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HomeMy WebLinkAbout3040 FALMOUTH ROAD/RTE 28 - Health 304 0 FALMOUTH ROAD/RTE 28 —Osterville E Marstons Mills Pines rzx�, opza - � r ,4 e E t i F. Commonwealth of Massachuse " Tithe 5 Official Ins ; ection Form n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 , e yyY Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA. 02655 08/16/13 required for every > > page. Cityrrown , State Zip Code Date of Inspection t- Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist.at the end of the form. Important:when filling out forms A. General Information on the computer, a use only the tab 1. Inspector: y� �•� �^� key to move your cursor-do not Paul W. Davis use the key. return Name of Inspector Rosano Davis Sanitary Pumping,-Inc. Company Name 9 Rocky Lane s Company Address I Cohasset MA 02025 CitylTown State Zip Code 781-383-8888 S149 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Faill ❑ Needs Further Evaluation by the Local Approving Authority 08/21/13 Inspector's"nature Date I 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. t./V t5ins•3/13 Tale 5 oal Ij�Form:S ffia ubsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville, MA 02656 08/16/13 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the fail u re�criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 3 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 r ' the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that.the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owners Name information is >required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken 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): i ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Groner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method.used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation, ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z 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 col'iform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 it Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required-for every 3040 Falmouth Road Osterv > ille MA 02655 ? 08/16/13 page. City/rown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•W3 Title 5 official Inspection Fonn:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines - Building C (Concord) Property Address Multiple Owners Owner Owners Name information is required for every 3040 Falmouth Road Ostery > ille MA 02655 08/16/13 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? , ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 TMe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > > page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Condo Association on maintenance schedule. f 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/Altemative technology.Attach a copy of the current operation and t 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): Septic tank,soil absorption system. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts ,klTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments iW Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name informrequired is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 29+years per previous inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Schedule 40 PVC inlet pipe. Distance from private water supply well or suction line: No known wells in immediate area. Comments(on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 15"w/covers to grade. feet Material of construction: ®'concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,500-gallon precast concrete septic tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 5'deep X 10' long. c Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" .. Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 18" II How were dimensions determined? Measured with a tape. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection. Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place. There are no repairs recommended at this time. f 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 b y Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: ',Date I Comments(condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments '< Osterville Pines - Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): I * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road,Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number: 1 -concrete leaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 40"of water in it.There was 32"of available capacity. Leaching appears to be in proper working condition.There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityr town State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �3�>il c1i17 C A - Z = 5v , A - 3 - 45 15C)o 6_1 5L'')'C a - 1 - 312 k 6 -Z _ �30' B- 3 = 4-1,S ' All covers -b grade. o 1�1 A -/-C) scak t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: SEE BELOW feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.25' below grade. This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I I New leaching installed at Bldg.D.No groundwater at 14'. �� rc `z��t tJR:4 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 a Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M Osterville Pines -Building C (Concord)': Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms •1 _ on the computer, use only the tab 1. Inspector: key to move your cursor-do not Paul W. Davis use the return Name of Inspector key. All Rosano Davis Sanitary Pumping, Inc. W Company Name 9 Rocky Lane Company Address moan Cohasset MA 02025 City/Town State Zip Code 781-383-8888 S149 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further'Evaluation by the Local Approving Authority 07/01/10 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will;perform in the future under the same or different conditions of use. t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page h of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: El One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool;or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•ogioa Rosano Davis.Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M s Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02665 06/21/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-09108 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 1 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines - Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins 09/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown. Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? ❑ Yes ® No Last date of occupancy: 06/21/10 - Building occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to,the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•og/oa Rosano Davis Sanitary Pumping,Inc .'781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Condo Association on yearly maintenance schedule. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system Single cesspool ❑ Overflow cesspool ❑ . Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. Other(describe): Septic tank,soil absorption system. t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 26+ years per previous inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 24" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Schedule 40 PVC inlet pipe. Distance from private water supply well or suction line: No known wells in area. feet Comments(on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 15"w/covers to grade. feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,500-gallon precast concrete septic tank. If tank'is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ .No Dimensions: 5'wide X 5'deep X 10' long. Sludge depth: 4.. t5ins•os/oe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured with a tape. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection.Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place. There are no repairs recommended at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-ogios Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•ogim Rosano Davis Sanitary.Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 1 t5ins-09i08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -concrete leaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 48"of water in it. Inlet 22" above water. Leaching appears to be in proper working condition. There are no repairs recommended at this time. ' r 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 teins-osfoa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C(Concord) Property Address Multiple Owners Owner, Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 8Ul"Idin , C f� A - 3 - 45' 6 -P = 30 1- 3 = 41,5 ' All covers l-),cgrade. J N o4 sca-le, t5ins•I=Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building C(Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: SEE BELOW feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.25' below grade. This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i re Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Osterville Pines -Building C (Concord) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file New,Ieaching installed at Bldg.D.No groundwater at 14'. It vzol / 5 �,4H hRw.JC� t5ins•+8 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (78.1)383-1234 (781)545-2800 (781)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address Building C—Concord 7 Osterville Pines,Osterville,M Owner's Name Multiple Owners Owner's Address Huntinpest Property Management 40 Industry Road—P.O.Box 340 Marstons Mills,MA 02648 Date of Inspection 11/17/06 Name of Inspector Jeffrey F.O'Connell Company Name Rosano Davis Sanitary Pumping,Inc. Mailing Address 9 Rocky Lane Cohasset,MA 02025 Telephone Number 781-383-1234 CERTIFICATION STATEMENT . I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: ®Passes t c:1 ❑ Conditionally Passes ❑Needs Further Evaluation by the Local A,proving Authority €� ❑Fails Inspector's Signature: Date: 11/24/06 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Heal or DEP-)'--within-;t4irty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or eater,A e inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should a sent to the system owner and copies sent to the buyer,if applicable and,the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 1 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 or in 310 CMR 15.3( exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more stem components as described in the"Conditional Pass"section need to be replaced or repaired. The system,a on Y P P_ PP completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no or not determined(Y,N,ND)in the_for the following statements. If"not determined"please explain. _ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _ Observation of sewage backup or breakout 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. The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced _ obstruction is removed distribution box is leveled or replaced ND explain: _ , The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed ND explain: 2 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (61.7)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property:Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/1.7/06 C Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board or Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) System will pass unless Board of Health determines in accordance with 310 CMR 15303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless 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 of more from a private water supply well". Method use to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3) Other: 3 Title 5 Inspection Form 6/15/2000 1 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property:Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 D System Failure Criteria applicable to all systems: You must indicate either"Yes"or"No" to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ X Liquid depth in cesspool is less than 6"below invert or available volume is than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [The system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO(Yes/No)The system I have determined that one of more of the following failure criteria exist as described in 310 CMR 15.303, fails. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E.Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"Yes"or"No"to each of the following: (The following criteria apply to large systems in addition to the criteria above.) Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone Il of a public water supply well) . 4 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: Buildin¢C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 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 with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 5 Title 5 Inspection Form" 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART B CHECKLIST Property: Building C—Concord/Osterville Pines,Osterville,MA. Owner: Multiple Owners Date: 11/1.7/06 Check if the following have been done You must indicate"yes"or"no"as to each of the following. Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the prevous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were the septic tank manholes were uncovered,opened,and the interior of the septic tank inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum? X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System on the site has been determined based on: Yes No X _ Existing information.For example, Plan at B.O.H. X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] 6 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (6.17)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION Property:Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 FLOW CONDITIONS RESIDENTIAL: Number of bedrooms(design): Number of bedrooms(actual):4. DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Varies. Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No (If yes separate inspection required) Laundry system inspected (yes or no): _ Seasonal use(yes or no): No Water meter readings,if available(last two(2)year usage(gpd)):Water usage records were not available at time of inspection. Sump Pump(yes or no): No Last date of occupancy: 11/17/06—Units were still occupied at time of inspection. COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd. Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): _ Industrial Waste Holding Tank present(yes or no): _ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER: (Describe) GENERAL INFORMATION PUMPING RECORDS Source of information:Property currently under regular maintenance schedule. Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-how was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool _ Overflow cesspool _ Privy No 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) No Tight Tank. Attach a copy of the DEP Approval X Other(describe).Septic tank,soil absorption system. Approximate age of all components,date installed(if known)and source of information: 23+years per previous inspection. Were sewage orders detected when arriving at the site(yes or no): No 7 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (6.17)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property:Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 BUILDING SEWER(locate on site plan) Depth below grade: 24". Material of construction: cast iron X 40 PVC other(explain) Schedule 40 PVC inlet wipe. Distance from private water supply well or suction line:No known wells in immediate area. Comments:(on condition of joints,venting,evidence of leakage,etc.) All piping appeared to be clean and flowing freely.No evidence of leakage. SEPTIC TANK: YES(locate on site plan) Depth below grade: 1.5" w/covers to grade. Material of construction: X concrete metal Fiberglass Polyethylene other(explain) 1.,500-gallon precast concrete septic tank. If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes or No):_(Attach a copy of certificate) Dimensions: 5'deep X 5'wide X 10'. Sludge Depth: 16". Distance from top of sludge to bottom of outlet tee or baffle: 14". Scum thickness: 4". Distance from top of scum to top of outlet tee or baffle: 6". Distance from bottom of scum to bottom of outlet tee or baffle: .16". How dimensions were determined: Measured with a tape. Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) Septic tank is on a semi-annual maintenance pumping schedule so tank was not pumped at time of inspection inlet and outlet tees are in place.Tank is structurally sound and water tight and all effluent levels were at an appropriate height There are no repairs recommended at this time. GREASE TRAP:NO(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) 8 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (61.7)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/1.7/06 TIGHT or HOLDING TANK: NO.(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm Present(Yes or No)_ Alarm level: Alarm in working order _(Yes/No) Date of last pumping: Comments:(condition of alarm and float switches,etc.) DISTRIBUTION BOX: NO.(If present,must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) PUMP CHAMBER: NO.(locate on site plan) Pumps in working order.(yes or no):_ Alarms in working order(yes or no):_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.) 9 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property:Building C-Concord/Osterville Pines,Osterville,NIA Owner: Multiple Owners Date: 11/1.7/06 SOIL ABSORPTION SYSTEM(SAS):YES.(locate on site plan,excavation not required) If SAS not located,explain why: Type: X leaching pits,number: 1—precast concrete leaching pit. leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system. Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): There was no surface wetness,breakout or signs of hydraulic failure observed.Leaching pit had 44" of water in it.Leaching appears to be in_good working condition.Cover on leaching pit was worn.Recommend new cover be installed for safety purposes. CESSPOOLS: NO.(Cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(Yes or No): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) ,r PRIVY: NO.(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) 4 10 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 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. � - 4-5 ' I � i 500. 1 = 3 ' - 30 '19- 3 , 4-15 All coue-cs t'llude- NO k sukle it Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property:Building C—Concord/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater: 18+feet Please indicate(check)all methods used to determine the high groundwater elevation: . Obtained from system design plans on record. If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) X Checked with local Board of Health-explain:Previous Title 5 Inspection dated 11/07/03. Check local excavators,installers-(attach documentation). Accessed USGS database-explain: You MUST describe how you established the High Groundwater Elevation: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.25' below grade.This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. New leaching installed at Bldg.D.No groundwater at 14'. % it / \lN bRuvJC) LTitlepection Form 6/15/2000 L COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a , d DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED Sy0 DEC 16 2003 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 3040 Falmouth Rd,Osterville,Osterville Pines,Bldg C MAP a� --p'� Owner's Name: Huntingest Management(Osterville Pines Condo Trust) pr,RcLl, Owner's Address: Unit#c,40 Industry Road,Marston Mills,MA 02648 Date of Inspection: 11/07/03 Name of Inspector: Brian T.Axon Company Name:A&K Septic Systems Plus Mailing Address: 565 Carriage Shop Road East Falmouth,MA 02536 Telephone Number: 508-540-6706 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ` Inspector's Signature: _ Date: 11/12/03 4. a.> 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. Notes and Comments: System functioning fine. There are no violations of failure criteria. System consists of 1500 gallon tank,D-box and leaching pit. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Bldg C,Osterville Pines,Falmouth Rd,Osterville,MA Owner: Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Bldg C,Osterville Pines,Falmouth Rd.,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank.and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Bldg C Osterville Pines,Falmouth Rd.,Osterville,Ma Owner:Huntingest Management(Ostervile Pines Condo Trust) Date of Inspection: 11/07/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ x Discharge or-ponding of_effluent to the surface of the ground or surface waters due.to an overloaded or clogged SAS or cesspool x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow _ x Required pumping.more-than 4-times.in the-last year NOT-due to clogged or obstructed,pipe(s).Number of times pumped — x Any portion of the SAS, cesspool or privy is below high ground water elevation. x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. x Any-portion-of acesspool.or-privy.is within a Zone-1-of.a public wel-1. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. T x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds -indicates that the well-is_free.from-pollution from-that-facility and..the-presence of.am mania nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine-what-will be necessary-to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead-Protection Area—IWPA)or a mapped- Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed-under-Section-D-shall upgrade the system-in-accordance with 310.CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTS CHECKLIST Property Address: Bldg C,Osterville Pines,Falmouth Rd,Osterville,MA Owner:.Huntingest Management(Osterville Pines Condo Trust) Date of Inspection:11/07/03 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No X — Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X — Has the system received normal flows in the previous two week period? — X Have large volumes of water been introduced to the system recently or as part of this inspection? x _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X — Were all system components, excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a plan at the Board of Health. n - _ — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] f Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART-C. SYSTEM INFORMATION Property Address:Bldg C Osterville Pines,3040 Falmouth Rd, Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):440 Number of current residents: 5, Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no):no [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use: (yes or no):no Water meter readings, if available(last 2 years usage(gpd)):NA Sump pump(yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):- gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: System on regular maintenance schedule,project manager Was system pumped as part of the-inspection(yes or no):no If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool —Overflow 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: 20+years,town hall Were sewage odors detected when arriving at,the.site.(yes.or no):NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Bldg C,Osterville Pines,Falmouth Rd.,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage, etc.): SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction: x concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10'6"x 57' Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 34" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined:Field instruments Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Recommend pumping every two years. Tees liquid level in relation to tees and structural integrity are all fine.No evidence of leakage. GREASE TRAP: NA(locate on site plan) Depth below grade: _ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:. Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Blg C,Osterville Pines,Falmouth Rd,Osterville,MA Owner:Huntingest.Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: x (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): Distribution equal.No evidence of solids carry over.No evidence of leakage. PUMP CHAMBER:NA(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): F Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Big C,Osterville Pines,Falmouth Rd.Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 SOIL ABSORPTION SYSTEM(SAS): x (locate on site plan,excavation not required) If SAS not located explain why.- Type X leaching pits,number: 1 leaching chambers, number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): Condition of soils and vegetation fine.No evidence of hydraulic failure. 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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): i PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Page 10 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Bldg C,Osterville Pines,Falmouth Rd,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 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. J a 3� Page I I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Bldg C. Osterville Pines,Falmouth Rd,Osterville,MA Owner: Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 11/07/03 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water: le+feet Please indicate(check)all methods used to determine the high ground water elevation: ;.a Obtained from system design plans on record-If checked, date of design plan reviewed: x Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: x Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: New leaching installed at Bldg. D. No groundwater at 14'. t Commonwealth of Massachusetts O?9^036.6&A p Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ' 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name / information is required for every Marstons Mills'/ MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out forms A. Inspector Information �'t� Iy d,� filling out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Company Address Teaticket Ma. 02536 City/Town State Zip Code low 508-280-3356 S13938 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 fa,f 11-23-2019 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 4 bedroom condo has a H-10 1500 gallon septic tank and a d-box feeding a leaching pit with stone at the time of the inspection there were no visible failure criteria found. 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the.environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is Marstons Mills MA 02648 11-21-2019 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5 Large Systems: To be considered a large system the system must serve a facility with a 9 Y g Y Y Y 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 El Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 't e 5 Official Inspection Form `I; Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® El approximation 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 ale Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .� 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is Marstons Mills MA 02648 11-21-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 plus GPD Description: Number of current residents: appx. 6 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 occupied Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ . 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 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.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments(on condition of joints, venting, evidence of leakage, etc.): water was flushed and it came freely. t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Flo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): I' Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No .Dimensions: standard H-10 1500 gallon Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of'outlet tee or baffle 12" How were dimensions determined? Sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ........... 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owners Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c , Commonwealth of Massachusetts : Title 5 Official Inspection Form <F' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown 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): 011 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. City/Town State Zip Code Date of Inspection D.-System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: one ❑ 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 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form �l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): - Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ .u 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title, 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 3040 Falmouth Road Bldg Property Address Osterville Pines Condo. Owner Owner's Name information is Marstons Mills MA 02648 11-21-2019 required for every - - page. Cityrrown State Zip Code Date of Inspection D.•System Information (cont.) _ y. ,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 Of W - • 9a Y! lv !3•i-T� -�• l Q) p . 1 3 ^z._-.:..rr�..wh,;r;`"„-u-.�LL�.a_t;'� n�.,�.�, �.�r ,ate _.,-;..... ..;;,_ ....�.r..-,..:,..�»a=.•� •.r . ,s,.�� .,�41 t5insp.doc-rev.7/262018 Title 5 Official Inspection Forth:Subsurface Sewage Dlsposal*System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 14 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole to 14 feet Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3040 Falmouth Road Bldg D Property Address Osterville Pines Condo. Owner Owner's Name information is required for every Marstons Mills MA 02648 11-21-2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. I Erowo OFFICE OF THE BOARD OF HEALTH OF THE i BARNSTAMIS. o TOWN OF BARNSTABLE, MA.%S. 9 MAS13 ppp�1639 'F9 MAY pr. "' "".----- '�.:+ %# SE��,.� GE DISPOSAL ;PERMIT � f ,, 6 I Permission is granted to __" to construct --- ---------- .______ --- - - - -- - - - -- -- -= - - t—..-"-- f _ - i .,�UiDon—f.he Premises of Sketch f � r In the village of --`-- -- - --------- '* u 100 or more feet from any source of water supply s 20 feet from building ' 0. 10 feet from property line a' W� alth Officer. No.----= ' — Q,,oFq"FTowy OFFICE OF THE BOARD OF HEALTH OF THE Y ]UMNST"LFy o TOWN OF BARNSTABLE, MASS. MAG9pp 6390. • 0 MAY A -- _ 19 -;7 S GE DISPOSAL PE�.l�►�IIT r i Permissi-, is 5n ed to o,W to construct _ ____ _____ Upo,7e Premises of Sketch n.h village of r 100 or more feet from any source of water supply 20 feet from building 10 feet from property line ,< Health Officer. < f' No. OFFICE OF THE BOARD OF HEALTH BARNSTABLE, OF THE MASS. Arf 039. 8 M TOWN OF BARNSTABLE, MASS. 19 kj�E W7/AGE DI$POSAL PERMIT Permission is granted to to con _4ruct UP on/he Premises of in thevilla 4 of--- 100 or' more-feet from any source at water supply 20 feet from building 10 feet from proper e ,j Healt9 Officer. Commonwealth of Massachusetts �n�8� C '�Ali, a. Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ''< Osterville Pines -Building D (Dover) . Property Address Multiple Owners Owner Owner's Name information is >required for every 3040 Falmouth Road Qstenille> MA 02655 08/16/13 page. Cityrrown 4P I q[5h h J Ih/1 I ( State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, (� use only the tab 1. Inspector: �1 key to move your �� I cursor-do not Paul W. Davis I use the return Name of Inspector key. Rosario Davis Sanitary Pumping, Inc. Company Name 9 Rocky Lane Company Address Cohasset MA 02025 City/Town State Zip Code 781-383-8888 S149 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fail% ❑ Needs Further Evaluation by the Local Approving Authority £ L . 08/21/13 Inspectors S ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official I s n Form:Subsurface Sewage Disposal Sorn•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 1 *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): 1 t5ins-3/13 Title 5 Official Insp ection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yy< Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owners Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. t 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 4❑ Z 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D(Dover) Property Address Multiple Owners Owner owner's Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page." Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: l ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation, ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure 1-1 ® criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. r For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection Area IWPA)or a mapped Zone fl of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Tft 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D(Dover) Property Address Multiple Owners Owner Owner's Name information is required 3040 Falmouth Road Osterville MA 02655 08/16/13 page. C4frown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Z ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design). Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every > 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? ❑ Yes ® No �ast date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) l Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Condo Association on maintenance schedule. Was system pumped as part of the inspection? Q Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Q 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/Altemative 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): Septic tank,soil absorption system. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: 29+ years per previous inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Schedule 40 PVC inlet pipe. Distance from private water supply well or suction line: No known wells in immediate area. Comments(on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 20"w/covers to grade. feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) 1,500-gallon precast concrete septic tank. If tank is metal, list age: . years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 5'deep X 10' long. S Sludge depth: 4.. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > > page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured with a tape. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection.Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place. There are no repairs recommended at this time. Grease Trap(locate on site plan): j Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy� Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'< Osterville Pines - Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -concreteleaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 46"of water in it. Leaching appears to be in proper working condition. There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer - Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, >Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 J Commonwealth of-Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines,-Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Buildw' g 0 A - I 29. 5 �5-00 �( I Wosed cover t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: SEE BELOW feet Please indicate.all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.25' below grade. This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y�. Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file New];,aching installed in 1/2000.No groundwater at 14'. � - �; 12' 3 t • i, 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines--Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information I on the computer, r U11: use only the tab 1. Inspector: / key to move your cursor-do not Paul W. Davis use the return Name of Inspector key. Rosano Davis Sanitary Pumping, Inc. ,y Company Name 9 Rocky Lane Company Address Cohasset MA 02025 Cityrrown State Zip Code 781-383-8888 S149 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training;and experience in the proper function and maintenance of on site sewage disposal systems. I am a DER approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: t ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furth Evaluati the Local Approving Authority 07/01/10 Inspector's S gnature 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 user t5ins•09/08 Rosano Davis Sanitary Pumping,Pum in ,Inc 781-383-8888 Title 5 Official Inspection Forth:Subsurface Sewa Disposal stell• age 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-ogim Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 �l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. City(rown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•ogios Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters El due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09/08 Rosario Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM Osterville Pines -Building D(Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every u page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑' ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design,flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑, the system is within 400 feet of a surface drinking water supply El ❑" the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection El ❑ Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a.significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 1, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown. Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes-® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sum N um Yes o PP P ❑ 06/21/10 - . Last date of occupancy Building occupied. Commercial/industrial.Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•og/oe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M Osterville Pines -Building D(Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Condo Association on yearly maintenance schedule. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Septic tank,soil absorption system. 15ins•og/oa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 26+ years per previous inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 30" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Schedule 40 PVC inlet pipe. Distance from private water supply well or suction line: No known wells in area. feet Comments(on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 20"w/covers to grade. p g feet Material of construction: Z concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,500-gallon precast concrete septic tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 5'deep X 10' long. Sludge depth: 6" t5ins•ogtoa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Measured with a tape. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection. Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place.There are no repairs recommended at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09108 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•og/oe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•ogios Rosario Davis Sanitary Pumping,Inc 781-383-8888' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -concrete leaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 44" of water in it. Leaching appears to be in proper working condition.There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•og/m Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D(Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•os/oe Rosano Davis Sanitary Pumping,,lnc 781-383-8888 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for"every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �c1 i Y6, 'P 500 610i ulk, OZ j. / - 1 lnpcscc!Caver BJ l . � 3 Nol'ki sca& t5ins•0�=Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,M s Osterville Pines -Building D (Dover) { Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 j page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) J Site Exam: ❑ Check Slope ❑ Surface water I, i I ❑ Check cellar i ❑ Shallow wells Estimated high depth to round water: SEE BELOW p g g feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ' f } ❑ 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: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.25' below grade.This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing"this.Inspection Report, please see Report Completeness Checklist on next page. t5ins•09i06 Rosano Davis Sanitary:Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building D (Dover) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file New leaching installed in 1/2000.No groundwater at 14'. . ►t • �; �2 3 - •I N«�1Lt)L3 F b C I, t5ins••l /08 Rosario Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTI N RECEIVED e �a JUL 0 2 2004 OF 13ARNSTA13LE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:3040 Falmouth Rd,Osterville,Osterville Pines,Bldg E Owner's Name:Huntingest Management(Osterville Pines Condo Trust) AUEUORSNAPNO. Owner's Address:Unit#c,40 Industry Road,Marstons Mills,MA 02648 PAWS Date of Inspection:06/28/04 Name of Inspector:Michael T.Bisienere Company Name:A&K Septic Systems Plus Mailing Address: 565 Carriage Shop Road East Falmouth,MA 02536 Telephone Number: 508-540-6706 CERTIFICATION STATEMENT I certify:that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails E Inspector's Signature: Date: 06/28/04 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. Notes and Comments: System functioning fine. There are no violations of failure criteria. System consists of 1500 gallon tank with D-box and a 6 x 10 leaching pit. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:Bldg E,Osterville Pines,Falmouth Rd,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 06/28/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health).- _ broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: . t ' I Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:Bldg E,Osterville Pines,Falmouth Rd.,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection:06/28/04 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. • a 3. Other: a E . fi. w ' Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:Bldg E Osterville Pines,Falmouth Rd.,Osterville,Ma Owner:Huntingest Management(Ostervile Pines Condo Trust) Date of Inspection: 06/28/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in cesspool is less than 6"below invert or available volume is less than'/Z day flow x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ x Any portion of the SAS,cesspool or privy is below high ground water elevation. x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. x Any portion of a cesspool or privy is within a Zone 1 of a public well. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia - nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] no (Yes/No)The system f ils.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 y 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:Bldg E,Osterville Pines,Falmouth Rd,Osterville,MA Owner: Huntingest Management(Osterville Pines Condo Trust) Date of Inspection:06/28/04 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No X ____ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? x _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components, excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ 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 CNM 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:Bldg E, Osterville Pines,3040 Falmouth Rd,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 06/28/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual):4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder(yes or no):no Is laundry on a separate sewage system(yes or no):no [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use: (yes or no):no Water meter readings,if available(last 2 years usage(gpd)):NA Sump pump(yes or no):no Last date of occupancy: current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: System on regular maintenance schedule,project manager Was system pumped as part of the inspection(yes or no):no If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information:20+years,town hall Were sewage odors detected when arriving at the site(yes or no):NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Bldg E,Osterville Pines,Falmouth Rd.,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 06/28/04 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: x1 ca_ (o teon site plan) Depth below grade: 2' Material of construction: x concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10'6"x 57' Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 35" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined:Field instruments Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Recommend pumping every two years. Tees liquid level in relation to tees and structural integrity are all fine.No evidence of leakage. GREASE TRAP: NA(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_.polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Big E,Osterville Pines,Falmouth Rd,Osterville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 06/28/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass^polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: x (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): Distribution equal.No evidence of solids carry over.No evidence of leakage. PUMP CHAMBER:NA(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Big E,Osterville Pines,Falmouth Rd.Osterville,MA Owner:Huntingest Management(Osterviile Pines Condo Trust) Date of Inspection: 06/28/04 SOIL ABSORPTION SYSTEM(SAS): x (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: 1-6' x 10' leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.): Condition of soils and vegetation fine.No evidence of hydraulic failure. 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 or 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: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Pagt 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: Bldg E,Osterville Pines,Falmouth Rd,Ostexville,MA Owner:Huntingest Management(Osterville Pines Condo Trust) Date of Inspection: 06/28/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. t C {3k r � o At 33' 37'6 " Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORI7 PART C SYSTEM INFORMATION(continued) Property Address: Bldg E. Osterville Pines,Falmouth Rd,Osterville,MA Owner:Huntingest Man agement(Osterville Pines Condo Trust), Date of Inspection: 06/28/04 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 18+feet v Please indicate-(check)all methods used to determine the high ground water elevation: Obtained system design plans on record-If checked,date of design plan reviewed: _ x Observed site(abutting property/observation hole within 150 feet of SAS) _Checked with local Board of Health-explain:__— x Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Installed new leaching at Bldg D.No.groundwater at 18'. IY JL9L J i Alll(�' ©9� 65( -0bck . „ Commonwealth of Massachusetts 's � � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owners Name information is required for every 3040 Falmouth Road, ®stet i#te-,> MA 02655 08/16/13 page. Cityrrown ,n/1 n� ( " O s State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector key to move your \'•� yt cursor-do not Paul W. Davis use the return Name of Inspector key. Rosario Davis Sanitary Pumping, Inc. Company Name 9 Rocky Lane Company Address » Cohasset MA 02025 Cityrrown State Zip Code 781-383-8888 SI49 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ❑ Faill ❑ Needs Further Evaluation by the Local Approving Authority W- -- 08/2 1/13 Inspectors Si ature 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. IV A� t5ins-3/13 Title 5 Official Inspection Fo : b urface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, >Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C.D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines - Building F (Franklin) Property Address Multiple Owners Owner Owner's Name informrequired is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public"health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �( Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owners Name information is required for every 3040 Falmouth Road, >Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 Y day flow t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 'l Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every > 3040 Falmouth Road Osterville MA 02655 08/16/13 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation, ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The i system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems:'To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No s ❑ ❑ 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 f El ❑ 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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage disposal System•Page 5 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. w ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System,Information Residential Flow Conditions: Number;of bedrooms(design): Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i e t , a . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? ❑ Yes ® No bast date of occupancy: Current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA . 02655 08/16/13 required for every > page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Condo Association on maintenance schedule. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System upgraded in 1996 per previous inspections. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Cast iron inlet pipe. . Distance from private water supply well or suction line: No known wells in immediate area. Comments (on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500-gallon precast concrete septic tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 6'deep X 10.5' long. Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every > 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 10" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured with a tape. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection.Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place. There are no repairs recommended at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines - Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Ostery > ille MA 02665 08/16/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.). Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every > 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0,1 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 was structurally sound and watertight and providing even distribution of effluent. Carryover was moderate. There are no repairs recommended at this time. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yyr Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owners Name information is required for every 3040 Falmouth Road Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -concrete leaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 50"of water in it. There was 20" of available capacity. Leaching appears to be in proper working condition.There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Tale 5 Official lrgwdion Form:Subsurface Sewage Disposal System-Page 13 of 17 i . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'y< Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy� Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately f_MAkllh 61d. A rear e 6 - c - D - 3 ' 5cb - . . sepi c l� - D y L = 4 dsfribv�iot) box T leach' pi 4 /�lof �O sca.�rL t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 - _ 1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments �t Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Ostery > ille MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: SEE BELOW feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Previous inspection dated 08/02/99. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: During a previous inspection on 08/02/99 the high groundwater was indicated to be approx. 21' below grade.This determination was approximated and based on information from the Dept. of Interior Geological Survey and USGS database. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 S Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Ostery > ille MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file z l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information I on the computer, use only the tab 1. Inspector: key to move your cursor-do not Paul W. Davis use the return Name of Inspector key. Rosano Davis Sanitary Pumping, Inc. Company Name 9 Rocky Lane Company Address Cohasset MA 02025 City town State Zip Code 781-383-8888 S149 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site I� 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 07/01/10 Inspector's Sig ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the-DEP.$The original should be sent to the system owner and copies sent to the buyer..-if.applicable,-and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does,not.address how the system will perform in the future under the same or different conditions of use. t5ins•ogioe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Dis sal System Pa a of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal se tic tank will ass inspection if it is structural) sound not leaking and if a Certificate of P P P Y 9 Compliance indicating that the tank is less than 20 years old is available. Y ❑ N, ❑ ND (Explain below): t5ins-ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•ogioe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ns•osioe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered ..yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? 0 ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® El Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 8 DESIGN.flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•ogfos Rosano Davis Sanitary Pumping,Inc_ 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M ,•''r Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown. Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? ❑ Yes ® No 06/21/10 - Last date of occupancy: Building occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Condo Association on yearly maintenance schedule. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. Other(describe): t5ins•ogioa Rosario Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System upgraded in 1996 per previous inspections. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Cast iron inlet pipe. Distance from private water supply well or suction line: No known wells in area. feet Comments (on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: 4 ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,500-gallon precast concrete septic tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 6'deep X 10.5' long. Sludge depth: 2.. t5ins•o9joa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness V. Distance from top of scum to top of outlet tee or baffle 10.1 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured with a tape. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection. Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place. There are no repairs recommended at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•ogios Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow:: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M Osterville Pines - Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box was structurally sound and watertight and providing even distribution of effluent. Carryover was moderate. There are no repairs recommended at this time. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines - Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® Teaching pits number: 1 -concrete leaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 30" of water in it. Leaching appears to be in proper working condition.There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M s Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M Osterville Pines -Building F (Franklin) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately l ranklih (old, Lj � rear e A - C Z!5 ` 8 - C = Z7 ` A - D .= '5 3 � �5M_y f ' spnh R — D = L 4 iD -- ] disfri�bv�io"� boy, Nof -/70 Sa& /eactii)y Pr4 t5ins•l /08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: SEE BELOW feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Previous inspection dated 08/02/99. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: During a previous inspection on 08/02/99 the high groundwater was indicated to be approx. 21' below grade. This determination was approximated and based on information from the Dept. of Interior Geological Survey and USGS database. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•osio6 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s Osterville Pines - Building F(Franklin) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed - ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 p"S-r 0?9 - Commonwealth of Massachusetts 13 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector key to move your U 2 cursor-do not Paul W. Davis J use the return Name of Inspector key. Rosario Davis Sanitary Pumping, Inc. ras Company Name 9 Rocky Lane Company Address Cohasset MA 02025 City/Town State Zip Code 781-383-8888 SI49 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority r 08/21/13 Inspector's SignIrt6re 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. 0 t5ins•3113 Tide 5 OfficVF : ce Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > ' page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired'. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road,Osterville, MA 02655 08/16/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ -Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1`)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: I ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Ostery > ille MA 02655 08/16/13 page. Citylrown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: a 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 t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation, ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ N Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal.to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area.(lnterim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 a. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville MA 02665 08/16/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? ❑ Yes ® No fast date of occupancy: Current Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville, MA 02655 08/16/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Condo Association on maintenance schedule. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gations How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): Septic tank,soil absorption system. t5ins•3/13 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts OKI Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 29+ years per previous inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28.Efeet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Schedule 40 PVC inlet pipe. Distance from private water supply well or suction line: No known wells in immediate area. Comments(on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 20"w/covers to grade. feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1,500-gallon precast concrete septic tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 5'deep X 10' long. Sludge depth: . 6.0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building G(Groton) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road Osterville, MA 02655 08/16/13 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Measured with a tape. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection.Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place. There are no repairs recommended at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'y( Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owners Name information is required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: f Alarm in working order: El Yes El No • Date of last pumping: Date Comments (condition of alarm and float switches, etc.): i i i "Attach copy Cof current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 ! Title 5 Official inspection Form:Subsurface peck Sewage Disposal System•Page t 1 of 17 { Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y< Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I t5ins•3/13 j TNe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owners Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: r ® leaching pits number: 1 -concrete leaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 31" of water in it.There was 40"of available capacity. Leaching appears to be in proper working condition. There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of,liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every 3040 Falmouth Road, Osterville, MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): / t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '( Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is 3040 Falmouth Road Osterville MA 02655 08/16/13 required for every > page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A 3l ' A — 4 1 500- C o S �l< # - exposed- cove-1 - 3 == 40 O's we-11 c(s m[ddle cover 3 © - s ca& t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner owner's Name information is ,3040 Falmouth Road Osterville MA 02655 08/16/13 required for every , page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: SEE BELOW feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date El 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: I You must describe how you established the high ground water elevation: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.25' r below grade. This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. . r t v. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts F` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is > >required for every 3040 Falmouth Road Osterville MA 02655 08/16/13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file New leaching installed at Bldg.D.No groundwater at 11. — — -- -- µ,ow 1 . t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information 3U ( n� on the computer, ►��l l'I� use only the tab 1. Inspector: V key to move your cursor-do not Paul W. Davis use the return Name of Inspector key. Rosano Davis Sanitary Pumping, Inc. kCompany Name 9 Rocky Lane Company Address Cohasset MA 02025 Cityrrown State Zip Code 781-383-8888 S149 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 07/01/10 Inspector's Si ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,'if applicable;-and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does.not address-how the system will perform in the future under the same or different conditions of use. _ t5ins-09/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal ystern•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09f08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 - 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•og/os Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑, 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•og/os Rosario Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El ® 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 El ® tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ . Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-osioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown. Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? ❑ Yes ® No Last date of occupancy: 06/21/10 - Building occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•og/oe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe.below): General Information Pumping Records: Source of information: Condo Association on yearly maintenance schedule. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for um in : P P 9 Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract Tight tank. Attach a copy of the DEP approval. ® Other(describe): Septic tank,soil absorption system. t5ins•09r08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 26+ years per previous inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Schedule 40 PVC inlet pipe. Distance from private water supply well or suction line: No known wells in area. feet Comments (on condition of joints, venting, evidence of leakage, etc.): All piping appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 20"w/covers to grade. feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,500-gallon precast concrete septic tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 5'deep X 10' long. Sludge depth: 10" t5ins-o9/oe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cant.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured with a tape. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is on a semi-annual maintenance pumping schedule and was not pumped at time of inspection. Tank was structurally sound and watertight and all effluent levels were at an appropriate height. Inlet and outlet tees in place. There are no repairs recommended at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•osroa Rosano Davis Sanitary Pumping,Inc .781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owners Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions`. Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•ogioe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•ogtoa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -concrete leaching pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness, breakout or signs of hydraulic failure observed. Leaching pit had 25" of water in it. Leaching appears to be in proper working condition. Cover to pit is at grade. There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•ogioa Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc): l5ins-ogioe Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t3cn /,//),q C7 3v f� — 3 - /1 Zc �� 19 - 3 = +� ` cc)'v le-i", /Vo-� v Ca t5ins-0/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is required for every Osterville MA 02655 06/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water, ❑ Check cellar ❑ Shallow wells / Estimated depth to high ground water: SEE BELOW {I feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.25' below grade.This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Rosano Davis Sanitary Pumping,Inc 781-383-8888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r I Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Osterville Pines -Building G (Groton) Property Address Multiple Owners Owner Owner's Name information is Osterville MA 02655 06/21/10 required for every page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed 9® System Information— Estimated depth to high groundwater Y P ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file New leaching installed at Bldg.D.No groundwater at I A' ED �A\tH U+CZovtJi� t t5ins\tj ioe Rosano Davis Sanitary Pumping,Inc 781-38M888 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 �l\ 1, ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (781)383-1234 (781)545-2800 (781)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address Building G—Groton , Oqq G230 o a C7 Osterville Pines,Osterville,MA Owner's Name Multiple Owners Owner's Address Huntingest Property Management 40 Industry Road—P.O.Box 340 Marstons Mills,MA 02648 Date of Inspection 11/17/06 Name of Inspector Jeffrey F.O'Connell Company Name Rosano Davis Sanitary Pumping,Inc. Mailing Address 9 Rocky Lane Cohasset,MA 02025 Telephone Number 781-383-1.234 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training 4nd expe nce in-the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursua0t to Section 15.340 of Title 5(310 CAM 15.000). The system: c C-7 ®Passes 1 Uri ❑Conditionally Passes s' ❑Needs Further Evaluation by the Local Approving Authority ❑Fails Inspector's Signature:espection. �/ (! Date: 11/24/06 The System Inspector shall s this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30)days of completing this e system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable and,the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 1` r 1 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE C014ASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/1 7/06 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 or in 310 CMR 15.3( exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no or not determined(Y,N,ND)in the_for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout 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. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced _ obstruction is removed ND explain: 2 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (61.7)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property:Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 C Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board or Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless 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 of more from a private water supply well". Method use to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3) Other: 3 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 D System Failure Criteria applicable to all systems: You must indicate either"Yes"or"No" to each of the following for all inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ X Liquid depth in cesspool is less than 6"below invert or available volume is than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below the high groundwater elevation. _ X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (The system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO(Yes/No)The system I have determined that one of more of the following failure criteria exist as described in 310 CMR 15.303, fails. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E.Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"Yes"or"No"to each of the following: (The following criteria apply to large systems in addition to the criteria above.) Yes No 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) 4 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS ' 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 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 with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. MAO np�.ge nM� �ffi (0)M&Uy MUM EDn&Mlk a 5 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART B CHECKLIST Property: Building G—Groton/Osterville Pines,Osterville,MA. Owner: Multiple Owners Date: 11/17/06 Check if the following have been done You must indicate`des"or"no"as to each of the following Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the revous two week period? — — Y p X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were the septic tank manholes were uncovered,opened,and the interior of the septic tank inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum? X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System on the site has been determined based on: Yes No X _ Existing information.For example, Plan at B.O.H. X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] 6 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 4 -2 178 617 383-1234 617 5 5 800 617 749-6 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION Property: Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 FLOW CONDITIONS RESIDENTIAL: Number of bedrooms(design): Number of bedrooms(actual):4. DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Varies. Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No (If yes separate inspection required) Laundry system inspected (yes or no): Seasonal use(yes or no): No Water meter readings,if available(last two(2)year usage(gpd)): Water usage records were not available at time of inspection. Sump Pump(yes or no):No Last date of occupancy: 11/17/06—Units were still occupied at time of inspection. COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd. Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): _ Industrial Waste Holding Tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER: (Describe) GENERAL INFORMATION PUMPING RECORDS Source of information:Property currently under regular maintenance schedule. Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-how was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _ Single cesspool Overflow cesspool Privy No 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) No Tight Tank. Attach a copy of the DEP Approval X Other(describe) Septic tank,soil absorption system. Approximate age of all components,date installed(if known)and source of information: 23+years per previous inspection. Were sewage orders detected when arriving at the site(yes or no): No 7 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 BUILDING SEWER(locate on site plan) Depth below grade: 28". Material of construction: cast iron X 40 PVC other(explain) Schedule 40 PVC inlet pipe. Distance from private water supply well or suction line:No known wells in immediate area. Comments:(on condition of joints,venting,evidence of leakage,etc.) All piping appeared to be clean and flowing freely.No evidence of leakage. SEPTIC TANK: YES(locate on site plan) Depth below grade: 20" w/cover to grade over inlet and middle cover of tank. Material of construction: X concrete metal Fiberglass Polyethylene other(explain)1,500-gallon precast concrete septic tank. If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes or No):_(Attach a copy of certificate) Dimensions: 5' deep X 5'wide X 10'. Sludge Depth: 12 Distance from top of sludge to bottom of outlet tee or baffle: 14". Scum thickness: 2". Distance from top of scum to top of outlet tee or baffle: 6". Distance from bottom of scum to bottom of outlet tee or baffle: 16". How dimensions were determined: Measured with a tape. Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) Septic tank is on a semi-annual maintenance pumping schedule so tank was not pumped at time of inspection.Inlet and outlet tees are in place.Tank is structurally sound and water tight and all effluent levels were at an appropriate height.There are no repairs recommended at this time. GREASE TRAP:NO(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) 8 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property:Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 TIGHT or HOLDING TANK: NO.(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: -gallons Design flow: gallons/day Alarm Present(Yes or No)_ Alarm level: Alarm in working order _(Yes/No) Date of last pumping: Comments:(condition of alarm and float switches,etc.) DISTRIBUTION BOX: NO.(If present,must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) PUMP CHAMBER: NO.(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.) 9 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property:Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 SOIL ABSORPTION SYSTEM(SAS):YES.(locate on site plan,excavation not required) If SAS not located,explain why: Type: X leaching pits,number: I—precast concrete leaching pit. leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system. Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): There was no surface wetness,breakout or signs of hydraulic failure observed.Leaching pit had 18" of water in it.Leaching appears to be in good working condition.Cover on leaching pit is at grade.There are no repairs recommended at this time. CESSPOOLS: NO.(Cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(Yes or No): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: NO.(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) 10 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 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. olj 0 A 40 exPose'(. c ove-r� a S Lue-! i c(_S ty1 t' d I e c c)ve-r. 11 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: Building G—Groton/Osterville Pines,Osterville,MA Owner: Multiple Owners Date: 11/17/06 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater: 18+feet Please indicate(check)all methods used to determine the high groundwater elevation: Obtained from system design plans on record. If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) X Checked with local Board of Health-explain:Previous Title 5 Inspection dated 11/07/03. Check local excavators,installers-(attach documentation). Accessed USGS database-explain: You MUST describe how you established the High Groundwater Elevation: During a previous inspection on 11/07/03 the high groundwater was indicated to be 18.17' below grade.This determination was by Fripter method. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. New leaching installed at Bldg.D.No groundwater at ljl'. ---- T i 1LoJ �5, i 12 Title 5 Inspection Form 6/15/2000 J i .i' C -, „Z I_`' ""�► ww + � „ a July 10, 2011 Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Thomas A. McKean,CHO/RS RE: Emergency Condemnation and Order to Vacate Sriruen Chunephisal, Osterville Pines, Unit D1 Dear Tom. I have not received notice that this order has been rescinded. Noi has been staying there off and on/overnight. , She parks in the lot facing Rte 28, instead of her spot. Mostly so you wont notice and because she can't manage to get into her spot. If this Order has been removed, please forward me a copy. If not, I feel her residence should be checked and maybe her door posted again. I am concerned about her and others in the building if she is continuing to collect more "stuff'. Thank you for your attention to this matter. aU CYours truly, c:) cc 1 —Ja Curtis � v Manager Cc: O�-terville Pines Trustees l oFIME roy, Town of Barnstable * Regulatory Services * swxtasraBLE. 9 . MASS. g Thomas F. Geiler, Director i639. 10 Public Health Division Thomas McKean,Director 200 Maim Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail:70060810000035246024 April 2,2008 Sriruen Chunephisal 3040 Falmouth Rd. Unit D1 Osterville, MA. 02655 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter 11 Minimum Standards of Fitness for Human Habitation, Donald Desmarais RS, Health Inspector for the Town of Barnstable, on April 2, 2008, conducted an inspection of the dwelling located at 3040 Falmouth Rd. Unit D-1 Osterville, Massachusetts. The owner's name in this dwelling is Sriruen Chunephisal. Based on the results of that inspection,the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay maybe permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (I) .Failure to comply with any provisions of 105 CMR 410.600, 410.601,, or 41.0.602 which results in.any accumulation,of garbage, rubbish, filth or other causes.of sickness which may provide a food source or harborage .for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. The occupant, Sriruen.Chunephisal, had debris piled high on floors and furniture. 410.451: Egress Obstructions 41.0.451.: No person shall obstruct any exit or passageway. The owner is responsible :for maintaining free from obstruction every exit used or intended. for use by occupants of more than.one dwelling unit or rooming unit. The occupant shall be responsible for maintaining free from obstruction all means of exit leading from his unit and not common to the exit of any other unit. The occupant, Sriruen Ch.unephi.sal.has no access in or out of dwelling to R due to the :Large amount of debris. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH T omas A. McKean, CHOIRS Director of Public Health Town of Barnstable Cc: Sriruen Chunephisal, Owner Mr. Tom Perry, Building Commissioner Chief;fohn Farrington, COMM Fire Department Ruth Well, Town Attorney Chief Macdonald,Barnstable Police Chief r 04/09/2005 10:54 FAX Z001 The N`'Mi"r ST koup p.a,. _ Real Estate 6� Mamageotek Under all-The land ---... ---'-- --T-----------------------------------------------------------------------------------------..I-------- ----------------------- Date ;T4 I #U=C or-1h:5` i �yy.� �/ y G/ �_L '2 't.��`K�_.....d__ ,(Inc.��:�IngcCnG�'1 ;FROM --f , ----...--- ----------------------------------------------------------- ----------------------------------------------------------------- ay --------- b1,22�4-djIl",j---- -l------------------------------------------------- ----------------------------------------------------------- -------------------------------------- - � � , I 1 -- r-L iz-- - ------ 4 I --= ✓--- _-----yam'--7------------}--/----------- ��- ------------- --------------------- --- --------------------- -------' �1 � ' J / /fl r-1 7 1 -- Ca -�A C--- ------------------------------------------- ..---------------- -- --- ------------------------------------ ----..--- ---------.._. -------------------------------------------------------------------------- , , ----.._.__-:.-------------------------------------- ------------------------------------------------------ 7 ------------------------------------------------ - — ------ -------------------- ---------------------------------------------------------- , , ---_....._..:..---------------------------------------------------------------------------------- � ----- -=------------------ ------------------------------------------------------ --------------------------------------------------------- PLEASE NOTE j This Document is intended only for the addressee. if you have received it in error we would appreciate if if yyou would notify us at 508.428-1112 and then destroy this document. _ TI LANK YOU FOR YOUR HELP_The HUNTINGFST GROUP' _ 40 hidur y Qoad Marston Mills, MA 01649-0940 508.41E-111Z Fax 4,345*5 April 30 2008 Barnstable Board of Health Att: Don Desmarais, RS 200 Main Street Hyannis, MA 02601 RE: 3040 Falmouth Road, Unit DI Dear Don, One month ago,4/1/08, you observed the condition of this unit at the request of the COMM Fire Dept. and declared it uninhabitable. The owner was served and started to remove "stuff'. Was there a time limit put on her to clean.the place up? The other occupants and the Trustees are concerned for health reasons and the possibility of mold that would be detrimental also to the integrity of the building. The purpose of this whole exercise was to replace the gas meter to the building and since I have heard nothing from the Fire or Health Depts., this has not been accomplished. The Trustees and other owners need to know what has been done for the time and money that was spent. Please advise. Thank you for your time. You ly, Curtis I Cc: Trustees �I �a�YH�r Town of Barnstable SASM S Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 11, 2004 Sriruen Chunephisal 3040 Falmouth Rd. Unit D1 Osterville, MA. 02655 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO 1 The property owned by you located at 3040 Falmouth Rd. Unit DI, Osterville, MA 02655., was inspected on May 27, 2003, by Donald Desmarais, Health Inspector, because of a complaint. The following violations of the Town of Barnstable Board of Health Regulations, Nuisance Control Regulation No. 1 were observed: Nuisance Control Regulation No. 1, Part V1I, Section 1 00: Many bottles with questionable liquids. Plastic bags with unknown contents. Must be cleaned up to avoid rodent harborage. You are directed to correct the violations within seven days of receipt of this order letter. You may request a hearingbefore the Board of Health if written petition requesting p q ><ng same is received within ten(10) days after the date the order is served. Please be advised that failure to comply with an order could result in a fine if Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T B ARD OF HEALTH Thomas A. McKean, R.S., CHO. Director of Public Health Town of Barnstable ` Q:Health/orderletters/refuse/274 South.doc p 11J: COMMONWEALTH OF MASSACI-IUSETTS BARNSTABLE DIVISION BARNSTABLE DISTRICT COURT CIV.NO. 96-25SU3210 •�#f#iiiif#ii��f#iiifff##��ffifi• , RICHARD COCIVERA and F. RUSSELL LIDDELL, Plaiiht;ff's • TRIAL SUBPOENA(DIST./MUN. ' CT. R. CIV. P. 45 ) V. CALLA E. GUSTAVIS, Defendant • #I��f###•##M#ff�f#il��fffii�f*ftt TO: Jerome Dunning, Inspector, Barnstable Public Health Divison, 367 Main St., Hyannis, MA 02601 GREETINGS: - YOU ARE HEREBY COMMANDED in die name of the Commonwealth of Massachusetts, in accordance with die provisions of Rule 45 of District/Municipal Court Rules of Civil procedure, to appear before die District Court Department holden at Barnstable District Court, Mavi Street, Barnstable ,MA 02530, within and for die county of Barnstable, on the 18th day of Ucjober, 1996 at 9:43 a.m. in the forenoon, and from day to day thereafter until the act an hereinafter med is heard by said court,to give evidence of what you know relating to an action or motions then and there to be heard and tried between Richard Cocivera and F. Russell Liddell, Plaintiff's and Calla E. Gustavis , Defendant,No. 96-25SU3210. You are also requested to bring with you the documents described on Schedule A hereto. HEREOF FAIL NOT as you will answer your default under the pains and penalties in the law in that behalf made and provided. Dated: October 14. 1996 NOTARY PUBLIC My commission expires: Ask for: Harry G. Lent, Esquire Attorney for Richard Cocivera and F. Russell Liddell CA U OPY, ST I I I State Street Boston , MA 02109 IE E. M BELL (617)523-0004 CO SJABLE /0 /G�y` SCHEDULE "A": hispection report for 3040 Falmouth Rd., Apt. 2E, Osterville, MA,dated 09/20/96 10-16-96 to:26AM P02 Calla Gusyavis 3040 Falmouth Rd. E2 Osterville, Ma.02655 Oct. 11,1996 ���' OCT _4CC 5 Tit l/ Town of Barnstable Board of Health e ; Public Health Division 367 Main St. Hyannis, Ma. 02601 Re: Landlord:Richard Cocivera of above address. On 9-27-96 at 8pm R. Cocivera called me at home requesting to come into the apartment to do repairs on Sat. 9-28-96. I requested atleast 24 hr.Notification and attempted to explain I work every Fri., Sat. , Sun., 11pmto lam at a Nursing home, and attend college full time Mon. Through Fri.. I requested he come Mon. Through Fri. On an agreed time. R. Cocivera insisted on a weekend day, I agreed to his coming on Sun. 9-29-96. R. Cocivera came to do repairs on 9-29-96 from 8;40am to 12;30pm. In the course of time he was present,the repairs were minimal, he left twice and again insisted on returning Sat. 10-5-96. I again mentioned my work and college schedule,requested he come Mon through Fri. To which he responeded, "You don't want us to come?" five times to which I again requested he come Mon through Fri. R. Cocivera then said it would probably have to be in the evening or he would get back to me. R. Cocivera next called me on 10-7-96 at 7:30pm saying he is going to come on Tues. 10-8-96. Again I rquested 24hr notification and agreed to his coming on 10-9-96 to do repairs. R. Coivera has elected to do some repairs at his convenience, rather than consider my health and safety. R. Cocivera has of this date done some repairs; however the repairs are incomplete. It has taken the landlord over 1year to do the repairs requested and needed to this date. Respectfully Calla Gustavis FoFsA3o HOSES&WARREN,INC.NOV.19M1 9W THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T CITY/TOWN W o DEPARTMENT j l �Iz_t.-r'F tr.r�tK1 ko" 'y ADDRESS U TELEPHONE Address -A a 3 O FoLtmA q Occupant Floor I Apartment No:_ No.of Occupants No.of Habitable Rooms—No.Sleeping Rooms No.dwelling or rooming units No.Stories ) Name and address of owner �:ac91.C► ( e.% ,r S W�,rQ c. X,l7. 7t, 7 Vv44k Qj*,-k, A-&— e3.o 9 b Remarks Reg. Vlo. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Iv p Roof Gutters,Drains: Walls: I AVr,� c., 1, O Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: m�. J,M a,�, x Z Stairs: QI ' Lighting STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: , Q, y Hall Windows: 4 a ,o ;,� HEATING Chimneys: w U Central ❑Y ❑ N Equip. Repair TYPE: Stacks,Flues,Vents: n D PLUMBING: Supply Line: '014, ❑ MS ❑ ST ❑ P Waste Line: V H.W.Tanks Safety and Vent(s) ELECTRICAL Panels,Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen �/ ✓ �/ Bathroom Pantry Den —Livina Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks,Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facll. Vent.,Plumb.,Sanit'n.: Wash Basin Shower or Tub: Infestation Rats Mice,Roaches or Other: Egress Dual and Obst'n: General Building Posted N,.D 1V Locks on Doors: t>, , 9,,e SK rim w, Of I �d ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." ! /� INSPECTOR �c- TITLE A.M. DATE - "��� TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. A f 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may.endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this. category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 OIR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electricity or gas. (D). Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. .(F) Failure to provide a toilet and maintain a sewage system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 41b.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (R) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or dafety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any of the following conditions which remain uncorrected for a period of five or more days following- the notice to or knowledge of the owner of said condition or conditions: (1) lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating,. gas-fitting, or electrical wiring standards that do not create an immediate hazard. .W failure to maintain a safe handrail or .protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. ,J a 3 Town of Barnstable n Department of Health, Safety, and Environmental Services BA MA". Public � public Health Division 9 A98. i6?9. Eon 367 Main Street, Hyannis MA 02601 Office: 509-790-6265 Thomas A McKean FAX: 508-775-3344 Director of Public Health September 25, 1996 Richard Cocivera 65 Wildwood Drive Westwood, MA 02090 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at Apt.E2, 3040 Falmouth Road, Osterville was inspected on September 20, 1996 by Jerome Dunning, Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code H were observed: 410.100: The hot water faucet does not shut off. 410.020: Build up of mold in central air system. 410.254: The tenant can't control the outdoor and hallway lights. 410.150: The tub drains slowly. 410.480: The front hall lock doesn't lock automatically. 410.481: No sign posted showing the owner's name, address, and phone number. 410.500: The wall next to tub and shower stall rotting near the floor. 410.501: There is no storm door or storm windows in rear of apartment. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. a t You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH T omas A. McKean Director of Public Health cc: Calla Gustavis c D.ram NUTICE TO ABATE VIOLATIONS VIOLATIO14S OF 105 MR 410 00 R 1111NINIUM S'I'ANUAItUS Uf FICNESS CUR llUMAN 1lADITATIO ANU 'IIIE 'I'U�VN UI, IIAItNS'1'AI]LE 1tEN'I'ALORDINANCE ARIICLLE3I1 I The property owned by you located at A�k E oVo Inspected on 1994 by llealth Agent for the 'Gown of Barnstable because of a cc,n,pl1int. r he following violations of the Town of Darnstable Rental Ordinance Arlicic SI And the SAnilnry Code 11 were observed: 1 O 0 aLo -� XXL may/ /4� !o 4 a K f q l o . 6"0 0 0 yo . You are directed to correct the violation of within 24 hours of receipt of this notice by Yon ore Also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Ilealtli within seven (7) days aRer the date order is received. however, these violations must be corrected regardless of any request for a hearing. i'lease be advised that failure to comply with an order could result in a fine of not more than $500. Each separate (lay's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and V 5.00 for each additional violation. Tickets will be issued daily until the violations are corrected. Enclosed are citation numbers due to violations observed on PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public health Town of Barnstable I OSTERVZ.L.LE PINES condominiums 0�,T �� J� r `l7 September 30, 1996 `9 Town of Barnstable ;r Public Health Division 367 Main St., Hyannis, MA 02601 '' RE: 9/25/96 Letter to Richard Cocivera, Apt E2, 3040 Falmouth Rd., Osterville Pines Gentlemen, The Huntingest Group is the manager of the Condominium Complex know as Osterville Pines where unit E2 is located. In regards to the work list which was submitted following is the situation: 410.254 The tenant can't control the outdoor and hallway lights. Section 410.254 does not state that the tenant has to have control of the lights. Both the outdoor and hallway lights are paid for by the Association and are turned on and off by a timer. These lights have the necessary lumins and are paid for by the Association. 410.480 The front hall lock doesn't lock automatically. We agree that this section does call for automatic locks in hallways with more than three dwelling units. We had planned to install same a few years ago but the residents of the E (Exeter building), unanimously said that they did not want automatic locks installed. They far preferred.to lock the hall door in the evening rather than be locked out during the daylight hours. They particularly felt this way as Osterville Pines is located in a relatively free crime area. Obviously, we will have to install same if the Board of Health insists on our following the letter of the regulations. When automatic locks were installed on the N (Newton Bldg) the residents complained so much that we had to modify it. It does seem a shame to make the other three residents suffer because one tenant who is being evicted for non-payment of rent is trying to cause problems for her Landlord. Please advise as to whether this is absolutely necessary over the ob- jections of the other residents. 410.481 No sign posted showing the owner's name, address and phone number. As a Management Firm we attended and very vocally opposed the posting of Owners names when the Town adopted this regulation a few years ago. Can you imagine posting 43 names at Osterville Pines or any condominium? We were assured, at that time, if the Management Co. (Huntinget Group) erected a sign (at all of the condominiums we manage) at the entrance that this would be more than adequate. Said sign is located at the entrance of Osterville Pines. I hope this answers all questions as regards that portion of your letter as concerns our responsibility. Please notify us concerning the necessity of changing the hall lock over the objections of the other Owners. Cordially, Jim Curtis, Manager cc Richard Cocivera %Huntingest Group, 40 industry Rd,Marston Mills;MIL 02648 508.428-1112 Fax 428-1605 --_-. Z 3 4&-t-59"917 Receipt for Certified Mail No Insurance Coverage Provided Town of Barnstable „Ems,® Do not use for International Mail VOSr1r Si GVM:I (See Reverse) --r-�-�----- :ment of Health, Safety, and Environmental Services Public Health Division 367 Main Street, Hyannis MA 02601 ` o` ti ` � "I-• T a a oo• � - n.�, - 'n101tlaa A.McKean Director of Public Health a ,• � 3 ..ZJE Richard Cocivera. 65 Wildwood Drive Westwood, MA 02090 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE ARTICLE 51 The property owned by you located at Apt.E2, 3040 Falmouth Road, Osterville was inspected on September 20, 1996 by Jerome Dunning, Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code_U were observed: 410.100: The hot water faucet does not shut off. 410.020: Build up of mold in central air system. 410.254: The tenant can't control the outdoor and hallway lights. 410.150: The tub drains slowly. 410.480: The front hall lock doesn't lock automatically. 410.481: No sign posted showing the owner's name, address, and phone number. 410.500: The wall next to tub and shower stall rotting near the floor. Y. 410.501: There is no storm door or storm windows in rear of apartment. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. � )S no �-7 OOAI(e� ) n n vwne m S / vSS ,� 11 N Yj'I y � � , Ode cVr7 y (�D e l UeY-g o7nal /eOSe -fd C`c7//07 (�v S�47 v�•S Gct �a Gv e � r� � ���� �� � -rt2 ,e viC� Or nori MLon ]�e�- �� � e/UJ n � '` e l�0 ��c•e o /2,7/ ge Gt� A D ���o GlJ�� , 917 / 0- 7;�e On l ') v r d a t 9 7 f'!'1 h" ft--ee- 7�e tub l / -Q o7n J hc)Vraom /r/o �� �`�or� y�o. /s . 7) jc 4• C l 1�1s v I c� w e C o v� =t �� 7� �► � Ul'1�fior� �J �✓��S� or rnon N� 5 c�hoL o� c��7�ef— 3•' 3a ✓yj on �v�sq� s �r/d UPS 5 a7,j d /o : 30 A. �1. �iv G���h pS o/ J , Q7Ne- n 4/irj� 1"7 e1- � m ee� � e 7 � 7� ese d 6re re� �es r(. -PAC �eh s/ /V• �,/ be � n Coh �67c-t yov b .� y Iron �-eq 67rc-/ ) s vn 87 �e �-. THE COMMONWEALTH OF MASSACHUSETTS . 7 TOWN OF BARNSTABLE SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC SPECIAL PURPOSE ❑ POOL VOLUME: GAL. MAX. BATW LO D NAME OF POOL i` (e j ADDRESS �. OWNER ADDRESS Re tion 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory. / Re and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. Z-0,5 / ,Sewage disposal y Location,structural stability,finish � 00�6 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers l/ 0 uitable automatic equipment for disinfection of pool water. _ 06 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. V 088 1 is&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. _ 0'� 8 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one anti-vortex drain provided Y/08 E ch system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly and plumbed. _�_ _Ocated 8 uction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose can be removed w/o tools until repairs are made. 08�pecial purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. j/— 09 Sross-connections.Potable water supplied through air gap. ��12 ' imming Facilities.50%of recirculation drawn from surface of pool. e with floats separates non-swimmer area from deeper water. �/ 12 water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. 13)Ata/ Ikways&Decks 4 ft.wide.Safe condition. 14 ealders,steps-one per 75 feet.Not less than 2 ladders. 15 iving equipment in safe condition. 1 Pool supervision provided.CPO w/proper training.On staff or on contract,Documentation provided. V 21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. 22 Health Regs.Signs posted Warning signs for special purpose pools. f 23 Lifeguard ❑Qual.Swimmer -01f lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhorn provided.Qua].Swimmer:CPR trained, SOH approved.Limit bather load to 19 ❑Red or orange bathing suit with proper lettering for lifeguard ®Yellow Qualified Swimmer attire t� SSafety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. V 25 list aid equipment provided.First aid kit complete. 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the blic.Operating instructions and emergency numbers posted. Waste&backwash water disposal properly discharged.No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. '! 29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 , Lj CyanuricAcid 30-50,max 100 Comb.chlorine 0.0-0.2 Water tem . 78-84,spa<104 pH 7.2-7.8 g 30 Water testing equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips 32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. 3333 Specialpurpose pool drained&cleaned every 14 days minimum Trmostic he at c control provided for each SPP.Thermostatic control only accessible to the pool operator. _ 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: � C�0 T� SIGNED: SI D DATE: i� /6 ERATOR Board of Health/Health Dept. Representative Certified Mail#7006 0810 0000 3524 9452 Q�oFzrt�ralyti Town of Barnstable 4i O Regulatory Services � IIARNS'rABLE, ' MASS. Thomas F. Geiler, Director �O i639. ArF°"`AAA, Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 12, 2007 Janet Murtha 137 River Isles Bradenton, FL 34208 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN.OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 3040 Falmouth Road Unit N4 Marstons Mills, was inspected on April 11, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the Town of Barnstable Code were observed: 170-10—Smoke Detectors and Carbon Monoxide Alarms. No CO detector. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by installing CO detector in accordance with Mass State Fire Codes. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Q:\Order letterMousing violations\Rental ordinance\3040 Falmouth Road N4.doc w s Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE B ARD OF HEALTH I s A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Rockey Dye, Tenant Cc: Meredith Morgan, Health Inspector QAOrder letters\Housing violations\Rental ordinance\3040 Falmouth Road N4.doc 1 NOTES ON OSTERVILLE PINES CONDOMINIUM FROM BOARD OF HEALTH MEETING MINUTES 10/11/2005 Excerpt PAGES 4 - 8 VI. Informal Discussions: A. Jim Curtis, Manager,Osterville Pines Condominiums regarding proposed septic upgrade. Jim Curtis stated in Dec, 1995,a supplement to Title V was passed to say you can not aggregate flows from existing condominiums to avoid the situation of local rule of 1,650 gallons,we are aggregating the flows of the whole system. This is different from state law and how legislatures were looking at it. In my mind, many years ago,you should have been going after more town sewer systems. We all want clean water. Dr. M i I ler's response: 1)this regulation is not required,but it allows the Board to look at each one individually in determining whether the public will be better served by an IA system or a shared system. It's not absolute requirement. It gives the Board the discretion. 2) The Board has a number of regulations that are more restricted that the state. That's because we feel it's more needed right here on the Cape because of our situation with our many nitrogen sensitive areas and our sole source aquifer,we feel those protections are necessary. In terms of individual homes vs.condo or apt.buildings or commercial,you have to look at the density of nitrogen and waste products going directly into the system over a given area. And, if a house does not fall into the required guidelines,we do require consideration of an IA system. The Board continues to look at where a condo. is located in relation to nitrogen sensitive areas and look at the costs related. Ostervi Ile Pines is in a nitrogen sensitive area. No one in this room wants that area's problems to be compounded. Jim Curtis asked why are we going so far beyond state requirements. Every other septic is functioning except one. Why are we applying the 1,650 gallons rule? Dr. Miller reiterated that we are going to look at each case individually. In terms of Osterville Pines, if it's a failed system(nothing has been submitted at this time),then it's going to come before the Board and we'll examine it. What we suggested since you have this failed system,the other systems are the same age,and you may be looking at replacing each of the systems within the next few years,so one of the things you should be considering at this point is looking into a shared system which in the long run,would be much cheaper than replacing each of the systems one by one. Sue Rask said in all other areas that are nitrogen-sensitive,the town 20+years ago passed what is called the 330 Rule which says you get 3 bedrooms per acre. Everyone in town who is in this sensitive area has been held to that and that's al I they can have. So,if you have an acne,you don't get more than 3 bedrooms to be built. Other people in town have restrictions placed upon them. You,as the condo owners,are not the only ones to have restrictions. You are not being singled out. The 1,650 gallons✓day equates to roughly a 5 3- bedroom homes. So any new subdivisions with 5 or more 3 bedroom homes,we have the option of requiring them to put in an IA system. And we have done that. Any time a commercial building changes use and increased its design flow, it has to put in an IA system. Jim Curtis said these condo's haven't expanded or changed anything. Just going about the same building permits originally issued. He said the legislature amended the regulations. Sue Rask corrected him to say DEP amended it, it did not go through a legislative process which is a different process. Sumner Kaufman expressing the Cape's unique issues. The impact of nitrogen on the Cape is not common with the rest of the state. Dr. Miller summarized that this local Board has decided we want the ability to look at each case individually,given the situation,to decide how public health is best protected. We are sitting on a time bomb and we need to protect everyone as best as possible. We are trying to protect the Cape for now and for the future. We will work with you. Historically,this Board works with people. When I receive bids in writing,.price is not as large as it originally appears. Jim Curtis said he knows for a fact the first one will cost$50,000 and they have 9 systems. Susan Rask points out that is for 60 units and will be less than$10,000 per unit for the repair. For a single homeowner, CAcache\Temporary Internet Files\OLK176\Ost Pines Condo BOH Minutes Summary 2005 and 2006.doc Page 1 of 5 4 � r I FROM BOARD OF HEALTH MEETING MINUTES 10/11/2005 Excerpt PAGES 4 — 8 cont. it costs$8-10,000. Jim Curtis states the%of repairs to the value of the house is so much greater in a condominium. These are affordable housings and people on fixed incomes. Number 2) when an owner sells their home,that is usually the only time you find your septic has to be replaced,and that's at a time where there is ready pool of cash. With condominiums,we take better care of septic because we're certified every three years and we pump yearly. That's more frequent than most homeowners. Fisherman's Village told him there is no money in the Town fund left to help finance this. Sue explained that the Town gets$200,000/yr to loan out. It may be all used up this year. What we hope for next year is that the County will be$10 million from the state to loan out. Jim Curtis asked if the BOH is going to wait until Osterville Pines can get the finance. Dr. Miller explained the bottom line is that we'll look at each case individually. We reviewed this regulation for 3 months before passing this. This regulation was passed given the expertise of the board and engineering and citizen's comments. We have to act on what best protects everyone in the room. We're going to take into consideration of all the facts each time. We've done other things that applies to individual home owners as in limitation of flows. No one is being singled out. Dr. Miller said the cost of a shared system maybe much smaller than the 9 individual systems. That's why the Board looks at the whole picture. Tom McKean called Bill Boller,Fisherman's Village,up to speak. Bill Boller explained Fisherman's Village received approval to put in an IA for the entire complex and sewer was not available. Sue Rask explained we do not control the sewer project nor the funding for it. If the Board of Health had their way the Wequaquet Lake project would proceed. She sincerely hopes it does,but it's going to depend on the vote of Town Council to allocate the funds. Jim asked what planning has the BOH done in terms of putting in a satellite system. Sue said there is a Waste Waters Facilities Plan active in town and I recommend you get in touch with Mark Giordamo to bring you up to speed on that. There will be a Citizen Advisory Committee Forum to advance the waste wafter plan and I urge you to ask to be nominated. I've been on it since 1993 which is when the citizen's plan began and it has representatives from all over town on it. The number one project we identified was the Wequaquet project and if that one goes through, it will be a cost of about$20,000. That's the latest engineering and installation cost. The bigger issue is that we can't add more flow to the sewer system that we have and we can't lay more sewer I ine because we can't dispose of any more treated affluent at the plant and unti I the town designs and builds an alternate disposal location and lays the pipe to get the water out to that location,we can't accept any more flows in the sewer system because we can only treat it,we can't dispose of it. That's the road block that's blocking the Wequaquet project. Bill Boller said he can attest to this. I talked to the state as well. State suggested I ask for a tie in in sewer where we were only 250 ft away. DEP said the state knows the town can't take anymore flow, therefore,they cannot tie in. The cost for Fisherman's Village IA is priced at$92,000 for 12 units(less than$8000 per unit). Bill Boller restated the major difference with the condominium owner doesn't have option of financing by themselves. The bank wants each of the unit owners responsible for the total bill and that is much more uncomfortable to do. Next speaker was Mr. Factor,unit owner at Osterville Pines. He and his wife purchased the unit for his daughter. Her income is very meager. The burden for septic cost is great(based on$250K). Osterville Pines is just the kind of affordable housing Barnstable is looking to have. Yet this puts in jeopardy the largest pool of affordable housing in the jurisdiction. Granted you have to weigh the values to the water tables with other values. Next to speak was Francis Curray, resident of Ostervil le Pines who asked for an explanation of"nitrogen sensitive". And what is the location of the closest municipal sewerage system. He stated the low income housing recently built on Ost-W.Bamstable Road was tied into a sewerage system and questions if there is more room there. Sue Rask said believes there's probably not more room there at the school. Francis asked if there is a possibiIity.that Osterville Pines might do a combination system with other subdivisions thatare being proposed for development. Sue said if you can come up with a joint system,that would be a good idea. Tom McKean said the definition of nitrogen sensitive area is any area(a)that there can be private C:\cache\Temporary Internet Files\OLK176\Ost Pines Condo BOH Minutes Summary 2005 and 2006.doc Page 2 of 5 FROM BOARD OF HEALTH MEETING MINUTES 10/11/2005 Excerpt PAGES 4 — 8 cont. wells, (b)where you're in a zone of contribution to public supply of water(that's what you're in)and(c) recharge areas. Sue explained the maps of zones were mapped for the town after a very extensive and expensive geological study that looked at where the wells draw their water from. It's based on very good »»> science. Osterville Pines is in a state defined nitrogen sensitive area. is there any question whether this — system has failed? Dr. Miller said a septic inspection has not been submitted: Mr.Curtis said he has stain marks and he is waiting to get it certified. Sue said we're not calling it a failed system at this point. John,resident of Osterville Pines asked Mr.Curtis for a clarification. John had understood Osterville Pines has a unit that failed and he was informed an engineer was hired and paid$5K and instructed to start this fall,and then we were told by letter that we couldn't get a building permit due to the Health Department. Dr. Miller said it hasn't come to the Board. Mr.Curtis said he thought because the flows were below 1650, the repair would be allowed but Mr. McKean explained it has to be the aggregate of the whole system. Dr. Miller said they would have to discuss their own management issues outside of this meeting. Tom McKean also explained to the Board that the regulations are difficult for him to make a decision because of the word "may" in the definition. Sue agreed and rightfully so,you are correct in sending them to the Board to make that determination. John said ok so the next step is to come before the board. Yes. Carl Davis of Centerville stated concern at the cost of doing the whole complex all at once. William Raves of Centerville stated he opposes Article 13 and Rule 1650. Asa person on fixed income, the assessments will be higher than his yearly income and wondered where are people going to live who can't afford it. Dan Ojala,P.E.—Update regarding upgradeat Center Village Condominiums,Centerville Tom McKean said there was an emergency failure,and Jim Curtis said Dan did not come tonight because he was notable to acquire all his facts yet. Tom Rugo is the liason for Board of Health for Town Council. An agenda for each meeting will be sent to him. FROM BOARD OF HEALTH MEETING MINUTES 11/15/2005 Excerpt PAGE 9 X. Correspondence: A. Multiple letters from Osterville Pines and Center Village condominium owners regarding replacement of septic systems. Dr. Miller commented that the Board stated their position at the last Board meeting. He understands the concerns of the individuals in terms of expenses. Dr. Miller clarified that the regulation says the Board "may", not "must" require shared innovative systems, we have the ability to look at each situation CAcache\Temporary Internet Files\OLK176\Ost Pines Condo BOH Minutes Summary 2005 and 2006.doc Page 3 of 5 FROM BOARD OF HEALTH MEETING MINUTES 11/15/2005 Excerpt PAGE 9 cont. individually, we have never required a place to replace all of the systems, we've suggested that they look at the other systems because if one has failed, the others may be very close to failing and, in deed, there would probably some economies of scale to replace them all at once versus over a 5-year period. Finally, in terms of cost, he can appreciate the cost but many of these complexes are in areas of concern and have an extremely high density of bedrooms on a very small area so we need to do what we can to protect the public health. Dr. Miller understands the Board will probably be hearing from the two that are in question, as a formal application process. Dan Ojala spoke to the Board of costs regarding the hooking up a I/A system, a large cost of the upgrade can be the logistics of working around the existing pipes in the ground, the utilities, etc, than the cost of the system can spiral up versus a new project where the I/A system is planned for in the initial project. FROM BOARD OF HEALTH MEETING MINUTES 12/13/2005 Excerpt PAGE 5 E. Jim Curtis, Manager, representing Center Village Condo Trust— 6 Captain Cook Lane, Building 1, Units 6, 8, 10, 12, 14, and 16, Centerville, requesting extension of the time to install required I/A nitrogen reduction component. Dr. Miller said this will be continued because Mr. McKean will have a meeting on December 21, 2005, with Brian Dudley, MA DEP, and Mark Ells, DPW, to discuss future sewering and how to handle escrow accounts and what to suggest for temporary assistance. FROM BOARD OF HEALTH MEETING MINUTES 1/17/2006 Excerpt PAGES 4-5 Continued Items from Previous Meeting(s): A. Jim Curtis, Manager, representing Center Village Condo Trust— 6 Captain Cook Lane, Building 1, Units 6, 8, 10, 12, 14, and 16, C:\cache\Temporary Internet Files\OLK I 76\Ost Pines Condo BOH Minutes Summary 2005 and 2006.doc Page 4 of 5 1 FROM BOARD OF HEALTH MEETING MINUTES 1/17/2006 Excerpt PAGES 4-5 cont. Centerville, requesting extension of the time to install required I/A nitrogen reduction component. Dr. Miller said in consideration of the first discussion of the agenda, the Board will probably hold off on Center Village Condominium Trust until something is discussed and developed with the town engineers, the town attorney and viewing of the time table for sewer and then the implementation of the agreements. Mr. Curtis mentioned an additional cost to condominiums for a sewer project would be the additional plumbing required for each unit. On one of his projects, the additional plumbing cost $150,000 spread over 48 units (roughly $3,000 per unit) and the repaving, landscaping, etc., added quite a bit. Dr. Miller said this is helpful to know in terms of establishing the escrow amounts. Upon a motion duly made by Dr. Canniff, seconded by Mr. Kaufman, the Board voted to give conditional approval for Center Village Condominium Trust's septic system "as is" until the Board has the Administrative Consent Order (ACO) plan in place, and then come back before the Board. Estimated time is three to four months. (Unanimous vote in favor.) C:\cache\Temporary Internet Files\OLKI76\Ost Pines Condo BOH Minutes Summary 2005 and 2006.doc Page 5 of 5 THE COMMONWEALTH OF MASSACHUSETTS a TOWN OF BARNSTABLE >� Board of Health Fee: $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD., MARSTONS MILLS MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. Wayne Miller, M.D.,Chairman Board This permit is valid until December 31, 2009 D.M.D. of Paul J. Canniff, Junichi Sawayanagi Health POST CONSPICUOUSLY By am#�" Thomas A. McKean, RS, CHO, Health Agent COMMONWEALTH OF MASSACHUSETTSID TOWN OF BARNSTABLE SWINIMIIJG POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC V_ SPECIAL PURPOSE ❑ POOL VOLUME: GAL. MAX. BATHER LOAD NAME OF POOL V ` ADDRESS L OWNER ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory. athhouse and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. — 04.S wage disposal 05 Location,structural stability,finish Ld 06 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers _ 06�Suitable automatic equipment for disinfection of pool water. ��C2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. ts&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. V'08 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one anti-vortex drain provided _V08 Each system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly � located and plumbed. %V/08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose �or can be removed w/o tools until repairs are made. 088 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. v/09 Cross-connections.Potable water supplied through air gap. V ]0 Skimming Facilities.50%of recirculation drawn from surface of pool. r 12 Line with floats separates non-swimmer area from deeper water. V 12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. Walkways&Decks 4 ft.wide.Safe condition. —L14 Ladders,steps-one per 75 feet.Not less than 2 ladders. —_15 Diving equipment in safe condition. � 1 Pool supervision provided.CPO w/proper training.On staff or on contract,Documentation provided. {. 21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. Z22 alth Regs.Signs posted Warning signs for special purpose pools. V 23 Lifeguardo&ual.Swimmer ❑If lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhorn provided.Qual.Swimmer:CPR trained, BOH approved.Limit bather load to 19 ❑Red or orange bathing suit with proper lettering for lifeguard DY`Olow Qualified Swimmer attire V 24 Safety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. `�5 First aid equipment provided.First aid kit complete. v 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. //'26 Waste&backwash water disposal properly discharged.No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. V29 Chemical Standards. Frequency of Testing: \�C� POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 0 CyanuricAcid 30-50,max 100 Comb.chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-7.8 '!""30 Water testing equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips " 3-LA0T Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. 3 ecial purpose pool drained&cleaned every 14 days minimum 33 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. _ 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: co IJQ� SIGNED: SIG D: DATE: 0 P AT 0R oard o Health/Health Dept. Representative 05/11/2009 15:34 FAX 508 888 6446 ENVIROTECH LABORATORIES a 0004/0005 ENVI*ECHLABORATORIES,INC. , MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Oceanside Pools Location Osterville Pines Address 161 Queen Anne Rd. Barnstable,MA Harwich MA 02662 Sample Date 05/05/09 Collected By Oceanside Pools Sample Time NA Sample Type Swimming water Date Received 05/06/09 Lab Order Number PS-90195 Locat�onS,ource ,Date Collected: Time Co[lerted Commends QuiW1 Pool Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By Total Coliform /100 ml 2 0 9222 B 5/6/2009 MC .. -...,.,.,x....... .:... Standard Plate Count 11 ml 200 <1 9215 B 5/6/2009 MC ................................................._...... _................. Pseudomonas Aeruginosa MOD ml 1 0 9213 E 5/6/20D9 MC Comments: Yes-Water is suitable for swimming for paramete tested. • ..........._.... ....._ ._. ...._.-._.. Date.........._.�f. �` �...._......_ Ronald A Saari Laboratory Director 1 BRL=Below Reportable Limits Page 1 of 1 *See Attached THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE _ rl Board of Health Fee: $75.00 Permit To Operate A Swimming Pool P g In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health( 105 CMR 435.00)permit is hereby issued to OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD., MARSTONS MILLS MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. Wayne Miller, M.D.,Chairman Board This permit is valid until December 31, 2008 of Paul J. Canniff, D.M.D. Junichi Sawayanagi Health POST CONSPICUOUSLY ByC�n Thomas A. McKean,RS,CHO, Health Agent r • Ft r Town of Barnstable Board of Health 9�b ��� 200 Main Street QED MA'S a Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D.' Junichi Sawayanagi May 22, 2008 Jane Curtis Huntingest Group 40 Industry Road Marstons Mills, MA 02655 RE: Osterville Pines, Lifeguard Modification for the Swimming Pool Dear Ms. Curtis, We will allow you to employ "qualified swimmers," in lieu of the requirement to employ fully certified lifeguards, at your swimming pool located at the Osterville Pines Condominium Trust, located at 3040 Falmouth Road, Marstons Mills, MA. This includes persons in your pools and includes all other persons within the pool enclosure. The following conditions must be complied with: (1) The pool must be supervised by a "qualified swimmer" all times the pool is open. We wish to make it clear that this swimmer must be at the pool and cannot be observing from the desk unless another swimmer is provided and physically present at the pool. This swimmer must be certified in adult, child, and pediatric CPR by the American Red Cross, American Heart Association or equivalent, be familiar with lifesaving equipment and knowledgeable in first aid procedures. (2) All qualified swimmers shall wear orange colored hats or orange colored visors with the words "POOL STAFF" in 15 millimeter (5/8 inch) black colored lettering on the front of the hats. (3) The maximum capacity of the swimming pool is reduced to nineteen (19) persons. (4) You shall maintain a permanent record on a form prescribed by the Board of Health listing each swimmer supervising the pool when it is in use. The Q:\POOLS\QUALIF.SWIMMER LETTERS\Pool Modifi Ost Pines w SwimTest 2008.doc attached form must be posted at the pool site in a convenient location to be viewed by the Health Inspector any time inspections are conducted. (5) You shall submit a copy of the applicant's insurance policy naming the Town as coinsured in the amount of$1,000,000. (6) All other regulations contained in Chapter V, Minimum Standards for Swimming Pools, must be strictly complied with. (7) The qualified swimmers must hold a current American Heart Association, American Red Cross, or equivalent CPR certificates with training in adult, child, and pediatric CPR. (8) The swimming pool water must be tested for coli form bacteria at least monthly by a certified laboratory. Please be advised that if you exceed this capacity of 19 persons, your modification'will be invalid and you will be required to cease operation of the pool. This modification expires December 31, 2008. It is your responsibility to ensure that you request renewal of the variance from the lifeguard requirements each year prior to opening the pool. Sincerely yours, 'Thomas A. McKean, H �G Town of Barnstable Public Health Division Attachment Q:\POOLS\QUALIF.SWIMMER LETTERS\Pool Modift Ost Pines w SwimTest 2008.doc I certify that the below listed qualified pool supervisors pass the swimming test administered by me. I further certify that the pool supervisor is familiar with lifesaving equipment and knowledgeable in first aid procedures including resuscitation. The pool supervisor is/or was at pool site supervising the pool during the hours listed below: DATE TIME IN NAME OF QUALIFIED TIME MANAGER'S POOL SUPERVISOR OUT SIGNATURE QAPOOLS\QUALIF.SWIMMER LETTERS\Pool Modifi Ost Pines w SwimTest 2008.doc April 2008 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: Lifeguard Modification for Outdoor Swimming Pool c:OSTERVILLE.PINES CONDOMINIUM-.J Location: 3040 Falmouth Rd., Osterville The Condominium requests a variance for Lifeguard Modification for Qualified Swimmers instead of Lifeguards. The pool is supervised at all times the pool is open. The pool is closed and padlocked when a Qualified Swimmer is not in attendance. The Certified Pool Operator is Oceanside Pools. The CPR certificates will be sent as I receive them. People wait until the last minute. Please find attached Insurance Liability Certificate. Huntingest manages the property and is the legal mailing address. Si c rely your ,-) ane Curtis untingest Management PO Box 340 Marstons Mills, MA 02648 == r � i {Pi: ;'t .,'.'=.•fit ;iz_(( r r-f. ACORDT. CERTIFICA rL OF LIABILITY INSURAIWE DATE(MM/DD/YYYY) 4/7/2008 PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick MA 01760 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Norfolk & Dedham Insurance Osterville Pines Condominium Trust INSURERB: c/o The Huntingest Group 40 Industry Road INSURERC: Marstons Mills MA 02648 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. s DD POLICVEFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER LIMITS A GENERALLIABILITY R06444425A 1/1/2008 1/1/2009 EACH OCCURRENCE $1 000 000 DAMAGETORENTED }{ COM MERCIAL GENERAL LIABILITY PREMISES Eaoccureence $100 000 CLAIMSMADE 7X ]OCCUR MED EXP(Any oneperson) $ 5 000 PERSONAL&ADV INJURY $ 1 0 0 0 0 0 GENERALAGGREGATE $2 000 000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $Included X I POLICY PEA LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Eaaccident) $ ALL OWNEDAUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ HIREDAUTOS - BODILYINJURY $ NON d WNED AUTOS (Per aocidern) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTOONLY-EA-ACCIDENT $ ANYAUTO EAACC $ OTHERTHAN AUTOONLY: AGG $ A EXCESSIUMBRELLALIABWTY U001895 1/1/2008 l/1/2009 EACHOCCURRENCE $ 1 000 000 OCCUR CLAIMS MADE AGGREGATE $ 1 0 0 Q 0 0 0 DEDUCTIBLE $ X RETENTION $ 10 1000 $ WC STATU WORKERS COMPENSATION AND OTH- TO IM T- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ syyes describe under E.LDISEASE-POLICY LIMIT $ PEG�IAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS.ADDED BY ENDORSEMENT SPECIAL PROVISIONS Town of Barnstable is named as an additional insured for General Liability re: swimming pool CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER Town •of Barnstable WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE Z�-&67—Main'Street CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Hyannis MA 02601 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORRED REP RESENTATI At ACORD 25(2001/08) m ACORD CORPORATION 1988 .......... ROBYN PITERA completed the requirements for all LIFEGUARD TRAINING AND FIRST AID conducted li)- Ch,iP[- Barnstable Recreation Department I fold-', The American Red Cross rccuan1v9(/�0,7,42S,9a5,cj,c 011) as%-did for 3 )�r(.$)frM commj,1411.0(late. q/-710 (RT.Ocl.2,J11 1) 1 11"1'.�1-111116(late. ---------------------- ........... .... .... �J,i.,recognizes(hat C tft ROBYN 1PITERA_�JNJJ tile requirements for la, [WATERFRONT LIFEGUARDING 4� c()jiducted 11), Barnstable Recreation Department J 1kJtc Completed 09/07/200P I'lic American Red(5's,59 recivdze%thin ceril tale a,valid for n1a yvar(p)fruit,completion di'te. Col.6i3,M)8(I?C,.O,j.2(11)1) This recognizes that Robyn pit,* Instructor's tiignaturc -ca has Completed the recluiremelits for E PRIAED—Adult and CPR—Child and Infant !A Chapter /-I- conductedeill ily r - C"Pe Cod and Islands Chapter sigmwr, Date completed Th Americ 12117/2007 1'L'9 ;M vilid for ft,Red rt"Piy�This retifficale 653998(Rev.Oct.2()()1) Vel"(0 frM cOr"Pleffrin date, AKOMMONWEALTHOFMASSACHUSETTSO TOWN OF BARNSTABLE SWM IING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC Y SPECIAL PURPOSE ❑ POOL VOLUME: GAL. MAX. BATHER LOAD V-91) NAME OF POOL sy, ? e ADDRESS r� OWNER ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory. L/03.Bathhouse and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. i/04.Sewage disposal 05 Location, structural stability,finish 66 Water circulation&filtration systems.Filter effluent flow meter reading �0 gpm.#of turnovers C/06 Suitable automatic equipment for disinfection of pool water. 06 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. _8 Inlets&Outlets-Inlets located to produce uniform circulation. Over rim fill spout 6"above max. water level.Properly shielded&located. '*"08 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one anti-vortex drain provided _V 08 Each system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. 08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. Q�08 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. L1419 Cross-connections.Potable water supplied through air gap. 10 Skimming Facilities.50%of recirculation drawn from surface of pool. a Line with floats separates non-swimmer area from deeper water. ((�-�O' ,.-'/12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls. Step edges marke-kith contrasting color. ✓13 Walkways&Decks 4 ft. wide. Safe condition. ZI4 Ladders,steps-one per 75 feet.Not less than 2 ladders. Or 15 Diving equipment in safe condition. D '.7 Pool supervision provided.CPO w/proper training.On staff or on contract,Documentation provided. f1 t/21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. _3�/22 Health Regs. Signs posted Warning signs for special purpose pools. 23 Lifeguard ❑Qual. Swimmer A lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhom provided.Qual.Swimmer:CPR trained, B H approved.Limit bather load to 19 ❑Red or orange bathing suit with proper lettering for lifeguard ❑Yellow Qualified Swimmer attire 24 Safety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. V25 First aid equipment provided. First aid kit complete. _,;,,x25 Emergency Communication system at the pool and in working order.E ergency corpmunication device in unlocked area and available at all times to staff and the .public.Operating instructions and emergency numbers posted. LA, r I l tee. V4 ca&i �26 Waste&backwash water disposal properly discharged.No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. ;L 9 Chemical Standards. Frequency of Testing: `1�/ �lnu .( POOL SIDE READINGS IN PARTS PER MILLION-ppm �rT Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 CyanuricAcid 30-50,max 100 Comb. chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-7.8 -"30 Water testing equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips 31 &32 Water Clarity: Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. Ii 11�-32 Special purpose pool drained&cleaned every 14 days minimum !1�3 Thermostatic control provided for each SPR Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31. If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENT o f �I SIGNED: SIGNED: UVv DATE: / OP RATV and of Health/Health Dept. Representative COMMONWEALTH OF MASSACHUSETT' TOWN OF BARNSTABLE SWIMN41NG POOL INSPECTION REPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC XSPECIAL PURPOSE ❑ POOL VOLUME: GAL. MAX. BATHER LOAD Iq NAME OF POOL ,y, L y✓tiZ1 ADDRESS 36 LU ti /Z OWNER I ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory. 03.Bathhouse and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. 1-111*' 04.Sewage disposal 05 Location,structural stability,finish S�/So -70 ✓ 06 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers _ 06 Suitable automatic equipment for disinfection of pool water. Nil-06 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. _�'f68 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max. water level.Properly shielded&located. _✓08 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, - etc...At least one anti-vortex drain provided V/08 Each system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly xlocated and plumbed. 8 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. �CT Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. ✓09 Cross-connections.Potable water supplied through air gap. -t—A 0 Skimming Facilities.50%of recirculation drawn from surface of pool. 2 Line with floats separates non-swimmer area from deeper water. / ) _kz*'1'2 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls. Step edges marked with contrasting color. ✓13 Walkways&Decks 4 ft.wide. Safe condition. 14 Ladders,steps-one per 75 feet.Not less than 2 ladders. ,!?IA5 Diving equipment in safe condition. Pool supervision provided.CPO w/proper training.On staff or on contract,Documentation provided. --III Permit issued.Adequate maintenance and testing records. Records initialed by person making tests. ­-'22 Health Regs. Signs posted Warning signs for special purpose pools. —r�Lifeguard ❑Qual. Swimmer f lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhom provided.Qual.Swimmer:CPR trained, BOH approved.Limit bather loadto 19 ❑Red or orange bathing suit with proper lettering for lifeguard ❑Yellow Qualified Swimmer attire C//24 Safety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. 25 First aid equipment provided. First aid kit complete. Emergency Communication system at the pool and in working order.E ergency commkr ica io device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. �H I'" (G of /�26 Waste&backwash water disposal properly discharged.No direct connection to sewer system S paration tank provided for diatomaceous earth filter backwash water. t' 29 Chemical Standards. Frequency of Testing: r h h%N✓� POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 2,6 CyanuricAcid 30-50,max 100 Comb. chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-T8 ✓30 Water testing equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips &32 Water Clarity: Can see 6"black disk at bottom of pool.Water clarity maintained. Filtration operating continuously. )�_32 Special purpose pool drained&cleaned every 14 days minimum 33 Thermostatic control provided for each SPR Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31. If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: a SIGNED: SIGNED: DATE: J -7 ERATOR d of Health/Health Dept. Representative TOWN OF BARNSTABLE tt)eS LOCATION3090 Alw,o��► Rd. f31�g,D5-�rv;�le SEWAGE # VILLAGE bsfe vil)@ ASSESSOR'S MAP & LOTG (� O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15®ti a14I)OnS LEACHING FACILITY: (type) )fu .k l na (l o (size) 1000 NO.OF BEDROOMS 4 BUILDER OR OWNER CAS}*will-e 91' is (f/Adoml oin PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist with 00 feet of leaching facility Feet Furnished by• T��'���. f3l 'Tank I , a . 3 � Al 35'� a 3LI 3 ' ya 131 a s° -37r�al. 3 50V TOWN OF BARNSTABLE LOCATION Ir�a� R�I, d�dG ��,,C�S4etV;/IUAG# VILLAGE 0sleryill-c ASSESSOR'S MAP & LOTG99 r73 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 3000 QC1 16 n S LEACHING FACILITY: (type) 0A (size) f000 da PrJAS NO.OF BEDROOMS O Bu .DER OR OWNER 05[6 'do11t Pines Condoy`►nium VVA (dw nT6 PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1 c .5 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa ility) Feet Furnished by �"v IA pq+l 3b' 3 4se 3 7' [32 t3 1 371 d Litt � 3 7v�► Loft 3c� LOCATION `" SEWAGE PERMIT NO. 78 VILLAGE T 1 S AL E iADDRESS R S NA Aa B U I L D E R OR OWNER ©X C� ink �. ,.- DATE PERMIT ISSUED DATE COMPLIANCE ISSUED '77 -�' .. �� �� � �p� ��� W �� �� . :: <oti LOCATION SEWAGE PERMIT NO. -30 VILLAGE 4&Zak INS AX ER'S NAME i ADDRESS BUILDER OR OWNER 0ATE PERMIT I.SSIIED DA.T E COMPLIANCE ISSUED cc,� ��, �� �� �r� �. 0s4,fru?A,e ,0� TOWN OF BARNSTABL'E LOCAnON,2g_10 V0&aJj61,0,���Ct . �. SEWAGE# VILLAGE ASSES R'S MAP &LOT 1�KSP R3 AME&PHONE NO. pl/bg i SEPTIC TANK CAPACITY 1,90d aallm - / LEACHING FACILrTY: (type)'' (size) /0b6 sae lS• NO.OF BEDROOMS BUILDER OR OWNER,&1)V1 -C&TZ u�iUI.e10 PERMPTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ��Co e�.r ������df' � i �i���� �����' ,� 0 5,�,, u TOWN OF BARNSTARL4 LOCATION �� SEWAGE # VILLAGE ASSESS S MAP&LOT 9 All� S�NAME&PHONE N rV�(y �l� SEPTIC TANK CAPACITY cG LEACHING FACILITY: (type) Y/ 4 a (size)16C D G'Q�_ �Q NO.OF BEDROOMS BUILDER OR OWT,�4YAr&R- PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility C Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Fac41 ility If any wetlands exist within 3 t of leac 'ng facili Feet Furnished b /g�' 30 e uu O a TOWN OF BARNSTABLE LOCATION30 yQ— A% 3a uA Rd �`f,(,�S rv;fie SEWAGE # _ VILLAGE 054Tef'1/i/�� APSSESSOR'S MAP & LOT 0 c Q Q INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY GU/dr7 S LEACHING FACILITY: (type) �l�'C�ST hnocj l'02 04(size) fool) Cr0��Or1 NO.OF BEDROOMS , -I � BUILDER OR OWNER XT�Pfyr�lr 1'In�CS �U�nddM;,lit1rr1 11rU4- ( Owr0) PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fac�ity) Feet Furnished by i 'V Al 3 O -k e 131 a8' 3 33' .-;7 TOWIN OF BARNSTABLE LOCATTON300 FQIMIIJ* Ad, d ✓;%lr SEWAGE # VILLAGE �S+'21`iJe e ASSESSOR'S MAP & LOT09 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 g g l l o n S LEACHING FACILITY: (type) J'ekA\ir►a ,nii' (size) fOoU 401idn' NO.OF BEDROOMS 3 BUILDER OROWNER (XA2ef(II1-e P1()t.S CUnddminium 20JL(ClWnh--el PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility R5 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci 'ty) Feet Furnished by Task r o° Al 45' 0 3 3 a' 3 ��i TOWN OF BARNSTABLE LOCATION 3®9 0 �v►�dml7vt Rol, Q�a�4®►®�+���,SE WAGE # VILLAGE OS iery o l i r ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 9000 Qal)()n5 LEACHING.FACILITY: (type) — I tC��nG o� (size) Q4110 1 S NO.OF BEDROOMS i /� \\ BUILDER OR OWNER IJ Trryilte Roo Cona omini vim, 1fyS�(('LJY1Y�) PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f ility) Feet Furnished by 9 I� O� o Al 11' a '30 a 3 4 � 13 3 4' 3 14 y s� � TOWN OF B RNSTABLE r--- Gav�� 9� LOCATION ��/ j�. �Ga,,_SEWAGE # S VILLAGEQ ler'U>1/e ASSESSOR'S MAP & LOTeR,0, -6Z50 INSTALLER'S NAME & PHONE NO.�__ 114�6 4 SEPTIC TANK CAPACITY ISW ���� 7�/7 LEACHING FACILITY:(type) 2."/- C /J (size) ',Y ' NO. OF BEDROOMS PRIVATE WELL R PUBLIC WATER _ BUILDER R OWN �rJ q� :e DATE PERMIT ISSUED: � �'`S"-- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4; 36 q® 32 573 93 3- 4`6' 1 3 TOWN OF BA(RJNNSSTABLE L cm LOCATION S y® r57�Miju-W el&�� a-6- ; WAGE VILLAGE C/�5 �21 ASSESSOR'S MAP & LOT 03o INSTALLER'S NAME & PHONE NO. 6'1tr lJ » CCA+�S� J SEPTIC TANK CAPACITY Aboo a LEACHING FACILITY:(type) /Z>i7 (size) 7L)� NO. OF BEDROOMS PRIVATE WELL OR BLIC WATER BUILDER OR w�W DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ° foiv Rear • yS' O '30;�10 aLtoq Zt�o TOWN OF BARNSTABLE LOCATION /] SEWAGE # VILLAGE (J14r L- ASSESSO MAP & LOT O 1 "05b :WSPMM)?S NAME&PHONE NO. ,7J� hr 60 -g�z)& SEPTIC TANK CAPACITY /. uJ(D , i /GN✓�c%1- �� LEACHING FACILITY: (type) G ;e,, (size) Q&L NO.OF BEDROOMS t /L BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum-Adjusted Groundwater Table and Bottom of Leaching Facility Feet f Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ' Feet Edge of Wetland and Leaching Facility(If any wetlands exist ;. within�3,00 feet of leaching facility) Feet Furnished by �p �� : , 30' 3� ,, ��� ����� �+' �'e�'0TOWN OF BARN STABLE LOCATION C SEWAGE # VILLAGE ASSESSOR' MAP&,L/OT G 30" SNSP�M,f,&NAME&PHONE NO. - �� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �iL.�o C�� (size) NO.OF BEDROOMS BUILDER O OWNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a ��E� I�! d����' �'�'� F P �� ��� > /� .� �(o f S�' ��9 B7 0 i� �� THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE e� Board of Health Fee: a � $75.00 Permit To Operate A Swimming Pool f! In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to • OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD., MARSTONS MILLS MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. f' , r � Wayne Miller,M.D.,Chairman Board This permit is valid until December 31, 2006 of Sumner Kaufman, M.S.P.H. Paul J. Canniff, D.M.D. Health POST CONSPICUOUSLY Bye Thomas A. McKean, RS, CHO, Health Agent 1 *COMMONWEALTH OF MASSACHUSE TOWN OF BARNSTABLE SWIMNUNG POOL INSPECTION REPORT Co TYPE OF POOL: PUBL SE I- L SPEC! P OSE❑ POOL VOL MAX.BATHE4042 NAME OF POOL ( i -ADDRESS OWNER - -- .- — JADDRESS R703. tion 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. Bathhouse and sanitary facilities adequate lighting.ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. Z04. Sewage disposal 105 Location,structural stability,finish 06 Water circulation&filtration systems.Filter effluent flow meter readingvgpm.#ofturnovers 06 Suitable automatic equipment for disinfection of pool water. 6 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. 08 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. Z8 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one antivortex drain provided 08 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. V/08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. 8 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. V9 Cross-connections.Potable water supplied through air gap. �0 Skimming Facilities.50%of recirculation drawn from surface of pool. 2 Line with floats separates non-swimmer area from deeper water. p VI Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. Walkways&Decks 4 ft.wide.Safe condition. 14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 15 Diving equipment in safe condition. 111��• 7 Pool supervision provided. CPO w/proper,training.On staff or on contract,Documentation provided. 21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. 422 Health Regs.Signs posted Warning signs for special purpose pools. fw 23 Lifeguard❑ Qual.Swimmer If lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhorn provided. Qual.Swimmer:CPR trained, lalto BOH approved.Limit bather 19 �4 Safety Equipment.Ring buoys and rescue hook provided. Rescue tube and backboard w/straps at pools attended by lifeguard. f 5 .First aid equipment provided. First aid kit complete. 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. 26 Waste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION- m Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 C anuricAcid 30-50,max 100 Comb.chlorine 0.0-0.2 Water,temp. 78-84,s a<104 H 7.2-7.8 V31 Water testing equipment.DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips &32 Water Clarity:Can see 6"black disk at bottom of pool.Water clan maintained.Filtration operating P t1' p g continuously. w" Special purpose pool drained&cleaned every 14 days minimum 6 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.Ifthe pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: ILL( V SIGNED: SIGNED: E: PE T Board of Heatth/He ep. ese tative 06/06/2006 14: 37 5084329244 OCEANSIDE_POOLS � PAGE 04/04 00/00/2006 TUE 15:03 PA$ 501) 5440 ENVIROTECH DABS ZYMOTECX LABORATORIES,INC. MA CERT.NO.;M-MA 063 8 Ian Seboalfin Drive Unit 12 1 �� Smrdtvich.MA 02463 (508)88&6160 1-800339.6660 FAX(508)M&644d Client Name Ocanslde 11,001s Locatfotr ''7 Addrew 101 Comm Anne Rd. gets,MA+ Netwbli MI► o28a2 S&Vle Date owi= Collected By Crantsier•Pools Sample 1Ylne Sample Type Pool Date Received 06101/05 Lab Order Number 13W-2=610M Well Specs NA LAeat nit Somme .Date 77me CoM died S CettaRra •A Pool _ IMM9 . HA , Analysis Regaeered UnILt ]RemnmiendedLimitsiAnalyslyResa/Y]__Afe&WAale Analyzed AagrVz&By _ Tow t:oobtm(peo0 /100 ml 2 0 =2 s erlr,= MC Po"hindstd P1aev Count n ml 200 <1 kid B em a w MC Comments: .. _ _ llae-„ftew is sunfible ADrawhurNe,*w w meters Embd._-n Date Rope !.Saarl' •.•_ Laboratory Dbrrlor RRG—Melbw RqwWe Ito Page 1 of 1 •SbeAmamfited ` COMNIONWEAI TH OF MASSAC HUS TOWN OF BARNSTABLE SWD4. IING POOL INSPECTION REPORT TYPE OF POOL: l'UBLI SE I- L SP CI P OSE 11 POOL VOL MAX B HE NAME OF POOL ADDRESS OWNER ADDRESS Regu Cron 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. 7_03. Bathhouse and sanitary facilities adequate lighting.ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ff.above ground. 04. Sewage disposal i_05 Location,structural stability,finish 06 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers 06 Suitable automatic equipment for disinfection of pool water. 6. CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. 08 Inlets&Outlets-Inlets located to produce uniform circulation.Over run fill spout 6"above max.water level.Properly shielded&located. 4081. Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment offingers,toes, etc At least one antivortex drain provided /08 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets / and plumbed provided for each pump,properly located V 08 Suction outlet covers in place,unbroken and secure and cannon be removed except w/use of tools.Close pool immediately if outlet covers missing,broken loose or can be removed w/o tools until repairs are made. 8 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently y marked. 9 Cross-connections.Potable water supplied through air gap. 20 Skimming Facilities.50%of recirculation drawn from surface of pool. 12 Line with floats separates non-swimmer area from deeper water. Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. V11, alkways&Decks 4&wide.Safe condition. 14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 15 Diving equipment in safe condition. 7 Pool supervision provided. CPO w/proper training.On staff or on contract,Documentation provided. /21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. X2 Health Regss.Signs posted Warning signs for special purpose pools. 23 Lifeguard❑ Qual:Swimmer, If lifeguard:proper credentials,proper suits and garments BOH approved.Lmut bather.lbad to 19 Worn Whistle&bullhorn provided. Qual:Swimmer:CPR framed Safety Equipment.Ring buoys and rescue hook provided. Rescue tube and backboard w/straps at pools attended by lifeguard. Bu �5 .First aid equipment provided. First aid kit complete. 5 Emergency Communication system at the pool and in working order.Emergency communication devic e in unlocked area and available at all times to staff and the .public.Operating instructions and emergency numbers,posted. 26 Waste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-pm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 C anuric Acid 30-50,max 100 Wat Comb.chlorine 0.0-0.2 tern . 78-84,s a<104 H 7.2-7.8 _3P Water testing equipment.DPD kit provided for chlorine&bromine.Unbreakable the for special purpose pools.No test strips 31&32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. Special purpose pool drained&cleaned every 14 days minimum Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. T4 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.If the pool is closed by a Health Inspector or other agent ofthe B.O.H., the pool shall remain closed until the Health Inspector re-opens pool In writing. COMMENTS: SI SIGNED: SIGNED: PE T E: Board of Health/He a five THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE >� Board of Health Fee: • Permit To Operate A Swimming Pool $75.00 In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD., MARSTONS MILLS MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. This permit is valid until December 31, 2005 Wayne Miller, M.D.,Chairman Board of Susan Rask, R.S. Sumner Kaufman, M.S.P.H. Health POST CONSPICUOUSLY By cC�� Thomas A. McKean, RS, CHO,Health Agent TOOMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE SW84 IING POOL INSPECTION REPO TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC SPECIAL PURPOSE ❑ POOL VOLUME,GAL. AX. BATHER LOAD NAME OF POOL ADDRESS OWNER ADDRESS Refulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory.. t 03.Bathhouse and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. i 04- .Sewage disposal 05 Location,structural stability, finish 6 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers 06 Suitable automatic equipment for disinfection of pool water. 6 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. 08 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. 108 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one anti-vortex drain provided V 0.. Each system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. 08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. 8 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. 9 Cross-connections.Potable water supplied through air gap. 10 Skimming Facilities.50%of recirculation drawn from surface of pool. 2 Line with floats separates non-swimmer area from deeper water. Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls. Step edges marked with contrasting color. 3 Walkways&Decks 4 ft.wide. Safe condition. 14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 15 Diving equipment in safe condition. / 7 Pool supervision provided.CPO w/proper training.On staff or on contract,Documentation provided. Permit issued.Adequate maintenance and testing records. Records initialed by person making tests. 22 earth Regs. Signs posted Warning signs for special purpose pools. 23 Lifeguard a1. Swimmer ❑If lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhorn provided.Qual.Swimmer:CPR trained, BOH approved.Limit bather load to 19 ❑Red or orange bathing suit with proper lettering for lifeguard ❑Yellow Qualified Swimmer attire V,24 Safety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. 5 First aid equipment provided. First aid kit complete. 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. 26 Waste&backwash water disposal properly discharged.No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 Cyanuric Acid 30-50,max 100 Comb. chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-7.8 30 Water testing equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips 31 &32 Water Clarity: Can see 6"black disk at bottom of pool.Water clarity maintained. Filtration operating continuously. 32 Special purpose pool drained&cleaned every 14 days minimum 33 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. __ 34 POOL MUST_BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31. If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS. Lr— 0 ; Ao 0W.A16 SIGNED: SIGNED: �2 OP MATb R Aciard of Health/H t Dep presentative / V j ' i c VYWJ SWIMMING ]POOL FIRST AID KIT CONTENTS 45 1"Bandaids 3"Solt Roller Bandages vi 3'x 3"Sterile Gauze Pads ',4"Roll of oalle NYp rgemc tape 5"x 5"Surgipads y� Triangular bandage 1 B"x W,Surgipad Pair Scissors NZ' 2"Soft Roller Bandages v1 Pair Tweezers V / Rescue Blanket �3' Antiseptic Wipes t, " Disposable Instant Ice Packs v1' Sterile Isotonic Buffered Eve Wash Pairs of one-size-fits-all latex gloves L.1"' Micro-shield or pocket mask with a one way valve i i DATE: FEE: HARNBTABr$ KAM 1639' � REC. Y Town of Barnstable CHED DAT Board of Health 2 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 u, FAX 508-790-6304 Ser Klan,M.S.P.H. W ie A f Wer,M.D. VARIANCE REQUEST FORM LOCATION t� tt JJ 1 Property Address: Y/s�y>/1�r�7 G� �� /1 Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes _ No PROPERTY OWNER'S NAME CONTACT PERSON ' Name: l N me /- -i 7 ) Address: Al©�P7d��4 G� Address: Phone: 'j�j =/7r �—/1 � Phone: l VARIANCE FROM REGULATION(usr Reg.) REASON FOR'VARIANCE(May attaph if more space needed) NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ eckltrt(to be completed by q,{j'ice staff-person receiving variance request application) _ Four(4)copies of the completed variance,request form r Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same bwner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan O.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\Application Forms\VARIREQ.Doc �R k I"Er°`` Town of Barnstable BARNST ABLE. = Board of Health 9W 6's9. ,m� 200 Main Street .eTfD�rp Hyannis,MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Wayne Miller,M.D. Sumner Kaufman M.S.P.H. April 24, 2004 Ms. Jane Curtis The Huntingest Group p.c. 40 Industry Road Marstons Mills, MA 02648-0340 RE:` Osferyille Prnes.Condorniniums/ Request forVariance Dear Ms. Curtis, Your request for a variance from the Board of Health provision which requires qualified swimmers to wear orange colored hats or orange colored visors with the words "POOL STAFF" in 15 millimeter (5/8 inch) black colored lettering on the front of the hats at Osterville Pines Condominiums outdoor swimming pool, 3040 Falmouth Road, Marstons Mills, was not granted. It is our understanding that once the padlock is unlocked at the pool gate, all residents (and visitors) of the condominium complex have easy access into the pool area, whether they are certified or not. There is no procedure in-place for limiting or restricting certain persons, particularly those persons who are not CPR certified "qualified swimmers" from entering the pool area at the present time. The Board requires the orange pool staff attire so that health inspection staff will be able to easily identify who is the certified "qualified swimmer" supervising the pool whenever it is open to the residents and visitors there. Variances may only be granted when, in the opinion of the Board of Health, the applicant has demonstrated that (a) enforcement of the particular provision would be manifestly unjust and (b) the same degree of protection could be achieved without strictly adherence to a particular provision or regulation. You were not present during the meeting of the Board of Health. Therefore, you did not demonstrate manifest injustice and you did not provide information relative to how you would provide the same degree of protection to the swimmers at this ool .' Therefore your request for a variance was not granted. Sin /ely , Wayn Miller M.D. VarianceDenial DATE: FEE: BARNSfABM HAM 039. ,0�' REC. BY Town of Barnstable,CHED DATE:.., Board of Health 200 Main Street,Hyannis MA 02601 0 =' taa Office: 508-862-4ti44 v,. > FAX 508-990-6304 Z Sur�morrr Kar "pan,M.S.P.H. W8T A.MAer,M.D. VARIANCE REQUEST FORM ca r ru rn LOCATION n Property Address: p K Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent hit-or her? Yes $4._ No PROPERTY OWNER'S NAME CONTACT PERSON Name: 4!!�� ��) I Y c� jam_ Name: Address: Address: Phone: Phone: VARIANCE FROM REGULAT11ON(List Reg.) REASON FOR VA LANCE(ma attach if more spa needed) 9 r r NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Cheek!!st(to be completed by office stqff-person receiving variance request application) 'f" _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outs ms ide dining variance renewals[same ownerlleasee only],and variances to repair failed sewage disposal system [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan O.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\Application Forms\VARIREQ.DOC THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE SWIIVIIVIING POOL INSPECTION REPORTn TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC SPECIAL PURPOSE ❑ POOL VOLUME: GAL. MAX. B THER LOAD NAME OF POOL ADDRESS OWNER ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory. �& 0-3 &athhouse and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft. above ground. 04.Sewage disposal 0/Location,structural stability, finish 06 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers 6 Suitable automatic equipment for disinfection of pool water. 02 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. ���6 .:nlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max. water level.Properly shielded&located. J Z8 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one anti-vortex drain provided J/"'08 Each system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. 08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools..Close pool immediately if outlet covers missing,broken,loose �or can be removed w/o tools until repairs are made. J�� �08 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. V 09 Cross-connections.Potable water supplied through air gap. r V 10 kimming Facilities.50%of recirculation drawn from surface of pool. 12 ine with floats separates non-swimmer area from deeper water. 12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls. Step edges marked with contrasting color. 13 Ikways&Decks 4 ft. wide. Safe condition. t�14 Ladders,steps-one per 75 feet.Not less than 2 ladders. �5 iving equipment in safe condition. 17 Pool supervision provided.CPO w/ ro er training.On staff or on contract Documentation� _ p p p p g provided. v2l�ermit issued.Adequate maintenance and testing records. Records initialed by person making tests. Health Regs. Signs posted Warning signs for special purpose pools. _ 23 Lifeguard kNual. Swimmer ❑If lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhom provided.Qual.Swimmer:CPR trained, ) fI approved.Limit bather load to 19 ❑Red or orange bathing suit with proper lettering for lifeguard ❑Yellow Qualified Swimmer attire 24/Safety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. 25 First aid equipment provided. First aid kit complete. 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. v6 Waste&backwash water disposal properly discharged.No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing: .POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 Cyanuric Acid 30-50,max 100 Comb. chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-7.8 ? Jr 30 ter testing equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips _Y 31 &32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained. Filtration operating continuously. "2 Special purpose pool drained&cleaned every 14 days minimum 93JThermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31. If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: SIGNED: � SIGN DATE: �r'"OPIWKPO'R Board of Health/Health Dept. Representative 0AM ITHE COMMONWEALTH OF MASSACHUSETTS !� TOWN OF BARNSTABLE � Fee: i Board of Health �ermit $75.00 To Operate A Swimming Pool In accordance with the provis ions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of blic Health(105 CMR 435.00)permit is hereby issued to JANE CURTIS/DBA OSTE RVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD., MARSTONS MILLS MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER M ST BEAT POOL SITE ALL TIMES POOL IS OPEN. Susan G.Rask,R.S.,Chairman Board This permit is valid until December 31, 2003 Ralph A.Murphy, M.D. of Sumner Kaufman,M.S.P.H. Health POST CONSPICUOUSLY ByQ� Thomas A.McKean,RS,CHO,Health Agent i THE COMMONWEALTH OF MASSACHUSETTS MAY 2 7 2003 TOWN OF BARNSTABLE SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC❑ SEMI- UBLI SPECIAL PURPOSE❑ POOL VOLUME: GAL. MAX.BATHER LOAD NAME OF POOL ADDRESS OWNER ADDRESS Regulation 105 CMR 435.00.0 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. J!!�03. Bathhouse and sanitary facilities adequate 149 geventilati�on:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. V 04. Sewage disposal _V-6'5�Location,structural stability,finish 06 ater circulation&filtration systems.Filter effluent flow meter reading3-0—mm.#of turnovers _06 Suitable automatic equipment for disinfection of pool water. jj/�06 02 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. 3� 08 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. V 08 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one antivortex drain provided V08 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located _Zand plumbed lil 08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. N708 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. 09 Cross-connections.Potable water supplied through air gap. / 10 Skimming Facilities.50%of recirculation drawn from surface of pool. " 12 Line with floats separates non-swimmer area from deeper water. /12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. �1/13 Walkways&Decks 4 ft.wide.Safe condition. JZ'14 Ladders,steps-one per 75 feet.Not less than 2 ladders. C 055 Diving equipment in safe condition. l/ 17- Pool supervision provided. CPO w/proper trai ing.On•staff or on contract,-Docurrc,-,tation Frovided. - —- �JV21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. f.�22 Health Regs.Signs posted Warning signs for special purpose pools. 23 Lifeguard ❑ Qual.Swimmer;( If lifeguard:proper credentials,proper suits and garments wom.Whistle&bullhorn provided. Qual.Swimmer:CPR trained, BOH approved.Limit bather load to 19 24 afety Equipment.Ring buoys and rescue hook provided. Rescue tube and backboard w/straps at pools attended by lifeguard. _V V2 irst aid equipment provided. First aid kit complete. 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. 26 Waste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing: 41 POOL SIDE READINGS IN PARTS PER MILLION-pmOf Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Q Free chlorine 1.0-3.0 �® C anuric Acid 30-50,max 100 Comb.chlorine 0.0-0.2 Water temp. 78-84,spa<104 DH 7.2-7.8 � � 3030 Water testing equipment.DPI)kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips '/ 31&32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. e32 Special purpose pool drained&cleaned every 14 days minimum 13 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: SIGNED: f SIGNED: --- -----_DATE:�a 3 _....... r OPERATOR Board of Health/Health Dept.Representative �----- p THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE � G SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC❑ SEMI-PUBLIC❑ SP IAL PURPOSE❑ POOL VOLUME: GAL. MAX.BATHER LOAD NAME OF POOL ADDRESS s �_ OWNER ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. t"03. Bathhouse and sanitary facilities adequate lighting.ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. 44. Sewage disposal 05 Location,structural stability,finish 06 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers A/06 Suitable automatic equipment for disinfection of pool water. VA CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. A//08 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. V'08 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use oftools.Open area does not provide entrapment of fingers,toes, / etc...At least one antivortex drain provided '✓ 08 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. L08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. �'/J Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. l�' 09 Cross-connections.Potable water supplied through air gap. VI Skimming Facilities.50%ofrecirculation drawn from surface ofpool. V�12 Line with floats separates non-swimmer area from deeper water. r1-11, 12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. Y`13 Walkways&Decks 4 ft.wide.Safe condition. V14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 15 Diving equipment in safe condition. y� 4'17 Pool supervision provided. CPO w/proper training.On staff or on contract,Documentation provided. 21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. /22 Health Regs.Signs posted Warning signs for special purpose pools. 23 Lifeguard ❑ Qual.Swimmer� If lifeguard:proper credentials,proper suits and garments wom.Whistle&bulthom provided. Qual.Swimmer:CPR trained, BOH approved.Limit bather foad to 19 V 24 Safety Equipment.Ring buoys and rescue hook provided. att nde by lifegu d� }1 /�25 First aid equipment provided. First aid kit complete. ) 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. p/l ►✓ 26 Waste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-ppm 11 Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 C anuric Acid 30-50,max 100 Comb.chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-7.8 ,✓30 Water testing equipment.DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips (l 31&32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. Special purpose pool drained&cleaned every 14 days minimum !t1'!!D Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: ,f` g r SIGNED: SIGNED: DATE: OP Board of a th/Health Dept.Repres ive THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC❑ SEMI-PUBLIC❑ SP CIAL PURPOSE❑ POOL VOLUME: �L4iA�. MAX.BATHER LOAD f NAME OF POOL J Cr ADDRESS 4frp/G� OWNER rdL,t 4"— I ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. V03. Bathhouse and sanitary facilities adequate lighting.ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. /04. Sewage disposal //05 Location,structural stability,finish �/ (46 Water circulation&filtration systems.Filter effluent flow meter reading z gpm.#of turnovers 1!�6 Suitable automatic equipment for disinfection of pool water. 6 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. "8 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. 1�08 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one antivortex drain provided ,LA8 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. Z'10 8 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use oftools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. 8 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. yA 09 Cross-connections.Potable water supplied through air gap. � ` � � tZ 10 Skimming Facilities.50%ofrecirculation drawn from surface ofpool. Y 12 Line with floats separates non-swimmer area from deeper water. V12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. // 13 Walkways&Decks 4 ft.wide.Safe condition. 14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 15 Diving equipment in safe condition. e 4/17 Pool supervision provided. CPO w/proper training.On staff or on contract,Documentation provided. io _�21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. t/22 Health Regs.Signs posted Warning signs for special purpose pools. V 23 Lifeguard ❑ Qual.Swimmer bl If lifeguard:proper credentials,proper suits and garments wom.Whistle&bullhorn provided. Qual.Swimmer:CPR trained, BOH approved.Limit bather load to 19 24 Safety Equipment.Ring buoys and rescue hook provided. Rescue tube and backboard w/straps at pools attended by lifeguard. 25 First aid equipment provided. First aid kit complete. v 25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. k"'26 Waste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 ° C anuric Acid 30-50,max 100 Comb.chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-7.8 _1'30 Water testing equipment.DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips Y 31&32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. 02 Special purpose pool drained&cleaned every 14 days minimum Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.Ifthe pool is closed by a Health Inspector or other agent ofthe B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: SIGNED: SIGNED• /_ jO OP TOR Board of Health/Health Dept.Representative i IP 1 FtME Town of Barnstable BARNSTABLE. � Board of Health 9��r . s`�� 200 Main Street ED Mp'l Hyannis, MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman M.S.P.H. June 13, 2003 Ms. Jane Curtis The Huntingest Group p.c. — 0-Dustry-Road — -- -- - - . Marstons Mills, MA 02648-0340 Dear Ms. Curtis, We will allow you to employ "qualified swimmers," in lieu of the requirement to employ fully certified lifeguards, at your outdoor swimming pool located at the Osterville Pines Condominiums, 3040 Falmouth Road Marstons Mills, MA. This includes persons in your pool and includes all other persons within the pool enclosure. The following conditions must be complied with: (1) The pool must be supervised by a "qualified swimmer" all times the pool is open. We wish to make it clear that this swimmer must be at the pool and cannot be observing from the desk unless another swimmer is provided and physically present at the pool. This swimmer must be certified in adult, child, and pediatric CPR by the American Red Cross, American Heart Association or equivalent, be familiar with lifesaving equipment and knowledgeable in first aid procedures. (Minimum swimmer qualification requirements are enclosed). (2) The maximum capacity of the swimming pool is reduced to nineteen (19) persons. (3) You shall maintain a permanent record on a form prescribed by the Board of Health listing each swimmer supervising the pool when it is in use. (Sample of prescribed form is enclosed). (4) You shall submit a copy of the applicant's insurance policy naming the Town as coinsured in the amount of $1,000,000.. PoolOstervillePines (5) All other regulations contained in 310 CMR 12.00, Minimum Standards for Swimming Pools, must be strictly complied with. (6) The qualified swimmer(s) must hold a current American Heart Association, American Red Cross, or equivalent CPR certificates with training in adult, child, and pediatric CPR. (7) The swimming pool water must be tested for coliform bacteria at least monthly by a certified laboratory. Please be advised that if you exceed this capacity of 19 persons, your modification will be invalid and you will be required to cease operation of the pool. This modification expires December 31, 2003. Sinc ely your , yn Miller M.D. Chai an BOA D OF HEALTH TOWN OF BARNSTABLE P0010stervillePines 1�1�hc� Abnr�me�z� —r66e, l 4�, C? 2 10o3 ,11; Yl c�s� po its wM.n RCc'� The Huhtingest Group P.C. Real Estate and Man*mentCEIVED 40 Industry U. 508.418-1111 Fax 428-1605 r Marstons Mills, MA 01648 - 0340 APR 2 4 2003 TOWN OF BARNSTABLE "�°' 'i DEPT. Date: 04 15/200T Subject Town of Barnstable Outside swimming pool Office of the Board of Health Lifeguard modifications 367 Main Street Hyannis, MA 02601 This letter is a request for a modification of the swimming requirements at Osterville Pines. This modification expired December 31, 2002. This pool is used by less than 19 persons at any one time. Our pool is maintained by Oceanside pool, Inc. They will be in charge of contacting the Board of Health regarding the opening of the pool and shall pay for all Town of Barnstable Board of Health permits pertaining to the pool. There will be a Certified Lifeguard or Qualified Swimmer in attendance when the pool is open. Please find enclosed a copy of insurance policy naming the Town as co-insured in the amount of$1,000,000.00 Sincerely, Jan rtis, Manager enc. jsd/MJC �PI34-17-2003 08:52AM FROM TO 15084281605 P.02 'ACORo CERTIFICATE OF LIABILITY INSURANCE D4/17 /2003 TM 04J17/2003 PRODUCER (508)540-2400 FAX (508)540-6671 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 406 Jones Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth, MA 02540 CIC, Robert Cabral INSURERS AFFORDING COVERAGE INSURED Ostervllle Pines Condominiums INSURER A: New London County PO Box 340 INSURERS: Hartford Insurance Marstons Mills, MA 026SS INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY BRC31983 01/01/ZO03 01/01/2004 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 300,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY .NOWOWNED AUTOS:., (Per accident) $ PROPERTY DAMAGE" _A_ (Per accident), $ . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT' $ ANYAUTO7 .. - •' - -- OTHER THAN - EA ACC S - AUTO ONLY: ' AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 771X635A01 07/19/2002 07/19/2003 1 TORY LIMITS ER B EMPLOYERS'LIABILITY - E.L.EACH ACCIDENT $ 100,000 E.L.DISEASE-EA EMPLOYEE $ 500,0O E.L.DISEASE-POLICY WAIT S 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Below named individuals are listed as additional insureds on the Condo Policy CERTIFICATE.H2OLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - - •` - ���f - w u - - - EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of-Barnstable R t BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 367 Main Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRE TATIVES. Hyannis, MA 02601 RIobert UTHORIZEDREPRESENTATIVE Cabral, CIC .,� ACORD 25-S(7/97) IDA7 CORPORATION 1988 This recognizes that C M Meehan A br&,*,c.7L y K y` ox has completed the requirements for ov 51 CPR for the Professional Rescuer Ejconducted by CAPE COD CHAPTER 1 Date completed 05/04/2003 The American Red Cross cecoptites this cefdcytt as vilid for I ymr(s)from completion date. a HUNTINGEST GROUP 40 Industry Road Unit 4 MARSTONS MILLS, MA 02648-0340 (508) 428-1112 Errylh.OTECHLABORIITORIES,INC. ` r,'A CERT.NO.:M-MA 063 SAY 2 g 2003 449 Rte. 130 S -,n rch, MA 02563 508(888-6460) 1-800 3394460 FAX(508)888-6446 POOL ANALYSIS REPORT Client: Oceanside Pools PO Box 610 So. Orleans, MA 02662LTOWN � Sample Location: Osterville Pines 7 2003 Barnstable MA Pool RNSTSample Type: Ae OEPT, �' Time Sampled: N/A Date Received: 5/15/03 Collected by: Oceanside Pools Lab ID#: 0305308 Results of Analysis: Parameters Method Recommended Limit Results Coliform/100 ml @ 35 C for 24 hrs. 9222 B 2 0 Pseudomonas Aeruginosa/100 ml @ 35 C for 48 hrs. 9217 B 1 Heterotrophic Plate Count/ml @ 35 C for 48 hrs. 9215 B 200 < 1 Background Bacteria/100 ml @ 35 C for 24 hrs. 9222 B 200 YES POOL WATER IS SUITABLE FOR SWIMMING FOR PARAMETERS TESTED. TNTC =too numerous to count < = less than > =greater than DateA � nald J. S H Laboratory D rector t 1i4 Health Complaints 05-Mar-03 Time: 9:40:00 AM Date: 3/4/03 Complaint Number: 3939 Referred To: DAVID STANTON Taken By: KARYN DACE Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Unit G 3 Number: 3040 Street: Falmouth Road Village: OSTERVILLE Assessors Map-Parcel: Complainant's Name: Address: Same Telephone Number: Complaint Description: Complainant spoke to us previously regarding insufficient heat in condo unit. the owner. Has spoken to Condo. Association/ Managers and they have told him that it is his problem. Currently his condo unit is unable to sustain 68 degrees, despite a setting of 72. Would like someone to speak with him regarding this problem, not sure how to best proceed. Actions Taken/Results: DS SPOKE WITH MR. HURRIE AND JIM FROM HUNTINGEST MANAGEMENT 428- 1112. JIM SAYS IT MIGHT BE THE OWNERS RESPONSIBILITY AS STATED IN THE STATE HOUSING CODE(410.200) . THEY ARE GOING TO REVIEW WITH THEIR ATTORNEYS AND ASSOCIATION MANAGEMENT TO SEE WHAT THE SITUATION IS, AND HOW TO RESOLVE. THEY ARE GOING TO LOOK INTO THEIR ASSOCIATION TERMS. THEY SPOKE WITH THE OTHER TWO OWNERS IN THAT UNIT, AND THEY SAY THE HEAT IS FINE. MR. HURRIE HAS HEAT, BUT NOT AS MUCH AS 1 Health Complaints 05-Mar-03 HE WOULD LIKE. DS CALLED MR. HURRIE TO EXPLAIN. IF THEY NEED FURTHER ASSISTANCE FROM US, THEY WILL CONTACT US. CALLED 03/05/2003 @ 9:45 am Investigation Date: Investigation Time: 2 i " TOWN OF BARNSTABLE �ie a raw e` OFFICE OF 99HH9TABL$ i BOARD OF HEALTH y NAG& p pp,e�163g. `�� 367 MAIN STREET 't0 MAY HYANNIS,MASS.02601 April 15, 2001 i Jane Curtis, Manager C/o The Huntingest Group P. O. Box 340 Marstons Mills, MA 02655 Dear Ms. Curtis:' RE: Your outdoor swimming pool - Former Bather Load Capacity 45; Modified Bather Load Capacity - 19. After some discussion, a motion was made by Sumner Kaufman, duly seconded by Susan Rask, and the Board voted unanimously to allow the applicant to set a maximum capacity of 19 persons at the applicant's swimming pool located at Osterville Pines Condominiums, Route 28, Osterville. This includes all other persons within the applicant's pool enclosure. The following conditions must be complied with: (1) The pool must be supervised by a swimmer all times the pool is open. We wish to make it clear that this swimmer must be at the pool and cannot be observing from the desk unless another swimmer is provided and physically present at the pool. This swimmer must be certified in adult, child, and pediatric CPR by the American Red Cross, American Heart Association or equivalent, be familiar with lifesaving equipment and knowledgeable in first aid procedures. (2) The applicant must keep a permanent record on a form prescribed by the Board of Health listing each swimmer supervising the pool when it is in use. (3) We must have a copy of the applicant's insurance policy naming the Town as coinsured in the amount of $1,000,000. (4) All other regulations contained in 310 CMR 12.00, Minimum Standards for Swimming Pools, must be strictly complied with. (5) The swimmer(s) must hold a current American Heart Association, American Red Cross, or equivalent CPR certificates. i (6) The swimming pool water must be tested for coliform bacteria at least monthly by a certified laboratory. The applicant is granted this modification of the applicant's previous pool capacity of 45 persons because the applicant has stated the applicant's pool is used by less than 19 persons at all times. Please be advised that if the applicant exceeds this capacity of 19 persons, the applicant's modification will be invalid and the applicant will be required to cease a'. s ab... I Th' ,I'f'..,,+'..., f1..,...Y,L..,. 2 Onn- operativi i of a is pool. i 1 its modification expires vc�.ci i Sincerely yours, Susan G. RasK, R.S. . Chairman Board of Health Town of Barnstable SGR/bcs The HUNTINKST Group P.C. real Estate 6 Managetment Under all-The Land op March 23, 2001 y��oyo tis ��OJ (F Town of Barnstable Office of the Board of Health 367 Main Street Hyannis, MA 02601 RE: Outside swimming pool-lifeguard modifications This letter is a request for a modification of the swimming requirements at.Ostervilie Pines. This modification expired December 31, 2000. This pool is used by less than 19 persons at any one time. Our pool is maintained by Oceanside Pool, Inc. They will be in charge of contacting the Board of Health regarding the opening of the pool and shall pay for all Town of Barnstable Board of Health permits pertaining to the pool. There will be a Certified Lifeguard or Qualified Swimmer in attendance when the pool is open. Please find enclosed a copy of insurance policy naming the Town as co-insured in the amount of$1,000,000.00 Sincerely r Jane is, Manager enc l 03-21-2001 03:25PM FROM TO 915084281605 P.04 ACORD LtK 1 .1F1(;A-I E OF LIABILITY INSURANCE DATE,MM/0D/YYp TM 05/03/1199� PRODUCER (568)540-2400 FAX (508)540-6671 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDo1lald Insurance Services 406 hones Road ' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE � HOLDER.THIS CERTIFICATE DOES NOT AMEND,E�TEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOK Falmouth, MA 02540 INSURERS AFFORDING COVERAGE I INSURED OsterVille Pines. Gondominitims" INSURER A: New London County I C/O The Huntingest' Group INSURERS: PO Box 340 INSURERC: Marstons Mills, MA 02655 INSURERD: . INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAN0111G ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIbNS OF SUCI I G POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY 8RC31993 01/61/2001 02/01/2002 EACH OCCURRENCE $ 1,0�0,1000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) 1s 60,i000 CLAIMS MADE X OCCUR MED EXP(Any one person) S 5,;000 A PERSONAL&ADV INJURY $ 1,000,i000 GENERAL AGGREGATE $ 2,0 0,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,0 0,1000 POLICY E� LOC i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT !$ I ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ I I ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ CE EACH OCCURRENCE O1/01/200Z/ 8CU10794 01/012001 EN $ EXCESS LIABILITY 1,000,1000 OCCUR CLAIMS MADE AGGREGATE $ I A DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- TORY LIMITS. ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT B E.L.DISEASE-EA EMPLOYEE $ I I E.L.DISEASE-POLICY LIMIT S OTHER I i DESCRIPTION OF OPERATIONS/LOCATIONSI,VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I i i CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANCELLE�BEFORE THE i � I EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEOOR TO MAIL Barnstable Town Hall -L(L_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAI[IED TO THE T. Attn: Health Department BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION ORLIA6.ILI 367 Main Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Robert Cabral ACORD 25S(7/97) �ACORD CORPORATIQN 19$8 TOTAL P.04 C H This recognizes that U1 �; MICHELLE MENDES 'L O � has completed the requirements for .00 Adult CPR Q� conducted by CAPE COD CHAPTER Date completed 10/23/2000 The American Red Cross recognizes this certificate as valid for 1 year(s)from completion date. aq, airman, Ame nn Red Cross structor's Signature �9 . Chapt GL g VP JHolder's signature o f.653999(Rev.Feb.1999 ) �f j) HUNTINGEST GROUP 40 Industry Road Unit 4 MARSTONS MILLS, MA 02648-0340 (508) 428-1112 04/13/2001 09:28 FAX 508 539 0481 MAY ADULT CENTER OOL _ This recognizes that MICHELLE MENDES OQj y ` bw w has completed the requirements for E.O .o Standard First Aid O d a �'S conducted by The May Institute Date completed 03/08/2001 The American Red Cross recognizes this certificate as valid for 3 year(s)from completion date. /4. i Ghauman,Ame RcdCrass PC:}itj •�.;�' ?�;�: structor's.Signature 'ib;.5 �a•ccl �,?`s.,,:�t,4;:��-.• ...t.:.� f f .. .:... ...� _ 01 cure - _ Hv der s _ ram„ I Signature � c-. ,:• �; �. � ••.:"Ceti;'.5.3. �'•`; 9:. r t- 1 . . C0 This recognizes th:1t This rcco);nizcs Ih:u �� ftristcn f�fo„iinicl:I �! L ® Kr. _slai -Mogil_nick.i - �� has completed the requirements I*()I' hats cotnplctc(l the requirements for LifcbuardTtainin andCumtntttlity -0 CPR For. The Professional E First Aid and S..ifety aw iu Rescuer �S conducted by Conducted by CAPE COD C1lAf TER � CAPE COD CHAPTER t . D:ue complctecl 06/08/2000 i I>atr contplctccl 6/8/2000 , . jt[_ t ty'u 1'hc Autrrlc.ut HnI C. >.rccol,ni/cs Ibis n't1ilicatc 'I'hr Amn-inm Hc(I I;rres recogilizcs this mrlilic:ttr J }ear(s)Iroin t•umpleliuu flaw. as v:did fur }'c:v(s)Irow cuIIIJ)Biun elate. at\� Chairman. Anm6 n It_e_d(-:roes pyVB`\� Chairnun. r\inc, n lied Cross '� PQ� .CVA Listntct is Si :uurc,� t"Ie Instryctor'sSinaturn \�\�9 +( A S Chapter ��I or Chapter p\D Jcai\ r, (;AIj. COD CHAPTER �a Cl''-PL C01.I CI'IAi i Lii Ite� Fpl Fp O Elolder's Sign• m•c ® if Ader's Si auu'r ..8 Ccrl.G539))(Rcv.Feb. 1999) "' W`O Cert.653999(Rev.Fcb: 1999) HUNTINGEST GROUP,40 Industry Road Unit 4 `.'• -' MARSTONS MILLS, MA 02648-0340 (508) 428-1112 a — SENT BY: HUNTINGEST GROUP; 508 428 1605; MAY-18-01 11.:22AM; PAGE 1 The HUNT1NsrST croup p.c. Real Estate rs, Mal gewent Under all,-The land Y 'Dece Dl rr2 >_______________�-_--------------: ---- -"-'"TO n0r ,FROM ---- L� ---------------------------------------------------__-.-....-- --------------------------- i-------------------- -- - r'_—f_ -- ----- _ --- 1` /' t_' '!_-- -� - � -- U -, 1�--------- -- ------ ---ate---r-��- -- 1�le.�----------- - ------- ------------------------------------- . ------------------------- ----- -_ ._..- - ------ ----- y - --; --------------------------------------.- .-..------------------------------------ ---------------------- ---------------------------------- ---- ----- • .____________ ------------- :..___----_--------_---_______� i P 1 -- _ _ 1 . - --------------------------- ---------- v ------1 c -----� ------------- —�' --- --------- ------ ------ --- -,. --------------------------------- 1 ' f 4 y PLEASE NOTE This Document is intended only for the addresses. If you Oave received it In error we would appreciate It if you would notify us at 508.428-1112 and th n destroy ; • y this document. THANK YOU FOR YOUR HELP_The HUNTlfGEST _______ _ ---- ? 40 Indu"Road,Marstom Mills,MA 01648-OSO 58.428-1111 Fax 41$-1605 k ' an-erican Red Cross Course Record � (SEE INSTRUCTIONS ON BACKOF THIS FORM.) Page of r LU Q ss uNIT REDCRO ro a :............. .....tllsrRucrI:.:..::...:L�ff. :. :::..::.::: .....- . . . : ..�( ... SPaDtIStiF1 ....:....__..........._...-......._ �.`::: TRAMANIO Sn N (rwrne of mlho ,ww mnnrdl oip9r ar 't ut� m ADDRESS �D.>£e�fTr�a� rt1�'il D2(�A¢ Ce �� STRrp T t�PHa MUM M 1 ) 4 77— 2 7 m 74 two lies �' `I Cf11f,STATE,21P UNIT OF AUTHOR ATiON �a _N 0—d COURSE NAMIE CD r ADDRESs gAL�is T KOZbo CD 1 3 . _ tc COURSE OpOE CD w Plasea check f "la W3 Orah4 i1 pefy Is chsf Ad,indk�e name oT wAl0 med Pmwmw. TOTAL 1NN)IVIDUALS ENROLLED 1N TtE COLMSE ! 000 p WTVOLUN►EER Q UNIT PAID STAFF TTiIFTU PIV1T1f SSA _- . . �._ coeflPouaNT InFamla OM g Mw►STRUCTOR CONNPONETIT NAME CODE NOURB MQMGMa AUNIV M. 11w neras x�� r. �.. ,Hfs<w ..,,.....N ,.y ,.. �•-,..r__ r. �..k s:..,.«_.oa.-. y. .,.<>.�._..... H . .. Ms_..� CPq �0 MM MUMaERI( raw '= 'j 'Z.. !j � urratr of knllDa . SPEA co ADDRESb D N - n�j•. d tdth lepN�) taDl «t�.i �• T a�i TOM d" co sSSEs br tia DATE oaJRSE STARTED�Z �pp�oouE COURSE ooMPLETED a�7 r OQ�UNiT VOIIINTEEA lJrIIT PMD STAFF Q lIi1RD PAR1Y � ETINC ORI9NOR�RTION Chsdk hoe i e dd sea hka NA�sr 1Me MlneNor a oo inasuaor hk oast p lIAMTE ASIAWPfaICIfIC SIJVMR MATE CdN"ENTS Wes �+ t�ti"W l -C V�QS 1 Uj> Q(\ GC. 4t� FLACK AMERICAN INDIAWNJIBiKANNTNE PE#W F HIBw►ISIC DID NOT REPOIW /Efmn of aMasr= nftwk % PLUM CHEM ONE: LUT OF HOURS COURN WA OULOP"Gt �w as.Ieatae .M.,pussla VOL PM T!"Rd ROLE All1MORMATION INVOLVED POR IrINAIOi�INCRIIOM>I�IOIIi OIIITf PApTr/ COla1iSE LOCATION iCl+aak taf>tk tl>a1 bAIlOeeabs Ev saNlYkp iR sidck Iraw+p eras eodelMa� a (Chb,* YOV t OSemOLK-12 000LLEMUMNERBTY 0MOIR ¢ (Tf"oro) ADULW 0 COMMIIIMTY O IIMOWPIACIE c7 F t�mROaRES(pros wwk 0 IANruft VA pickup awocaNes, p SaW aefi N"&m try oartllioatee to autlwtwd prwidar. 0 owftem)ausd on akw O OW RW 0 oEaae LijI gftiiy Mot iraiinp aeadon has beer,oorrluoMd ii d000rdanoe wi1N aM prooedapes d Un An»Area Red Cams.Nape A/rao-hatuoaom seep eipk Ills form I aefeaad aDOMa. Z = INSTRUCTOR,S SMATUFIE 0(3-INSTRUCTOPS SIGNATURE Aw rtN1f MTAIAINF 19 w an Now PRDORNM t11II1S 061VEIiEDe Q FtJll SEAVICEBErrrICE cOhrtAAcr O�oNMDRIv Q Al mM71iQED rIIOMIDETI D wilum 9RIWd4 w TWALFEE8t70LLKM REDC1tO3S OF HAM OF CCAMSTFW=R .� Mr.-,i A-1 w M*f,re r,MY a M"I u F.T ff IT i _ NO]i _• r _..:� .. Ilfi w.y•1• f•1(L•f>�:1Yi"Y' .�.'�..r; MUM �7 AM gal TWX �y = tf! This recognizes that •I�� H o; Kristen lvlogilnicki P4 �� �� w has completed the requirements for Chairman, .�me �RedCro.� / N Training y lnsr or s si 01 Lifeguard T�,. r�,.- � � g g and Community "-Lei :'°;r::»:.;^':a�fir. ::..•r First Aid and Safety conducted by eR chapter d�\a or CAPE COD CHAPTER FP�t Date completed 06/08/2000 The Arn i Red Cross recognizes this certificate Holder's Si azure as valid for 3 vear(s)from completion date. Cert.653999(Rev.Feb. 1999) - Cod Y}-----�.---�-_ s Kristen LVIo li�niek) � ® > g °un in h. s has completed the requirements for 49 ,� CPR for the Professional Rescuer 3 conducted by Sandwich Community School H gyME Date completed 01/23/200..1 rye ; The America Red Cross recognizes this certificate � as valid for Year(s)from completion date. HUNTINGEST~GROUP 40 Industry Road Unit 4 MARSTONS MILLS, MA 02648-0340 (508) 428-1112 ga04-00 009::21am From-MURRAY & MACDONALD 15085406671 T-078 P.02/05 F-256 ACORQ,, CERTIFIGA I t Vr LIAMILI 1 lr 11VQUF-kf 1M%.fc 1 05/03/1999 IODUCER (508)540-2400 (508)540-6671 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION urray.&.MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1.06 Vi nes Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. =almouth, MA 02540 INSURERS AFFORDING COVERAGE SURED Osterville Pines Condominiums INSURER A: New London County C/0 The Huntingest Group INSURERB: PO Box 340 INSURER C: Marstons Mills, MA 02655 INSURERD: INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. fH POLICY EFFECTIVE POUC EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY ATE /DD/VY GENERAL LIABILITY RC31983 01/01/2000 01/01/2001 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one lire) $ 50,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ S,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JET LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ Excl:ssLIABILm CU10794 01/01/2000 01/01/2001 EACH OCCURRENCE $ 1.000,000 OCCUR CLAIMS MADE AGGREGATE $ $A $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYE S E.L.DISEASE-POLICY LIMIT .$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Barnstable Town Hall Attn• Health Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 367 Main Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES, Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Robert Cabral ACORD 25-S(7/97) OACORD CORPORATION 1988 •L¢�A L 1 Name of Judith A.Abodeely A_HARegion Name of Community IRS panicipaled in an American Heart Association saver Course. Training Center Instructor's 08/05/99 08/05/2001 Name Barry A-Pina Rc:commarlded Renewal Data Insfrucioes '— I.D.No. Holder's Signature 01997,American Heart Association 7Gotti3 A y. _ _Cathleen J. McDontiell has parficipaled in an American Heart Arsocialion I Ietulsaver('nurse September 10,1998 September _20_00 Is;:ua Dade --- neconur ended nenowal Date Name of ARIA Region New England Affiliate Name of Coimnunity Training Cenler_mid-Cape Instructors _ h,slrnclor's Paul- Frazier Name ------Ito yn- --Eros ;cgglinator- -- Inslrnclnr's y I{/ I.D.No. I Inldel's sign alure�� C.)1997,Anrrrican Hearl Assobotion Ill 016a L-1-2e HUNTINGEST GROUP 40 Industry Road Unit 4 MARSTONS MILLS, MA 02648-0340 (508) 428-1112 ............ _................ i - Chic reco^nines h This recognizes that Kristen twogilntit�ckt,.e..-tts cki ® v Kr.ist(`n -Mogilnicki ® i �8 0, i P- Z has complete I the requirements for I e 1 has completed the requ for an � v Lifeguard'Trainin9 and otunity i a CPR For The Professional I First Aid and Safety j k' I pis �, Rescuer 1� v I conducted by conducted by E CAME COD CHAPTER CAPE COD CHAPTER Date completed 06/08/2000 ,,(, i)ate completed 6/8/2000 he American Rccl Crwis rc c ognizes(his(crlilicatc The Americ:.Ilt Red Cross rccol;ni,1.cs Ihts Certificate s .Is v:dul fur 1 yeal(s)Irum completion(kite. i :ts valid for ),Car(s)from completion date. t� t Chairman, Ame( w n Itcd Goss ' V9tW Chai mean, A(nc n Red Cross I �� ! .i PqP `«ar." •' type, v. as:s <g _ Instntct r'sSi ature� aC29 f Instr etor's Signityu� �pl' �ww�9 i C i, ;. Chapter Chapter a�.tlP\Door; 1 CAPE COD CHAPTER PIGQ� CAPE COD CHAPTER °"` :oFPIcQ ;F® ` nac.w�:tet_Zixuwraxreaz.--. .x.l .l ® - Holder's Sign• Holder's Si t' Cert.653999(Rev.Feb.1999) low, o Cert.653999(Rev.Feb.^1999) i Vil .�, � � •. �i/v HUNTINGEST GRO'-- UP 40 Industry Road Unit 4 MARSTONS MILLS, MA 02648-0340 (508) 428-1112 ti THE COMMONWEALTH OF MASSACHUSETTS va TOWN OF BARNSTABLE Fee: r Board of Health $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to JANE CURTIS/DBA OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD., OSTERVILLE, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. This permit is valid until December 31,2001 Susan G. Rask, R.S.,Chairman Board Ralph A.Murphy,M.D. of Sumner Kaufman, M.S.P.H. Health POST CONSPICUOUSLY ByCa� Thomas A.McKean, RS,CHO, Health Agent I J TOWN OF BARNSTABLE � CFTHETO OFFICE OF so ^ i HAMSTM : BOARD OF HEALTH y MAO& pj 1639. 367 MAIN STREET 'e0 MAY \ HYANNIS,MASS.02601 June 12, 2000 Jane Curtis Osterville Pines Condo 3040 Falmouth Road Osterville, MA 02655 Dear Ms. Curtis: RE: Your outdoor swimming pool - Former Bather Load Capacity 45; Modified Bather Load Capacity - 19. We will allow you to set a maximum capacity of 19 persons at your swimming pool located at the Osterville Pines Condominium, 3040 Falmouth Road, Osterville, MA. This includes persons in your pool and includes all other persons within the your pool enclosure. The following conditions must be complied with: (1) The pool must be supervised by a swimmer all times the pool is open. We wish to make it clear that this swimmer must be at the pool and cannot be observing from the desk unless another swimmer is provided and physically present at the pool. This swimmer must be certified in adult, child, and pediatric CPR by the American Red Cross, American j Heart Association or equivalent, be familiar with lifesaving equipment and knowledgeable in first aid procedures. (Minimum swimmer qualifcation requirements are enclosed). (2) You must keep a permanent record on a form prescribed by the Board of Health listing each swimmer supervising the pool when it is in use. (Sample of prescribed form is enclosed). (3) We must have a copy of the applicant's insurance policy naming the Town as coinsured in the amount of$1,000,000. (4) All other regulations contained in 310 CMR 12.00, Minimum Standards for Swimming Pools, must be strictly complied with. (5) The whirlpool water must be tested for coliform bacteria at least monthly and pseudomonas bacteria at least once every two months by a certified laboratory. (6) The swimmer(s) must hold a current American Heart Association, American Red Cross, or equivalent CPR certificate with training in adult, child, and pediactric CPR. (7) The swimming pool water must be tested for coliform bacteria at least monthly by a certified laboratory. You are granted this modification of your present pool capacity of 45 persons because you have stated your pool is used by less than 19 persons at all times. Please be advised that if you exceed this capacity of 19 persons, your modification will be invalid and you will be required to cease operation of the pool. This modification expires December 31, 2000. Sincerely.yours, Susan G. Ras , R.S. Chairperson BOARD OF HEALTH TOWN OF BARNSTABLE SGR/bcs Enclosure i 1 The HUNTINKST Group p.c. Real Estate f Management -- Under all-The Land �x �y k '1114 ro 8 May 04, 2000 '` 'j,4,91 e Town of Barnstable Office of the Board of Health 367 Main Street Hyannis, MA 02601 RE: Outside swimming pool-lifeguard modifications This letter is a request for a modification of the swimming requirements at Osterville Pines. > This modification expired December 31, 1999. This pool is used by less than 19 persons at any one time. Our pool is maintained by Oceanside Pool, Inc. They will be in charge of contacting the Board of Health regarding the opening of the pool and shall pay for all Town of Barnstable Board of Health permits pertaining to the pool. There will be a Certified Lifeguard or Qualified Swimmer in attendance when the pool is open. Please find enclosed a copy of insurance policy naming the Town as co-insured in the amount of$1,000,000.00 Sincerely, J ne urtis, Manager enc do 40 Industry Road,Marston Mills,MA 01648 508.418-1111 FAX 418-1605 } IAmerican Heart PROVIDER Fighting Heed' and Stroke DONNA HOW A M has successfully comPleted the national cognitive and skills evaluations in accordance with the curriculum of the American Heart Association for the BLS for Healthcare Providers Program. 6110/98 /l0/00 Recommended Renewal Dale Issue Dale HUNTINGEST GROUP 40 Industry Road unit 4 MARSTON�OMI)28 i 02648-0340 �(7 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE Board of Health Fee: $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to JANE CURTIS/ DBA OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD. , OSTERVILLE, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. This permit is valid until December 31, 20 00 Susan G. Rask, R.S.,Chairman Board Ralph A. Murphy, M.D. of Sumner Kaufman, M.S.P.H. Health POST CONSPICUOUSLY By �� Thomas A. McKean, RS, CHO, Health Agent THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC❑ SEMI-PUBLI SPECIAL PURPOSE❑ POOL VOLUME: _ /c GAL. MAX.BATHER LOAD NAME OF POOL i / ADDRESS OWNER ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. 03. Bathhouse and sanitary facilities adequate lighting.ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. 0 Sewage disposal 05 Location,structural stability,finish 066 Water circulation&filtration systems.Filter effluent flow meter reading �->gpm.#of turnovers 146 Suitable automatic equipment for disinfection of pool water. 4406 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. ✓08 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. _108 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one antivortex drain provided L-08 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. 08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. l08 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. 09 Cross-connections.Potable water supplied through air gap. V10 Skimming Facilities.50%of recirculation drawn from surface of pool. t' 1-�2 Line with floats separates non-swimmer area from deeper water. i/12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. '✓I1/3 Walkways&Decks 4 ft.wide.Safe condition. _✓14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 15 Diving equipment in safe condition. / G/p P ✓7 Pool supervision provided. CPO w/proper training.On staff or on contract,Documentation provided. OU i/l l Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. _-IT2 Health Regs.Signs posted Warning signs for special purpose pools. 23 Lifeguard ❑ Qual.Swimmer If lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhorn provided. Qual.Swimmer:CPR trained, BOH approved.Limit bather loa to 19 Lo&' Safety Equipment.Ring buoys and rescue hook provided. Rescue tube and backboard w/straps at pools attended by lifeguard. N/25 First aid equipment provided. First aid kit complete. Emergency Communication system at the pool and in working order.Emergency/communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. 00 6— t z— `/26 Waste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. P n ✓29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 1 0 C anuric Acid 30-50,max 100 Comb.chlorine 0.0-0.2 Water tern . 78-84,spa<104 pH 7.2-7.8 _30 Water testing equipment.DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips _31&32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. _32 Special purpose pool drained&cleaned every 14 days minimum 33 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.Ifthe pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing.COMMENTS: � - Sal./ SIGNED: SIGNED: ( ' v DATE: (� OPERATOR Board of Health/Healtri Dept.Representative M ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Me.130 Sandwich, MA 02963 908(888-6460) 1-800-339-6460 FAX(908)888-6446 POOL ANALYSIS REPORT Client: Oceanside Pools PO Box 610 So. Orleans, MA 02662 Sample Location: Osterville Pines Barnstable MA Sample Type: Pool Time Sampled: N/A Date Received. 619/00 Collected by: Client Lab ID#: 0006222Z Results of Analysis: Parameters Method Recommended Limit Results Coliformf100 ml @ 35 C for 24 his. 9222 B 2 0 Pseudomonas/100 ml @ 35 C for 48 his. 9217 B 1 Heterotrophic Plate Count/ml @ 35 C for 48 his. 9215 B 200 < 1 Background Bacteria1100 m1 @ 35 C for 24 his. 9222 B 200 YES POOL WATER IS SUITABLE FOR SIMMM/NG FOR PARAMETERS TESTED. TNTC=too numerous to count < = less than > = greater than ate 1 4nald J. Sa ri Laboratory Dmctor THE COMMONWEALTH OF MASSACHUSETTS _ TOWN OF BARNSTABLE r� Board of Health Fee: $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to JANE CURTIS I DBA OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD. , OSTERVILLE, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. This permit is valid until December 31, 19 99 . Susan G. Rask, R.S.,Chairman Board Ralph A. Murphy, M.D. of Sumner Kaufman, M.S.P.H. Health POST CONSPICUOUSLY By Thomas A. McKean, RS, CHO, Health Agent roll t THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUBLIC❑ SEMI-PUBLIC SPECIAL PURPOSED POOL VOLUME: fi GAL. MAX.BATHER LOAD NAME OF POOL ADDRESS p c+i t V OWNER ira o osy ADDRESS Regulation 105 CMR 435.000 effecti date:2/20/98 a items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. 03. Bathhouse and sanitary facilities adequate lighting.ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. V/b4. Sewage disposal \z , Location,structural stability,finish ✓06 Water circulation&filtration systems.Filter effluent flow meter reading gpm.#of turnovers 06 Suitable automatic equipment for disinfection of pool water. /1 06 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. u48- Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. t/68 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one antivortex drain provided ('1,08 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. 11108 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. 08 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. !,0 09 Cross-connections.Potable water supplied through air gap. Skimming Facilities.50%of recirculation drawn from surface of pool. 12 Line with floats separates non-swimmer area from deeper water. s 12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. ,I cw 0 Walkways&Decks 4 ft.wide.Safe condition. j9g _14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 5 Diving equipment in safe condition. 77✓1//7 Pool supervision provided. CPO w/proper training.On staff or on contract,Documentation provided. `!21 Permit issued.Adequate maintenance and testing records.Records initialed by person making tests. o Health Regs.Signs posted Warning signs for special purpose pools. 1 23 Lifeguazd`i`<Qual.Swimmer 0 If lifeguard:proper credentia s,proper uits d garments wom.Whistle&bullhom provided. Qual.Swimmer:CPR trained, BOH appfoved.Limit bather load to 19 ;f, , }„t�/�t% 444 Safety Equipment.Ring buoys and rescue hook provided Rescue tube and backboard w/straps at pools attended by lifeguard.` 25 First aid equipment provided. First aid kit complete. 1 5 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the ttTT public.Operating instructions and emergency numbers posted. fWaste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. / / 29 Chemical Standards. Frequency of Testing: T.gyp X f Q(61y CIO'r L o otlof k7/ — /^ sko-� POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.0-3.0 C anuric Acid 30-50,max 100 Comb.chlorine 0.0-0.2 Water �temp. 78-84,s a<104 H 7.2-7.8 "7. 3 V3�0 Water testing equipment.DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips ����`ff���31&32 Water Clarity:Can see 6"black disk at bottom ofpool.Water clarity maintained.Filtration operating continuously. /"/132 Special purpose pool drained&cleaned every 14 days minimum JJ�� 3 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.If the pool is closed by a Health Inspector or other agent ofthe B.O.H., the pool shall remain closed until the Health Inspector/re-opens pool in writing. /� �� �+ ,, COMMENTS: C�` S d �� R- L% L7� 1'I 1 e S kh P'_j A � t- SIGNE SIGNED: �- �� j DATE: } Zp LX' OPE OR Board of Health/Health ept. epresentative THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE Board of Health Fee. $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to JANE CURTIS/DBA OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD. OSTERVILLE, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. This permit is valid until December 31, 19 98 Susan G.Rask, R.S.,Chairman Board Ralph A.Murphy,M.D. of — Sumner Kaufman,M.S.P.H. Health POST CONSPICUOUSLY By Thomas A.McKean,RS,CHO, Health Agent 01 THE COMMONWEALTH OF MASSACHUSETTS t ' TOWN OF BARNSTABLE BOARD OF HEALTH SWIMMING POOL INSPE TIO REPORT a Name Date Address o. Operator Max. Bathing Load Permit Posted Regulations of the Massachusetts Sanitary Code: Title 2 "Minimum Standards for Swimming Pools". Items: 1.DEFINITIONS,2.PLAN APPROVAL,8.SEWAGE, 11.BATHER LOAD, 12.STRUCTURE, 14.CONSTRUCTION, 15. INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and '1/1.LADDERS.These items approved on the construction plan are of permanent nature and need not be checked at each inspection. 3. HEALTH: No employee sick,bathers take showers,clean bathing suits,sick or infected bathers not allowed,spitting prohibited, no glass or dangerous objects. Health and shower signs posted. V4. LIFEGUARDS: Trained lifeguards in attendance according to Health Department ruling. V5. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2,000 sq. ft. water surface. 6. FIRST AID: Red Cross first aid kit(24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available within 100 ft. (not a pay station). V7. BATHHOUSE: Separate dressing and sanitary facilities for each sex,adjacent to pool,adequate,well lighted,drained,ventilated, impervious construction and light color.One shower and one toilet per 40 Bathers(min.2 ea.),hot and cold water,soap provided, one wash bowl per 60 bathers.No common cups,towels,combs or brushes.Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). POOL ADEQUATELY ENCLOSED. Approved drinking water facilities. . CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT-RECORDS: Permit Posted.Written records available of daily operation of the pool,including attendance,water tests, chemicals used, hours of operation, backwashing and other information required. 13. RECIRCULATION-FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours. Max.filtration rate 2-3 gal.per min.per sq.ft.filter.High rate filters—max. 15 gal/min/sq.ft.Disinfection equipment finely adjusted. Ltd' 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end)25 ft. intervals (deep end). ^$22. DIVING BOARDS: Rigidly constructed,properly anchored,braced for heaviest load,sound,no splinters or cracks,non-slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. U23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. d24. BACTERIOLOGICAL QUALITY: Health Department shall cause water samples to be analyzed as considered necessary. ❑ 25. CHEMICAL STANDARDS: Treated with chlorine or other effective method.Tests taken 4 times daily as required by Health Department. Free chlorine 1.0-3.0; ph 7.2-7.8 Total alkalinity 50- 150 ppm. S/26. TESTING EQUIPMENT: DPD test kit provided, in good repair and complete with fresh reagents. V27. WATER CLARITY: A 6-inch black disc at bottom of deepest part of pool visible at 10 yards away. ,a'30. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REM d'S CA' fle npal VU Person Interviewed Sa itari THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE Board of Health Fee: $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to JANE CURTIS / DBA OSTERVILLE PINES CONDOMINIUM corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 3040 FALMOUTH RD. address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. This permit is valid until December 31,1997 Susan G. Rask, R. S., Chairman Board Brian R.Grady, R.S. of Ralph A. Murphy, M. D. Health POST CONSPICUOUSLY By AGENT THE COMMONWEALTH OF MASSACHUSETTS ' OWN of BARNSTABLE l L01 V P � HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT 0 D® POOL CAPACITY - gal. NAME o`�I Li�-�V 1 �� 9! 1 V DATE A MR q ADDRESS MO TEL. NO. OPERATOR MAX. BATHING LOAD_ PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD. 12. STRUCTURE, 14. ;ONSTRUCTION, 15. TNLETS AND 0 TLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved on t e construction plan are of permanent nature and need not be checked at each inspection. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept. ruling. . 55 SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. v. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). 7. BATHHOUSE: Separate dressing and sanitary fact lities for each sex, adjacent to pool, adequate. well lighted, drained, ventilated, impervious constructio and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water. soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers. with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. yCLOSURE: Operator to close pool when water does not meet the requirements of this code. .1O PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including :/ attendance, water tests, chemicals used. hours of operation, backwashing and other information required. 13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max. filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment finely adjustable. 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). ams— 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. . WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 2 . BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. _25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine combined 0.0 to 0.2; Free chlorine 1 to 3, pH 7.2 to 7.8, total alkalinity 50 to 150 ppm. 26. TESTING EQUIPMENT: Testi.:g equipment provided, in good repair and complete with fresh reagents. _27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. �2. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS: l/l II ,� �LVoZ'L tv el- 0 D PERSON I TERVIEWED SANITAUAN i CAPACITY: 19V OUTDOOR POOL PERMIT FEE THE COMMONWEALTH OF MASSACHUSETTS 53 TOWN.............. of.... STABLE $75.00 ......... ................................................ Board of Health This is to Certify that ....JAKE... ......................................................PINES CONDOMINIUM ............. NAME ....................................................... .............................................. ADDRESS IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At ...................................................................................................................................................................... Q.V.AL.jjjEEt..SWI1v1MER MST BE AT POOL SITE ALL TIMES POOL IS OPEN. ......................................................................................................................................... ........... .a..QE..WATER TREATMENT: CHLORINE-AUTOMATICALLY FED. . ......................................................................................................................................... This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts, and expires ..............DEJUMER...31.t...1.9.9A.................... unless sooner suspended or revoked. ............. ............ .. .. .. ..... .............. ............-Bd 8ftR.0rady;R.8. ............................... Boar d ...........JANUARY I 19... ............ of Re .................................................................................................................... Health ............................................... ................. FORMS 1712 A.M.SULKIN.INC.-BOSTON (617)542-5858 By .................... AGENT X a X ... ...... ..... .......... ........... trtP/c. +Fri.F' r`.1�`.4i'. v�`' Crf'. rsa'ii�'p,""` iYV.A,R •.-:�"'>�I�iw»L.�s�rt'; ya y�=� ..,,y,,.,i�"r4.a �...�'-x":y�,a.�,i,:�,,:1 ».;��r. f '. �' THE COMMONWEALTH OF MASSACHUSETTS I TOWN OF BARNSTABLE BOARD OF HEALTH SWIMMING POOL INSPECTION REPORT Name � �P��4 Date Address +w "3 /:_/1: __ _ �./ L 0 Tel. No. I j !1 n f t Operator tCMA_ Max. Bathing Load Permit Posted Regulations of the Massachusetts Sanitary Code: Title 2 "Minimum Standards for Swimming Pools". Items: 1.DEFINITIONS,2.PLAN APPROVAL,8.SEWAGE, 11.BATHER LOAD, 12.STRUCTURE, 14.CONSTRUCTION, 15. INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21..LLADDERS.These items approved on the construction plan are of permanent nature and need not be checked at each inspection. 0,4 HEALTH: No employee sick,bathers take showers,clean bathing suits,sick or infected bathers not allowed,,spitting prohibited, no glass or dangerous objects. Health and shower signs posted. 0,1 4o. LIFEGUARDS: Trained lifeguards in attendance according to Health Department ruling. El SAFETY: One shepards crook and one ring buoy with adequate rope for each 2,000 sq. ft. water surface. ' 9 6. FIRST AID: Red Cross first aid kit(24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available within 100 ft. (not a pay station). EJ,-"7. BATHHOUSE: Separate dressing and sanitary facilities for each sex,adjacent to pool,adequate,well lighted,drained,ventilated, impervious construction and light color.One shower and one toilet per 40 Bathers(min.2 ea.),hot and cold water,soap provided, one wash bowl per 60 bathers.No common cups,towels,combs or brushes.Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). POOL ADEQUATELY ENCLOSED. Approved drinking water facilities. 0-19". CLOSURE: Operator to close pool when water does not meet the requirements of this code. ❑ 10. PERMIT-RECORDS: Permit Posted.Written records available of daily operation of the pool,including attendance,water tests, chemicals used, hours of operation, backwashing and other information required. E 3. RECIRCULATION-FILTRATION: Purification system capable of maintaining quality of water,turnover every 8 hours. ` Max.filtration rate 2-3 gal.per min.per sq.ft.filter.High rate filters—max. 15 gal/min/sq.ft.Disinfection equipment finely �,�`adjusted. ❑4 DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end)25 ft. intervals(deep end). Nd ❑ 22. DIVING BOARDS: Rigidly constructed,properly anchored,braced for heaviest load,sound,no splinters or cracks,non-slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. L3. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 4,,24/BACTERIOLOGICAL QUALITY: Health Department shall cause water samples to be analyzed as considered necessary. E "25. CHEMICAL STANDARDS: Treated with chlorine or other effective method.Tests taken 4 times daily as required by Health /Department. Free chlorine 1.0- 3.0; ph 7.2-7.8 Total alkalinity 50- 150 ppm. L-26.TTESTING EQUIPMENT: DPD test kit provided, in good repair and complete with fresh reagents. 0,21. WATER CLARITY: A 6-inch black disc at bottom of deepest part of pool visible at 10 yards away. ❑ 30. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS:— P.c{y — + r I76 ; ers n Interviewed Sanitarian I CAPACITY: 19 OUTDOOR POOL PERMIT FEE THE COMMONWEALTH OF MASSACHUSETTS 168 $75.00 .............TOWN...--•----• of •-•.BARNSTABLE. Board of Health This is to Certify that ......JANE CURTIS D/B(A OSTERVILLE PINES CONDOMINIUM .................•--••--------•------•-...........••--•- NAME ......................••-----•--.....................---.3040_ FALMOUTH..ROAD,..OSTERVILLE....-_.._..----------...----............... ADDRESS IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At .........................•-...............•••.......................-•••-............................-•--...........................................--.....--......... .UALIFIED SWIMMER MUST BE AT POOL SITE ALL POOL IS OPEN. ..__•___METHOD--OF•WATER.TREt�T(�EUT;-_--•CHEQRI NE-AUTOM,AT.LCALI,X..FEI?.................................• This permit is granted in conformity with Title 2 of the Sanitary Code of The Common. wealth of Massachusetts, and expires .-__________________DECEMBER----31_,___1995---------_-----------------unless sooner suspended or revoked. ...............•......_........................----•..................---.--.......... ----------&li�n71:Gf8dyj-R;G;j a1fi1m------------------------ Board ........... ANUARY......--------------19..95. .------ - K- of ..........Joseph-G:Snow,ill:D--------------------------------------- Health .............................................. -------------------------------- By` ;��f7j 1 .. FORM 1712 HOBBS& WARREN, INC. AGENT Y 7* - ~ THE COMMONWEALTH OF MASSACHUSETTS TOWN 'of BARNSTABLE HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT POOL CAPACITY - gal. 96 NAME 2sy 0 Q DATE ' ADDRESS �,0 TEL. NO. OPERATOR far MAX. BATHING LOAD_ PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming.Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. CONSTRUCTION, 15. INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. �t �3:yHEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. N 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept. ruling. " 15'. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate. well lighted, drained, ventilated, impervious constructio-t and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. b^10 PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used. hours of operation, backwashing and other information required. =1,;-RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max. filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment finely adjustable. 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). ft/0 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. �.- WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 24. BACTERIOLOGICAL QUALITY: Health Dept. shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine combined 0.0 to 0.2; Free chlorine 1 to 3, pH 7.2 to 7.8, total alkalinity 50 to 150 ppm. 26. TESTING EQUIPMENT: Testiag equipment provided, in good repair and complete with fresh reagents. 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. �.32. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS: A9 P-W 7 �/ L A PERSON NINTERVIEWED _ SANITARIA AQUA TEST 1653 MAIN STREET PO BOX 526 WEST CHATHAM,MA 02669 508-945-5895 DEP LABORATORY NO. M-MA102 SWIMMING POOL ANALYSIS DATE OF SAMPLE: 05/17/95 DATE OF ANALYSIS: 05/17/95 DATE OF REPORT: 05/19/95 LABORATORY NO: 14867 BOTTLE NO.: 116 SAMPLE LOCATION: Pool Osterville Pines Barnstable, MA MAILING ADDRESS: Oceanside Pools, Inc. PO Box 610 South Orleans, MA 02662 COLLECTED BY: S.Simon STANDARD PLATE COUNT /ML LIMIT: 200/ML* TOTAL COLIFORM 0 /50ML LIMIT: 1/50ML* I PSEUDOMONAS /100ML METHODS: STANDARD PLATE COUNT MF-HPC COLIFORM MF PSEUDOMONAS CETRIMIDE MF *. 105 CMR 435.28(1) REMARKS: LABORATORY DIR CTOR 79 - © 30 No......J _-__.....0 1 � Fis............Q............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE . fiJ t�iPFItii�lt for DiripaiiMl Wnr1w Tomitrurtillti t1muff Application is hereby made for a Permit to Construct ( ) or Repair De) an Individual Sewage Disposal System`at: ----------------------------- ................................. -Location-Addre or t No ClI^[ r1_ �m T/V�t/.S � b d!/1 4,11 L�S -_.. -...--•-�-----•-------- -------•----------------. ................................ - ._.... 7T7_. Ow icr Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms______________ ___--__------------__-.-_Expansion Attic ( ) Garbage Grinder N�: Other—Type of Building -----_---_----------------- No. of.persons....................-------- Showers ( ) — Cafeteria ( ) P4 Other fixture -------------- W Design Flow............... %---------------------gallons per person per day. Total daily.flow----------------- --® gal WSeptic Tank—Liquid capacity�5'...gallons Length- ------------- Width---------------- Diameter.-_-_-------.-- Depth................ Ions. x Disposal Trench—No. .................... Width-------------------- Total Length-----------.-------- Total leaching area....................sq. ft. r Seepage Pit No...................... Diameter.........6V.------ Depth below inlet-----6............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY------------------------------------------------------------------------- Date.-.-----------......................... a Test Pit No. 1----------------minutes per Inch Depth of Test Pit.---------.._.-.._-_ Depth to ground water------------------------- ri, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ---•----------•---------•------------------•--...........-----------.....-•-•-•-----.........------.......................................................... ODescription of Soil...............................................----...................................................................... ------------------........................... x v -------------------------..................................................................--•-----------------------••-•-•---------------------•--------- ............................................. ----------------------------------------------------------------------- -------------------------------------------------------- --------------------------ei. ................................. Nature of Repairs o lterations—Answer whe applicable._.__J_AI-X �4____ __._.1� � !°n L It -0L _ ........ ...... t--------- Gvo i:�- ..... i^' - f �5l�!,�. ...............:.................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian ha een Issu b e board of health. Signed ----- �f 7� � ------------------------ ------------------- .... -- --------- Dace Application.Approved By ........... - - - ------------------------------------------------------------- ------3..-- .Q.. �� Dace Application Disapproved for the ollowing reasons: .................... ...................................._... .--...........----------------------------------------------- --._...._----- -- ------------ -------------- --- ----- ------------------------_...-----......-----._----------------------------------------------------------------------------------- ........................................ Dare Permit No- --------------- -- ..- : 1-5.1------- Issued ------------- ..�.d..G ...-.���'� Dare i D 717 , C50 No..---..1.. -! o FR$....' Q.............. THE COMMONWEALTH 05,rMASSACHUSETTS BOARD OF HEALTH J 0 Q-- TOWN OF BARNSTABLE �� Appliration for Diripw l Ulor1w Tomitrurttnn tamit Application is hereby made for a Permit to Construct ( ) or Repair (1>4 an Individual Sewage Disposal System at: &d ya) r�_-:-__LM0V-n4 /�--cA� .................••••-'----'•'-••. .....•••------••-•'--••-----•-----••--•-----------•--•-•-- /V j_..\ddres/s r�J.F' ��� F /v✓JI�.s eu,4 0. A,1 ✓Y1 ) L� G �l ....................._.--...--•--' ?......................................... " Ow//ner ` - tw.l �o� C 1_J 1. ✓���/�1/C.!((Y)+� �6y� �u Address ��=�s Installer Address Type of Building ., Size Lot............................Sq. feet aDwelling—No. of Bedrooms.................S----------------- ----Expansion Attic ( ) Garbage Grinder pa Other—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) at Other fixtures ------------------------------- - - W Design Flow------------------ ---------____:._------gallons per person per day. Total daily flow---------------- .............gallons. WSeptic Tank—Liquid capacit. -_-gallons Length---------------- Width---------------- Diameter----.----------- Depth____-_:____-_.-- x Disposal Trench—No_ ____________________ Width.................... Total Length-------- Total leaching area....................sq. ft. i Seepage Pit No..................... Diameter........&...... Depth below inlet-----6---.________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) r a Percolation Test Results Performed by.......................................................................... Date........................................ .l Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fT Test Pit No. 2_______ ________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Description of Soil---------- U -•----•...-•-••----------•------------•--••--•--••--•-•--------•------•----•---------•-----••-•---------••--------....•.••••----•---•------•...••••-----------••-•-•----••-•••-••-•....-----••••-------- W .............................. -------------------------------------•---•--------------•--------------- ------------------------------------------------------ ----------•••••-•-•--•--• U Nature of Repairs or Alterations—Answer whe�? applicable___.J..N-s -_----�, . /-Zoe- .S�.. � ----------�G VU�u-! 5 N ._.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha een issu by> h e board of health. Signed / - '`- ".�. .-... ........ ........,1 -.......... Dace Application.Approved By .............. ..� �..._ _ _�a.�_• . . .._.................. ...__............. ------- 5 Dare Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------- ............... .... .. .. ........................................................... .. . ... .................._.................._....._..... . ........................................ Date Permit No. ................�1....-. J.. .l..._...... Issued -------------3--- q_�.-_-C . —........... Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BAR��..��TNSTABLE Tertifirate of LLIImplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) i� c� --- --G.-4—J--- �----7--1-----a---------`--1-by ..................................._.. GC .-.L.�-G. .--....._... .. at --------------_.------ Install dn f �._... 1c2I. ... s Ld ---------------------------------------- has l I t been installed 1n,accoa with the provisions of TITLE 5 ojjhe State Environmental Code as described in the application for Disposal Works Construction Permit No. __------ -.5_-.------.4 . a..0.. dated ..._. _ .. rt._-_��".yS:. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFY TOR DATE .. .... .. ....._.._..-�� ..�....._.....:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �' TOWN OF BARNSTABLE No....... ��'. / FEE.. ................ Dispoli l v kii Tomitrudi.ait "nutit Permission is hereby granted___________________________ _ ...._...................... to Construct ( ) or Repair (,>L.)�arjndividual Sewage DisposaLSystem at No. ....�G---------r-�........vim')_--- :.-------(2-II',I-A� -t _.. lam/G �11 Street G as shown on the application for Disposal Works Construction Permit No._1-)_';���_ Dated_____ ...__....��.LV.`.... ................................ ............................................................._' Board of Health DATE.....................�---:- n f `:? ....................... —B-oard 36508 HOBBS h WARREN-INC..PUBLISHERS 03o - THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH- TOWN! OF BARNSTABLE ,pphrati>ait for Mitip Sal Work6 C iamitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (b<) an Individual Sewage Disposal System at: ---------------------------------------------------------------------------------------------•-•-• ---•-••-----------•--- -• •------ ..........................-` ..---------------- Location-Address or Lot No Owner Address W '`.' �i�O l.R V v`"`��V C."Z d �l�J' WA9!C* //7! Lt�S � 1(�--•-•-•------•-- -•-----•--------- -------•----......--•---•---------•y--- . .. ............. Instalter Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms..._.___..__�-----------------------.-_Expansion Attic ( ) Garbage Grinder - --j NO P4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------- W Design Flow--------------- ---------_-------gallons per person per day. Total daily flow-------------- ' __:___.........._gallons. WSeptic Tank—Liquid capacity�p---gallons Length---------------- Width---------------- Diameter__.---_.__._- Depth................ x q Disposal Trench—No. .................... Width--------- Total Length-.-____---.-__-____ Total leaching area_O...._..........sq. ft. Seepage Pit No..._...._�..__-_.- Diameter--------.lQ------ Depth below inlet........6._._._._. Total leaching area..................sq. ft. Z Other Distribution box (b4 Dosing tank ( ) ~' Percolation Test Results Performed by..-------------- ...................................................... .Date................. .................. + .a Test•Pit No. I-______--__---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........................ ODescription of Soil....................................................................................................................................................................... U ------------------ ......-......................................................................................................................................................................... W -••- ------------------- U Nature of Repairs or Alteration —Answer when applicable._.__!.N__-'�'�_._.��-__-�_____..1�� ..__.57.t- _ . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not-to place,the , t1system in operation until a Certificate of Compliance s been issued oard of health. Dace e� Application.Approved By - - ----` .lt - - ---- ------ Mate-..._._-_.------..__ are Application Disapproved for the following reasons: --- -------------------------------------- ----------------------------------------------------------- ------------------------------.._._----------- -------- - -------------------------------------- .................--............. Permit No. - 7/_ 7�------- --- - Issued ----------' nao_--�-I-1__. Da e...... Dace Fxs....`3� ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratilan for M5pa!ml Workri Tomitrnrttnn ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ILV ca-jC m(U LC ,z/® i4 •-•-•---••-•• ---------------------------------D4 .................. /p Location Add or Lot No mil s- es / v P yG Ti..10 UJ � < ��� = �a I LC.5 .. ..................... -- ..............................wner --_ ... -•,-••- ..... ---.....•... O Address /N I L LS Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling— No:-•of-Bedrooms------------�3--------------------------Expansion Attic ( ) Garbage Grinder t-'j t J(3 aOther—Type of Building ---------------------------- No. of persons----------------------.----- Showers ( ) — Cafeteria ( ) s1' Other fixtures -----•--•------ •------------ W Design Flow---------______�J_._...................gallons per person per day. Total daily flow------------.-7�0_.._..__._.......gallons. WSeptic Tank—Liquid capacity $PP---gallons Length---------------- Width--.-----.- ---- Diameter---------------- Depth---------------- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........e.--.----.- Diameter---------/Q------ Depth below inlet------ .......... Total leaching area..................sq. ft. Z Other Distribution box (�A Dosing tank ( ) .4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date....................................... 04 Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water...................... Gi, Test Pit No. 2________________minutes per •inch Depth of Test Pit.................... Depth to ground water........................ fZ ---•-------------------•----------......--•-----•--•---•---•---•---•--•----•......------------------......................................................... 0 Description of Soil....................................................................................................................................................................... x c, --••--------------------------------------------------------------------------•--------------------------------------------------------------...__._.... ............................................. W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable.-.._!_N S '` ____A........ 62.._._---_-- ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE,5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance I s been issued th board of health. Signed ......... ............ Date qq.. _ ApplicationApproved By ....... � ---------------------------------------------------------- ------ - ..'------� Application Disapproved for the following'reasons: ----------.._--------------------------.-..------------------------ ------------------------------------------------- Permit No. —1 _ 1"/7(^ _... ...... Issued o��e Dare r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE TPltifi ate of Coraylianre THIS IS TO CERTI�, hat the Individual Sewage Disposal System constructed ( ) or Repaired ( �) b ,ls'oIG-Q.c _.'------------.CUv.!S /--v-U---/ f.l--- ----------- Y ............................................. �p rLllJ...... '-1,>1^0 �.- ,gip ..,.. C 'G r.�c(0, 3 c O G (.�.5 /Lv I L c c� at . --- - - has been installed in accordance with the provisions of TITLE 5,of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ... ,``------- dated ------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 1-3, ` Ins ec r-J - ��54 TE "' � ----- 71 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.....IL.-)_�. 6 FEE...........d........ 'Billpallat !, �rkp Tunstruti.osn rrmit Permission is hereby granted--------------- ...-�� ?U�rU ._..0 U to Construct ( ) or Repair (0�) an Individual Sewage Disposal System at No. Q © 1R U�1T I....!� •--- ��C-�!� ccrrcJ C�`f' /C�!. ..t:�.... Street CC�� as shown on the application for Disposal Works Construction Permit No..-!. .-_�� Dated____. .-. a.::P. ......: ••- �O �� i U Board of Health DATE--------------------�---------------••-••.................................. FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS p�p � oc 70 THE COMMONWEALTH OF MASSACHUSETTS /F iEc jBo........................... BOAR® OF HEALTH TOWN OF BARNSTABLE AVVUrattvit for DtnVniiul lVorkii C owitrnrtinn Prrntit Application is hereby made for a Permit to Construct ( ) or Repair (D4) an Individual Sewage Disposal System at: ..Y..�..........................Location-i\ddres. ^`rJ.__......��'-- __._._- -�--%'__------------'-----'--------. ------------ o c 0,-4 11 0�-► 6 —Ual 0-< . W ._... _G W t�........ Owner a �1�.�.---�-•---;-=------------Wit'-^���---�-----------7 ----...�'�''__-_�.�.—_-�y----- =--- Ad�^5`-------�-�=�'-�'-------------- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............7..............:.........Expansion Attic ( ) Garbage Grinder._��A� Other—Type of Building ______________________ ..... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) p' Other fixtures ...jr- W Design Flow............. ------------gallons per person per day. Total daily flow--------------- ..................gallons: P♦ Septic Tank—Liquid capacity.L V_.gallons Length-------_----_ Width---------------- Diameter..-------------- Depth............................. Disposal Trench—No_ ____________________ Width____-_-------------------- Total Length--------- _r_____ Total leaching area....................sq. ft. Seepage Pit No---------J....... Diameter.____._1 :...... Depth below inlet____ _________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ L14 Test Pit No. 2................minutes per inch Depth of Test Pit______..--__________ Depth to ground water....____.-_____--______- 94 ---------------------------------------------- ---------------------------------------------------- ----------------------------.....-•------•----------- 0 Description of Soil.......................................................----------------------- ...............-------•--•-----------------•-•....----------••-•------•-------•-•-••--. x . U W ..................................................... --------------------------------------------------------------------------------------------------------(__-•- VNature of Repairs or Alteration Answer whgn applicalbl�.__._ _—M, __,___ ....._rsZ _ ___c _. ..: �i?U'�--- ........................................` .. f------ ---------Ifft ........... ' � .....,5'� t......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s be n issued t oard of health. Signed �1-7/!�- - ----- --------- ------------- Dace Application.Approved By .. ....... - re .r Application Disapproved for the following reasons- ----------------------------- ------------------------------------------------------------------------------------------------- ... ........ ..........................................._._.......... ... .......... .. ........ ................................. ........................................ Permit No. .......1.5....... . -- ---- ----------- Issued -------------- JDare / �........ . � a THE COMMONWEALTH OF MASSACHUSETTS /Fmc.............................. _ BOARD OF HEALTH TOWN OF BARNSTABLE Appl ralion for Dtvj-pwml Wnrk,6 Tontitrnrttnn ramit Application is hereby made for a Permit to Construct ( ) or Repair (_'44 an Individual Sewage Disposal System at: - --------------------------------------------------------------------- Location-Address or Lot o. Owncr Address - Installer - Address QType of Building _ Size Lot............................Sq. feet U Dwelling— No. of Bedrooms.............. .. ' `_._-_.-__-_.__....Expansion Attic ( ) Garbage Grinder_(—)AU( aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures .......... .................... . ..--••--------•-------------- W Design Flow............. _. ....gallons per person per day. Total daily flow..._._........ v..................gallons. a: Septic Tank—Liquid capacity__/5Y galIons Length________________ Width._-_--------_ Diameter..._._...__, _... Depth.....__....... Disposal Trench—No_ ____________________ Width.................... Total Length--------.. ..�..... Total leaching area_-_.--...._.--------sq. ft. Seepage Pit No.......... ....... Diameter......./0------- Depth below inlet....... Total leaching�area.....____._.._....sq. ft. z Other Distribution box ( ) Dosing tank ( ) 14 Percolation Test Results Performed by-_------------- ------_--------- ..................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-.__--------f�_.___ Depth to ground water....................... Test Pit No. 2................minutes per inch Depth of Test Pit._.__..__...___.-__. Depth to ground water........................ p4 --------------------•--•--•--------------............_...---•-••-•------------••--------------•----......................................................... ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x W ------------------------------------------------------------------------------------------•-------••----•-----------------------_..._----------------------...__.....__.. UNature of Repairs or Alterations—Answer when applicabl ...._�4�1, �- --__.! -___.-/5 �._ ----------a_e.r t.S-'-- --- 90 � rY'C.....-----. - - t..J ,— S aN :: '- ---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with w the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h �be n issued the oard of health. Z^� Signed ----- ....... t /"/��, /....... Dace Application,Approved BY (` ......... ...... -- ----�� ' Application Disapproved for the following reasons: ...._......... ---------------------------------------------------------------------------------------------------------------- --------------------------- - -------------------------------------------........................... Dare Permit N Issued �,[, � . ....-.. ....�...�f' .�....._. 4� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fertYfiraxte of Compliance, THIS IS TO CERTIFY-T t}�e t Individual Sewage Disposal Sy - - ... System constructed ( ) or Repaired (/-,.) y ---------------------------------------------_..-------------- ------------------------------------------ Installcr ----------------------------------- 3� ------------------------------- has ------------------------ at been installed in accordance with the provisions of TITLE 5�y�jf The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... .... ... .._ _ -�--.- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _....--------- Inspector ----------------- Ins �d - ----- ---- ................................................ DATE ...��`" ...a. �:,,,.�..... p THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....�_7�_._.r..'�.Q �- FEE.... G............ �i n tt1 arks Tonotrurflon permit ��2�-...a•7.. Permission is hereby granted--------------- ?_✓�1..S:TIl /C�?7-U':�.._._.._....._..---•------....... to Construct ( Lor Repair an Individual Sewage Disposal System at No................ ---------- ---if......J 1 j T�L�Tz� �-- C;-----------�J-------- __ Street 11 as shown on the application for Disposal Works Construction Permit N©.�i-_—_7�_� Dated-----,; ._.__�-C?_...:�.�2....... , . ^� �� Board of Health DATE.------•--•--------------:.;!•----._ __ •_ l/ FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS CAPACITY: 19 OUT PERMIT FEE , THE COMMONWEALTH OF MASSACHUSETTS 98 $75.00 TOWN BARNSTABLE .................................. of •................................................................ Board of Health JANE CURTIS D/B/A OSTERVILLE PINES CONDOMINIUM Thisis to Certify that .......................................................................................................................... NAME ......................................................3.04.0J.ALM0.V.jjj..R.Q.AJ).....Q.ST.E&V1LLE,_..M&.................................. ADDRESS IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At ..................................................................................................................................................................... QVALIFIED SWIMMER MUST BE.A..FQ.QL...S1.TE_.ALL..11MES...POOL.-I.S.-DREN................. ............................................... .......... ... ......... METHOD OF WATER TREATMENT:......CHLORINE-AUUMATICALLY..F.ED................................ ................ ..................................................... This permit is granted in conformity with Title 2 of the Sanitary Code of The Common- wealth of Massachusetts, and expires -------DECEMBER 31,--------------------------------1994 -----------------------------------------------unless sooner suspended or revoked. -------------- ..................... ---------------------------------------- Board JANUARY 1, .19.......94 'S. ............ of .......................... ..................................... jQ;Wh.G0.S)10.W8XD.*..............•.................... Health .............................4%t---------------------------------- . ... ... . ....... .. FORM 1712 Hoess& WARREN, INC. 4� THE COMMONWEALTH OF MASSACHUSETTS ��^� TOWN of BARNSTABLE / o N�� ✓� �s-nQ 0 fn HEALTH DEPARTMENT SWIMMING POOL INSP CTION REPORT © POOL CAPACITY - gal. NAME "' � '� ! ► DATE �� � ! /% ADDRESS !�U 1 (/ 1 e l V TEL. NO. OPERATOR MAX. BATHING LOAD_ PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD. 12. STRUCTURE, 14. JONSTRUCTION, 15. INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20, WALKWAYS and 21. LADDERS. These items approved on t I e construction plan are of permanent nature and need not be checked at each inspection. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept. ruling. 15. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). i t 7, BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious constructio:i and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common I cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. t/9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. �3- RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every H 8 hours., Max- filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment finely adjustable. o � � F��TFr� i.7 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft, intervals (deep end). .+- 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no spl-inters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. v2A. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. _24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 25 CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine combined 0.0 to 0.2; Free chlorine 1 to 3, pH 7.2 to 7.8, total /,46-: TESTING alkalinity 50 to 150 ppm. EQUIPMENT: Testi.,g equipment provided, in good repair and complere with fresh reagents. 7. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. 2. WADING POOLS: ,Quality of the water shall be the same as s,�wi/mmin(g- pools. Turnover 4 hours or less. REMARKS: C6e.1 'FI E0 (-���C(/�y�LJ O V ty r' 411 rof-/d( ' 0.19.Er a e6e fVT �VB L ON3 IrA &OV CL'-�A- Y\-, �-- luxy]IM A' ;tF-M-JL PERSON IN RVIEWE'? SANITARIAN ' i CAPACITY: 19 OUTDOOR POOL PERMIT FEE THE COMMONWEALTH OF MASSACHUSETTS 24 $75.00 ........... OWN-------------- of ---.BARNSTABLE Board of Health This is to Certify that .... ANE__CURTISD __CONDOMINILM NAME 3040 FALMOUTH RD. , OSTERVILLE -•.............•----....--••--•-----.....-----•-•-•-•---••--------••-------•--••--•-•-••--•----•---------........----•-•---•---------•---•......-••---------.......------... ADDRESS IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At ...----•-•...--•--•-----•---•.... .. .- ----•--•=-------------•--•-------...--••--.......---............------...-----•-•--•--------------------------•---------- QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. --------•----------------------------------••-------.......----------•---------------------------•---------------------.. METHOD OF WATER TREATMENT: CHLORINE—AUTOMATICALLY FED. ............ ................ . . .•-------................-•---•--.............------.........----........-----•--•---•----------.....-----• This permit is granted in conformity with Title 2 of the Sanitary Code of The Common. wealth of Massachusetts, and expires ----_____-_-___DECEMBER_31? 1993---------------------------------unless sooner suspended or revoked. ------------ Chairwomen----------- Board IANUARY• 1 19.-93_ J08@phC:BnoW,�.D. ' of T18IIrTSd1--- ................................ Health BY AG '. ...... ------------------------•--- FORM 1112 HOBBS WARREN. INC. ENT I THE COMMONWEALTH OF MASSACHUSETTS .�,. ...G',-.`?•1`1►,f...OF....... �"�. ri`/.. ` l.fi.C. ... .... HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME tV -I J Al v ..r DATE ADDRESS1171'�V, TEL. NO. OPERATORi MAX. BATHING LOAD - ✓'d PERMIT POSTED r Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. XNSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. 3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept, ruling. !�I 5. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. V 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious constructio:i and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including ,/ attendance, water tests, chemicals used, hours of operation, backwashing and other information required. Y 13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max, filtration rate 2-3 gal. per min, per sq. ft. filter. Disinfection equipment finely adjustable. 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). =22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. �'1—( P�✓tv2 WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department, 4' 24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often � as required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7.5. 126. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. 2. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS: -77 V ` \-PERSON INTE*IEVkD SANITARIAN FORM 17oe A. M. SULKIN, INC. TOWN OF BARNSTABLE BOARD OF HEALTH APPLICATION FOR A PERMIT TO OPERATE A SWIMMING POOL Application is hereby made for a permit to operate a public, semi-public, or priVA.te pool. This. pool is to be operated according to the minimum standards for swimming pools set forth in Article VI of the Sanitary Cbde of the 'Commonwealt'i'.:of:Massachuse.tts. OWNER 42(jk - TEL. NO. LOCATION TYPE OF POOL LENGHT �--1.2 WI.DTH 2- 0 VOLUME `ZS- SSO SKETCH (A detail plan must be filed with original application) SIZE: SWIMMING AREA Z, CDC( `i� NON SWIMMING AREA DIVING AREA SOURCE OF WATER 1 oL Dr7 DISPOSAL OF SEWAGE AND WASTE WATER L y'cW tr&c" ?t+ TYPE OF FINISH Cof1 SCUM GUTTER 'n DECK: TYPE AND WIDTH COrlc(t)d 2-SKIMMERS: WEIR LENGTH TREATMENT SYSTEM (Kind of filters etc.) �A ` cgi DISINFECTION METHOD (Method, type, capacity etc.) <z-)0kv v►1 L CHEMICAL TREATMENT Feeders, capacity, quantity etc.) V'c)�, C: Clam a REMARKS SIGNED DATE (Permits expire on Dec. 31) r 1 TOWN OF BARNSTABLE CF THE T0� OFFICE OF DA"STMM i BOARD OF HEALTH � rasa e 367 MAIN STREET HYANNIS, MASS.02601 May 13, 1993 Jane Curtis c/o The Huntingest Group 40 Industry Road Marstons Mills, MA 02648 Dear Ms. Curtis: Re: Osterville Pines, Your outdoor swimming pool - Old Bather Load Capacity 45 Outside; Modified Bather Load Capacity - 19. We will allow you to set a maximum capacity of 19 persons at your swimming pool located at 3040 Falmouth Road, Osterville, Ma. This includes persons in your pool and includes all other persons within your pool enclosure. The following conditions must be complied with: (1) The pool must be supervised by a swimmer, by you at pool site at all times the pool Is open. We wish to make it clear that this swimmer must be at the pool and cannot be observing from the desk. If your swimmer is temporarily assigned duties at the front desk, another swimmer must be provided physically present at the pool. This swimmer must be certified in adult, child, and pediatric CPR by the American Red Cross, American Heart Association or equivalent, be familiar with lifesaving equipment and knowledgeable in first aid procedures. (Minimum swimmer qualification requirements are enclosed). (2) You must keep a permanent record on a form prescribed by the Board of Health listing each swimmer supervising the pool when it is in use. (Sample of prescribed form is enclosed). (3) We must have a copy of your insurance policy naming the Town as coinsured in the amount of $1,000,000. (4) All other regulations contained in 310 CMR 12.00, Minimum Standards for Swimming Pools, must be strictly complied with. (5) The whirlpool water must be tested for coliform bacteria at least monthly and pseudomonas bacteria at least once every two months by a certified laboratory. (6) The swimmer(s) must hold a current American Heart Association, American Red Cross, or equivalent CPR certificate with training in adult, child, and pediatric CPR. (7) The swimming pool water must be tested for coliform bacteria at least monthly by a certified laboratory. l . Ms. Jane Curtis RE: Osterville Pines Condomoniums May 13, 1993 You are granted this modification of your present pool capacity of 45 persons because you have stated your pool is used by less than 19 persons at all times. Please be advised that if you exceed this capacity of 19 persons, your modification will be invalid and you will be required to cease operation of the pool. This modification expires December 31, 1993. Sincerely yours, ^� oseph C. Snow, M.D. Acting Chairman BOARD OF HEALTH TOWN OF BARNSTABLE JCS/bcs Enclosure I I American Heart Association Cardiopulmonary Resuscitation and Emergency Cardtfid Care Dori d HotM d has successfully completed the hill hal cognitive and skills examinations in accorddi dO With thd,burriculurn of the American Heart Associatl8fi.,lor*`:;:' " y N., BASIC CARDIAC LIFE SUPPORT C 10/28/92 10 28/93 Date of Issue Date of Expiration j t I u011e13ossd tieaH ueoiaawV ''1439 Bulsueoll pus senjule gists elgebed W¢uo a11Wil pus euo a nmd sto of iwfgnsaj uoeeldwoo esmoo inleseoons touop!udy anleuBIS e,)eploN 'ON•p•I s,Jolanysul eweN e,4013ruleul aMlalussaidey-nosey ueaN uopelao >rseN►o awsN TL':ITaSOH POU w"Ll 61e111HY uoTsTATQ spuejsl 9 ad80 sjjasn4oess8W t r • American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiac Care JULIE FJ=ON has successfully completed the national cognitive and skills examinations in accordance with the curriculum of the American Heart Association for I B.L.S a "C''' I C 5/29/93 Date of loos Date of Expiration I Massachusetts Affiliate I Name of heart Assodatinti— J COOKeart Assoc.Representative FALMOUTH FM OM Instructor's Name Instructors I.D.No. Molder's Signature Rxogninon of ivc:esslul course completion is subject to the provisions and limitations Of applicable state statues and licensing acts. d American Heart Association j , THE HUNTINGEST GROUP REAL ESTATE INC. OFAq`L 40 Industry Road Marstons Mills, MA 02648 (508) 428-1112 March 29, 1993 Town of Barnstable Office of the Board of Health 367 Main Street Hyannis, MA 02601 RE: Outside swimming pool-Lifeguard Modifications This letter is a request--for a modification of the swimming requirements at Osterville Pines Oste vine: 1 This modification expired December 31, 1992 This pool is used by less than 19 persons at any one time. Our pool is maintained by Oceanside Pools, Inc. They will be in charge of contacting the Board of Health regarding the opening of the pool and shall pay for all Town of Barnstable Board of Health permits pertaining to the pool. There will be a Certified Lifeguard or Qualified Swimmer in attendance when the pool os open: Please find enclosed a copy of insurance policy naming the Town as co-insured in amount of $1, 000,000. 00 erely, ane Curtis, Manager enc i ��®��'►�ITm ISSUE DATE(MM/DD/YY) CERTIFICATE,0F:.INSU LANCE 3/26/93 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DRAKE, SWAN & CROCKER INS. AGENCY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. BOX 429 ORLEANS, MA. 02653 COMPANIES AFFORDING COVERAGE COMPANY LETTER A TRAVELERS INS. CO. COMPANY INSURED __ -- LETTER B OSTERVILLE PINES CONDO TRUST COMPANY G. _— C/O THE HUNTINGEST GROUP.`. f LETTER 40 INDUSTRY ROAD COMPANY D MARSTONS MILLS, MA. 02648 LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE !$ 2 000,000— A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 2,000,000 CLAIMS MADE _X-OCCUR. 680-11 OK3794 TIA 1/1/93 1/l/94 PERSONAL&ADV.INJURY $ 1 ,000,000 OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 50,000 MED.EXPENSE(Any one person) $ 5,000 AUTOMOBILE LIABILITY - COMBINED SINGLE $ . ANY AUTO LIMIT ALL OWNED AUTOS BODILY---'.._.. _.. .. .. _.. .__ ._ .. .. BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) GARAGE LIABILITY -- PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ � :UMBRELLA FORM AGGREGATE $ —OTHER THAN UMBRELLA FORM STATUTORY LIMITS WORKER'S COMPENSATION EACH ACCIDENT $ - AND —__.____._....._...... —_—. DISEASE—POLICY LIMIT $ EMPLOYERS'LIABILITY DISEASE—EACH EMPLOYEE $ OTHER V i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS INCLUDES SWIMMING POOL CERTIFICATE HOLDER ;, - CANCELLATION .i.nb.s Y.w�€.�:,...,.t,.x...._v�,,.me.,-.�:.,�+�...u..s.:..:cacL...aw,.......z:. ., +,h..,�...........:..:w:w�..., �.,6..G..,.,t>eaM....,aw...r+,��.,::.�+wa....rr:,;�..,_.,...:.�'s.H....,1_..:,.:,.�.,...,,_....u,:w-,.;_.,._a,e..,,...,,.:�..,.a•�.„� ro a� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF HYANNIS EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO : MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 367 MAIN STREET HYANNIS, MA. 02601 $' LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR _: 1,] LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. =A? AUTHORIZED REPRESENTATIVE r.....v .•-w.._;r—.....+.¢.-.'z+— '9Ra.--.,r .c+..e sa+wm'PT 'T aayrtt.R/'>�i'—.ekfC^im`,. +IaS#x^_".,�+ '•:�wv'L":'..p ACORD 25-S (7/90—s.) CORPORATION 1990' ' I A American Heart Association Cardiopulmonary Resuscitation and Emergency CardlM Care Donnd Howard has successfully complOtbd the h6tId iat cognitive and skills examinations In accorddritO With the turriculum of tho American Heart Associall6h for BASIC CARDIAC LIFE SUPPORT C 10/28/92 10 28 93 Date of Issue Date of ExPMallon t G uoileioossd taeaH ueoiaawd 'sios aupuooll Pus senRls wis em3ode . p 9000811WH Pus suolgead sa of polgns ej uopsId=o eunoo Inpssoons to uoplutbooy smleu le s,isPloH •oN•Q•f s,ioforuprut swsH s,iotorwsul GApnussudsy mossy Use" uoptgo NUN to MIN je d elelll Y uolslATU apusjaI q ad80 etlesnyassseyy • American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiac Care rTIILZEI T TON has successfully completed the national cognitive and skills examinations in accordance with the curriculum of the American Heart Association for B.L.S. "C"' 5/20492 Data of mtr Date of E�inoon Massachusetts Affiliate Name of heart AssoaaODA.— aan Assoc.Reprwntatt" FAL MOUTH FM Oi instructor's Name instructor's I.D.No. holder's Signature Fecognioon of 4.cces61u1 cbUtae comobtion.SUbj*C1 to Yfe D•' ana trttitamoro ai aVwcw fe atate Stet.-&W dcens:ng am. d American Heart Association i THE HUNTINGEST GROUP i REAL ESTATE INC. clot O I P? RAIL—TNE�. (508)428-1112 iii M INDUSTRY ILL JANE CURTIS,CRS MA 02648 MILLS Res.428-7828 • � MA 02648�. l � I CERTIFICATE OF INSURANCE ISSUE DATE 3/26/93/93/YY) {PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER 6F INF611MATIBN ONLY AN6" CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DRAKE, SWAN & CROCKER INS. AGENCY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. BOX 429 ORLEANS, MA. 02653 COMPANIES AFFORDING COVERAGE i COMPANY LETTER A TRAVELERS INS. CO. I I COMPANY B ;INSURED LETTER OSTERVILLE PINES CONDO TRUST COMPANY ' LETTER C C/O THE HUNTINGEST GROUP 1 40 INDUSTRY ROAD COMPANv 1 MARSTONS MILLS, MA. 02648 LETTER D COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lCO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ILTR DATE(MM/DD/YY) DATE(MM/DD/YY); GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 3A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 2,000,000 f CLAIMS MADE X OCCUR. 680-11 OK3794 TIA 1/1/93 "1/1/94 PERSONAL&ADV.INJURY $ 1,000,000 OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 1,000,000 1 FIRE DAMAGE(Any one fire) $ 50,000 i MED.EXPENSE(Any one person) $ 5 000 AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ 3 !i HIRED AUTOS BODILY INJURY 9 j NON-OWNED AUTOS (Per accident) $ I - t GARAGE LIABILITY i PROPERTY DAMAGE $ i EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ v I OTHER THAN UMBRELLA FORM(....... ._..,.,.. .. .. .._. .. .,,_..,.. .......__.,...,T..,......,. ..... ... ... _, .. .,.,..,r�._..,._. i WORKER'S COMPENSATION STATUTORY LIMITS i AND EACH ACCIDENT $ DISEASE—POLICY LIMIT $ EMPLOYERS'LIABILITY DISEASE—EACH EMPLOYEE $ .............. .... ._.... OTHER " f r 1 i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS f _ ' INCLUDES SWIMMING POOL i CERTIFICATE HOLDER CANCELLATION ( { SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF HYANNIS EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 367 MAIN STREET MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE j HYANNIS, MA. 02601 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 3 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE . I t ACORD 25-S (7190) ©ACORD CORPORATION 1990 L e t_ BATHING CAPACITY: 19 OUTDOOR POOL PERMIT FEE THE COMMONWEALTH OF MASSACHUSETTS 32 $75.00 TOWN of -----BARNSTABLE Board of Health This is to Certiy���i�t ....__OS . •RVIL E PIN S CON OMINIUM �� 1�'(QJ NA .a . MARSTONS MILLS 40 �S GR�C�O..HUNTINGE -- :... ADDRESS IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At .....A..QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. .•-•• ..... METHOD OF WATER TREATMENT: CHLORINE AUTOMATICALLY FED. . • . ..-•••• -•---•••••........ .............•....................................................----•----.....---•------......................--••-•----•---.....-----•------•------•--..._...•---........ This permit is granted in conformity with Title 2 of the Sanitary Code of The Common- wealth of Massachusetts, and expires ---------DECEMBER__31x___1992---------------------_-----------------unless sooner suspended or revoked. /� ---••- eT088 �L`i. A0W... _,y.. .................P............ . �� �i�aA1L7II8A---- Board MAY 13.:. 1992 S11B$1�.�7G'.. k............................................ of .........B1IiMM-Grady--•--------•-------------------------•----•-- Health •--•-------•....................•-......-----.......•-•-----.......................... By .......•••-----••....................•------•-••••••--...-•••..........--_.... FORM 1712 HOBBS$WARREN, INC. AGENT L t • American Heart Association Cardiopulmonary Resuscitation and i Emergency Cardiac Care JULIE KILLION has successfully completed the national cognitive and skills examinations in accordance with the curriculum of the American Heart Association for B.L.S. "Cu Date of Issue ate of Expiration i 1 I Massachusetts Affiliate Name of Heart Associatinn.i i.. eart Assoc.Representative FALMOUTH FM OM Instructor's Name Instructor's I.D.No. Holder's Signature Recognition of successful course completion is subject to the provisions and limitations of applicable state statues and licensing acts. American Heart Association I 1 y • American Heart Association , Cardiopulmonary Resuscitation and Emergency,Cardiac Care U Donna Howard has successfully completed the national congnitive and skills examinations in accordance With the Standards of the American Heart Association for BASIC CARDIAC.LIFE SUPPORT C 10/23/91 10/23/92 ;DRte-or Issue .- patq p(Fjcplr.tlon. �; f I Cap .iS� IslaAd'i Ir v a ttn ' YawmChta>IPtf�i Ca a Go d kl4spit s]. ' Aftillate P tlMp.,gt.yrnrt "' '. ' �Inetruewr s f,p.N9• f ' r:; '� %n tun �t Moopnhron M wa«�'A oar"compbto0 w prole �vo rlva•lpne a �p�llorgN.�Nw.�!�tuM'nd. no am j r 1 • al THE COMMONWEALTH OF MASSACHUSETTS OF................................................_.......... . .............. .... HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT / � 14 - NAME GG� DATE' _ P ADDRESS �. '`` r TEL. NO. A OPERATOR ''MAX. BATHING' LOAD PERMIT POSTED Regulations of,the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD. 12. STRUCTURE, 14. ONSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20, WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. 3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. f 114. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept, ruling. 5. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. !6'. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious constructio: and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common v cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. _13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every / 8 hours, Max. filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment finely adjustable. _19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. _23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. _24;BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. _25: CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often y��J�as� required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7.5. P26. TE"STING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. /2ZqAATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. _34/WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS PERSON INTERVIEWED SANITARIAN FORM 1708 A. M. SULKIN, INC. l BATHER CAPACITY: 19 OUTDOOR POOL PERMIT FEE 40 THE COMMONWEALTH OF MASSACHUSETTS $75.00 ..-----• ---------------- of....BARNSTABLE.......... Board of Health This is to Certify that ....................OSTERVILLE PINES CONDO NAME ..............................----•--•.......................•----•-- ........................ ADDRESS 1Srf-IEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At .........A-qualified-swimmer. must,_be-_at„pool„site_all,:times__pool is open. Method__of__water treatment Chlorine automatically fed-„ ...................................................................:............................................................................... This permit is granted in conformity with Title 2 of the Sanitary Code of The Common- wealth of Massachusetts, and expires -___Dec--ember__31,---1990--- ----- _______________---_ unless --- - ----- sooner suspended or revoked. Grover_C.M. Farrsh,„M.D„Chairman-- Ann Jane Eshbaugh___,._,,,,, Board ........May.-D ....---•...............19--90• James H., Crocker,Sr. ------•-•--_..... of ---.................................•••--•.......•-------------.......-----------•----- Health ...................................... FORM 1712 HOBBS$ WARREN. INC. A By ..--•---•.............. _--....•---- __-_.--•---__----..... gent S THE COMMONWEALTH OFM�gA�SSACHUSETTS �......OF.......�rCC'm u— VG.................................. 6 HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME a ti"t P��" DATE ADDRESS `� LJ O J�J, I % �" TEL. NO. OPERATOR M.-a kz:�QAA MAX. BATHING LOAD_ PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD. 12. STRUCTURE, 14. ONSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. Z. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. ,/4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept, ruling. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 1 b, FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). _ 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious constructioni and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. _ 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. -1/13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max. filtration rate 2-3 gal, per min, per sq. ft. filter. Disinfection equipment finely adjustable. =T9. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). _22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. 23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. /5CHEKICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine residule .4 to 1.0, pH 7.0 to 7.5. __,e�216• TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. _32. WADING POOLS: Quality of the water shall be thesame as swimming pools. Turnover 4 hours or less. REMARKS• I per' ,[ i �, -c L r h� PERSON INTERVIEWED SANITARIAN FORM 1708 A. M. SULKIN, INC. 7 0 THE COMMONWEALTH OF MASSA-CHUSETTS HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME DATE 2 d� ADDRESS to yo &7 I�`4'�,lsi,�19 TEL NO. 4/20 OPERATOR A �r ll4 MAX. BATHING LOAD 2 32 PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12, STRUCTURE, 14. ONSTRUCTION, 15. INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20, WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. f3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. _ 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance agcording to Health Dept. ruling. ,✓ . SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). .� 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One shower and one toilet r per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common t cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code.- 10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. 13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max. filtration rate 2-3 gal, per min, per sq. ft. filter. Disinfection equipment finely adjustable. a/19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). =22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. ,-*'23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. '24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 25, CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7.5. /26. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. _32. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS: ` — a he a PERSON INTERVIEWED SANITA AN FORM 1708 HOBBS&WARREN. INC. i 77 e+ Bather Capacity: 19 Outdoor Pool See Reverse PERMIT FEE THE COMMONWEALTH 9F MASSACHUSETTS _45 TOWN BARNSTABLE 50.00 of.... ..................................••------•--_....._........ Board of Health This is to Certify that ..O$TERV�LLE-PINES-CONDO___ ---•----•' ------- •---------- 3040 FalmoutlMoad, Marstons Mills ..--•.......................•--••-•-•-•--••-•--•---............_.._..------'---'-.._..._. ADDRESS IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool At ...A_.Qualified swimmer must be at pool site all times pool is open. Method of water treatment:'Gfiloririe=automatically fed. •"•"--•-----------"'------------- •--•-•-•.................................•-----•-•---...-----•-- This permit is granted in conformity with Title 2 of the Sanitary Code of The Common- wealth of Massachusetts, and expires --- December 31_1988 sooner suspended or revoked. -------------------------------unless ............ And_J�Ii�.Es baug --------•---••--•--------------------•---•----- Board ..........jww..17..."--'----........_..1$8..._. It Crocker Sr_ .......................'-•....................... -'- Health FORM 1712 HOBBS&WARREN, INC. y -.--•--.-.--•-'"-•___""•" THE COMMONWEALTH OF MASSACHUSETTS Ovt t 1 , POOL OF....... J _ ,,f /�01 HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NA WP'11410 DATE NAME V--__J ADDRESS Alodfiu. NO. OPERATOR MAX. BATHING LOAD PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. 0ONSTRUCTION' 15. TNLETS AND I OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved onythe construction plan are of permanent nature and need not be checked at each inspection; 3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept. ruling.- '70fr. 5. SAFETY: One shepards crook and one ring buoy with actcf"te rope for each 2000 sq. ft. water surface. 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police,, fire and several available physicians. Telephone available (not paystation). I Jq I T 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 440. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the.pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. 11/13. RECIRCULATION - FILTRATION: Purification system capable of.maintaining quality of water, turnover every 8 hours, Max. filtration rate 2-3 gal. per min, per sq. ft. filter. Disinfection equipment finely adjustable,. i19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. L23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. \4Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 25- CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more I often a. required-by Health Dept. Chlorine residule .4 to 1.0, PH 7.0 to 7.5. k.) \.�6. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. 27- WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. ____32. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. X3 REMARKS: A/ A n -Y o r 41 J-, PERSOJN INTERVIEWED SANITARIAN' FORM 1708 HOBBe&WARREN. INC. s ISSUE DATE(MMIDD/YY) 5/12/88 ,..ya PRODUCER � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 4'*• AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS y=_ CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVER- AGE AFFORDED BY THE POLICIES BELOW. Southea.6.tenn In,6unance Agency P.O. Box 2610 COMPANIES AFFORDING COVERAGE Hya.nn iA, ma. 02601COMPA .� LETTERNY A St. Paue. F Ae 6 I&V i.ne IM(aance #! �2 COMPANY B �f. INSURED LETTER OsteAvitteP.i,ne6 Condominium TAu.6.t COMPANY WiU-iam Buwn, TAwstee LETTER r+ 3040 Fatmouth. Road COMPANY 06 .c,UteAve, Ma.. LETTER is COMPANY LETTER E THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY �� PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS,AND CONDITIONS OF SUCH POLICIES. " 1. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS LTR DATE(MM/DD/YY) DATE(MM/DDIYY) EACH OCCURRENCE AGGREGATE _°� GENERAL LIABILITY A BODILY ' INJURY ='E':i=4Y x COMPREHENSIVE FORM 66ND 1634 1/1/88 1/1/89 - �' PREMISES/OPERATIONS PROPERTY UNDERGROUND DAMAGE EXPLOSION&COLLAPSE HAZARD x PRODUCTS/COMPLETED OPERATIONS _}E't x CONTRACTUAL COMBINED X• INDEPENDENT CONTRACTORS BI B PD 1,000, 1,000, x BROAD FORM PROPERTY DAMAGE X• PERSONAL INJURY PERSONAL INJURY 1,000p ;? x Bnoad Foam CGL End AUTOMOBILE LIABILITY BODILY INJURY i PER PERSON) ANY AUTO BODILY INJURY ALL OWNED AUTOS IPER ACCIDENT) „t�l HIRED AUTOS ('£ PROPERTY NON-OWNED AUTOS DAMAGE GARAGE LIABILITY BI 8 PD COMBINED ��=J EXCESS LIABILITY 21 UMBRELLA FORM 1 ` BI 8 PD COMBINED OTHER THAN UMBRELLA FORM - •',.`ri WORKF�RS' COMPENSATION STATUTORY J AND _ IFACH ACCIDENT) - (DISEASE-POLICY LIMIT) .,1•}"j'' EMPLOYERS' LIABILITY - (DISEASE-EACH EMPI.OYFF) OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Town o6 Bahn6tab.2e - Heatth Dept. i6 heAeby named a6 Add c ti.onat In slviced undeA . r Section 11 L.i ab.i ti ty • • I;I • Town os Bann6tabf-e SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED _D I_ BEFORE THE EXPIRATION DAT THEREOF, THE ISSUING COMPANY• Heae h. Depantmen.t WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO Town Ha Q.e THE CE ATE H LI R?OAPIMED TO TF • LEFT, BUT FAILURE TO + MAIL S OTICE LLPN / IGATION OR LIABILITY OFHyann cb, Ma. 026U1 ANY PON " CO TS !d� � k; E J REPRESENTATIVES. AUTHORI 6 E to:xrr;srrxxsmrr t prss nr:lrtgss»F stss sssrxm�rmssxs::ntn:ss��rrt sxn:sssxmrr{rsmFs�ssxsssss�xsfrntnrtmxmxfnfjss fxrxrxxsrs:srnnxr�fm !T rxixrlxxt srs;I x ttnrr,.:1 I 9 i ,pp ...... ... ,..t...:,t. }..1}}111r r .:t.tttt:}t}t}tllfll}'({t{1F:1 .i. - .Flel.. :.;1t [ 11::•. . },.T.-.}},!.::::11:•. . t};t}1t1;;;;:;:.: ....-}ri.. ..,li.,• .. .. .. -.... ..f,,y ENVIROTECH LABORATORIES 449 Route 130 Sandwich, MA 02563 Ha 888-6460 i~ POOL ANALYSIS REPORT _ EF CLIENT Osterville Pines LOCATION Same ADDRESS: Osterville, MA COLLECTED BY: Sparkling Pools SAMPLE DATE: 6/13/88 TIME: 11 c 15 AM DATE RECEIVED: 6/13/88 SAMPLE ID: 140B JOB #: POOL CHLORINE LEVEL: 1.5 _ RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100ml (MF Method) 0 0 Pseudomonas aeruginosa/100ml (MF Method) 0 Heterotrophic Plate Count/ml (Pour Plate) 200 0 Background bacteria/100m1 z ; COMMENT: _ YES NO Pool water is suitable for swimming purposes for parameters tested. xqx DATE it - ist:s:t! .i___,' �.:• ,i�t..i.-.. .tf: :tt.:tttt ...t,.:.: .t.t .,t t.•i tt:',t:ttii:ii ii e::ieie::'2::•ii ::,ti :::•,:::: .................:it ��i:iiiii#s�ussslull1s11issss3�lusuusuWlstutluusl:sssuu�ssuuutsoustsulubilts:iususuusu:ussustasis:fsuss�Fs::lsu:usuus:susssusssuss:usususuuuuuulss:suslsulliiiiiiiiiiuiiiiiiiililliilllilifll`. uF.tllEro TOWN OF BARNSTABLE OFFICE OF HAaasTs> BOARD OF HEALTH MAlt ' i639"0 MAX 367 MAIN STREET � �' HYANNIS, MASS. 02601 August 6 , ,1987 Richard C. Pepin, Manager Osterville Pines Condominium 3040 Falmouth Road Osterville, MA 02537 Dear Mr. Pepin: The Board of Health voted on August 4, 1987 to require all semi-public swimming pools to be tested for coliform bacteria at least monthly, and that hot tubs and whirlpools be tested for pseudomonas as well . You are directed to have each swimming pool tested monthly for coliform bacteria . Test results for August must be submitted. to the Board of• Health prior to August 30, 1987 . Failure to comply may result in the closure of your pool . You are also reminded that violations of 105 CMR 435 . 000 : Minimum Standards for Swimming Pools (State Sanitary Code: Chapter V) subjects you to a fine not to exceed $500 . Each days failure to comply constitutes a separate violation. Very Truly Yours , J n M. Kelly erector Barnstable Health Department TLIE COMMONWEALTH OF MASSACHUSETTS OF.... ........................................................................ .... HEALTH DEPARTMENT SWIMMING POOL INSPECTI.ONb6tEPGRr._ t NAME- _... .c..� �..: . DATE ADDRESS ' d' ., '— s� V b v� TEL: NO. -, ,cry ' OPERATOR l tom' r�.-- MAX. BATH ► '� «ERti13' P STED Reguiations`of the Massachusetts Sanitary Codes Article VI-"Minimum Standards for Swimming Pools". ,. ., • ITEMS:- 1. DEFINITIONS, 2. PLAN APPROVAL 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. JONSTRUCTION,g15 INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17.�SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These I items',approved '-on the construction plan are .of,pamanent-nature and need not be checked at each inspection.. HEALTH: Ao�employee sick, bathers take showers, clean bathing suits, sick.or infects$ bathers not allowed, spitting prdiibited, no glass or dangerous objects. Health and Shower signs posted. . LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance agoording to Health Dept. ruling. 5. SAFETY: One sheparda crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 6..FIRSr.Am: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept.. and several=available physicians. Telephone available (not pay station). BATHHOUSEt Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One'.shower and one toilet pe°r','40 bathers (min. '2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cu s' "�wels combs or brushes. Emergency-room-provided. for sick or in ured bathers with cot and p �7, . 3 � blanket. ;;Foot showers (if required). Pool adequately enclosed_ Approved drinking water facilities. 9 'CLOSUREs.Operator to close pool when water does not meet the requirements of this code. X: PERMIT - RECORDSt Permit posted. WritteW records available of daily operation of the pool, including' ww ,.attendance', water tests, chemicals used, .hours.ot operation..backwashing and other information required. _ 13. RECIRCULATION - FILTRATIONt Purification system capable✓of.maintaining quality of water, turnover every ` • '.R,. 8 houra, Max. filtration rate 2-3 gal, per min. per sq. ft. filter. Disinfection equipment finely adjustable. 19,. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 23 ft. intervals (deep end). 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks. non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. _23. WATER.SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 24. BACTERIOLOGICAL QUALITYt Health Dept. shall cause water samples to be analyzed as considered necessary.' l YQuality shall meet the USPHS drinking water standards:. Untreated water not over 2400 MPN Colifo , Aft 9. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine residule .4 to 1.6. pH 7.0 to 7.9.. : & �. 26. TESTING EQUIPMENT: Testing equipment provided. in good repair and complete with fresh reagents. 27. WATER CLARITYt A 6 inch black diso at bottom of deepest part of pool visable at 10 yards away. 32. WADINB.,POOLSt Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. r1'c \_...1� r,,�, ,•.r. 1 1 I (-. �. `,`s s G� L PERSON-'I R SANITARIAN FORM 81708 A. M. BULK:N 542-585B Bather Capacity 1. 45 Outside Pool Only See Reverse PERMIT FEE THE COMMONWEALTH OF MASSACHUSETTS 46 50.00 1.0m................... of Barnstable .................................................. Board of Health " This is to Certify that ........Osterville. ...Pines....Condominiums.. .. .......... .................-------• ... NAME •............... ...•-••--•••--.............._....--•--.............-•----.............. ADDRESS IS HEREBY GRANTED A PERMIT To Operate a Public, Semi-Public Swimming or Wading Pool A lifeguard must be present at pool site at all times pool is open. At ...::......... . Method o water treatmeiif Cfi1o"r'irie-suomal•it12�"f�' :""""""""""""""' ........---•-----•--•.................................................•--.........-•--••-•--•-•---......-•----.....----..............----......--------•--.....-•----....... ............... ........................................................••---....._...i! ................ _ This permit is granted in conformity with 'iArticlf VI of the:,-,Sanitary-Code of The Commonwealth of Massachusetts, and expires ........ME,.Cembe,X.31.....1.95.7.................:.:'........ unless sooner suspended or revoked. : ,�, ,. , Robert" ") Cli'i��ds : t-Ch'ai'rman ......... ...................................................................... Ann Jane Eshbaugh F.,.:_,. ::: Board Z1i 1 �-•-- .........•--•-•. Grover C. M. Farrish, M.D................ of . . ......................................••---...............•---•-.....---...........--- Health .............................................•--............---.........---........--- By .................... .... ...._1 .._.//Jj• FORM S 1712 A.M.SULKIN.INC.-BOSTON (617)542-5858 i Fee aks o C9c) r of Tws To TOWN OF BARNSTABLE OFFICE OF _ ""' s BOARD OF *HEALTH a r�ua i679• � 367 MAIN STREET �o r�Y 6• HYANNIS, MASS. 02601 �. VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. NAME OF APPLICANT 0- 5-TERvTLLr PINK CONDOMINIUM TEL. NW —aaA=Z1 0 5 _ ADDRESS OF APPLICANT Read , �t • ,r ,-2040 Falmouth er:z r- - T NAME OF OWNER OF PROPERTY OSIERVIIIE a ct 6�n ni n nM r ni r i M SUBDIVISION NAME DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUEST VARIANCE FROM REGULATION (List Regulation) A QUALIFIED SWIMMER MUST RE AT POOL SITE ALL TIMES POOL IS OPEN i(P/.r,a5�lnG I r fi Q y�G2. ✓o rv- spa r c�lc �1 D C'M 2 �a Z 3 REASON FOR VARIANCE (May attach letter if more space is needed) Pool is not used extensively _ Pnnl attendant_ dniih ley aS nw budget for Condon Aver hc okeyt- n of s e v swomrs a , pao l CAAO-- at w O AA— PLAN - TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL Robert L. Childs, Chairman Ann Jane Eshbaugh Grover C.M. Farrish, 14.D. BOARD OF HEALTH TOWN OF BARNSTABLE r � Signature P.O. BOX 2726.22 DEPOT STREET OUXBURY, MASSACHUSETTS 02331 Management TELEPHONE (S17]934-0105 MCorp. P.O. BOX 310 449 ROUTE 6A SUITE 2 EAST SANDWICH, MASSACHUSETTS 02537 TELEPHONE 16171 888-0866 June 30 , 1986 Town of Barnstable Office of Board of Health 367 Main Street Hyannis , Massachusetts 02601 Dear Sir : We are enclosing a Variance Request Form on behalf of Osterville Pines Condominiums . The reason for this request is that the pool at Osterville Pines is not used extensively . Because of a low budget , one person is hired for work as the pool attendant and as a maintenance worker as well . We , therefore , request a variance from the requirement to have a pool attendant on duty whenever the pool is open . We would appreciate your favorable consideration of this variance request . Sincerely , Richard C . Pepin Property Manager v. jm Encl . THE COMMONWEALTH OF MASSACHUSETTS _.. . .. ..... . ... .....OF......` ..............,.................................... . . �, i I1©v r HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT, f NAME I r. ,�, i `��- �� P '. y-+,.�1' DATE `) z``t P 1N ADDRESS v 1fly Q; I , I TEL. N0. 1'�2 — ' OPERATOR C �� a, ��;t 1-, MAX. BATHING LOAD G U PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8, SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. ONSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS;, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. O t1 —3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. Oy'4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept, ruling. -� 5. SAFETY:�One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 8 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local Kit police, state police, fire dept., and several available physicians. Telephone available (not pay station). 7. BATHHOUSE: Separate dressing and sanitar y facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One shower and one toilet per 40 bathers (min, 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 1V 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. `+' 10. PERMIT - RECORDS: Permit posted, Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. C_'13 RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max, filtration rate 2-3 gal, per min, per sq. ft. filter. Disinfection equipment finely adjustable, ^ {Z19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 2. ft. intervals (deep end), �J�22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or ii cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room, 23. WATER SOURCE: Water used in any swimming pool shall be from a source approved bythe'Health^Department. 0 !�24, BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. �) -25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7,5. 6. TESTING EQUIPMENT: Testingequipment provided, in good repair and complete with fresh reagents, -27, WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. �32. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less.. 1�r(-Vk f ti nC71<' 39Ir+ ft L.C,eo REMARKS: b✓�i.�kh do ti ����\ as� �U u eL 4 X ej �. 2 PERSON INTERVIEWED SANITARIAN FORM 1708 HOBBS&WARREN. INC. ]-�3+'f q � •r "e't t-.+ },"s ,. � ..,p t3 .,b ,r . '. r7J, r .y R r� r ••. �. y �, t ?^ 13,E-. v � -ri. � ��' Y,,s" t �,+<_* ��•N: , ,=r,} .. ^* ,'s 1C w .r -n , . 'Sh. T + m`Y' qGf• :.e"Sx ,- r y�g ,,i a f 6 3 a ;, 1R,. x�P LAv.. 'r �•. > • y .,..� y��+ r 4y,sy� }',� sit •s,i' t4-.. . a'•,.�I �. sY Y 4+..�,.,�� � l' ' ��� a. t,? �d j 4r .�� ` '����s g,^tt+a _ ..� 9 yi i ik f ^�, ry•. . *`� � .t a t � "*A.�..tw1 a >'.Y � {�{r h,j-�.t Y'� s � t..+ .s ,+� n a _�. + .y k _ •fit ya.. � _ • ,,. =r``• ,e, 9 + � + 41.1 �.i� 1 t t ^,.y i ,y , J' � J�� # - `k• fl R. . g Y'i,+rr C :. y ,tw.y � Rif 'rM1,r t •�• y- *-"t ;tt A.t..j„ ,• t G '.� .r`."• S' ti t Maq-22 �1985 � ,t T x t YrK .t,,.t .�,• tf r� � "4 .+ y, r tt5•. ; "•� 1 �Y c �a-r .ax f w y t- '.. b ,�. ,�-1 •„f. 3i{ r ,+ + ,t ,^r.:. +e c�: 4 a >,,,i t t ' r y t � f "`r .t : •< '7« ` to Ms.'Marilgn Sachs Trustee t k ` r .. L f�... `� + �" y t a xyKXu't'C ,� S + •, ; Ostervlle:PinestCondominium Resort 3040;Palmouth Road" a P+ n- _ .. , 74, 'Okdrdille, MA.-,62655 , 1� ", f yr l ~ N •'_''+ J � y +t �'ny.. R • 11 d' �! ., +<.'�iti._. + y t +p,+ to •'+ s R Re.4y4 Your,toutside swimming'pool Old'Bather Load Cap"acitq X ,` 'Modified Bather`Load Capacity I9 rt ' a "' ,i„ , �: `beartMs Sachs. t ;� ,w , ^�.�` J$. f, - I',.. 7 i t . � t r'.- s-J~,f•. - •r ,!.' :; ..R , r - ,+ ,�„ ` ,wewwillallow yqu to-set.a'maxini um capaciEy,of 'I9 pereons.:at'your-sw immi ng pool. This { �_ `includes persons in`your ,pool and includes all other'parsons:wi thin'your pool enclosure -` The following conditions must.be complied with: , t" ' rys,kr•�a :�� t a{, `_. t �..,. „, S d s:. dYi +fY..�r f > ' `7,t , at,.'.' t;•, t ,r+ •'`'�. -f.: 'pool 'must,.be supervised, by' a swimmer, eighteen.'(18) years of�'age , or1°older, qua 0, management",at pool site,at a11=times the;pool is opEn. '•We _wish to !.t7+9 J; r r l , make it°c earg•that+µthis swimmer must�be,�aty the,.pool and cannot.be observing. from r ;:, ';' elsewhere this swimmer`'must€' beuphysicaily present"at-"the pool<:at all`times:the .Y i,., * poo is`=open. This swi er' 'must, ber,k familiar'" wit :k.' • min •knowledgeable 'in'first' aid procedures Anciuding resuscitatton. (Minimum swimmer,. qualification r`equtremen,fs,are enclosed) 1. a'4.' .i�,t r!'� '• � y aFt i#at i ,6+t�' 4,y�'� `� �94- `$; .« aft` j� ,t W,".i+r S: #,y`.•`i' .�i ^f"'`` y�v '. y.. }try F . 3., ' (2). You'must.keep a-permanent ,record on 'a•form, prescribed by the Board ;of Health listing`each swim me_r:y super vising the,-pool •when•itAs,in use-,,Oamgle of.,pre'scribed formfis enclosed)#ti tt+is`�� r ,. �5 F� ., "inust�,have,a,copy of,°>your •insurance policy' naming the`Town as coinsure°d in the amount of$1,000000. su' . ' +R� '�& �'n a f. ,� 74 ,j,^ i , � ,�.•}. r .a; f�-e ter' Y ; � _' 9 .,_ r :- t,i�'���:'w ��� �'=a h> >r 4 Y-e gr,'�J'.:Jy c ,rat. tP-' ; Y L Yf�'. y 6!.. -•. "a_ .y., r ,�. #,f ws.� 9(4)• All other:rdgulations'contained'an 310 CMR 12:00, Minimum Standards for Swimming "" Pools, must be strictiy cbi6lied'with A��� ;. d�� (t�'� *r+ ,� ..<� t fir{_.. ,C' .7r"">`- .i.? ` _ t `� •�, " ~^�E X"a ti.+a r �"`5 M < r #'r' y . `" ` ,3" +'N,tl � + �y.. r? ''�i � yP .�.•.,,.f# �,_,, ? pti .,b.. kf#,n„ r 4,r. -(5) �In ahe�event ypur' pool is-:,used- by ;persons•,`other than: owners, tenants Viand `.their. : r guests, {or bq ,persone'.charged�afee it".isf�your:responeibility;'to provide ea life guard ,with',•a current:`Red;+Cross"Senior LifeSaver's°Certificate or.a"Nat'ionalY:AiC.A. A' } : t SenioryLife Saver's Certificate t `' '•� ' °_, ' d �' -sR t' r..,� k.� � µ'+ � sr'� 'h •,�art # a't i�s• :)`ty .,+ ;. w a+.. •f •+. �.,:-�,/A � ,:n � >a?s t t;: 4� �; �r .T" �s'�xl•" t,,Y is �.k"' i==`- ,' z k� .:'� ♦ �yf,'`. �'a" ,k.�, r ! •.,,ie r A. ;^ <e .-sr^'� ° -`?hS ' i�.Fr ,,r"`xN'P+'rt� •s. J , You'are ;granted..this. modification Hof,gour``present` pool ,,capacity" of 45 persons-tdcause, you haveM�stated your,pool is_used by,less than-19 persons,at all times.,',� 4p a S{.��`' s�,{ :♦ 1 r. t � rfV•+ d w'.•.4;'T { t-' 4 r: � �rR a 4, i �` '"'.:.1'M p ,t � 7P♦ ,{f� t �i f .. i i +� ,t y. 3'.�'�"+ ra,*.,, r��r i +�'t• 4F:, +'� �;:, P *:.• �,�i r' s t, ,� y- F' a4. � Our�•:health inspect6r' have verified that qou" have had ;less than 19,,persons,At`pool site r ' �'�`it Ry ,a K._- e s S+ .-s r x-r- 1 L•r. 4 ,� � t r t during tther'inspections. � ' r .` s , + t.'° t t., < r �k a ;t Yr ,.-, 'rTM� we E 'S 1 •t r rk*�w r y ' y:.r. 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C r*' ,�k 4'ti = - . d' •.+n. r ., t v> i# a a sen :96 ''j1.s'3`r '..w � ..� r r...:k r �y' � ✓ .-' trt A. t .��..�+�„ -�,� °+ �44' rz• ! �, �€,�.v. 4 .¢�•f�r s t '(-r-"��.#[S.i ,,r4 n ,< a'i a ,�L i ., Se a 7 - R,•'� S •L �Y E q. � � �i Y y '•; d'S. • ,� + � ., # sra e," a '.`tT k {,,# r a .. �+�,, .�; r r ka- r , 1,� 1 t #.. f t' r�"•�: .�" E.+ w :. ,x ,,�°F^. f' ,t J e '� .�. �., � } -• � R Y"t .r< . yr. r r.,y� d. a e�"� •€� va.+"t d a > 0�u s - r,( a �pZ �, y ! r sa � '�. � � ,�,� "''C �. # .f..� r a sir' ( Y t .. , 4', r '- f ; •- � "•S' gyp. t w �, �# t Sf: L . + d,^:`•..+�� { f yd ,,.�'..+ s ti,'� >''F At 4 k ��., �t -.a'e�•� ,. .. � .r `� ..s �� bs _ � t� >. ����s. '! v t, r? , 1_ y ,e`.'t ti - �. ,•' y yr /}.:� k '', f r1,r.i''+ +t•.n r1 +A . .-t ! 'S �f , +.4,,yp .?rt 1�f.f wm,,. .-. , k �, A..... { -fR t �.," 1„i,' •,•_� , ` . "� t- .._ :fir P" N , ' r r' ."'S+" d,i .;: a S , i I .+'4 } ti ' a1t. ,,, i,:1.P .,,a +r-r, 1•' 1 • s x + . t: .. •.} r ::T k s 'ter r t .r: i IIII n , l$4'w-,J c�'k..h 1 4 t ?r s.cI yi .; } t a r'v`- .["' ' Maillyn,Jachst. i.•�s t. �t„5 � r 4 4? '� y 4".,. A a� i s�r�`f i* _' t. �. Ifi' �.. 1r *f . ay P., t Usterville.Pines,&ndoininium Resaet I+,,;'"j'; t`$ '' ;A Page 2 t ' '? r 3+. i>� . 31. 1 ` s. r ,` :May 22. 1985-, ,, F - ,� y: {I,' 4 t ti. ttit�k9 "- `A cr , t `t r �'w s S .. �4r i 4 yy g 4 +< } T yl .* ..t, a x P ' trr", r .i 1. t�-.r •:., s,, f' ra ,+ t r ;S°1a y li } ;� d i "� iI * sr.y� 114 r x ; 'i. ,, J 7 +, •� ,_- '. ` Y`.. a , k'•'.. Y+- t•i a#' ,r a�,,. fclr ' # 1 'r4,"x yi ,* 1' k r-r+, t,,.. a4°y:' • I" 9 ., r 4'••`* 4 ti ..•4 .r r .S"'`. ',j { r}� A ,d w'n t. +s ` a K �• ' r is f t, r + f +' �_ ` 1 yJ1 •,r a K a ' t '�`• ) ` ; 'V N , ,z i. ` 0. '- a 't l r"�t+'' J, :t +t { +1S`r�r s' r t y ., a� !^.1; - r• .- A_', s . - r °5 ° 'R f. r:ds,;" # n t r,1. a.� . s4x,. sY�.e ` r�,r. A Y T. 1,; ^ �*Please be advised that ifs,you exceed this capacitq of,W9 per sons.Np'aur iit"odification will " `1, '", be-;invalid Tandy you ;will,revert ,to your , easureii b ther loni3"ic'apacity oiy45'.persons ,'! • #-'''' , Y- -A certified life guard;will,tAen be required. ;. -' FAQ 4, "� •A, t:` _x- r, s . t N ;gA .. ,a , �'s_ d.- , t r; tS�.'�T 'ry. ?.F - t T .ST: 'fit�'t. �rI, ' max, t.`.4i +5"•,'_"y l ri4 j.: r?Y h �, ' k _ tM) ,K x`f,The Board :also reserves._,the.:_right=.:yt� require a certif led,lifeguard if'violations Hof 310 4� t .-�. ti ,r C R'i2.00. Minimum.standards'for Svaitnmii g Pools;are observed�,t ►. f F t Y ry 4, w 11. x _ - .5 a vw x ..t j!' ." >r '- -%. %r�1f .x i�'� -•11 r ' r1 r •. '' ,i_ .rr+ t,_ ,. 'n' - M1 y. .., r 0 ,� Y,,. y'�: Ot i Iz rs.. 1, :n t" J `'^ , This modification'egpires Decembe132;�1985, ,,: ; ti:� �',`.r rr. �, '. y l• « m n Rj A �ry ". s )l: 1s R4 r .f t , t t ,, f t, ,."ri -Zr 4 " ...' t '. 4 F s«,fi tr ti'+� f 1 C tC, Lxq •�, 'y.r ,. a ir• G- 'F: t 1K: •�1 'l r a 'h '+a L' of Ve Illly LlEs. , As' w,,,. -��;: t � t - w , � t , G` rf ; ;,, } + ., •�.".,.z a d?"{' ,,, kx a �,:. t �,. •"S , 44�r v n ' I.- - _ 't -c.. ^. " ,F •.r�. r� �. f3 q, r ,+ i>I t _ t� 3" $'t - �1 "'t a-.:' i ,ki:kv T C,. `` e { t.`i x 11� • y, `. "`" 1 r �"''x . k`I �. 4/ 4 r t " . i r1'1a•E rf,- J ,,�'! ` i - c !` It rt i:.`Childs;Chairman 3" 4 }.. x,, a , -, 5T*. " j`f � " "A , b;. .,4 .;. ti< �, . •. } „-'�. a .,t t +` ,•E F<i} r.. �'�Ott qqt,, q �i ri1 ...h , `. "' ,. '"I b I a 4 y J i• 0. ar r,ar r�`t,• t r y ~. + 4 `i .r ,�A� +�r,ST a,d a .?"' t r ..+. .+ 4 '"'} � " Y �'. 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Grt ti a,A4 i 'q ..r ' , R 'dud x t - r •,w r& +„6 3 + .`4 k', sae - w,,,,'Xk rr�,ct` }}, i y r $, 4:, ,� + .•'� ry ' ,�«.� .. y ' °,g.r� ,, ik.`'d'r -,�; VAi r.. I i �•.4 r"'4, K . +i^!6 }f�' r'`y}'k }1'w y S r� ¢{,, t�i S' .0.... W," rt� 4 r. 3'D'dt` » qe 1 ' -W `s 'o r k A k av ri. 7 < .1.r i„r.r 1 ..:�: % 'y j x s L :4 4' "� , " ?. Pr. ;J ♦$ .1 1 c L t 2 v r c .�,+ s 1a �� e�if i , .. ► ,+ . v' i' t o- ,4 -,?h a SY V 4" i_• '4 ram'�e t i C. j{ •{• �Yd C.. Y {. r.� f 1Y` ':" 1— s t,r s :.^ 1` r �.,^+ j, S .u 6 ! .1 S• T ♦ a :3 ♦,p 7 t i } 1. L$ i '".i , _ i, .9fi -rSi 1 1,r ` zr� f!1 ' , '4 t .. k'' t,':k rR. ' + "r .a: i! } .l i�. ' i ° 'n ). d `y a7".,jt 44 ;�' ' r : 'f. :3.E t x''r +.d' ." :vA t.y• i jr ,. ; I@ r f 6 , i J C ;+��`F ,,'..� d -L '9. r")y '`y ,t I. '` °-'f`,7 i!'; ?...`T' ?r.. j !.-, µ': �"'4,..,"' Y� fy e,. '.A;cp' T i+ i,, "t��,e, K '�" .z'-',r:'0.i•! a'1, r.'+rr ! !,} �: ..., W� ?�k 4.-✓k•.._�a•�•a _ I. OSTERVILLE no P �° "1 0 V U �� May 15, 1985 Mr. John M. Kelly Town of Barnstable Board of Health 367 Main Street Hyannis, Massachusetts; 02601 Dear Mr. Kelly: Thank you for your letter dated February 26, 1985 regarding the pool operation at Osterville Pines Condominiums. The Board of Trustees hereby apply for a modifica- tion of the lifeguard requirement by the Board of Health. Attached is a completed variance request form. Also' attached is a certificate of our insurance coverage in the amount of $1,0000000.00 which names the Town of Barnstable as co-insured. When the pool is filled, we will submit our water sample for testing and notify your office as per your instructions contained in your letter of February 26, 1985. The pool will be attended by our Manager, William Murphy, who is a qualified swimmer. If you have any questions, please feel free to write the Trustees or call Mr. Murphy at 775-4379. Thank you in advance for your consideration. Very truly yours, OSTERVILLE PINES CONDOMINIUM TRUST MARILYN SACHS Trustee MS/m -Encl.(2) 3040 Falmouth Road Osterville, Cape Cod, Massachusetts 02655 I7�Rx� No. DATE PyOFTHE T TOWN OF BARNSTABLE FEE OFFICE OF i BARIISTAM MU& BOARD OF HEALTH amnc � 367 MAIN STREET HYANNIS, MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted five (5) days prior to the scheduled Board of Health meeting. NAME OF APPLICANT OSTERVILLE PINES CONDOMINIUM TRUST TEL. No. 775-4379 ADDRESS OF APPLICANT 3040 Falmouth Road, Marston Mills, Massachusetts 02648 NAME OF OWNER OF PROPERTY OSTERVILLE PINES CONDOMINIUM TRUST SUBDIVISION NAME =- DATE APPROVED=-.-___ -- - LOCATION OF.-REQUEST--3040j'Falmouth Road, Marstons Mills, Massachusetts 02648 - VARIANCE FROM REGULATION=(List regulation) - - - - VARIANCE REQUESTED (Specific request)_ -_.Modification of lifeguard -requirements.,_ .. _ . REASON-FOR -VARIANCE- (May attach letter if more. space needed) -- - Qualified swimmers will be present at all times. No more than-15persons -in - pool at any given time. PLANS - Two -copies of plan must be submitted -clearly outlining- variance _requested,____- . VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL Robert L. Childs, Chairman Ann Jane Eshbaugh Grover C.M.. Farrish, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Insurance TYIIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. NAME AND ADDRESS OF AGENCY SOUTHEASTERN INS AGC1Y COMPANIES AFFORDING COVERAGES FT BOX 66 - ,[ A MAIN yy�``'' q COMPANY y q 1 641. MAIN S i � LETTER CY 1 I',!"I U I... I"IYPlNNIS ESA 02601 COMPAN LETTERY B ST -PAUL NAME AND ADDRESS OF INSURED ///��� _ COMPANY ■ (('�yy 'q I� - r y�,o LETTER' v ST 1-AUL OSTERVII...IL�E 1P J�,1.NES COMPANY - (30,10II__11 I"AI...MO�� ! I"I RD 2 > t [ LETTER OSTERVII._L 1"� IllA 0A CJ55 COMPANY LETTER This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time.Notwithstanding any requirement,term or condition of any contract or other document with respect to which this certificate may be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms,exclusions and conditions of such policies. OrLICYLimits of Liability in Thousands COMPANY TYPE OF INSURANCE POLICY NUMBER PTION EACH LETTER EXPIRATION DATE OCCURRENCE AGGREGATE ! GENERAL LIABILITY t(r��i�/N�.,`�C� 77 date 8 BODILY INJURY $ .I. u 000 $ .1. , 000 COMPREHENSIVE FORM 7r1[:.'[}(�tiorI d to 1/01./85 PREMISES-OPERATIONS PROPERTY DAMAGE E 1. Y 0 0 0 $ .1' Y 000 EXPLOSION AND COLLAPSE HAZARD UNDERGROUND HAZARD PRODUCTS/COMPLETED OPERATIONS HAZARD BODILY INJURY D CONTRACTUALINSURANCE PROPERTY DAMAGE $ $ BROAD FORM PROPERTY COMBINED DAMAGE INDEPENDENT CONTRACTORS PERSONAL INJURY PERSONAL INJURY $ IIx Directors doff cers AUTOMOBILE LIABILITY. BODILY INJURY E (EACH PERSON) COMPREHENSIVE FORM $ BODILY INJURY OWNED (EACH OCCURRENCE) HIRED PROPERTY DAMAGE $ NON�OWNED BODILY INJURY AND PROPERTY DAMAGE $ COMBINED EXCESS LIABILITY �669NC 9677 1,101/86 'UMBRELLA FORM ./..I--,c e 1E'1.i.o n d a t e 1.11 0 1/t: 5 BODILY INJURY AND $ 1, Y �0 0 $ ,1• q � OTHER THAN UMBRELLA PROPERTY DAMAGE FORM COMBINED i WORKER'S COMPENSATION STATUTORY ` and EMPLOYER'S LIABILITY $ )EACH ACCIDENT) OTHER Blanket Building 1/01/86 $1 ,415,000. replacement cost B Property- Fire Blanket Contents 1/01/86 $ 2,000. replacement cost DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES CL7NI:,OMIN:%I..1MS Cancellation: Should any of the above desCf..) policies be cancelled before the expiration date thereof, the issuing com pany will endeavor to mail days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. NAME AND ADDRESS OF CERTIFICATE HOLDER J� 'I ((}} DATE ISSUED: AF'r`i. .1. 9 V 1.985 .W, TOW-- Cif= I AR14STABI_E B A I*-.'.N E T(-t 1=,I E. mi A AUTHORIZED REPRESENTATIVE LORI WADSWORTH 0 Of B.1?�l � sa BARNSTABLE COUNTY HEALTH AND ENVIRONMIENTAL DEPARTh1ENT SUPERIOR COURT HOUSE p BARNSTABLE, MASSACHUS,ETTS 02630 J 1� PHONE: 362-2311 AS 7 EXT. 331 SWIMMING POOL ANALYSIS Client: Osterville Pines Condominum Trust Collector: William D. Murphy Mailing Address: 3040 Falmouth Rd. Affiliation: Manager Osterville, MA 02655 Time & Date of Collection: 6/12/85, 9:00 a.m. Date of Analysis : 6/12/85, 12:00 p.m. Telephone: 775-4379 Chlorine Approved for Total coliform/100 ml SPC/ml 1.0-3.0 Free Swimming Sample Location limit: 0 limit: 200 0.0-0.2 Combined Yes _ No Condominium 0 <1 x Remarks : •� Board of Health cc. Barnstable Analyst: 2/24/84 THE COMMONWEALTH OF MASSACHUSETTS _ ...,... .__ . ...OF......................._.......................................... ....... HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME DATE ADDRESS .J I _= n� ilk '- \- TEL. N0. OPERATOR MAX. BATHING LOAD PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. 0ONSTRUCTION, 15. INLETS AND OUTLETS, -16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved . on the construction plan are of permanent nature and need not be checked at each inspection. 3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not'allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in&ttendance ageording to Health Dept, ruling, /7. One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. _ 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). s Alf\ 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted-, drained, ventilated. impervious construction and light`color. One shower and one toilet per `0 bathers%(min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common c s, towel's, combs or brushes. -Emergency room provided for sick or injured bathers. with cot and lank et. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities.: 9. ,C'LOSURE: Operator to close pool when water does not meet the requirements of this code. ::10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used. hours of operation, backwashing and other information required. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every S4ours, Max. filtration rate 2-3 gal. per min, per sq. ft. filter. Disinfection equipment finely adjustable. 1/19 DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). ,L22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, -no splinters or cracks, on slip surface. Not over 10 ft. above water level. and at least 13 ft; unobstructed head room. r . 23. WA;ER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department, . ,BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as .considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 25. CH12JXA7L STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often required by Health Dept. Chlorine residule .4 to 1.0, pH 7.0 to 7.5, t/16. STING EQUIPMENT: Testing equipment provided. in good repair and complete with fresh reagents. 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. __32. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. RMARK � Z PERSON I TERVIEWED Si4NITARIAN FORM B1708 A. M. SULKIN 542-585a a i i r'• ,rk vs, '�"'� J.�..�' .i- � �'tk <k Y a - 4 � ti - , e�, ✓, Y ..Y � t. - � I ti h..'a ih'L' rF ,�. 1 '"e' , '3 q �, kk °t J. - '- L .PS` i 7 i,- aw Fs, r ,{ - 2 .E � °m`� x ..�'� °>v:5 `�Y{"- } "�• � e�•, "i Ya 1� � ♦� :� C .. r + F »,'�.k d.� *r ..,.r� Y ;-e,r s,"�...• § � �. Je' ,, �.f sr ; ♦ f ♦ •i � C R' �e �-_ .. � �' , ', • * Yct rt ,a <.� t fk' � i rw � , t f U r rhd i #�` M. ..} "�:w -c��"re. r r +_ - ,,�� S -. h..ra a r r t .Y a r>.:r t�`,•.e 6 k y a4tM aa'y�' 6,.` � �a'`ti a.r':� 4 i.♦ a -' � ° , A�x � � `� -K� ..S Ea k,'�w %C„'�a `. . f .: <44f . +y F (^ (�.;n - ! (per M - k.�C e: 3a" .dk j J Y !`` F 1 ' -74 .� a :�iey 1. ..r k d r •"4. < . n Z r t e «ri: +n. "t<. -e 7 - a d'r, -+, y + 1 f ` 's _ .. '•« _ i1 '._ ! �.y'Y sL el `r V* '.y n 4F < , r• ,�kL s a:i Y- y J. tMt,x, >:A `February"26, 1985 F y \ JTr.41 < CA Chairman,Board of Trustee`s+' Usterville`Pines'Condominiuin `' c' J ....3040 Falmouth Road a r { y , n w sterville,;MA.`152655 _ < u , t- s,i i F a .l-: L •'� a to.. .:9 ,r s�'. u .v.-Jj. kt r Dear Sir ,y . - State.''.regulations", require you to *v „your s.` mmnppr }�(�oi er tested r. L� po •� 3 =prior:+to the 'licensing.of=;your door: pool r,1985 A The pool ;must r , r F• - . t k� °, be filled,and clil©rmated prop j before�yo ake a wat sa�riple iwhe rr } ;. $ H v ate sample must�Ymeet, all . and T standards;before`3you Tare ' gjanred., a>license Co open'" 1 lea a"ca onna MacCafftey;z e y 'A.r ; R ,at theK Cciunty Laborator.: ,for an,a i merit and-instruct this I t " tedt.ing There isAa f Dr ` may use:'any other authorized laboratory fpr tkiis rpose: Do t wa nttl the;'.last xXlfiutekto have, = X 4 *rWt ;- i r•, t ..r5a..k Ahis one 4' �.a .a. �f,,, ' '3'•r C r �.r. ., r: r ' e� _ �. o-'t i� r .f ... t ;.. � Y's' » +^ � rt t n i �+ -!r _-.� '*`•g° , f, _ f'The}.Board''of�H lth.,requires k,z( rtified lifeguard.Jin 'att-edance,'nat r' - � "i N�e ", '.the'gool site at'al rives#when;the ol}"is openr � `'� � �fw. k ,,�,� ^hi x �`.:ha 9 .�' � �a *. ••' � � t ,` ° , k :, ,et' .: en d n `c' •�• Reme _ aft aI State and local `regulations; your .; m� a inspected Ple €or an inspectiion at least,three (3) days • 1 F .t�nY � k a pro.to our antic ted-opening 1 y a w ��" �� "� e ? t ^h �� k �,.f's` r ,'�`y1`` r,.♦ > .V,t f'., s :.;_•. � +.». ,.k ..ai.:'T i !" •y rt x � � i ,� ',r ow have any que tons,Jplease call 7'75-1120; extension:182 # <. �' ` n t S"R'i +7a ✓ .,: j '4.ry,.r,r+e. �_. - i { t ^` a�. t `'."y, a s is 4 h ✓ w r sr :.truly yours, f'y t e ,Yr t`. $. ,� �. ' er, .$h prFe'n '» ^f ,� ..fix 4 .en °'n r+'. -•+r7e - k... :iP <` 44 '��"a d�_ 4 ti: � ...w' �' � :,a : r � .�� x � T :ii a'f r a e , k .ar 1 a a c 'S. er. ' i,# ♦x.9 :. x. John M Keliy= , , _ > �, R1 ti« �'� Director oU ublic Health y.. `} , - - , h '�r f �•L z„�* *' ,, j a r °r'^. `st it !;� t .s• ar'�k d xa " b r ,f�-'X t Crr r e*?r x'vg, '._ � >ty s r W'� � �zj,•J lY1K mm �e � 'Y ,-, h r �..� Y �_ � '. '� .�1 I - � '�# �� ,�y F. �r �.�� sin,.y;.� ,rp � y �..•� i"'s r ' ro , � X;, d .$ , - r k Yk �"� '"a'4 y .*d' � t� e' . .� « '3 rm n� ,t a`Rx..w?a <� pr s !e,*r� � +t' n�,�m 7 i-„ - � •� �' � +�`.�"� -mot 3 � i s.., "' Y k�' .-,kk•.Y.'� } a Y �°" ,+ .F. y;, + B- .: Y _4 ak ae 1C. '�."dr rkFs 't" x ,n R-.+' : 1` t -L .2f" s * r :•-. _ 1 ,,""' f.y..o i Y' .ty'- n' *c..- + 'y° , E'R nr b /h j S ^+} F T •i .� i #s" t 3 J5"k"` r43 2 - i + ♦ *. F ,t R'�c'tl YV 'n 4 `ae 1& w J'r ,b } •'. vr,[ s.� ..✓"• aS� .t r F .e. '. .:{ `''.` id t�1 .`i t-t+X S r " .> ..� •1- r -r i 5' i .ro' ..F'. r 'SL.r' 1 � :;[ �s , ,3 :,,ti ta`. ,, s,.rF .j ` ee;k •. t x y s.[. .,�F '' .a n - r+1,. +'r.y T -6 3a t 3 tram- e + � - a ..�cc; c't.S,�S� �'�� j.ft �t x ry' t ry- * 4 ; �'• - "- - : `' ,ka• ,� i .�.?ems � .. S '"+ x�� f -. 6.,S..A•{ L --t`` S• ^A:' ,.a,# � •. r "� ,1� + 4 '. {�n - .a� f J„ $ .« s'+,. r s e+ Y >z " �T' k T•-.� 5k,;� ii V'11 r i#�a a � �a i s t �r try -�_a y 5.9 .;:t � n w ! iy � n-•. + `� � �!. -<t n - a r s � ,. t si'�,;- °�Yt� sr� .o-#r,n�`f`{ �.�,..�3 �.;;,♦ e y y'-'. `�lj ,' k.:.. t F'. ,-f� f ., „L i''c J,g„� t' 3 ;As,(F s% ?b,,.�� 7,7 S AY + P,y '�.�ww;'��y w �7 ,,,, �'.�yx ?Y�y♦ � ny a=w t f :r,` n � ♦. , .°'- � .1 � S: 'F FV.A -..«V" ^ -F 4R 3 -:i aA # J ; �i • { a � U ¢.: 'f' . ^.. •��. G n 1 '7.,r. rr .,j .T - � }':I f• Sr r , �.L '°,. 'ru F 3-�s kr i� 'max ne•;;� ,:� ,�;- a�`��r '.4° " a �c � *s# �.k t�, �. ,��f r •'��,_ t ♦ e a c =o- a � ,�yk � „¢.., « u a' u.,.:'D`, y* _ *fi r a �` t t xr ^j -:,+'r 14 +'$ q'`✓ - F « .+§. :✓� t° v' ri ,.:-,r t�^+ ,.n,P 4 .: t �.` � ... �rra4-.1�`. .: :.:t4 .. . .. _ « sa...- t--.'c wu...... +:C',+_ •... t:- THE COMMONWEALTH OF MASSACHUSETTS _- - OF........................................ ............ :. HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME i l{ C / vc r t j-)J, 4, -.) DATE ?12 ADDRESS TEL. NO. OPERATOR MAX. BATHING LOAD_ PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. JONSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. PL 3. HEALTH: No employee sick, bathers. take showers, clean bathing suits, sick or infected bathers not allowed, U spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept. ruling. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). _ 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT - RECORDS: Permit posted, Written records available of daily operation of the pool. including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. _13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max, filtration rate 2-3 gal. per min, per sq. ft. filter. Disinfection equipment finely adjustable. 0119. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. _23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. __24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. - 25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required .by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7.5. 26. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. lyi--27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. _32. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS: � . � - e�4 t: ,C.. ✓?i4 mil.( tg !t r ;1 - ,:1°4•�'r PERSON INTERVIEWED SANITARIAN r' FORM 1706 HOBBS&WARREN, INC. OF BARS sa BARNSTABLE COUNTY HEALTH DEPARTMENT 2 7_ SUPERIOR COURT HOUSE O BARNSTABLE, MASSACHUSETTS 02630 O t) • • PHONE: 362-2311 �lA SO EXT. 331 SWIMMING POOL ANALYSIS Client- Osterville Pines Condominiums Collector: Mailing Address: 3040 Falmouth Rd. Affiliation: Manager' — Osterville, MA 02655 Time & Date of Collection:—. 611 /R4 A-nn a m bate of Analysis : 6/13/84 Telephone: 428-8562 - Chlorine Approved for Total coliform/100 ml SPC/ml 1.0-3.0 Free Swimming Sample Location limit: 0 limit: 200 0.0-0.2 Combined Yes No Osterville Pines . 0 16 0.6 x Condominiums Remarks: The chlorine level should be kept between 1 .0 and 3.0 ppm. cc:/Barnstable Board of Health Analyst: 2/24/84 .i of e�Rti m� BARNSTABLE COUNTY HEALTH DEPARTMENT 7 SUPERIOR COURT HOUSE Z I7 O C' BARNSTABLE, MASSACHUSETTS 02630 O R! J PHONE: 362.251 1 �1ASO EXT. 331 SWIMMING POOL ANALYSIS Client: Osterville Pines Condominiums Collector: Mailing Address: 3040 Falmouth Rd. Affiliation: Mana4er Osterville, MA 02655 Time & Date of Collection:__ 611 �/f34 R•nn a m Date of Analysis : 6/13/84 Telephone: 428-8562 Chlorine Approved for Total coliform/100 ml SPC/ml 1.0-3.0 Free Swimming limit: 200 0.0-0.2. Combined Yes No Sample Location limit: 0 Osterville Pines 0 16 0.6 x Condominiums Remarks: The chlorine level should be kept between 1 ,0 and 3.0 ppm. cc: Barnstable Board of Health Analyst: 2/24/84 THE COMMONWIc.AL- W.`OF MASSACHUSETTS 6F.. ................................... ... HEALTH DEPARTMENT t` SWIMMING POOL INSPECTION REPORT -;,NAME DATE � / 1• "ADDRESS TEL. NO. r OPERATOR MAX. BATHING LOAD PERMIT POSTED f. Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ^- ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. CONSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS., 18. DIMENSIONS, 20, WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. n_ 3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, 04 spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. yi 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept. ruling. �_ 5. SAFETY: One shepards crook and one ring huoy with adequate rope for each 2000 sq. ft. \water surface. 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water. soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities... 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool. including -r;- attendance, water tests, chemicals used, hours of operation,— ckw,a in -and other information required. r.. �..� 113. RECIRCULATION - FILTRATION: Purification system apa- a of.maintaining quality �''>water, turnover every 8 hours, Max. filtration rate 2-3 gal. per ,,per sq.sq. ft. fil r. Disinfectio equipment finely adjustable. ,.a k 19. DEPTH MARKINGS: Marked on deck and wa11 o e' •oot nt �-�als (shallow end) 25 f . intervals (deep end). 22. DIVING BOARDS: Rigidly constructed, aoredd braced or heaviest load. ound, no splinters or cracks, non slip surface. Not over 0 ft. above�wat .. �rom�a vand at least 13 ft. obstructed headroom. 23. WATER SOURCE: Water used in any ing pool shall'be source approved by the Health Department. 24. BACTERIOLOGICAL QUALITY: Healt D t, shall a water sampl s yze as cons ed necessary. Quality shall meet the USPHS ink ng wat stan ct.-tJe1t a water not ver 2400 MPN Coliform. 25. CHEMICAL STANDARDS: Treated tiilth chl• ine or other effective method. sts taken daily or more often IT as--required by Health Dept. Chlorine idule .4 to 1.6, pH 7.0 to .5. 26. TESTING EQUIPMENT: Testing equipment provided, n god repair and complete with fresh reagents. 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. 2. WADING P OLS: Quality of the wat sha 1 be the same as swimming pools. Turnover 4 hours or less. i RKS: t c I P PERS INTERVIEWED SANITARIAN FORM 1708 HOBBS&WARREN. INC. �� / t tb .. :xp,,,h § . . _ K•:..�� : r J. .. T ro r♦ - .r. , n n:-r,tt 3 -tws' a � :f•j r.t Srk'e r",�fit.{ = r -> .1• � > ; ,-rr. y a1i 4 V C7f1. ' r 14 •-' 4_:. ,I../'' , l - F ice. x _• i '�� i ,��• 'a N j 'S M•..'i i•, e + : t ] - r y i� ! f � k ` rss �t�` a '� ! t w `+► •t t .tii $ ' t` '} + . .� +., ''yr .F ., �' •� t .r'•Z xM� t .4t! r ry v >' �� j �•§.i§Y',.± ts�'+'k Sfi �• t�Iy.'{�r r.s. r t :t' r, fie, � t� , „ k .�' 'h + � ,t, `•' .4. t*I,a 'i. y}^'�` .:s.t:,'. •1 t-t�.r ^t,. ","i v§i `"'' s . , � . . §•+ _ ;.t � 4 `k* rr�;,ry ,w d tr t 4 S �t •« R't.. 0.'* n�•�n,..Sr,, Febru r r :I,r�.'w r, x � 'w� .[ d'�,- ;,,..'".. ' xt �` (vf.. ., :. k: i d 'dt i,a, t_ ^ M .c ^q .t. • � a tr;r'r `'� •'" '` 'i. , 'k• r r r•,. 4,". � .F:.:a z '�,., r �¢" a �a • + i' f �, ,t� .i. :+e , j e r /- t ."�• ` _ ,. h 7 M;, y r v :t • ., +, ry. � ,: 7 r t 4 y ,J , K � d e, 1. r tr. t • r ''' �T` �b'�"f ,r t +rt t �� �, r ; q M1,,fi ! "'� •t v �-�t r.w C?�t 4i t "�. t �_ '3 , '?. i 4 •tr Nry .�,�} �e "� + 'r''+. 5, r'^; ,��"°' 1 a ., i � .+r, y tt ,rt.. y�3 A t, tY �• of '`t ^ ''Y' \ Fti 4, •wY 1 r '•`�5t ,hJ� t^^ k �1L :ti � , + �,tN �„� r1 �J Cr.i�t ,;, r ` „ y,r _ r `' a a y ,15, �1984 t _ �,� z ;,• : � ''- d� c,•� 4'� -' � � ,'.�: � �, ••• {rr _ .i > .i d Y�v 4"�."f - tt• ry "' E '✓ Gx .r < ''- ^.4r '9 +:°,t °n ti.t kr n t, j' ,•,+, 1 .. + . ,+}•s'T-A 4.A t {1x � 't ,� rxh � 9f' •:ii y i. . r„'` Chairzaan' a Board r ofr'Trus"tees, ' .Osterville Pine `'.•*" ��, r=t' Y ,N, ✓ s Condominium,,• , }- 3640' Faimouth 'Road r r x' r a �• a at { Ostez�vl'1e, 'Ma t02655rt : ,t k;> R, t+ , • s, r ,� <•. t+` t F" SS` .r r. {.y c� rYa'7 '=.Tw v x r xr•w .f_ j `' •, ^� f'd; . Deay.Slri h, y 7#''.i" t>./ '�t y...rrr ,. "' j �t 4y rYT rr b` > I, t °•4 '• ✓ � , ` .x r: do-t a r' ``sr • T `£ w Semi u li + r p b c andtpublic :swxmmiag"pools^'in the Town 'of Barnstable will be `gr ted,. Z.. .sv " n. , V iAs i,: x - 4-a J• t �..; ,ta permlt,:only lfal]Spiovis' on� of 31U`CMR 2;' Minimum;~Standard'sfor ,Swimming Pools (Title "2, of. the"State-,Environmental,Code) ;are•teat -,,kCopiesR of. this ,regu- Iation cantbe 'purchased'.aty the Board:o'f"Aliea.l.th office rA11 switnaing pool ' , M ` oEr pe- , ktu1ii aciy ohregulain: �'rLrators'$ v ' ' ,r� r •. it - I r i! ;.,{ _... x^i A'" :'•q41, €f' ,. *7rr' '•x) ,t,4 s.,9 .. , 1 , -,�k',. .. •.r• *r a 7 x + i ¢. ;s. r y. a Y t. t r. Y[ k �w k r �,y, i. k a` a 't' •rs n „f ' t,dtf.Srrt °! �1-,•Significant regul�itions+lnClt�dei IleAW,' 'REGULATION: 12 "�$: rw Your sw be;veil%6&d andchl,orinste prior; 'to receiving a,permita �t e4swimming pool raater�mtist be V*t'esCed" and must{y L7.1 ' !'. i y?meettate tstanilards: The;'County Lab has`certain:days;ftliey, will :do the `. r, ,+r , `+ ,t�,`testin Y'Please ca1'1' 362 2511r` ext' § a , , �g x , ens on-`331, and arrange14or` an -ap oint d t anent td>instr-1 ns fdr this f testing + r Do•not wait until t}ie 21ast minute F c You must{allow+�n €ew, days.to get .the ,testing •done You -may. also have-your swiimning spoolfrwate tested liy -an accredited latoraCory Al 'r 4) � R v unrl " eP" s cannoopen t stresZu c! se re% i b 1B o"a"r§1 d orfr t` ear:1't th and ;;,v t ` Y' •; ,, "`a you',are;issued a.�pe ermit. t°t " § ' . •a 'A tt ;`+. tg' ►{ ` § - ' Al"4" t t' F•" '' `•'. h 4 _t~ T'. d '` - E��tyx` .,, `�` REGtJ7jt�TION _12.O�i Requires automatic,chlo',{Hato,$.';"('„filee 'attached b artment §�yy NW, t of Eitvirgttmental,Quality Bngineering' interpretation) "ix a; *r�#�'i •r�':-:� ,z=' �• n �9 r^ �.-� r <',1. *::t s.; y � d `'ej. .' -1, •r�r :§ -* a � w REGUVATION 12 '23_: Gives' lifeguard requirements `w; a€'r. +>,• Y 0 ,,.. � t . .. - :F, •+c i .;', r � t -' �xat,,. §. -.. .+. �• " ', The Board rules one"modifications do lifeguards requiremeritt;'on .t�ie``.flrst' rand•' +'tr p. t ; , .third. Tuesdays of each`.month .,Any�requests:5for tnodifcaCion�should be'`sutimitted» •` prior t0{"these dares r r . ._v'., tS,.bv x�.. d �" .t• c.•` >'v 3 a',h •t..., e YY.- Y t ,,�'. fi? e'v a ., h,, - "� �" +p nt , r •+F +.5 e•s '-' •.e.r ,-. ' e •• C€ - �• r t, ,� y Rd y,, F t ? ,.d Y S ,w # r t' `�* r"'' ;^ ,J ' 4 §. " � �*t�� �'�4�d2' rjrr�' �rt kx s, { .> • f ry �:•� �. i yS^ `{".0 x`.rY.. t ^.y r s. 4' %i ♦ V'.r Y j. / .r, n 6 } r r. k} !tt,, J�, �7 1`s. 7•' �l�.t. 1 ��i. � ! }e ,.'-i r,[',' L r,• � y � f'• `-_Y s y.. >`tiiT`J t+� y<, '' y 8 F rr. f'+1.•} r i '�, § r T dx r , x 4,~ s +•�.r:i t .. '� '+"'..3+' Y$ •�' r .� ,, r'- tr�• � r r J t w ti ti , i r� + 4 a ri'''- t " a w f.£x. ♦ _:,r t v,y ,.r " .i, , d '•. .}d s. t t e +_i i - y++� ,�'_ '� �,£t� �, t t y, ♦ r f�a -a! 9` s+++c y�<ati��,.. < i 1tl�a .• tl x f f r r ij+. r'f,£ -"0 � 4 + >+r, `x'• , T.xs. •. 4 y f k•{ '� ,�.. ` s ` 4 h,:w„d^w2' 91.1 y tt xrr. v h g, sv A• ,n , r t ' ` ° "t ''` fi' ,r'k,ti��.""• x. ' t I+; r i.4, ,,r,.� ( ;,"k �w�i��� "� ;�yi t '� �%�`•`� �' .� ice• j•'{kf'N w' . .!,*. S rl t".v�.'W f,yJ` ^'�+'t +. rt [. • y J fi , w &:j'" } r (s. +„ '.r- c -k"k i� y�N_tf��tii ?t p�C. t +? f} a '"t'.•* ��ry�rt, F,,x ��{atl.�.�:u �•�jt i'.,y .���t'tie(j °r'3 r y * a 5 t a A t Y.T��. ,. , s: rr a` t v t�m s .sty' r s. �+ ✓ , i§«. r f; o- , �' i i r lv•:•t'B' # t.r rt r + i4 � 3 '+ a •+. �. .�. re ,T. i 4 r ) -tyf �v t r< �. F• � t x d lx.i�. .�+•rii-.fi1'i1�1'[`.+,w. ,.r. ,.. w°+#M'-: a.,.. ,efn_!,1� 8i�x v'�*.` ..t w.-. t .ry4�+:. S�_�1.� .^,. .r.v �' _ .- Z c.. .. !`�'...`" .r ;f:4, -M. _r. +�•' .. , - r.r �C IMF f ''�k v- 'e -•r" lr+ L •ad rtr ' Q +,� ! _••^' s .�r i'.-H t' �art.`� �� r °w�}j( ago-p�F[tl�. '�.� 6 ., �'r ,. f` `` a� r -w v c .[`fij'. r { 4 o-rd,:`{ }�i•w .� Jx �l }�` tih y + r ? } f,y. *t y .?, g +f -.i?4 P ;r r '. ,± i.{ - ,r', °F r ,,,1_ •» a1,�,"' 3� Da r'Chaf � ,?•. T rman, lBolyd.of Trustees: sv F, r 4 A,L >,' } A •�' l ri r 4 r.. z ,, `, ;�• r wOstervtl'le. Pines' Condominium �' a Pebriiary► 15, 1984 9`y + '� fit' F a ` v •M `:§ e s r'4 t k ..'� c a� w1 ' t A f. Page.V: r 9t a, ,r - } 84 ., ru a ta." 1.i .'r ♦* f r J+F � � t r.,�- .f.' a r �. r c .5 '... �,r �. •,� +., ar � -ter F >.5 t `i�a � its a t �y . •�r J h r �_ y r,z Wes. r i fa r i a r ,K•+ : J• . 4 L.r.. t« hJr,, .�.; A 'Operators'without modification ,approval wil`h.be';iequired to have.;d6rtified;,.� , , 11feguar'ds­in attendgnce;.when» the pool; is:open until iaodfficationfapp oval`': a- obtained Stinbat in within,the ool' 'g ,p enclosure ist` prohib' ted kifFno, lifeguard"rat �y �is�on ;duty �The�pool',must`ibe locked and*`free of " " '6onb if,no ~1�ffeguard 'is, Y' $ } /"o duty' " ' ' Vie . }� ; r ' .. z r yrr y. a tt r'r.f�^ i�" k w T rr• . •.,! , Y °d. + e J v '-ek '.yrFti4 Mj Jrc' r��fi r ti t�If p oui�h, aii .{west{oils' please':ca11*. y Y 9 �' �� � 'r`r+L J •,:.r v f �i F x rit 9 � .0 q Veiy'itriiI` "yours, , % e `y; r ?- t a?/ a 'F 4t ty r a , t .< A• , t'� JF.! 94 i rr7 ;.. � t •! rr ,�. c ., ,•�= .e'.� .°Aa""t y�� �,•; ,.t� -.::'. �F�� rs i_. ++Y`' 't F.� �r .. r, .r John ,"-Ke 1ly., 5+l ''�.• t .r,t s !+ r. a ,�. y,.tr-it 4 ,i a ! h r r+.. 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J1 r�' •�� t, f c -r c: r i G •`'!)' t,�r ,l v� �r + i F�'^ Mf''� s "r�+ ! +� .a;'�' .r r 9;,•d• r .r;r J'Q~ Y.,... i r'r¢lY 5 + v .r ri''i 5 �t s,;y ..'.t *•: it f J i�." s., �� " F•r - # �F ��� j.f F,. y� ,,."'"}N6r.+;x.ti<a � t'F. ��� `�A .c 4` •`'� { 4:r� 4 t.,4 . �'.r L �• ° � .`i iy { t. � s}� ur 5rF � Ffiui+ g q�; x sk �Dr ,t F At 5r"`6 � C;; atrs,:x 4Ff,�¥2 t ' , S a '� ,�fa +, t wa�` '�,+'3* r �? .;, r,. , ;` ''Xu a ;i •k r;b*e r 4 {, r:. t U ", - 'dAt �� x r'Y4v •c 4. t3 �.� .. :�. fesl"t .`'+ �+r fMd"., a r`, ar'.�.c &t..r �e�f�^r.t:• » P .. tpf F ...�`�. �''. o-,` _ . ts.r. ;!'an.., ra _K .rr: THE .COMMONWEALTH IF MIA6,SA�ICH14SETTS OF.......................................................... i HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORTNAME �. DATE ADDRESS r �y' .j TEL. NO. ' OPERATOR MAX. BATHING LOAD PERMIT- POSTED Regulations of the Massachusetts Sanitary. Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1, DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE,'11. BATHER LOAD, 12. STRUCTURE, 14. 0ONSTRUCTION, 15. INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 1�. SKIMMERS, 18: DIMENSIONS, 20, WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and :need not be checked at each inspection. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed,. spitting prohibited, no glass or dangerous objects. Health and Shower signs posted, 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept, ruling. 5 AFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. f 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). V7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well. lighted, drained, ventilated, impervious construction and light color. One shower and one toilet per 40 bathers (min, 2 ea,), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT - RECORDS: Permit posted, Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required, _Y 13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max, filtration rate 2-3 gal, per min, per sq. ft. filter. Disinfection equipment finely adjustable. _6/"19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). 422. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room, +j 23, WATER.SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department, L,d4, BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. ,,�uality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. _25- CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7,5. 6. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. _tee<WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away, r�2. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. ZMRK PERSON INTERVIEWED SA1IT RIAN V,,, FORM 1708 HOBBS&WARREN. INC. - - THE COMMONWEALTH OF MASSACHUSETTS _.OF......................_.............................................. ......_ . .. HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME DATE /`.mod Z ADDRESS { TEL. NO. OPERATOR MAX. BATHING LOAD PERMIT POSTED Regulations of the Massachusetts Sanitary Code: Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. ZONSTRUCTION, 15. INLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20, WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. a i 3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. 5 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance a9cording to Health Dept. ruling. �r5 5. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). It 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. 10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. 13. RECIRCULATION - FILTRATION: Purification system capable of.maintaining quality of water, turnover every 8 hours, Max. filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment finely adjustable. r 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). L �' 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. 23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. /r 24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. �} Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. / 25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7.5. " 26. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. /=32. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours or less. REMARKS: /r.f ;d 7f � t PERSON INTERVIEWED SANITARIAN FORM 1708 HOBBS&WARREN. INC. THE COMMONWEALTH OF /AS5ACHUSETTS U V'^ ... HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME 15C%r i t! f - DATE /,ZZ, ,- ADDRESS 6 `% TEL. NO. OPERATOR MAX. BATHING LOAD PERMIT POSTED Regulations of the Massachusetts Sanitary Coder Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, 8. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. ONSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20, WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. Az- 3. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance according to Health Dept, ruling. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. 'i 6'. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). 7. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated, impervious construction and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. Ai— 9. CLOSURE: Operator to close pool when water does not meet the requirements of this code. z` 10. PERMIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. 13. RECIRCULATION - FILTRATION: Purification system capable of maintaining quality of water, turnover every 8 hours, Max, filtration rate 2-3 gal. per min, per sq. ft. filter. Disinfection equipment finely adjustable. 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). 'V2:22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. A_/ 23. WATER SOURCE: Water used in any swimming pool- shall be from a source approved by the Health Department. / 24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7.5. 26. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. /LL32. WADING POOLS: Quality of the water shall be the same as swimming pools.. Turnover 4 hours or less. � r REMARKS: f` PERSON INTERVIEWED rf SANITARIAN FORM 1706 HOBBS&WARREN. INC. - c r 4 THE COMMONWEALTH OF MASSACHUSETTS �I�i� !^ O HEALTH DEPARTMENT SWIMMING POOL INSPECTION REPORT NAME ^. ,� , f� 4 DATE ADDRESS ,n �7'��l, ` TEL. NO. OPERATOR MAX. BATHING LOAD PERMIT POSTED Regulations of the Massachusetts Sanitary Coder Article VI-"Minimum Standards for Swimming Pools". ITEMS: 1. DEFINITIONS, 2. PLAN APPROVAL, B. SEWERAGE, 11. BATHER LOAD, 12. STRUCTURE, 14. ONSTRUCTION, 15. TNLETS AND OUTLETS, 16. CROSS CONNECTIONS, 17. SKIMMERS, 18. DIMENSIONS, 20. WALKWAYS and 21. LADDERS. These items approved on the construction plan are of permanent nature and need not be checked at each inspection. HEALTH: No employee sick, bathers take showers, clean bathing suits, sick or infected bathers not allowed, spitting prohibited, no glass or dangerous objects. Health and Shower signs posted. -9 4. LIFEGUARDS: No unsupervised swimming. Trained lifeguards in attendance ageording to Health Dept, ruling. 5. SAFETY: One shepards crook and one ring buoy with adequate rope for each 2000 sq. ft. water surface. ' 6. FIRST AID: Red Cross first aid kit (24 unit or equivalent), emergency telephone numbers posted, local police, state police, fire dept., and several available physicians. Telephone available (not pay station). �77. BATHHOUSE: Separate dressing and sanitary facilities for each sex, adjacent to pool, adequate, well lighted, drained, ventilated. impervious construction and light color. One shower and one toilet per 40 bathers (min. 2 ea.), hot and cold water, soap provided, one wash bowl per 60 bathers. No common cups, towels, combs or brushes. Emergency room provided for sick or injured bathers, with cot and blanket.. Foot showers (if required). Pool adequately enclosed Approved drinking water facilities. / 9 CLOSURE:�Operator to close pool when water does not meet the requirements of this code. /•. 1 10. P_-ER.MIT - RECORDS: Permit posted. Written records available of daily operation of the pool, including attendance, water tests, chemicals used, hours of operation, backwashing and other information required. /� 13. RECIRCULATION - FILTRATION: Purification system capable of.maintaining quality of water, turnover every 8 hours, Max. filtration rate 2-3 gal. per min. per sq. ft. filter. Disinfection equipment finely adjustable. / /_) 19. DEPTH MARKINGS: Marked on deck and walls at one foot intervals (shallow end) 25 ft. intervals (deep end). Y/,'4 22. DIVING BOARDS: Rigidly constructed, properly anchored, braced for heaviest load, sound, no splinters or cracks, non slip surface. Not over 10 ft. above water level and at least 13 ft. unobstructed head room. I�23. WATER SOURCE: Water used in any swimming pool shall be from a source approved by the Health Department. 24. BACTERIOLOGICAL QUALITY: Health Dept, shall cause water samples to be analyzed as considered necessary. Quality shall meet the USPHS drinking water standards. Untreated water not over 2400 MPN Coliform. 1v!�25. CHEMICAL STANDARDS: Treated with chlorine or other effective method. Tests taken daily or more often as required by Health Dept. Chlorine residule .4 to 1.6, pH 7.0 to 7.5. G 26. TESTING EQUIPMENT: Testing equipment provided, in good repair and complete with fresh reagents. fj 7 27. WATER CLARITY: A 6 inch black disc at bottom of deepest part of pool visable at 10 yards away. /1 a 2. WADING POOLS: Quality of the water shall be the same as swimming pools. Turnover 4 hours.or less. MMARKS• �zi in ix; < t 1 i PERSON INTERVIEWED SANITARIAN FORM 1708 HOBBS&WARREN. INC. THE COMMONWEALTH OF MASSACHUSETTS .a, ...OF................................................................... ........... .... BOARD OF HEALTH APPLICATION FOR A PERMIT TO OPERATE A SWIMMING POOL Application is hereby made for a permit to operate a public, semi-public, or wading pool. This pool is to be operated according to the minimum standards for swimming pools set forth in Article VI of the Sanitary Code of the Commonwealth of Massachusetts. OWNER J)� TEL. NQ '� `�/ RJ LOCATION c_ 7 L 0-t 6 r J1 TYPE OF POOL lv ti�C;�e.��- _LENGTH G G9 wInTH,23°`� VOLUME 5 O0o SKETCH (A detail plan must be (filed with original application) } SIZE: SWIMMING AREA -75y Sb-TT. _ NON SWIMMING AREA 6 DIVING AREA fV 1 SOURCE OF WATER Tb w _ 2 DISPOSAL OF SEWAGE AND WASTE WATER C]V!A W ed TYPE OF FINISHa SCUM GUTTER r✓r��,c ©��n� ����\ V DECK: TYPE AND WIDTH —SKIMMERS: WEIR LENGTH TREATMENT SYSTEM Kind of filters etc.) �-C) l " d DISINFECTION METHOD (Method, type, capacity etc ) CHEMICAL TREATMENT (Feeders, ca2acity, quantity etc.) cam- - REMARKS SIGNED �. --- (Permits expire- on Dec. 31) FORM 1707 HOBBS&WARREN. INC. A Jfi 4 t � " i ' NUMBER OF UNITS �� THE TOWN OF BARNSTABLE BOARD OF HEALTH APPLICATION FOR MOTEL LICENSE NO. 1" 19_ TO THE LICENSING AUTHORITIES The undersigned hereby applies for a License in accordance with the provisions of the Statutes relating thereto (Full name of person, or corporation making application) r GIVE LOCATION BY STREET AND NUMBER INSIDE POOL BATHER CAPACITY OU1TSIDE POOL g/' MAXIIMUM BATHER CAPACITY 0 in said Town of ' (� in accordance with the rules and egulations made under authority of sa ' Statuteso r signature o.� a -cant nt _---P--- �>^D, Telephone Home Address T O W N OF B A R N S T A B L E Axonlication for Motel License Date Name of Motel AA- Location of Motel � Village of ✓� =�X� Name of Applicant Z% Address of Applicant Number of Units b Swimming Pools : Gl'-- Outside Inside Capacity: Q Outside Inside (Signature of Applicant (Home address) ,inspected: G /o 7S (Building Inspector) - Date ( fire Departm t) (Date) card of Health) .(Date) �iu, AM, 1,14.f T O r.; r:, OF B A R .T S T _ B L E 7ppli cati on. for iotel License Dates Name of Motel Location of 1Iote1 Village of Name of Applicant Z-yddress of Applicant dumber of Units yq6� Swimming Pools : Outside `Z Inside Capacity: B Outside Inside (.Signature o i.can� (Home -Iddress) (B 1 . Inspector) Date) . . (Fire Department) (Date) "(Board of Health) (Date) t ` z sc 914 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Application for permit to operate a swimming wading pool. Application is hereby made for a permit to operate a (public) (semi-public) (Swimming) (wading) pool. Location: Route 28 - Osterville - Mass-.--',_„ Owner: Henry A Hylton FOLLOWING SECTION TO BE COMPLETED ONLY FOR ORIGINAL APPLICATION AND NEED NOT BE COMPLETED FOR RENEWAL APPLICATIONS. TYPE: ronrrPtpi �- LENGTH: 40 feet�u WIDTH: 20 feet VOLUME: 40,080 gallons, SOURCE OF H2O Well SKETCH: SIZE: Swimming Area (sq Ft.) 560 Non Swimming Area (Sq.. Ft. 240 Diving Area (Sq. Ft. 360 SCUM GUTTER: Ye s TRIM and FINISH: Pools walls and bottom Concrete DECKING: Type , Concrete. Minimum Width 6 feet MECHANICAL INFORMATION; Filters: Kind Sand and Gravel Skimmers: Weir Length 15; lnches Number 2 Chlorinatort Type Manual Capacity As test regure Chemical feederst Manuall Capacity lbs;. Quantity REMARKS: a THIS FORM MAY BE DUPLICATED J AQUA TEST 1653 MAIN STREET PO BOX 526 WEST CHATHAM,MA 02669 508-945-5895 DEP LABORATORY NO. MA102 SWIMMING POOL ANALYSIS DATE OF SAMPLE: 08/04/93 DATE OF ANALYSIS: 08/04/93 DATE OF REPORT: 08/09/93 LABORATORY NO: 10637 BOTTLE NO.: 363 SAMPLE LOCATION: Pool Osterville Pines Barnstable, MA MAILING ADDRESS: Oceanside Pools, Inc. PO Box 610 South Orleans, MA 02662 COLLECTED BY: S.Simon ****** STANDARD PLATE COUNT /ML LIMIT: 200/ML* TOTAL COLIFORM 0 /50ML LIMIT: 1/50ML* PSEUDOMONAS /100ML METHODS: STANDARD PLATE COUNT MF-HPC COLIFORM MF PSEUDOMONAS CETRIMIDE MF * 105 CMR 435.28(1) REMARKS: LABORATORY DIRECTOR THE COMMONWEALTH OF MASSACHUSETTS ....................of............................................................................ No------------------------- ................................................19........ PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT Tothe Board of Health of: •-•-•--•......--•--•------------•••---•-•-••-••-•-•-••••••••••-•--•--•••.....•-•----•---•--••••--••••-•----------------•--•--••••-•-••----•----•••- Application is made for a Permit to operate a Food Service Establishment in accordance with the provisions of d Chapter 94, Section 305A and C apter 111, Section of the General Laws:— z i ¢ Full e of Applicant 3 Type of Establishment m ....................................•••--•-•-...-------•------••••••-••-•••-••••-•-••-•-•••--••-•-•-•••--••-------------------------............-•-•-•-•---•--------------•-•-------•----------------- m Business Address m i If applicant is a partnership,full name and residence of all partners v ---------------•-----------------------------------------•--•-------------•----•--------------•------•-....------•---------•---•--•-----•-------•--•---------------------------•-•--••-•--•------------ n E aIf Applicant is a Corporation ------------------------------------------------------•----------------.....-----....-----------------•-----------•--•••-•-•--••-------•-...••••. State of Incorporation -------------------------------------- ....... --------- Full Name and Address of: �� /A PRESIDENT ----------------------------- I-------------------- ------- ................................................ -----(�/= -----------------•-•----- TREASURER -------------------------------------------------------------------------•-------•-----•------•-•-------...........----------------------•----------------••--•--•••-••..... CLERK ----------•-•--.......---••-------------•-•--•--•------------•-----•--•-----------...........--••---•----•-----------•-•---------------------•---------------------•----••--•---••••.... Signature .-------•--•---•-----•-----------•-••---••------•......•••......--•-......... ---•...............•---•--•--.......---...•----•••--•--•-•--•.........--•••---••••... City or Town THE COMMONWEALTH OF MASSACHUSETTS F _of _ APPLICATION FOR LICENSE Z No. !� — mTO THE LICENSING AUTHORITIES: The undersigned hereby applies for a License in accordance with the provisions of the Statutes relating thereto x L __-- --- _....._.. _ _ ---...._ ............................................_...._.._...........».... a' _M.__ __ �___— —... - -�' y _..� _ .......----- --��.. -•.............----............ ...Y� �,4_,....... ....._' . ? (Full name of person.firm or corporation malcinY aDDlicatio rcZ To � _ .. .._................ ....._........... STATE CLEARLY - " •••••-••••-••_.........._. 6 PURPOSE FOR 3 WHICH LICENSE ..................................................._...._........................................_....»...._...._...............—............._................._..._............................................................................................... df IS REQUESTED ................_................ .-......................................................._..`._-----._._...._. .._..... .........-----..............----......_........................................ �. ) 4 -T n O GIVE LOCATION tD BY STREET d' AND NUMBER ...........__.._........_..._...._._......._.»._ ._ _._ _»_..—. _ _____..._ _ _ .._.__.._.................. � City 0 in said Town of__. LL. in accordance with the rules and regulations made under ority of id Sta�t�., Received....-....._-_..— .....19— -- Signature of Applicant Hour A.M.— P.M.— _ — Address Approved..-.—..— 19_ License Granted-.-- COMi101\1WEALTH OF MLSSA.CHUSETTS Fee v4.00 Permit to operate a ?per,,,, 1;";71 t in ;.a oc st r ins pool. Location: R.oLte 23. nctery''11 e Owner: n, T;vj t,(;n Method of Water Treatment: Sand and rayp Number of lifeguards required: 1 Maximum pool capacity (persons): 20 Remarks: P-11 permits shall expire December 31 following the date of issue, and may be revoked for cause at any time by the Board of Health. Date: July ze 1967 Board of Health of Barnstable T'-IIS PERMIT TO BE POSTED IN A CONSPICUOUS LOCATION (THIS FORM MAY BE DUPLICATED) �r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTA 'A FAIRS t DEPARTMENT OF ENVIRONMENTAL PRO T I 2 6 2000 I ONE WINTER STREET,BOSTON MA 02108(617)292-5 ,% r f 0FA4N ►+E *DEPr. `TRUDY CODE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION P roperty Address: B1d.0 Osterville Pines Barnstable,Mass, Owner:Huntingest Mng. Date of Inspection:6/15/2000 Date of Inspection: Name of Inspector:(Please Print)Brian T.Axon ' I am a DEPapproved system inspector pursuant to Section 15.340 of Title 5(310 CNIR 15.000) Company Name A&K Septic Systems Plus Mailing Address: Isl?�ox eatiC eett A4a.U2536 Telephone Number- CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature. Date: 6/19/2000 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner -shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to The system owner.and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS: No violations of failure criteria 1500 gal tank w/1 leaching pit w/5'available space r revised 9/2/98 Page I of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Bld C Osterville Pines Owner:Huntin est Mn Date ofinspection: INSPECTION SUMMARY: A X B C or D A. SYSTEM PASSES: X I have not found any information which indicates that any of Me failure conditions described in 310 CIVIR 1-6.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS:SYstem functioning fine should be pumped for maintenance. B. SYSTEM CONDITIONALLY N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes, no, of not determined(Y, N,or NO). Describe basis of determination In all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)Indicating that the tank was Installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pips(s) or due to a broken,settled or uneven distribution box.The system will pass inspection If(with approval of the Board of ,Health). broken pipe(s)are replaced obstruction is removed distribution box Is levelled or replaced The system required pumping-more then four times a year-due to broken or obstructed pipe(s).The system will pass inspection If(with approval of the Board of Health): broken pipe(s)are replaced obstruction Is removed revised 9/2/98 Page 2 of 11 ` ' I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address Bld.0 Osterville Pines Owner Huntingest Mng. Date of Inspection:6/12/2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — Cesspool or privy Is within 50 feet Of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water suppy. The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER f revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Bld C Osterville Pines Owner: Huntingest Mng.. Date of Inspection: 6/12/2000 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: N/A I have determined that one or more of the following failure conditions exist as described in 310 CMR 1 6.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facillity or system component due to an overloadedor clogged-SAS or-cesspool. Discharge or pending 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 G'below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ Any portion of the Soil Absorption System,cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less-than 1 00 feet but greater than 50 feet from a private water supply well with no --- acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic.compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems In addition to the criteria above: N/A The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant throat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system Is within 400 feet of a surface drinking water supply the system is-within 200 feet-of-of a tributary to-a surface-drinking water supply the system is located In a nitrogen sensitive area(interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the System In accordance with 310 CMR 16.804(2).Please consult the local regional office of the Department for further information revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Bld C Osterville Pines Owner: Huntingest g. Date of Inspection: 6/12/2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system„components have been pumped for at least Two weeks and the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced Into the system recently or as part of this Inspection. X As built plans have been obtained and examined.Note if they are not available with NIA. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on-the site has been determined based on:Field instruments X Existing information.For example,Plan at B.O.H. X Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance Is unacceptable) [15.302(3)(b)j X The facility owner(and occupants,if different from.owner),were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .Bid C Osterville Pines Owner: Huntingest Mng. Date of Inspection:6/12/2000 FLOW CONDITIONS RESIDENTIAL: Design flow:440 ,p.d./bedroom. Number of bedrooms(design):4 Number of bedrooms(actual):4 Total DESIGN flow 440 Number of current rest en s: Garbage grinder(yes or no):no Laundry(separate system)(y­or no):no If yes,separate Inspection.required 7 Laundry system Inspected(yes or no) Seasonal use(yes or no), Water motor readings,if available(last two year's usage(gpd): NIA Sump Pump(yes or no):no Last date of occupancy:now COMMERCIAL/INDUSTRIAL Type of establishment: N/A Design flow: gpd f Based on 15.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank presTc [n:(yes or no)_ Non-sanitary waste discharged to the Title 5 system:(yes or no)_ Water motor readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: _Maintenance pump 1999 Project Mng. System pumped as part of Inspection:(yes or no)­ If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) IIA Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installed(if known)and source of information- 20+ yean Town hall Sewage odors detected when arriving at the site: (yes or no)no revised 9/2/98 Page of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: B1d.0 Osterville Pines Owner:Huntingest g. Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construMUlff" cast iron _ qp PVC_ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,-etc.) SEPTIC TANK: (locate on site plan) Depth below grade:0" Material of construc if on- x concrete x metal _ Fiberglass_Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed-by Certificate of Compliance_(Yes/No) Dimensions: 10'6"x5'7' Sludge depth: Distance from tope o�ge to bottom of outlet tee or baffle: 34" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle:9" Distance from bottom of scum to bottom of outlet tee or baffle-l3" How dimensions were determined: Field Instuments Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert,structural integrity evidence of leakage,etc.) recommend oumying every 2 years.Tces liquid level m relation to tees and structural integrity all fine.No evidence of leakage. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass_Polyethylene—other(explain) Dimensions: Scum thickness: Distance from top�um to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 page 7 of I t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Bld. C Osterville Pines Owner:Huntingest g. Date of Inspection:6/12/2000 TIGHT OR HOLDING TANK:N/A (Tank must be pumped prior to, or at time of,inspection) (locate on site plan) Depth below grade: Material of construction:_ concrete_ metal_ Fiberglass_ Polyethylene _ other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:0" Comments: (note-if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)Distribution equal.No evidence of solids carry over.No evidence of leakage. PUMP CHAMBER:No (locate on site plan) Pumps in working order:(Yes or No) Alarms In working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) I revised 9/2/98 Page 8 of 11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:Bld, C Osterville Pines Owner:Huntingest g. Date of Inspection:6/12/2000 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching Pits,number: 1 leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Alternative system: Name of Technology; Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) Condition of soils and vegetation fine.No evidence of hydrohc failure. 5"available space CESSPOOL& (locate on site Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of.vagetation,etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) revised 9/2/98 Page 9 of t t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:Bld. C Osterville Pines Owner:Huntingest g- Date of Inspection:6/12/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) '23 6 01 3a :3q 6 3� 45` revised 9/2/98 Page 1Q of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:Bld. C Osterville Pines Owner:Huntingest gn Date of Inspection:6/12/2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth:Shallow Moderate Deep SITE EXAM slope Surface water Check Collar Shallow wells Estimated Depth to Groundwater 14+Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions X Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Date Describe how you established the High Groundwater Elevation:(Must be completed) New leaching installed - 1/2000 no groundwater at 141 i i, I revised 9/2/98 Page 11 of11 0 No.. .. .�� Fss.............................. THE COMMON OF MASSACHUSETTS ' BOAR® OF HE TH AhMEW..� 60 ...-.-..--of.... :.......... ...... ....:..... Appliration for lh"vii al Morks Towitrurfintt Prrutit Application is hereby made for a Permit to Construct ( } or Repair ( ) an Individual Sewage Disposal System at: /'� .........�"? .. 7 ............................. .M.1 �_..._.........--•------- ------.....----...._.._.................. -- -- ----- ----------- �' *� Loc_ alwn,Addre� or Lot No. .......•.... �_/......•.. �J.z/..._...../ G`�"......n..................•..... --...................................._ ........-•----•-•-•--•----............................ Address Owner ................•...--•-..-----_ Installer Address Type of Building Size Lot_____ __ ___________ el-feet U Dwelling—No. of Bedrooms--_. ---_.._ ............Expansion Attic ( ) Garbage Grinder A4 Other—Type of Building ____ --.-.--_- No.- of persons.......1_9............. Showers ( ) — Cafeteria ( ) p' Other fixtures ---------------------------- - W Design Flow....................... ,5:7........gallons per person per day. Total daily, flow..........F..�6.................... WSeptic Tank—Liquid capacity_a0POtgallons Length--- -0__.. Width __ __- Diameter................ Depth.&_....... Disposal Trench—No- -------------------- Width-------------------- Total Length-_-__.._/__........ Total leaching area-_--.jj-----_ sq. ft. Seepage Pit No.___ — Diameter......... .p' .. Depth below inlet_....___... Total leaching area__l a7.�_sq. ft. Z Other Distribution box ( ) Dosing k ) y `" Percolation Test Resumes Performed by..._ - f� ... _ .. _ --_.-... Date.... ,tea Test Pit No. 1..-._..z---minutes per inch Depth of Te Pit.. ............... Depth to ground water..L3 Test Pit No. 2................minutes per inch Depth of Test Pit----1�------- Depth to ground water.......!..........`.. /---------4-------- ------------------------------------------------------------------------------------------------------------------------------ ---.. 0 Description of Soil-...... `"7l.------ 42-491 Y1-7��.j�.�, �� -------------- V °•..�_/.©�..---------�.- ••---- �r--------------------- -- - W --------------------------------------------------------------------------------------------------•----------------------------...-------------•--------•---------------------------------------------- UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ..----•----•-----------------------------------•------•-•------------------------•-----••---....-------•----------------....-------•---------------•---•-•-----------------•••-----•....._...._._...••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLi� 5 of the State Sanitary Code— The undersigned f thet agrees not to place the system in operation until a Certificate of Compliance has be by the board o Signed ,�;. .... .. ....... .................. ............ Date Application Approved By--- .---- . ---------------------•--------- 13 Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ....................•-•-•-------------•--•---•-....-----------------------•------............--------------------•----•------------------------------ ------------------ ............................... Date PermitNo......................................................... Issued--------------------------------------------------------- Date _ 9 3 Fnz CIO No. ...... ..................... THE CO�MM OF MASSACHUSETTS BOARD OF" F HEAA-TH ........OF..... ..... .5 Appliration for Dhoposal Work.6 Tomitrurtion Frrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .......... ...................................................................................... > Location Add or Lot No. r............ . ....... .......?,• ............................. ----------------I.....----------------....... .................................................. 9Owner ddress ...................... ........ ------------------------------ --------------------------------------------------------------- ....... —Ins�taller Address Type of Building Size Lot...... .. .... .........Sq.--feet, Dwelling—No. of Bedrooms -Expansion Attic Garbage Grinder .........No. of"persons......../.,F------------ Showers Cafeteria P14 Other—Type of Building ..... 04 Other fixtures ......................... -9� .........*-------------------------------------------------------------------------------------------*-------------------- Design Flow.......................6 �� ........gallons per person per day. Total daily flow........... ...................gallons. 1:4 Septic Tank—Liquid capacity..2f?�Kkallons Length___f�.l.___ Width.4=6-- Diameter________________ Depth-- Disposal Trench—No_ .................... Width___._._._.____._.___ Total Length.__._____._ ....... Total leaching area..... . —.'sq ft. Seepage Pit No._._.,5Z--------- Diameter._.______ Depth below inlet.......6_7 _ ..Total leaching area .........sq. f t. Z Other Distribution box Dosing nk ( ) Percolation Test Resul ,�IA.Dv — _ts Performed by..... ...... ....... Date...... �4 Test Pit No. 1.4....4---minutesperinch Depth of Te;��lt------­44 Depth to ground water_._ Test Pit No. 2...............minutes per inch Depth of Test Pit____ 914 ....... Depth to ground water....___..''_.___..__._. 04 F .................................................................................................................................. 0 C Description of Soil........ ... . . .. . ........................ ..... ......../........................................ ...................................... --------------W. ......... ...................... ..... )L/-—--------------------------------- U W I ...................................I................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable--------------------------------.............................................................. ..............I....................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T.IT 1E 5 of the State Sanitary Code— The undersigned f I et agrees not to place the system in operation until a Certificate of Compliance has begi-kaRup by bo d of he th. Y Signe .... .. .. ............... ................................ d .. Application Approved By... . ---------- 401*2vev .............................. ........6, . . ... . .... .. 5; Date Application Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... Date PermitNo. =7------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................OF............................I......... ..................I...................... THIS IS70 ERTIFk, That the 4ndividual Sewage Disposal System constructed or Repaired by------------------ ... .... .......... -------------------_Install r 1� -------------- at............................... -------- *--------- ..'has been installed in accordance with the provisions of TIT __P 5 of�he State Sanitary Code as described in the application for Disposal Works Construction Permit No.______ ..Y.46... dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE XCONSTRU D AS A GUARANTEE THAT THE SYSTEM W!1 NCT1ON SATISFACTORY. DATE._..... f-2......................................... ........... A .............. Inspector... %......................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................0 F..................................................................................... N o....83n.lu. FEE..... ............. Dispawd Warkii T.FainmArtution "prrutit Permission is�hejeby granted.............. ---?..... ........................................................................................... to Construct ( )I-6F Repair an Individual Sewage Di at No...........(S2A-,.0.............06� ,Kosall System . ............>Zw_�j.y.... ................................... as shown on the appli tion for Disposal Works Construction' Permit No___________________- Dated______.__._______.____._..______.__.._.___ ......................................... ...... ...... card of Health ...... ......................................... DATE.... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS Gi!�� � i `�_ �, �, ... THE COMMONWEALTH OF MASSACHUSETTFr" BOARD OF H TH l..6c-�............0 F....bZwL;.. . Appliratinn for M-4po i al Morkii (nnntitrnrtiun Prrutit Application is hereby made for a Permit to Construdt ) or Repair ( } an Individual Sewage Disposal System at: c lion-n.ek or Lot No. _.../.... Own r Ad s Ile— Installer Address Q Type of Building Size Lot------ ........ U Dwelling—No. of Bedrooms__ Expansion Attic ( ) G rbage Grinder (MY aOther—Type of Building ... [.a...___._.. No. of persons__.._... . ......... Showers ( Cafeteria dOther fixtures ....•-••......••••••••-••------•............•---••••••--...---•-••-••-------•----------.._........••---------••--•••--••••••••...........I.........•--•- W Design Flow............................._......gallons per person per day. Total daily flow...........�e• ................gallons. WSeptic Tank—Liquid capacity.244..gallons Length................ Width................. Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.........__....--- Total leaching area------------- sq. ft. Seepage Pit No..__.e�----- .. Diameter....../;Z �.... Depth below inlet_............. Total leaching area..Zj. : ...sq. ft. Z Other Distribution box �5 Dosing to . aPercolation Test Result Performed by--•- - ��� .._ Dat ..... `. Ion. a Test Pit No. l... ....minutes per inch Depth of Test Pit......��.-._. Depth to ground ater._ (d_ 42, 914 Test Pit No. 2................minutes per inch Depth of Test Pit-_-____•-.--____--_ Depth to ground water........................ Description of Soil--------- ..--� �s�•: !_jn0-gW �----�-`� �1 � V ��� W -..... � •J'�. --------� ,D,..._.., , ► 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 iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha een issued b the a d of health. Signed. .•• •• . • .... ...•.•-••-••• ......•••......- Date Application Approved By--•••-•--.••. ......i�� G Date Application Disapproved for the following reasons-----------------------------------------------------------------•------------------------------------.....--••-- -------------------------------------•--...•••--••••••-•••-•-......-••-•---••-•••-•--........••••---•••..._......_.........................•••..•••...............••..••-•----•-•---- ........•----- Date PermitNo......................................................... Issued....................................................... Date i No.c9.3.._-2Z%!6 FEs.......`1.................. THE COMMONWEALTH OF MASSACHUSETTSi,— BOARD, OF HF �..TH ............;;------------.................................................. Appliration for Disposal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct r(' ) or Repair ( ) an Individual Sewage Disposal System at C•- ? l�j••- �rf - .. ..... - . -.1-. .........-- or Lot No. .. r ... ...... .. - •- --c ion- 8ress Owner Address W Installer Address r " �'�y Type of Building Size Lot....__�?.... ....____Sq.-fee c.�./ _, Dwelling—No. of Bedrooms... .._. _,..:...........................Expansion Attic ( ) G rbage Grinder (� PL4 Other—Type of Building ... . . .. ......... No. of persons--------1_4�--__--___ Showers ( ��-�T— Cafeteria (� Q' Other fixtures ---------�-------------------- d -___-•-------- Design Flow............................____.gallons per person per day. Total daily flow__..........�. .�--'?.._...__...._..gallons. W 2«e 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......I;,....... Total leaching area... .;._ ...sq. ft. z Other Distribution box Dosing tan ( y / / Percolation Test Resulti Performed by.................................................. .._... ._..._.. Date... , aTest Pit No. I.... -..7-minutes per inch Depth of Test Pit .... _-.-... Depth to ground water_!.!.!!..._....... . GT, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 1---------- ---........ -'-'---e Rai 1 r.._..-T......._.... �_...� 2^............... - 7 O Description of Soil.. ' ... r '-a?V/ I '1 I _ _ �r�� ' • --•---- = I- �� �`� �= ----------- —.._..__ f _ 1. _ f ------------------ W •'----- - - - ------------5-✓---------------------.-__.-_...----....._..--------•-------......._..._..-----........................_....._....._................ UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha een issued b t the a d of he�ilth. Signed ;-- ...... .............. .................. Date Application Approved By............... ........................................ Date Application Disapproved for the following reasons:-•-•--------•-•---•---------•--••-•-------•------•-•--•----------•--•---------------------•----------•---•_...._ •-----'-------•...............•-•-------...-'---...--------------------•----••--------------------'------...------•------•--------••---------------••-----•--•---•--•---•---•-----... -----•--.-..-- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rdifirFatr of Tontplinnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------------------------------------------------------------------------------------------------------------------------------'•-------------Installer at............................-...............................................-•----•-----------------------•------•---------•--•---------•---"--------•-'••-•------------•------•------------•------ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated__..._.___..._-___________-___-__._._-___-._- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEId WI /iFUCTION SATISFACTORY. DATE.... � .........'...................•-------------•-------. Inspector---•- --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / �� No............... Y..... FEE....;( Disposal Vo ks At wanstrnrtion rrmi# Permissionis hereby granted..........�..1.C-...... ----.......................----•-----••--•--•---------............_........--•--..................._ to Construct ( ) r Re�air ( ) an Individual Sevc�age Disposal Systll atNo-------------•-••----�U...X-0------------•e.......t........ .0................. ------------------...... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -----------------'• '% /. / _ J� Board of Health DATE.--•--------------------------------------------rrrttt•/---L----�-----�-----••--- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS I THE COMMONWEALTH OF MASSACHUSETTS No......................... .......... .... 19.�b.... APPLICATION FOR PERMIT TO OPERAT A FOOD SERVICE ESTABLISHMENT To the Board of Health of: ... .......................................................... Application is made for a Permit to operate a Food !;�: vice Establishment in accordance with the provisions of z Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws:— / ............................... �3���.cl.......L..•-----.....L..zzD.._.. ....!_%_.__......'RN....l�C............. ..................... s� PST a!�1........................................... Name of licant e-DiY1e 771" y�.l..�I 3 lishm ..--••----...-•................. � Type oP Estabent ....................•--.......---......._......_......._...._...................--••-•......••.................................•-------•--•••••-•-•-••...._..----•-•••---.............................. m Business Address o If applicant is a partnership,full name and residence of all partners a ..............................-....................................................................................................................................................................... .---•-•----------•-•---------•----•--....----•--------•----------•------------------•---•---.....-•--•-....---•-------•---....--••----------.........---..................----•-......•......._..._..... IfApplicant is a Corporation .....------•........................•.._..-----•------..•.....----•---•-...-•-----••--•---•----...------....................-••................... Stateof Incorporation ---------------------•-----.......-----=---------............•..--•-------.:.........•...--------------.........---•--..•...------........._........_......_. Full Name and Address of: PRESIDENT ..............................................•-------.......---•--.....----•--•---=--....------......-----------••--•--------...----•---------------...---...............--•- TREASURER .--•........................................................•-•---------------------------------------......-----........----------•-.....---------------•.........-----•... CLERK ---------------•-----------...---•-•---••-•---•---------••------•--•----•-------•-•----................._...._.................--------..................................... ...... ....... .. Signature .... ...._� .......... City or Town THE COMMONWEALTH OF MASSACHUSETTS ....................of............................................................................ No. -�-- �-- .......3--- -----...19. APPLICATION FOR P�EERMIT TO O )P� JERATE A FOOD SERVICE ESTABLISHMENT To the Board of Health of: -J.q..)n n-e7- u•.�/--[---e---------------------•---•-----•-----------------------------------------•------------------••-------. Application is made for a Permit to operate a Food Service Establishment in accordance with the provisions of d Chapter 94, Section 305A and Chapter 111, Section 5 of the Gen r I Laws:— ° a1 ull Name of Ayylicant e of Establishmen ----- •\ ,,tt 1✓ - 1 t✓� � '� Q = `z f-••••-•---- ga--------0-5G_eY'l �p- m Business Address m = If applicant is a partnership,full name and residence of all partners ° •-----------------------------•---------•---------------•--------------------------------•-----------••--------•--•-••-•-------------•-------•••-----•-----------•-•-•-•............-•••-•............ n ------•----•--•-••-----------------•---•--•--------------------•----•--••--------------------_-_•-_-----•-------------•--•----------••--------------------•--------------------------------------------- LLIf Applicant is a Corporation ---•-•--•-----•--•-•--•-----------••-----•----•--•----••----•-•-------------------------------•-•-----•--------------•••••......-•--•------------- Stateof Incorporation --------•-•---•--•---••---------•-•------•----••---.......--•-------------•-•-------•---••---------•-------------------------•-----•------.................... Full Name and Address of: PRESIDENT TREASURER ------------------------------------------------------------------•-------------------------d ---------- CLERK ----...-•---•--•----•--••-•-----•----•--•---•-•--•--••---•--•------....-•--------------•--.............. .......... - Signature \•---- --•-••-•-•------•• .................... ..............•----•---.....................----------...._...._.....--••-----........ City or Town No...8.. .�.� Fps.... ................... *THEMONWEALTH OF MASSACHUSETTS BOAR® PF HEALTH IUD .............OF....... .................................... App iratiou for Disposal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System ............ at: .:y .- ...... .... .. ... _3®..._. ocat Ad ss ` •i f ".�— .. Lot No. ------- pwner r s � -.. l��A. \............. ........... ........................ ... ----- Installer Address Type of Building Size Lot........ ..... U Dwelling—No. of Bedrooms.__ ....... Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building , No. of persons.......� Showers Cafeteria .....................•. Other fixtures A............................. W Design Flow.....................t .5.........__..gallons per person per day. Total daily flow._..'........................gallons. WSeptic Tank—Liquid capacity.5. allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—N ----------------•-- Width..... ----------- Total Length-----_.. .. Total leaching area....................sq. ft. 7S Seepage Pit No........S _____- Diameter.../��..... Depth below inlet...C.�......... Total leaching area..d7,T_..sq. ft. Z Other Distribution box ( ) Dosing nk Percolation Test Resu s^-� Performed by..... L a i°�- 1 Date------.7 --- -,-/�- ,4 Test Pit No. 1Z,_._ ---minutes per inch Depth of Test ' ..... . ......... Depth to ground w ter.f........C.4-Z, Test Pit No. 2................minutes per inch Depth of Test Pit._.__,_'....__...... Depth to ground water........................ x Description of Soil---• ��.. Z� - -�! �Jf�. � -------------- �. ----- U ---•--• ---• a, ------ - -- -- VNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ...... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h een issu d b e board of eal Signeh ----------------------•- ................................ D to Application Approved By......... — ,��.. rw�F'__.-_----•-. Date Application Disapproved for the following reasons:............................... ------•----•-•----•--.......-•............................... -----...._.... ................................................. ..----------------------------------.......-------------•---------•---•-------•-----------•---...-------------•-----------•--------------•------------ Date PermitNo......................................................... Issued-............................................----•;--- - -Date— ..-.-. .�__ No.... FE:B.... ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ' HEALTH ......fi --------------------.......OF. Appliration fax Disposal Works Tonstrurtion Vrrmit Application is hereby made for a,Permit to Construct O or Repair an Individual Sewage Disposal System at: 4 Yio ............. /A r......��j.................. ocatiort—Address or Lot No. .... ..........) ----------- .......................................................................... Owner Address ............................................a..................................................... ......................................................................................... Installer Address Type of Building Size Lot.........5,USq-feet ...... Dwelling—No. of Bedrooms .i aa .............................Expansion Attic Garbage Grinder Other—Type of Building .... .. ............ .......... No. of persons......../I............. Showers Cafeteria Other fixtures .................................... -t4 . ::17---------------------------------- ---------------------------------------------------- ....... W Design Flow------------*---------�?._j.............gallons per person per day. Total daily flow.._.._ .....................gallons. 9 Septic Tank—Liquid capacity...�?.�.4f.:(gal I ons Length................ Width__._............ Diameter__._-___-____ - Depth................ Disposal Trench—No_ Width................._.. Total Length.._._.............__. Total leaching area------_----_-----sq. f t. 17 Seepage Pit No......... ...... Diameter.._ C�l......... Depth below inlet... ........ Total leaching area..4tZE..sq. ft. / Z Other Distribution box 'Dosing tdnk -7 7 Percolation Test Results Performed by..... ..........;..r............. .......... Date..........I.................. ....... Test Pit No. I Z,... minutes per inch Depth of Test 6(---- /-7.1.... Depth to ground water.ef J_'7r-- _c�---------- 44 Test Pit No. 2................minutes per inch Depth of Test Pit............___.__.. Depth to ground water...:..............______ P4 ............................................................................ C/------------- ;7 0 /.........Description of Soil......C�. ?!(....... ............................... ... .................... U .............................. .............................I.................... ----------- - ---------��Oz&.................... ----------- 61w /I..... . ..... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h een iSSuCCI by I board of heal Signed . ....... .. .................................. ....... ............ Application Approved By.._.._...- . ....... .1...................................... . . ----- D ate Application Disapproved for the following reasons:.......................................................................................................7........ ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.........................................I.......................................... (9rdifirate of Toutplianu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer ..................................................................................................................................................................................................... has been instilled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-.................____._.___.___................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE-CONSTRUED AS A GUARANTEE THAT THE SYSTEM Wly. ONCTION SATISFACTORY. DATE..... ............ r..... ............................................... --------------------------- Inspecto ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................OF................................................. No..................... FEE.......---.............. Disposal orks (11natration Vvrrmit Permission .reby granted...........• ............................................................................................................................... to Constrijc4 or Repair an Indivi ual Sezva e Disposal-System 2- at No. --.I- �/A............. V- .. /............................................................................................................................. Street as shown on the application for Disposal Works Construction Permit No_____________________ Dated.._..........__.....__....._._............ ................................................................................... 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