmark on'-■For an additional fee,and with a proper this Certified Mail receipt,please present your rr endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion a of delivery(including the recipient's signature), of this label,affix it to the mailpiece,apply _! You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy.retum receipt, — complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-62-OOD-9047 , COMPLETE .N COMPLETE THIS 3ECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si item 4 if Restricted Delivery is desired. X ❑Agent M ■ Print your name and address on the reverse 4111 Addressee so that we can return the card to you. B. R eiv d by(Printee e), C. DaT�y�eli ery III Attach this card to the back of the mailpiece, � I or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 17 ❑Yes *,, if YES,enter delivery address below: El No Cap�C�d Islands ��a�r I�tna P D 13ix 3. Service Type A ^ S �Certifled Mail® ❑Priority Mail Express'" 11 ❑Registered Return Receipt for Merchandise M ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. 7015, 1730 0001 4989 - 0250 -, ,S PS Form 3811,July 2013 Domestic Return Receipt " UNITED STATEqfW. ERVICE First-Class Mail _ Postage&Fees Paid $. „? USPS I Permit No.G-10 I r • Sender: Please print your name, address, and ZIP+4®in this box• I • I I Town of Barnstable jd Health Division I. O8 200 Main Street Hyannis,MA 02601 I ` I ` ` .....::: ••......t-.:^. 133�itf#F 3A. I Town of Barnstable Barnstable Regulatory Services Department M�ftedcaC j STABLE, I 9 1' . ,0�' Public Health Division m FDM 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7015 1730 0001 4989 0250 July 12, 2016 Cape Cod & Islands Property Management c/o Kerry McNamara P.O. Box 1144 Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 817 Old Strawberry Hill Road Units 4 A&B, 5A&B, Hyannis, MA were inspected on 06/20/2016 by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year 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 OARD OF HEALTH omas McKean, R.S., CH Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\817 Old Strawberry Hill Road Units 4AB and 5AB Hyannis MA.doc Town of Barnstable • BARNS'rABL& 4 Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 office' 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 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 ONE (1) YEAR DEADLINE CRITERIA � `` Static liquid level in the distribution box above outlet invert due to an overloaded or �`// clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool'with high liquid level, <12" below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) - OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Fo m -Not for Voluntar Assessments ssments a,•`'•• 817.0Id Strawberry Hill Road c- Property Address Shallow Pond Condo's units 4 A&B, 5A&B CD information is Owner Owner's Name + required for every Hyannis MA im page. City/T own 02601 6/20/2016 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: / key to move your cursor-do not James Ford use the return key. Name of Inspector Ford Septic Services, LLC ?1 Fwrab Company Name P.O. Box 49 Company Address Osterville MA City/Town 02655 508-862-9400 State Zip Code S 12482 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 Furthe aluation by the Local Approving Authority 6/23/16 Inspect Signature Date The s st m inspec or shall submit a copy of this inspection report to the Approving Authority(Board of Hea 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °`�• 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 page. Cltyrrown State Zip Code B. Certification (Cont.) Date of Inspection 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �A,a,•'`y 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructedpipe(s).The s stem will ass inspection if with a Y P p ( 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 !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M a •`'• 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner ' information is Ow ner s Name required for every Hyannis MA 02601 6/20/2016 page. City/Town State Zi Code P Date of Inspection B. Certification (Cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ 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 1Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °°�M a •''y 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 City/Town 6/20/2016 page. State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,.cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B,5A&B Owner Owner's Name information is required for every Hyannis MA 02601' 6/20/2016 page. City/Town 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): 8 Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 880 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 6 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '' ., ••°•y 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner information is Owner's Name required for every Hyannis MA 02601 page. City/Town 6/20/2016 State Zip Code Date of Inspection D. System Information Description: Number of current residents: n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently 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: 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 • Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °,• 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 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: pumped on 1/2/16 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 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: system installed in 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 18" 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: 2000 gal. Sludge depth: 2 t5ins.3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form } X Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .e.•`'y 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner information is Owner's Name required for every Hyannis MA 02601 6/20/2016 page. CitylTown State ZipCode Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measure 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.): The tees were present and there was no sign of leakage. A outlet filter was present. The tank was just pumped on 1/2/16. The steel covers were to grade. Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑fiberglass 9 El 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner owner's Name information is required for every Hyannis MA 02601 6/20/2016 page. City/Town State ZipCode 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 9 El polyethylene El other(explain): N/a 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 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts G Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 ..page. City/Town State ZipCode 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 above 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 liquid level in the D-box was up to the top of the outlet pipes SAS is under water 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.): n/a * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °^. a 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 12x38 ❑ 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.): The liquid was backing up into the D-Box. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 page. CltylTown 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.): N/a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ' Commonwealth of•Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •''y 817 Old Strawberry Hill Road Property Address _Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 6/20/2016 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 ck 15ins.-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `�M e,•`'- 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 page. Cltyrrown State ZipCode Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Topo and water contours map. ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;•. 817 Old Strawberry Hill Road Property Address Shallow Pond Condo's units 4 A&B, 5A&B Owner Owner's Name information is required for every Hyannis MA 02601 6/20/2016 page. Cltyrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .7Cf—G:i-GrIk;JG 1 G•?70 LLICCLL L b/'c,H I Ut 1.G 5� TOWN OF BARNSTA.BLE LOCATION. }} " � (SEWAGtr�• VILLAGE c. SSI SSOR'S W&LOT—Z= di-L INSTALLER'S AME dt:PHONE M0.— i" 'c r-. �^ t SEPTIC TANK CAPACrrr LEACHING FACILITY: (type}_ �rrJ1 T1t [ t-41 (size) NO.OF BEDROOMS BUILDER OR OWNER____ PERMITDATE:—(4-/ IS Ga COMPLIANCE DATE: Separation Distance Between thc: � Maxlmum Adjusted Groundwater Table and Bottom of Leaching Facility eel Private Water Supply Well ttnd L.cacl ing Facility (If any wells exist , I A . on site or within 200 feet of.leaching fscinty) /�di Feet Edge of wetland and Leaching Facility(Ef any wetlands exist within 300 feet of lea facility) _��f (�. eN Furnished by A Cox �v E u�-\ L4 i TOTAL P.01 ........ ulCOMMONWEALTH OF MASSACHUSETTS °C;'" ;,� 8A1; EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS JA _4 J DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Shallow Pond Condominiums _ __. Property Address: FIX 4f0ld Strawberry Hill Road`Units 4A&B 5A&B 1�L imnIS Ca��e►vilte MA 02632 Owner's Name: (/ Cape Cod&Islands Property Management' Owner's Address: clo Kerry McNamara P.O. Box 1144 Osterville, MA 02655 sr 30�7 Date of Inspection: . December 12 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes NeedrFurther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: December 19, 2005 The system inspector sh\subia copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B. 5A&B Centerville MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR, 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or . repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B. 5A&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B, 5A&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or .clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool . ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 816 Old Strawberry Hill Roadd, Units 4A&B, 5A&B Centerville, MA Owner: Cane Cod&Islands Property Management Date of Inspection: December 12, 2005 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: Yes No ✓ _ Existing information: For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310-CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 816 Old Strawberry Hill Road, Units 4A&B, 5A&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 8 Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 Number of current residents: n/a Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no) -n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: - Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Tank was pumped approx. 3 weeks prior to the inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool overflow cesspool Privy Shared system(yes or no) (if yes,attach previous.inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Upgraded approximately in 1996-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 i Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B SA&B Centerville. MA Owner: Cane Cod&Islands Property Management Date of Inspection: December 12, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Carmnents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 18" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 2000 gal. Sludge depth: -- Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of.leakage, etc.): The tank was in good condition. There did not appear to be any signs of leakage The tank has an outlet filter in place Recommend yearly pumping/cleaning for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B, 5A&B Centerville, MA Owner: Cape Cod&Islands Proper Management Date of hnspection: December 12, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): F Date of last pumping: Corn ments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D box was level No solids were present There were three outlets The cover was 2"below grade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alanns in working order(yes or no) Comments (note condition of pump chamber,condition of pumps-and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B SA&B Centerville, MA Owner: Cape Cod&Islands Properry Manazenzent Date of Inspection: December 12, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ✓ leaching fields,number,dimensions: 12'x 38'6Qen In-Drian Bio-Matt fabric material) 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.): There did not appear to be any signs offailure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B 5A&B Centerville, MA Owner: Cane Cod&Islands froperN Management Date of Inspection: December 12, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. t/enT Jig y . a a� 3� 3 3 a'1 y l a y S3 r cove/ ro (,IA& y Ada S +Q 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B, 5A&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12, M05 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15+/ feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 15'+/-to ground water at this site. . I P This report has been prepared and the system inspected and passed as of the date of inspection: This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 COMMONWEALTH OF MASSACHUSETTS ?'x OF BARN: EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS "06 JAN _4 P Lv DEPARTMENT OF ENVIRONMENTAL PROTECTION 01V1SION, TITLE 5 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Shallow Pond Condominiums Property Address: ?iI' _84eOld Strawberry Hill Road, Units 4A&B. M&B �n►s QWtrvitte MA 02632 Owner's Name: Cape Cod&Islands Property Management' Owner's Address: c%Kerry McNamara P.O. Box 1144 Osterville, MA 02655 Sr 3ya Date of Inspection: . December 12, 2005 Name of Inspector: (Please Print) Janes M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT. I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Need urther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: December 19, 2005 The system inspector shall subs a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2'of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B, 5A&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. .System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed . distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced . obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B, 5A&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL.INSPECTION FORM-NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B, SA&B Centerville, MA Owner: Cape Cod&Islands Properol Management Date of Inspection: December 12, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow _ ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high groundwater 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system.must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the.system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 816 Old Strawberry Hill Road, Units 4A&B 5A&B Centerville, MA' Owner: Cane Cod&Islands Proper Management Date of Inspection: December 12 2005 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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. . a 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 816 Old Strawberry Hill Road, Units 4A&B, 5A&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12, 2005 FLOW CONDITIONS RESIDENTIAL ' Number of bedrooms(design): 8 Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 Number of current residents: n1a Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or.no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no):. No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Tank was pumped approx. 3 weeks prior to the inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate.age of all components,date installed(if known)and source of information: Upgraded approximately in 1996-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B 5A&B Centerville, MA Owner: Cane Cod&Islands Prouty Management Date of Inspection: December 12, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 18" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain). If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 2000 gal. Sludge depth: -- Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle- Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: _ Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was in good condition. There did not appear to be any signs of leakage The tank has an outlet filter in place Recommend yearly puntpinQ/cleaning for maintenance GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction:' concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B SA&B Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: December 12, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): I Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and Aistribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level No solids were present. There were three outlets. The cover was 2"below grade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Commments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B SA&B Centerville, MA Owner: Cane Cod&Islands Prouty Management Date of Inspection: December 12: 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ✓ leaching fields,number,dimensions: 12'x 38'(Elien In-Drian Bio-Matt fabric material) overflow cesspool,number: Innovative/alternative system Type/name of technology: Continents(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): There did not appear to be any signs offailure CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Cornments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 4A&B 5A&B Centerville, MA Owner: Cane Cod&Islands Property Management Date of Inspection: December 12, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. _—...__------------------- --- - V" �S 19 3 3 DL y I a y S3 II y Af Q S +a 10 Page 11 of 11 • OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road, Units 4A&B. 5A&B Centerville, MA Owner: Cape Cod&Islands Property Managensent Date of Inspection: December 12, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 15'+/-to ground water at this site. This report has been prepared and the systens inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the systens will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the systens,the inspection and/or this report. 11 0�r 3 P000 COMMONWEALTH OF MASACHUSETTS o� EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAI° DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 _ TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 817 OLD STRAWBERRY HILL RD QVffERVtLtE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES -v+Y►Ls Address of Owner: 595 MAIN ST.HYANNIS MA.02601 Date of Inspection: 9113/00 Name of Inspector: JOHN GRACI 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected.the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: f" Date:9/25/00 The System Inspector shall su mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M,. inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE. revised 9/2/98 Paae 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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 o the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance atta inspection;indicating that the tank was installed within twenty(20)years prior to the date of the ins ection•or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa Sewage backup,or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o due to a broken;settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced nLa The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2/98 Paoe 2 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: m Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM 11, NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WAT'EER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply.well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance Wa (approximation not valid). 3) OTHER n/a revised 9/2/98 Paae 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13100 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of.the following: a I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more.th'an 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n1a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply weil, r - X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. 7 • i� revised 9/2/98 Paoe 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner: WILLIAM JEFFERIES Date of Inspection: 9/13100 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was,provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water,have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling wa s inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X _ The facility owner(and`occupants;if'different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. a,i revised 9/2198 Paae 5 of 11 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13/00 FLOW CONDITIONS RESIDENTIAI Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 8 Number of bedrooms(actual):n/a Total DESIGN flow: 880 gpd Number of current residents:8 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIALIINDUSTRIAL Type of establishment: n/a Design flow: nla gpd(Based on 15.203) Basis of design flow: n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present: (yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a 3; OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes.or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) _ 1/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components;:date installed(if known)and source of information: 1982 Sewage odors detected when arriving at the site:(yes or no NO SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM revised 9/2/98 Paae 6 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9113/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 36" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 30" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1500G L 10'6"H 5'7"W 5'8 Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:nla Scum thickness: nla Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) n/a revised 9/2/98 Paae 7 of 11 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of, inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) I Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order: (Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a F revised 9/2198 Paoe 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)LEACH PIT leaching chambers, number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number, length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,;level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Paae 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9113/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar" Shallow wells'` Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health " Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High_Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET' 1, r revised 9/2/98 Paoe 11 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) o sae revised 9/2/98 Page 10 of 11 i Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposd. System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road lints 6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property"06nagement Owner Owner's Name information is Centerville MA 02632 7/9/14 required for every _ 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 A. General Information filling out forms q on the computer, i 0use only the tab 1. Inspector: (/ key to move your cursor-do not James Ford _ use the return Name of Inspector f. O Brae Company Name f� P.O. Box 49 Company Address erg Osterville C MA 02655 City/Town I State Zip Code 508-862-9400 S 12482 Telephone Number License Number Y B. Certification I certify that l 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 t; ❑ Conditionally Passes ❑ Fails r ❑ Needs Further aluation by the Local Approving Authority i . I 7/9/14 Inspe rs Signature Date The y tem inspector shall submit a copy of this inspection report to the Approving Authority(Board of He h or DEP)within 310 days of completing this inspection. If the system is a shared system or has a design flow of 10,000: pd or greater, the inspector and the system owner shall submit the report to the appropriate r6gional 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 describrrs'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 co�niditions of use. i t. . t5ins•3/13 ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 817 Old Strawberry Hill Road units 6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check;A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or,in'310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i 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 substarlial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing ti.�rik: 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): �i i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 l; i it n I�_ Commonwealth of Massachusetts v Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�M a 817 Old Strawberry Hill Road on)ts 6,7 A&B-Shallow Pond Condo's Property Address I Cape Cod & Islands Property f alnagement Owner Owner's Name information is required for every Centerville { MA 02632 7/9/14 page. CitylTown I' State Zip Code Date of Inspection B. Certification (cony) `. r ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repair,.ed. B) System Conditionally Passes (cont.): �I 7 ❑ 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): ii ❑ broken pipe(s)a:re replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is�rehioved ❑ Y ❑ N ❑ ND (Explain below): i . d ❑ distribution bdx is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): i i, ° f ElThe system required piumping 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,) sre replaced ❑ Y ElN ❑ ND (Explain below): ❑ obstruction issremoved ❑ Y ❑ N ❑ ND (Explain below): is i s 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 t I c I E; Commonwealth of Massachusetts W Title 5 Officials Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road units 6,7 A&B - Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville MA 02632 7/9/14 page. Cityfrown 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 aseptic 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 aseptic 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 sep.tic;tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private woter supply well**. Method used to determine distance: **This system passes if the'well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: t' t, u I: i ,l D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or``.No" to each of the following for all inspections: Yes No ❑ ® Bacleup of sewage into facility or system component due to overloaded or clog jed 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 I. , El ® Static.liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liqu','id depth in cesspool is less than 6" below invert or available volume is less than Y2:day flow 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ,I Commonwealth of Mas0achusetts Title 5 Official;: Inspection Form Subsurface Sewage DisposAl System Form - Not for Voluntary Assessments I: 817 Old Strawberry Hill Road units 6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville i MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any,portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or trib `tary to a surface water supply. ❑ ® Any potion of a cesspool or privy is within a Zone 1 of a public well. �1 ❑ ® Any'portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any;iportion 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. ❑ ® Thefsystem 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 systern owner should contact the Board of Health to determine what will be necEssary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to:15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the'system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the 'system is located in a nitrogen sensitive area (Interim Wellhead Protection Area ='IWPA) or a mapped Zone II of a public water supply well If you have answered "yet"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 sign�,idant 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. r� t5ins•3/13 �.' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 , Commonwealth of Massachusetts Title 5 Officil Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road;units16,7 A&B -Shallow Pond Condo's Property Address I. i' Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection it 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 thesystem received normal flows in the previous two week period? El ® Havedarge volumes of water been introduced to the system recently or as part of this inspection? l: ® ElWere'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'ali system components, excluding the SAS, located on site? ,l ® ❑ 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 inforn)ation on the proper maintenance of subsurface sewage disposal systems? The s`iie and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existling information. For example, a plan at the Board of Health. ® ElDetermined in the field (if any of the failure criteria related to Part C is at issue approxirn� ation of distance is unacceptable) [310 CMR 15.302(5)] i ' D. System Informatipl Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 8 DESIGN flow based on 310 CNIR 15.203 (for example: 110 gpd x#of bedrooms): n/a • 1 15ins•3113 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 l' I' h i r Commonwealth of Massachusetts Title 5 Officia[ Inspection Form Subsurface Sewage Disposq'l System Form -Not for Voluntary Assessments g• . a "r 817 Old Strawberry Hill Road Units'.6,7 A&B -Shallow Pond Condo's Property Address t' Cape Cod & Islands Property Management Owner Owner's Name information is i1 required for every Centerville I: MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: l� F V I' unknown Number of current tsli. Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sevua9e system? (Include laundry system inspection information in this report.)i El Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No 4 1 i Water meter readings, if available (last 2 years usage (gpd)): Detail: unavailable Sump pump? I ❑ Yes ® No E; currently Last date of occupancy: , Date Commercial/Industrial OW Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) u Basis of design flow(seats/persons/sq.ft., etc.): 4i u 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-3113 ,I Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 1 t Commonwealth of Mass'abhusetts Title 5 Official,. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road units`6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville MA 02632 7/9114 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): I h ' r General Information Pumping Records: I Source of information:' i pumped every year Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: I' gallons How was quantity pumped determined? Reason for pumping: ` Type of System: ® Septic tahk,idistribution box, soil absorption system ❑ Single cesspool j ❑ Overflow cesspool I r ; ❑ 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 i. maintenance contract(to be obtained from system owner)and a copy of latest inspection, of the I/A system by system operator under contract 1, ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(desc<ibe): is l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Officia(7lnspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'r 817 Old Strawberry Hill Road units 6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection D. System Informatibn (cont.) 1' t Approximate age of all components, date installed (if known)and source of information: I, installed on unknown l ' Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition cif joints, venting, evidence of leakage, etc.): f• r i. Septic Tank (locate on site plan): 15" Depth below grade: !I feet Material of construction. t ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) i ' If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 gal. Sludge depth: 2 ' .x t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I: Commonwealth of Massachusetts l- Inspection Form Title 5 Official' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road un,ts_6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) i ; Distance from top of sludge fo bottom of outlet tee or baffle 29 Scum thickness I 4 Distance from top of scuml;to'top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 24 t How were dimensions det rljlined? measure Comments (on pumping relcQmmendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The liquid level was even with the outlet invert. There was no sign of leakage. Steel cover on the inlet t, h t . Grease Trap (locate on site plan): Depth below grade: feet l Material of construction: ❑ concrete ❑ m',etol ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: i Scum thickness ' Distance from top of scumi'td top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: p Date !Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 ' L i i Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�.,a, °y 817 Old Strawberry Hill Road units 6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is Centerville required for every MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection D. System Information, (cont.) 3 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): is if i. y ; l 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): N/a Dimensions: i Capacity: gallons U' Design Flow: gallons per day t. Alarm present: `' ❑ Yes ❑ No i' a : Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: c Date Y Comments (condition of alar•`il and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i' l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 i� i Commonwealth of Massachusetts H Title 5 OfficiAl inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A,•°`F 817 Old Strawberry Hill Road units 6,7 A&B-Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owners Name information is required for every Centerville MA 02632 7/9/14 page. CitylTown 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 n/a 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.): I t� i� Pump Chamber(locate on site plan): I; Pumps in working order: El Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition?of pump chamber, condition of pumps and appurtenances, etc.): f- r . If pumps or alarms are noit 9n working order, system is a conditional pass. f 'U t Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain'why: I . k 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i, °°�• a •'" 817 Old Strawberry Hill Road units 6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owners Name required for is every Centerville required for eve MA 02632 7/9/14 page. City/Town ' State Zip Code Date of Inspection D. System Informatiop (cont.) Type: ® leaching pits number: 1 - 1000 gal. ❑ leaching chambers number: ❑ leaching galleries number: I ❑ leaching tre.,nehes number, length: ❑ leaching fields number, dimensions: ❑ overflow ceiss.pool 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.): The pit had 3' on the bottom:;There was no sign of failure Steel cover was to grade z Cesspools (cesspool must.be pumped as part of inspection) (locate on site plan): Number and configuration,, 1 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 a� Commonwealth of Massachusetts 4 Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road units 6,7 A&B-Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owners Name information is required for every Centerville MA 02632 7/9/14 page. City/Town I': State Zip Code Date of Inspection D. System Informatip (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: 1, Dimensions Depth of solids I' Comments (note conditiorliof soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a 1 i, j. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 x Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° .,a,••` 817 Old Strawberry Hill Road un'Its 6,7 A&B-Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owners Name information is t required for every Centerville '; MA 02632 7/9/14 page. CitylTown 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 supplyj�.enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I s on T —� , A it ii a o 133] a DL 1 03 30 3 a� `(3 I 4, I' i l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts 7. Title 5 Official, Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 817 Old Strawberry Hill Road units 6,7 A&B -Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owners Name information is required for every Centerville MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: i ❑ Check Slope ® Surface water i ❑ Check cellar ❑ Shallow wells Estimated depth to,hi h. round water: 25' , feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, dale of,design plan reviewed: Date i ❑ Observed site?(abutting property/observation hole within 150 feet of SAS) f ® Checked with'local Board of Health - explain: Using topo and water contours maps ❑ Checked with.local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: i You must describe how you established the high ground water elevation: see above I r, i i� Before filing this Inspection Report, please see Report Completeness Checklist on next page. 4 t5ins•3/13 ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • 1•i f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r °. a •''t 817 Old Strawberry Hill Road 'unfits 6,7 A&B-Shallow Pond Condo's Property Address Cape Cod & Islands Property Management Owner Owner's Name information is required for every Centerville MA 02632 7/9/14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary::1, 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 Disuposal System either drawn on page 15 or attached in separate file i, I: t I� { ,I 1 r •I e 7 t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 v .. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIQN . S 6 $r 5l qI ilo 013-/6 a�3--0/3 !0 TITLE 5 a -dl��/c�/�I OFFICIAL INSPECTION FORM-NOT FOR VOL WARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL STEM FORM PART A CERTIFICATION Property Address: 817 Old StraWberry Hill Road nits 6&7 A&B Shallow Pond Condo's Centeryr 026 2 Owner's Name: Cape Cod&Islands Property Management Owner's Address: m � Date of Inspection: August 15, 2008 co w Name of Inspector: (Please Print) Janes M. Ford - rn Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infonnation 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 Needs7rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date:. August 19:2008 The system inspector shall sub a copy of this i spection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions it the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I 1��' Page 2 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Many eng ient Date of Inspection: August 15, 2008 Inspection Summary:, Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass".section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N;ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved.by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): . broken pipe(s).are replaced obstruction is removed distribution box is leveled or replaced ND explain: . The system required puinping more than 4 times a year due to.broken or obstructed pipe(s). The system will. pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cane Cod&Islands Property Management Date of Inspection: August 15, 2008 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detennine if the system is failing to protect public health;safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 (1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the. system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank.and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water'supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for colifonn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis trust be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Shallow Pond Condos 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cane Cod&Islands Property Mana eng Tent Date of Inspection: Auzust 15, 2008 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓. _ Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow _ ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet,of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen-and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. Lhave 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 deternine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with.a design flow of 10,000 god to 15,000 god. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped . Zone II of a public water.supply well If you have.answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cave Cod&Islands Property Management Date of Inspection: Aujzust 15, 2008 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 infortnation 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of.distance - is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Mana end Date of Inspection: August 15, 2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a Number of current residents: n/a Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): spd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,,if available: - Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION, Pumping Records Source of infonnation: Unknown Was system pumped as part of the inspection(yes or,no): No If yes,volume pumped:'_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system,(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be . obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of infonnation: unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Management Date of Inspection: August 15, 2008 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Connnents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ . (locate on site plan) Depth below grade: 15" Material of construction: ✓_ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) : Dimensions: 2006gal. . Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 10" Scum thickness: 2" Distance from top of scum_to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recoimnen,dations,inlet and outlet tee or baffle condition,.structural integrity; liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping; Coirunents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels, as related to outlet invert,evidence of leakage;etc.): 7 � Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strmvberry Hill Road Owner's Name: Cape Cod&Islands Property Management Date of Inspection: August 15. 2008. TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other.(explain): Dimensions: Capacity: gallons. Design Flow: gallons./day Alarm present(yes or no): Alann level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alann and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even . Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of. leakage into or out of box,etc.): The D-box was clean. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Many eng gent Date of Inspection: August 15, 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 - 6x8 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: Commments(note.condition of soil,signs of hydraulic failure, level of ponding;damp soil,condition of vegetation, etc.): The leach Pit had 2'of water on the bottom There did not appear to be any signs of failure The cover was to grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid'to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Cotmments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 f Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART G SYSTEM INFORMATION(continued) - Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry.Hill.Road Owner's Name: Cape Cod&Islands Property Management. Date of Inspection: Aufzust IS, 2008 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. un a- r 33 a a- 3C) 3 y - 3ac� Y3 : y 9L 33 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Shallow Pond Condo's 6&7A&B 817 Old Strawberry Hill Road Owner's Name: Cape Cod&Islands Property Management Date of Inspection: Aujzust I5 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic aiid water contours snaps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 18'+/-to groundwater at this site This report has been prepared only for the septic system and components described herein. This septic system has been inspected.and passed as of he date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection,"this report and/or any components of the septic system which have not been located and inspected. 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENT L I OCT 3 TOW N B LE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RECEIVED CERTIFICATION f allow Pond Condominiums NOV 1 2 Z002 Property Add ss. 81 Old Strawbe Hill Road Units 6&7A&B whn43- e MA 02632 TOWN OF BARNSTABLE Owner's Name Shallow Pond Condominiums HEALTb#DEPT• Owner's Address: Same Date of Inspection: September 14, 2002 Name of Inspector: (Please Print) James M. Ford MAP a Z�� Company Name: James M. Ford PARCEL w 3 0 6 Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 LOT Telephone Number:Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F her Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: September 18, 2002 The system inspector shall sub ' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority.. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, MA Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, AM Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville,AM Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or'cesspool _ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed_pipe(s). Number of times pumped— ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, AM Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes.of water been introduced to the system recently or as part of this inspection? n/a 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, AM Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a Number of current residents: n/a Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system.pumped as part of the inspection.(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of i l a OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, M4 Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 1 S" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions- 2000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present The liquid level was even with the outlet invert. There were no signs of failure. Recommend pumping annually for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, MA Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. There were no signs of solids. PUMP CHAMBER: None (locate on site plan) Pumps in.working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, AM Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 8'-1500 gal. 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.): The pit had approximately 5'of water on the bottom. There were no signs of failure. The bottom to grade was approximately 12'. The cover was to grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY:. None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): 9 r Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville,MA Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Ue% '1 . 3. �31- 33 r9a- 70 a ► 3 `/ Jai' a�° a3• �3 Aq- a-7 10 Page I l of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 817 Old Strawberry Hill Road, Units 6&7 A&B Centerville, AM Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: ✓ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high round water elevation: Y g g � The bottom of the leach pit to grade was approximately 121. Using a transit to determine elevations, the bottom of the leach pit was approximately 5'above the highest level in Shallow Pond in the back yard. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE LOCATION sk b ��•STt#*4h�`a� ������tlw�� �.t SEWAGE # VILLAGE J:N 13 ASSESSOR'S MAP.&LOT-IS—Res v`lb-10 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACULM: (type) at� (size) L NO.OF BEDROOMS iO BUILDER OR OWNE DATE: 751")JACOMPLIANCE DATE: '-.SepaiationxDistance Between the: Maximum Adjusted Groundwater Table \�! Feet Private Water Supply Well and Leaching Facility (If any wells exist f on site or within 200 feet of leaching facility) `� Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 3CJ feet of leaching facility) ` Feet Furnished byL.¢L �✓ 1 r y O y a a. arr ✓ ace � e e 4c � r Yr, COMMONWEALTH OF RL-%SSACHt;SETTS EXECUTIVE OFFICE OF EV IRONMENTAL AFFAIRS = F DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE R-INTER STREET. BOSTON NL-% 02108 (617) 292-5-500 TRUDY COXK Secre:ar. ARGEO PALL CELLUCCI DAVID B STKHS Governor Commiss:::,e: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A `, CERTIFICATION Property Address: � 'p LU&-t"t"(eg) 6g9ek'Vj �t% of Owner Et`� NW1� Address of Owner: \O Date of Inspection:. 5��`etj�+ / \ AY1..t'tSvC�L �=� ,-5 Name of Inspector:(Please Print)! [ cl cI C � r J cc_. //U 1 am a DEP approved system inspector pursuant to Section 15.340 of T-rde 5(310 CMR 15.0001 Company Name: �[C�tr r dog �c✓ .- r. �... tom_f u Mailing Address: ���., Telephone Number: . CERTIFICATION STATEMENT 1 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluatiod By the Local Approving.Authority _ F ils Inspector's Signartur `� Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS a•• _ l S t41CIT-_er>,ckc k S .��sT-�.Y� �e:��� ����� , ��.-� �.�-�• tom`�.J •�`' C.�s�,� revised 9/2/98 page Iof11 4i Prmied on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART A �—p CERTIFICATION (continued) 'roper-ty Address: 2�(ip Jwner: Date of Inspection: INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: G T-L 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. Indicate yes, no, or not determined(Y. N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection: or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced - _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continuedl Property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: have determined that one or more of the following failure conditions exist as described' 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determi what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overload or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surf ce waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert du o an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool is less than 6" below invert or ava' ble volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year N due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cessp I or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 10 `feet of a surface water supply or tributary to a surface water supply. a Any portion of a cesspool or privy is within Zone I of a public well. Any portion of a cesspool or privy is wit in 50 feet of a private water supply well. Any portion of a cesspool or privy is ss-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to eac of the following: The following criteria apply to large stems in addition to the criteria above: The system serves a facility with design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the enviro ment because one or more of the following conditions exist: Yes No the system is wit n 400 feet of a surface drinking water supply the system is w hin 200 feet of a tributary to a surface drinking water supply the system is ocated in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water suppl well) The owner or operator of any uch system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for rther information. i revised 9/2/98 Page 4of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) property Address: Owner: Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determin if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE H 310 CMR 15.303 11111b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH NO SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland r a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(A PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE P LIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has aseptic tank and soil abs ption 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 soil sorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and s ' absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and it absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution fro hat facility and the is of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used t determine distance (approximation not valid). 3) OTHER t revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION 'roperty Address: Sc� 71 Owner: J Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 'S3a g.p.d./bedroom. Number of bedrooms(design): U3 Number of bedrooms (actuall: Total DESIGN flow3�_ � Number of current residents: Garbage grinder(yes or no):k�� Laundry(separate system) ( s or no): If yes, separate inspection required Laundry system inspected ye or no) Seasonal use(yes or no):�-y N Water meter readings, if available (last two year's usage (gpd): Sump Pump(yes or no):-P— J Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gPd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informatSl�n System pumped as pan of inspection: (yes or no)-T-O If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other 1 APPROXIMATE AGE of all components, date installed(if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) � revised 9/2/98 Pagc6of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: T/q(0 V(j Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No -A Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and-the system has been-receiving normal flow rates- during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. xAs built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: NExisting information. For example, Plan at B.O.H. X _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) "C 115,302(3)(b)) The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance-of SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / QQ Pf�J (/�}�Q SYSTEM`INFORMATION (continued) %roperty Address: V((, c)(A s1�"`' " � ` Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site pl n) ti[ Depth below grader oncrete_metal_Fiberglass _Polyethylene_other(explain) Material of construction: Xc If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: tA.ti Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: �lJ Scum thickness: 1511 L4 Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: ►-U—C How dimensions were determined: MQta.i�tii 'omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outl invert, stru urel integrity evidence of leakage,etc.) 'T-Cvv� P W � GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene—other(explain) Dimensions- Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address:'6 c(, Owner: 1 Date of Inspection: TIGHT OR HOLDING TANK:�(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete_metal_Fiberglass _Polyethylene—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:",.04d v Comments: (note if vel and distributi n i eq 1, evidence of solids vidlepce of leakage into out of box, etc.) PUMP CHAMBERIA-4-) (locate on site plan) Pumps.in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Py�ss�rtl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C vo (�� SYSTEM INFORMATION (continued) '$roperty Address: �D old. Q'A' 1 1 )wner: ` f Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) y o L -yq flZ- ;Lq revised 9/2/98 Page 10of11 r I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -roperty Address: Owner: Date.of Inspection: SOIL ABSORPTION SYSTEM(SAS): S (locate on site plan, if possible; excav lion not required, location may be approximated by non-intrusive methods) If not located, explain: Type. leaching pits, number: leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition o eget ion, etc.) l N (Q N t t �� CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) 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.) revised 9/2/98 pagcoofll , r _ i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) roperty Address: ���p �� �Z V" Owner: Date of Inspection: NRCS Report name - — --- - — Soil Type_ -- - --- - - — Typical depth to groundwater_ __ _ USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep —_ SITE EXAM Slope Surface water • Check Cellar t-af ro Shallow wells m(( Estimated Depth to Groundwater±kj Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property. observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) V,S t ca�`C-.ck� revised 9/2/98 Page 11of11 w I 4 i Commonwealth of Massachusetts T W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `,M sV•, ---81 Old Strawberry Hill Road units 8a,8b,9a Ub Property Address Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 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. fl Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your (�I cursor-do not James Ford key the return Name of Inspector " Y x Company Name P.O. Box 49 Company Address R Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 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 Furth Evaluation by the Local Approving Authority 12 Insp tor's i /16/13 gnature Date The stem 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. l5ins•3/13 Title 5 Offdal Ins ctio Form:Subsurface Sewage Disposal System•Page 1 of 17 4 " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments •`'�• 816 Old Strawberry Hill Road -units 8a 8b,9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D 1 A) System Passes: ® I have not found any iniformation which indicates that any of the failure criteria described in 310 CMR 15.303 or�n 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 substantiilal 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): f . I :. I 11 7 ' t, t t5ins•3/13 ' Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 �i i j Commonwealth of Masgachusetts Title 5 official; Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M a 816 Old Strawberry Hill Road ,.units 8a,8b,9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name information is GI required for every Centerville _ MA 02632 12/16/2013 page. City/Town !! State Zip Code Date of Inspection B. Certification (cont j ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage' backup or break out or high static water level in the distribution box due to broken or obstructeq'pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(withi`approval of Board of Health): ❑ broken pipe(s)1ar.4 replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ii ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 1 I� 4 r l ' ❑ 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)L're"re laced I P ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): I i 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 priy,yis within 50 feet of a surface water I ❑ Cesspool or priyy js within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 r' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 f i f Commonwealth of Massachusetts Title 5 Offici�' I' inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary ,. y Assessments `'°• a,•y'•v 816 Old Strawberry Hill Road ,units 8a,8b,9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name n information is required for every Centerville MA 02632 12/16/2013 page. City/Town 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 ept,c tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a sepfiic 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 aosent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, prov,ded that no other failure criteria are triggered. A copy of the analysis must be attached to this form. i 3. Other: i . it D) System Failure Criteria Applicable to All Systems: t, You must indicate"Yes" or".No"to each of the following for all inspections: Yes No f ® Back6p 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 '2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ii V Commonwealth of Massachusetts v Title 5 Official.. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM a,•'•y 816 Old Strawberry Hill Road 1'units 8a,8b,9a Ub Property Address Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville I MA 02632 12/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont)i Yes No fl ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply, ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any O'ortipn of a cesspool or privy is within 50 feet of a private water supply well. El Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis. and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No t' . d; El Elthe system is within 400 feet of a surface drinking water supply t is ❑ ❑ 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 f�IVVPA)or a mapped Zone II of a public water supply well If you have answered "yes to.an y y 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 3,1 q'CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•3/13 i p Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official";Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 816 Old Strawberry Hill Road units 8a,8b,9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 page. City/Town State Zip Code Date of Inspection C.'Checklist Check if the following havd been done. You must indicate"yes"or"no"as to each of the following: .' Yes No ® ❑ Pump-nq 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 thb:; ystem received normal flows in the previous two week period? ❑ ® Have I`arge 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 avai4le,dote as N/A) ❑ ® Was tl'e facility or dwelling inspected for signs of sewage back up? ® ❑ Was the"site inspected for signs of break out? i, ® ❑ 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 sie: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)] 1r. D. System Informatio, .n,; t Residential Flow Conditions-. Number of bedrooms (design): n/a Number of bedrooms (actual): 7- per info DESIGN flow based on 31 QbMR 15.203(for example: 110 gpd x#of bedrooms): 770 1` !Sins•3/13 } Title 5 Official Inspection Form:Subsurface Sewage Disposal System•P+ 9 P Y age 6 of 17 r t. ; V Commonwealth of Massachusetts Title 5 Official9 Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M a •`'�r 816 Old Strawberry Hill Road units 8a,8b,9a &9b Property Address Shallow Pond Condominiums 4 Owner Owner's information is required for every Centerville I MA 02632 12/16/2013 page. City/Town " ?� State Zi Code� P Date of Inspection D. System Information Description: j r; ii `[ { '1 Number of current residents-,' n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? El Yes ® No Seasonal use? Pp r, ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unavailable Fi I i Sump pump? {f; ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow,Conditions: Type of Establishment: Design flow(based on 310>CM'R 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 dischargd to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 o. t' Commonwealth of Massachusetts v Title 5 Official., Inspection Form aX Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !I °,M®,•''V 816 Old Strawberry Hill Road units 8a,8b,9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name information is ° required for every Centerville MA 02632 12/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) l Last date of occupancy/usb: Date Other(describe below): ; r if Ir ' .'. General Information Pumping Records: Source of information: pumped yearly Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped',etermined? Reason for pumping: Type of System: } ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy a ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/�Iternative 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 t, ti� ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 17 4'• i Ii Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 816 Old Strawberry Hill Road units 8a,8b,9a &9b Property Address Shallow Pond Condominiums (; F) Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 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: installed - 1982 V '- ff Were sewage odors detected when arriving at the site? El Yes ® No Building Sewer(locate od ite plan): � 1 Depth below grade: �� + feet Material of construction: 0 ❑ cast iron ®40'IPVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of.joints, venting, evidence of leakage, etc.): � 1 ei Septic Tank(locate on sit0lan): Depth below grade: j 20" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) i 0 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No t, Dimensions: t, 1500 gals. Sludge depth: 2' 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ry �4 � I. f Commonwealth of Mas$ac6setts u Title 5 Official: Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 816 Old Strawberry Hill Road I units 8a,8b,9a &9b Property Address it Shallow Pond Condominiums Owner Owner's Name d ;i information is required for every Centerville k ,'t MA 02632 12/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Informatioh (cont.) Septic Tank (cont.) Distance from top,of sludge to bottom of outlet tee or baffle 29" E , Scum thickness Distance from top of scum'to top of outlet tee or baffle Fi I; 12" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured t, i Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): There were no signs of leakage.Steel cover was to grade. 1 Grease Trap(locate on site plan): r k r. Depth below grade: '. feet Material of construction: t' ❑ concrete ❑ meta( ❑fiberglass ❑ polyethylene ❑ other(explain): N/a Dimensions: r Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of sc6m to bottom of outlet tee or baffle Date of last pumping: t, Date t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 !i a Commonwealth of Massachusetts Title 5 Offici l; Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ° a- 816 Old Strawberry Hill Road ':units 8a,8b,9a &9b Property Address ; Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 page. City/Town 1. State Zip Code Date of Inspection D. System Informatio' (cont.) l Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): "a f Tight or Holding Tank(tank;",must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ me'tal ❑fiberglass ❑ polyethylene ❑ other(explain): N/a li ; Dimensions: Capacity: gallons Design Flow: t . .'.. gallons per day Alarm present: [' ❑ Yes t: El No Alarm level: Alarm in working order: ❑ Yes ❑ No t; A 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 k t t5ins•3/13 ° Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 t; Commonwealth of Massaphusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M A,• 816 Old Strawberry Hill Road units 8a,8b,9a &9b Property Addressi Shallow Pond Condominiums Owner Owner's Name information is t` required for every Centerville MA 02632 12/16/2013 page. City/Town r + State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if presentmust be opened)(locate on site plan): it Depth of liquid level above;oUtlet invert n/a ' 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.): i, d� ra - It Pump Chamber(locate on:asite plan): Pumps in working order: i _ ❑ Yes ❑ No' Alarms in working order: El Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/a c. r a •t: a, " If pumps or alarms are not in working order, system is a conditional pass. t !: Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official, inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M a,••'•y 816 Old Strawberry Hill Road=units 8a,8b,9a &9b Property Address r i Shallow Pond Condominiums R' Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 page. City/Town t, A. State Zip Code Date of Inspection D. System Information (cost.) Type: CI o ® leaching pits i' number: 1 -6'x6' 1000 gal. ❑ leaching chambers number: ❑ Leaching galleries number: ❑ leaching trene;hes number, length: is ❑ leaching fields` number, dimensions: ❑ overflow cesspool number: i, ❑ 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.): The pit had 6"of water on the bottom.There was no signs of failure The cover was to grade. il •n a' 1a Cesspools (cesspool must�6e,.pumped as part of inspection)(locate on site plan): t;l Number and configuration ` N/a Depth—top of liquid to inlet invert Depth of solids layer �! I Depth of scum layer Dimensions of cesspool Materials of construction r• : Indication of groundwater inflow ❑ Yes ❑ No (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of MasSn, husetts Title 5 Official'! Inspection p Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M a 816 Old Strawberry Hill Road-',,uhits 8a 8b 9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name a required for is every Centerville required for eve MA 02632 12/16/2013 page. City/Town ,5 State Zip Code Date of Inspection D. System Information (cont.) is I Comments (note condition'of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): +' I. Privy(locate on site plan)::' Materials of construction: r : Dimensions Depth of solids :? i Comments'(note condition;of,soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a it .1 I{ tt. ' d t. m 2 II^fi !I v t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 . a Commonwealth of Massachusetts 91. Title 5 Officiate Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM a •'�• 816 Old Strawberry Hill Road-units 8a,8b,9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Sketch Of Sewage Disposal.System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: t ® hand-sketch in the area below ❑ drawing attached separately �3Ack ' A ! ` o D.- V f t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ' � Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °r 816 Old Strawberry Hill Road =units 8a,8b,9a &9b Property Address Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: is ❑ Check Slope I. ® Surface water �l ❑ Check cellar =: ❑ Shallow wells i; 15+ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date,'of design plan reviewed: Date ❑ Observed site wutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Using topo and"water contours maps ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USG:S database -explain: You must describe how you established the high ground water elevation: see above I. It Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 li9 ., Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M a,•''y 816 Old Strawberry Hill Road -units 8a,8b,9a &9b Property Address t R Shallow Pond Condominiums Owner Owner's Name information is required for every Centerville MA 02632 12/16/2013 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B;C, D, or E checked ® Inspection Summary 1(System Failure Criteria Applicable to All Systems)completed ® System Information—Es.tirriated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file s t ; Iv . 3. a i ii j pni } i (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f „t. t ` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMERR” gFA jRSjNB -E DEPARTMENT OF ENVIRONMENTA '. P'YJRTE3cT';ON. Q 1 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Shallow Pond Condominiums Property Address:4?/ 9:D7 0Qld Strawberry Hill Road, Units 8A. 8B&9A i�an 'Ce-nt¢rvelle. MA 02632 Owner's Name: 0 Cade Cod&Islands Property Management �, 1 Owner's Address: c%Kerry McNamara 381 Old Falmouth Roadd,Marstons Mills. MA 02648 Date of Inspection: June 7, 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Fu r Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: June 12, 2005 The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 8A&B, 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval.of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 8A&B, 9A Centerville, MA Owner: Cane Cod&Islands Property Management Date of Inspection: June 7, 2005 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 CAM 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 I Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 8A&B. 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 816 Old Strawberry Hill Road, Units 8A&B. 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 816 Old Strawberry Hill Road. Units 8A&B, 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a. Number of bedrooms(actual): 7(per available info.) DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 770 Number of current residents: Unavailable Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed approximately in 1982-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 i Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 8AcP&B 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage Recommend pumping. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: , Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road, Units 8A&B. 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) 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.): PUMP CHAMBER: None (locate on site plan) . Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Road Units 8A&B 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 ag 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.): The leach pit had i'ofliguid on the bottom The bottom to grade was 11' The steel cover was to grade There did not appear to be any signs of failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 8A&B. 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. (�AL� 8B $A ' R fib 3y a 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 816 Old Strawberry Hill Road, Units 8A&B, 9A Centerville, MA Owner: Cape Cod&Islands Property Management Date of Inspection: June 7. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ✓ Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours traps, the maps were showing approximately 15'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 S i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION yM � R d H yC � v0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION $/7 Property Address:,�WOLD STRAWBERRY HILL RD UNIT 8A,811 9A E,MA 02632 'aS 3.-(�(3 Owner's Name: KERRY MCNAMARA Owner's Address: BOX 1144 OSTERVILLE MA.02655 (V Date of Inspection: 5/29/01 Name of Inspector: (please print) JOHN GRACI RECEIVED Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 JUN 1 2001 Telephone Number: 508-564-6813 FAX 508-564-7270 TOWN OF BARNSTABLE CERTIFICATION STATEMENT HEALTH DEPT. 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: X Passes _ Conditionally Passes _ Needs Furth e-:Evaluation by the Local Approving Authority Fails i j Inspector's Signature: Date: 5/29/01 The system inspector shall submit 4py of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ". THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. T;0, 5 rt),,-n n 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,813 9A CENTERVILLE, MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as'described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a 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. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,8B 9A CENTERVILLE, MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a z Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,8B 9A CENTERVILLE, MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system rails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,813 9A CENTERVILLE, MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period'? X Have large volumes of water been introduced to the system recently or as part of this inspection '? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up`? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS,located on site'? X _ 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 ? X _ 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: • r Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] ' S Page 6ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,8B 9A CENTERVILLE,MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 7 Number of bedrooms(actual): 7 DESIGN flow based on 310 CMR 15.203 (for example: t 10 gpd x#of bedrooms): 770 Number of current residents: 5 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy of the DEP approval Other(describe): n/a r Approximate age of all components,date installed(if known)and source of information: 1982 Were sewage odors detected when arriving at the site(yes or no): NO r, Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,8B 9A CENTERVILLE, MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5' 6" W 5' 8"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED 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 SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM '_NSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,811 9A CENTERVILLE,MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER:_(locate on site plan) .Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): n/a R Page-9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,8B 9A CENTERVILLE,MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD Y OF WATER IN IT AT THE TIME OF THE INSPECTION.THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) ' Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,8B 9A CENTERVILLE,MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �o l✓K�e Pagel 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 8A,8B 9A CENTERVILLE,MA 02632 Owner: KERRY MCNAMARA Date of Inspection: 5/29/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE.OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Sha ow Pond Condominiums Property Address: �l, 816 ld Strawberry Hill Road Units 10A&B ✓ annis MA 02601 Owner's Name: Shallow Pond Condo Association JG G Owner's Address: c%Cape Cod'&Islands PropertyPzmt. P.O. Box 1144, Osterville, MA 02655 Date of Inspection: May 25, 2006' Name of Inspector: (Please Print) James M. Ford Company Name: James M..Ford Mailing Address: P.O.Box 49 '� } Osterville,MA 02655-0049 Telephone Number: (508)862-9400 == CERTIFICATION STATEMENT ;, ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported_ below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my F, 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 N Further Evaluation by the Local Approving Authority F ils Inspector's Signature: Date: May 30, 2006 The system inspector shall sub a copy of this 'nspection 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. a Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of.use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I r Y ' Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Rd.. Units 10 A&B Hyannis, MA Owner: Shallow Pond Condo Association Date of Inspection: May 25, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructedpipe(s). The s stem will Y 9 P P g Y Y pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Rd., Units 10.A&B Hyannis. MA Owner: Shallow Pond Condo Association Date of Inspection: Re 25, 2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance. **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 +1 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 816 Old Strawberry Hill Rd.. Units 10 A&B Hyannis, MA Owner: Shallow Pond Condo Association Date of Inspection: May 25, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water- supply.well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 god to 15,000 god. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 816 Old Strawberry Hill Rd., Units 10 A&B Hyannis, MA Owner: Shallow Pond Condo Association Date of Inspection: May 25, 2006 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)). 5 Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 816 Old Strawberry Hill Rd., Units 10 A&B Hyannis. MA Owner: Shallow Pond Condo Association Date of Inspection: May 25, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n1a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: n1a Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occu iep d COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped yearly for maintenance-per management Was system pumped as part of the inspection(yes or no):. No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes.or no) (if yes,attach previous inspection records,if an Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Approximately 1982 Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Rd., Units 10 A&B Hyannis. MA Owner: Shallow Pond Condo Association Date of Inspection: May 25, 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1560 gal. Sludge depth: 2" Distance from top of sludge to,bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs ofleakage Steel cover was to grade. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 f Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Rd Units 10 A&B Hyannis. MA Owner: Shallow Pond Condo Association Date of Inspection: Ma v 25, 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: P-allons Design Flow: eallons/day, Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: -- (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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 appears to be under an asvhalt walkway PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Rd., Units 10 A&B Hyannis. MA Owner: Shallow Pond Condo Association Date of Inspection: Me 25. 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leach nit had Y ofliauid on the bottom. The scum line was approximately at the same level There did not appear to be any signs offailure. Steel cover was to grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Z.11 Page 10 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Rd Units 10 A&B Hyannis, MA Owner: Shallow Pond Condo Association Date of Inspection: May 25, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. «k °► A C] ld O p e 6 a ,o a 3� ay 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 Old Strawberry Hill Rd.. Units 10 A&B Hyannis, MA Owner: Shallow Pond Condo Association Date of Inspection: May 25, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of.design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water.elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 20'+1-to ground water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed, written or implied, relating to the septic system,the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Address of Owner: 816 OLD STRAWBERRY HILL RD UNIT 10 B HYANNIS,MA 0 Date of Inspection: 6/8/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 508-564-6813 FAX 608-664-7270 CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true- tk atefi and complete as of the time of Inspection.The inspection was performed based on my training and experience in the proper f apd.t maintenance of on-site sewage disposal systems.The system: b X Passes a {, _ Conditionally Passes , _ Needs Further Eval tion By the Local Approving Authority ! ✓�/1/ f `io a _ Fails p 20 h�T�AN Op 4' l'tiF r Inspector's Signature: Date:619100. `►� The System Inspector shall submit opy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of 1't1 completing this inspection.If the sys m 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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The Inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its components useful life" THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM NOW AND EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A$B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 6/8/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nta The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)Indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial Infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. p($ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced p/g The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 6/8/00 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance Wa(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A$ B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 618/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or Privy is within 50 feet of a private water supply well, - X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further Information. r. revised 9/2198 Page 4 of 11 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner: SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 6/8/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping Information was provided by the owner,occupant,or Board of Health. X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. X - As built plans have been obtained and examined.Note if they are not available with N/A. X - The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or Industrial waste flow. X _ The site was inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable)1 5.302(3)(b)] X - The facility owner(and occupants,if different from owner)were provided with Information on the proper maintenance of SubSurface Disposal Systems. rr revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 6/8/00 FLOW CONDITIONS RFSInENT1AL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual): Total DESIGN flow: 440 gpd Number of current residents:4 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM MERCiAL/iNDUSTRIAL Type.of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of D E P Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1982 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 6/8/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 6" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 1" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1260G L 10'H 6'7"W 6'" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 6/8/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) , Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution Is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 618/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6 leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,.etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 8"OF LEACHING LEFT AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions:,n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 .. y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: 618/00 SKETCH OF SEWAGE DISPOSAL SYSTEM:. Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) ell i A � 3g � � revised 9/2/98 Page 10 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 816 OLD STRAWBERRY HILL RD UNIT 10 A& B HYANNIS, MA 02601 Name of Owner SHALLOW POND CONDOMINIUMS PROPERTY MANAGER Date of Inspection: . 618100 NRCS Report name: nla Soil Type: nla Typical depth to groundwater: nla USGS Date website visited: nla Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet n/a Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12 FEET MAP _ LOT PAR ,yam Uq�\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary DAVID B. STRUHS ARGEO PAUL CELLUCCI Commissioner Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM /VD Co v PART A & ERTIFICATION J N,LL C-41 WV'1yg /4NAJ SI4691117 I Property Address: g`f!a S�QAw u l�R Address Owneff Owner Date of Inspection: /2 RUSE HIVY Name of inspector:(Please Print) Dion C.Dugan RR / (4 g�s� 1 am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CM115. Od) ' Company Name: Dion C.Dugan Marring Address: 1543 Main SL Telephone Number: 8rWrater,Ma.02831 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal-system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site ewage disposal systems. The system: 7Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fail Date: Inspector's Signature: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty 1301 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS 8/ m � o ApR 9 1999 !N, revised 9/2/98 Pagel of II 40, Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:C� ,5-Am ao"/ Po 'n Como gl. d L b •S/-R,}w C),,-R8 y Hl u- Rb 6'6N-&RV/ Owner: AIVAI 6i/491114n/ Date of Inspection: 3/�2 INSPECTION SUMMARY: Check A, B, C. o/ A A. STEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes,no, or not determined(Y,N, or NO). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 61-4 sH PART A O��O�tI p0��.�/��ERTIFlCATION (contirwed) Property Address: -o pG� 01-115 sfR�ru13 R y Nla RD 1�1�fI F vl Owner: ANAI .S'f1EEyi91y Date of Inspection: 3%24/7 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 the public health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A A 61441 W Pa�D Cobb CERTIFICATION(continued) OLD 6tRAw161r-49y Owner:oper Address: AN AV' -S 7J45f7 d/�I Date of Inspection: �/ D. SYSTEM FAILS: •[ 7 You must indicate either "Yes" or "No" to each of the following. I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes N - Backup of sewage into facility,or system component-due to an overloaded or-clogged SA 9 or-ces spool. ' _ 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria,volatile organic-compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: N/A The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Cd/U b0) PART p r� CHECKLIST Property Address: 716 A0LD s/_ A UJJ EAR� Nl LC -b Owner: AAW SN61-41,*IV Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Ye No Pumping information was provided by the owner,occupant, or Board of Health. None of the system components have been pumpediforatleast two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid, depth of sludge,depth of scum. , The size and location of the Soil Absorption System on-the site has been determined based on: J _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria.related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) The facility owner(and occupants,if differerit from owner) were provided with information.on the.proper maintenance-of Subsurface Disposal Systems. revised 9/2/98 Page 5of11 II//,�,, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM C`,,,, .7t�/�4L[/�L� &N,6 C0A,),6 G,) PART C /Q S,YSSTEM INFORMATION Property Address: G 0L D s/R� ,`y ji/� Owner: /-CNN 51-16F4 I Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:_14033 g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): IV 01VI T " .2 6�6MOOMS; Z50::f# Total DESIGN flow W33 Number of current residents: 0 /-A/ UNrT /I -A Garbage grinder(yes or no):_0 Laundry(separate system) (yes or no):-040; If yes, separate inspection required Laundry system inspected (yes or no) NO 11VF0 OAt TILE Seasonal use(yes or no):90 1997 Water meter readings,if available(last two year's usage(gpd): +000 gels. 1998 ,000 gals. , 4RRNSt�M1P,I� Sump Pump(yes or no):-N-0 Last date of occupancy: .2 Oita 7S 6CCVPiEa, (/N/rs COMMERCIALANDUSTRIAL: - I Type of establishment: F Design flow: qpd ( Based on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: .2.cnv 45, -3L.2 &A/i✓!`IAt LE System pumped as part of inspection: (yes or no) If yes, volume pumped:2JS)_o'� gallons Reason for pumping: g!jj41A1-W".4— ITYPOF 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank = Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed{if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)-A10 revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C 1- 4 Poti N4i6 SYSTEM INFORMATION(continued) property Address: gI G Owner: AIAOLp v /V S/l,-4�111'/V Date of Inspection: BUILDING SEWER: T (Locate on site plan) a Depth below grader Material of construction:_cast iron_40 PVC_other(explain) h Distance from private water supply well or suction line Diameter q Comments: (coition of joints,venting, evidence of leakage,-etc.) D SEPTIC TANK: (locate on site plan) /concrete Depth below grade:Material of construction: _metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age. Is.age.confirmed by Certificate of Compliance_(Yes/No) Dimensions: 26 iW 6AL _ Sludge depth: IT#i Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: S" A Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: by tape and rod comments: (recommendation for pumping, condition of inlet and outlet tees ovbaffles, depth of liquid level in relation to outlet invert, structural*trite rity, evidence of leakage,etc.) A Lr Of Tor * Recommend: Maintenance pumping every 3 - 5 yrs. GREASE TRAP: (locate on site PIAP Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) �I revised 9/2/98 Page 7oftt . Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �? SYSTEM INFORMATION(conntinued) Property Address: o I�d OL,D S /Q(,✓�E/ere`! K� (;4; N&!�V jLL Owner: hA11U Sil9,6/7/1N Date of Inspection: TIGHT OR HOLDING TANK (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX- (locate on site plan) u Depth of liquid level above outlet invert:_ Zomments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) - S s a PUMP CHAMBER: /A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C C�/V /TJ SYSTEM INFORMATION(continued) roperty Address: Owner: ANN 511Z II,,�N Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: � leaching pits, number: ONE 2 k /'�4 leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note conditio of soil,signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) opir CESSPOOLS: y1 (locate on site pl Y-T Number and configuration: Depth-top of liquid to inlet invert: lepth of solids layer: -)epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) * Recommend: Maintenance pumping every 3 - 5 yrs. PRIVY: N/A (locate.on site plan) 6 Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 6-W �L _ PART C / /'� SYSTEM INFORMATION(continued) roperty Address: $/6 -SfR�l�v/3�'ip / f-l/Le R,6i11�.�,PG'1LC� Owner: AN N SN6--r#.4A1 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) E C A - C - 366 A A 4 C — 15 v�lrs �o 13 a _ 33 4Nb ' _ 3.21 UN IDS llf A /Mb !I. 3 PAR� � revised 9/2/98 Page 10oth SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM &A1/t �1 PART p �J SYSTEM INFORMATION(continued) 'roperty Address: O/4 '0 �R W� �/ /71 /�� iV Fes' Owner: 41 N SN.FSHAAJ Date of Inspection: 3126 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please ndiCate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed-Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 13 �Ei:k 1,�sr o1v 3 f.2#12-1 /3 ` ��� No y revised 9/2/98 Page 11of11 TROY WILLIAMS SEPTIC INSPECTIONS 1AM), 4 4- Certified by MA Department of Environmental Protection `` ! (508) 585-1300 19 Hummel Drive South Dennis, MA 02660 ' . Commonwealth of Massachusetts O D V Executive Office of Environmental Affairs Department of Environmental Protection William F.Wald ao•smor Trudy Coxe Argeo Paul CNlucd LL KK David B,Stru sh ConwNsatorw SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I PART A `S`�a�/°�^' ne ""`�•S CERTIFICATION �I Old S!+-wwsrvr7 lfj// /1d, (tth.f : II A ) Property Address: Um;}3 Il if el /a.4"/o d Date of Inspection: L/ �9 / 7 1 / Address of Owner. J�O n v''/' 4 (If different) Name of Impector.�cs,9 w; I l;q H,s a 5 v w,w,. k (�,�. Company Name,Address ind Telephone Number. IS, +Sz, CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature , Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B. C,or D: A] SYSTEM PASSES: PASSES: V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: N119 One or more system components need to be replaced or repaired. The m,u com _ cysts upon pletion of the replacement or repair,passes Win• Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) l r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: `� S f�-" w •y iy7i era Owner. A ✓� 4 y Date of Inspection: y/y 1 S 7 B1 SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstucted pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A1119 Conditions exist which require furthef'evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environinent. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM I9 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 vggetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the 'presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address Owner. Date of Inspection: DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 142 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes pumped Any portion of the Soil Absgrption System, cesspool or privy is below the high groundwater elevation. — Any portion of a 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 I of a public well. s 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: L OI�l s�4-�,r �� /V.i Owner. Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. /As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow VThe site was inspected for signs of breakout. ZAll system components, excluding the Soil Absorption System, have been located on the site. ✓The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: b/L d/J Owner. /1,,J-P 1, 7 Date of Inspection: y// FLOW CONDITIONS RESIDENTIAL• Design flow: 8 YO gallon Number of bedrooms:— R'o ✓ .4-. Number of current residents: 4/ Garbage grinder(yes or no):i1/o Laundry connected to system(yes or no):—�jf5 Seasonal use(yes or no): /1/0 I s Water meter readings, if available: lN.1 AJ p (( Last date of occupancy: ✓w COMMERCIAL/INDUSTRIAL: AVM Type of establishment: Design floc':_gallon/day Grease trap present: (yes or no)_ Industrial Waste Holding T. nk_present: (yes or no) Non-sanitary wgste distborged to the Title 5 system: (yes or no) ' Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL.INFORMATION PUMPING RECORDS and source of information: 1.-aS ✓w, . �-v� 4 rok �y/ .�r.ar �t� 4. ty >� System pumped as part of inspection. (yes or no) /11O If yes, volume pumped: -------gallons Reason for pumping-- TYPE OF SYSTEM �L Septic tank/distribution box/soil absorption system Singie cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: �— Sewage odors detected when arriving at the site: (yes or no) /01 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontlnued) Property Address: 6 S f>-R.../(�t rr y 1:15 11 Owner. /Ll Date of Inspeotton: L//9/� 7 SEPTIC TANK: (locate on site plan) Depth below grade: I Y �1�5 ris+— Material of construction: /concrete_metal_FRP—other(explain) Dimensions: p �_% Distance from top of sludge to bottom of outlet tee or baffler S' Scum thickness: 'A'.h /4-11 Distance from top of scum to top of outlet tee or baffle: -N/0 /u- Distance from bottom of scum to bottom of outlet tee or baffle: H- %«. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) A16 /( � o� �o` p u .� t G'-'S *--� G.h cJ�-. .L. t LI f l.•./cw S K. S t ti o c aJ �t. f— • r GREASE TRAP:!/.q (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. M rho 1. y Date of Inspection: L//9 TIGHT OR HOLDING TANK (locate on site plan) Depth below grade: Material of construction:_ooncrete_metal_FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: V (locate on site plan) l Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)- 0-/3,,k� W w s a b-S c.s/r trl 4. J2w.i ` ul C, w o/ C 4. w u ..e. ; S [ F v c✓ 0[ti. h ✓o J 3s l-. -' C,e X �- w '/'I ✓f u -V Q 4r1 CL1M (w S a ` d d — 1 ,c w cc PUMP CHAMBER: ltl(4 (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Owner. Date of Inspection: �y/y SOIL ABSORPTION SYSTEM(SAS). V/ (locate as site pLut, if Possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: leaching pits, number:G�. /X� c,a /�:/- G✓ / / S�°`' leaching chambers,number._ leaching galleries, number. leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of so'il, s�'gna of hydraulic failure, level of ponding, condition of vegetation,etc.) o!'1 y � �"a-.� !', c. -� '. /,,i-.� r.� � spa � �� r+-•l s i ti I c u c / ��. b� t�. .. wo11-� J CESSPOOLS:L 119 t A �.�• (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:-Z—vl/^J (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. v Date of Inspection: i SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' j" � I 2° 0_t),,x r IS-ooy4�� DEPTH TO GROUNDWATER Depth to groundwater: feet adjusted high groundwater level method of determination or approximation: rk o W <r i -�—L. �— 4 L 4�7 l f oA c.J cl 9 Health Complaints 28-Jun-05 Time: 8:40:00 AM Date: 5/1/617 Complaint Number: 18190 Referred To: DONALD DESMARAIS Taken By: JUDITH FLYNN Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Number:_84-6" 111reet: OLD STRAWBERRY HILL R Village: QF.NTfRV1tLE YVI"'"'�'Rssessors Map_Parcel: Complaint Description: SEPTIC ODOR FROM RAINBOW ACROSS STREET VERY STRONG Actions Taken/Results: DD WENT AND COULD NOT FIND ANY ODORS. THE PROPERTY IN UNDER ORDERS TO REPLACE SYSTEM. THE MOTEL IS ALSO (SUPPOSSEDLY UNDER A P AND S AGREEMENT. Investigation Date: 6/20/2005 Investigation Time: 1:30:00 PM 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 817 OLD STRAWBERRY HILL RD CENTERVILLE, MA UNIT 5A 02632 M252 P013 Name of Owner WILLIAM JEFFERIES Date of Inspection: 9/13100 1, SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) T i i T ' S TF . f revised 9/2/98 Paoe 10 of 11 Page 10 of 11 l' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I PART C SYSTEM INFORMATION (continued) Property Address: 817 Old Strawberry Hill.Road, Units 6&7 A&B_ Centerville, MA Owner: Shallow Pond Condominiums Date of Inspection: September 14, 2002 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i O Aa- a i y A3• P'3• �13 Aii- a-7 4 s OV- 33 i I: 9 I 1 . 1 i 1 1 I 10 No. _vim 1� 7 w ' L ° 1 ✓c ,' —� � l( eQ f THE COMMONWEALTH OP MA ACHUSETTS Entered in computer: 'Y Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZfppYication for Migool *pOtetn Cow5truction permit Application for a Permit to Construct O Repair( )Upgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No. X l ®�® S't�A W �� fl r Owner's Name,Address and Tel.No.010V 1,6 QW t 1 ssessor s ap arcepAkor s m In aller's Name,Address,and Tel.No. Designer's Name,Address and Tel.N Ap poW MAO o. yMi 44A o23 ys ®v s r ✓-b Type of Building: Dwelling No.of Bedrooms Lot Sizsq.ft. Garbage Grinder( ►V Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow b O0 gallons per day. Calculated daily flow gallons. Plan Date (. Number of sheets_ Revision Date Title ffiks sbei'rG Sys-r&A th WE5 S - s A Size of Septic Tank ? OO r,?A L Type of S.A.S. Cf l N Description of Soil `t' AM L Q S mature of Repairs or Alterations(Answ r when applicable) r. �k 1'�T 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 En mental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d ealth. Signed Date Application Approved by a Date Application Disapproved for the following reaso Permit No. Muaf 347 Date Issued f L ----------- % --------------------------- .i. ' Y..--1 � 4 ..r.' 9F. ♦'Y..N - 1 No. jr ��` '�, e, Fee `.....► i -'THE-,CO MMONWEALTH=O M ► ACHUSETTS Entered in computer: Yes PUBLIC HEAL�AD�I-914*-TOWN OF?BARNSTABLE, MASSACHUSETTS , ricatioi fobtgogarpgtiu `Congtruction Permit a k Application fo14, r a Permit to Construct( Repair,( Upgrade( ` )Abandon( ) O Complete System Lndividual Components Location Address or Lot No. g� DL p StR At^! T LOwner's Name,Address and Tel.No.001, LGow N� 11A -Q Aw s A+� R c/o cP�� +��P�s _ � MZNA0 v4ssessor ap arc l „3 n Gr 3_ ON O 6r r�D (�� s g y _D N 1 ��i7C In$ ler's Name,Ad�ss,and Tel.No. Designer's4, e Address and Tel.N jSn E fj w � LU_J S 7_' 94^- N1 `V�-S t(�`Vn/A' �SG� GJ v�_�. �' ZAJ/3 u.s-r/-y Iz-5 511 = 77 t -9 3 7 1 yn t 14A 02,3�0 Type of Building: Dwelling No.of Bedrooms Lot SizeC7Ssq. ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) s Other Fixtures r' ? Design Flow 7%0 gallons per day. Cal ulated daily flow V' _ gallons. Plan Date 11 SEID 20j(. Number of sh ets Revision Date Sr` Title s� S S S i�G nio t G k S LL W S YAt Size of Septic Tank I)(- COAL Type of S.A.S. 1 d< Description'of Soil NOMY n� r"f r ICJ . AAP l 1 P 94r, 1 d NuAeof Re airs o Alterations(Answerwhen applicable) � 6510. EA iR Sr 0 cG T6 .S A-3 0 6 5 G -- f Date last inspected:_u xl� ' 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 Etal Code and not to place the system in operation until a Certifi- cate of Compliance has'beeti issued by this Board'' ealth.nva o�n f Signed .�'` --� - t... $ ` Date Application Approved by t. � t. i a nt �€ Date c _A Application Disapproved for the following reasori' ; i Permit No. M ' ,t' Date Issued J d'r 1 7 9 - THE COMMONWEALTH OF MASSACHUSETTS 11),S Ai d-k K BARNSTABLE, MASSACHUSETTS } 2 C I A Certificate of (Compliance 1 THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by (� to t` Ql'J S t at -7 A-ItA� ir cam/-7 G L 6 f6�Wl rl--t-L- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. b fa" w 7 dated rl k j l Installer f Designer The issuance of this permit shallnot be construed as a guarantee that the ystem u c 'o as designed. Date c�- i 5 116 Inspector t Y No. �l)I —Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal *pmem Construction permit Permission is hereby ranted to Construct s. )Re�Pair( )Upgrade( ) Abandon( ) P System located at n O( ,' `�tA �'r'l. 6 �k itIi .tt) G, et !rk And as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to '-�,domply with.Title 5 and the following local provisions or special conditions. 1'tovided:Construction must be completed within three years of the date of this permit. , Date: �� ��aC' Approved by L )-,A (� Town of Barnstable ' �. Regulatory Services Richard V. Scali,Interim Director • sntuvsrneu. • Public Health Division o Thomas McKean,Director u 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Ibesiener Certification Form Date: ii 2% Sewage Permit# Assessor'sMap\Parcel2a2tm--Co Designer: ksczr-ME�N .Installer: ti Adfl s _tI 1�' —Pop Address: j$ SPY yp " G�6�8 On l0 5 was issued a permit to install a (datL; (installer septic system at �att based on a design drawn by (address) dated V614 I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed'with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. `I certify that the systetft Tefere cep above was constructed in compliance with the terms: of the IAA pproval letters(if applicable) of MgsS c - - q o EDWARD L. (Installer's Signature) PESCE CIVIL in No.32001 9 O Q /STEP ( e ign is"Si ature) ,)' '(Affix ` Here) . ar PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc TP o Q EL=198.5 ING • / NIT 1 G i STY INC FF199'2 ,, DNIT ZA WOOD P�� DECK ®.. 2 SN e R=200.5 pLING 19 2 W T FF. S woo. N s DEC e \ S R=201.6' =` 73' New Chambers (6) ' e ti9� 2 \� ~i Dr.... .. ' Riser & Cover rn FF' TO Grade (typ) WOOD Top EI=200 4' -DECK •� �� O Elec y �P box 1 Tel Tran Inv-199.5' ry�DyD=195.9 O - � T a � M Inv=199.6' BIT R= 0� Inv--198.6' PARKING c S S' v SInv=200.0' AREA c'RW967 tOP 2"=193.6' x ump=1996 Tcp EI=1 0, Inv-1936' Pipe \ c I Septic i i Inv-199.5' �— Inv=199.6' 19°� an m i_ � v-199.6 2"PVC Riser & Cover �G' Force Main a To Grade to J �\Lawn a As-Built Sketch Of New Septic System For Units 4 A+B, & 5 A+B At 817 Old Strawberry Hill Rd Hyannis, Mass �1 G Shallow Pond' �� ' �, 0 NOP Condominiums CapeSury 23 West Bay Rd, Suite G QsterVilla MA, 02655 ' (508)420-3994 (508)420-3995 fox copesurvftopecod.net O 151DEC116 C158_2g2 1"=20' 05 10 15 20 30 40 FEET 1 PESCE,ENGINEERING & ASSOCIATES, INC. 451 Raymond Road Plymouth, MA .02360 Phone 508-743-9206 epesce(c�comcast.net September 28, 2016 Mr. Thomas McKean. R.S., C.H.O. Director, Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 Subject: Shallow Pond Condominiums, Septic System Repair for.Units 4A, 413 & 5A, 5B .817 Old Strawberry Hill Road, Centerville, MA Dear Mr. McKean. As we discussed yesterday, I am submitting this letter in order to document for the project record, the decision regarding the approval of the septic design plan for the repair of the existing failed septic system, which serves Units 4A, 4B, 5A & 5B, at the subject Shallow Pond Condominiums. A septic design plan for the repair of the above mentioned failed septic system was prepared by Pesce Engineering &Associates, Inc., and was submitted to the Health Division for review and approval on September 13, 2016. After performing changes and edits to the design plan due to siting and depth considerations, and from comments received from the Health Division Staff (Ms. Marybeth McKenzie), a final version was submitted to staff for approval on Monday, September 26, 2016. It was agreed to conduct a final review of this design plan with Ms. McKenzie the next morning on September 27, 2016. During this final review with Ms, McKenzie, the question arose as to whether this project was subject to the local by-law for residential condominiums with a failed septic system, and a total wastewater design flow of 1,650 gallons per day or more, which may require the use of innovative/alternative technology for the reduction of nitrogen in the wastewater. This local bylaw (Chapter 360, Article XIII, Section 360-36 thru 39, of the Barnstable Town Code) is sometimes referred to as the 1,650 Rule." Since the total wastewater design flow involved for this repair was only 880 gallons per day, I felt that the 1,650 Rule should not apply in this case. It was collectively determined that the applicability of the 1,650 Rule for this project would best be decided by discussion with the Board of Health (BOH), and that this might be accomplished at the BOH meeting that afternoon. However, you expressed concern over whether having this discussion over the applicability of the 1,650 Rule at that afternoon's BOH meeting would be a technical violation of the State's Open Meeting Law, since the usual public notice was not possible. In order to determine if discussion of this matter with the Board that afternoon would be an open meeting violation, you contacted the Town Attorney's office for their advice on the matter. It was discussed that the project was an urgent matter that could be classified as an "emergency" for consideration by the Board, due to the septic system's failure (and associated pumping). I further stated that if this matter could not be discussed by the BOH that afternoon, and had to be postponed to the next meeting on October 25, 2016, that this would represent and financial hardship to the residents, due to the pending sale of 3 of the 4 units involved on September 30, 2016. ' Mr. Thomas McKean. R.S., C.H.O. Shallow Pond Condominiums September 28, 2016 Paget After explaining the situation over the phone, and then following up this phone call with a joint meeting with you and I, and Town Attorney, David Houghton, Mr, Houghton felt it was a "borderline emergency case in his opinion, and that this decision was best left to the BOH Chairman to decide. After leaving the Town Attorney's office, you immediately called the BOH Chairman, Dr. Paul Canniff, to discuss this situation, and explain the details. After review of this situation with Dr, Canniff, he allowed that due to the urgency of the matter (with a failed septic system), the 1,650 Rule would not be required to be implemented for this repair, and that the project may proceed. However, during your discussions with Dr. Canniff, it was determined that any future proposed repairs to this septic system must be reviewed by the Board of Health at a public meeting for a determination in regards to the 1,650 Rule. Thank you for your help with this project, and as always, please call if you have any questions. Sincerely, Edward L. Pesce, P.E. cc: Cape & Islands Property Management PESCE ENGINEERING AND ASSOCIATES Phone 508-743-9207 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 SHALLOW POND CONDOMINIUMS 817 OLD STRAWBERRY HILL ROAD, HYANNIS, MA Head Loss Calculation for pipe sizes Input Values Pipe Material (C): PVC C= 140 140 Pipe Size Diameter (D): 2 inch 0.167 feet Discharge (Q): 66 GPM 0.147 CFS Length of pipe (L): 50 Feet 50 Formula: Headloss in Pipe = (4.73*L*Q^1.85)/(C^1.85)*DA4.87 4.50 feet Elevation Head difference between pump chamber and D-box = 11 feet Total Dynamic Head = Elevation Head + Headloss in Pipe = = 11 feet + 4.5 feet = 15.5 feet Prepared by Pesce Engineering Associates, Inc. Date: 26 September 2016 BARNESr S SECTION 1 B PAGE 1 SUBMERSIBLE NON-CLOG PUMPS DATE 11/02 2" Spherical Solids Handling REPLACES 6/02 Specifications DISCHARGE: 2"NPT,Vertical LIQUID TEMPERATURE: SE411: 77° F(25°C)Continuous. SE421: 104'F(40°C)Continuous. VOLUTE: Cast Iron ASTM A-48,Class 30. MOTOR HOUSING: Cast Iron ASTM A-48,Class 30. SEAL PLATE: Cast Iron ASTM A-48,Class 30. IMPELLER: Design: 2 Vane,Open,With Pump Out Vanes On Back Side.Dynamically Balanced, ISO G6.3. Material: Cast Iron ASTM A-48,Class 30. SHAFT: 416 Stainless Steel. SQUARE RINGS: Buna-N HARDWARE: 300 Series Stainless Steel. PAINT: Air Dry Enamel. SEAL: Design: Single Mechanical,Oil-Filled Reservoir, Secondary Exclusion Seal. Material. Rotating Face-Carbon Stationary Face-Ceramic Elastomer-Buna-N Hardware-300 Series Stainless CABLE ENTRY: 15 ft. (5M)Quick Disconnect Cord w/Plug On 115 Volt,Pressure Grommet For Sealing And Strain Relief. Series: SEA HP 1750 RPM UPPER BEARING: 1750 RPM(Nominal). (SE411 & SE421) Design: Single Row, Ball Lubrication: Oil Load: Radial Manual & Automatic LOWER BEARING: Design: Single Row,.Ball `Lubrication: Oil Load. Radial&Thrust MOTOR: Design: NEMA L Torque Curve.Completely CIP®Canadian Standards Association Oil-Filled, Squirrel Cage Induction. File No. LR16567 Insulation: Class B. SINGLE PHASE: Permanent Split Capacitor(PSC). U` Includes Overload Protection In Motor.Underwriters Laboratories Inc.® FLOAT AUTOMATIC MODELS: File No. E142177 A-Wide Angle, PVC,Mechanical, 15ft(5M),Cable w/Piggy-Back Plug, N/O. Description: AU-Wide Angle,Polypropylene, SUBMERSIBLE NON-CLOG SEWAGE PUMP Mechanical,N/0, Integral to pump. ON and OFF Points Are Adjustable. DESIGNED FOR TYPICAL RAW SEWAGE VF-Vertical Float,PVC,Snap Action, APPLICATIONS. 15ft(51M), Cable,w/Piggy-Back Plug. OFF Point only is Adjustable. OPTIONAL EQUIPMENT: Seal Material,Additional Cable and Cast Iron Impeller. Sample Specifications:Section 1 Page 3. CRAN E PUMPS&SYSTEMS 0 1485 Lexington Ave. 420 Third Street/P.O.Box 603 83 West Drive SuhmusibbYYwgvnhr' A Crane Co.Company Mansfield,Ohio 44907-2674 Piqua,Ohio 45356-0603 Brampton,Ontario Po;A.°ft0A Ph:(937)778-8947 Ph:(937)778-8947 Canada L6T 2J6 5W Fax:(419)774-1530 Fax:(937)773-7157 Ph:(905)457-6223 www.barnespumps.com www.cranepumps.com Fax:(905)457-2650 SECTION 113 PAGE 2 DATE 11/0 REPLACES 2/98 SE411VF SE411 &SE421 (Less Float), CS411AU, SE421AU SE411A 10.75 10.75 10.75 273) 5.32 1.56 &211) 1.56 (273) 5.32 •1.56 (135) (40) (40) 1(135) 1(40) S.DO ! u q152) 3.861% 3.863.86 (98) -- O (98) (98) 7.75 197.7S7.75 (197) (197) ' g 1 BARNES R"S.WC, ' I enarlm wrnas.Iwc. ' I BARNES carps,INC. --, ''16.76 '16.76 '16.76 (426) I (426) (426) 8.75 (222) 5.00 5.00 5.00 2.75(12') 1(127) (127) (70) MODEL PART HP VOLT PH RPM NEMA FULL LOCKED CORD CORD CORD NO. NO. (NOM) START LOAD ROTOR SIZE TYPE O.D. CODE AMPS AMPS SE411 096747 0.4 115 1 1750 C 12.0 19.0 14/3 SJTOW-A 0.375 SE411A 096748 0.4 115 1 1750 C 12.0 19.0 14/3 SJTOW-A 0.375 SE411AU 096749 0.4 115 1 1750 C 12.0 19.0 14/3 SJTOW-A 0.375 SE411VF 100836 0.4 115 1 1750 C 12.0 19.0 14/3 SJTOW-A 0.375 SE421 096750 0.4 230 1 1750 C 6.2 13.0 1413 SJTOW-A 0.375 SE421AU 096751 0.4 230 1 1750 C 6.2 13.0 14/3 SJTOW-A 0.375 Mechanical Switch on SE-A,Cable 16/2,SJOW-A,Piggy-Back Plug. Mechanical Switch on SE-AU,Cable 14/2,SJTOW-A(UL),SJOW(CSA). Vertical Switch on SE-VF,Cable 16/2,SJOW-A(UL),SJOW(CSA),Piggy-Back Plug. IMPORTANT ! 1.) PUMP MAY BE OPERATED"DRY"FOR EXTENDED PERIODS WITHOUT DAMAGE TO MOTOR AND/OR SEALS. 2.) THIS PUMP IS APPROPRIATE FOR THOSE APPLICATIONS SPECIFIED AS CLASS I DIVISION 11 HAZARDOUS LOCATIONS. 3.) THIS PUMP IS NOTAPPROPRIATE FOR THOSE APPLICATIONS SPECIFIEDAS CLASS I DIVISION I HAZARDOUS LOCATIONS. 4.) INSTALLATIONS SUCH AS DECORATIVE FOUNTAINS OR WATER FEATURES PROVIDED FOR VISUAL ENJOYMENT MUST BE INSTALLED IN ACCORDANCE WITH THE NATIONAL ELECTRIC CODE ANSI/NFPA 70 AND/OR THE./1UT iORITY HAVING JURISDICTION.THIS PUMP IS NOT INTENDED FOR USE IN SWIMMING POOLS,RECREATIONAL WATER PARKS,OR INSTALLATIONS IN WHICH HUMAN CONTACT WITH PUMPED MEDIA IS A COMMON OCCURRENCE. CRAN Eo PUMPS &SYSTEMS A Crane Co.Company 1485 Lexington Ave. 420 Third Street/P.O.Box 603 83 West Drive Rk�r Mansfield,Ohio 44907-2674 Piqua,Ohio 45356.0603 Brampton,Ontario "1°'v 06 Ph:(937)778-8947 Ph:(937)778-8947 Canada L6T 2J6 Fax:(419)774-1530 1 Fax:(937)773-7157 Ph:(905)457-6223 900 www.barnespumps.com www.cranepumps.com Fax:(905)457-2650 • STANDARD IMPELLER SIZE ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■m■ ■■■■■■■a■m■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■mmml■mm■■■■■■■■■■■■■■■■■■■■■■■ 0.4 ■■ m■■■■■■■maaaa■■■■■■■■■■■■■■■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NEW on ■m��mm■m■U■■a■nm■■a■■■■■■■■■■■Unman ■ MEMNON EMENNINomil .q oamm■l■m■■■■■■■■■■■m■■■■■■■■ ■. ■■`\■■■■■■mmlm Mamma MOONS■mma■ .qm►�■■■■■►�■■■■■■■■■■■■■■■■■■■■■wawa■■Miami■■■■■MIN ■■■■■■■■■■■■■ ■ ■■■■■■.■■■■a■■■■■■■■NONE■■a■m■■■■m■■■■■l■mll■llmmSEEMS �l■■m■.�m■■m■■■■1mm■m■■■■■■■■■■■■m■a■a■m■m■mm■■■m■■■■■ ■■ ■U`■■m■■.`■■U■■■■ ■m■■■■■■■■■■■■■■mmU■■mla■■ma■mm■M■am■ ■ ►Iqm.■m■lm.`■m■■■■■mM SEEMS■■■an■ma■■aml■MM■■■■mamlm■NNE■ ■.� ■►\m`\■m■■.\■■■■■■■■■■■■■■m■■■■/amm■■aa■■■■■■■■m■■■■m■■ ■m , on-n■nn■■■■a■■■■m■■■a■■■m■m■■■m■■■lammml■■m■m■■■■■mama ■■. ■.elm�m■-\m■■.•■■■l■■■l■■■l■m■m■■■■mm■■■a■■■■■■■■■■■■■■■ MENUS AVONm■Nam■0 amzMEMM■■m■■■■■■ma■mm■m■■m■■■m■Mum■m■mmmm■■■■■■��■■. ■��■■■►�■■Zrm■■■■■■■■a■m■■■■■■■a■■■■■■■m■■■■WMEMENNE ■■m■■ MENEM MEMSSICICIS ■■■■■■■■■m\a■\\■\\■■■■\\■■IIm►`■■■m■■■■■■■m■■■m■■■■■mmm■■■■am■ ■■■■■■■■■■■\ ■\`■■\"a■■m\m■I Ian►`■■■■■■■■■■■■■■■■■■■■■all■■■■a■ ■■■mmmmammmma�\■■►\■■\■■■■1I►\m■■►`m■■ma■a MENUS■■m■■■a■■m.■■■■■ ■■■■■■■■■■■■aam\■■■►`■■\\■■1I■\. ■■■\`M■■■■■■■■a■■/wan■■■■■■■■■■■ ME ■■■■■■■a■■■■■a■■■■\\■a■►gym■I:D.\■■■a■■►�■■■\■■a■■■■aware■■■■m■m■■m■ ■■■l■■■■■■■■■■■■■■■►�■■■■. ■I \\■■■■■m►\■■\\■■■■■■■■■■■■n MEN lmom ■■■■■■■■■■■■■■■■■■■■\■■■M\I: ■\\■■■■■■\■■\\■■■■■■■■■■■■■■■■■■■ ■a■■■■■■■■■■■■■■■■■■\\■■■\f�■■\aa■■wan\�/■\\an■■■■■■■■■■m■■m■■■■■■■■■■■■a■■■a■■■■a■\�■■■i:`■■■►■■■■■■\\■■\\■■■■■■■■■■■IYISEEMS ■am■■■■■m■ MEMO NNW■■►gym■■I 1.\m■m.\■■■mm■\`■■■►■■■m■mm m■mmm■■am■ ■■■■■■■■■■■■■■■■■■■a■■m.\a■I:,\\■■\\wa■a■■■►�■■■►`a■■■■■■■■■amll■■ ■■■■■■l■■■■■■■■mm■■■■■■\.'�mlIm\IR■■\\m■■■■■\■■■►`■■■■■■■■■■■■■■a■■■■■■■■a■■l■■l■■■■a■■■aOman\\I:OII■■►`■■■\�■■■■■\\■■■.\■■■■■■■■■■■■MOM ■m ■■mmmmm■■mmm■■■■■■ma■■m■■■is�■mm\7mmm.l■mmmm■\�■mom\■m■■alm■■■m■ ■■■■■■■■■■■■■■■■■■■■■■■■■■I\\■■■►\■■■�'�■■■■■■\`a■■\`wall■al■■■■a■■■■■■■■■■■■■■■■■■■■■■Ummm■I■\\■lIL\■ma.\■m■■■■■►`■■m.\■a■■■■m■■m■■■■■l■■■■■■l■■■■■■■■■l■■■■]L%M■\■■■\'�ma■■■■■►\■a MNm\\■■■■■■■■■■ ■■■■■■■■■■■■■■■■l■■■■■■■■of NNE a Willilill ■C1■■■■\01:1■■\mElmllall■►\mi\■■■■■■■ Mammamamum■■mm■mmmm■unman■roam■mm.\amm.\mnu.\ma/■■a■a■.�■\`m■■■■■■ ' ' MEMBER Town of Barnstable Department of Regulatory Services / n�rwernnr� i Public Health Division Date 7l 200 Main Street,Hyannis MA 02601 i Date Scheduled, Time Fee Pd._ Soil Suitability Assessmentfor Sewqge ispos Z Performed By: Witnessed By: 6ut__U LOCATION&.GENERAL INFORMAT�O Location Address r, 1 C'�e rl�,�e+ , Owner's Name �W ��,QIJI� �: k1'�►n>A, y 11(� gJQ ()L) S_rAk'r ddress pt. Assessors M%Ice Engineer's Name ©Sr 'kU�,''t AA ©� NEW CON STppRU��CI ION REPAIR 1•o f'+Telephone.# Land Use- ICrk.$ Slopes(96) `S Surface Stones ` Distances from: Open Water Bo dy S ft Pos l _ .p y �6� sib a Wet Area ' �ft i Drinking Water Well .. —ft •. a y ftDraIha a W Property rty Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes perc tests,locate wetlands In proximity to holes) Ark r � ► Parent materi.al(geologic) + apt 13edrockAA ' Depth to Groundwater. Standing Water in Hole: WAM&eeping i5an Plt Face ` Estimated Seasonal High Groundwater 90TION.�r�F,�O�R SEASONAL' GD WATE TABL � Method Used: tslly hr soww V P' / V, � � •� G� Depth Observed standing in obs.hole: In, Depth to soil mottle Depth to weeping from side of obs.hole: In. 'Groundwater Adjustment ft. T Index Well-4 Reading Date: tadex Well levol � r„ Adj,factor— AcU.Groundwater Level, d ,1 r PERCOLATION TEST Duie3iU6 tag. C Observation Hole# 2. Time at 9" Depth of Pere ,,: Time at 6" Start Pre-soak Time @ • Pima(9"-601 ) End Pre-soak -1 ,.,,,, 9 ; Rate MinJlnch �'�J �) Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-, ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. QASEPTICVERCFORM.DOC d DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. u onsistency,%'aravel) 6Topsbvl 36` /0 qlr- lob . 01 f&PAVIAZYk ►,D .sy DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture -Soil Color Soil Other Surface(in.) (USDA) (Munsell) ,R Mottling (Structure,Stones,Boulders. Consistency.% h. S80% GRAM , ' _ ---- p 6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other'•, Surface(in.) (USDA) (Munsell) " "Mottling (Structure;Stones,Boulders. r' Consistency. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) '(Munsell) ' Mottling (Structure,Stones,Boulders. Consestency. i Flood Insurance Rate Man: Above 500 year flood boundary No. Yes Within 500 year boundary No Yes,X,;r Within 100 year flood boundary No,A Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ES:---- If not,what is the depth of naturally occurring pervious material?� • Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of nvironmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and ex er ce described in 10 CMR 15.017. Signatur r Date Q:\SEPTIC`\PERCPORM.DOC ' PESCE ENGINEERING AND ASSOCIATES 3 Leona Lane Osterville, MA 02655 Voice/FAX (508) 428-3730 July 2, 1996 Chairman Susan G. Rask Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 SUBJECT: Notification of Abutters for the Shallow Pond Septic System Repairs Dear Chairman Rask, Please see the attached evidence of the notification of abutters for the Shallow Pond project Variance request. Unfortunately both certified mail notification letters were returned since the addresses I used (from assessor's records) were incorrect- I have since hand delivered each letter and personally spoke to the abutters to explain the project, and remind them-of the hearing that they may wish to attend this evening. Mr. and Mrs. Keller indicated that they have no objections to the project. Mr-Keller chose to write this on the side of the return receipt card and initialled it. However, Mr. McDonough felt that he wanted to speak to someone regarding storm drainage- that was encroaching from Old Strawberry Hill Road onto his Property, and is planning. to attend. Sincerely, 1 Edward L. Pesce, P.E. cc: Shallow Pond Trustees SENDER: I also wish to receive the W • Complete items 1 and/or 2 for additional services. m • Complete items 3,and 4a&b. following services (for an extra v ` • Print your name and address on the reverse of this form so that we can fee): return this card to you. m • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address does not permit. t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery " • The Return Receipt will show to whom the article was delivered and the date e delivered. Consult postmaster for fee. m -o 3. Article Addressed to: 4a. Article Number I�� N IAA , � £ . 4b. Service Type fr `� / El Registered ❑ Insured N J [-sx [� (Certified ❑ COD tyil ❑ Express Mail ❑ Return Receipt for 3 0 y� �l I Merchandise 7. Date of Delivery w a ' 0 5. Oature (Address 8. Addressee's Address(Only if requested,Y M j and fee is paid) w 6. Siture .gent) I— r C �► y PS Form 3811, December 1991 u ao:t 352-ata DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE, $300 o Print your name, address and ZIP Code here ' PESCE ENGINEERING&ASSOCIATES 3 LeanA Lane OstervilleNA 02655 d SENDER: I also wish to receive the H` • Complete items 1 and/or 2 for additional services. • Complete items 3,and 4a&b. following services (for an extra d • Print your name and address on the reverse of this form so that we can fee): m return this card to you. m N • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address N 'does not permit. G N • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery • The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. 3. Article Addressed to: 4a. Article Num er A%01/,4,V-tf4 . ServiceType E ¢ c ❑ Registered El 2 Certified COD 5 W ��� ElExpress Mail ❑ Return Receipt for Merchandise PA 7. Date of Delivery o Z 5. Signature (Addressee) 8. Addressee's Address(Only if requested X W and fee is paid) W r 2 6. Signature (Agent) AM ~ 3 0 PS Form 3811, December 1991 *U.s.GPO:19ss—sszal4 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE I Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT U.S. A LI OF POSTAGE,$300 Print your name, address and ZIP Code here PESCE ENGINEERING&ASSOCIATES 3 Leona Lane Osterville,MA,02655 ;PESCE ENGINEERING AND ASSOCIATES 3 Leona Lane Osterville,MA 02655 508-428-3730 June 17, 1995 TO: The Abutters of Shallow Pond Condominiums, Assessor's Map #253, . Lot #13-1 SUBJECT: Notification of a Request for Variances for Septic System Repair TO WHOM IT MAY CONCERN, In accordance with State Law; 310 CMR 15 .00, Title 5, and .the Town of Barnstable, you are hereby notified that an request for variances has been filed with the Barnstable Board of Health by the owners of the Shallow Pond Condominiums . Additional details follow: APPLICANTS : Shallow Pond Condominium Trust ADDRESS : 816 Old Strawberry Hill Road, Hyannis, MA PROJECT LOCATION: a. Same as above b. Assessor' s Map #253, Lot #13-1 PROJECT DESCRIPTION: The existing septic systems which service the Units in Buildings 4 & 5 will be repaired to Title 5 standards . APPLICANTS ' AGENT: Edward L. Pesce,P.E. , Pesce Engineering and Associates, Osterville, MA PUBLIC HEARING: Tuesday Evening, July 2, 1996, 7,:00 PM Barnstable Town Hall Plans for this project and application describing the proposed activity are on file with the Barnstable Board of Health. Sincerely, Edward L. Pesce, P.E. �� / ee. Fold at'line over top Jf�envelope to the right of address ENGINEERING&ASSOCIATES 3 LeM2 Lane ,- Oslerviile,MA 02655 6 8 6 9 6 12 3 Tt4 ZApi yMA PS Form 3800, June 1991 (Reverse/ ' Fol• • • • • • • • '.E ENGINEERING&ASSOCIATESCERTIFIED 3 Leona Lane Oslerville,MA 02655 P 3 6 8 6 9 6 12 4 PS Form 3800, June 1991 (Reverse/ - Town or WINSTADLC DATE J ° orrice or FEE � �., n CEO/ m or HEALT{� ' IVF.n�1�fY� RE(.F � t �'�� i6J°►`r 361 MAIN STREET q y 4� T/MI1 IYANNIS.MASS.02601 ..� , VARIANCE REQUEST FORM ALL VARTAKES MUST 11R SURMT.TTHU FIFTEEN (_15) DAYS PRIOR TO '1'lifi 1)111,E1) I1OAIII) UE HEW)TH MEETING. NAME OF APPLICANT shallow Pond Cond. Trust 0 TBL, N00428-0503 ADDRESS OF APPLICANT P.O Box 144, Osterville, MA 02655 NAME OF OWNER OF PROPERTY SAME SUDDIVISION NAME N/A - DATE APPROVED N/A ASSESSORS MAP AND PARCEL NUMB Map #253, Par�Hyan�nis LOCATION OF REQUEST 816 qld av�berry Hill Road SIZE OF LOT 67,018 SQ.FT WETLANDS. WITIIIN 200 FT.YBS XX VARIANCE? FROM REGULATION(LIst Regulation) (For Units 4 & 5�'--- 1 Barnstable By-Law. Section 1 ..14 less than 250' from watercourse tok leaching facility. 310.C'.MR 15.404 (2)(d). Maximum Feasible.Compliance reduction of soil absorption capacity (25%)J ;3� GU6I��S. 22/ REASON FOR VARznrICP,(May aLtactl �f more space is needed)JkJ 361j6alr. To accomodate the repair of an existing failed leaching system for'o�S 'fJh buildings 4 &1�5, L+r,nrl - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY UUTLINING VARIANCE REQUEST. VARIANCp APPROVED OF NOT APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADY, R.5..1 CHAIRMAN SUSAN G. RASKt R.S. tf QD JOSBPH C. SNOWt M.D. HOARD OF HgA,LTN TONN OF BARNSTA9LB TOWN OF BARNSTABLE y FTHETO� OFFICE OF i BA"9TUL i BOARD OF HEALTH NABS. A 0o i639• �� 367 MAIN STREET 0 MAY k HYANNIS, MASS.02601 July 8, 1996 Edward Pesce Pesce Engineering 3 Leona Lane Osterville, MA 02655 Dear Mr. Pesce: You are granted variances on behalf of your client, Shallow Pond Condominium Trust, to repair two onsite sewage disposal systems located at 816 Old Strawberry Hill Road, Hyannis, with the following conditions: (1) The septic systems shall be installed in strict accordance with the submitted plans dated revised May 22, 1996. (2) The designing engineer shall supervise the construction of the onsite sewage disposal systems and certify in writing to the Board that the systems were installed in strict accordance with the submitted plans. (3) The buildings must be connected to town water. The variances were granted because the existing septic systems were malfunctioning. The Board of Health deemed this condition as an "emergency repair" at their June 18, 1996 Board of Health meeting. Sincerely yours, `OW]o(- �R Susan G. Rask, .S Chairman Board of Health Town of Barnstable SGR/bcs cc: Frank McDonough shallow PESCE ENGINEERING AND ASSOCIATES 3 Leona Lane Osterville, MA 02655 Voice/FAX (508) 428-3730 July 1, 1996 Chairman Susan G. Rask Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 SUBJECT: Final Inspection of the Shallow Pond Septic System Repairs Dear Chairman Rask, The purpose of this letter is to notify you that I have completed the on-site inspection of the repairs to the Shallow Pond Condominium septic systems located at 816 Old Strawberry Hill Road. These repairs were completed by Mass. Cape Construction on the following: - Buildings 1, 2, & 3 - Stone and Pipe Leaching System _ s Buildings 4 & 5 - ELGIN In-Drain Leaching System The construction of the above septic systems(existing septic tanks remained in service) were completed today, July 1, 1996, and were installed in accordance with the approved design drawings, as revised 22 May 96. The completed As-Built Inspection Cards are enclosed for your records. Thank you for your help with this project, and please call if you have any questions. Sincerely, Edward L. Pesce, P.E. cc: Shallow Pond Tnistees Mass. Cape Constr. f t. 3 (awg-DAQ_.TOWN OF BARNSTABLE LOCATION IA AGE N VILLAGE •k S ASSESSOR'S MAP 8t LOTJa'&_L INSTALLER'S NAME&PHONE NO.. e\. -7 SEPTIC TANK CAPACrN l 0Qi l< ( ►-� C LEACHING FACILrrY: (type)\4 u� •�t�t F!V'44 (size) !U kz4 i A d NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: LOGJ TACAr5.16 ## Maximum Adjusted Groundwater Table and Bottom of Leaching Facility142, Feet 1 Private Water Supply Well and Leaching Facility' (If any wells exist OP) on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within '00 fect of eachin cility) 7�•�i Feet Furnished by 05AW .y may;.,4 ti•.� yy ;,� CV 13 A E3 IL 7 3cV, NOT S i , �QINGS4D�NC�S, TOWN OF BARNSTABLE _ QQ LOCATION SEWAGE # `VILLAGE ASSESSOR'S MAP & LOTZS'3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �L / r-e^ V4-S (size)NO.OF BEDROOMS "BUILDER OR OWNER4c.<<r�e,� �j��1 C1C PERMTTDATE: G,14-t I C 6 COMPLIANCE DATE: atvc-5 'PaA� Separation Distance Between the: TAW-*"D a Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 2. Feet ` Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) C..• Feet Edge of Wetland and Leaching Facility(If any wetlands exist ., , within 300 feet o leachin cility) 14 Feet Furnished by v we&z I&OiE 4V" G& . I �� c /a!°l &A6 D o Ao zleim VO a Q� V .46 p r 40 1N TOWN OF BARNSTABLE LOCATION ` " ^ ,SEWAGE# VILLAGE,. Ar..... �•S SSESSOR'S MAP&LOT ZS i3^ INSTALLER'S NAME&PHONE NO. SC�1 �� SEPTIC TANK CAPACITY ol'6:10 Q Eox LEACHING FACU rTY: (type) ��(' T4 (size)_ �3 NO.OF BEDROOMS BUILDER OR OWNER .StklLO,,� Eon( cQ" r PERMITDATE: G 0//I Cp COMPLIANCE DATE: y Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility I©• Feet Private Water Supply Well and Leaching Facility, (If any wells exist � ) on site or within 200 feet of leaching facility) I�QAt— Feet Edge of,Wedand and Leaching Facility(If any wetlands exist within 300 feet of lea,04 facility) ` �� D Feet_ Furnished by f' -ti Q( R V 4 floil r_ 42 - � TOWN OF BARNSTABLE LOCA-11ON lo /� 0ls E !fib 1 SEWAGE# doo VILLAGE Zfl/�l� ASSESSOR'S MAP &LOTia I3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY v�Cnn�J� LEACHING FACILITY: (type) V--Ij'7— 6,x d , (size) NO.OF BEDROOMS 0 , ) BUILDER OR OWNER S �l�66.i On C COn GOlr 4 PERMTTDATE: 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 leacl4ng facili Feet Furnished byT-r►S�GG ►On It W w 9V w � ZA v�- r SV _ W 0 1 C S II O VAS S $8, q A TOWN OF BARNSTABLE SA4116W Pbse Gbn�OS LOCATION I (D 01� Si SAW 6f( 141 II SEWAGE # VILLAGE Ckrtrv.16, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY AGO LEACHING FACILITY: (type) �)X(e . ! (size) NO. OF BEDROOMS J BUILDER OR OWNER �• G f t'S1M Propf,4 M �n OA PERMITDATE: COMPLIANCE DA 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 leachi g facility) J Feet Furnished byi►SP� �., 3 Fa�C 8B � $A+ ' aC,uk i A 6 /cv a 3y a .................... Permit THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, ...................OF..........,g. tis` Trdif tratr of Tompltttorr THIS.IS TO CERTIFY That the Individual Sewage Disposal System constructed or Repaired ( ) b s filer at has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.' Q,,' .23-':d............. dated............................I................... THE ISSU CE OF THIS CERTIFICATE SHALL NOT BE UED AS A UARANTEE THAT THE SYSTEM WIL 'FU TION SATISFACTORY. DATE.....�- l ... ..�-T................................................ Insp ... ....-- �Mcrrtica.�s.� OC.�r ASSESSORS MAP N0: -� � 00' PARCELNa C3 l ,� yD No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for Migpogal *potem Construction permit Application is hereby made for a Permit to Construct( )or Repair( ±)an On-site Sewage Disposal System at: Location Address or Lot No. 51HAI OW POA6 69WO, Owner's Name, ddress and Tel.No. yZi$—�s03 _,:�rknwegm-1 �N� pajo � �� ► �yp►uns F o• j� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. PA 1 . P1556C K<oe OV6 Rom-- AssBc_ 3 Z*Iu1: yam- �30 Type of Building: Robs �i Zl 3 yl s Dwelling No.of Bedrooms 240 T"L) Garbage Grinder( ) Other Type of Building -- No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 22W x al ns. Plan Date 1 Z umber of sheets Revision Date ?.Z Title ,�' T 411 w Y L u Description of Soil HYS S v J�VAO. Natuq of Repair&or Alterations(Answer wh n applicable) LH H!!E5 -4061eAg Date last inspected: GII� 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 Certifi- cate of Compliance has been issued by t 's Board of Healt Signed 11 - Date Application Approved b 0 " Application Disapproved for the following reasons Permit No./ t `' ` Date Issued ' _ 5 Z No. 'z Fee n THE COMMONWEALTH OF MASSACHUSETTS _Y a PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 011ppYication for �Dioogal *pgtem Congtruction 3pernfif... i Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: a �, �n Owner's Name, ddress and Tel.No. Zg O SQ3 Location Address or Lot No. SHAU_,0 / 601VAW, ow ,,5. ,A re �',`1.No. y 3 mo �/fi S S,�OGl7 S'rRA wB>GRk P.D- - G�DXYI(�l Uy�lC.�t.� yA,vuz sAAA 2.6Ss- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ip L. CSCi P P sG Gr-ry ,e -e AsseiG TO AM yzg- Type of Building: RX6 S 11 Z1 3/ y15 Dwelling No.of Bedrooms '1"OTAG) Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures I Z0 a1rr� �2, Design Flow gallons per day. Calculated daily flow�� z fi gal ns. Plan Date Z ZZ umber of sheets 2- Revision Date ZZ Title iZ 1 /a(� T G W 60,4y Description of Soil Mffitbel `z9r 644sq6n S'Wc Zo S Ny �s Y l S V3 Y' S -1 V D i,6, NatuiV of Repair or Alterations(Answer wh n applicable) Z '� Sar �n __ S'f v6 rt�� L916H r5 . -r G 3 v u� S'T T.�.CHES Date last inspected: S�G/l1 PG/aN- 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 EnvironmentatCode and not to place the system in operation until a Certifi- cate of Compliance has been issued by t1us Board of Healt / Signed Date r j( _ Application Approved b ' Application Disapproved for the following reasons , I , i - _ P `►�-� ermit No./ �`A / � Date THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance �I THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or re aired/replaced( on by �.�GG -c,r�.,t.1/. , for GV 15 as f 1.. ti \ ?01\has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 'G-Z17 dated Use of this system is conditioned on compliance with the provisions set-forth below: V No. W, a. Z Fee THE COMMONWEALTH OF MASSACHUSETTS } PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �Digogal *pgtem Construct i o n permit Permission is hereby granted to SN L42 !LL Cav l (/f to onstruct( )repair( �an On-site Sewage System located at IVAN 7 G 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. All construction must bCe�com fetedwithin tw years of the date below. Date: Approve `\ 94 1 1 N TM ENVIRONMENTAL EL PRODUCTS ' SINCE 1979 AN INTERNAtTIONAL . COMPANY.h¢t • _ ., TM . � n n .�] N-DRAIN. SYSTEM The non-aggregate leach field system with new Bo-Matti" Fabric. t.• of : ram... "tt, y so Soo y i, ri• ' • In-Drain system pretreats effluent with a 'two-stae b�omat • System maintains greater long term leaching capyacity w r •. Requires much smaller,area than conventional, systems • Lower site impact and less offsite fill; requiredit�.=4., t-t • Ends worries about dirty stone and stone .dust•f r*' '� -}• • Made with lightweight recycled materials f4 • Excellent documented long term track"record <<� `A • The leach field system with a 10 hyearwarrartyniqu Fdatureg.of the. - OP i" .? "9r# `a"'ry M w ,. ..•\. +` - t t- Only the Elj'en In-Drain TM System "Pretreats" effluent with a two-stage 'biomat. 1 how it works. . . New t• r �''.f Bio-MattTM -_. - .' `t • = _ - ;` r ;f Fabric •6" Sand Layer .+ Nave oil 0 Fill _ .Y *Conventional Systems • In-Draihe offer 2 bidh at'layers... have a sin le biomat 1. Primary surface on fabric forming atThe soil interface. 2. Secondary at 6" sand layer. • 'SF.''�� rr,"�� rf. ��x � 1r`�'��� ce Y''�ylApp�4�}3n ,�.�'•:� i 0 ; Porous top of In-Drain . ' Perfoi°ate�, pl s pe,Ir ," allows evapotranspiration distributes effluent to In-Drains'. Pipe is and oxygen exchange for = ;;, ~ "f better effluent treatment. _� secured to In-Drains with preformed.metal -' clamps . Antisiltation fabric E fines out of keeps - ; In-Drains. :' y �'�t ' Primary,biomat layer _ forms on"Bio:Matttm fabric U to.s1'0'W of Cuspated plastic coreP�e provides separation' fabric provided for between layers of every.ft of;soil Bio-Matt^ fabric. -interface,."` `"" Maintains unit structural ,� ► t Q � tttr � :.s integrity and aids in oxy- 7 ° , . • o ° ° Secondary biomat gen transfer. Increases a layer,forms at sand treatment surface area & ° °° ,` ayes: Long term effluent storage capacity. . • ° 'acceptance rate of this biomat layer is 3 Pretreated effluent ,; to 10 times that of reduces potential for conventional systems. ground water pollutio �(� '��. .� � • ' 6" Concrete sand layer Native soil or fill E Directio I of pipe �� Height I Wuith j 1 Length / ".5 3, 5 Width r , erns � PDS r Prefabricated Eljen's cost effective non-aggregate solution to site water problems. :�...., a Cuspated '•�'��� .� plastic a� � • -,�� a. ;� y core .,, Surface'water >.41 A ;. I interception tV '� / °yl y'f`S$' - Subsurface water- ar�' / � interception 'It t _ 1 sle eotextile 3 . fabric �- 1,.h #` �'g Foundation b d h ✓ Curtain Drain a Drain _ Installation Installation ' 4�y Perforate Detailed PDS brochure and installation r < r drain i e instructions available p p LIMITED WARRANTY 10i t K^' Eljen Corporation 1.Each In-Drainlm unit Is warranted to the original purchaser against defects,In`mated- 15 Westwood Rd. Storrs, CT, 06268 als and workmanship for one year from the date of manufacture wheh'installed in accordance with manufacturer's instructions. Eljen Corp. must be notified within fif- 203-429-9486. 800-444-1359 teen(15)days of the appearance of any defect during this period.'Ellen Corp.will sup- ply a replacement unit. Eljen Corp.'s liability specifically excludes the cost of removal Fax 203-487-1124 and/or installation of the units. ''':`q Patent nos. 4,465,594 and 4,880,333 2•The warranty does not extend to incidental,consequential,'special or Indirect-dam- age.Specifically excluded from warranty coverage are:damage due to ordina-i:year and tear,alteration,abuse or misuse,subjection to stresses or effluent loading greater Distributed By: than those prescribed in the design and installation instructions, the placement of improper materials by buyer into buyers system,any event not caused by or under the control of Eljen Corp.In no event will Eljen Corp.be responsible for loss or damage to the buyer,the units,or any 3rd party resulting from its installation or shipment. �Ij�lov 3.Buyer shall be solely responsible for Insuring that.Installation of the system is com- pleted in accordance with all applicable laws,codes,rules and regulations. 4.No warranties or representations at any time made by any representative of Eljen Corp. shall vary or expand the provisions hereof. No warranty applies to any party other than the original purchaser. EXTENDED WARRANTY Eljen offers a 10 year-warranty for residentlal,.in-Drain systems.Conditions of system design,installation and maintenance apply.Please refer to detailed warranty available (, from Eljen or an authorized representative4-lt;tcx .` ' Bien, In-Drain and Bio-Matt are trademarks of Eijen Corp. © 1994, Eijen Corp. #C94 tip Recent studies' have shown that the hydraulic con- ductivity ratio (HCR) of nonwoven fabric has a sta- ble long term permeability in contact with sand. QQQ Bio-Mattlm fabric in standard In-Drains offers a w.. comparable environment to soil for biomat growth . . and presents no masking effect on infiltration Nonwoven fabric-50x magnification capacity. Many years of field experience confirm the `> long term acceptance rates (LTAR) used in sizing In-Drain leach field systems. t 1989 study by Geoservices Inc., Norcross, GA. Fabric photo courtesy Amoco Fabrics & Fibers Co. Concrete sand photo courtesy GRI/Drexel Concrete sand-50x magnification Flexibility of . . • •Mound or in-ground installations •Trench or cluster,(bed),layouts •Level or sloped sites • D-Box or serial distribution •Lightweight preassembled units • No stone/gravel cleanup ST Trench system-straight line or curved to follow contours ,Section - f+, } .+tits 4 i a *: rx (fir a• � �' s: '�'y„+;"W.r^,vtt ST Mound or in-ground cluster Serial disteibution,on,slope s t, .. .• �.{+t:Eta..•. r. K'rYr a lhz'tupt `y .t' taNwa`+9ai raj available for all types of systems �z Raised or O Install a line of 4" perforated pipe on first row of In- Drains. Cap pipe at far end. y O Follow steps#1-3 for trench installation. ©rPlace at least 10'�of capped perforated overflow pipe at the far end and downhill side of the above pipe. © Compact fill, in max. 6" lifts, with a light tracked 1 +;.V machine. Use clean soil free of organic material, clay, O Connect overflow pipe to a line of perforated pipe on construction debris, stones larger than 6"and no more the next row of In-Drains with 2 elbows and a short length than 10%passing a#200 sieve. of solid pipe. Cap perforated pipe on opposite end. ri © Provide 6"sand bed, per trench step#4, directly O Continue this procedure until the last row of In-Drains under the In-Drains. has an end capped line of perforated pipe. © Complete system per trench steps #5-12. Complete assembly by following steps #8-12 at trench Installationik Serial Distribution on Slopes Pumped Systems OSite preparation is the same as for trench and fill sys- O Prepare disposal site as described above. tems. Groove receiving layer by raking or contour plow- .: ing at right angle to slope before placing fill or sand. ©Provide a well anchored D-Box with a velocity reduc- tion tee or baffIle.',Use SSI Inc.Type P flow equalizers or © Install rows of In-Drains at design elevations. equal in the D=Box;one for each distributioh line. © Provide a well anchored D-Box with velocity reduction' ©System assembly is the same as for gravity designs. tee or baffle. D-Box serves as an inspection port. 3fi .d a �:ti •,.. Q Pressure distribution does`not result in reduced sys- hs. ;t3 tem size and is therefore not generally used for In-Drain disposal systems. 7"A Y Design Manual Available j Effluent pretreatment offered by In-Drain technol- ogy generally allows substantial reductions in leach tr field size compared to conventional stone or chamber ® systems. Sizing formula conforms with code variations from state to state. Consult your area distributor for a . state specific Design and Installation,Manual.- LIMITED WARRANTY E I j e n Corporation 1.Each In-DrainTM unit is warranted to the original purchaser against defects in materi- 15 Westwood Rd. Storrs CT. 06268 als and workmanship for one year from the date of manufacture when Installed In accordance with manufacturer's instructions. Ellen Corp. must be notified within fif- 203-429-9486 - 800-444-1359 teen(15)days of the appearance of any defect during this period.Ellen Corp.will sup- ply a replacement unit. Ellen Corp.'s liability specifically'excludes the cost of removal Fax 203-487-1124 and/or installation of the units. Patent nos. 4,465,594 and 4,880,333 2.The warranty does not extend to incidental,consequenf a"'I,r special or Indirect dam- age. Specifically excluded from warranty coveiage are:Adniage due to ordinary wear Additional Patents Pending and tear,alteration,abuse or misuse,subjection to stresses or effluent loading greater than those prescribed in the design and installation ln'structlons, the placement of Distributed By: improper materials by buyer into buyer's system,any event not caused by or under the control of Ellen Corp.In no event will Ellen Corp.be responsible for loss or damage to the buyer,the units,or any 3rd party resulting from Its Installation or shipment. 3.Buyer shall be solely responsible for Insuring that Installation of the system is com- pleted in accordance with all applicable laws,codes,rules and regulations. 4.No warranties or representations at any time made by any representative of Ellen Corp. shall vary or expand the provisions hereof. No warranty applies to any party other than the original purchaser. "EXTENDED WARRANTY Ellen offers a 10 year warranty for residential In-Drain systems.Conditions of system design,installation and maintenance apply.Please refer to detailed warranty available \ From Ellen or an authorized representative. ProductsEljeffm.. . clean, healthy EljenT""and In-DrainT"'are trademarks of Eljen Corporation 01994, Eljen Corp. #D94 i 0 0 . 00 REF. oO Bedroom Add pl mbi g' ventin cpift 0 Bedroom Run fan vent o 1 ?x10101sts 16"OC a C � I `I i i Armstrong New Plan 0 0 o � y � o � q� 'b � I � '.�� i fi O a � `� F n 1 snnLLow 4 - Jl +condominiums N 4 1995 centerville, ma P.O. sox 1144, Osterville MA 02655-1144 (508)428-0503 i� 4f m q.. !-r'1C:'I::i -'i"r ` 1 s 'C h e= p t.=m p 1 1"r g r t)C"o P"d arid ' e p t.:r.C CI t_:' 3.Cl:I"1 `J 0�U. _C..i:..:a:i _ E'i :Ie c:slKed +or r. eq_�rd.irl'q i_ln-it •1!-i at e1.6 I...Iid SZI'...akwbe_._1:..v F.Iiii. We ha vi-, t.._--x fi'[:.a4 1 :'L"j ::i. f't?q!_€L ci1' t::)€..i(Trj::)-_i 'i'rt;J CiC: rt:"at':h.!.i. ? and V)]. 1. 1. C�I I i r'l U e to do so in r ::w-0-1 e "' -[:(D protect" Q i,iF" e n i i-C)1'l ir'r e n t 91 i-::.e r:-r,); MM c Na i'sl•mot r-Y}v Qo�6-/09/1995 11 . 05 FROM PRIME HOMES TO 4200789 P. 02 KIF.E.-PND PHO'E No. 513,2. (p, 24�3 Jun. �F' :11)19!' 1 2ESAN P2 S Town of 11'arnsitabic Dep�:Irtment of Health, S,-Sety,, and Environjulatal flervicei Hef Ith Divisi.an XAM 367 IN/lain Street, ffvmnis Wi 02-501 Office: 508-790-6265 Thoma; FAX: 508-775-3344. Director of Pljblk� Kt"'alffi TO: C/O NlargD 4 horeland RealtyMay IS, 199:5 724 -MAan Str.-e Hyannis, MA..02601 RE, Unit 3A, 817 Old Str awl terry Bill Ro; A ShAow Pond MA 04'1,6P32, ORDER TO COAUILY Wrl"H 310 CNIR. 15.00, -M S jk,])'E E,NVIRONME-MAL COD171, TITLE S., The septic system o-med by you located ;it Unit 3i!, 817 01<1 'S',,raAbeny IEII Ro,td w,�v,; inspected on May Al2. 1995 by WLUari Robiwro,:)n a Mass!>I'hwetts hcer-sect, SEW,K inspector, The inspectiorl, of y::Ilw Septic system slhaw<xi thc, yoi,'ir system fias failed urc.ei the guidelines of 1995 TITLE 5 (310 CNRIIu'.00)due to the AbUo�irg; Liquid level of sewage effluent ob:-)erved.over the inlet pipes. You al-e dkecvd to lire a-license,,I c f Bwmsta-rile septic �y 4,tem instaftcr to s-Lbinita sketch diagram of a I)roposed system tg -t:ie Ti)wn of B-arn=!Aa UmIth Dixision Office ir (To,Am. Hall, 3,57 ,rrnaia Street, Hyannis;� f-liat iNiI brLng the sq)tliC system into COMPlionce with 3'(0 CN2,� - 15.00, The State Fnvironmi�mtal Codc, Title S 'qvk.fin (14)fourteen 4.j-jyg ()f' receipt of this You are also directed to bring the septic,: seem into !;,:)mj)fiant-.e id-th-n thirty (30) (.'ays of ' receipt of this order htier. You are fuT-th(,'T dirc-ted to i--drt iyslC .ai birii-S a 5--astd septage h;wlt;j' to pump the septic—sVste--:n to prevent disrh'axp of! wa—'e or efflutir, int.) the biulding--, -,nto the surtke of the groind, or in to surface,vaterot. Any person ausuieved by arty ordtr i&sa.L�d by the 1 ayprovi aut),ority may to any court of it juri,-5dicttoji as pyr,F,7ided Ibr b-,,, the laws oft1 e lot' monweall Ii. PER ORDER OF '.SHE]BOARD C)IF EIAI' TH Tfi-o—eas A. McKean, 'K.S.'. C.H.Q. Agent of the B.)ar(I o., Health -TOTAL P. 02 s DAGE w C:ARGTS'AND C'F2EDITS BALANCE FORWARD 5-18-95 For services done at: 816 Old Strawberry Hill Road H ann s . Three full loads pumped from : Units 1 -A 1-B 2-A 2-B 3-A 3-B 4-A 4-B 5-A and 57B including all dumping fees. 780 00 Thank-you Johnny $ 780 00 ACE CESSPOOL SERVICE, INC. � PAY LAST AMOUNT �� IN THIS COLUMN PRODUCT 9E1 Inc.,Grotm Mass.01471.To Order PHONE TOLL FREE 1-800-225-6380 \ /t//F- Fk'4.v/c .P• MC DO.VOUGH� t°T UX. � 0 46"Ob 46 u 7.Do I: z9,7 iV49°ZO. 99.95 .N �im M;q �lA 2J-d9 vl o°,` T3.90 I S 0'4854'W �I df Nr of p \ ° uaiT f� P/43T FLCpj tt•O. '.\O ..� 'l-/. `O ¢3 rJ. ^ O E SRu�oFLcuz �i ti//.9 o M % 0 ti 0 f e.o ' � ♦ b a� pYgy Uw//T N Cl3QCW Z 3L.o \ 7 I Oo 7zn f 3� uv/r L 4 a '� Fi.P3PFLCo4 ^ 1' IO' I` o,��1I I IO.e LAJir'�4 O sr40,N C.WiT 7,s 4.07 2. V aecw/os�nct Tj P R PLAN B00 36 V �. bSSo•4�3Z 4. O t me /.$QGQES y �•\ `� \�S49V4S°"W y, 0 UV/T y�y �� o A.?3)•az� U c/sE \ o \ cuw/c q 0 C.AI//T� n A41r FLcoq �1 n p uNi r 9 B ry �t![L<yG40 t. �4 �q. .seiv..n Hoot 9 2. S 3 0 � Ytt_ �•, uv/rL�q �eaJ_ww;.�w \ Atar FLcoR � `•• F uAi,r/OB N . X4v°A ZO.0 32.o � y h Q SBbu°Roo[ 32.6 .� ,)2.0 3r✓d '' 91 ti f 1ai SENDER: I also wish to receive the :2 ■Complete items 1 and/or 2 for additional services. H ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. a; j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. El Addressee's Address permit. � y ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery t ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. o d 3.Article Addressed to: 4a.Article Number 4b.Service Type j6 a� Registered [� Certified c co000 Express Mail ❑ Insured ¢ ❑ Return Receipt for Merchandise [ICOD yl aJ 7.Date of Delivery 141 I ¢ �' 5. ce' a By:{Print N ) % 8.Addressee's Address(Only if requested W and fee is paid) t ¢ H g .Signature: A k ressee or ge ('. a°, X N : PS Form 3811, December 1994 Domestic Return Receipt • -i UNITED STATES POSTAL SERV F'NGE — -irstwG Mai { r M r. sta & ees Paid o =Rermit No.G-10 d 7 0 CT <., �.."" • Print your q ress, and I I Halt DepaftmeA Town of Barnstable P.O.Box 534 i Hyannis,Massachusetts 02001 Fax(508)775-3344 aph=(508)790-05 i 1� .Z� 348 651 005 Receipt for Certified Mail No Insurance Coverage Provided ® Do not use for International Mail UW1ED SD1TE5 vO5U�l5E1NiCE (See Reverse) OMf Sent to 0) L Str a No. g P.O. rate d�IP Code O � OCR Postage M Certified Fee 0 l LL Special Delivery Fee a e t r,Lqt g I ivtery ,ee Ow Ne"'?Lp't§q'n;iRyg to,Whom&Date Delivered Return Receipt Showing to Whom, , Date,and Addressee's Address TOTAL Postage &Fees Postmark or Date .p`,� -7 I ESTICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to j your rural carrier Ino extra charge). CC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return c) address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co rf ends if sjiace permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. O `t l 00 ►4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. sr E 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. in a 6. Save this receipt and present it if you make inquiry. 105603-93-8-0216 Town of Barnstable Department of Health, Safety, and Environmental Services Health Division e3 ,� 367 Main Street, Hyannis MA 02601 �A Office: 508-790-6265 Thomas A. McKean FAX: 508-775-3344 Director of Public Health October 5, 1995 Betsy Dalyrmple Unit 3A, 816 Old Strawberry Hill Road Shallow Pond Condominiums, Centerville, MA 02632 SECOND ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at Unit 3A 816 Old Strawberry Hill Road was inspected on May 12, 1995 by William Robinson a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Liquid level of sewage effluent observed over the inlet pipes. On May 26, 1995 you were directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14)fourteen days of receipt of this notice. On May 26, 1995 you were also directed to bring the septic system into compliance within thirty(30) days of receipt of this order letter. However, the system has not been repaired. You are again directed to upgrade the septic system within thirty (30) days of receipts of this notice. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH �Th . Kean, R.S., C.H.O. Agent of the Board of Health h IA/H"ILE YD,U 1NERE"A1A%Al(> x /�_ I,I FOR S" D'L�TE�iTIME P.M. M I - - ;HONED OF D _ REl'URNED, � RH O N E`5 D f •2 a •�J! ,S '2�' J`� YflLlt OA4 l AREA CODE NUMBER EXTENSION M = GE1 GALL ►0 GAME T �• SEEYOt1 SEE YOU..: SIGNED U iversal' 48002 Zol m CD J e SENDER- ,y • Complete items 1 and/or 2 for additional services. I also Wish to receive the • Complete items 3,and 4a&b. following services (for an extra V H • Print your name and address on the reverse of this form so that we can 2 feel: N return this card to you. m • Attach this form to the front of the mailpiece,or on the back if space 1. ElAddressee's Address N does not permit. t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery a • The Return Receipt will show to whom the article was delivered and the date U c delivered. Consult postmaster for fee. 0 3. Article ddressed to: 00, 4a. Article Number y�/� 2- °� 4b. Service Type d p ❑ Registered ❑ Insured IMI ® d ❑ COD c W it ❑ Return Receipt for Merchandise 01 0 ate of ry 4- a �+• 4 0 5. atur esse 1 8. Ad e' s ddress (Only if requested Y H e and �s id) LU 6 Signatu ent) 0 PS Form 3811, December 1991 *U.S.GPO:lees-3sxa14 DOMESTIC RETURN RECEIPT UNITED STATES POSTA I E4 Oj FM tu PM r_ a Official Busines 12 ---'W@&-Tg,6V0ID U.S.MAIL OF PUSTAGE,$300 ! Print your name, address and ZIP Code here Board of Health Town of Bams%b P.O. Box 534 Hyannis, Massachusetts 02601 ! I! 1 u . O FAX TRnN*5M'rrAL Oof From:�.00Lo: b Heaffh DoOL508)7'10-6265 Fax ahone a ax 0 (508) 775-3344 h l 4 - Town of Barnstable dye Department of Health, Safety, and Environmental Services $ RAMMA19M i Health Division MAW %639.� 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A. McKean FAX: 508-775-3344 Director of Public Health May 26, 1995 Betsy Dalyrm le Unit 3A, 816Old Strawberry Hill Road Shallow Pond Condominiums,Centerville, MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at Unit 3A 817 Old Strawberry Hill Road was inspected on May 12, 1995 by William Robinson a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: Liquid level of sewage effluent observed over the inlet pipes. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health `` ASSESSORS MAP NO" PAPUI,N10. t � FROM SHORELAND PHONE NO. : 509 779 2423 Jun. 07 1995 11:29RM P1 KBN I AJ-N 9 SAL" PROIMR'IY MANAGEMENT ISUYVR BROKERAGE SINCE 1979 Shoreland Real Estate "17TE PROITIM LOCATOR" MARGO WIIARMN-PISACANO (b()9}77I•$008 724 MAIN FI'RRUT } (808)77844435I°AX 11YANNIS,MA 08601 FAX �#r(S08) 778-2423 FAX TRANSMISSION SHEET TO: /1 L� FAX NUMBER: 38 VV NUMBER OF PAGES: c2 (including cover sheet) , DATE- 6 L71'9s COMMENTS: 1�s � PROPERTY MANAGEMENT RESIDENTIAL & COMMERCIAL RENTALS FPOM SHORELAND PHONE NO. 508 778 2423 Jun. 07 1995 11:29AM P2 tm Town of Barnstable Department of Health, Safety,and Environmental Services • ►ems Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790.6265 Thomas A. McKean FAX: 508-775-3344 Director of Public Health TO: C/O Margo Shoreland Realty May 26, 1995 724 Main Street Hyannis, MA 02601 RE: Unit 3A,817 Old Strawberry Hill Road Shallow Pond Condominiums,Centerville,MA 02632 ORDER TO COMPLY WITH 310 CMR I5.00, THE STATE ENVIRONMENTAL, CODE,TITLE 5. The septic system owned by you located at Unit 3A 817 Old Strawberry Hill Road was inspected on May 12, 1995 by William Robinson a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: Liquid level of sewage effluent observed over the inlet pipes. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or into surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to. any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH C 1 � Thor�Yas A. McKean, R.S., C.H.O. Agent of the Board of Health P 411 221 232 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIO AL MAIL (See R se) e Sent to M N S treaLand No. m a P.O., State and ZIP Code N Postage S Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing H to whom and Date�laehveAr of Return Receipt shtwing to whom, Date,and Addrekof;D livery L;'y m j TOTAL Postage ar�d 0) ee`'s"-, G'St � o Postmark or Date Q IGo m ® / E 0 U. N a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) i i 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. ' (no extra charge) 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. � 7 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space per- mits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. *U.S.G.F.O.1989-234-555 � ^ °' SENDER: .0 I also wish to receive the rn • Complete items 1 and/or 2 for additional services. N Complete items 3,and 4a&b. following Services (for an extra N ► i • Print your name and address on the reverse of this form so that we can fee): > return this card to you. • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address y does not permit. - i t • Write"Return Receipt Requested"on the mailpiece below the article number. 2 ❑ Restricted Delivery " • The Return Receipt will show to whom the article was delivered and the date c Consult postmaster for fee. C delivered. P 3. Article Addressed to: 4a. Article //Number 4b. Service Type E � ❑ Registered ❑ Insured ccc hi " a) to ® Certified ❑ COD E W �� ❑ Express Mail ❑ Return Receipt for 3 cc Merchandise L G 7. at ofjDeery Ignatu Addressee) 8. dd a see's Address(Only if requested x� and fee is paid) H C cc 6. Signa re (Agent) f7 Ir 0 PS Form 3811, December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE i h I Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE,$300 Print your name, address and ZIP Code here Health Depattm�s� Town,of BamstWe pa.Box 534 gyannis, Massachuseffs 026M 4 i Town of Barnstable Department of Health, Safety, and Environmental Services s a�cvsresi8, j Health Division 11' 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A. McKean FAX: 508-775-3344 Director of Public Health May 26, 1995 TO: C/O Margo,Shoreland Realty 724 Main Street Hyannis, MA 02601 RE: Unit 3A, 817 Old Strawberry Hill Road Shallow Pond Condominiums,Centerville, MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,TITLE 5. The septic system owned by you located at Unit 3A 817 Old Strawberry Hill Road was inspected on May 12, 1995 by William Robinson a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Liquid level of sewage effluent observed over the inlet pipes. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thus A. McKean, R.S., C.H.O. Agent of the Board of Health [Installer letter] TO: �erq- (Date) 4j'r,� S Z7Z nId�S ' �,-(v-v,((,*- MA ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. V"�- --'>A 19-1 The septic system owned by you located at�J -7 1 SJ '<< was inspected on 2,1 9-1 by Wiliam �b��s�.,, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 199\\5 TITLE 5 (310 CMR 15.00) due to the following: n - •, e Tl oe t7 c> 52 e0� -- ,n d4- You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable over i ASSESSORS MAP N0: 3 6`a PARCEL N0: 6� 113 f SUBSURFACE SEWAGE DISPOEM`L SYSTEM INSPECTION FORM JY1 S)� Address of property Shallow Pond �� �'` , f e � �d Strawberry Hill R Cvi��rl`le. Owner's name Gerald e. Jaquot Date of Inspection 5-12-95 MAY. 1 5 1995 PART A HE TH DEPT. CHECKLIST TOWN OF&WWME Check if the following have been done: Pumping inzormation was zequested of the owner, occ.,pant, and Board of Health. V None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not / available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. V All system components, excluding the SAS , have been located on the site. The septic tank manholes were uncovered , opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge , depth of scum. The size and location of the SAS on the site has been determined based / on existing information or approximated by non-intrusive methods. y The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. t 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: C-6 VW 3 0 Last date of occupancy 1 GENERAL INFIORMATION Pumping record y and source of information: �s System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous ins ec records, if any) p tion Other (explain)__ Approximate age of all components. Date installed information: , if known. Source of A," Sewage Sewage odors detected when arriving at the site, es or n Y o 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) depth below grade: 1- material of construction: ZcOncrete metal FRP other(explain) dimensions: I. 2--Z --V 7 -t I � sludge depth distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) O G 0v�fz s DISTRIBUTION BOX: v (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal , evidence of solids carryover, evidence of leakage into or , oi4t of box, recommendation for repairs, etc. ) S A S S v s it, Z,- PUMP CHAMBER: (locate on sit plan) /V pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) t , 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION Continued SOIL ABSORPTION SYSTEM (SAS) : `�>> (locate on site plan, if ---,�-- p possible, excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: � U Type. leaching pits and number 6 ® Z5 }a ;L leaching chambers and number _p 2 z C. b s T' leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum- 1ayer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, 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, 1 condition of vegetation, recommendations for maintenance or repairs,etc. ) lI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE ElSPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' l DEPTH TO GROUNDWATER 15 depth to groundwater method of determination or approximation: T e t i I�oJ< _ I � , r 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND ) . Describe of determination in all instances. If "not determined" , explainb why snot) �-- Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? .- Static liquid level in the distribution box above outlet invert? Liquid depth in. cesspool <6" below invert or available volume<flow? 1/2 day _ /' Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? �✓ within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? .1V less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water has been analyzed to be acceptable, attach copy If the well . for coliform bacteria, volatile organic compounds, ammonia well tnitrogen er si. and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION ame of Inspector W.E. Robinson Jr ompany Name W.E. Robinson Septic Service ompany Address P.O. Box 1089 Centerville MA 02632 ertification Statement certify that I have personally inspected the sewage disposal system at zis address and that the information reported is true, accurate and :)mplete as of the time of inspection. The inspection was performed and iy recommendations regarding upgrade, maintenance and repair are Dnsistent with my training and experience in the proper function and initenance of on-site sewage disposal systems. ieck one I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. YI have determined that the system fails_ to rotec the environment as defined in 310 CMR 15 . 303. The basiscforalth thisand determination is provided in the FAILURE CRITERIA section of this form. ispector ' s Signature ! ate -iginal to system owner )pies to: 3uyer (if applicable) approving authority I i i I Ad ®1 ! F c�HALLOW POND-�._..... ��� condominiums 2 1 centerVille, ma P.O Box 1144, Oslervilk MA 02655 1144' ,(508) 428-0503 I 6/12/95 Thomas Mct':.ean Board c-f He 1 t1h Dear Nr: , Mct.ean 7 Attached is:, theR'pua pi ng records :-hd se,pt c deg_;i.L)n Vc:)l_( have as[::ed F.:or', r-egardriig.:.Unit (. at 81iS Old strawberry I; I11 _ fed. in ..Cent6rvi11eo� � tie Have mai ntai nod a regular pump i'ng schedule wid cant i nue'•-'to"da,:so a."n` :or,der,;.,t ,,,ptrbtect a�ur- environment. . Thank: you, F Property Manager Al '.t'w q.i: l;V t# i w V .. 27t .#Jr , Ci'i }n•i- ,4+k, � ;l i 1 ' I 06/09/1995 11:05 FROM PRIME HOMES TO 4200789 P. 02 .,yam =RQ1'I :-:,HORE'.AND PHO\E NO. 5,08 '7 78 Z ae 3 Jun. G_P 1.599,'.; 1:�:26PPI P2 f . i Iowa of Harnstable: c Dopzrtment of Health,$FSoty.,and Enviro.n>rrer;tal ►3ervites s aaruraraas�, t il;teFlth 1(livisi:on i I 367 Main Street, ]3yrini$IV11'i 0251 Office: 508-790-626s Thoma> A. M:CI<:ezui FAX: 508-775-3344 . Director 4xF Piibli.;, Hc�altt� May 26, 199;5 TO: C/O Margo Shoreland Re; ty A.. 724 M<un,StrW Hyannis,M.A.02601 RIZ; Uaitt 3A,817 Old Strawberry 13(ill Ro;lid ShW10W.lPond Condominiii'ns.,�entei'ville,MA U'2632; I ORDER TO CO1MLY WrM sto (:111R 15.00, THE SUYE ENVIRONMK I'AI, The septic'syst.em cnmed by you located at Unit 3A 817 Old airawberry lfill Road wa,,; inspected on May 12, 1995 by WiLUari Robinwi a Massq.chu;;etts licensed septic: inspector. i i The inSpe:ction, of your septic system showed thm yoi;+r:s;rstem lras failed un.�:trr the guidelines of 1995 TITLE 5 (310 CMR 15.00)clue to the Liquid level of sewage effluent obierved over the in of pipt�s: You are directed to l:dre a•licensed Town of Bazmstahle,sE: c system iastallvT to sL.bnut a sketch diagram of a proposed system to -e ie Town of B;Ix stabl: Health Division Office (Town-Hall, 3,,67 main Street, Hyan*)tlult'wi?l br,ig the, sg5tio system into compliance with 3:10 CMR. 15.00, The State Emviroiamtmtal Code!:, Titles i itlik('14)fourteen dralls of receipt of this notice, You are also directed to bring the septice S73teM into QoMpliand,e:within thirty (30) da,13 of receipt of this carder letter, You are further directed to maintain the wstem by hiring a Ilio—Mmd septage lviu t,r to pump the septic system to prevent discharge of sewage or effideiv inb) the bWldiN;,, .ti.nto the surface of the€ro---ind, or in to surface waters, Any person asgigieeveti by any ord-ee isseae cl by the local approvrl. authority may app,(N31 to any court-of-competwt jurisdiction is prv,ided f br.b r-the taws of the CommonweaIi h. PER ORDER OF THE BOARD OF HEAT TH TReas k McKean,:lZ S., C.H.O. .Agent of the Beard oMealth 1 ACE C SSPOOL SERVICE, 1NC. j ;I P.O. Box 534 CENTERV!'' MA 02632 (508) '75-1056 OW 362-3400 SOLD BY DATE � � .r , NAME ; ADDRESS e pgFi CHAR C AND RETI!NEP s >� AiA OG�!A(3CbU ��. QTY. DESCRIPTION AMOUNT fr , 3 in I 1.. c 1--- I Y 1 I f RECEIVED BY TOTAL f THANK YOGI 1 i , l a �•.`+ ? �Contents:40%Pre-Consumer•10%Post-Consumer ., I F� _.._ .� ....� THE COMMONWEALTH OF.MASSACHUS rrSUBJECT TO APpRCi L OF WANSTASLE CONSERVATION BARD OF HEALTH COMMOSSIO ...........j 1 W..0.............OF........ZZ. M61-G._............................... Appliration for Disposal Voiks Tonstr rtion Permit' Application is hereby made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal System at ............ ........................_....................... ..........................._..__..._..... o ti Address- - . ll. .. .............. ./. ... r. a O A dress Installer Address Type of Building CUI�t�111 ll.'/Vi'1'1- 2(3Cb0 N1n S/O i7- (6 ... Size Lot � q. feet g— ............................................Expansion t-ic (N 6) Garbage Grinder (1,1)j..� Dwellin No. of Bedrooms Other—Type of Building �v�? :_.._ No.. of ersons........•-_AiP1TShowers — Cafeteria a YP g -P ( ) d Other fixtures --------- ------- ___•-• --------- low Design F ____.._..__`?_` -.......................gallons per person p�r day. Total daily flow...........� .._.__....._gallons. �d WSeptic Tank—Liquid capacity/5.C�gallons Length.__.._/ .:_. Width_. ... Diameter......: Depth_.:.._/..6 x Disposal Trench.—No. Width_._:�_....__.. Total Length.......... Total leaching area........ ......sq. ft. Seepage Pit No......... ........... Diameter.......�4.f'_Depth below inlet........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank �L Percolation Test Results Performed b .......a...... C.... .� Date.. ��1� Test Pit No. I.....:��c...t__..O minutes per inch Depth of Test Pit---,�P......... Depth to ground water....6*b..1.C3 "(Z-) w Test Pit No. 2.......Z.�minutes per inch Depth of Test Pit.....1.,Z,0....... Depth to ground water..&- ..(����� t ...... _•................................................:.T•----------------------•-- - --- O Description of Soil...0._73......W. -SV. 1 x x ....-----::•.:...:....................•.......••.•.••••••••••-• ... : ---:::::::--------.----------------:::::::::---.--------:::::_:::::------------::::::::::_:::::---- U Nature of Repairs or Alterations—Answer when applicable................................................................:......................:....... -------•••--------------------------------------••---•-----........--••-=---•--....................._...........-----•----------•--•--•-•.............•-............................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a.Certificate of Compliance has been issue by the.board of hea th.. f ��/ o Signed... . ...... .............. `- ••-- - �`�'l'L-_-• ,!Z 4 Dat Application Approved By........ ...... 5 _ _: .....__.G2s/,d��._.._.. .................... ....._ bate nlication Disapproved for the following reasons:............................................................................................................... ---•...................................•---•-•--••---•-•---•-------...---...................-••-•--••----•••-------•----------------•-•-------------.............................. Date No...................................................:..... Issued_--..................................................... Date X65 P7 rV 3d o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ............OF.......1 .� Xi'S. ...1[.. ............................ Apphratiott for Ui,gpoottt WorkB (nottotrudion Frrmit Application is hereby made for a Permit to Construct C'� .or Repair ( ) an Individual Sewage Disposal System at: o ti Address ................................................... .. o ._........---.................... ......._.... 1_.l. d - .............................................. : . ... ..'!A, Ow A dc,_ss y:......6 NIX"i :T...�'.................... C.. r ... ,.., . Installer Address U. Type of Building COI.;Lv tvi I:'IVi"-.,Z(��f2���)S/U(�31 J" Size Lot-. ::� -. q. feet Dwelling—No. of Bedrooms........... :........... ................ ...Expansion jNt•ic (10) Garbage Grinder (PC) Other—Type of; Building .____J!Sl ?�3 ..... No. of persons........ /U_N.1TShowers ( ) Cafeteria ( ) a' Other fixtures .. dj, ... -•----• -•--•-•.......••-•.......•-•-•---•..._....--•-•-•--•-••--- ----••-'•-•-.... ------------- -----•---. Design Flow._.... ...5.5 ..... •..gal lons per person per day. Total daily flow.........._bL ...................gallons. Septic Tank——Liquid capacttyl� vgallons Length..._./.G7._:. Width... ...y Diameter... ............ Depth...61 W p —. .._.... Total Length............-. Total leaching area___.:.-.:+------sq. ft. x Disposal Trench — No. .:. � .:....: Width_._..._. Seepage Pit No__-....J........... Diameter....:,.iq...f Dcpth below inlet........ ..... Total leaching area.................sq. ft. z Other Distribution box ( ) Dosingttank a Performed Percolation Test Results by. . .-'Nl .... '�-��Date.A/Ift ',�-.. �. � ,a Test Pit No. I...... :Vminutes per inch Depth of Test Pit...�01-�..._..._ Depth to ground water...IJO..L&,!AfL'-1Z-J t4 Test Pit No. 2......2zininutesper inch Depth of Test Pit-----I.,Z Depth to ground water..f-11C.?:.G�.) c� , ._.... ...... . ••--- Description of Soil.. __..._ _ -----•---- � •- �`� ���-�.G ��L -_.-----•---•----------------•---------•-•-----•---- - �U .--. , --------------------------------------------------------------- 1- .. UNature of Repairs or Alterations—Answer when applicable.......................................................... -------------------------------------------------------------------------------------•..........-•-.......----•---......--------•------•------..._.._---------------•-------........................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITLE 5 of the State Sanitary Code— The undersigned further agr es not to place the system in operation until a Certificate of Compliance has b ii issfie tl�oar&of hea tf e, �' njeF Application Approved By............................... ' ... --••••-- •.......................••.......•••••. ................... .................... Date• Application Disapproved for the following reasons---------------------------------••---.......--------------•--•-----------•-- ----....----•-------------•...._. ---•-•--•---------------------------------........................................................... Date PermitNo. .............. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��e 1 .�y� ,V.............OF...........6A,)C S.�? ............................. Carrtif irate of Tomphatirr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed or Repaired ( ) bY.........1-11&,ke .....�C�11a, ' UC /��1�,}---•..................'---•-- ------------..•..---•--......----------=-------......---•--..... ----- � /�,� t s Ile: .. at. .. � l.r '.....`A)vu.C�.._.-•--...:1,, -,�Z. /Y ......�:'. ?.. C °............... ....... . i has been installed in accordance with the provisions of TI GIa 9API e Stale Sanitary Coale as described in the application for Disposal Works Construction Permit No---------------_-----................... dated. ... _ ...... ......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ISFA TORY. DATE.................................. ..f . . ................... Inspector- ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ': -3 C ��f'/> )�Z .....�� ................OF........(�TI �U��...........:............... No.....- FEE_...................... f Difilloott Wor o Tonntrurtion Prrmit Permission is hereb ranted...__... +e .. .... ......�l. Sj���L ....................... Yg to Construct tX ) or Repair ( ) an Individu Sewage Disposal System at No............................................................................................:........-------........... .:........ --------- ---------------------------------------•-- Street as shown on the application for Disposal Works Construction .Pe—it Noy....... E a c -------------------............. .... +' F �1121 r— ................................................•--. .......-•---•......-- Board of Health DATE.................................................... No. ��..3a1 , FsB..... ........... THE COMMONWEALTH OF MASSAC CT TO APPROVAL OF H ST STABLE CONSERVAT _ BOARD OF HEAL ACOMMISSIONIOfy ...........' ��' .... ....:..OF....... b'. -57 11, L ...... Appfiration for Uifipviial iforks Tomitrurtiun Prrind Application is hereby made for a Permit to Construct or Repair ( } an Individual Sewage Disposal System at ILL:...if......................... p�o/ ti -Address W /_ lC f��L:..._ !!l?.SZ' ...... !4 iz( ....__ '..........rl , a Installer Address ,f Type of Building CQJ_Lb Ai jk;iUi'►'�- 2-6i`bOW-41I-S/0w 17 Size Lot_.":#-_...% �q. feet U Dwelling—No. of Bedrooms............................................Expansion Attic (Nth Garbage Grinder (�'c ��?Qj? ?__..... No. of persons............ .Ultir'1TShowers — Cafeteria � Other—Type of Building ....__.__.. p ( ) ( ) dOther fixtures ....................................-..........................................................................._._....._...........••--....._..._..... W Design Flow._.._...._ .Jr......................gallons per person per day. Total djil "flow._._._._.._.. ? ___ ___.._._.___ lons.', WSeptic Tank—'Liquid capacity..).. allons Length../.(,?.... Width:....... Diameter................ Depth_../®. x Disposal Trench—No. ...... :.... Width Tot Total Length..._�i'.-..`_...... 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.......E ------- minutes per inch Depth of Test Pit... D......... Depth to ground water_-1�? .._L�L !Test Pit No. 1....__'�f•._.__�___. P P �- eP Test Pit No. 2.......2.-minutes per inch Depth of Test Pit..... i...... Depth to ground water. Q0..LAs.)ATL ' W1 ....._..T------------------------------------:.............._................T............._..............---•---.-•-----------. ... .__ O Description of Soil...Q..- ,3•-•-..W.441-1_...±..SV 63- 01.�= .. .......I ... -••-�. ........................K V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...........................................................•••...........-•----........................_.....•--•----•-••--•--•---•...••--._.._....--•••------------•------•-•-------..._..._._._.._.. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep iss by the�board of health. Signed ............ .. ._� � .... D e Application Approved By......._ .................-�.... ........ a Date Application Disapproved for the f ollounry ram!,,con$s::..............................•--•••.....-•••••••---•......•••-•--------•-----•----•------•---•--•---•--••-. _.max Date PermitNo................................................... a Issued........................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `� ✓� .......:..:........OF.......... - �I�NJJ.�L.�.�,��............................. l Trrtif iratr ,af Tompfiaurr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (?e-) or Repaired1.06 ( ) by••••....��/7L/1�e j� �j�� ltL.2 11U'C' �j at.......6 1_I?!S...I L_14 5.'_._._...L-19-7v-... �J 7` s lle6L4,r ... ~ . -� � t � has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No0__J.?_._1................. dated---............................................. \THE ISSU CE F THIS CERTIFICATE SHALL NOT B O RUED A�A ,ARANTEE THAT THE SYS' EAA WI.L TION SATISFACTORY. N� i�- f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF- HEALTH ':J� ; .........OF . .....r,'.Afx)-S:M LE... Applirtttion for Bi,ipniitt1 Works Tonotrurtion j1rrmit Application is hereby made for a Permit to Construct. or Repair ( ) an Individual Sewage Disposal System at o i - -`or..._-•-... _'.. k , . .-_ I. ld - -Address ------------•--........................... �. .� ... 1. �"r --•- L -�� !�� �: .1�?A, Address aL �I.J..l ...._. �}I-�.}.J�•(`.:�(T l._ ..................... ..�. 114!f� ......J.�/!�! ess Installer Type of Building a �(j 2W � ' SizeL feet U / Dwelling— No. of Bedrooms................_....................__..._...Ex Expansion (lV6) Garbage Grinder (k`C) aOther—Type of Building ....:y A?J: No. of.persons...........i#Kl rShowers ( ) -- Cafeteria ( ) Q, Other fixtures ..... --------------------------per t iiow_: ^':'•.--•-�.C-�0.................ga-llons.,, W Septic Tank--1_,iquid capacitylICTkal Ions Length /. __:. Width.��...L._. Diameter....... Depth-Li � . Disposal Trench-- No. ......Nv+...... Width•.�_ _...,_:...._._.. Total.Length...� ....... Total leaching area...-----__.......•.sq. ft. x r d............ Diameter...... .__tt.. t Seepage I it No....._. f`1 Depth below inlet........-....._. Total leaching area.................sq. ft. Other Distribution box ( ) Dosing tank Percolation Test Results (} Performed b ��� .._. . �'. !Ltt ��'t �Date.. 7 �h`...4"� Test Pit No.. I......A minutes per inch Depth of Test Pit... ......... Depth to ground water...h.?C1-.-L,;:• ��L l`✓ Test I'it No. 2.......Zztninutes per inch Depth of Test Pit.....1.2,....... Depth to ground water:./�1CZ..L.J1 -----------•--- Description of Soil...'_:.-.:a-----��,�?> Y.` �V.�3.5�11�—- /----- ..:`-... <.......C.(?. �y-= �..._._ -------�� ."�..�7��X!Z-L. U -----.---•• -------------•-- �.----- I_,. UNature of l:epairs or Alterations--Answer when applicable................................ ---------------------.......................................-................................................... .............................................. .............................. Agreement The undersigned agrees to install the aforedescribed Individual. Sewage Disposal System in accordance with the provisions of TITALL 5 of the State Sanitary Code{The undersigned further"agrees not to place the system in operation until a Certificate of Compliance has begn issued by the board of heal h. Ile Signed • •--•--•• .................................................. � ------- �--- f .'! / . : . �°......."'APPlication Approved BY ........................... D:"te Application Disapproved for the follouring reasons...........................................................------- ..................... ........................ ........................................................ ------ ..............................------------------------......... ................ Date PermitNo.--••----•--•......•-----•-• •-----......-•-------- Issued-.................................. ..... --------------------- Dau THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..loll) OF..... ..... (Irrtif irtttr of Tomphatirr THIS IE TO CERTIFY That the Individual Sewage Disposal System const.ructecl (-,4) or Repaired ( ) by......... ...... 0.0�j L'� �3 ......................--------•-----------------------------------------------._----------•----------------------------- � � � � ts-Iler � , :tt.._._._C: :1 k 1.r4��= ..--.LJq C..._.......�5 64 -------t=� �. :_..�_�._. . ...........--------•-- N has been installed in accordance with the provisions of TIT ` of The State Sauit:u y Cn(lr' as ticr;cribed in the .t��.application for Disposal Works Construction Permit No - - i l .. dated. .. .: ... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. • j DATE.......................•../� .,�d`l�� ...... Inspector.......•-•.• •---.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . " 2 ..T, .'N........ oF........��f.O1 ���1. ............................ j N �..._:._........ r'KL.............•.......... Diopostt or s Tonotrurtinn rrmit Permission is beech ranted...----./" 4:!e.... ......�L1SjQ:��� 0_. .............. hereby to Construct �X ) or Repair ( ) an Individu Sewage Disposal System at No....-•-••----•-------•------------ •------------------------------------ -•............................... Street as shown on the application for Disposal b1'orks Construction/Permit NoI)tt`cY --------------------- Board of Kalth DATE........................---------------------------..............--------------- FORM 1255 Hoses a WARREN. INC.. PUBLISHERS &JIL'P Jfiv } 142�......._..... Fxs....J...._. . THE COMMONWEALTH OF MASS'ACHUSETTS BOARD OF HE `VHe, L 'ui ............0 ..... .i . hS7 1l L. _ r �bi� . Appliration for Bispoiial Works Toatstrurttnn ti Application is hereby made for a Permit to Construct (°�� or Repair ( ) an Individuah°l''ewage Disposal System at: IL ..... . ?...................... -o ti Address or a i�1C K -- -Cv C Tj rt L J: �Zl ....._ -9S ................. Installer Address of Building � Type g Cc�l�1�M��.'fUwl- 2(�'��';JCIati�S�Caf..�l7' Size Lot---- '-•-----•-•-••--•--- q- feet <. Dwelling-No. of Bedrooms.....................................:......Expansion At (1�j Garbage Grinder (PC) , Other—Type T e of Building .C7�p� yp g __._.u1�?............. No.- of person s..__,____._�VtV1T5howers ( ) — Cafeteria. Otherfixtur .------•------------•----...............•----------------._.......-----•-•-•- W Design Flow________________��___._:_..__.___.--___..gallons per person peer day. Total daily flow..__...8 �.........._..._.......galllons� WSeptic Tank—Liquid cap ity/5�gallons Length...�__�!�-,. Width..5.._-:f!' Diameter................ Depth..6.•/')-.. x Disposal Trench—No:_._. <. ..._.. Width... ..---------- Total Length.............. =. Total leaching area---- ---sq. ft. y� Seepage Pit No..•_-_-.I........... Diameter....../:- ...F% Depth below inlet.......---...... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank l .. a Percolation Test Results Performed by.._.__.Div( .._: !���l�3Date_..I.! 4ht.'A-—-/��1 l Test Pit No. 1.....:2.: D.Uminutes per inch Depth of Test Pit...4. ......_.. Depth to ground water... (i, Test Pit No. 2.......Z.-minutes per inch Depth of Test Pit.....J_Z,I:__._. Depth to ground water..t.00..ls.�' � r------------------------------------------------------ -----------.:_T------------------•-----•--------•--------•----•--•------• ------ ------- O Description of Soil... .._-� ......W_� ......'!...SV.� �l��---•--f-....� ....�:Q�== = i �. x W Nature of Repairs or Alterations—Answer when lt-------------------------------------------- ......................................................... U p ---lt r --._ ....-•-- n applicable..................••--•-•••---•••------ ---------------------------- •----------------------------------------- •...................... ----------- •...............................................-..........---.............................--•- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the�oard of health, Signed .. e�`t"�-�. kk............. ....... .........�...... ,y Da Application Approved BY ��..- /-L.�:_.:.....1✓.. ........................._ 0/2k_;�'1-..:..._... Date Application Disapprov,,f�� irl° ,fahowinq reasons:............................. Date Permit No--------------------------------------------------- Issued.......... Date----- THE COMMONWEALTH OF;MASSACHUSETTS BOARD OF KiALTH — 6�It�.............OF...........6—A' ............................. Trrtifiratr of (gomphatire THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed 0,,61 or Repaired ( ) by ��/ ..._�Uti1,5 ---------- ---------------------------------------------------------------------------------- •-----------. s Iler f rn�-A a I at 1. 1 r ..........L }/U ISk A)j -1l�Z.4. t•�•r•- t.,...•.�.�. C`�- - ... has.been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No d. d... ............................................ THE ISSUANCE OF HIS CERTIFICATE SHALBE O STRU A CrUA TEE THAT THE SYSTEM WIL U O SATISFACTORY. v' Insp - DATE...� ••...- ------------••----•-•--..._-----•._.....•--- r..... •= 11110 No......................_ Fula......................... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD . OF' HEALTH .....OF .... f:` L<G....... ......:_-...:_... , pphration for 0iqu,ial York, Tuatitrurtiurt Permit Application is hereby made for a 1'errnit to Construct or Repair ( ) an Individual Sewage Disposal System at: n1.1.�� ti n'V- IL .....d0 ............ ..�............. ......----...-..--------- .. .---.......--,-----------...__..........f Address � F ----•--. .... . �/ ..7 4, Ow ? Address a •---•---� tCK..y..:---����ST�'�:rif��-- - ----------------- ..... t-------�.........,���n�..�. Installer _ Address d Type of Building C(�1-%�l11ijk''N)ftl- 2-65bCalt;I)S JUti11_ Size Lot.. �� q. feet U Dwelling—No. of Bedrooms............................................Expansion�t•ic (N� Garbage Grinder (M) Other-Type of Building ._...W..Q?��...._ No of persons__._._.-__. V_tS.'_1.Showers ( ) -- Cafeteria04 ( ) QOther fixtures-.......................................... -••--•----..-_...•-•--•--•-••----------------..._..._---• •-•-•• ...... W Design Flow.............___6_�..................:gallons per person 7r day.. Total daily flow_.._... ��_.___.____________._._ �lons. WSeptic Tank—Liquld cap Ity I 5�gallons Length._.'f__j-0r__. Width.- .'�f:--- Diameter________________ Illepth_.. _-__Z��..-. x �r Disposal Trench- No. .__. 5 __.._. Width___ ._.. Total Length.........:... Total leaching area___-- ---sq. ft. Seepage Pit No-------- Diameter.........f-A Depth below inlet....... ........ Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank �L 7 Percolation Test Results Performed b __ . E....L.Xi Test Pit No. I.._.._� Aiinutes per inch Depth of Test Pit...4.al....... Depth to ground water...kX)...L.QAft-« Gi. Test I'it No. 2.......Z.+ minutes per inch Depth of Test Pit.....j.,Z!._____ Depth to ground water../_l;K?..4,-)iM. C� t r-----• -•--•-----•---•..................... ..•••-••-••--........--T.........;..--•--- -----•----••---_-- --••-----••- - ------- .O Description of Soil... ..-•- �> 1Y) y.:SV.I�;S�J(�-. f..-•---'--`-••-I �---- �J�.'•�I � ��.�.�.�.'• {�t*,L V ......................... .•---- --•--•--...---_•--- _- - ............ ....................................... __••---••...•---..-...•••...---- --•................-_.._...._._.._..---•••--•-•••- w ... ......... ........ ... ........ ----.---•----....._••---•--•------------.._.__. -................................. UNature of Repairs or Alterations—Answer when applicable...--............................-................•-............................................ .--.._..•----------•-•• --------------•----•--_.-.._..-•--••-••--.._..-.-.._.----.._.-.4.....•-• --••-----•- -------.....---..•-..___.....__... ----- --- - - -------•- ..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accord.nce with the provisions Of TITLE; 5 of the State Sanitary qde lT�lhe undersigned further grees.notto place th syst hPin operation until a Certificate of Compliance has been I'sd�y the�oa&Of;let'el�h L,.i x 4: Sig «...d..._....j�-'....... -- y . Application Approved BY..................................................'✓%'--..-•---•---•-••--•-•-•..__..._...-,._...- ------------ ------ - ------•••••••-- Date Application Disapproved for the following reasons__............._..........................................-.......•.........-.-......___................... ------------- ---------••--•----•----..............................._.......................................................................----•--------------- ......... ........................ Date PermitNo................................................... Issued.................. .................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .V .............OF..... .......................... (Iertif irate of Tompliallre THIS I1' TO CERTIFY That the Individual Seti,lge Disposal System constructed or Repaired ( ) ler at ...-.G 1- 1.r� ...........0 �C.,----• r - J has been installed in accordance. with the provisions of 4,,s he State Sanit try Cuir as descrihcd in the application for Disposal Works Construction Permit No..---------------------------------.-.._- dated. ... - .... .... .... .......... ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ISFACTORY. d •� 1 DA"I'L •-----•---°-------•--- �. Inpgctor - ._ .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... lr° ' .........OF-... ...................... )'G No......................... I''EE......................... �i o�ttt fur Tonotrurtiont Permit 5 n is hereby granted . .C:! "--:_ ___...C11Vsr (�/C.7 ..U- .................................... Permission y g 7( to Construct (X ) or Repair ( ) an Individu Sewage Disposal System atNo....................................• - ............................ ................................. .......... -...-.....----=-•----•-------- - --�?----------------- Street ✓ as shown on the application for Disposal Works Con,,,,,!. xr3xr NO�!r > � ed... .... ........ ....................... f. •---•................................:':.-•----._._._..........-•--•--.----•---•..................... � Cv Board of Health DATE................................................................................ i Wall 3-L3 No,... > ........... SUBJECT. TO APPRUMAA,.3fd............... THE COMMONWEALTH OF MASSACHUWS4rr46TABLE CONSERVATION BOARD OF HEALTH COMMISSION 3. i,�� .........'.o�....-. � --------------------------- , Iir than for Disposal Works Tonstrur#iun 111rnti# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at .. #I/CL.... ............. ............................. ...... ........................................_.... o ti -Address _ .............................................. or O Address .....�' rQ w�r 0 ..................... ��-J~�� ...... -�.=_ Installer Address { U Type of Building Cop,Et)i)lIll:i(ftl- 2(�r'»7�mS/0W17— Size Lot._�,J(; �q. feet ,., Dwelling—No. of Bedrooms............................................Expansion�f t•ic (IV6) Garbage Grinder (M) p`4 Other—Type of Building ...... Qj�?..... No. .of persons........... UN-1T-Showers ( ) — Cafeteria ( ) a' Other.fixtures ............... Q W Design Flow...................._55. ._-..gallons per person p`r day. Total daily fll9w....... "O------.----____-_____---gallons. WSeptic Tank—Liquid capa�jit {gallons Length•45.b..... Width..4 rQ . Diameter................ Depth_.. ..� x Disposal Trench:—No. �.l-� ..... Width. Total Length Total leaching are. ..............sq. ft. Seepage Pit No......../........... Diameter....44/.F-r. Depth below inlet...... Total leaching area..............:...sq. ft. Z Other Distribution box ( ) Dosing tank �L Percolation Test Results (� Performed b .. 4��4�= . Qka ` Date.. � ._ a Y .Il hg-.. --...�._._.:. 7 Test Pit No. 1......'sr—_-.e:._-minutes per.inch Depth of Test Pit.....Q.......... Depth to ground water.__ .._Lti !�1�� t=, Test Pit No. 2......2Z.minutes per inch Depth of Test Pit.....I.2........ Depth to ground water..&20_4h_)f� X. - O Description of Soil... x c, t C.I. - -•----- Uw ------------------------------------------------- ................................................t ......------------ Nature of Repairs or Alterations—Answer when applicable.............................................................. ..--------.-----------------------------•---•--------............................................... ---•----------•--••--••----•••-----------------............................--•-................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the=State Sanitary Code—'The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issu y the hoard of health. Signedy!�_--l_.-----�....--•---------------------•---.... -------- ... _ Date -.... Application Approved BY �: .... ................. Date Application Disapproved for the following reasons:.............. - `.............. ----------------=----------------------------------------•--..._....._.....__ ---------------------•--------------....------------...••-------------•-•......--------..._..------•----'--------------•---•--••------•-----•------•.... ------------ ---------------------------------- Date PermitNo.......................................... - ........................................... No........:............- Fuit ....... ........ THE COMMONWEALTH OF'MASSACHUSETTS _ BOARD OF' HEALTH 1�'A ,..5..71 L E"............................ Apphratiall for. Mipaiiai Works Tonstrurtion Permit Application is hereby made for a Permit to Construct CI) or Repair ( ) an Individual Sewage Disposal System at C D SIM Q,L -. VILL....� Of............... ............................... ... ... ..................... ti Address w iICK T...._ O ?�dL:e.s_s ..............�T .Installer Address' 'f Type of Building C(JI�%Jx1./11jll.i(�i►'3- (31�Ir_' }31�5/��17— Size Lot--`#::K, feet Dwelling—No. of Bedrooms..................................:.........Expansion t•ic (l�,j Garbage Grinder (V' ) a Other—Type of Building Qi?.__ r .....J!�1:u,.. _. : No. of persons.__.._.:__.�UN F.Showers ( ) -- Cafeteria ( ) 4 Other,fixtures__.._..._... ------------- •...... --------------------------- ........ W Design' Flow..... . _._ .gallons per person pyr day. Total daily fhgw........ +Q gall ons. e 04 Septic Tank--1-'quid cap- i.tx .. __..gallons Length.: _. .".._ Width.. ___f(� . Diameter.... Depth__ r._ . Disposal Trench_ No. .l``.�8� ...... Width_. Total.Length...........::.:..... Total leaching are2--•--:__..___...sq. ft. Seepage Pit No--------I.......... Diameter....e 4_.,". _--_. Depth below inlet.....1/11 _. Total leaching area..................sq. ft. 7 Other Distribution box ( ) Dosing tank Percolation Test Results (� Performed b �= � ! �Date:_ y _ _...r. 1A ,...._.. Test. Pit No. I..__._:fi-+--_minutes per inch Depth of Test Pit...,�_D4.._.._._ Depth to ground water... w Test Pit No. 2......_Zzininutes per inch Depth of Test Pit.....J_2 ........ Depth to ground water-./&K?..4�R'1��'-' �I r............................................... ._.. 3_:`.._..�_ .. � Description of Soil... ----- 5?. 6 J ."!.�i�.'�{rt�.�, x � U Nature.of Repairs or Alterations-Answer when applicable..................._ ._ ----------.------------------------------•.----------------------•------------••-----.....:----•----.....-----------------------._..-------------.....-----------------....................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a.Certificate of Compliance has been iss ed''b th board o lieal' y./J��l. / of{'�,r. F+W •. '�1/ ! %/ j Signed...__ ... ! [................•••---•-------- /! -- Application Approved By---• ........................................... Date - _ Application Disapproved for the follouring reasons__............._................................................................ . ................................................... -•--- Date PermitNo...................................................... Issued....................... ........................ _...:.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ IU.............OF.......... .► 7�yS.7.ljfL(. ............................. Trrtifiratr of Tomphaurr THIS 19 TO CERTIFY That the Individual Sewage Disposal System constructed (?) or l'epaired ( ) by......... . ..............= ----------------------------------------------------•-----.-_.._.._..-------- --•-•------._....---------- s-Iler , - at........ :A:�'y 1... . ..... 74-- 15�4.�f./ '�' fSZ. = t,/Y }.,...-.L' C.... i:.�..._.- has been installed in accordance with the provisions of T �The State Sanita ry Guie :i; described in the application for Disposal Works Construction Permit No.`....�..... �Lo....................._....... d;tted. _ ._ .._. ................... THE ISSUANCE OF THIS CERTIFICATE .SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ATISFACTORY. l:)A'1't�....,::. �}/ Inspector s. _....... ............................ 9 THE COMMONWEALTH OF,MASSACHUSETTS BOARD OF HEALTH .j' 7`�'w'N.... ....oF..:..... / ! L�� =:.......................... �S .................. FEE........................ Diavofia fur o Tonotrurtion Permit Permission is hereby granted........ . . .�L .:: ......(fdA) r1e.6L�Q -_. ......-•-•........................ ........• ................. to Construct �O or Repair ( ) an individ.0 Sewage Disposal System atNo................................................................................................................. .:_.... ----------------- --- Street as shown on the application for Disposal Works Construction ,Pe it �9...._._..__. 1�•t d1.f'..._............................... 10 -� ......................•••-•-.._.....-•-_.... -- -------•--•------•--•• ._..__._ /Z 51 Board of Health DATE..................................................•-...•-•-•................. .FORM 1255 HOBBS & WARREN, INC., PUBLISHERS Fss...-J....._.... .— , THE.COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH SttJI_CT TO APP ®VAS. ®� CiAp� S7-gELE C®MSERVATiON I-OU0 .....:...®F........ ........................:....COMIMISSI®N Applira$ion for Dtopaaal Works Toustrurtion Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at 14 o ti Address - ---------------------------- ------ ------ ... q� Installer Address 4U Type of Building COPED h•1 j&M)M- Z,:64► blC M-S/U.f-j i I Size Lot .... ��q, feet Dwelling—No. of Bedrooms............................... ..........Expansion t•ic (lV1� Garbage Grinder (I)o • No. of ersons............ .V1V�TShowers a Other—Type of Building -_--.:11 VU p /. ( ) — Cafeteria ( ) QOther fixtures ....................... .............................................................. W Design Flow...................? ... --.. gallons per person ear day. Total daily.flow...... Q_...__.__...._.____._..._ Ions. W. Septic Tank—Liquid ca a 'tA gallons Len h._.. .1. ... Width..5. 1. .. Diameter..._._. P 9 P g ---•--. Depth-. t!o:Disposal Trench-No. ..... t ... Width.. _..._.. Total Length......:.- ........ Total leaching area............ .:.sq. ft. 'S �Seepage Pit No.........l......... Diameter..... Depth below inlet..... ~ 9 g q -. .::.....:. �...:�.:: Total leaching area----•----...__.._s . ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by....... ... ...... .._.^.._ . + -- ------- Test AXY.- ! Date.. �h` Test Pit No 1 .....,�..-.egminutes per inch Depth of Test Pit.. .......... Depth to ground water...11� ?.._L�} r� Y f14 Test Pit No 2 .....ZZ.minutes per inch Depth of Test Pit,....1. ..... Depth to ground tx .......r--•---•---•-- --------•-•--•- T '.....:......:........... Description of Soil----�'---.: ------W- ) --�_V.. �1 �-- l --� ...�. .. �.�!�/ �Z.:, .•• •••. •--•••.............•••---.•--••----- --- --- ......................... -----P : ......................................................... . U Nature of Repairs or Alterations—Answer when applicable............:.....................:.....................................:...................... ..... .•...............• ---------•------------------..... ------•----------------.................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has an Zisd by thg board of he/al`th';� / Signed ,•--••--•---.. `--...�� .� .......... �`Z� 8/•-- A lication Approved B nat Date .Application Disapproved for the following reasons:........-..................................................................................................... ........................---•-•----•-..........................-------------------------------- - ------------- Date �3��t/,o��►�s 0 �r / f 3,,) ;.� No...................... Fall......... ......... THE COMMONWEALTH OF .MASSACHUSETTS BOARD OF HEALTH ;�l L' J........... oF_..... ............. Ap,phration- for Diipniittl Works Tonstruxtion 11nutit Application is hereby made for a Permit to Construct > or Repair ( ) an Individual Sewage Disposal System at 0 l?2M--- � I:'......9ILL._...0 ND............. o �.. n - . ....T� I ----.....-. .. d.` gy................... ..--.. _.r.. ..1....... • Installer Address ,' U Type of Building C(3K� (X)!}1jjUJl,'I''► - Z uc',,ICI�1�5/u�17- Size Lot..`�_:� �q. feet .. R Dwelling—No. of Bedrooms..............................:_...._.......Expansion'f�t is (hJ� Garbage Grinder (VIC) aOther—Type of Building No. of..persons I- TShowers--•--�uC�l:-•---- ' - ( ) -- Cafeteria QOther fixtures ........... ....................................................•----...._.. W Design Flow..................? .............. per person, per day. Total daily flow.......8. X;-_-..-_-_.-._-..-._--�lons. W Septic "Tank--Liquid c:apa 'tyi .!.J gallons Length.._. ..1.�?_._ Width .... Diameter........... x Disposal Trench- No. _._.Nt__.. .:_.. Width._.._._.:......... Total,Length----- Total leaching area......... • .-..sq.ft. Seepage Pit; No....._....h.....__...*Diareter..... .. ..:?+-. Depth'below inlet.....r __rl_:_ Total leaching area.:................sq. ft. ti Other Distribution box ( ) Dosrng tank ... < < .. a Percolation Test Result � Performed by _:._t�-.......��..�--•- �(.�Ut�l�iDate-.�:7!�'��?`_..:�.�_���� �l Test l'it No. 1------�,e-__.minutes per.inch Depth of Test Pit...It_Ds.- ....... Depth to ground is, Test Pit No. 2.......Zzininutes_per inch Depth of Test Pit.....1.,-,'...... Depth to ground O Description of Soil... .'_:-, ---...W.411:)• .._...&..`._..1..2-:...... ------------------ .......-.................................. ...---• ........... ...................- --------------- .: ............... ...............................:..__....._....----•-------.......__... .................. 0 Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the proVisiolls of L ITLL 5 of the State Sanitary Code ,— The undersigned furthrr agrees not to place the sys I in 7 operation until a Certificate of Compliance has been issuedb�,thboa ;of� e,Ilth.;f 'y� � �,�t, Gf'� ti^ r Signed j Application.Approved By...................................._._ ............................................... ��/ •• - -._--------------- Date Application Disapproved for the following reasons:................................................................................. ........ •---•--- -------------- -••--------•--••--••-•----------.....---•----•---•-••--•---.....-------•------••-•--------..........--•---•--.....-------•--•----- -- .-------------...... ----------- ................ Date PermitNo................................................... ._ Issued.............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Qrrtif iratr of Tnutpliaurr TI[IS IS TO CERTIFY That the Individual Sewage Disposal System constructed (7C) ur Repaired ( ) by-•--•.....Hla_L. ....... 0.0AJL'CTllr'!�.�..-•--------------...... ------.......---•------••------------.... --------------------- ----- at.......�:A �r '......`-4m!"..._.....LJ, has beers installed in accordance with the provisions o#:ATVV, 1" of The State Sanitary Gvlo :ts described in the application for Disposal Works Construction Permit N� el ......... ..........•.--......... dated. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIOR,SATISFACTORY. t DATE.......................... .. ./ ........................... Inspector. ......... .. .:..------------------------------- 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ZkY'v.........OF........ !. �`� = -, ................ .... No.... ... ........ FEE........................ �t,��rrr�tt 3�ur � �nti,�#r�.r#ivri rrutif 1 Permission is hereby granted-.. (. . . ! '..:_ .._.._�lJ/US K-�1<� -Q. ,(.. ...................................... to Construct �X ) or Repair ( ) an Individlu Sewage Disposal System r at No..••-•••-•--•••-•••-•-•---•--•-••............•-- ..............................................I.......... ....................................................... --------•------• . --- Street as shown on the application for Disposal Works Construction Permit Not z.. ,Dated... .... .................. ...... ............... ._...........Y ...._.......__......... Board of Health DATE................................................................................ FORM 1255 H01389 & WARREN. INC.. PUBLISHERS .................................................. lsSued. ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............6F .... .....It5j.(, Trrfifiratr of TvU*t:pjjaHrr­* THIS IS TO CERTIFY That the Individual Sewage Disposal System Constructed or Repaired by......... ...... 'y at--------641V. —j-0 . ....... .... installed in accordance with the provisions has been inst provsons o T L& ..... -----------of The State Sanitary Co .............. --------------- Code as described in the application for Disposal Works Construction Permit No.-(49W- .... d ated- .......... ........ THE ISSU VCNCE OF THIS CERTIFICATE SHALL No C NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL: FUTION SATISFACTORY. DATF..... ... . ........................ ........ -------- nspec .j... ... --------------------------------------------- BUILD iA)Gs /, 2. 4 .3 _` . .. 00 Z THE COMMONWEALTH OF MASSACHUSETTS A BOARD OF HEALTH a . '...._......®F ...... ....711E c cAppliration for 14sposal Works Tonstrnrturn 11trumfit Appfi&d2 is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System Ft:-Ai -- — 1 .. . . .......................... ..-----•------•------•---..... - ----...------......................... I ,., Lo ti Address or . .............................................. J....q--f#% �tzl.....��At1.44 O Address ........l...' l"�!:>.... �1h? t''cTjQrt ...._.. - Ll4 jZL .._...L .... co Installer Address U Type of Building CUll EV P41&/()j'►''1- 2 6gbewm-S/��11— Size Lot.. _I _ q. feet Dwelling—No. of Bedrooms............................................Expansion jktjic Garbage Grinder (SIC) Other—Type T e of Building W v�.?.l.-�_...... No. of persons — Cafeteria a YP g -----.....- P ( ) a' Other fixtures ...................... ... Q --------•-----------------...-----••--•------------------------_------•-----�•-.._..... ------•----............... W Design Flow..............5 ..............._.•._gallons per person per day. Total daily flow--------- f��loLLns. WSeptic Tank—Liquid capacciityZ gallons Length.11..1.__ Width.(........ Diameter................ Depth-. �7.._.. x Disposal Trench—No. ............A:.. Width__ .._ Total Length Total leachin area___......—.__..s ft. Seepage Pit No....'t.......... Diameter.....�74... Depth below inlet.......:_P.k Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by.......� .'/�?lam.... �Date_. �h`._ •�_���` Test Pit No. 1......Ze -minutes per inch Depth of Test Pit---J.D......... Depth to ground water...11.2 fs, Test Pit No. 2.......Z..niinutes per inch Depth of Test Pit._._.1.2 0.._._. Depth to ground water..&Xa..Z'J)W-' a' t r............ ....................................................-•-•T._......................................................................... O Description of Soil-••©- ......W --------!._.Sl�. �?��-- f----- ..... �. x c, -------------------- x ..._.���f:.-------- •---------- .............. VNature of Repairs or.Alterations—Answer when applicable............................................................................................... ------------ ------------------ -------- ----------------------- •------------------ ------------------------- •----------- -................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issu d y the boakd of health. ' Z Signed___ `� .. T .... ...... . Date.. ... Application Approved By............... � � .... � ....................... -•--•- ............. Date . Application Disapproved for the following reasons:........................................................... ------------------------ ------- ----_ ............................................................ ............................................. ....... .. .............................................. --------------------- Permit Pj )63 N6.�'.....�' 2. 3 Ficz ... � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF - HEALTH ............0F 7&E................. ..... Allptiratiou for Bi.ipniiul Worka Ton,strurtion Permit Application'is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .' ...4l�c ...L �00............. ........... ..................7 ................................-----..... tiAdresso or Ow Address a ---••--•� �C K ..... v r.USjlr:ri. ..................... ...... 1ra ..... _... .. Installer Address /' U Type of Building CUI_%J-i/Yljll:7L)ft1- Z(-�x�CL)0 1S/ul" Size Lot.-"#_:� "q. feet Dwelling—No. of Bedrooms.........................................:"Expansion jktjic Q46 Garbage Grinder (PC) p, Other—Type of Building ...... 4QQl No. of persons............ .UM-rShowers ( ) -- Cafeteria ( ) QOther fixtures' .......................... Design Flow.............. ..gallons per person per day. Total daily flow......... c� Septic Tank—Liquid capacit,L4(��g llons Length:-/..r _ U................ Ilons. `y _..Q-- Width.&. Diameter................ Depth_.6.1.1.I/.. Disposal Trench- No. ----- Width..... ........... Total Length ................ Total leaching area---------=:.....sq. ft. Seepage I'it No.... ..... .... Diarneter.._...1 .. Depth below inlet ...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test.Results Performed b �=Z�K� /�� P 4)( � Date_. �H' y 11'I Test flit No. I......2'Aiinutes per inch Depth of Test Pit...4.0...._._.. Depth to ground water; ICJ-,_L�a�IC-1CJ 44 Test Pit No. 2.......Zznlinutesper inch Depth of Test Pit.....I.,Z,0...... Depth to groundPr4l t _ r ................... ----..............•........... .. .. .... ..... ................. O Description of Soil... --....-•---••---•----------=-----••------•-•--------••-•--...--n _ _ . !� -----.k........ _......-•---•--••-- U Nature of Repaiis or Alterations—Answer when applicable...................................... . .. .. . ........................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with k the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place th system in operation until a Certificate of Compliance has been issued;t y;:t o rd of h"�-th.•'� j�/ ��Z/�/ ' Signed.......... .I.......--......................... ............ ..---•- A tication Approved B f'h �' ` � PP PP y---.....---•,_....: . ..:....j_....�.�.......:-•--- ........................................ Date Application Disapproved for the following reasons:......................................................................................................... •--•-- ------------------------•--------•------._....._.._......................................................................................... --------- ...- ----. ------ ------......-- Date PermitNo....................................................... Issued------........--•------ ------_--------._.--•-------- Date THE COMMONWEALTH OF MASSACHUSETTS 4*4 BOARD OF HEALTH �JYI��............OF...._ S61L(� ... (9prtif irate of Tomphatire TI11S IS TO CERTIFY, That the Individual Sewage Disposal System constructed (/-,) or Repaired ( ) b -•-•-•-••--........`.....................•---•----......-----.....--•-------•-----•-----------..........-•-----•----•--•---• - 6 , I Iler has been inst;riled in accordance: with the 1�rovisions of Ti, > f Yie State S;Iuit II}' (")do ;t: dcscribtd in the applic, oil for Disposal Works Construction Permit No.___ ...................... dated. _. .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 5ATIS.FACTORY. C)A'1'E.._.. y� ..1 # -..--•----------------- Inspector. .._....... -------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH u..N...... 0F........6f !?1 1.r4=............ No.--•--... ............ ............. U.ifyvfi t nr ii Tunotrurtinn Permit i y g ..:: .:.. ............................. . Permission is hereby rante<1__.__._.I . .�: _ �(�I�S�K.��-C.nIQ to Construct �X ) or Repair ( ) ate In(liv,du Sewage Disposal System atNo.:... .............................................................. ............................................................................................................................. Street as shown on the application for Disposal Works Construction. F'errnit No........ ------ IJ;ttr.d.._ ... .... .............. ! .........................................�; -------- .................................................. C. ',{ ✓ '' Board of Health DATE................................................................................. FORM 1.255 HOBBS & WARREN.- INC.. PUBLISHERS MOTEL N�F FkA/,/K 46'o •• R. MC DOVOUGH ae U.Y. o //9• 6 Mia 7•p0 _to zy,7 _ _ — N49°2o /a F-+ 99.95 a So•bo n Oar 4,a4 o,f 0 ° 0 NUJ• �. . uu/r4B a � P I�.7 � •lz,, roc. l e.o orcoaT "� �N/�.lA p•'7p" 0 bALI P.O6• y y J�,?� SB jZ­ 3z0 l \ xcovo rye Q1 .9 � �`4 7 1 #'' • 10.b3 J2.e cav/r 74 v n r .4Rar N ram g sr yM uv,r76 N ryi» !r LOT" O a` 1 omt P Q PLAN Boo& va• .� fir,^dS$O��sq, �1 �y C e7,0/8QGFES ti 3'.tr, ••, o ..,tar.acoq p �0 � I \ 8��1.VE55� b Ucr/r6g ry �h E \ ti o• N $ 6,766 S. + 90 d\ J z.o lo. ��V77AC USE CX//T� -sxe.q crbvv�t \0 a\�_ N C//J/r q g n 32.0 0 Yti•_ �'�.� CAV/r2••4�•00�4 �ear..•�.v.,,4, ' n ui./ir • U 7.0 0 r�= �LZ A N f� f/43T F(ppq 4 ri Z N�� c /v0r•a.R• p � "•� l Q ry' U4/I r/ZB ,q�" s a /a 5V J A(/ .Pv/tip a F n - EX. CAST IRON COVERS TO GRADE PROVIDE WATERTIGHT RISER AND CAST IRON FINISH GRADE OVER D-BOX= 202.8' 4" SCHEDULE 40 PVC FINISH GRADE OVER CHAMBERS= 202.01 - 204.61 3/4"TO 1-1/2" DOUBLE WASHED -�- COVER TO GRADE OVER ALL SEPTIC TANK MIN SLOPE 1 /o STONE TO CROWN OF PIPE GENERAL N O & 7_S FINISH GRADE OVER COVERS (CENTER COVER TO BE PLACED TO SLOPE @ 2% MIN. OVER SYSTEM � � H-20 CONCRETE RISER WITH FILTER FABRIC OVER 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS TANKS EL.= 196,2 - 199.0 ALLOW EASY ACCESS TO MAINTAIN FILTER) WATERTIGHT CAST IRON COVER `` VENT WITH CHARCOAL FILTER SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY ---- TO GRADE I ENTIRE LEACHING FACILITY APPLICABLE LOCAL RULES. __- - _ - --� - - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND TPLACE H-20 CONC.RISERS 12" MIN. TOP OF SAS = 200.5' WITH WATERTIGHT CAST THE DESIGN ENGINEER. _ 36" MAX. 36 MAX. 5" DIA. OUTLET(S) 199 5, 9" MIN. IRON COVER TO GRADE 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL 3" Min. 4 SCH. 36" MAX. a OVER CENTER CHAMBER 6" 311 g„ 40 PVC INLET TEE :�L BREAKOUT EL= 200.0 OF BOTH TRENCHES SYSTEM UNLESS OTHERWISE NOTED. 2"DROP MIN._ _ SLOPE 196,nin. PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN _1 3" T DROP MAX. JOINTS (TYP.) _ ELEVATION =200.0' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS j 14" 48" I 2" PVC IN FROM O po poo O p A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF LIQUID PUMP COMPARTMENT 4 PVC OUT TO o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEVEL CONTRACTOR SHALL o o p0 1 VERIFY CONDITION OF _ LEACHING FACILITY op pp o p 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. EXISTING TEES AND GAS BAFFLE p0 p�0 0 REPLACE AS NECESSARY INLET TEE 12" 6" 2' o o o o0 0 0 op 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. - - - 1000 GALLONS 200.17 _MIN. 200.0 O po po INV. OUT= 1500 GALLONS pp 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 193.4 # s° CRUSHED STONE o 0 0 0 0 0 0 0 p o 0 0 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 6" CRUSHED STONE OVER OVER MECHANICALLY o p - NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 193.0' MECHANICALLY COMPACTED BASE 192.75 COMPACTED BASE 4.0' 8.5' 3.5' 4.0' 2.5' 4.83' 2.5' AND DESIGN ENGINEER. (TYP.) EXISTING 2000 GALLON 2500 GALLON TWO COMPARTMENT 6 OUTLET DISTRIBUTION BOX 40.5 8. ELEVATIONS BASED ON ASSUMED DATUM OF 200.0' OBTAINED FROM A NAIL SET IN A PINE SEPTIC TANK SEPTIC TANK/PUMP CHAMBER H-20 TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 186.31 9.83 TREE AS SHOWN ON PLAN. ( ) BASE. FIRST TWO FEET OF OUTLET 197.5 12'-211 61-8„ ' " PIPES TO BE LAID LEVEL. ' 3 - 500 GAL. CHAMBERS PER TRENCH SHALLOW (APPROX. 179.1' PER 5' MIN. CHAMBER EN9 VIEW 9• UTILITIES LOCATIONS ARE SHOWN AS APPROXIMATE ONLY. CONTRACTOR SHALL VERIFY LENGTH WIDTH DEPTH 7 -2 SHALLOW POND) ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 CROSS SECTION VIEW I-YPICAL CHAMBER PROFILE HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY OTHER SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL (H-20) CHAMBER DETAILS (H-20) APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO THE DESIGN ENGINEER. NOT TO SCALE Y NOT TO SCALE NOT TO SCALE -- --- ----- -- 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE 1"TOP COURSE -- T-� TEST PIT DATA I WATERTIGHT. INSTALL 1-1/4" PVC TO HOUSE. JOINTS TO BE MADE (CLASS I BIT. CONC.) ;.%► -,,;'•-,,' �f `r,✓ ."".�;` rf r t -,� a� � '+:: �, j PERC NO. 15104 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING WATERTIGHT. WIRE PUMP AND FLOATS TO SIMPLEX �++,►�' r ..ts ' , 2" BASE COURSE �, .�. �� r _w. , IRS CONTROL PANEL No. 1-CC2 NEMA-1 MFG. HOOVER _ f., ' • , ��, tJ: INSPECTOR: David Stanton, REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM 0. INSTRUMENTS. (CLASS I BIT. CONC.) o 0 o y ,. `s r.J�-,r, ' %., :, �l �''-; /� �_.-,. ' '$r„ y APPROPRIATE AUTHORITY. SLIDE RAIL(TYP.) !,.,�,; , , •. .--„ 1 +;r., SOIL EVALUATOR: Edward L. Pesce, PE 9 8"GRAVEL BORROW, •' ;°�.,� ,,;•-;� - �. C.S.E. APPROVAL DATE: April 1995 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED NEMA 4 JUNCTION BOX CORROSION RESISTANT& MDPW SPEC. M1.03.1 "'` " LIQUID-TIGHT CABLE CONNECTORS SUPPORTED HOISTING CABLE 7 x 19 STAINLESS STEEL CB/ ' -_ r', UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND 193.0 (95% COMPACTION) `^'- r1r, ` �x. ,•.►'*` DATE: August 3, 2016 1/8 DIA. / 1,760 LB. STRENGTH (non-leaching) o 0 o vA► ,,, ,.,� �'"'-� _ H-20 LOADING. CONNECTORS SUPPORTED BY 1-1/4" PVC CONDUIT, � � #:r '"�+� ..._ �.v.../ o �'�. ^',�,-.. .�-. �,, JOINTS TO BE MADE WATERTIGHT / `J' '•'a' ! ..�'„ r '� f1 TEST PIT#: 1A 2"BALL VALVE w/ UNIONS SCH. 80 PVC / X. �� '`" -r� J. `• �•" .•� I 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. GEORGE FISHER CO. MODEL NO. 560 // / // r' ZONE 2 `'• �= ELEV TOP= 198.0' PAVEMENT DETAIL LOCUS 17 6" -r- �, I ''" y��. ,.► '=.. "' '- /i � ELEV WATER= < 186.3' 14. WHERE REQUIRED CONTRACTOR SHALL REMOVE ALL LOAM SUBSOIL AND UNSUITABLE 2 SCH. 40 TO D-BOX , MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. -_ 2"DROP MIN._ - 1500 a �°� N07 TO SCALE / ,". � 0. S GALLONS 2"SCH. . I/;�- ""'. .,: 13 3"DROP MAX. 2 SCH. 40 TEE w/CLEAN-OUT CAP l ��� , NT \ i O y'.; PERC RATE= MIN/IN REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 7-2 ALARM ON / .p� fig ' .er. , FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 60" GAS 1/4"WEEP HOLE IN DISCHARGE PIPE - ° •• /. " 7 DEPTH OF PERC= 5'_g�+ LIQUID BAFFL h �( r DESIGN ENGINEER MUST INSPECT THE BOTTOM OF THE STRIP OUT BENEATH THE 4 � �Y LEVEL UMP ON /� // t� }..- ` r v �.r/ s r , loo0 18"ZABEL FILTER - // i r '� °� ' '•y ; ,r �'• TEXTURAL CLASS: 1 LEACHING SYSTEM TO CONFIRM SOIL TYPE AND DEPTH OF STRIPOUT. MODEL C 2 BALL CHECK VALVE SCH. 80 PVC 100 / �/ GALLONS PUMP / , � �I►_ , +a1�"w , �1 (CASE AND CARTRIDGE) - - 15 ND IN P.S.I. FLOWMATIC MODEL No. 208S CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND COMPARTMENT WALL �o,Lj 10h •� ,� ' ' , • 0" 198.0' SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. EO / \ IBM EL=200.00 ASSUMED A (2)WIDE ANGLE CONTROL FLOATS 1/4"WEEP HOLE IN DISCHARGE PIPE // ` SPIKE IN 20" PINE i a• .,'' , Topsoil 16. PROPOSED PROJECT IS LOCATED WITHIN: BARNES 073618 o 11" 197.1' 1: PUMP ON/OFF 120 ACTIVATION V2" SCH. 40 PVC DISCHARGE PIPE /// `' r" �Ji' , Y . y ' ;,r ASSESSORS MAP# 253 LOT# 013-10 2: ALARM ACTIVATION (2) BARNES SE411AU PUMPS, 66 GPM @ ` o,� %j/ �G5 ���G I 0fvj �� � p 4�, "s "" '" °,` B C // �� r ` j ' Loamy San FLOOD ZONE X AS SHOWN ON PANEL #250001 Co562J ,r L d 15.5 TDH, .4 H.P., 115 V, 1750 RPM, 5.44 IMP. �� „/ .� i L I �� +�.�� -- - - " t " 1OYR 4/6 2500 GALLON TWO COMPARTMENT DIA., 2 DISCHARGE PASSING 1-1/2 SOLIDS ` _ KING �� '• �"v '� 3 i 36" 195.0' 17. TEST PITS#1 AND#6 AS SHOWN ON A"PLAN OF SANITARY DISPOSAL SYSTEMS IN OR EQUAL-PUMPS SHALL ALTERNATE ��\ ......_ � . / REA / / ' !<;..''. y ,'` '`'` y m�),� �,,.. SEPTIC TANK/PUMP CHAMBER o ® _ ` I HYANNIS, MA, PREPARED BY ELDREDGE ENGINEERING CO., INC., REVISED JUNE 11, I Dc�� � G" � / ' �, / i � ; , '-•i '® 3`��•`6�-�" 1i � �,� � TP#1 � TP#6 LOCAL UPGRADE APPROVAL REQUEST / / x ° Loam and 193.2 o Loam and 201.3 ' / \ P / ;•/ M-C Sand 9h / 1 \ / �r / , i�-.1 x _,/ , r,r and Gravel Subsoil Subsoil IN ACCORDANCE WITH 310 CMR 15.401-15.405, THE FOLLOWING LOCAL � C1 20-25% v / o, Z. ' ./�t. , "rra ^. * ( ) 3 190.2 2 199.3 UPGRADE APPROVAL IS REQUESTED FROM 310 CMR 15.221(7): / \ / / �� �°' , s 10r� � � �i �; 10YR 5/6 q G 1 TP�2A-L- --_� _ o- 4 ryir�' �,,� r f Coarse Coarse (1.) A 2.0 VARIANCE (5.0 -3.0) FOR THE MAXIMUM DEPTH OF COVER OVER \ 2 STY Tt: 9g5 _/N N 4 `A ' . f �'; w:c! . Sand and Sand and THE SEPTIC SYSTEM COMPONENTS. � W/F WELLING / ` (/ ,'� �/ ��� °'_ /`' $ ' � r, +r�� '' r; 100" 189.T Gravel Gravel _ D 1 A& fp w, / `to m --` Med. Sand 13 180.2 12 189.3 UNIT 9 EL � / / h _ C2 2.5Y 7/4 o -- NOTES: G �, r ti 2 STY \ ,'/ / 01 - / , / = LOCUS PLAN 140" 186.3' F LEGEND W/F G g9.2 / ✓ ' ' No Groundwater 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP ,o �/ , 'f i DWELUA&B FF��- / /i �y0��'LO `` / 9^ SCALE: 1" = 1000' I EDGE OF EACH SYSTEM COMPONENT. / UNIT 2 , - WOOD / i/ p5 r i i -o - - 50 -- - - EXISTING CONTOURS 2. ENTIRE PARCEL IS LOCATED WITHIN A DEP APPROVED ZONE IL DECK -� ; G��x / CB ®� - Y -- - --- - ----- -- - - - 3. BASEPLAN SURVEY PROVIDED BY CAPESURV, HYANNIS, MA. 2 Sr( / / ��l i �RS200.5�,L �' it �� �o � I EQ r PIT DATA 5 PROPOSED CONTOURS W/F G _,98'2- - , , % 20 J_ BIT `; I ; ` / 2 f1�E S I G N 6..lr'�1 Tk. WE IN B , M oD / PARKING ti PERC NO. 15104 / D LL & FF, WO ��� /. LOCATION OF FORMER AREA I•` �\ i ---- - W --.------- EXISTING WATERLINE T �' / �r''� /� ' I C _ INSPECTOR: David Stanton / 0NI 3A `, ECK / LEACHING PIT �,, �, �� I NUMBER OF BEDROOMS (DESIGN) 8 I ,, F, s I� S R={201.6' �� -' "�' �I PR. (3) 5W GALLON DESIGN FLOW 110 GAUDAY/BEDROOM EXIST . = 3' I '� I ; Ex. Vent PiDe a'- ,� SOIL EVALUATOR: Edward L. Pesce, PE EXISTING UNDERGROUND UTILITIES 6 ' TANK, ° � BE REMOVED) 23 /CH IN A i14�Nf�f TOTAL DESIGN FLOW 880 GAUDAY Aril 1995 ° _ C.S.E. APPROVAL DATE: P 00 1 N - , DESIGN FLOW X 200 /o = 1760 GAUDAY DATE:FF'19 J _rn \ \ PR. VirJVfi W11H �� CONFlGURAl10N ii E: August 3, 2016 TEST PIT LOCATION 11g / F WOODY 1 \ � CHARCOAL FXTR - s ' cs7 0 FOR 2) I 9 GK O is, / /' USE EXISTING 2000 GALLON PRIMARY SEPTIC TANK AND DE - > 5 TEST PIT#: 2A Ex. D-box / - �� / O PROPOSED 2500 GALLON TWO-COMPARTMENT SEPTIC TANK O O EXISTING 2000 GALLON SEPTIC TANK XIST Top=195.9' ^ ' r> L G� ELEV TOP= 198.5' ,,,r�REAK0 p i� / i \ I UTILIZE FIRST 1000 GALLON COMPARTMENT'AS A SECONDARY ; i '� E a ELEV WATER= < 186.5' PROPOSED 2500 GALLON 2-COMPARTMENT R=196 2 e� / <� / u `- 1 TANK AND THE SECOND 1500 GALLON COMPARTMENT AS THE - O O I O SEPTIC TANK H-20 h \ w S / � - ,{� PUMP CHAMBER PERC RATE_ <2 MIN/IN 11' #L 1 4" SOLID SCHEDULE 40 PVC PIPE DEPTH OF PERC = 46"-64 e cP , 4 i�M NOTE #17) 1. to SAWCUT EXISTING INSTALL (6) 500 GALLON LEACHING CHAMBERS 0 2� cp PAVEMENT AROUND IN TWO SEPERATE TRENCHES iI SAS AND REPAVE TEXTURAL CLASS: 1 -.�_.__ _____...__ 2" SOLID SCHEDULE 40 PVC PIPE I OF Lown/' �\ ' ACCORDING TO J�O�O t 3� G �0 / )\ • \ PAVEMENT DETAIL 6P�0 �991 ' ` sO / i I \ �1° SIDEWALL CAPACITY °„ 198.5' p DISTRIBUTION BOX (H-20) �_ 5 / �OF', 4 / �� x /�`� �' "� `' B \�-\ �� (2) (LENGTH + WIDTH (2 SIDES) 2' HIGH .74 GPD/S.F. = GAL/DAY A Topsoil 500 GALLON LEACHING CHAMBER H-20 PYf �• g�� L / (SEE NOTE #17 (2) (40.5 + 9.83) (2 ) (2 ) ( .74 GPD/S.F.) = 298.0 GAUDAY 7 197.9 0ii,^) r L0� REMOVE A REPL,4CE 2 9/26/16 BMB ELP ADDED SECONDARY DISCHARGE PUMP w c /�O Lawn / /UNSUITABL MA AL o B Loamy Sand 9 0 / oa �, ro c sorts IMT}f BOTTOM CAPACITY - 1oYR 4/6 0 1 9/21/16 BMB ELP ADDED TANK, PUMP, AND REV. LEACHING AREA CLEAN,,COARSE/SAND / � 2 LENGTH x WIDTH .74 GPD/S.F. GAUDAY 45" 194.8' (SEE NOTE ,{"I AND INSET) / O ( ) ( ) j REV. DATE BY APP D. DESCRIPTION ! PR. 2,500 GALLON, �G w/ i I / / / / a (2) (40.5'x 9.83') (.74 GPD/S.F.) = 598.2 GAUDAY 46" 194.T - � TYYn COMPARTMENT, 5�v�'��P� w LOCA110N OF FORMER / BIT Perc ' SPOT GRADES REPRESENT THE APPROXIMATE ti5 LEACHING PIT o� PARKING r PROPOSED SEPTIC SYSTEM UPGRADE ,SHALLOW ELEVATION OF CLEAN SANDS BENEATH THE PROPOSED I SEPTIC TANKAO MP o��( � F w'`��`� �� o� � AREAS � ' 64" 193.2' 1 PREPARED FOR: SOIL ABSORPTION SYSTEM. THESE ELEVATIONS ARE CHAMBER (H-� J / C(��GgO w c�'�.`� R�r;. I I TOTALS: M-C sand SHALLOW POND CONDOMINIUM R POND ' �\ U TRUST, C/O TAKEN FROM TEST PITS PERFORMED MARCH 1981 AS PR. PUMP �� �;' ti 5��,�gP \�,) C' �' � CURB � � � TOTAL NUMBER OF CHAMBERS 6 (20%Gravel) ' SHOWN ON A PLAN BY ELDREDGE ENGINEERING CO., W ELECTRIC LINE <<`' F ��'� \ c - , I C1 10YR 6/6 CAPE COD AND ISLANDS PROPERTY MANAGEMENT INC., DATED JUNE 11, 1981. 199AAL AND \ 'r' J� `�I G '�C+ w / ��� TOTAL LEACHING AREA 1198.9 SQ.FT. �- _ LOCATED AT AUDIBLE (A GREAT POND) x ? "� �SUALARM LOCATION \ �� 5 �oP�� ��TF94 �� SHALLOW POND CONDOMINIUMS � TOTAL LEACHING CAPACITY 887.2 GAL./DAY ELEV=179.1' (20/JAN/96 IDS•+/BE1,ow " CO '` tioy -� / �E�o 817 OLD STRAWBERRY HILL ROAD ASSUMED DATUM) 1SIPOUTOF gp N �� �_ J�� ter' 4IF /�TioNW " -- - -- -- -- 105" 189.8' 130Ro� EX. ELJEN IN-DRAIN \ 5���,���P�� EX. WATER Med. sand HYANNIS, MA (UNITS 4A, 4B, 5A, 5B) / Z LEACHING FIELD - 191.OX ° ! SYSTEM TO BE MAP 253 `�0 "51 METER PIT DOSING & STORAGE REQUIREMENTS C2 2.5Y6/4 / SCALE: 1 INCH 20 FT. DATE: SEPTEMBER 13, 2016 • . x 199.0 ABANDON LOT 013-10 J�� IF , / SHALLOW POND DESIGN FLOW: 880 GPD 144 No Groundwater 186.5 _ PREPARED BY: CONDOMINIUMS x200.0 DOSING REQUIRED: 4 CYCLE/DAY 880 GPD/4 =220 GAL/CYCLE of ASSESCE 192.0 / to 1500 GALLON COMPARTMENT/5 FT DEPTH = 300 GAL/FT �Pti fARD L. o�, ENGIh-EERING �r o PESCE & ASS©CYATLS, INC. / 193.OX \ U t� ^' DISTANCE REQUIRED BETWEEN PUMP CIVIL / • 200.0 N N v ON AND PUMP OFF FLOATS: NO. 3200'1 Edward L, Pesce, P.E. 451 RAYMOND RD O 6?>>3),, °' 220 GAUCYCLE - 300 GAUFT = 0.73 FT/CYCLE c � PLYMOUTH, MA 02360 1 �S•+/BELOW O' rri (USE 0.75'TO PROVIDE FOR BACKFLOW) i L D L epesce@corncast_net Rhone:508 743-9206 x 15TRPOU OF SAS STORAGE REQUIRED ABOVE WORKING LEVEL: 880 GAL. ' J cell:508-333-7630 FAX:508-743-0211 194.0 g0 SCALE: 1" =20' SITE PLAN Os STORAGE PROVIDED ABOVE WORKING LEVEL: 900 GAL. �. ram►+/-1 SCALE: 1" =20' Drawn By: BMB Designed By:EL Checked By: ELP JOB No.3588 -- 2� M 9 4 7777 771, Y .( y , , t4 {��'7�aG .e _ - . °S ,�', ,. .. -may. ;}'t t•:f� f tt��, rt�r ,.1 rn±�Yi� : ,..1. : ^ : , d , d • 44. , ,l 4.j%;; EXISTING FOUNDATION 12 _ G� vent '" "-_" _ Vent 2' ; End View Finished Grade 5 4' SCH. 40 PVC N 4' SCH. 40 PVC AS(M CJ3 Clean Sand P ASTM C33 Clean Sand ' SLOPE .02 (1 4' PER FT 6. �E •02 (1/4" PER FT.) l �` 4" PVC Perforctea P',je ,i "IN-DRAIN" 8io-Mott ' 1 1 �.,,,,�._� e� XZ I11 +: " fall t�- Mra �a�.^ �e� �r It i ��r 'm.' 'krr^.tr^ r _ ,..y.. {.: -� �92.8' r .. .,+ , .: 5, i .T� t r.t r r III 14 "s t'''N.`iyt.'id.� a f ,jtf ditil a al It.. .w 11 d i' �� i !Y 1�4. �T u 1 yyv / Existin 193.7 �MN. ¢ �j� /d}, .'." tri i t 19 it?� t d. I I ,tt i.e t a.t. F r 193.a ;1 .iW4;l, .9� .` .f.+d4e.n wk�ww dr y� ''� ¢^s: r t •Y'�f� t,• •A�h f,��_;,, e�.L:i��•,f•:. y�:` •i Ir4, 17' .,. r•�x• S I .- •Y,. r:. N-y.'.y, 17 .dr. , di.. ♦'....i11.r.v 193.2 i - q i +�6 ------ .�• ` 10' min. 12' ----+j 7 93 0 / r _ --4_._ _�.__�"� 3S �"__ _.4' �...,j.1 12' Existing Septic Tank Proposed Distributior; Proposed IN-J,RAIN Leaching Field Sys C4m Proposed IN-DRAIN Leaching Field System 2000 GALLONS (PE ORIGINAL DESIGN) BOX iv r S. N.T.S. (H-]0) (H-10) Desire Calculations: Septic T<,-ik: Leaching Facilities: SEWAGE +�/ /�� DISPOSAL ,"+ ;y Design 1=1cw (no garbage disposal): 8 Bedrooms X (110 GPD)75X = 660 GPD SE WAGE DISPOSAL �" Y IF REPAIR 8 X 11'.'.PD/Bedroom X 2' - 1,760 GPD Use 3 Trenches of `IN-DRAIN' System by EIJen Corp. �y /^► w Use LTAR - Effluent Loading Rate - 1.1 GPD/SF FOR BUILDINGS 4 5 Use Existing 2000 gal Septic Tank Use Effective Leaching Area - 6.2 SF/LF (per DEP) N07 TC SCALE Sidewalk (38'+12')(2' h/gh)(2 s/des)(.74GPOIV)-148.0 GPD Bottom: In-Drains:(3 trenches)(36' X 6.2SF/LF)( 74 GPD/SF) 495.5 GPD End Areas:(3 trenches)(2ends)(4'wldeXi)(,74 GPD/SF) = 17.76 GPD Total = 661.3 CPO > 660 GPD EXISTING FOUNDA T70N sI ' " of i/d-1/z +� r �� ti , �.w .,•-......."�+.r+s ' '� ;. ,Noshed S at t an e ` 1 ^�i�..x ,r /'q /f ,:"-,.. .,r�r ,��a„�h. ., - --- '• �i, r�s+• 4 SCH. 40 PVC 7 Concrete R;see r SCH 40 PVC w. _ ^� Tan ''' Septic ic. -� Otiign Flow (no gorboge disposal) I ?95 4�a.7� Ventr.r SLOPE .02 (1/4' PFR FT.) SLOPE .02 (1/4" PER FT.) ( 9";mint 1.'', Bedrooms .: 10' W 7 ems- -- 2' Use Existing 2500 gd Septk Tank I, } F_xlstin c MIN. 5' 194.4' r? o 000 ° uo�oC rluda Slope-0.t7U.5 min y oumo° 0 194.7 G" o 0 666 d?1 2 5' ddT�! oo by o 00 0 0 0 -t Leaching Facilities: 192.9' -i- �� - ¢ Design Flow For Leaching: 10' min 12' -- 193.1' i 12 Bedrooms X (110 GPD) = 1,320 GPD 3/4 to 1-1/2' B 192.5 END VIEW Existing Septic Tank Distribution A 192.6'r Washed Stone ! Ci792.2' 2500 GALLONS (PER ORIGINAL DESIGN) BOX B: 192.E i D ' 192.1 1-4" Perf PVC (SCHD 40) Use 4 Trenches - 4'wide x 2.5' deep x 54' long (H-10) Sidewalk (4 trenches)(58'x2'x2 sides(.74GPD/SF) - 686.72 GPD D 192.4' PROFILE OF Proposed Leaching Trench Bottom: (4 trenches)(54'x 4)(.74GPD/SF) - 639.36 GPD 1,326 GPD > 1,320 GPO SEWAGE DISPOSAL SYSTEM REPAIR Total Leaching Area = 1,792 SF FOR BUILDINGS 1, Z &3 NDT TO SCALE Soils: Title: TEST PIT #1 PROPOSED SEPTIC SYSTEM REPAIR GENERAL NOTES: Pert Test /�P--8625 Horizon Texture Color Test/ Board ate: 4fiiE �S��sr_e c:� 2" .......... .r....n.."St .......__.......Np.......,....1 AT 1. PLAN REFERENCE PLAN BOOK 362 72. Board of Health En e, esge ny_ t A C us ed Stone _Sl��� Blue Stone � 2.) THIS PLANS FOR THE INSTALLATIONS REPAIR O AN EXISTING SEPTIC SYSTEM I � 816 OLD S TA WBERR Y HILL ROAD Representing: Pesc_o 1-11 AND NOT IS TO BE USED FOR SURVEYING OR ZONING PURPOSES. -' (subgrbdef iCD 3 i.eano Lane 3 4 ........................................ ........ 3.) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. 05erville MA Loamy lOYR 5/6' a TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS Excavator LAW-i+IAC 8 Sand SHALLOW POND CONDOMINIUMS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 24 ..................... "' "........ •••• -1S3.6' Medium erc a I N 4.) ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN Sand & Tesf 12" OF FINISHED GRADE. NOTE: °. Grovel �_ 5.) EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME, _ _ 19 3.6' UNLESS NOTED BY FINAL CONTOURS. The need for a second test pit was waved 78' C • OYR 6 6 ,Q f�� HYANNIS ,�N Otr \,, per Mr. Ed Pesce and Mr. Ed Borr due to 90" Gravel Layer / BARN STABLE ( ) MA SS 6.) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF ': ��'"�. �C p y tiledium thick frost layer and other site ..onditions. » , WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR w1THIN / _,N `C Sond & I FEBRUARY 2, 1996 (rev: 22/MAY/96) Scale; 1 =20 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED ti, sr Ff)WARG 1. Gravel UNDER OR WITHIN 10' OF DRIVES OR PARKING UNLESS NOTED. .I0 PF C'E 1 1 720 186.6' ;iv�l I No Water • 7.) ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE 4 pro 17001 Pesce Engineering & Associates capesury MORTERED 1N PLACE. r ���q 3 Leona Lane PO Box 718 eit�f°_` . .` :` Percolation Rate: ' rr,rn,'7:i Osterville, MA 02655 Hyannis MA 02601-0718 8.) ALL PIPE TO 8E 4" SCH 40 PIPE. tiSY16 a� '' (24 Col/5min pert) 9.) THIS DESIGN DOES REQUIRE APPROVAL OF VARIANCES BY THE (508) 428-3730 (508) 790-7902 voice/fo- BARNSTABLE BOARD OF HEALTH. 10.) LOCATION OF UNDERGROUND UTILITIES MUST BE VERIFIED BY � �� y 96 Field: RLH RIM Date: ,/, W '96 20 0 10 20 40 "0 DIGSAFE PRIOR TO EXCAVATION. Caic. Desf n: RLH ELP Draft: RLH MEN Review: P SHEET �2 OF2 File- WG Title: PROPOSED SEPTIC SYSTEM REPAIR HATHAWAY1\ CB/ -192.9 PONDS - AT (non-leaching) A� 816 OLD S TA WBERR Y HILL ROAD l LOCUS SHALLOW POND CONDOMINIUMS PawD IN /l NT rnf 194oching) ' O ;.' BARNSTABLE (HYANNIS) MASS SEARSE4 \.,. „ , , , , , POND / SCO/e' 1 =20 Leaching basin to be rt-. e d / _ FEBRUARY 2, 1996 (rev: 22/MAY/96) with new drainage Swale t.� rwlororc-.d hash ' LAKE > � \ MEQUAKET � 1Pesce ]Engineering & Associate caplc_�su y ,gti j TBM EL=200.00� ASSUMED / / Q' .. \ ^,A, , 3 L.eona Lane PO Box 718 � New location of leaching bas�l�ji/ �5�', �CP. SPIKE IN 20' PINE Osterville, MA 02655 Hyannis MA 02601-0718 ( 508) 428-3730 (508) 790-7902 voice/fax / ®� 61 e LOCATION MAP (i' =200o t) \ \�� 9 .a` °c h� e v , P /, ,l � I 1 car �`�• cld: RLH RJM_ Date: JAN196 20 io zo +o eo L �.� / R� P alc. si De n: RLH ELP Draft: RLH , � '' i � ✓ r —20 .. , ✓- =� I .� RFA i Review: ELP12 SHEET OF ti .. .. � ,'C � \ / ��'� •� ' r File: C158G1.DWG DUMa 200 �� \ - 4 / 0' / r -„ 199 / T \ \ G N 41 J ' n , r---�; 03 Il. gICNA)0 _` �C3!",'srTr, //X EW i '[" co REFERENCE: � co Assessors Ma 253, Parcel 13-1 CC ' I „ /qq STr V-eox �� ��`' ;� / £ _ -�/V Deed Book 3462/127 ,xI 14,0n c / W/U Plan Book 362 72 Asa ZONE: �'�. �►' o / QC /' c� 0. RC 1 & B � ` C� ,, '7 _,.r Groundwater Protection Overlay District z /,q , q � , it F// GP - Groundwater Protection District , r o L. F GK >' � � GQ'�z ( CA 0 Ty • QS. / 1 / pal^ A / yv0�,,_ �/i SEE SHEET 2 OF 2 FOR DESIGN DETAILS o t? / s ��, rAILED �•--- ,��� a / 1 EXIST J I i ,v?"I G- • .� ;I ,�/ miTAV�l- , ! Prepared for: SHALLOW POND CO'dDOMINIUM TRUST / l ' '� ', - RM •/ r If ; a OS Tr-R-o ..,'1. i° A +12('55 Q, �-� "�/ I 4`` \�+ \ 'AM ,`a, / ., 1� / •y ` J4, 3 > w QRA- GRASS SHA L L O W I � POND � / ,( P (A GREAT POND) er ELEV-179.1 (20/JAN/96 ASSUMED DATUM) ' O /5� \,\t'P I is r �G NVL R 0 J r Vi rri . wraM..ew.r»rrw,.rrrwprar';•=.wwr.,..+ww,..swnwr..uw+w•.ancr.«ew:a,:aa.amuu,.r•wwwuraowM.++wrwwrwrsw...+rrnnuw,H,.win.,,.,,.... ,.... ,:.+r,+w, ....' w.:,,..... .:.,..,w:n.:•+vr..rr.wawr.- m .. y a- 4-., f,..»`e+,k �, ,�:I•t-`�d�ir°�Y,�'Ii.RNaF'rS@W,".� �''� .. MOTEL I 32.0o io z9 7� _ /V 49 �J /D "�—� 9 9.95 /V 4? '0$ 2orES9,8/ D �Ia o - u 23-89 - 0 23.9U So,6o fil L ,o i t I ell ',/ o I 0 .0-- o TN � I , � 5-048 54„vy � � � N I °I DV S fZ P tJA//T 2 `9 0 / \ 3 , D 1./ a 220 Q `'19 0 32 a 3� Fik.:y r III=/ A� s �5 wee J may, fj cJ.v/r -76 N 3y�.. � L. � •` '• dos 50 �t8 54" !R . �•'. `� '�¢ \ CUES -t- -S 4 9 944-'S 0'W y � a 'J,t// 7- ct i �0 o , l88 I ° 3�,0 -SECCID S7�y�K \ ury/r G� C�lCJ,C!/ 7- 9 to N � BCX.L'4tEA0 bILZ 32 0 f \ i FiQST ' -op,i2 nl lZ � 0; 32.o \ •` n FiF15T FL yLx• � V CJ r )�!/T p /74ST� q 0 0 v 3Z- li1 p0 ly o p�/ / V Q o 0 14 o 2 n , o a P 0 v 4 A4A.o,110 TMKk L{1 J ;Z i bOb 1 1 (, t7 o► � t SC)rl P 1 •`S,`-\Jems /,���. �, p `�. C CERTIFY THAT THIS PLAN A4A S L, �• BEEN PREPARED /N CONFD'�Z/r;ANCE v� � ' TD THE �/,4AI I, I976 ROLES- .AN0 / • / CERTIFY THAT THIS NLArV FL/LLY AND AC- REOULAT/ONS aP THE 5AR/YS`T. ,6LE CU/ZATELY OE'P/CT.S THE L0CATJD/V AN0 COUNTYREr�/STEWS OF1.�EEDS. /VOTE O/IYJE/V.S/O/VS OF "rHE 8U/LOINGiS,4S OL//LTL /fj 8� L L A IEA S U/�EMEN 7-S A RE T� k� / A 4/0FL/LLY L/°5'r5 Tfh/L-= U/V J T.S CO/V TA //V F.D �A TE c / Th'E CONCRETE F7 JNL /�T/..�J�/5 s TI-1E.?E/A/. 4z' GQ b' REC/STER,ED LANO.SURVEY"vR a � L A /V \ �b RA`GIS TERED LA/VO SURY.EYo,4e SHALLOW PO/VD CONLDOM//il l OM Its, Z ! f/EREBY C',PRT/RY THAT T,-/E PROpER S NYANN/S 8�1 RNSTA ,BL, SASS o , f SNOI/VN O/V TH/S PLAN A R-= Tip IE LINES O/V/- FOR VINE EXISTING OWV46R51//10S, AND THE LINES t..E�EL - SOU/ELDS CC`r�TQ�'T/CkJ �^. I,C�C. OF T/-/E 5 rR I7--5 A/VO PYA Y.S Sh/O!N/y 14 0 0,4ZA"Al BY A.A.M. Ar ?'HUSE 4F' OdBL/G' oR' f'RJ V,4TE STi'?EETS o.e y(/q ys 3 OATS: SEPT. 2/ /98/ t lb' F ALRE•QOYEST,QBUS/4/.t�o, AN0 THAT /yO IVEW LY�ECh�EOBYR.A.E �+,��• '"" "a' "�. P' G LINES Fv^2 OIV/5/OIV O.c EEC/ST/AlC7OPi4I RSHIPs II SCALE' /N. c 20 FT. OR /Fc:)F�' "yF YV 1�V�Y 5' �4 RE S'f-!©1-t/A/, , Y" "=4VRFDI6EEN6/NEZ'R11VG CO., PVC. Y 009 REG.C/V/L ENC/VEERS ,SUR VE y�.?S 5 �1 R,EC,l.STERPO L.4NL>6�S—URVEYOR f 7/2 MAIN ST. N_o 8006 5 _ -I--,-- _,_.,-.. _ _...,_..— - --- _.._._. --- ----.I--- ------ _ --- —...._,• _ ,.•,.,_....---. -. .. - ,- __ i I 1 ' I I - . ;;� ,r - �1 , -4'--��r-•c, ,, �A (J� �'C`'L-9 d i/s rlT[�S. -, l / y' ,�,,�., '' tJ !L �T` 1 � i Y/�"�j' ,►_� �' /2 a 7.) -� . �^' OF!�/ ; I -T-,�- 4 U W. V _ - /I , , "NS F •� t• / �� s- + �,�_.3 3 _ ,C7 0.. ' r. L�_.. J 'ECT .�_ _ I Y l APPRD1iAL I /' �k ,,#= , /- r- _ &. 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