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HomeMy WebLinkAbout0920 MAIN STREET (OST.) - Health 920 Big_ 2 5-Main Street (Ost.) "=- �Ogtbro le P w �4 - a o 1 r 15 2016 23:02 Jim The Inspector Man. 5085349919 page 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments fVl. 920 Main Street Bldg, #2 (Units 1-4) Property Address Osterville Village Condos, (First Property Mgmt.) Owner Owner's Name AD information is Ostill MA erve 02655 4-14-16 required for every page. Cityrrown State Zip Code Date of.lnspection W 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 InformationLb I on the computer, ``` 0F/r1es�ii�i� use only the tab 1. Inspector. � ''� W V, key to move your ��`O� G cursor-do not James D.Sears ; DAMES , use the return Name of Inspector _ key. Capewide Enterprises, LLC F-* ' •.,0 �. o ay Company Name - TIR f-Nv f v AIF 153 Commercial Street �!�5 t 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 tti.Section 15.340 of Title 5 1310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further.Evaluation by the Local Approving Authority r, 4-14-16 . nspectoes Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. +\ t5ins•3112 / Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I i� r Apr 15 2016 23:02 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg, #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. City/Town State Zip Code bate 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. i • I j i B) System Conditionally Passes: i ❑ 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 exflltration 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): t i 3 9 l5ins•3l13 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System-Page 2 of 17 i 3 g� Apr 15 2016 23:02 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts L� '..;U w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main Street Bldg, #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. Cityrrown State. Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y< ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken orobstructed 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 151ns•3M3. Title 5 Official Inspection Form:SubsurFace Sewage Disposal Syslem•Page 3 of 17 9 Apr 15, 2016 23:02 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title -5 Official Inspection Form A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main Street Bldg 92 (Units 1-4) . Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 ' , page. CityfTcwn 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 0 ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than %day flow 7a I t5ins•3113 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 j Apr 15 2016 23:02 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments 920 Main Street Bldg, #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is Osterville MA 02655 4-14-16 required for every , page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion.of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified l laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] . ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following,-in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply Elthe 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 w regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of V Apr 15 2016 23:02 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main Street Bldg, 92 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. City[Town Slate 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. El ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3. 10 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 8 Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 t5ins 3113 Tllle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 01 Apr 15 2016 23:02 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg,#2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owners Name information is required for every Osterville MA 02655 4-14-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 2000 Gal. Tank D Box and two pit. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage �d NA g ( Y 9 (gP ))� • t 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: t5ina•3113 - - Title 5 OM69 Inspection Form:Subsurface sewage Disposal System•Pape 7 of 17 Apr 15 2016 23:02 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r` 920 Main Street Bldg,#2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. Cityrrown State Zip Code Data of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): t 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) ❑ 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): J 4 (Sins•3113 Title 5 Official Irspadion Form:Subsuiarx Sewage Disposal System•Page 6 of 17 Apr 15 2016 23:02 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessmentslug . 920 Main Street Bldg, #2 (Units 1-4) Property Address Cisterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is Cisterville MA 02655 4-14-16 required for every " page. City/Town Stale Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1981 4-2016 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30" 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.): w . Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan); Depth below grade: 16 feet Material of construction; ®concrete ❑ metal ❑fiberglass ❑ polyethylene ' ❑ other(explain) If tank is metal, Fist age: years 1s age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 Gal. Precast H-20 . 1rr Sludge depth: !Sins-3/13 - _ Title 5 Official Irepedion Form:Subsurface Sewage Disposal System-Pago 9 of 17 Apr 15 . 2016 23:03 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o 920 Main Street Bldg,#2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. Cityffown 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 29" 0.1 Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" � How were dimensions determined? Asbuilt-TapePast report Sludge 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.): Yearly pumping. Tank at 16" in black top drive wlboth covers steel at.grade. In and outlet tee's. No sign of leak age or overloading. 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 l5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System;Page 10 of 17 r Apr 15: 2016 23:03 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg, #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. Cityrrown 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: Dace Comments{condition of alarm and float switches, etc.): 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ina•3113 Title 5 Official Nspeclion Form:SLOudace Sewage Olsposal System•Page 11 of 17 Apr 15 2016 23:03 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg,#2 (Units 1-4) Property Address y Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 39" below grade w/cover at 6". Two lines out. Box is new 4-2016. 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. Soll Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 Apr 15 2016 23:03 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 920 Main Street Bldg, #2 (Units 1-4) Property Address Ostervill_e Village Condos. (First Property Mgmt) Owner Owners Name information is required for every Osterville MA 02655 4-14-1'6 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: ❑ 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 two precast pits. Pit 1) 2"Water w/stain line at 2'. Steel cover at grade in blacktop pit at11"below grade. Pit 2)3"water w/stain line at 20". Pit at 5'below grade w/cover 16". No sign of over loading or solid carry over in pits. c - 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 sol'ids layer Depth of scum layer, Dimensions of cesspool - . Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 17 Apr 15 2016 23:03 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg, #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16. psge. City[Town State Zip code Date of inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): { 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Apr .15 2016 23:03 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 920 Main Street Bldg,#2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner owner's Name information is required for every Osterville MA 02655 4-14-16 page. Cityrrown 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 — t t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 17 I Apr 15 2016 23:03 Jim The Inspector Man 5085349919 page 16 Mao rake 1 of Town of Barnstable Geographic Inct6rmation System parcel Viev+ler ' Custom map Abutters ma"Size room Out 1-1-1 IBM I E vIn Yr Ra - jl!C K Y `� f `�%6 -ram'" w -5:5 l zw �V 1 - - 1 Yot•....h..Y'"ylS:tii�-�'-2 � � � Wry Si r i •r 3-r�x' �.- V 5 4 1 1 9 VIA y(� Kk �:�1. •i:J.:� z.:-.. - .`V,ice_ - __ -�X �� ..1 rx � � � 1 s set scale 1° = ZO ' I Aerial Photos i MAP DISC€AZMIER ^nn.vinh4 9nn1._q Y,r1 I nu.n nl Q7 rnet h AAA all rinMfc roecv.n _- 1_.i.. -^n e%: -61 n._ /J:n.L n .A. ./ 4» v)...n+n. `• • a Apr 15 2016 23:04 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v' 920 Main Street Bldg, #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. Cityrrown State Zip Code Date of Inspection- D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N4 30+ Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed 1981 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: G.W.off Past report 30+'. Bottom of pit 11". Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System Page 16 of 17 Apr 15 2016 23:05 Jim The Inspector Man 5085349919 page 18 Commonwealth of Massachusetts Title 5, Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg,#2 (Units 1-4) Property Address Osterville Village Condos._(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 4-14-16 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ec ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official inspection Form:Subsurtece Sewage Disposal System•Page 17 of 17 ,. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg#2 ( Units 14) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms 0F U,q 9 411, 11 on the computer, .. gSs use only the tab 1. Inspector: o= key to move your � b55 3 �J�N�; DAMES cursor-do not =�; James D. Sears use the return - _�: SEARS , key. Name of Inspector apewide Enterprises,LLC T� o� Company Name r,���/,...N.... 153 Commercial Street '''�un,,,,,,,,nu"``�� Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number rt 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. 1 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 • a a 1-8-13 spectoes Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. J /2 t5ms.11/10 Title5 ciallns pection Form:Subsurfa Sewage f3 Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owners Name information is required for every Osterville MA 02655 1-8-13 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"-or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.-System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking.and if a Certificate of Compliance',indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts 4 r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 920 Main St. Bldg#2( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osteryille MA 02655 1-8-13. page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s)..The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine.if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Foam: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 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 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 ❑ ® 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 is less than 6" below invert or available volume is less than 1/z day flow e/$///u C t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 'Ili Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-5-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ - ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 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 920 Main St. Bldg#2 ( Units 1-4) Property Address O_sterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is Osterville MA 02655 1-8-13 required for every page. CityfTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® [] Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑, Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information. Residential Flow Conditions: Number of bedrooms(design): 8 Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 t5ins•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 920 Main St. Bldg#2( Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: The system is a 2000 gallon tank, D Box and leaching pit Number of current residents: 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? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( y 9 (gp ))= Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: 4 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 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 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: 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 Form:Subsurface Sewage Disposal System-Page 8 of 17 f Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•'" 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. 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: 30"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" pvc sch 40 Septic Tank(locate on site plan): • 16"' 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 gallon Sludge depth: lot t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" o„ Scum thickness Distance from top of scum to top of outlet tee or baffle 8" 'Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-TapePast report Sludge 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.): Yearly Pumping. Tank at 11" in black top drive w/both covers steel at grade., in and outlet tee's, No sign of leakage or overloading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityrrown 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 w❑ 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f 1 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg#2 Units 1-4 Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): 0,. Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Camera D Box from Pit Box at 30"below grade. two lines out, No sign of over loading or solid carry over box looks to be solid. 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): 1f SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityfrown 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: ❑ Teaching 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 two precast pits. Pit 1). 1'water w/stain line at 1'above water steel cover at grade in blacktop pit at 11" below grade. Pit 2) 6"water w/stain line at 20"above water pit at 5' below grade w/cover 16". No sign of over loading or solid carry over in pits F 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM �' 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M a 920 Main St. Bldg#2 Units 1-4 ( ) Property Address Osterville Village Condos_ (First Property Mgmt.) Owner owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityrrown 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 f -M rage- i of Town of Barnstable Geographic Information System ��rcei Viewer � CuskOm Map � ��u�ee� ��?SEZp .. Zoom Out s } rZz 1 t �% N � r _ t „ram 44, i t ` 1+ n 15 -f R �--�� 5 m D 1�k Mac t v y r 3 � y •1. yl � v�� � I S -�h 1 d s%0 'r 4 s •is 'i r'- •r l y Y, 0 -- :__ _._. - 31. Set Scale ILL 20 L Aerial Photos MAP DISCLAIMER ..^nnurinht 9nn;;-?nIn T".—of Q—fohI. KAA Aii AM'fc racunr. 7_...,-,Il//nA'1 11C /1^1//_..,-._._7_..___� 7____.. __.__�r'f._.._.___.t__t'T'1 tt�"(!5C//?(lE n ... _ .. _ ..t. .t LZt R'th,ntn ,'._}L -•.. r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. BldgUnits 1-4 #2 ( ) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells 30+' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 1981 If checked, date of design plan reviewed: Date Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As-built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: G.W. off Past Report 30+' Bottom of Pit 11" 4 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 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg#2 ( Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 056-- ODA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property.Mgmt.) s Owner Owner's Name a_• information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection P Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When .. filling out forms A. Inspector Information /83��- ;,._�:.• ' on the computer, =��: DAMES use only the tab James D.Sears R, key to move your Name of Inspector !0; SEARS cursor-do not Capewide Enterprises use the return 's, Company Name %, T'.- RTIF� key. 153 Commercial Street i,����/.5 1 N Si;_J``���\ Company Address u Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After.conducting this inspection I have determined that the system:. 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1-22-19 pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) u Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: The system is a 2000 Gal. Tank D Box and two pits. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. t *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I l r cam. Commonwealth of Massachusetts Title 5 Official Inspection Form ^14 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): �I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form pia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4). System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg.#2 (Units 1-4) u Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in @@sspml is less than 6" below invert or available volume is less than 'h day flow P/7 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ 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)] f t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 l Commonwealth of Massachusetts h Title 5 Official Inspection Form i. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) V Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is Osterville MA 02655 1-18-19 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 8 Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 Description: 2000 Gal. Tank D Box and two pit. Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage NA 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form _ Ie Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1981 4-2016 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 3011 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" PVC SCH 40. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form FI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 16" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 Gal. Precast H-20 3" Sludge depth: - Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Aspuilt - Tape Past Report Sludge 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.): Yearly pumping. Tank at 16" in black top drive w/both covers steel at grade. In and outlet tee's. No sign of leakage or overloading. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts P Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holiding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 39" below grade w cover at 6". Two lines out. Box is new 4-2016 I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I I c Commonwealth of Massachusetts Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) u Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 s c Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two precast pits. Pit 1)2"Water w/stain line at 2'. Steel cover at grade in blacktop pit at 11" below grade. Pit 2) 3"water w/stain line at 20".Pit at 5' below grade w/cover 16". No sign of over loading or solid carry over in pits. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts :. Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (mote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I ,V 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 • Jan 1419,12:55p Capewide Enterprises 508-477-4977 p•5 rage i oz Map �i Town of Barnstable Geographic Information System • Parcel Vie Ilb Viewer custom Map1 utten "Da S ne ■ zoom Out Ir•. IEEE isy . Ulf K rd Set Scale 1" = Zo ' I Aerial Photos ! MAP DISCLAIMER f V. IWO.nA1 /fir f♦me'. I Commonwealth of Massachusetts Title 5 Official Inspection Form <; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 920 Main Street Bldg.#2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar I ❑ Shallow wells tV 0 Estimated depth to high ground water: 30+ 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: 1981 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: G.W. off past report 30+'. Bottom of pit 11". Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I r Commonwealth of Massachusetts Title 5 Official Inspection Form _ i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg. #2 (Units 1-4) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` I ,M 920 Main Street Bldg#2 (Units 5-6) c Property Address Osterville Village Condos.(First Property Mgmt.) ►.� Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. City/Town State Zip Code Date of Inspection W CO Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, ���`� �OFttgo ii;��� use only the tab 1. Inspector: key to move your cursor-do not D.Sears N �: DAMES James =_ - key.use the return Name of Inspector = SEARS y Capewide Enterprises, LLC * ', el_ : * nil I I Company Name ��I'•-. RTIF� 'O V � 153 Commercial Street �0;�5 I N SpEG��```�\ Company Address t�ttttt 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 1-18-16 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 of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal Tank and pit. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑'Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 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 ❑ ® 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 ewapad is less than 6" below invert or available volume is less than '/2 day flow A1T t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is Osterville MA 02655 1-18-16 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This Y system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑. ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to b surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M a 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First PropertyMgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank and pit. Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No j Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: PresentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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) ❑ 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •°'� 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. Cityrrown 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: 48" 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.): I Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 44" 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: 1500 Gal.Precast H-20 Sludge depth: 1" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 920 Main Street Bldg#2 (Units 5-6 Property Address Ost_enrille Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle na Scum thickness 0" 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? Asbuilt-Tape-Past ReportSludge 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.): Yearly Pumping. Tank at 44" below grade w/inlet cover steel in brick walk way. In and outlet tee's. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osteryille MA 02655 1-18-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Box Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i i ' f Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: i ❑ 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.): Leachibg is one 1000 Gal. precast pit. Pit at 4' below grade w/18" cement cover at 4", 4"water. Stain line at 4' below inlet line. No sign of over loading or solid carry over. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM , 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osteryille MA 02655 1-18-16 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.): I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I� Jan, 13. 2016 12:02PM No. 0320 P. 9 Page I of 2 'own of Barnstable Geographic Information System parse; V iew M a - e Custom Mep Abutters sD 5►:e E l Z'OOM OUt 33 2 J d I ., .._ /� �,`}-�'':,' ..:••' .''_.�. ,:ems. ;.? tla Q i I A ",fie,• O et Set scale v = zo ' I Aerial Photos I MAP DISCLAIMER !'M, l-ko 9W.."M Y. ..'4 Ct.—ooAly NO All'o-NIo r000n,. Commonwealth of Massachusetts M W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-18-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N© 30+, Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: G.W.off past report 30+'. Bottom of pit at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6 Property Address Osterville Village Condos.(First Property Mgmt.) Owner Owner's Name information is required for every Osteryille MA 02655 1-18-16 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 p Jan 31 2019 22:08 HP Fax page 1 (0-- Dot+ Commonwealth of Massachusetts rTj �4t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main Street Bldg#2(Units 5-6) rho Property Address -� Osterville Village Condos (First Property Mgmt) ; s ;•,.t Owner Owner's NameInform ./ required is Osterville V MA 02655 1-29-19 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please sea completeness checklist at the end of the form. p��uttn i t t U rrHp�l Important:When filling out roans A. Inspector Information on the computer, JAMES m use only the tab James D.Sears _ _1-1 �r-A key to move your Name of Inspector cursor-do not Capewide Enterprises use the return 'F�?�I r a Company Name '�i,,�F" key. 153 Commercial Street nNS`Pti������• Company Address Mashpee MA 02649 City/Town State Zip Code ' 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1-29-19 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform In the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 1 of la Jan 31 2019 22:08 HP Fax page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Village Condos (First Property Mgmt) Owner Owner's Name information is required for every Osteryille MA 02655 1-29-19 page. City/Town State Zip Code Date of Inspedlon C. Inspection Summary Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6, 1) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and pit. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined" (Y, N, ND)for the following statements. If`not determined," please explain. The septic tank is metal and over 20 years old*or the septic.tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. El Y ❑ N ❑ ND (Explain below): t5msp.doc•rev.V26/2418 Title 5 OfGdal Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 6. Jan 31 2019 22:08 HP Fax page 3 Commonwealth of Massachusetts IV, Title 5 Official Inspection Form C Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Village Condos(First Property Mgmt) Owner Owner's Name information is required for every Osterville MA 02655 1-29-19 page. City/rown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ll ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i ❑ 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 ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 15insp.doc.-rev.V2812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 16 f Jan 31 2019 22;08 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y' 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Village Condos First Property M mt Owner Owner's Name information is required for every Osterville MA 02655 1-29-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cost.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a borderingvegetated g etat ed wetland or a salt marsh b. System will fall 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 it the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other; 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp,doc•rev.7/2612018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 4 of 18 Jan 31 2019 22:08 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Village Condos (First Property Mgmt) Owner Owner's Name information is required for every Osterville MA 02655 1-29-19 page. City/Town Slate Zip Code Date of Inspection Cr Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in I is less than 6" below invert or available volume is less than day flow (r ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.tloc•rev.7/2 6 12 0 1 6 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 5 of 18 Jan 31 2019 22:08 HP Fax page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg #2(Units 5-6) Property Address — Osterville Village Condos (First Property Mgmt) Owner Owners Name information fo ati is aired for every Osteryille MA 02655 1-29-19 page. City/Town State Zip Code Date of Inspectlon C. Inspection Summary (cunt.) If you have answered "yes'to any question in Section C.5 the system is considered a significant threat, or answered"yes' to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 16.304.The system owner should contact the appropriate regional office of the Department. 6, You must indicate"yes"or"no"for each of the following for all inspections: I. Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health u ❑ ® 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)1 t5nsp.doc-rev.7/2812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 16 Jan 31 2019 22:08 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg #2(Units 5-6) Property Address Osterville Village Condos (First Property Mgmt) Owner Owner's Name requiiredfo is Osteryille MA 02655 1-29-19 required far every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: 1500 Gal. Tank D Box and pit. Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ 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 t5insp.doc-rev.7/26/2018 Title 5 Ofridal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Jan 31 2019 22:08 HP Fax page 8 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg#2(Units 5-6) l , -f - Property Address Osterville Village Condos First Property M mt Owner Owner's Name information is required for every Osterville MA. 02655 1-29-19 page. City/Tom State Zip Code Date of Inspection D. System Information (cunt.) 2. Commercla'lllndustrial Flow Conditions: Type of Establishment: r Design now(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available:. Last date of occupancy/use:, pate Other(describe below): 3. 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: Mwisp.dac•rev.7/28/2018 Title 5 Of clad Inspection form:Subsurface Sewage Disposal system•Page 8 of 18 i Jan 31 2019 22:08 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Village Condos (First Property Mgmt) owner Owners Name information is required for every Osterville MA 02655 1-29-19 page, Cityrrown state Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes,attach previous inspection records, if any) ❑ 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 DEP approval. ❑ Other(describe):, Approximate age of all components, date installed (if known)and source of information: 1981 1-2019 New D Box Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 48" -feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feel + Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. twsp.doc-rev.7/26/2018 Title 5 O trial In spectlon Farm:Subsurface Seorage Disposal System•Page 9 or'I8 Jan 31 2019 22:09 HP Fax page 10 Commonwealth of Massachusetts U 9 ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg 42(Units 5-6) Property Address Osterville Village Condos (First Property Mgmt) Owner Owners Name information Is Osterviile required for everyMA 02655 1-29-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 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: 1500 Gal. Precast H-20 Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 0" 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? Asbuilt-Tape-Past Report Sludge 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.): Yearly Pumping.Tank at 44"below grade wlinlet cover steel in brick walk way. In and outlet tees. No sign of leakage or over loading, t5insp.doc-rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 10 of 18 Jan 31 2019 22:09 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6) Properly Address Osterville Village Condos(First Property Mgmt) Owner Owners Name information is required for every Osteryille MA 02655 1-29-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction; ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness l Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7126/2018 Title 5011cial Inspection Form!Subsurface Sewage Disposal System•Page 11 of 16 I , Jan 31 2019 22:09 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments. y 920 Main Street Bldg#2 (Units 5-6) Property Address Osterville Village Condos(First Property Mgmt) Owner Owner's Name information is required for every Osterville MA 02655 1-29-19 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 20"x20"-44"below rade w/cover at 6". D Box is New 1-2019 Mone line out. r t5insp.dac•rev.7f2612018 Title 5 Offdal Inspecton Form;Subsurface Sewage Disposal System-Pape 12 of 18 Jan 31 2019 22:09 HP Fax page 13 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6) Property Address Osterville Village Condos (First Property Mgmt) Owner Owner's Name information is required for every Osterville MA 02655 1-29-19 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) I 10, Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ` ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.W26/2018 Title 5 Ofridal Inspection Form:Subsurface Sewage Disposal System.Page 13 of 18 Jan 31 2019 22:09 HP Fax page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Villaige Condos (First Property Mgmt) Owner Owner's Name information Is required for every Osteryill@ MA 02655 1-29-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is one 1000 Gal. precast pit.Pit at 4' below grade w/ 1 B"cement cover at 4",4"water. Stain line at 4'below inlet line. No sign of over loading or solid carry over. 12 . Cesspools cesspool must be pumped as part of inspection)(locate on site.plan)., . Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of.groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.dac•rev.MA12018 Title 5 Offidel Inspection Form:Subsurface Sewage Disposel System•Page 14 of 18 Jan 31 2019 22:09 HP Fax page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. CI 920 Main Street Bldg#2 (Units 5-6) Property Address Osterville Village Condos(First Property Mgmt) Canner Owner's Name information Osteryille MA 02655 1-29-19 required for every page. City/Town State Zip'Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.T2BfIt)18 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Jan 31 2019 22:10 HP Fax page 16 Commonwealth of Massachusetts �UV Title 5, Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 920 Main Street Bldg#2 (Units 5-6) Property Address Osterville Village Condos(First Property Mgmt) Owner Owner's Name information Is Osterville MA 02M 1-29-19 required for every ' page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 14, Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks, Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 15insp.doc•rev.W612018 - Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page is of is Jan 31 2019 22:10 HP Fax page 17 Jan. 13, 2016 12:02PM No. 03N P. 9 •tt • Page 1 of 2 •-;.,,�,�� Town of Barnstable Geographic information System ' ! Pdr;e; 'r iA�(Fl Cu8toR1 01ep1 Abuttart ' mop$lte 0 � � ZOorn Out j 3 J-1 J j IJn LATV `t t� J. � f ! 2f�< @t O i 1 I Set Scale 1" 2G 1 Aerial Photos I MAP DI5CLAIMER PnnwAwN 9Mf�9Y11A .J l%—.e9Od% M0 011 Jan 31 2019 22:11 HP Fax page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 1' 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Village Condos(First Property Mgmt) Owner Owners Name information is required for every Osterville MA 02655 1-29-19 page. cityrrown State Zip Code Date of Inspection D. System Information (cunt) 15. Site Exam: ❑ Check Slope I ❑ Surface water ❑ Check cellar ❑ Shallow wells N° Estimated depth t 30+p high ground water: feet Please Indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USES database -explain: You must describe how you established the high ground water elevation: G.W.of past report30+'. Bottom of pit at 10'. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc rev,7/26=18 Titte 5 Officlal Inspection Form:Subsurface Sewage Disposal Syslem•Page 17 of 18 i, Jan 31 2019 22:11 HP Fax page 19 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main Street Bldg#2(Units 5-6) Property Address Osterville Village Condos(First Property M mt) Owner Owner's Name Information Is requlr>;d for every Osterville MA 02655 1-29-19 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C, Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included -L _.�_._ --------- N r t5inap•doc•rev.7/2 612 0 18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 w I i _ Commonwealth of Massachusetts ,k Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 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 ng out forms A. General Information on l the computer, 61N�` H OF rMgsso,,��� use only the tab 1. Inspector: key to move your S `��;' JAMES G cursor-do not c_,!� mi use the return James D. Sears =1: Name of Inspector key. Capewide Enterprises,LLC '•. `�o:e�z Company Name �i,'��••.RfitF •G� `\�. 153 Commercial Street '% s�INSP��``p�`` Company Address Mashpee MA 02649 City/Town State Zip Code 508477-8877 . S 1623 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 1-8-13 pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 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: ® 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: . t B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion.of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y, ❑ N ❑_ND (Explain below): 4 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 M 920 Main St. Bldg 2( Units5-6) Property Address O_sterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced. ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, . safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: x " 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 El ® 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 easppoO Is less than 6" below invert or available volume is less than Y2 day flow 4�' C4/«1457 t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ N Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with,a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form. o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 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? ❑ N Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 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 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 . page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 gallon tank and pit Number of current residents: 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 Seasonaluse? ❑ Yes ® No Water meter readings, 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.): 6 , 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 e Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) - Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): e i t ' General Information Pumping Records: Source of information: eaearly 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) ❑ 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property M mt.) ` Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Cityfrown ` 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):. T' - o Depth below grade: 4811 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 et -feet Comments (on condition of joints, venting, evidence of leakage, etc:): Pipeing is 4" pvc sch' 40 Septic Tank(locate on site plan): 41' 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 1500 Dimensions: 2 Sludge depth: 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 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property M mt.) - Owner Owners Name information is required for every Osterville MA 02655 1-8-13 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 28" . Scum thickness 011 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle a 181, How were dimensions determined? Asbuilt-TapePast report Sludge 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,): Yearly Pumping. Tank at 41" below grade w/inlet covers steel in brick walk way, in and outlet tee's, No sign of leakage or overloading. 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 M 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Forth: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 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. (First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. Citylrown 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 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: k t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �b 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ` Leaching is one1000 Gal precast pit. Pit at 4' below grade w/ 18"cement cover at 4"6"water. stain line at 4' below inlet line. No sign of over loading or solid carry over. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM , 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 - 1-8-13 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.): Y • . t5ns•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17, Commonwealth of Massachusetts' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately f 1 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 � r s page I 0 IwA RM' gg Ss Y � ftrhae Geographic Information System s Custom ma Ma size �oorn out g * ,Aj � - J Im \ ' F �t 1 NOE affi% MIA t � 'L ye i N a j L`• Set scale` V — 20 t ( Aerial Photos MAP DISCLAIMER P'ro+++rinhh 9M�9M(1Tnuen of i7artet�hiu..AAA A8 rir.htc racnne httn-/16A ?0,; 05 ��(i{aT�ntclarrtt>P:�arstlrrsarsa nx�l�mnP9-iz�1Tl�1'i7(1,Klllyr� Q., ,__ ---3_ . „ �,,.A. . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 920 Main St. Bldg 2( Units5-6) Property Address Osterville Village Condos. ( First Property Mgmt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 30 it feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board'of Health -explain: ` ❑ Checked with local excavators'installers- attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: G.W. off Past Report30+' - Bottom of pit at 10' r ` 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 920 Main St. Bldg 2{ Units5-6) Property Address Osterville Village Condos. ( First Property M mt.) Owner Owner's Name information is required for every Osterville MA 02655 1-8-13 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 R . t5ins-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatlon for MIsposal 6pstem Go s Union 3pErmit Application for a Permit to Construct( ) Repair(X Upgrade( ) rbandon( ) ❑Complete System XIndividual Components Location Address or Lot No. S-L 0 Cx a ' �IP_S-r ner's Name,Address,and Tel.No. Sao 64AW Ti- 6ST voTs i- P�a�b�T`i e�a�gi1 6�T Assessor'sMap/Parcel 1 ®� �� , •-0� jp M,q(N #/t Installer's Name,Address,and Tel.No. 5OjR—q`t'($Y't 7 Designer's Name,Address,and Tel.No. (�,A p Fv c l p r 6N a't7' 4u S eT, LLC_ fj/4 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) �( E ? 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 Healitthr Sign Date Application Approved by LlDate Jt� Application Disapproved by Date for the following reasons Permit No. / G= Date Issued yNo. r 0 Feein• 3` computer: THE COMMONWEALTH OF MASSACHUSETTS Entered PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,.MASSACHUSETTS Yes application for Misposal 6pstrin Dons uction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Kandon( ) ❑Complete System KIndividual Components Location Address or Lot No. 8C.0 C:A �#Ls-r ner's Name,Address,and Tel.No. q 30 MAW ST "T • voT S 1- P R 0*t f,---k-,r4 Nt404CER t90-f— Assessor's Map/Parcel a p -D 0 Installer's Name,Address,and Tel.No. 50Q_q,?j gg-t 7 Designer's Name,Address,and Tel.No. G40a<w �'Ds= 6_079Uki W4 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 w Nature of Repairs or Alterations(Answer when applicable) FWX 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 Heal Signe - Date oCQ/ Application Approved by Date L Application Disapproved by Date for the following reasons Permit No. 9-0/6 Z6) 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS N` BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by CAf_-7—__w/b 6 FirJ 7FAPQ1S&�__ L,1,0 at 9610 M A4 Al S7 ©ST& (I-LC �Tcji.0 has been constructed in accordance - Y with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer`A0@,ys0c- e&rr=pQ1,SF,-3 LL.Q Designer 14 #bedrooms ( Approved design flow gpd The issuance)of this permi shall not be construed as a guarantee that the system wiPl function as des gned. Date �� Inspector ----- ----------- ------- -7 _ - ---------- ------ No. d�lr��/dj Fee THE COMMONWEALTH OF MASSACHUSETTS T— PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair()Q Upgrade( ) Abandon( ) System located at (?ZLo Mk / r" s7, OS7_6kV/G_E' / aL)1L4)1P 9 UNITS 1- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a com eted within three years of the date of thisC-,- Date ' /�� Approved i I i' u G R G YJ 1 n u if$"ram LU N U c ' ra c ,r C _ ----------- = 41 OF QA v. O .„yam •a�+�Yr��`'��z�, >w .� t � d_ �' '����� it�?-�i�,gP�t�'�� �•� .4" � > t,� .c t-�5"n-�S, K. ' _, •v� � .ry�,r u,.,��- ,y' S 3a. `'` � rr �,� •#cv ,.r{ biro , (V x 1 .fix�� �, � .. r g `pj��'41'• X 1,4 u �Ott...ter. `'"' `�-� �� Jill ,�„;, �r �- �'`�' � ��3 �Z�rarer, a �✓`'..✓''r�^ l t 1 — N ' � s O 14A- s v a31 Em I rir N O v Ck n 3 2 n � r s _ rqOF n V p ♦ - Z 3 n _ Z t— A 0 r ' e : N f` S `s cr n e = > ��c0 n 1 2Z�+ IT=1q,�� 10 •�j.*. m �. p3. s - w s . At O o UIC S ' v v q� 1A = n _ n �p r Mo daa �to,;r ♦3 0 $ 4 0 t 8 I d3S bZ +��F CL Osterviiie Village. , O"POre° SEWAGE INSPECTIONS fi LOCATION 0,6.te2v.i e ec Vi eiage. Condo ' , DATE 9/16103 B .ii.in 2 n.c � 117-056 VILLAGE 0.6 eayi P-, 17a,6,3. ASSESSOR'S MAP & LOT :INS,PECTOR jo.6eRh l. 1%,romPen 12. SEPTIC TANK CAPACITY 1500 gaiion, LEACHING FACILITY: (type) 9-Li- 1000 (size) 1500 gaiion-6 NO. OF BEDROOMS BUILDER OR OWNER 0-3tQ2 V.i teage Condo 4.6-60c.iat.ion OWNER MAILING ADDRESS Guy Coiie.t.t-i 21 Co.t.tage Lane. Cen.teay.ii e, Na,5.6. 02632 a(6 C5 IF ', ' 1. • ,'�y n TOWN OF BARNSTABLE LOCATION 1�2& C,Q SEWAGE VLLLAGE_ ,�s ,//e ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. &'!¢ff eg,pr�s 77S-G2G ,. SEPTIC TANK CAPACITY) r1® LEACIHING FACILITY:(typ`)-)A& (size) /a®v C-4 NO. OF BEDROOMS PRIVATE W-0 LfOR"PUBCk WATER'-Auk BUILDER OR OWNER-,Y4jj,Ld,' egt a � � - DATE PERMIT ISSUED: O DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t � — i �� ��� ���a ��¢ 5 Y is 3 y TOWN OF BARNSTABLEU' LOCATION Cj;0 MA►n 3T 13V, �►�� v'1. S Ett E# *ILLAGE O —9ry 4 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) e►J (size) NO.OF BEDROOMS O + OWNER _ OS%Crv.t�- V►I�ACc. Gnn�Ot PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist 13 . within 300 Ofe of leaching facility) /a, Feet FURNISHED BY %1` 2 d(C / e I d a A o • a. 3 A 3 A a 13 a-1 3� S� a- aq y 3 by a TOWN OF BARNSTABLE •'--�L7r LOCATION ��`� 3 MA3/1 SEWAGE # VILLAGE OS- eUb- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C,Qsspw LEACHING FACILITY: (type) CAI(ID ( (size) NO. OF BEDROOMS. 11 BUILDER OR OWNER Hogg 6 r PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachi g facility) Feet Furnished by T^SAGtu^ •� . FO/ A I FroAr 6 a yo y. TOWN OF BARNSTABLE � � LOCATION Sa0" I3 1014wl SEWAGE # & VILLAGE 6 5Tte'yAt ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CQSSAo� LEACHING FACII.TTY: (type) CQSSp011 - (size) NC,OF BEDROOMS i BUILDER OR OWNER pAv PERMTTDATE: COMPLIANCE DpATE:Z Separation Distance Between the: Maximum Adjusted Groundwater Table to-the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of Igaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by IF At' a3 . 131- 31' O