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HomeMy WebLinkAbout0727 MAIN STREET (OST.) - Health (5) 727 (,Al-B3 Main Street (Ostm) Osterville P i) A = 141 013 No V g`� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitation for Misposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 ;L7 M A-I N ST (DS(, Owner's Name,Address,and Tel.No. 10 o.uuro KNt7u, Co&jDo 'tpO.CT' Assessor's Map/Parcel 1911013 7 y-1 Mor}t N Sz OS-7— Installer's Name,Address,and Tel.No. 50j-47 Z-g$77 Designer's Name,Address,and Tel.No. CA0GwcDc N1A- L Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building -No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) O u-rL-eT Date last inspected: 'Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign e Date -3 o"� Application Approved by -- -�— "� Date / Application Disapproved by Date for the following reasons Permit No. Date Issued �' .� IeR +�.E,..�.a.f.-..,,,..,^K`y�`�.rwlre,�.,�.n'y,.«�e•t�.inry+st'..i;.,.� ,7...''�•i�,.wfhM`"it'ti....?'X`n f4+ o,.�_:+w...e"��Y 1,�a,�"�"Mri•'hdre.��.�..i.4y ,.-'t-' �• .isr`4+ .�,.`,"i-+-r't:-+,�x•-ri•.•rnrWa^^q',r,.w'•,;.n+y'L`,'��`"'"", No. .CJr(`..� Feet ( ©(J � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplication for NspoBal 6pstem Construction Permit Application for Permit to Construct( ) Repair(} Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 17 M A,I P SST 0 S-r. Owner's Name,Address,and Tel.No. W K N 0 L(,. �-'0101W 'rP.J.0 T Assessor's Map/Parcel 1911013 '►-,�L1 Molr(P 5T Q s7-- Installer's Name,--Address,and Tel.No. Sp 6-47'7 -$fs7 7 Designer's Name,Address,and Tel.No. (:,A0G"31 t= Nr/-�- t 51 St Type of Building: - d Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No:-.of Persons Showers( ) Cafeteria( ) Other Fixtures - Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil a Nature of Repairs or Alterations(Answer when applicable) 5WS714(..L D u-rLC'T t_�^ ►C_�t4�� h,c,)[a-:ti Date last inspected: Agreement: 4 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in , F accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 7J(� / t Application Approved by /,,, Date r Application Disapproved by Date for the following reasons •a z Permit No. 7 Date Issued v e a lY THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(/) Upgraded( ) Abandoned( at 7 a�:j t-f A xJ s-rA g�,T l)5-r has been constructed in accordance (/ with the provisions of Title 5 and the for Disposal System Construction Permit No, W-11- dated Installer QP&l¢)t l)F G 07—*wQl S EE Designer_ �4 #bedrooms Approved deessign flo gpd The issuance of this permit sh�11 not lie construed as a guarantee that the sy of m will fun asasde designed. Date ) ,� Inspector \ -- - ------ -------------- - --- ------ -=-------- -- ------------------------ ------- - ( - - No )r Feel�5 Q0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at �] '7 fVkI XJ 577 DSTEW4.4.. -, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provide�d/:Cons �tion must be completed within three years of the date of this permit. Date 1 3y aaL Approved b 01,3-00A Commonwealth of Massachusetts Title 5 official Inspection Form �il' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i -� 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is K. Osterville ✓ MA 02655 � required for every 3-29-18 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information autplln►drr on the computer, use only the tab �i�0� A OF 1. Inspector p . key to move your q �p4'r �y cursor-do not ,lames D.Sears '� JA MES ;) key.use the return rn Name of Inspector :v Capewide Enterprises =* ' o �'•.t? Q Company Name 153 Commercial Street Company Address Masfipee MA 02649 Cityrrown State Zip Code 508-477-6877 S1623 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 T-rtle 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �2 Key 3-31-18 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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.doc•rev.6116 Title 5 offi ial Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 61• a5ed xed dH 92:02 9 1,0Z ZO Jdy Commonwealth of Massachusetts _ Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 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 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: The system is a 2000 Gal. Tank D Box and two pits. 113) 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.doc•rev.sm6 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 OE a5ed xed dH LZ:OZ 9 602 ZO udy Commonwealth of Massachusetts gi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 page. Cityfrown 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 or 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 s stem required pumping more than 4 timesbroken r . Th❑ y q p p g e a year due to o obstructed pipes) e 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.doc-rev.6f1E Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pap 3 of 17 62 a5ed xe:1 dH LMZ 8 602 ZO Jdb' Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y% 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name _ information is required for every Osterville. MA 02655 3-29-18 page. City/Tom 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 El ® Liquid depth in INEWis less than 6" below invert or available volume is less than Y2 day flow P1T_'s' Wns.doc•rev.6116 —itle 5 Official Inspection Form:subsudaoe sewage Disposal system-Page 4 of 17 ZZ a5ed xe j dH LZ:OZ 9 60Z 20 JdV Commonwealth of Massachusetts 157,9Title 5 Official Inspection Form !� Subsurface Sewage Disposal System Form- Not for Voluntary Assessments _,P� 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owners Name information is required for every Osterville MA 02655 3-29-18 page. CityfTown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue 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 CM 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, tslns.doc-rev.6!16 Title 5 Official Inspac6on Form:Subsurface Sewage Disposal System-Page 5 or U £Z a5ed xed dH K:2 8 XF ZO Jd`d Commonwealth of Massachusetts ,o Title 5 Official Inspection Form ASubsurface Sewage Disposal System Form -Not for Voluntary Assessments 727 Main Street Bldg A-B) ,v Property Address Wianno Knolls Condominiums Owner Owner's Name information Is required for every Cisterville MA 02655 3-29-18 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant; or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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)1 D. System Information Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203 (for example; 110 gpd x#of bedrooms): 660 t5ins.cloc•rev.6116 Title 5 Official Inspection;:wrn:Subsurface Sewage Disposal System Page 6 of 17 t7Z a5ed xe:1 dH 82:OZ 8 60Z ZO JdV Commonwealth of Massachusetts f: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 page. City1rown State Zip Code Date of Inspection D. System Information Description: 2000 Gal. Tank, D Box and pits. Number of current residents: _ Unknow 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): NA Detail Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 16.203): 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: l5ins.doc-ray.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 5Z a5ed xed dH 6Z:OZ 9 60Z ZO Jd`d F Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 727 Main Street Bldg A-B) ,v Property Address Wiannc Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 page. cityrrown 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: Yearly Pumping 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) ❑ InnovativelAlternative 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 DE approval. ❑ Other(describe): t5ins.doc•rev.W6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 9Z a5ed xeJ dH IBME 860E ZO udV Commonwealth of Massachusetts ,p Title 5 official Inspection Form rd Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Cisterville MA 02655 3-29-18 per. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3' 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.): Pipeing is 4" SCH 40 PVC. Septic Tank(locate on site plan): Depth below grade: 28" 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.0c-rev.6116 Title 5 Oftel Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 �2 a5ed xeJ dH OE:02 9 60Z ZO add f Commonwealth of Massachusetts Title 5 Official Inspection Form ri Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 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 NA Scum thickness 2 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Plan -TapeSludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level w/inlet tee. Inlet cover steel at grade. Outlet cover at 28" below grade. Note: Outlet cover should be raised. No sign of leakage or over loading. Grease Trap(locate on site plan) Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions. Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.W6 71da$Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 gZ a5ed Y2J dH OE:OZ 960Z ZO Jd`d c , Commonwealth of Massachusetts Title 5 Official Inspection Form > Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F� 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): k *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5irls.doc-rev.E 16 70 5 Official lnspectioi Forth:Subsurface Sewage Disposal System-Page 11 of 17 6Z a5ed xed dH 0£:OZ 9 1,0E ZO JdV Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Cisterville MA 02655 3-29-18 page. Cityfrown 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is clean and solid 30" below grade, wlsteel cover at grade_ 2 lines out. No sign of over loading or solid carry over. 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: 15ins.doc•rev.6f16 Tdle 5 Official Inspection Form:Suosurfaoe Sewage Disposal System-Page 12 of 17 0£ a5ed xed dH O£:OZ 9 60Z ZO Jdy Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owners Name information is required for every Osterville MA 02655 3-29-18 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 2 ❑ 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.): Leaching is 2 precast pits with steel cover's at grade. Pit# 1 is dry. Pit#2 has 1"water. 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 El Yes No t5in&doc-rev.W6 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 l•£ a5ed xed dH O£:OZ 8 1,0E ZO JdV Commonwealth of Massachusetts Title 5 Official Inspection Form `A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Z£ a5ed xeJ dH l-£:OZ 91.0E ZO JdV Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) 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 t5ins.doc-rev.6116 Tille 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 EE abed xed dH 6E:0Z 8 60Z ZO Jd`d Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom MapIF Abutters Map Size ® Zoom Out I N 'I I I I gin ]I IL !1 EN— 'z ri . TT �a wit 4 f y �;:�•��&:-•fie 4 0 ewe%;.•' : RN sill -- L J •_N 1 ca'`i -.f'..w.. - 71111m; ^'t' - _ _ f .Fy�' - .,✓�.i-t. t'`''' e,""�_ _ '- - •i�Y'`is:!-s•'ry.A1'd.';.-.•:`'-'�'}_;: 1. W __<-- - :N" T Si-.Y''•' Telx r t ..FarJ ?(i `.t e> :__ _?i=.sw:.x`J`-.�.i:`e,'�'•�'�Y� _ou''.:�.:.y:�v2�»�:�•:�%a3`�:.�'"a���1:`.�;K.._ z:S {c-y^,;.isAi��,''�•s'A'.�.,.�-�c`��;..Y�F.va - -:��:;'*�,�'Y":cam`�''.�7r-=>`?� � =:lit• _!-.��:�:-_'.d �.� cx=`:a' ��':.....r,�,;:�r�:.,,��)•r'ti;��!-: �. f'' �. +�`T•. �p y''. ` �'�€.;ice: :t:::.Ft�i:_�'i:._�i.`=�j"'�•*'%rys.'s'�- -ez•:_ �'i- x4.,t:�" �_'•:-'t' rs..,t - s:_c.:--- � -�.•e+.. :'':ram`_"• s„ .-: .}�1�•^�.x:�.-:::,' _ ,nr sg6 5:`•�.�q,��_t"�.,� �- `'ram'=`', :v v.';':_>r ti,�.r:, .•. r ice' .,..#•- .<i.s?• =:iF•�-=.+' �.s:yv d'u L�s. }� `r#�.h > ^,tia„q �h,��'rh•.m�M,�+ir.rc. ''+ _..�.ii �a�+"'z..-r�i"...` .� ?- 3,•.��,+v�-� ;:�. -�r�`.• , =d ,r�.� -_,'.fir^' t i - Q 20 Feet Set Scale V ='20 Aerfai Photos MAP DISCLAIMER r llSnh/9MC_7rin$k Tro 14 Qe f,WJ AAA Alf dnhf.rocenn http://*-,.vw,town.bamstab le.ma.us/arcims/appgeoapp/map.aspx?propertyID=141013 0OA&... 4/27/2009 bE a5ed xed dH 6E:N 9 602 20 JdV Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49,'Y� 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owners Name information is Osterville MA 02655 3-29-18 required for every page. CityrTown Stale 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: 12'+ 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: 1985 Date ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ❑ Checked with local excavators, installers'-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Per design plan i Inspection Report, lease see Report Completeness ness Checklist on next page. Before Jilin this P p g 9 P P P p t5ins.doc-rev.6116 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 16 of 17 5£ a5ed keJ dH £UZ 860E ZO Jd`d Commonwealth of Massachusetts Title 5 Official Inspection Form &e Subsurfaee Sewage Disposal System Form-Not for Voluntary Assessments uv� 727 Main Street Bldg A-B) Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 3-29-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, 8, 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 l&ns.doc•rev.606 Title 5 Official Inspection Form:Suoswlace Sewage Disposal System-Page 17 of 17 gE abed xed dH EE:2 91.0E ZO JdV Commonwealth of Massachusetts �- Gv Title 5 Official Inspection Form y, _or3- BeOWNy Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -rG►.�, 1 y?—o i3 ��d� GM 727 Main Street BIdg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altored in any way. Please see completeness checklist at the end of the form. Important:When ng out forms A. General Information ' ���t��ltlff►,,, oln'the computer, `\�������H�FSS use only the tab 1. Inspector: ( � o � 9° key to move your ' �� JA M ES tiG cursor-do not .lames D. Sears _=g use the return Name of Inspector �U : key. C", Capewide Enterprises,LLC *�•.op for Company Name Cc,s-IN fitFp"�G ``� 153 Commercial Street ���n„r,,,,,,,,❑,����``` Company Address Mashpee Ma 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority - 4-15-15 ;spector's Signature Date The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 fuse/ at that time.This inspection does not address how the system will perform in the futur under the same or different conditions of use. ' t t5ins•11110 Title 5 Official Inspection Forth: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 M SV.'r 727 Main Street BIdg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 1 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: The system is a 2000 Gal. Tank D Box and Two Pits. 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 exMtration 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•11/10 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 727 Main Street Bidg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is Osterville MA 02655 4-15-15 required for every , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N FIND(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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 727 Main Street Bldg.A-B Property Address Wanno Knolls Condominiums Owner Owners Name information is required for every Osterville MA 02655 4-15-15 page. Cityrrown 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 0 ® 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 El ® Liquid depth in is less than 6" below invert or available volume is less than Y2 day flow PST;P , t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 t .� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 727 Main Street Bldg:A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is re Osterville MA 02655- 4-15-15 wired for every 4 Ci !Town State page. tY Zip Code Date of Inspection B. Certification (cont:) Yes No ❑ ® Required pumping more'than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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- El ❑ the system is within 400 feet of a surface drinking water supply El El 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 El El Area—IWPA)or a mapped'Zone I 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•11/10 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 727 Main Street Bldg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 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): 6 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins-11/10 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 M 727 Main Street BIdg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. Cityfrown State Zip Code Date of Inspection M System Information Description: The system is a 2000 gal precast tank,D Box and Pits Number of current residents: unknow Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readin s, if available last 2 ears usage na 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present 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-11/10 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 727 Main Street BIdg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. Cityfrown 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: Yearly Pumping . Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: a 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-11/10 Title 5 Official Inspection Forth: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 727 Main Street Bldg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 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: 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 31 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.): Pipeing is 4" SCH 40 PVC. Septic Tank(locate on site plan): 28"- Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 Gal Sludge depth: 2" t5ins•11/10 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 727 Main Street Bldg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. Citylrown 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 NA Scum thickness 211 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Plan Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at workink level w/inlet Tee. Inlet cover steel at grade. No Sign of leakage or over loading.. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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 `Date of last pumping: Date t5ins•11/10 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 727 Main Street Bldg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes . ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 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 727 Main Street Bldg.A-B Property Address Wianno Knolls Condominiums . Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. Cityfrown 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is clean and solid 30" below grade, w/steel cover at grade. 2 lines out. No sign of over loading or solid carry over.t Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order- ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 727 Main Street BIdg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: El 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.): Leaching is 2 precast pits with steel cover's at grade.Pit# 1 is dry. Pit#2 Has 20"water. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 4 Commonwealth'of-Massachusetts u v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments M 5 727 Main Street Bldg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is Osteryille MA 02655 4-15-15 required for every •� 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.): t - , Privy(locate on site plan): Materials of construction: Dimensions Depth of solids T Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): - # t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 727 Main Street Bldg.A-B lg — Property Address Wianno Knolls Condominiums Owner Owner's Name information is Osterville MA 02655 4-15-15 required for every page. Cityfrown 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Map F. Page 1 of 2 Town of Barnstable Geographic Information System Parcel newer Custom Ma Abutters Map Size Zoom Out _ 9 In P � - X�CfW'Y tf -+ 3.. A t { i x ' 1 ; _ f a7at -T0 1= IN. t Katy. h 0vg­ .. .F f k i i c ? ti' �' Spa �`�.•-�.rrr� F 9 3�E5'a s:a -aq' ., 'aF me U. .4 �}RE "z F •• -OW rar..c - .R i Q 20 Feet a Set Scale 1" = 20 Aerial Photos =' MAP DISCLAIMER r`nnkni.ht 9Mr-,)nnR Tm..n of Ramefohlc AAA all W fe.amen hq://www.towm.bamstable.ma.us/arcims/appgeoapp/map•aspx?propertyID=14101300A&... 4/27/2009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 727 Main Street Bldg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville MA 02655 4-15-15 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) u Site Exam: El Check Slope ❑ Surface Water ° ❑ Check cellar. El Shallow wells Estimated depth toFh ground water: 12�+ 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: 1985 Date ❑ Observed site(abutting property/observation hole'within 150 feet of SAS) ® Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per Design Plant Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 727 Main Street BIdg.A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is Osterville MA 02655 4-15-15 required for every - 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 t5ins•11/10 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 17 of 17 A Commonwealth of Massachusetts Title 5 Official Inspection Form -. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 727 Main St Bld A-B Property Address Wianno Knolls Condominiums Y Owner Owner's Name information is required for every Osterville Ma .02655 4_g_2012 page. City/Town �. State' Date of Inspection. Zip Code" 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: ngoutfrms A. General Information filling out forms -- pUlgrrtllpUb on the computer, ��``� S"OF kfq use only the tab 1. Inspector: I llG O``���' ..•...`'sy9�'''�i key to move your 1I cursor-do not James D. Sears. �° _ :' JAMES N urn se the return Name of Inspector S .-+keys Cape Wide Enterprises, LL n�l�n I I Company Name 153 Commercial St. t ''� ;�s iNSPE�vo�°��` Company Address Mashpee ," Ma =; 02649 CityrTown ' State - Zip Code' 508-477-8877 S1623 Telephone Number License Number B. Certification ,I 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system:. ® Passes ElConditionally Passes ❑ `Fa ❑ :Needs Further Evaluation by the Local ApprovingAuthority 4-11-2012 3 �_ spector's Signature Dater The system inspector shall-submit a copy'of this inspection report to the Approving Authority-(Bo4ry4 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. �3 t5ins-1Ill t Title 5 Official Inspection F.=S s ace Sewage isposal System-Page 1 of 17 a , TI S " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 727 Main St Bid"A-B ' Property Address 'Wianno Knolls Condominiums Owner Owner's Name information is required for every Cisterville Ma 02655 4-9-2012 page. Cityrrown State' Date of Inspection Zip Code 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 systemcomponents 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. ' u 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 z Compliance indicating that the tank is less than 20 years old is available. F ❑ Y .❑ N ❑ ND (Explain below): t5ins•11/10 title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ; '727 Main St Bld�A-6 Property Address , Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville ,' Ma 02655 4-9-2012 a p ge. ty!Town State Ci Date of Inspection Zip Code B. Certification (cont.) B) System Conditional! 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 ❑T'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 r 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, t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M '727 Main St Bid A-B Pro a�Y Address P Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville Ma 02655 4-9-2012' page. City/Town z State ZI CI Date of Inspection p r-, 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 B. Certification (cont.) 2. S stem will fail unless the Board of Health and Public Water Supplier, if an y) Y .- (and Pp Y) determines that the system is functioningin 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. / t ❑ 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: a - a j + • • r t • - t D)' System Failure Criteria Applicable to All Systems: You must indicate".Yes"or"No",to each of the following for all inspections: • Yes No t5ins•11/10 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 727 Main St Bid A-6 Property Address *' Wianno Knolls Condominiums Owner Owner's Name information is ` required for every Osterville Ma 02655 4-9-2012 page. Cityrrown State Date of Inspection • Zip Code 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 orsurface 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' '� B.-Certification (cont.) -Yes No r ❑ • ® Required pumping more than 4 times in the last year NOT'due to clogged or obstructed pipe(s). Number of times pumped- u [:1 ® Any portion of the SAS, cesspool or privy is below,high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or p tributary to a surface water supply. ❑:° '® Any portion of a cesspool or privy is within a Zone 1 of a.public well, ❑ ® Any portion ofa cesspool or privy is within 50 feet of a private water supply well. El I ® 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 4 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 w ; and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 4101000gpd. The system fails. l 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. 1 , 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 t5ins-11110 .Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form v Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y 727 Main St Bld A-B ` Property Address Wianno Knolls Condominiums a Owner Owner's Name information is Ma 02655 required for every Osterville 4-9-2012 page' Cityrrown State Date of Inspection Zip Code r ❑ . ❑ the system is within 200 feet of a tributary to a surface drinking water.supply ❑ 0 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. t C: Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No R . M ❑ 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 1-1t ® this inspection? ' ® ❑ Were as built plans of the system obtained and examined?.(If'they were-not available note as N/A) • TM ® ,., ❑ 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? - Z" ❑ 7 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, t• ' 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. s= c., - f' Determined in the field(if any of the failure criteria related to Part C is at issue'.''' t ® approximation of distance is unacceptable)[310 CMR 15`302(5)] i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 v Commonwealth of Massachusetts ° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 727 Main St Bld A-B " Property Address Y, Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville Ma 02655 4_9_2012 page. Cityrfown_ State Date of Inspection Zip.Code D. System Information Residential Flow Conditions: I w Number of bedrooms(design):- Number of bedrooms(actual): 6 . DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 D. System Information Description: The system is a 2000 gal precast tank, D Box and 2'Pits Number of current residents: Y unknown Does residence have a garbage grinder? ❑Yes,® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑- Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? r ❑ Yes ® No , na Water meter•readings,if available;(fast 2 years usage(gpd)): r Detail Sump.pump? + _' El Yes. ® No _ t • ``f Present Last date of occupancy: Date r Commercial/Industrial Flow Conditions: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 • r t ' Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 727 Main St Bld A-B Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville Ma 02655. 4-9-2012 t page. Citylrown State Zip Code Date of Inspection Type of Establishment: Design flow(based on 310 CMR 15.203): canons 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: D. System Information (cont.) „ Last date of occupancy/use: , • Date Other(describe below): . General Information t Pumping Records: Source of information: Yearly Pumping 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: , K Septic tank, distribution box, soil absorption system ❑ Single cesspool t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts` ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 727 Main St Bld A-B Property Address Wianno Knolls Condominiums Owner owner's Name information is required for every Osterville Ma 02655 4-9-2012 a /Town page. Ci ty State Date of Inspection Zip Code El Overflow cesspool k 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 DO approval. ' ❑ Other(describe): D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1981 - Were sewage odors detected when arriving at the site? ❑ Yes ® No ' Building Sewer(locate on site plan): ' Depth below grade: : ; t 3 feet ..F 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.): Piping is 4"Sch 40 pvc , Septic4ank'(locate on site plan) 'Depth below grade: 28„feet t5ins•11/10 , 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 727 Main St Bld A-6 Property Address Wianno Knolls Condominiums Owner Owner's Name information is required for every Osterville Ma 02655 4.9-2012 page. Cityrrown State Date of Inspection Zip Code' w 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 Gallons Sludge depth: D. System Information.(coat.) Septic Tank(cont.) ` Distance from top of sludge to bottom of outlet tee or baffle NA 4 Scum thickness y Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle, NA , Plan Tape How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level w/inlet Tee, Inlet coversteel at grade no sign of leakage or over loading t5ins-11/10 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 •F .�" 727 Main St Bld A-B Property Address Wianno Knolls Condominiums Owner Owner's Name - information is required for every Osterville Ma •02655 4-9-2012 page. Cityrrown State Date of Inspection Zip Code Grease Trap(locate on site plan): ' Depth below grade: feet Material of construction: r • El concrete+ Elmetal ❑fiberglass ` - 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 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.): i ^ • a t 4 Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): - Depth below grade: Material of,construction: ` El concrete, •❑ metal- ❑ fiberglass , 4 � ❑ polyethylene •❑other(explain): . , Dimensions: t .. 'Capacity gallons r t5ins•11/10 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 •{ r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments e 727 Main St Bld A-B Property Address Wianno Knolls Condominiums ' Owner Owner's Name information is required for every Osterville - Ma ..02655 4_9_2012 page. CitylTown" State Date of Inspection Zip Code. Design Flow: gallons per day . Alarm present: F El Yes El. No " Alarm level: Alarm in working order:, ❑ Yes ' ❑ No j `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 D. System Information:(coat.) 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.): ' D Box is clean and solid, 30" Below grade w/steel cover at grade, 2 lines`out. No sign of over loadind or solid carry,overiu . r r d - Pump Chamber(locate on site plan):. Pumps in working order: ` ❑ Yes ❑ No t5ins•11/10 ` Title 5 Official Inspection form:Subsurface Sewage Disposal System Page 12 of 17 T i. - y . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "t 727 Main St Bld A-B ' Property Address Wianno Knolls Condominiums Owner Owner's Name - ' information is required for every Osterville Ma 02655 4-9-2012 page. Citylrown State Date of Inspection Zip Code Alarms in working order:' ❑, Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located; explain why: - { D. System Information (cont.) . Type: a •r r . = • ® Teaching pits `. number: 2 _ ❑ leaching chambers number: ,, leaching galleries, number: . ❑ leaching trenches number, length: ❑ leaching fields _ number, dimensions:. ❑ overflow cesspool number: 3 innovative/alternative system T Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,"level of ponding„damp soil, condition of vegetation, etc.): t5ins•11/10 � 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 M 727 Main St Bid A-B' Property Address ,. :R Wianno-Knolls Condominiums:. Owner Owner's Name information is ; :Ma 02655 A ' required for every osterville 4-9-2012 page. Ci !Town State tY ` Date of Inspection t. }. #Zip Code Leaching is 2 precast`pits with steal covers at grade:`Water-level 2'6" No high stain line. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan)- • e Number acid 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, a Yes E No r D. System lnformation (cont.) w Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): x b ,a • r t 41 f Privy(locate on site plan): 'Materials of construction:. Dimensions Depth'of solids r P t5ins 11/10 . " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•`Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Ins4pection Form' .. ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 727 Main St BidA-B ns =* Property Address _ - 4 Wianno Knolls Condominiums - Owner Owner's Name ` information is _• required for every Osterville.`' Ma 02655•'r 4-9 2012 page' Cityrrown „� < State Date of Inspection.' Zip Code Comments(note condition of soil, signs of hydraulic failure, level;of ponding, condition of vegetation, etc.): i n .. �$ " F r i `.y �: e a � rt ti 'x-' �•p4 1 • 1 e a �.. ! ,. 4 y � - ".) .r. •fit. ^ t .. .. i i ,. L 7 ' -- • ' S A'+ * G r� r.}n s'r �rI>,. �Ir � .- ..+ px ._ x' e a a °Y D. System,Ififormation (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 f F where public water supply enters the,building. Check one of the boxes below:- ' °hand-sketch'in the area below,, 'drawing attached separately + ate^ s. ,g. ..r+",R; s.: .� - •. . ' a , " - /:. - •.w t5ins-11110 f 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page`15 of 17 •Map Page 1 of 2 Town of Barnstable Geographic Information System t _ Parcel Viewer Custom Abutters Map^Size Zoom Out QIn .4; - - _ - - iA 3 1 r - 4E AIR z. r y � 4i • M 0 20 Feet . Set scale 1" = 20 I Aerial Photos ! MAP DISCLAIMER (`nnvrinht 9!1l1F_9!1(1R Trn.m nfjR-f.hlo MC All HMO.rocenn { http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=141013 00A&-..: 4/27/20019 Commonwealth of Massachusetts=.,. Title 5 Official Inspection form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments ` �x 727 Main St Bld A Property Address r §4 Bann •. . , o Knolls Condominiums`' Owner Owner's Name, , .. information is Ma 02655' 'u required for every Osterville 3 ' 4-9-2012 page. State Cityrrown f • Date of Inspection Zip Code y , .r • d Y- e r D System Information (cont.) t uy. r :i.. e• ,. Site Exam: . Check Sloe • KF� � ,� r,� , .. r - ® Surface water •.. ; , • .. Checkcellar_` t+ f , y 'Shallow wells" �. t • .12'.+ Estimated depth to high ground water. `' w feet Please'indicate all methods used to determine the high groundwater,elevation: t5ins 11l10 •Title 5 Official Inspection form:Subsurface Sewage:0isposal System•Page 16 of 17 Commonwealth of 1Massachusetts } • s Title 5- Official Inspection. Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments'. 727 Main St Bld A-B Property Address Wianno Knolls Condominiums Owner Owner's Name rr information is s required for every Osterville Ma 02655 4-9-2612 page' Ci /Town State ty Date of Inspection Zip Code ® Obtained from system design plans on record., # 1985 checked, date of design plan reviewed: Date - . ^ El (abutting property/observation+hole within 150 feet of SAS) ® z Checked with local Board of Health -'explain: 4 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database—explain: You must describe'how you established the high groundwater elevation: ' Pei design Plan ,. y • / a ('tj j Before filing this Inspection Report, please see Report.Completeness Checklist on next page. e E. Report Completeness Checklist ., ❑, Inspection Summary: A, B, C, D, or checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed . 0 System Information-Estimated depth to high groundwatern' , ❑ Sketch of Sewage Disposal System`either drawn on page 15 or attached in separate file 4� t5ins•11/10 + Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17. a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �n r + c DEPARTMENT OF ENVIRONMENTAL PROTECTION 1 W � O w qM See" 350 MAIN STREET WEST YARMOUTH, MA ^� 508-775-2800 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A !9- CERTIFICATION MAP 141 PAR 013 PROPERTY ADDRESS.: 727 MAIN STREET, OSTERVILLE ADDRESS OF OWNER: �. DATE OF INSPECTION: JULY 7, 2006 WIANNO KNOLL CONDO NAME OF INSPECTOR : JAMES D.SEARS BLDG A 1-2 AND B 1 &3 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 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: t X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: x�'J4_e� DATE: JULY 20,2006 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 inspectof-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: 3� NOTE: BUILDING A-SYSTEM ALSO SERVICE B-1 B-3 � y SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME, OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. CD CU 1_r f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDOS BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20, 2006 INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: X 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. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A 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 is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming 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 pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20, 2006 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A 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)THT 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 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 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 1 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 and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20,2006 D]SYSTEM FAILS: N/A 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 16.303. 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 over- loaded 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 pit is less than 6"below invert or available volume is less than%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 X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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: N/A You must indicate either"Yes"or"No"as 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 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 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. �i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20, 2006 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,including 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.Ex. 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)[15.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20, 2006 FLOW CONDITIONS RESIDENTIAL: Design flow: 660 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 6 Number of bedrooms(actual): 6 Total DESIGN flow Number of current residents: N/A Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): YES Seasonal use(yes or no) NO Water meter readings,if available(last two(2)year usage(gpd): Sump Pump(yes or no): NO Last date of occupancy: N/A COM M ERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 16.203) 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: YEARLY PUMPING—NOTE:MAINTENANCE PUMP AFTER INSPECTION. System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons Reason for pumping 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 DEP Approval Other APPROXIMATE AGE of all components, date installed (if known)and source of information: 1984 BARNSTABLE HEALTH DEPARTMENT. 1998 NEW D-BOX PERMIT#98-104 Sewage odors detected when arriving at the site:(yes or no) NO x r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20, 2006 BUILDING SEWER: N/A (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: X (Locate on site plan) Depth below grade: 30" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 2,000 GALLON Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: 1" 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 How dimensions were determined PLAN&TAPE 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.) NOTE: OUTLET COVER NOT RAISED OR DUG UP UNDER GREEN SHRUBS.TANK AT WORKING LEVEL,INLET TEE,INLET COVER STEEL AT GRADE.NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP: N/A (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.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -SYSTEM INFORMATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20,2006 TIGHT OR HOLDING TANK: N/A (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: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D-BOX IS 24"BELOW GRADE,STEEL COVER AT GRADE.ONE LINE IN,TWO LINES OUT. BOX IS CLEAN AND SOLID NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/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.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20, 2006 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: 2 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 of vegetation,etc.) PIT(1)IS BLOCK 10'DEEP 20"WATER. PIT(2)PRECAST 5'DEEP,1'WATER. BOTH HAVE STEEL COVERS AT GRADE. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/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: N/A (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.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JULY 20, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) SEE ATTACHED PLAN i� - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) f ' t Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A l-2 AND B 1 &3 e Date of Inspection: JULY 20, 2006 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to no groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: X Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data NO TE: PLAN ON FILE AT BOARD OF HEALTH,12'NO GROUNDWATER—SITE HIGH. Describe in your own words how you established the High Groundwater Elevation.(Must be completed) 7, N. GRAB � 8 P'T N ° L�Vr47ER Title 5 Inspection Form 6i 1 J'.'.i;o l 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A- L �AtA �r � �;•_�` _- r ~ —� ./�,�tliG ?wr•: �:. ram. •.• ,. �. +- : ��-. ON -77 / T� � .vJw � / • ••� _J• - - - •\ \. - -� . �..:. /fie.. /' -• , •,,-rl ,�. � . r �) r LUMMUN WEALTH OI MASSACHUSETTS EXECUTIVE OFFICE O.F.ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVI_RONMEN'.I'AI. PROTECTION \� ONE WINTER STREET, BOSTON MA 02109 (fill) 292-5500 z- TRUDY CORE 350 MAIN STREET Secretary ARGEO PAUL CELLUCCI WEST YARMOUTH, MA I)AVID B. STRUits Governor 4 ® 508-775-2800 Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION MAP 141 PAR 013 PROPERTY ADDRESS: 727 MAIN STREET, OSTERVILLE ADDRESS OF OWNER: DATE OF INSPECTION: JANUARY 18, 2000 WIANNO.KNOLL CONDO NAME OF INSPECTOR : 'JAMES D. SEARS BLDG A 1-2 AND B.1 & 3 ' I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 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 INSPECTORS SIGNATURE: DATE: FEBRUARY 2,2000 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: NOTE: SYSTEM ALSO SERVICE B-1 B-3 SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM:. Ge. V vo 3.; 14000 SI All revised 9/2/98 M1 1 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDOS BLDG A 1-2 AND B 1 &3 Date of Inspection: JANUARY 18,2000 INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: X 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. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A 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 is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming 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 pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 114 3 Date of Inspection: JANUARY 18,2000 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A' Conditions exist which require further evaluation by the Board of Health in order to determine if the a 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)(4)THT 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 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 PUBLICHEALTH AND SAFETY AND THE ENVIRONMENT: s 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 1 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 and is equal to or less than 5 ppm. Method used to determine distance" (approximation not valid). 3) OTHER a' A r 0 revised 9f2/98 3 ' ' - it it .. - o- ... ➢. • . i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JANUARY 18,2000 D] SYSTEM FAILS: N/A 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 16.303. 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 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 over- loaded 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of 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: N/A You must indicate either"Yes"or"No"as 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 i 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 - 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. f ' revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 727 MAIN STREET,OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JANUARY 18,2000 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,including 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. Ex.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)11 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: January 18,2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 660 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 6 Number of bedrooms(actual): 6 Total DESIGN flow Number of current residents: N/A Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): YES Seasonal use(yes or no) NO Water meter readings,if available(last two(2)year usage(gpd): Sump Pump(yes or no): NO Last date of occupancy: N/A COM MERCIAUINDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 16.203) 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: YEARLY PUMPING System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons. Reason for pumping 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 DEP Approval Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 1984 BARNSTABLE HEALTH DEPARTMENT. 1998 NEW D-BOX PERMIT#98-104 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JANUARY 18,2000 BUILDING SEWER: N/A (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: X (Locate on site plan) Depth below grade: 30" Material of construction X concrete metal _ Fiberglass _ Polyethylene other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 2,000 GALLON ' Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: 2" 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 How dimensions were determined PLAN&TAPE 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.) NOTE: OUTLET COVER NOT RAISED OR DUG UP UNDER GREEN SHRUBS.TANK AT WORKING LEVEL,INLET TEE,INLET COVER STEEL AT GRADE. GREASE TRAP: N/A (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. 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: TIGHT OR HOLDING TANK: N/A (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: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc) D-BOX IS 24"BELOW GRADE,STEEL COVER AT GRADE:ONE LINE IN,TWO LINES OUT.BOX IS NEW,REPLACED IN 1998 PERMIT#98-104 PUMP CHAMBER: N/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 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JANUARY 18, 2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not Vocated, explain: Type: Leaching pits,number: 2 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 of vegetation,etc.) PIT(1)IS BLOCK 10'DEEP 3"WATER. PIT(2)PRE CAST 5 DEEP,DRY. BOTH HAVE STEEL COVERS AT GRADE. CESSPOOLS: N/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: N/A (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 9 6 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JANUARY 18, 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) SEE ATTACHED PLAN revised 9/2/98 10 . • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET, OSTERVILLE Owner: WIANNO KNOLL CONDO BLDG A 1-2 AND B 1 &3 Date of Inspection: JANUARY 18, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked a Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to no groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: X Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data NOTE: TEST HOLE ON PLAN,NO WATER AT 12' Describe in your own words how you established the High Groundwater Elevation. Must be completed) w .r revised° 9/2/98 11 ' RECEIVED iz13isz JUL 16 2003 COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE HEALTH DEPT. Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION e o, o v` 350 MAIN STREET WEST YARMOUTH,MA LA:1F1L;O 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 141 PAR 013 Property Address: 727 MAIN STREET-BUILDINGS A1,A2,B1,AND B3 OSTERVILLE,MA 02655 Owner's Name: WIANNO KNOLL CONDOMINIUMS Owner's Address: PO BOX 1073 OSTERVILLE,MA 02655 Date of Inspection JUNE 25,2003 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yannouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT 1 ce'ify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: ea® The system inspector shall suPmnitopy 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 tot he 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 727 MAIN STREET-BUILDINGS Al,A2,B1 &B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 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: t B. System Conditionally Passes: N/A 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 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 of 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 727 MAIN STREET-BUILDINGS Al,A2,BI &B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 C. Further Evaluation is Required by the Board of Health: N/A 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 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 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 detennine 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: s a Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 727 MAIN STREET-BUILDING A1,A2,B1 &B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 D. System Failure Criteria applicable to all systems: N/A 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 pit 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well n N/A 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 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 detennined 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 detennine what will be necessary to correct the failure: . E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of I0,000 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 lI 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 is 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. Title 5 Inspection Form 6/15/2000 4 " fi Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 727 MAIN STREET-BUILDINGS Al,A2,Bl &B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No ✓ Pumping infonnation 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 infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ Existing infonnation. 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)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 727 MAIN STREET-BUILDINGS Al,A2,B1 &B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 FLOW CONDITIONS RESIDENTIAL-CONDOMINIUMS Number of Bedrooms(design): 6 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 660 Number of current residents: N/A 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): YES 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: Design flow(based on 310 CMR 15.203): - 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 infonnation: ANNUAL PUMPING 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 J 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1984,NEW DISTRIBUTION BOX IN 1998 PERMIT#98-104 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET-BUILDING Al,A2,B1 7 B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 BUILDING SEWER(locate on site plan): N/A 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 onsite plan): ✓ Depth below grade: 30" 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: 2,000 GALLON Sludge depth: 3" Distance from top of sludge to the bottom of outlet tee or baffle: N/A Scum thickness: 2" 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 How were dimensions determined: PLAN AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity;liquid levels as related to outlet invert,evidence of leakage,etc.): OUTLET COVER NOT RAISED OR DUG UP,UNDER GREEN SHRUBS.TANK AT WORKING LEVEL. INLET TEE,INLET COVER STEEL AT GRADE. GREASE TRAP(located,on site plan) N/A 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.): Title 5 Inspection Form 6/15/2000 7 r Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET-BUILDINGS Al,A2,BI &B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) I 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: Alanm in working order(yes or no): Date of last pumping Comments(condition of alanm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS 24"BELOW GRADE.STEEL COVER AT GRADE.ONE LINE IN,TWO LINES OUT. PUMP CHAMBER: N/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.): t Title 5 Inspection Form 6/15/2000 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET-BUILDINGS A1,A2,Bl &133 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 SOIL ABSORPTION SYSTEM(SAS): ./ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2 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.) PIT(1)IS BLOCK, 10'DEEP WITH T WATER.PIT(2)PRE CAST,5'DEEP,DRY. BOTH HAVE STEEL COVERS AT GRADE. CESSPOOLS: N/A (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: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET-BUILDINGS Al,A2,B1 &B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Title 5 Inspection Form 6/15/2000 10 Page 1 1 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 727 MAIN STREET-BUILDINGS Al,A2,Bl,&B3 OSTERVILLE,MA 02655 Owner: WIANNO KNOLL CONDOMINIUMS Date of Inspection: JUNE 25,2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 feet Please indicate(check)all methods used to detennine the high ground water elevation: ./ Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE ON PLAN.NO WATER AT 12'. t Title 5 Inspection Form 6/15/2000 11 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) Im ^�IL DATA r JC I r' - y ,: •' - yam+ / �`� "� No. t5 0 !y v c� Fee _f 1� � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pprication for &zpoml *p6tem cottgtruction permit Application for a Permit to Construct( )Repair( ►,,f upgg��rade( )Abandon( ) El Complete System IPSdividual Components Location Address or Lot No. 7,�7 / Qzrl 5`14, Cscj Owner's Name,Address and Tel.No. e �i�/'1i10 /�r�o/I CcMcQ® �j Assessor's Map/Parcel /y -..-_� 13 Installer's Name,Address,,an*" `'CANCQ Designer's Name,Address and Tel.No. 350 Main Street �/� W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) + i( v irIN o C _ 1 - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d He Si gne Date �' � f Application Approved by 0 Date Application Disapproved Prthe following reasons Permit No. Date Issued No. (� OOA 00 r r>c,_ — Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zlpplication for Dizpaar *pgtent Construction Permit Application for a Permit.to Construct( )Repair( .Upgrade( )Abandon( ) ❑Complete System G;4hdividual Components Location Address or Lot No. 727 IWf;lJ Owner's Name,Address and Tel.No. Assessor's Map/Parcel 4 Installer's Name,AddressA fc9e19NCANCiO Designer's Name,Address and Tel.No. r 350 Main Street W. Yarmouth, MA 02673 Type of Building: a Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)" r Date last inspected: 'Agreement: -_, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system. in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo' d q He". SigneWrhe ! Date Application Approved� Date 6 Application Disapproved following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance '` i THIS IS TAERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired(✓rUpgraded( ) Abandoned( )by 24 AIc D at ttWW -C'-214 t- has constructed in accordance with the provisions,of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of,thi pe t shall not be construed as-a guarantee that the system*411 f nction as designed. Date Inspector 0 No. 9 -- — ��j-------------------------Fee A�q � 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Oiz pogal *pgtem Construction Permit Permission is hereby granted to Construct( ).Repair(./Upgrade( )Abandon( ) System located at Pl�Z lwdl;,! Sf and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction in st be bmp eted within three•years of the date of th' e )t. Date: Approved by o / Uri Ng........... .7..... �1 � , . 6........ Fps.. THE COMb!ixNWEALTH OF MASSACHUSETTS' _ BOARD OF HEALTH .....................T.Qw.n..........OF......] am atal:ae......................................................... Appliration for Dispvii al Morkii Tomarurtinaa 1hrmit Application is hereby made for a Permit to Const,�cb( or Repair (X ) an Individual Sewage Disposal System at: f� 7.2-7-..Main..St.f......0����I.7.1��;..M� 6 -----•.B G N.nrth_SjAe--------------------------•-•----- ....--•-- �-- � •---•-----;----- Location-Addre or Lot No. Wianno Trust..................... :••------ ... -••---...--••--•••--_.... ...._...XaAz._S _..,_._�..ts c�.17 ,..1�9 D.2E-55-----.------- Owner c Address a A & B Cesspool Service �,28_. �,sho� ..�.�xxa��.,..Hyannis,...1�4.....Q2.�Di__. ..............• .... Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `44 4 Other—T e of Building ............................ No. of persons.........i.................. Showers — Cafeteria dOther fixtures -------------------------------------------- ------------------------------------------------------------------------...----.........-- r W Design Flow..:.........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.....................................................................-. a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---_---------_-_----_--. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.---.__--__._-_------__. ---........-•............................................---------..................................................................................... 0 },Description of Soil.Sand.............................................. ---------------------------------------------------------------------------------------•------------- --------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable--iratallati n--o ..r�._�,50Q.. 7 o11__sept].C_..tank, with a 50' leach trench__stone..Packed. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITILE S of the State Sanitary Code— The and rsigned further agrees not o place the system in operation until a Ceitificate of Compliance ha een issued by the4ba lth:Sign -------- = 12,1 �82Dat Application Approved By----•----------:�'_ ...�•-• =- ------- ---------•---•---•----•-- ----•-•-----12�17_82 Date Application Disapproved for the following reasons----------------•------•-------------=--------------------------------------------------------------------•------ -------------------------------------------------------------------------------------------------------•---------........------------------------......----------------------------------------•--•-•--- Date Permit No. r�.............................................----- Issued -12�17/82--- ------------•------------ Date 1LA 9..... �, Fres....... ........ THE Ce)'M&WEALTH OF MASSACHUSETTS BOARD OF HEALTH --------- --T.own...........OF......Barn,Sta.ble......................................................... Appliratinn for Disposal Works Tonstrurtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 727-•Pain_.St.......Dista ills,_-_l,__...02655............... Puilding..G./ or. h.;lide...._......._________-.............._...._......._. Location-Address or Lot No. W ania.Q.Tmmt - -..v ..:.}}--:,.- ----••-•- 7. 7_._Ma�z1.. .. ..ta vila e.►__t'A----.G2655------------ Ow�[ef' Address a A..&-B Ces pool..ery_1aR-----------------------•-------•--•--•-•------ Installer Address Type of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers, a YP g -------------•-------------- P ( ) — Cafeteria•( ) Otherfixtures ----------------------------------------------------------------------------------------------------------..--•---• ------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (Y4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-___-_-_.____-_-__---. 9 .............................................---............................................................................................................. ODescription of Soil._S=•d.............................................................................................................................................................. x U .---------------------------------------------------------------------------------------------••------------------------------------------- ......................................................... W x V Nature of Repairs or Alterations—Answer when applicable_- rvta. lati_on__of-_a__1_,_500__ lon___septq_-tank, with-- - 50 leach-trench-st one-_packed,.................. ---•--•--•----------••-••-•--•-------------•------•----....--•....•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code— The unders' ned jx r agrees not glace the system in operation until a Certificate of Compliance NIS sued by.the bo Sign _.�v�/_j --------------••--• 12117� ..•-- .. • to Application Approved By.................. .. ....,- . ••----- -•--••--•-------------- -••--•--•--12 1�782 82 Date Application Disapproved for the following reasons:-----•--••---•••----••••••--•-------•••-•----------•----•-----•----------•--•----•---•----...-•••-•---•--•----•- ....................................................--------...-•-------------------•----...-------...-----------------------------------------------------------------------------------------•------- Date Issued_....._12/1'7/82 � Permit No.. ..... ............................. THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH Town........OF...........Barns.............................................................bl C9rdifiratr of lutpli alter THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by........ ��esga-Ql-,; exyioa.,...1,28_-�i p�-.T.ex ce_,__xyarznis,..MA.....026.01------------------------•--------•--- Installer at.......?-27__Main__StA4---- tez�ille+.-MA-----o2655---nATia=o.___Trust..........Bui.lding._!I/Xarth_.Si_d,e........ 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-------R2-........>.93. ........ dated---.-_---_.-12/..17/82................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C®NSTRIB ® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........2/17/82.................................................. Inspector--•---.... `Z- -----•--••-•-••••---------- �— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tcaan Barr table : .....................O F............-.-.......-....-......-..-.--.........._.-_.-........ .................. No. .....> FEE.__. ....... ... Disposal Works 0Wnnstrurtion rrntit Permission is hereby granted______A- & B-_Cesspool-Service_____________•_______-_______-__•-_-•__-._ ------------------•-•-•-•-_----- to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at No727..Main St. e Osterville� MA 026 -_Wianno Trust Buildir --GjX9rth Side s. .. Street 82_ 12/17/82 as shown on the application for Disposal Works Construction Permit No..................... Dated_______.-_--.--.__ .________ ..... s Boa o gaLthZz�17/82 DATE.............. ----•---------------..-.------------............ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS �i► REGISTERED ENGINEERMASSACHuserTis ' 100% 1110"Oewed", `/ 'RNODE ISLAND � NEW NAMPIIIHIRE Consulting Engineers & Land Surveyors VERMONT MAINE CIVIL, STRUCTURAL 6L MECHANICAL R[GIaT[R[D LAND • SURVEYOR 176 PRESIDENTS LANE. SUITE G•s, QUINCY, MASS. 02169 Tel ?73 2255 541 Plain Street, Marshfield, Mass. 02050 837 1614 58 Prospect Street, So. Dartmouth, Mass. 02748 Res. 990 0932 Bus. 997 1911 BUILDINGS s November 21, 1983. MISCELLANEOUS STRUCTURES Board of Health SPECIFICATIONS Town Hall DESIGN Hyannis, Massachusetts SUPERVISION Re: ability of septic system to receive flaw from Dentistry Office PLANT ENGINEERING at Wianno Knoll Condominiums, Main Street, Osterville, Mass. MECHANICAL DESIGN Dear Members, BUILDING INVESTIGATIONS It is the desire of the owners of subject condominium complex to allow the use of Office J-1 in'Building t19" foruse as .a dentistry ENGINEERING REPORTS program p office. That use is allowed under the resented. CONSTRUCTION The only question here is the projected use of water in the office, ESTIMATES and the method of disposal. The area used will be .about 1000 square feet on the ground floor facing Main- Street. My original design sheet dated 6-11-81, as rev- 7-14-81, envisioned a possible store or office area of 2000 square feet in each building, with a resulting allowance . SURVEYING of 2 x ?5 g.p.d. equals 150 g.p.d. water usage according to Code. INDUSTRIALSUBDIVISIONS, A copy of the enclosed letter from Jay Leonard Dembro,. D.D.S., ex- INDUSTRIAL RESIDENTIAL plains the use of a specific product, two adee cuspidor units, each having a rated estimated usage of 10 gallons- of water per day, for a total of 20 g.p.d. Added to the amount of water to be used by doctors and patients for. other purposes during the day, it is my belief that the existing 4-pit septic system, with a 2500 gal. septic tank, is PLANNING FOR quite sufficient to handle the expected water use from the offices RELOCATION OF and the six condo units on the system in front of Office J-1. STRUCTURES In this area the soil was excellent for gray water seepage, so this installation is expected to have no adverse effect on anything. g� aye Very truly yours, R. C: SOU THWICK -- 8883 _ i cad ym C. Southwick, P.E. B`a. wY asFiV$ • -:I to Y rt t �'{r 4y,fir�} '{ 'k:�� .�.� rr n•i+ � « 1: � i T it ;Y err A, C �y�"I 3 � , � dDj JAY LEONARD DEMBR®,L D.D.S. y t tI A',t4 t ".l 85 Harbor Drive P.O. Box 846 Pocasset, Massachusetts 02559' • ya. . 563-9596 fr 1147/83 John J Gallagher Raal' Estate 721. Main Street 0sterville, Mass. 0z655tF Dear Mr. Gallagher In regards to the water usage f or­' the . two adec:,,,cuspid.or units, it has been ' � estimated that ten gallons of water.-per, day .is used- to rinse the units. Each: unit IS, on a manual time release :Cycle'.,. ' 15 seconds This cycle uses one 4uart•, of, water,'when activiting the selnoid� sw�.tch chairside, unlike older dental units that have a constant rinsing 'cycle a Thank you for ,your help -in this matter ;t •. ';,y t� , 't }« yii n� tr I'xIi-r;.f�fi.��A h �i J, a` Sincerely, f r �> Leonard Dembro D 'DS. l k v.+ 'atn F. .. •. .. A:t.Y It M?i• 1« Ufa a: .W.PIN, $ ;IS.s�« .+Fsma r C.tvt '3�1kt d #. 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I G , f ,r o<'161J i',�{�' -7 \fl. i .C„�� Y ni jn i'3 a PJ., 4Z S'+ r t_i � _.� '�7 E C�� a <� " 7�c�s . :�Y.�.� ��..:^,�;�._;v Cry u�.�.�c�•� ; i �• `,. ~ ;.' C,� {'! ` ;'?'.`� /'. [..J�V �Q rry-j«./'a i`-I D A r'",-,»L"+.1. 'SZ uIi ^- • f tW- C ~r.x:�l fu'�2 j�T� ;� i G� 35 t ;#,1 EIC- 7 \ �1,7C.CY ,...: ,/J3FTr�-..,A• r=_ yL� `'TiWEA T:4t. its)j-T'A�Jr_ f w'+)ir1 ,ra i2L06i�,.)U \} k V A. TO T�l t 1 Q L �.. {,w r y t t JE CT:�J�J •i✓'� ,h.�"G J % r 1 Y' , `` i f'i• , i r A* >~ TO ' a tr T't.A7 E C E E r M .i c,tit, C .*A- IE:U OFF- r--r Aulc.IT o P�I_I F %', ZV_if-)6 S?A, €S; t� ��,�:i�. r • /( I�t.-- 1 � � '�t` Z t < w AF,AG &IEUT, :AGN ..�A:F_ 0(rrL-Fc& r r�i`1 � � � � t \��., rr.� "�`.• "�'_:.'mow' ,� 1 �, - - - 0. + 10 �Y PIT,, �' .... _\'_ _ r. ;� Mass. Department of Publ'O Health f r ! t D 3,\ �: ,, ,Jg.o }ivisi0 f Sanitary Engineering IT, �Y x ✓~—. '. Date_ 10P OVFLATE .rSk � tt. 7 [y;7u , , • � I ! 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