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Home My WebLink About2957 FALMOUTH ROAD/RTE 28 - Health .2957 FALMOUTRD. { llaisLon .s i2i]js 009 M E A®® No.H18Sv UPC 10871 smead com • Made In USA �xlo 9/ 1 2- ;� I • �.n� vvv fieeelll� APPLICATTON FOR SITE PLAN REVIEW Date: LOCATION Business Name: Subdivision Plan Assessor's Map# L _ Parcel# ANR Plan Prop Address: ' �� Site Plan OWNER OF PROPERTY APPLICANT � g Name: t a a r`[>2 I�.i g N f :Name: tj a y 1�— &2242h o Address: a rr�- r Du a_� Andress: -a ri eek � -, ov 'N s Telephone: r0 g-• 117 �-, p a t v Telephone: fro a Fax sv8-. Zpg_ gos, Fax a _7 ARCHI?ACT/DEVELOPER/CONTRACTOR/ENGINEER AGENTIATTORNEY Name: I-( FL_ Q ra P r.° Name: S96/!-). A t-:1 Address: z-1 1r.. K CL n•s Address,tq I-! Telephone:'SD,P• 7 9 F- S18° Telephone f.7?,F, a,�o Fax: ros• -i rp•-B9p l Fax: V., Y, P STORAGE TANKS(HAZ MAT/F uEL OR WASTE OIL) ZONING DISTRICT CLASSIFICATION Existing X Proposed >c District R r Overlay(s) Number Number X Lot Area (, 0 L q.Ft. — - Ac. Size Size Fire District Above Ground ,e Above.Grround / Underground ,c Underground- pe Setbacks $. Contents Contents x Front Side: / Rear. - Number of Buildiny-s Existing ? Proposed UTII.= Demolition r,l h Sewer [J Public ® Private Size )gal Water 0 Public ❑ Private TOTAL FLOOR AREA BY USE Electric- Aerial ® Underground Existing. Proposed Gas - Natural - X -Pro ane --- Grease Trap ❑Size --- gal �. Sewage Dai1y-.Flow * _ ,_- gpd --- -Residential V *GP or WP areas restrictwaste*ater discharge to'330 gallons per Restaurant acre per day into on-site system Retail Office PARIONG SPACES CURB CUTS Medical Office Required Existing Commercial( ec' Provided ` _ Proposed Wholesale(specify) On-Site ^' To Close �' Institutional(specify) Off-Site -+ Totals Industrial c' Handicapped All Other Uses On Site ; At 3 ,21 Estimated Project Cost: Fee: Gross Floor Area G�' 2- vex $ $ i SP-FORM P1.DOC-0611MOD4 =x Old King's Highway Regional Historic District File A Approved? Yes Q No .Hyannis Main Street Waterfront Historic District File#. Approved? Yes []No Listed in National and/or State Register of Historic Places? ®Yes [-]No Previous Site Plan Review File# Approved? d Yes []No Previous Zoning Board of Appeals File# Approved? Yes Yes Q No Is the site located in-a Flood Area(Section 3-5.1) Yes 0 No. In Area of Critical Environmental Concern? myes ❑No Is the Project within 100'of.Wetland.Resource Area? f Yes ❑No Site sketch—in€onnal preserttatign Yes ❑No Site Plan prepared,wet stamped and signed by a Registered PE-and/or-PLS. ®Yes No Parking and Traffic Circulation Plan [ Yes ❑No .Landscape Plan and Lighting Plan ffYes Q No Drainage Plan with calculations and Utility Plan (E Yes ❑No Building Plans,(all floor plans,elevations and cross sections) [0 Yes ❑No Note that all signage must be approved by Code Enforcement Officer at the Building Department Lot area in sq.ft. l l b(� e24 sq.ft Total Building(s)footprint „ i sq ft. Maximum Lot Coverage as%of Lot % GROUND WATER PROTECTION OVERLAY DISTRICT REOUMEM D-M:- OVERLAY DISTRICT(S): Lot Coverage (%) Required Proposed Site Clearing (%) Required Proposed PRINCIPAL BUII DING ACCESSORY BUILDINGS) des. ❑No Number of floors _ Height: fl. Number of floors ' Reight�_ fL FLOOR AREA: FAR FLOOR AREA: FAR- Basement -- sq.R Basement sq.ft. First •, sq.ft. First q.ft Second sq.ft. Second . sq.ft Attic r.--_ sq.ft. Attic , _ sq.ft Other(Specify) sq.ft Other(Specify) sq.ft Please-provide abrief narrative.description of your proposed project: I assert that I have completed(or caused to be completed)this page and the Site Plan Review Application and that,to the best of my knowledge,the information submitted heree is true. Date Printed Name of Applicant r9 SP-F0RM-P2.D0C-06J1&2004 l�-ooq c Commonwealth of Massachusetts �s ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road , u Property Address °# Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information S/=# 1353il on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 10 Company Address Sandwich Ma 02563 CitylTown State Zip Code rxr„ (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Brett Hickey 12-24-18 •'Uale'ZOfe.12)11TS1:05-0SW Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes- ,-,. i ❑O 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 was in working order at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 P Y rY 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every 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 ❑ 0 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 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ R Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E] Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ a Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ E 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.] ❑ a The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ a The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road V� Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ Q Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ ' Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? n ❑ Were all system components, excluding the SAS, located on site? 0 ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: El ❑ Existing information. For example, a plan at the Board of Health. El ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: 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 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑■ No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 cf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Office building Design flow(based on 310 CMR 15.203): 548GPDGallons per day(gpd) 75 G/D X 4.2=315 Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes 0 No Water treatment unit present? ❑ Yes 0 No If ,es discharges to: Y 9 Industrial waste holding tank present? ❑ Yes [E No ' Non-sanitary waste discharged to the Title 5 system? ❑ Yes @ No 2017-157,000gallons 2018-166,000gallons Water meter readings, if available: current Last date of occupancy/use: Date Other(describe below): 3 Pumping Records: Source of information: Owner- date of last pump is unknown 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 cry Commonwealth of Massachusetts �n Title 5 Official Inspection Form gal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 11611 Depth below grade: feet Material of construction: ❑ cast iron X 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road V� Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 611 Depth below grade: feet Material of construction: R concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 500gallons 611 Sludge depth: 3011 Distance from top of sludge to bottom of outlet tee or baffle 2rr Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1411 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumpirg: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): o„ Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form I?1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑• No* Alarms in working order: ❑ Yes [9 No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not Jn 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: (1 ) 6'X6' leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leaching was in passing condition at time of inspection. Pit had 1' of standing water with a stain line 1/2 way up from the bottom. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form 1el Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA 1 Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 AN, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road v Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 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 Route 28 B C A Al-21'6r' Ell.14' C2.22' 2 A2.57' 82.121" C3.52' A3.72' C4-69' 0 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 l c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owners Name information is Marstons Mills Ma 02648 12-24-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water ❑■ Check cellar ❑■ Shallow wells No GW T below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record 1986 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: A plan on file with the Board of Health was used. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2957 Falmouth Road Property Address Paul Gargano Owner Owner's Name information is Marstons Mills Ma 02648 12-24-18 required for every 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 W 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 i t5insp.doc•rev.712U2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 'YOU WISH TO OPEN A BUSINESS? J For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall)and get the Business Certificate that is required by law. DATE: Fill'n please: � t{ k APPLICANT'S YOUR NAME/S: ` J BUSINESS YOUR HOME ADDRESS: l 508.419.7372 1 7 TELEPHONE # Flome Telephone Number D - NAME OF CORPORATION: Sea-Dar Enterprises, Inc. NAME OF NEW BUSINESS Sea-Dar Construction TYPE OF BUSINESS Construction IS THIS A HOME OCCUPATION? YES __NO xx ADDRESS OF BUSINESS'2957 Falmouth Road, Q2kmn&, MA 02655 MAP/PARCEL NUMBER 12 I wq (Assessing) 06 V1f tW OZ(p . When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has(beer o of the per requirements that pertain to this type of business. �( V� MUST XMPLY WITH ALL COMMENTS: Authorized Signature** WA7ARDOUS MATERIALS REGULATIO !S 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: F � 1 / TOWN OF BARNSTABLE Date:((� /Z( all TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: _,tea .Dam s�yuc ol) BUSINESS LOCATION: dal! /1:tJZ"h INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: lI'1 EMERGENCY CONTACT TELEPHONE N MBER: � -a�L- � MSDS ON SITE? TYPE OF BUSINESS: 14 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids �L (dry cleaners) fi9a, ,&' S a,71-- rj) !� Me— Other cleaning solvents i/ Bug and tar removers Windshield wash eye ff� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Annioranti Signature Staff's Initials L—iv Commonwealth of Massachusetts Title 5 Official. Inspection Form Not for Voluntary Assessments Q Subsurface Sewage Disposal System Formlug /02/ 0 6 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: -d When filling out 1. Property Information: Q�-a�n� forms on the computer,use 2957 FALMOUTH RD.OSTE4`,ML€MA, 02655 only the tab key Property Address to move your CONSERV GROUP cursor-do not use the return Owners Name key. PO BOX 278 SAGAMORE BEACH MA, 02562 Owner's Address SAGAMORE BEACH MA 02562 City/Town State Zip Code 4/11/07 Date of Inspection: Date 2. Inspector: PAUL C. MARTIN Name of Inspector D.J. BURNIE&SONS bluewater holding corp. - - - Company Name 105 FERNDOC ST UNIT A Company Address HYANNIS MA 02601" City/Town State Zip Code_; 508-775-0139 Telephone Number B. Certification Y j S - r I certify that I have personally inspected the sewage disposal system at this addreA and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/13/07 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner. and copies sent to the buyer, if applicable, and the approving authority. *""'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 W-7 yz Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: , ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y, N, ND)in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is,metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the(Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: i i i f CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,y Subsurface Sewage Disposal System Form M B. Certification (cunt.) 2957 FALMOUTH RD.OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection 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 ❑ obstruction is removed distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: F 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 for privy is within 50 feet of a bordering vegetated wetland or a salt marsh f CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments s• Subsurface Sewage Disposal System Form B. Certification (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health(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: t i This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. i i 3. Other: I CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Pam- Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments z• Subsurface Sewage Disposal System Form B. Certification (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cdy-rrown State ZipCode CONSERV GROUP 4/11/07 Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for 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 of 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. Yes No i ❑ ® 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. CONSERV GROUP T-5.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System ! Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 2957 FALMOUTH RD. OSTERVILLE MA,02655 Property Address OSTERVILLE MA 02655 Citylrown ( State Zip Code CONSERV GROUP 4/11107 Owner's Name Date of Inspection i 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 b. 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. F I i { i i I t I CONSERV GROUP T-5.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M y• C. Checklist 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection 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 componentsg 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? z 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)] t i CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 1,7/fit f�l i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form h D. System Information 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 kjr-town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: 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 years usage(gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: OFFICE BUILDING Design flow(based on 310 CMR 15.203): UNKNOWN Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): UNKNOWN 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: 2005 63GPD,2006 39GPD Last date of occupancy/use: UNKNOWN Date Other(describe): CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System �� Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection General Information Pumping Records: Source of information:' NO RECORDS 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) ❑ Tight':tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN r t Were sewage odors detected when arriving at the site? ❑ Yes ® No i i CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System �j Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Building Sewer(locate on site plan): " Depth below grade: 21 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.): SCALING OF CAST IRON IN MAIN SEWER LINE. Septic Tank(locate on site plan): Depth below grade: lift g feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: yeas Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No -- certificate) --- ------------------------------------------------------------------------------------------- Dimensions: 1500 Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 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 How were dimensions determined? SLUDGE JUDGE CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information cant. Y (cont.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below.grade: Material of construction: 7 ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System �—, Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 CitylTown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Tight or Holding Tank(cunt.) 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 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.): BOX IN GOOD CONDITION,AND COVER BUILT-UP TO GRADE. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No i CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System -� Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Sy0,•W Subsurface Sewage Disposal System Form D. System Information (cont.) 2957 FALMOUTH RD. OSTERVILLE MA,02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owners Name Date of Inspection 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: i Type: ® leaching pits number: 1 6X8 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typelname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): UPON INSPECTION"PIT WAS DRY i i CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction . Indication of groundwater inflow '❑ Yes ❑ No 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 i Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y Subsurface Sewage Disposal System Form D. System Information (cont.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Citylrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A -12 Z8 , iy `3 A 9 t � y i i o z CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,y Subsurface Sewage Disposal System Form M D. System Information (cont.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Site Exam: ; Slope , Surface water IV,;+, Check cellar 0, Shallow wells•Wo Estimated depth to ground water 11 r I0 � 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: SDW 253 ZONE C 3-4 2.8 X 12=34" You must describe how you established the high ground water elevation: SEE ATTACHED CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 ro ,7j gr d Commonwealth.of Massachusetts ,�pR Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form V• I -- Inspection results must a submitted on this form. Inspection forms may not be altered in any way. A. General Mom ation Important: When filling out 1. Property Information: forms on the 2957 FALMOUTH RD.OSTERVILLE MA,02655 ,computeter,use u only the tab key Property Address to move your CONSERV GROUP cursor-do not use the return Owneft Name key. PO BOX 278 SAGAM DRE BEACH MA,02562 Owners Address SAGAMORE BEACH MA 02562 �--- � City/Town State Zip Code Date of Inspection: 4/11/07 Date 2. Inspector. PAUL C.MARTIN Name of Inspector D.J.BURNIE&SON bluewater holding corp. Company Name 105 FERNDOC ST U 1T A Company Address HYANNIS MA 02601 Cityrrown State Zip Code 508-775-0139 Telephone Number B. Certification I certify that I have persor ially inspected the sewage disposal system at this address and that the .information.reported-belo 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 _❑ Conditionatly.Passes 0 Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/13/07 Inspector's Signature Date The system inspectoi shall s bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)wit iin 30 d ys of completing this inspection. If the system is a shared system or has a design flow of 0,000 g d or greater, the inspector and the system owner shall submit the report to the appropriate regi nal office of the DEP.The original should be sent to the system owner and copies sent to th =buyer;if applicable, and-the approving authority. '""This report only des vibes onditions at the time of inspection and under the conditions of use at that time.This inspecti 1 does not address how the system will perform In the future under the same or differor t conditions of use. CONSERV GROUP T-5.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- , Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary As essments Subsurface Sewage I isposal System Form B. Certification 2957 FALMOUTH RDI OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes- ® I have not found ny information which indicates that any of the failure criteria described in 310 CWIR 15.3C 3 or in 310.CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more syst m components as described in the"Conditional Pass"section need to be replaced or repair Dd.The system,upon completion of the replacement or repair, as approved by the Board of Heal ,will pass. Answer yes, no or no determined(Y, N, ND)in the❑for the following statements. If"not detem-tined,"please ain.- El The septic tank k metal and over 20 years old*or the septic tank(whether metal or not)is structurally,unsot nd,.exhbits.substantial infiltration or eAltration or tank failure is imminent. System will pass Inspection if the existing tank is replaced with a complying septic tank as approved by the b!oard of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System. Page 2 of 16 Commonwealth of M ssachusetts Title 5 Offi ial Inspection Form Not for Voluntary I S essments Subsurface Sewage ispo sal System Form B. Certification (cdnt.) 2957 FALMOUTH RD OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown. State Zip Code CONSERV GROUP ! 4/11107 Owner's Name Date of inspection B System Conditional) Passes(cont.): ) Y Y � ) ❑ Observation of sewage backup or break out or high static.water level in the distribution box due to broken or obstr ted pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if rwith approval of Board of Health): ❑ broken pi (s)are replaced ❑ obstructio is removed ❑ distributio box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pilm(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist hick require further evaluation by the Board of Health in order to determine if the system is faili I g 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 CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of M ssachusetts Title 5 Offi ial Inspection Form ° Not for Voluntary As essments Subsurface Sewage disposal System Form B. Certification (cunt.) 2957 FALMOUTH RD.OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityfrown State Zip Code CONSERV GROUP I 4/11/07 Owners Name Date of Inspection C) Further Evaluation is Required by the Board of Health(cont.): 2. System will fa I unless the Board of Health(and Public Water Supplier,if any) determines that t Ne system is functioning in a manner that protects the public health, safety and envir nment: ❑ The systei n has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a su water supply or tributary to a surface water supply. ❑ The systein has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The systei n has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The systein has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more.from a privatewater supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates ab nt and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Tess than-ppm,-provi Jed that-no other failure criteria are triggered.A copy of-the analysis must be attached to this fora. 3. Other: CONSERV GROUP T-5.doc.doc-0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4of16 �7 �1- Commonwealth of M ssachusetts Title 5 Offi ial Inspection Form Not for Voluntary As essments ,^ Subsurface Sewage 61sposal System Form B. Certification (cant.) 2957 FALMOUTH RDJ OSTERVILLE MA,02655 Property Address OSTERVILLE MA 02655 Cityrrown State ZipCode CONSERV GROUP 4/11/07 Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indica "Yes"or"No"to each of the following for all inspections: Yes No ❑ 0 of sewage into facility or system component due to overloaded or dogged SAS or cesspool ❑ ® )ischarge or ponding of effluent to the surface of the ground or surface waters Jue to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded br clogged SAS or cesspool ❑ z Liquid depth in cesspool is less than 6"below invert or available volume is less Than%day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or IA)structed pipe(s). Number of times pumped: ❑ ® iMy portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 14ny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® My portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® y 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 ystem;passes.Hthe_w_ell water,anatysis,_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 of chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1,0,000gpd. Yes No ❑ j The system fails.I have determined that one or more of the above failure criteria exist as descnbed 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. CONSERV GROUP T 5.doc.doc•032006 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of.M ssachusetts Title 5 Offi ial Inspection Form Not for Voluntary As essments Subsurface Sewage Disposal System Form B. Certification ( nt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection E) Large Systems: II o be considered a large system the system must serve a facility with a design flow of 10,00tl gpd to 15,000 gpd. For large systems, yo must indicate either"yes"or"no"to each of the following, in addition to the questions in Section C. YES NO ❑ ❑ ( e 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 ea-I PA)or a mapped Zone ll 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 siignificant threat under Section E or failed under Section D shall upgrade the system in accordance 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of M ssachusetts mm Title 5 Offi ial Inspection Form Not for Voluntary As essments Subsurface Sewage isposal System Form C. Checklist 2957 FALMOUTH RD OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Citylrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Check if the following iave been done. You must indicate"yes" or"no"as to each of the following: YES NO ® ❑ P mping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Ze the system received normal flows in the previous two week period? El ® large volumes of water been introduced to the system recently or as part of i s inspection? ❑ ® as built plans of the system obtained and examined?(If they were not ailable note as NIA) ® ❑ llyas the facility or dwelling inspected for signs of sewage back up? ® ❑ VIVas the site inspected for signs of break out? ere all system components,-e*dWing the SAS, located on site? ® ❑ V tere the septic tank manholes uncovered, opened,and the interior of the tank ir spected for the condition of the baffles or tees, material of construction, d mensions,depth of liquid,depth of sludge and depth of scum? ® ❑ as the facility owner(and occupants if different from owner)provided with ir formation on the proper maintenance of subsurface sewage disposal systems? e size and location of the Soil Absorption System(SAS)on the site has n determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ 0 C etermined 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)] CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of M ssachusetts Title 5 Offi ial Inspection Form Not for Voluntary As essments Subsurface Sewage isposal System Form D. System Inform tion 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityfrown State Zip Code CONSERV GROUP I 4/11/07 Owner's Name I Date of inspection Residential Flow Conditions: Number of bedrooms design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence havea garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[f yes separate inspection required] ❑ Yes ❑ No Laundry system insp ted? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy: Date CommerciaUlndustri 1 Flow Conditions: Type of EstablishmenIt OFFICE BUILDING Design flow based on 310 CMR 15.203): UNKNOWN g ( Gallons per day(gpd) UNKNOWN Basis of.design.flow.( eats/persons/sq.ft.,-etc_): Grease trap present? ❑ Yes ® No Industrial waste holdii g tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 2005 63GPD,2006 39GPD Last date of occupant fuse: UNKNOWN p y Date Other(describe): CONSERV GROUP T-5.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System �� Page 8 of 16 Commonwealth of M ssachusetts Title 5 Offi ial Inspection Form Not for Voluntary As essments s- Subsurface Sewage isposal System Form D. System Information (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP . 4/11/07 Owner's Name Date of Inspection General Information Pumping Records: Source of information: NO RECORDS Was system pumped s part of the inspection? ❑ Yes ® No If yes, volume pumps : gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septi tank,distribution box, soil absorption system ❑ Singli cesspool ❑ Overl ow cesspool ❑ Privy ❑ Shard system(yes or no) (if yes, attach previous inspection records,if any) ❑ inno tine/Altemative technology.Attach a copy of the current operation and mainienance contract(to be obtained from system owner) Tight tank.-Attach a copy of the DEP approval. ❑ Othe (describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site? ❑ Yes ® No CONSERV GROUP T-5.doc.doc-0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 9 of 16 Commonwealth of M ssachusetts Title 5 Offi. ial Inspection Form Not for Voluntary As essments Subsurface Sewage disposal System Form D. System Inform tion (cont.) _2957 FALMOUTH RDj OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owners Name Date of Inspection Building.Sewer(locale on si a plan): . 21" Depth below grade: feet Material of construction: ®cast iron �{]40 PVC ❑other(explain): Distance from private Nater sl pply well or suction line: feet Comments(on conditi n of joints, venting, evidence of leakage, etc.): SCALING OF CAST I ON IN:MAIN SEWER LINE. Septic Tank(locate an site plan): 11" Depth below grade: feet Material of constructs n: ®concrete ❑ metal []fiberglass ❑polyethylene ❑ other(explain) If tank is metal, list ag : years Is age confined by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No --certificate)----------- ------------------------------------------------------ Imensions: - _. Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 8" Distance from top of cdcurn to top of outlet tee or baffle Distance from bottom Of scum to bottom Of outlet tee Or baffle How were dimension determined? SLUDGE JUDGE CONSERV GROUP T-5.doadoc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System �, Page 10 of 16 Commonwealth of M ssachusetts T,0 5 Offi ial jrspection :dorm Not for Voluntary As essments Subsurface Sewage E sposal System Form D.System Information (cont.) 2957_FALUOUTH RD-. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural imtegri - liquid levels as related to outlet invert,evidence of leakage,etc.): Grease Trap(locate c n site plan): ,Depth below grade: feet Material of construction: - .:O-concrete El metal ❑fiberglass ❑polyethylene ❑other i(explai 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.pumpi g recommendations, inlet and:outlet tee or baffle condition,structural liquid_levels as.relat . to-outlet invert,evidence of leakage, etc.): Tight or Holding TAF ik(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of constructi n: 0 concrete metal ❑fiberglass ❑polyethylene ❑other-(expla ): SROUP T-5.doc.doc-03/2006 Title 5 Offidal inspection Form:Subsurface Sewage Disposaal Syst Commonwealth of M ssachusetts Title 5 Offi ial Inspection Form Not for Voluntary As essments ry Subsurface Sewage isposal System Form D. System Information (cont.) 2957 FALMOUTH RD.OSTERVILLE MA,02655 Property address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's NaZiding Tan ( Date of InspectionTight or cunt.) � 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 f alarm and float switches, etc.): *Attach co of current pumping contract(required). Is co attached? ❑ Yes ❑ No copy P P 9 PY 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 i 1 to or out of box, etc.): BOX IN GOOD CONDITION,AND COVER BUILT-UP TO GRADE. Pump Chamber(lo to on site plan): Pumps in working or r: ❑ Yes ❑ No Alarms in working or r. ❑ Yes ❑ No CON -SERV GROUP T 5.doc.doc•03l2 Sewage 006 Title 5 Official Inspection Form;Subsurface Se ge Disposal System Page 12 of 16 ssachusetts Commonwealth of M Title 5 Offi ial Inspection Form Not for Voluntary As essments Subsurface Sewage isposal System Form D. System Inform tion (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11107 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): i Soil Absorption Sys m(SAS)(locate on site plan, excavation not required): If SAS not located,ex !!lain why: f Type: ® 1 6X8 leachingr.pits number: ❑ leachin chambers number. ❑ leaching.galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overFlo N cesspool number: ❑ innajaive/alternativesystem Type/I hame of technology: Comments note co� ition of soil signs of hydraulic failure level of ondin , damp soil,condition of ( � 9 Y P 9 vegetation, etc.): UPON INSPECTION PIT WAS DRY I CONSERV GROUP T 5.doc.doc•0312006 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System .1 �1 Page 13 of 16 Commonwealth of M ssachusetts Title..5 Offi ial Inspection Form Not for Voluntary As essments Subsurface Sewage disposal System Form D. System Information (cunt.) 2957 FALMOUTH RD. OSTERVILLE MA,02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configu 'on Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of constructi Indication of ground wl ter inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): - II Privy(locate on site F Ian): Materials of construction: -Dimensions Depth of solids Comments(note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): CONSERV GROUP TZ.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of M ssachusetts Title 5 Offi ial Inspection Form Not for Voluntary As essments y` Subsurface Sewage D sposal System Form 4 D. System Information (cont.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 City/Town State Zip Code CONSERV GROUP 4/11/07 Owner's.Name Date of Inspection Sketch Of Sewage Dis sal System: Provide a sketch of the sewage disposal system including ties to at least two perman nit reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. -�_ -78 ;2z �--�� "o// COvB`f /^acre /u v 1 f2�Y w k,'c ti �S ��ra9 G CONSERV GROUP T-5.doc.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 15 of 16 Commonwealth of M ssachusetts Title 5 Offi�Cial Inspection Form Not for Voluntary Assessments y Subsurface Sewage D sposal System Form D. System Information (cont.) 2957 FALMOUTH RD. OSTERVILLE MA, 02655 Property Address OSTERVILLE MA 02655 Cityrrown State Zip Code CONSERV GROUP 4/11/07 Owner's Name Date of Inspection Site Exam: Slope/►�„v f-✓ Surface water y%fn•2- Check cellar A,-I Shallow wells Ai& Estimated depth to ground water.lr Please indicate all methods used to determine the high ground water elevation: ❑ Obtained om system design plans on record If checked date of design plan reviewed: Date ® Observed s I ite(abutting property/observation hole within 150 feet of SAS) ❑ Checked ith local l3oard of Health-explain: ❑ Checked ith local excavators, installers-(attach documentation) ® Accessed USGS database-explain: SDW 253 ZONE C 3-4 2.8 X 12=34" You must describe hoN you established the high ground water elevation: SEE ATTACHED f — CONSERV GROUP T-5.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 16 oft 6 �C....,.... �r w\V'v t � P ems, i i qi I t Maximum Wastewater Discharge Allowed Based Upon Lot Size *if one parcel is within multiple zones, use the more strict limitation for parcel (bolded below) State 1+V3 1+2/3 r Defined True Acres Acres 2 Acres Acre Acre 10,000 13,333 20,000_ 30,000 =33,334 =40,000 =43,560 50,000 58,080 60,000 =72,599 80,000 =87,120 S.F. S.F. S.F. S.F. S.F. S.F. SY S.F. S.F. S.F. S.F. S.F. S.F. §TATE Red Title V: 310 ..� Diag. LAIR 15.214 110 110 220 330 330 440' 440 550 550 660 770 880 880 Lines_ *applicant call +. �. ;i apply for a variance. STATE Red Diag. With I/A � • Lines Technology 110 220 330 440 550 660 669 770 880 990 1100 1320 M30 [I/A with 660/acre Credit] (+not in town ordinance) TOWN ORDINANCE Green Regulation of 330 330 330 330 330 330 330. 330 440 440 550 550 660 +Red Wastewater Zones Discharge a *can not apply for variance and doesn't allow I/A. BOH-Interim Blue Saltwater Estuary 330 330 330 330 330 440 440 . 550 550 660 770 880 880 Protection Regulation ' *can apply for variance, but doesn't allow I/A QAOFFICE FORMS\ChartTable ListingW WDISCHARGE MAXIMUMS3.doc i No..............._......: , FEs......................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. .......................OF.......................................-- Apparatinn for Uiopnoal Workii Tonotrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: Location.Address or Lot No. ................ _................................................................................. --•---..........._....-----•--••-•--....----••-••-----____........._...____________............... .....................•---......----..........................•---^•..... . ........------------..•....--•--------.........................----..........._._..............--- .....-•---•--•-----...... Owner w Address a .................. .......... ........... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) U �'2 Other—Type e of Building No. of persons...........................:Showers yP g ---------------------------- P ( ) — Cafeteria ( ) 04 Other fixtures -------------------•---••---•--•---•------------•--•-..••--......•-•-••••••--------•--•--••-•--•••-•-•-•---.......--•-•-•....---......_............... W Design Flow............................................gallons per person per day. Total daily flow....... ..................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) •-' Percolation Test Results Performed by••-•-•--••••-••-•-••-----•-•-----•••-•-•-•----------•............•-•-•-•. Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ •-••--•--••-......--••--•---•••--•-----••-•••-•.....................•-----•--•-------------••-------........................................................ ODescription of Soil.........................................................•............................................................................................................... x W •-----•-•-••.._...------•---------------••-••-••-•-----•••••--------••---•-••-•---••-------•--•--•---------••••-•----•-----•••-•-•••--•----••-•••---•-----•------•••-•-••--•------••......------------•. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------•--------•---••-----•--------•-•-----------•------------•---••-------.....-•-•--.........--------------------......---------•--------...._..-•-•-------------......_.......--•-•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate ompliance has been issued by the board of health. 1 6 *gned. Application Approved By....... ' " ! _�....1�� 'I --•---------.. ........................................e Date Application Disapproved for the fo wing reasons:............................................................................................................. --•--•-•----•-••-•----•--•--•........................••••--....-----•••----•--...............•----....---._......•-------...........-••••--•----•...--•-•------•-•••--•-••-••••--•-•-Date PermitNo.......................................................- - - -- -Issued.•..----r........riu..-----------•------.._........_. i THE COMMONWEALTH OF MASSACHUSETTS — BOARD PF HEALTH .................:: ► .......OF........... G ... .... .......... (Irrtif irate of 11 Viittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (--)-er-Repaired ( ) by---------------------------------------------- ......... tf 'I--• - .. - i Installer '' � :...7......-•-t- I -_ ................. ..,.�,�'( at................................................. 52 1 .� --------------------------------------•------- .... I - has been installed in accordance with the provisions of TIT F 5 of e State Sanitary e desc ibef�,in the application for Disposal Works Construction Permit No......©s.5! %_Ij....... dated--------- . _fib THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANT E THAT THE SYSTEM WILL FUNCTION ATISFACTORY. DATE.......................... .........- ----- -------••-•._...----...----- Inspector................... ...................... - THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ........O F............: . r a r No......................... I FEE.........:.:.`:::_... Roposal Works Tonotrurtion "prrutit Permission is hereby granted......... -------w ----------- em a€°No...................2---q.S.3......... �!.l..r�-a t��-4:...--------------1 r" Street _ 1 as shown on the application for Disposal Works Construction Permit No.__ �?�_�l_.�--- Dated....-•.._..1- " �G ......... _ ........................................ DATE_ Board of Health ------------ --------•--••-•------✓•-G----...............---.....-- FORM 1255 A. M. SULKIN, INC., BOSTON .._ No..... ... Iz ......... ............ M ay. THE COMMONWEALTH OF MASSACHUSETTS R BOARD OF HEALTH ..................... ....................OF.......................................................................................... Appliration for Eioplaottl Workii Tandrurtion �r it Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individu Sewage Disposal System at ...2..�.51....._F�m.w lm -IZ° aobb, 16orhs �M z - 9......-.-- -------------------- �.... .......................................................... Location.Address ©r n or Lot No. 1 ....._.... . ....................................................................................................................................................................... .... o44RX •...................... �gwner Address C.'.Q�y'Amet. /Q!4.r�! f�R_�l!/!C.N Installer Address d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------•-••-•--••-•---•••-••-••-••-•---------•----•--••......•-••••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --••••---••--•-----•-••-•-•-•--••-•----••-•-----•--•---••..................•---.......---...•---............................................................. 0 Description of Soil.................•---...................-----•-----•--..............••-•--.._...------•---------------------••••.....---------•-••...._....-----•---•--....-•--••-•-•-•- x U ......................................................................................................................................................................................................... x -----------•------------------•----------•-•---•----•--------------•-•--••--••-•--.......•----••--••••••--------•----•--•--••••--•---•••••--•-•-------•------••••---•--•------•---••••••................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•--•-------•---------------•--------......---------..........-----•-----•-----------------------------------•-••----------------------------------------•------•---•••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLi; 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation it a Certi- t, mpliance has be issued b he board of health. ° � �u ��1 `t �6 d •--•-tea.. . -•-Y 4:vS .... ...........................Date Ap pr / - vv 2 �-,s-2 � A plication Approvefl BY . . . ............... ...----•- •-----------............... Date Application Disapproved for the ffigne ngre¢sons:............................................................................................................... ....................•-------..........•.....-•--•--•-•-•----•-------------...--------•--•--•------...----•-•....••--•••••----•-•--••-------•---•-•-•••-•••-•---•----•------------•----••--••----•-•-•--- Date PermitNo......................................................... Issued-....................................................... Date --�__�----�--'--------------- TIiTN OF BARNSTAB .Fj t_ . ir1 S Zoning.Board .of Appeals '94 SEP i.4 PM 2 23 Robert Byrne Deed:duly recorded in the Property Owner Sarre: County Rggistry of Deeds:in Book Page :. .egiatry Petitioner District of. the Land. Court Certificate No. Book Page T_ Appeal No. " 9R4�32 19 FACTff and DECISION Robert Byrne August 20, 84 . Petitioner filed petition on requesting g variance- ermit..for remises at 2956. Falmouth Road_ q g P P. in the village (street) OsteryiZZe J g P (see, attached list) ,..,of ad'oinin remises of '121 9.. Locus under' consideration: Barnstable Assessor's.Map..no. lot noc. Petition.for Special` Permit: ❑ Application for Variance:* ❑ made under See.... . 4 of the, Town of Barnstable Zoning by-laws.and See. Chapter.40A.; Mass. Gen. Laws for the purpose of 1 to construct additional office space o f 25 x.30 pZ� us� a 24. x 24 .trio-car garage = Locus is presently zoned ;n / Notice of this hearing was given by mail, postage prepaid,.to all persons deemed: affeeted and � by publishing in Barnstable Patriot newspaper published in Town of Barnstable a copy of which is attached to the record: of these proceedings filed with Town Clerk. A public hearing by the Board of Appeals,_of the Town of Barnstable was held at the. Town Office Building, Hyannis, Mass., at L 7:45 _ 1 fAJX P.M. &Ptember 60 1384 upon said petition under zoning by-laws. Present at ,the hearing were the following members: Richard L. Boy_ . Luke P. LaZly GaiZ NightingaZe Chairman Ron Jansson' Dexter: Bliss At the conclusion of.the .fearing, the Board took said petition under,. advisement. A view of the locus was made by the Board: Appeal No 1984-92 Page of On Sapp anber I3, 19 84 , The.Board of Appeals"found Mr. Giavietro, the arcliiteet .for the the-petitioner. Robert "Byrnes,, -presented the . petition before "the Board- in which the"petitioner is seeking a Special Permit to construct an addition of 25 x 30, plus a 24 x 24 two-ear. garage to his existing offices at •2956 Falmouth Road, OsterviUe in an RF zoning district. -said"addition to be for "office use. .-.._ the locus. is comprised,of 1.0.6 acres The newaddition will be 750 square foot.ground area and resuiential in appearance.. The petitioner proposes to block off three -of.the:present curb cuts; Zeaving•`the 'existing one .on route" 28" and cutting a new.-curb 'cut on the- other road. :There will be an increase in parkingg for: a totaZ of 3.3 spaces.. In :light .of the fact that.this area is. surrounded by many businesses., .it is felt that this use wouZd not- derogate.from .the public good. " The Board -voted to grant the.petitioner. a SpeciaZ Permit to construct four (4)"offi"de3F-onlj& per.Plan A-2..W - revised and dated 917184 - with-the .restriction. tivat the 'curb cuts; as shown on the newly revised definitive Plan, be in place no occupancy permit to be issued until such time as these restrictions are complied with. Also, .-there. is tol be no. retaiZ use on the"premises'. r L4 b ry 1.A ft o ti- s s 7 Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that twenty (20) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this °y day of 7- 19 under the pains and penalties of perjury. Distribution:— Property Owner Town Clerk Board of Appeals Applicant Town of Persons interested Building Inspector Public Information By Board of Appeals Chairman '' tiAR�SSABI.E• PhASS• 24 P 3 2ZOWN OF BARNSTABLE '80 Board of Appeals Bass River Savings,_Bank _,__ Deed duly recorded in the Property Owner County Registry of Deeds in Book Donald L. LeBlanc g _ -____, _ _.. . ..._.Re`istr Page g Y i Petitioner District of the Land Court Certificate No. Book ___ _ __ Page Appeal No 1980-35 _ _ __,June 18 1980 FACTS and DECISION Petitioner _ _Donald L. LeBlanc filed petition on April 24 19 80 .r_._ requesting a variance-permit for premises at Rte.-2.$ XNW, in the village of ___Marstons Mills adjoining premises of (see attached list)- for' the purpose o.f _ Variance/special pemit_to allow extension and change of _ non-conforming building:_ _ ___ _ ______,•_, _ _ __ _� _ Locus is presently zoned in ._._...._...........Residence F district-.. -.--•_•-. -- Notice of this hearing was given by mail, postage prepaid, to all persons deemed affected and Barnstable Patriot & by publishing in Cape Cod News newspaper published in Town of Barnstable_a copy of which is attached to the record of these proceedings filed with Town Clerk. A public hearing by the Board of Appeals of the Town of Barnstable was held at the Town Office Building, Hyannis, Mass., at R;3SL P.M. --._.....m1Y-2.2—..- _''_ 19 80 , upon said petition under zoning by-laws. Present at the hearing were the following members: Richard L,••_Boy_, Y ,_. Luke P. Lally__ Chairman At the conclusion of the hearing, the Board took said petition under advisement. A view of the locus was had by the Board. Appeal No. 1980-35 Page _..__. ....... of _.._3._ _ On June 5 _ 19 80.. , The Board of Appeals found Attorney Myer Singer represented the petitioner .who. is seeking a special permit to change and extend a non-conforming use at route 28 and Osterville-W. Barnstable Rd., in Marstons Mills, in a building formerly used as a real estate office and residence. Mr. Singer presented a brochure to the Board members which contained information on the petition and 32, on-site parking spaces can be provided. The- petitioner would extesively landscape this property which is presently in a dis- reputable condition. The petitioner proposes to have ten offices in this building with no residential use. The prior owner, Emory LeVay, was granted a special permit which allowed office use with one apartment on the second floor. Originally, this site contained a general store, residence and gas pump. The petitioner is asking to convert the permitted residential use into office use. Mr. Singer said that in view of the many commercial uses surrounding the site in question, allowing the petition would not be- detrimental to the neighborhood and would be in keeping with the spirit and intent of the zoning by-laws. The petitioner is agreeable to a restriction that would limit the number of professional persons occupying this building to eight and would provide four parking spaces per professional person for a total of 32 parking spaces. The parking would then comply with the four spaces per professional office as outlined in Section S. (b) of the zoning by-laws. No one spoke in favor of or in objection. to the petition and the Board took the matter under advisement. The Board voted unanimously to grant the petitioner a special permit under Section P. }non conforming building onroute 28, Marstons Mills; formerly`the p pertq`�of Einory LeVay,, `\fok 'office use only,, This special permit is restricted as follows: 1. All exterior structural changes and architectural design, site landscaping and parking shall be in accordance with plans submitted and cited as follows: "Site Plan — .20 Feb. 80 — Michael E: Jones Associates, Inc. , Falmouth, MA Ground Plan — 20 Feb. 80 — Michael E. Jones Associates, Inc. Falmouth, MA" (continued) yu 1oo�l _ SH ', Clerk: of the Town of Barnstable, Barnstable County, Massachusetts,. hereby certify that twenty-one (21) days have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this P� 1 sr day of �`��;__ _ _ ___�____ 19 under the pains and penalties of perjury. / Distribution:— Property Owner Town Clerk Board of Appeals Applicarit Town of B ble Persons interested Building Inspector Public Information By - / Board of Appeals Chairman �t PEALS BOARD OF A P i 31Al22TAXL s iYl on Appeal No. 1980-35 Page 3 of 3 2. Access from the locus to Osterville-West. Barnstable Road must be maintained as it presently exists to avoid congestion at the traffic lights on route 28. .3. A ladder-type sign may be. maintained on the premises listing the names of the eight occupants in the building; each listing shall not exceed two square feet for a total square footage of sixteen square feet. The Board found that allowing this petition would not derogate from the spirit and intent of the zoning by-laws nor cause detriment to the neighborhood inasmuch as the petitioner proposes to upgrade property which is in a state of disrepair and presently detrimental to the neighborhood. BOARD OF APPEALS ]117,T1z1. : r PARTIES IN INTEREST- APPEAL NO. 1980-35 - DONALD L. LEBLANC William and Thomas Archibald Bartlett Realty Co., Inc. Captains Log, Inc. Dennis Star Construction Norman Hord Charles Rogers & E. C. Marney Manuel H. & Lena R. Moniz Wilson W. Perry, Jr. Albert R. Richard �*.. Theo Construction Co. , Inc. Barnstable Planning Board Yarmouth Planning Board Sandwich Planning Board Mashpee Planning Board 9c5 Co30dgo o c�fforrc�,�I1 ofrh -2857 Mmough Rd. 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