Loading...
HomeMy WebLinkAbout0205 PINE LANE EXTENSION 2®5&215,pind lane.ext Osterville P 11 "9 n a t ors•,q ...,�;,mog;.. v 11 2015 23:14 Jim The Inspector Man 5085349919 page 1 Commonwealth of Massachusetts �/, , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205+215 Pine Lane Ext. imr Property Address Osterville Commons First Property Management ei Owner Owners Name information is required for every Ostervllle MA 02655 11-10-15 0� page. City/Town State Zip Code Daespection 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. Imngoutforms n A. General Information filling out forms L5/� // / ' ```\►►pumwup use Only he tab / ll/ �N OF Mgson the �ii,���' 1. Inspector: ` �`_ "" •. key to move your oZ; ny cursor-do not James D.Sears .' DAMES ;m key the return Name of Inspector Capewide Enterprises, LLC r*, Company Name -��S� Tk ��� 153 Corn ercial Street Company Address • Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below Is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-10-15 ,/inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ! t5ins•3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System:•Pape 1 of 17 Nov 11 2015 23:14 Jim The Inspector Man 6085349919 page 2 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owners Name informatlon is Ostervllle required for every MA 02655 11-10-15 page. Cdyrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is two 1500 Gal. Tanks, D Box and 18 chamber's 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): t51ns•3J15 Title 5 official Inspection Form:Subsurface Sewage uisposal system•Page 2 of 17 r Nov 11 2015 23:14 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is 05teNllle required for every MA 02655 . 11-10-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont:) ❑ PumpChamber •p um /ps alarms not operational. System will.pass with t3oard 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): El 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 pipes)are replaced ❑ Y ❑- N ❑ ND;(Explain below):• ❑ obstruction is rernoved ❑ Y ❑ N „ ❑ ND (Explain below): s C) Further Evaluation is Required by the Board of Healthc El 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 ISM 3/13 ,_ Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 - Nov 11 2015 23:14 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name Information is required for every Osteryille MA 02655 11-10-15 page. City/Town Slate 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 thepublic 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 Z. clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than Y2 day flow E140,flj^,1�" t5ins•3/13 Title 5 Officlal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Nov 11 2015 23:14 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address osterville Commons First Property Mana ement Owner Owner's Name information is required for every Osterville MA 02655 11-10-15 page. Clty/Town State Zip Code . Date of inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This . system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or.less than 5 ppm, provided that no other failure criteria are triggered.A copy of the.analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,D00gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or`'no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes".in Section D above the large system has failed. The owner or operator of any large, system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Nov 11 2015 23:14 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 205+215 Pine Lane Ext Property Address Osterville Commons First Property Management Owner Owners Name information is required for every Osterville MA 02655 11-10-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage.back up? ® ❑ Was the site inspected for signs of break out? �. ❑ Were all system components, excluding the SAS, located on.site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank Inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner] provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 12 Number of bedrooms (actual): 12 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1320 t5ins•3113 Title 5 Official Inspecuon Form:Subsurface sewage Disposal System-Page s of 17 Nov 11' 2015 23:14 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required for every Osierville MA 02655 11-10-15 page. Cltyrrown State Zip Code -date-of inspection D. System Information Description: The system is two 1500 gallon tanks D Box and 18 dry wells Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No . Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): na Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA 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: t51ns•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Nov 11 2015 23:15 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner information is Owner's Name I required for every Osteryllle MA 02655 11-10-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: _Pumping every 2 years 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): 151ns-3113 Tille 6 Official Inspecton Form:Subsurface Sewage OlsPosal System-Page 8 of 17 Nov 11 2015 23:15 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner owners Name information is required for every Osterville MA 02655 11-10-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 42" 26" feet Material of construction, ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Net Comments(on condition of joints, venting, evidence of leakage, etc.):' Pipeing is 4" PVC SCH 40 y Septic Tank (locate on site plan): Depth below grade: 3' 18" feet Material of construction: ® concrete El 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: 2/ 1500 Gallon Sludge depth: ill T. tsins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Nov 11 2015 23:15 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required for every Osterville MA 02655 11-10-15 page. City/Town State. Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29' 29' Scum thickness 0" 0i, Distance from top of scum to top of outlet tee or baffle 8 8" Distance from bottom of scum to bottom of outlet tee or baffle 1811 18'. .How were dimensions determined? Asbuilt-Tape 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.): Both tanks at working level w/in and outlet tee's. Inlet cover front tank at 7" back tank at 18" inlet cover at grade. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet` Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness 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 um in : P P 9 Date 15ins•3f13 . Title 5Official Inspection Form:Subsurface Sewage Disposal System,-Page 10 of 17 Nov 11 2015 23:15 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal gSystem Form - Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Clsterville Commons First Property Mana ement Owner information is Owner's Name required for every Osterville MA 02655 11-10-15 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 IeveL Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage ofsposal System page 11 o117 Nov 11 2015 23:15 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form ? Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is Osterville required for every MA 02655 11-10-15. 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is I Wx 36"-4'-4"below grade w/six lines out I Pump Chamber(locate on site plan): Pumps in working order: - ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located,explain why 15ins•3M 3 7ille 5 Official Inspeclion Form:Subsurface Sewage Disposal System•Page 12 of 17 Nov 11. 2015 23:15 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. ,p - Property Address Osterville Commons First Property Management Owner Owners Name informationfired is every Osterville required for eve MA 02655 11-10=15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 18 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 18-500 Gal. Dry well chambers. Did not open leaching. No sign in Box of over loading from leaching. Camera out to leaching clean and dry. 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 t5ine•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 o1.17 Nov 11 2015 23:15 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address ,p Osterville Commons first Property Management Owner Owners Name information isequiredore very Osterville. MA 02655 11-10-15 page. City/Town State Zip Code Date of Inspection D. System Information (cost,) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,): Privy(locate on site plan):, Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•3/13 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 114 of 17 Nov 1.1 2015 23:16 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntar y Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is C15tefVllle required for every MA 02655 11-10-15. 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 15ins•3113 Title 6 official Inspection Form:Subsurface Sewdge Disposal System•Page 15 of 17 Nov 11 2015 23:16 Jim The Inspector Man 5085349919 page 16 °3, �- PiN� �N Fxr 0 5T- Ito r r t • 1 ' 1 Nov 11 2015 23:16 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owners Name information is required for every Osterville MA 02655 11-10-15 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 t high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained#rom system design plans on record If checked, date of design plan reviewed: 12-12-95 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: T.H.on design plan 12-12-95. No water at 12' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ina•3/13 Title 5 Official Inspealion Form:Subsurface Sewage Disposal System-Page 16 of 17 Nov 11 2015 23:16 Jim The Inspector Man 5085349919 page 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form S Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owners Name information is requiredforevery Osterville MA 02655 11-10-15, 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 it t5ina-W13 Title SOfficial Inspeclion Form:Subsurface Sewage Disposal System•Page 17 of 17 Dec 16 2018 23:36 HP Fax page 3 Commonwealth of Massachusetts .A. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments R_'jf__ i 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Man ement Owner Owner's Name information is { s required for every Osterville fi/ MA 02655 12-12-18 page. City/Town State Zlp 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. ` �OF Iq„ir'1/ Important:When A. Inspector Information filling out forms P 64 a6ozy on the computer, JA M E S u' use only the tab James D.Sears =g; ;m key to move your Name of Inspector :rn` cursor-do not use the return Ca wide Enterprises key. Company Name 153 Commercial Street '�F,5 1 N st'E0.��``�` Y�I Company Address Mashipee MA 02649 City/Town State Zip Code m 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: 1 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 R 4. ❑ Fails 12-12-18 In toils 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. 15insp.doc•rev.7nar1016 Title 5 OfIldal InspecIm Form:Subsurface Sewage Disposal System•Page t of 1B Dec 16 2018 23:36 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext W1 - Property Address Osterville Commons First Propert Mangement Owner Owners Name information Is required for every Osterville MA 02655 12-12-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary I f Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is two 1600 Gal, Tanks D Box and 18 Chamber's 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): Wnap.doc-ray.7/2612 0 1 8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 16 Dec 16 2018 23:36 HP Fax page 5 Commonwealth of Massachusetts 1, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext lv- i 1) - Property Address Osterville Commons First Propert Mangement Owner Owners Name information is required for every Osterville MA 02655 12-12-18 page. City/Town State Zip Code Date of Inspectlon 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 ❑ NO (Explain below). ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ The system required pumpingmore than 4 times a year due t y o 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 ❑ NO (Explain below): t 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 i Dec 16 2018 23:36 HP Fax page 6 Commonwealth of Massachusetts rA Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 205-215 Pine Lane Ext Property address Osterville Commons First Propert Mangement Owner Owner's Name information is required for every OsteNille MA 02655 12-12-18 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 tSirep.doc-rev.7/2612 0 1 6 T?te 5 Official Inspecticm Form:Suhurlece Sewage Dlaposal System-Page 4 of 18 Dec 16 2018 23:36 HP Fax page 7 � Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owners Name Information is required for every Osterville MA 02655 12-12-18 page. OltylTo`"n State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cunt.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in is less than 6"below invert or available volume is less than Y:day flow /16#1 Al� ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The- system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions In Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well tslnap.doc•rev.7/2&=18 Title 5 offidal Inspection Form:Subsurface Sewage oisposal system•Pape s of 16 Dec 16 2018 23:37 HP Fax page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Man ement Owner Owners Name information required for e very Osterville MA 02655 12-12-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cant.) 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance Is unacceptable)(310 CMR 15.302(5)j t5insp.doc-rer.M612418 Title 5 OMclal Insneetion Form:Subsurface sewage Disposal system-Page 6 of 1B Dec 16 2018 23:37 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owner's Name information Is required for every Osterville MA 02655 12-12-18 pace. CityrVown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 12 12 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1320 Description: Two 1500 Gallon Tank's, D Box and 18 D ell's. Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? • ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): 2016-107,000Gal Detail: 2017-93,000Gal's Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc-rev.7IM2018 Ttle 5 Official Inspection Form:Subsurface Sewage Diepasal System•Page 7 of 18 Dec 16 2018 23:38 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments VIWV9 205-215 Pine Lane Ext Properly Address Osterville Commons First Propert Mangement Owner Owner's Name information is OSteNille required for every MA 02655 12-12-18 page. ChylTown 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): i 3. Pumping Records: Source of information: Pumping eve 2 years. 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.7/2012018 Title 5 Otfival Inspection Forth:Subsurface Sewage Disposal system•Page 9 of 18 l Dec 16 2018 23:38 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owner's Name Inforrequired ation is Osterville MA 02655 12-12-18 required for every page, CitylTown 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/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): Approximate age of all components, date installed(if known)and source of information: 1996 12-2018 New D Box Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 42" 26" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. 15insp.doc-rev.72612018 Title 5 official Inspection Form;Subsurface Sewage Disposal System-Page 9 of 18 Dec 16 2018 23:38 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owner's Name information is required for every Osterville MA 02655 12-12-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (Cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3' 18"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: year Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2/1500 Gallon ^„ Sludge depth: 211 C Distance from top of sludge to bottom of outlet tee or baffle 28' 28' Scum thickness 0" 0" Distance from top of scum to top of outlet tee or baffle 8' 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" 18" How were dimensions determined? Asbuilt-Tape 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.): Both tanks at working level w/in and outlet Tee's. Inlet cover front tank at 7" back tank at 18"inlet cover at grade. No sign of leakage or over loading. 161n .doc rev.7126/2016 � T16e 5 Official inspection Form.Subsurface Sewage Disposal System•Pape 10 of 18 Dec 16 2018 23:38 HP Fax page 13 Commonwealth of Massachusetts -. 1; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .1 205-215 Pine Lane Ext Property Address _Osterville Commons First Propert Man ement Owner Owner's Name information is every Osterville squired iorev MA 02655 12-12-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc rev.7/26/2018 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System.page 11 of 16 Dec 16 2018 23:39 HP Fax page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owners Name information Is Osterville MArequired for every 02655 12-12-18 page. city/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is New H-20 12-2018. t5lnsp.doc•rev.7/26/2018 Thle 5 Ofrwiel In specdon Form:St.bsurface Sewage Oisposel SyeOam•Page 12 of 18 Dec 16 2018 23:39 HP Fax page 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Cisterville Commons First Propert Mangement Owner Owner's Name irdormation is required for every Osteryille MA 02655 12-12-18 page Cityfrown State Zip Code Date of Inspection D. System Information (cont.) W. 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): I If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 18 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields : number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: t5insp.doc-rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r — Dec 16 2018 23:40 HP Fax page 16 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owner's Name information is reequiredquired for every Osterville MA 02655 12-12-18 page City(Town State Zip Code Date of Inspection D. System Information (cost.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Camera out to leaching Clean and Dry 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 TWO 5 OfBdel Inspection Forrn:Subsurtaoa Sewage Disposal system Page 14 of 18 Dec 16. 2018 23:40 HP Fax page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form k,V�rwl — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owner's Name information is required for every Osterville MA 02655 12-12-18 page. Cityfrown 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.): I z t5lnsp.doc•rev.70150018 Tide 5 official Inspecdon Form:Subsurface Sewage Disposal System•Pape 15 of 18 Dec 16 2018 23:40 HP Fax page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Ostervi►le Commons First Propert Mangement Owner Owner's Name information is required for every Osterville MA 02655 12-12-18 pap. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 t5inap.doc•rev.7/261Z018 Thle 5 Offidal Inspection Form:stesurfece SewaGe 0isposel system-Page 16 of 18 I i I .. �n AM i LN et Yr t ��Yx- sLsti t r t,�F � �{Ei��s',�`y�y�r•.J;��CL�".r.�}�� R-.....�a'�' �^L F, STc I A nd-s • •. 1 • . .•••'•. •• .• . • • .•' 1•'/ 96. ••. •. 11• Dec 16 2018 23:43 HP Fax page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owner's Name information is Osterville MA 02655 12-12-18 required for every Page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells d Estimated depth tcf—high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans an record If checked,date of design plan reviewed: 12-12-95 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: T H design plan 12-12-95 No water at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.71262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 17 of 16 f - Dec 16 2018 23:43 HP Fax page 21 Commonwealth of Massachusetts r Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205-215 Pine Lane Ext Property Address Osterville Commons First Propert Mangement Owner Owners Name formation is � Osterville squired for every MA 02655 12-12-18 page. City(rown 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:TightlHolding 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 G��,DE 7. U�C'MOMn t5msp.doc•rev.7/2612018 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal System•Page I of IS No G' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Disposal bpstrm Construction permit Application for a Permit to Construct( ) Repair(xj Upgrade( ) Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No. A05-.A(5 Pt JQ- "&)1r Owner's Name,Address,and Tel.No. EXT OWE a f Reco�dl Assessor's Map/Parcel I1-I ®44 C35-r , Installer's Name,Address,and Tel.No. j 0Q—4 7Z—2 S"1'1 Designer's Name,Address,and Tel.No. 1-4 1A 57 5'-i- M C-r—t Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) .gNS°T.4C_L, Ajokc) 14—;10 o —0,qx ICJ M SE Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health Sign I Date it 30 20(�5 Application Approved by Date ( ',)O I Application Disapproved by Date for the following reasons Permit No. � �� Date Issued 1 No. •r. •. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t PUBLIC HEALTH DIVISION - TOWN OF`BARNSTABLE, MASSACHUSETTS Yes Zippfiration for tigosaY *pstem Construction Permit 'Application for a Permit to Construct( ) Repair(,V Upgrade( ) Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No. ;to!•;,k(5 P104=�'- 4A"C. I�Owner's Name,Address,and Tel.No. nw v f'e c, r 4 Assessor's Map/Parcel 11-1 O(- Installer's Name,Address,and Tel:No. Sdg—1471 g$-1-7 Designer's Name,Address,and Tel.No. CAP6(AMvS N/A I S� Gatccr�t, �r 5T M.4�S�,bac� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil _-e* Nature of Repairs or Alterations(Answer when applicable) SN$7?,Ar te. IV C=icy l�•2v D P ® It J��SF Date last inspected: Agreement: ' f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health., -._ :«*�•~ "" 1 - Signp Date // 3 C, Application Approved by Date I bO Application Disapproved by: --. Date for the following reasons Perm f No.' ! '"' a -Date Issued -------------------------------- --- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY;.that the On-site Sewage Disposal system) PAC) Constructed( ) Repaired(� Upgraded( ) Abandoned( )by t ;���ttl(1)� t_►JT'ti- 6/� at P11CJ6 LTV F'1CT ?1 S-r. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-�M-:326 dated 1 ► { '3 1 - Installer CA tog /PRQ Designer N/A #bedrooms Approved design flow gpd The issuance of this permit shall,hot be construed as a guarantee that the system will coon as de igned. Date I4' 91 Inspector a „ :-_-. - -------------------- --.-:-_ -- - ___:.-. -_ _- -._:_- .:_. _ - -- ---- -- - -------------- No. C +Dl�' \>70 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION.-BARNSTABLE,MASSACHUSETTS__ _ Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( x) ^Upgrade( ) Abandon( ) System located at 20 5 1 15 P 1 ruF and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with t Title 5 and the following local provisions or special conditions. -^ Provided:Construction must be completed within three years of the date of this permit Date , Approved b �. pP Y Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Dis posal sposal System Form-Not for Voluntary Assessments 205+215 Pine Lane Ext. // 7 0Z Property Address Osterville Commons First Property Management owner Owner's Name Information is required for every Osterville MA 02655 11-8-12 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 X General Information filling out forms \`"���gnur«iU( on the computer, ll.lA ► n �O �ZH OFF N i, use only the tab 1, Inspector: -- 9c'� key to move your o=;' •.S- cursor-do not JAMES N s use the return James D. Sears =�: ;m key. Name of Inspector CapewideEnterprise,LLC Company Name N4111fl, TI153 Commercial StreetCompany Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP a_ pproved system inspector pursuant to Section 16.340 of Title 5(310.CMR 15.000).The system: .Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority a.,.. 11-8-12 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This Inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5ff. ..Oun Form:S Avjfaoe Sewaga 0isposel System•Pege 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 205+215 Pine Lane Ext Property Address Osterville Commons First Property Management Owner Owner's Name information is required for every Osterville MA 02655 11$12 page. City/Town 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 wi I 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 Cerrtificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): dins.11110 7iue 5 Official Inspection Fwrr Sub&rface Sewage Disposal System•Page 2 of 17 R�, Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required for every Osterville MA 02655 11-8-12 page. Ci yfrown State Zip Code Date of Inspection B. Certification (cant.) B) System Conditionally Passes(cost.): ❑ 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 0 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). rorther 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•11110 Title 5 offidal Inspection Forth:Subsuftoe Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required forevery Osterville MA 02655 11-8-12 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 r pp y o 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 col form 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 sampW is less than 6"below invert or available volume is less than Y day flow t5ins•11110 This 5 Official Inspection Form:Subsurlace Sewage Disposal System-Page 4 of 17 { f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is Osterville MA 02655 11-8-12 required for every state Zip Code Date of Inspection page Cityrrown 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- 10,0009pd. ❑ 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 16,000 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 fleet 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 16.304. The system owner should contact the appropriate regional office of the Department. t5ins-11J10 Title 5 Official Inspection Form:sosurraw Sewage Disposal system-Pee*5 of 17 s Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owners Name Information is Osterville MA 02655 11-8-12 required for every State Zip Code Date of Inspection page City/Town 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing 'information. For example,a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)] D. system Information Residential Flow Conditions: 12 Number of bedrooms (design): Number of bedrooms(actual): 12 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1320 t5rts•11110 Ties 6 Ofriaal Mspec ion Form:Subsurface Sewage oispossl system•Page 6 of 17 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required for every Osterville MA 02655 11-8-12 page. Corrown State Zip Code Date of Inspection D. System Mforma#ion Description: The system is two 1500 gallon tanks, D Box and 18 drywells_ 0 Number of current residents: Does residence have a garbage grinder'? ❑ Yes ® No Is laundry on a separate sewage system?[d yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes Z No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): 2010-32,000Gal 201141,000Gal Detail- Sump pump? ❑ Yes 0 No � Last date of occupancy: Na owe Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatstpersonslsq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes f] No Water meter readings, if available: Istria•11f1El Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form a ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Ownees Name inforrnation is Osterville MA 02655 11-8-12 required for every - State Zip Code Date of InsPection page. Cityfrown D. System Information (cont.)' Last date of occupancy/use: Date Other(describe below): General Information Pumping in Records: Source of information: Pumping every 2 years 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 UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t51ns•11l10 Title 5 Official 1rg3ed9n Fomc S~aw Sewage olsposel System-Pegs 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form v Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is sterville MA 02655 11-8-12 required for every O ' page. Cf1yfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 42" 26 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 3' 18" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2f1500 gallon Sludge depth: t5ns-11H D Titla 5 Ofridaf li"dion Form:Subsurface Sewage Disposal System•page 9 of'7 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons Firs_t Proger�yt r Management Owner Owners Name information is required for every Osterville MA 02655 11-8-12 e page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank (cost.) Distance from top of sludge to bottom of outlet tee or baffle 29" 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 1IT, 18" How were dimensions determined? Asbuilt -TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both tanks at working level w! in and outlet Tee's, Inlet cover front tank at 7" back tank at 18"inlet cover at grade, No sign of leakage or over loading Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness 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 f5ins•11110 Tide 5 official lnsmdan Form Subsurface Se"ga Disposal Systam-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 205+215 Pine Lane Ext Property Address Osterville Commons First Property Management Owner. Owner's Name information is Osterville MA 02655 11-8-12 required for every 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 0 metal ❑fiberglass ❑ polyethylene F]other(explain): Dimensions: Capacity: gallons Design. Flow: gallons per day Alarm present ❑ Yes El No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: pate Comments(condition of alarm and float switches, etc.): 'Attach copy of current pumping contract(required). Is copy attached? ❑. Yes El No 15ins-11110 Tine 5 Offidel Inspection Form:Subsurface Sawage Dispose'.System-Page 11 d 1 T Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is Osterville MA 02655 11-8-12 required for every 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 No Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): Camera out to D Box, Box is clean and solid, No sign of over loading or solid carry over Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order: ❑ Yes Q 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: 15ins-11110 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r_ . Commonwealth of Massachusetts - Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments b 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required for every Osterville MA 02655 11-8-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 18 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 18 500 Gal Dry well chambers, Did not open leaching, No sign in Box of over loading from leaching 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-7 V 10 7ite 5 Offidat Inspedon Form:Subsurlece Sawage Disposal System-Page 13 0`17 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 205+215 Pine Lane Ext Property Address Osterville Commons First Property Management Owner Owners Name - information is required for every Osterville MA C2655 11-8-12 page. Citylrown State Zip Code Date of Inspection D., System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.).- Privy(locate on site plan): Materials of construction: _ Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11110 Title 5 Otiimal Inspection Form:Subsurface Sawage Dispose!System-Page 14 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments W 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is Osterville MA 02655 11-8-12 required ed for every page. Citylrown state Zlp 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 ® drav4ng attached separately Sins•11110 Tifle 5 OfWal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Map' Page 1 of 2 'own of Barnstable Geographic Information-System b Parcel Viewer custom Map77]1 Abutters � Map Size 0 E ® Zoom Out 1111-111,In Zr X 9 �� - V. 444 .rtiiL ..r`.r ,tip-`dyG : 'd-ri' ,f- _ :}`:�="=i::'!K'ttt.'-�i;t':c+..S'�:_:f�:•'.�-?fit:.SpA;:er. 'q: '+:���T��.,;r '•ry.'Y�,:'^+1V::w'Sa�,±�T_w",^:;k'• .�.•�. _.:Sa-":�i.�t�-s_y...��.`�aF "'-ayti 'frr?' -`E"' ;:r"•'� r ?y':a='X�4'r= 't'1`.'�^p t;•::.- �,,,� it -�{� -s_- �.ir:.:-w..•..;'� 5. gg _ - - is F'i:+F.`��•-.r4;..:,•::)i�_ + 1 � ;�%fr ;.�• _�i�'� - cy;:yy��,,s�'.y,3t�'t 5",'r- S }{i°• I �a Set Scale 1" ='20 ( Aerial Photos I MAP DYSCLATMER r•nn%ai.hf?nnr_7M0 Tntun of Qwrte1%hin AAA AO rinhle mean:. 1 'http'H66.203.95,236/arcims/appgeoapp/map,aspx?propertylD=11706404A&mapparback= 11/13/2009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required for every Osterville MA 02655 11-8-12 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12-12-95 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H.on design plan 12-12-95 No water at 12' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ns-11110 Title 5 Official tispKrmn Fam:Subeuifara Sewage Disposal System•Pape 16 of 17 f s Commonwealth of Massachusetts Title 5 Official Inspection Form d Subsurface Y Sewage Disposal System Form- Not for Voluntary Assessments 205+215 Pine Lane Ext. Property Address Osterville Commons First Property Management Owner Owner's Name information is required Osterville MA 02655 11-8-12 iz page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, 8, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file tsins•11/10 Ttla 5Official Inspection Famt Subsurface Sewaga Disposal System•Page 17 of 17 No. Olm _ �r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: /►' PWWLM UB IC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pp tAtI01t for ]Disposal *p8tP11Y CDnstTULt10n VPrIItIt Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a o S 2 15 P'i n e..+--n Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.C4j" e4;r Designer's Name,Address,and Tel.No. ^ t� C P 6 6­4�71-3i'Yl� ,v Type of Building: Dwelling No.of Bedrooms —� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p Design Flow(min.required) /y gpd Design flow provided �— 0/ ' gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) i A.A__ �:✓ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal . Signed Date Application Approved by Date f `� Application Disapproved by Date for the following reasons Permit No. t9©v 1- 1"f0— Date Issued �°� No. 1 V Fee MD D THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE, MASSACHUSETTS Yes c? `'''"'` G Y14sapplication for ]Disposal *i stem Construction 'permit p Application for a Permit to Construct( ) Repair VUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a,o S Z 1,5 P i e L-a di e Owner's Name,Address,and Tel.No. Co 5 i-cry,<<< (4 .- &ft co S Assessor's Map/Parcel b 4 b YA CO n/t-21 p Installer's Name,Address,and Tel.No.C 4(Z.¢r j L oi1f/ej{j f Designer's Name,Address,and Tel.No. � Type of Building:Dwelling No.of Bedrooms A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) — Al gpd Design flow provided gpd J Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S1.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A.A_ r Date last inspected: __- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal Signed Date I) L.=-DOS Application Approved by Date ��'g ' d Application Disapproved by Date *w for the following reasons Permit No. C d b1— 140!L Date Issued 19- �'d THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�.) Upgraded Abandoned( )by �1 ►V�o_ 491 fit/'Qyi)e% t-L(- at Z.0) ( S Q.'� �..Ar�Q ,�T has been constructed in accordance o� with the provisions of Title 5 and the for Disposal System Construction Permit No.0061-Y61- dated Installer Cs � Designer_ 1)14 #bedrooms Approved rdesign ,flow gpd The issuance of this permit shall not be construed} / as a guarantee that the syste\ will ill fun-o ra's designed. Date I �`� 09 Inspector\„__ l ��----ram ,�q ---------------------Fee--------------_----- No. 0100/ �f O � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposai *pstem (Construction Permit Permission is hereby granted to Construct( ) Repair(\4 Upgrade( ) Abandon( ) System located at 2 o5- 2 1 5- t')�iJl (����R.. f�x 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. — C Date d Approved by Fee Y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21pprication for Mi5po.5ar *pgtem Construction Permit Application for a Permit to Construct )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a0S- O Nr sf�C� 05Fo O 1 s Name,Ad ss an Tel Ng�� Rig Assessor's Map/Parcel i ``7 ®�C� / 6 L c.J r / 0�K, Installer's Name,Address, land Tel.No. (Q / Des' nej's�Name,Address and Tel.No. U Z�j Cc �-�^�� C✓0 (s'a e ��F3� 'qo1 a Type of Building: Dwelling No.of Bedrooms Lot Size ' 76 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) DESIGNING ENGINEER MUST Sil 3'ALcA_I gUN AND CERTIFY IN WRehij Y !RYSTEM �Tg n, ... IN AC66RDAN STRICT Pc L 0 Date last inspected: � � S ��� /11 u S'r IV Agreement: Q�` 1 �0 ] 3 ,/ CC�Il S The undersigned agrees to ensure the construction and maintenance of the afore describedtysew�,a disposal syst �(Vq/py,' • in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued thi o d of Health. 1.2 �a ��� �✓ Signe Date Application Approved by Date ` Application Disapproved for the following reas Permit No. W2_ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETT'gESIGNING ENGINEER MUST SUPERVISE STALLATION AND CERTIFY IN WRITING Certificate of Compliance THE SYSTEM D�ETo I�,� IN STRICT THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired( ) Upgraded( ) AbandQned( )b at ® C has b n constructe{/in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Installer Designer The issuance of this p rmi sh 1 not be construed as a guarantee that the sygeT will functio as 'gnsd. a Date / >/ Inspector 'THE COMMONWEALTH OF MASSACHUSET,T$:. Entered in computer: Yes -PUBLIC HEALTH DIVISION..-TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for -Migpogat *vmerrt c(Congtruction errrttt Application.for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot 41�1No. �' O is Name,Address an Tel No. aos �;ti� 57��t� �.�i• � Assessor's Map/Parcel 1 ) O�Q�E C I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. } fType of Building: V v Dwelling No.of Bedrooms — Lot Size 7- sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) t Y Other Fixtures Design Flow �4 gallons per day. Calculated daily flow gallons. Plan Date Number'of sheets ~` Revision Date Title j Size of Septic Tank ---`--- �-- __-.._ Type of S.A.S. Description of Soil r =- y Nature of Repairs or Alterations(Answer when applicable) 'I Date last inspected: ° � j S7�i�s /1^U T N p a( f g - -- er 15:Agreement: ..:: — L. C�' 30 � 3 �/F�/"� I�. The undersigned agrees to ensure the construction and maintenance of the afore described 9ji-81 .�sewage disposal syste 7 in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this o d of Health. ,�; Signed,.--", Date !//a ��� Vik Application Approved by tty-114-4 Date Application Disapproved for the following reas - f Permit No. Date Issued ——————————————————-————————— — —————— { THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS d Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(X)Repaired ( )Upgraded( ) Aband ned( )b at has ben constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer t The issuance of this permi sh 1 not be construed as a guarantee that the system will functio"fas de igne�yd. Date / 'i/� Inspector ,�i .4,/,t � _ ens —— i ———-— �— No. "MS ��/�f - SCTr FeeUji D �� f THE COMMONWEALTH OF MASSACHING ENGINEER MUST �S SUPER PUBLIC HEALTH DIVISION o BARNSTABLEAMMADMISIVVERTIFY IN WRITING THE SYSTEM WAS INSTALLED IN STRICT �i$�logaY �pgteTlY �ort�tructia�t �4CFtTOPLANe Permission is hereby granted to Construct( )Repair( )Upgrade( )Aband7on(A ) System located at v r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. I� e Date: �AA.�o,. �in :Jt! /y mil_ Approved by / rL1•t,c.i W.,x �`1� . /T / -4 - - xe �. INE BARNSTABM _ .esv. Town of Barnstable Zoning Board of Appeals Decision and Notice Appeal No.96-54-Use Variance James H. Crocker,Jr. Summary: Granted with Conditions Applicant: James H. Crocker,Jr. Property: Pine Lane, Osterville, MA Assessor's Map/Parcel Map 117, Parcel 64 Zoning: BA(Business A) District Groundwater Overlay: AP Aquifer Protection District Variances: Use Variances to allow construction of two two-family residences Background: The property is located on Pine Lane, Osterville, MA and is referenced on Assessor's Maps as Map 117, Parcels 64. The property is owned by Holbrook Davis. This land was recently divided into two lots by an Approval Not Required plan on the west side of Pine Lane, shown as Lots 1 and 2 on the plan. The lots in question are completely located in the BA District. The.site is presently vacant. The proposal would site one duplex(two-family structure) on each of the lots. Residential use is not permitted in the BA District. Procedural Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on April 18, 1996. A public hearing before the Zoning Board of Appeals was duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened June 05, 1996 and continued to July 10, 1996, at which time the Board found to grant the appeal with conditions. Board members hearing this appeal were Ron Jansson, Emmett Glynn, Richard Boy, Gene Burman, and Chairman Gail Nightingale. This appeal is related in nature to the request in Appeal No. 1996-53. Although the applicant is the same in both Appeal No. 1996-53 and 54, the nature of the appeals varies in terms of location and the Board and applicant did not hear or present them together. However the two decisions were somewhat tied together in conditions imposed. Hearing Summary: Attorney John Alger represented the Applicant, James H. Crocker, Jr. Attorney Alger stated that the property in issue is owned by Holbrook Davis and under agreement with Mr. Crocker. Mr. Alger submitted a copy of the agreement along with a memorandum in support of the appeal. Attorney Alger continued citing the property on the west side of Pine Lane, (today's Lots 1 &2)was laid out since at least 1938, as shown on a plan dated June 14, 1938. Mr. Davis and Mr. Crocker have a right of way along Pine Lane from Main Street to the end of their property and no further. They do not have a right of way along Pine Lane to access through to Blossom Lane. Wth access to this property only from Main Street, the property is limited to the 19 foot way from Main Street only. The locus is zoned entirely for business and is currently vacant. The ANR plan was signed on February 15, 1996 that created the two lots from the single lot. The property is in a Business A which allows many uses, such as retail stores, trade services, shops, restaurant, hotel, etc. Attorney Alger cited the Planning Department staff report noting "Of importance is the fact that the proposed 4 residential units would be far less impacting on the traffic generation than many of the principal permitted uses for the BA District." The property is not allowed the less intense residential use without approval from the Zoning Board of Appeals which the applicant is seeking. Mr. Alger cited that parking is not an issue before the Board in this particular appeal because the lot has always been vacant and has no uses on it. Zoning Board of Appeals-Decision and Notice Appeal No.96-54-Use Variance-James H.Crocker,Jr. The applicant is seeking to build two units on two parcels. The units will have 1800 sq.ft. each and be 26 feet high to the peak(not the plate). Mr. Alger stated variance conditions exist in that it is impractical to use the property for which it is zoned, due to the shape of the lot and the layout of the road. Residential use would be less detrimental to the area in terms of traffic and compatible with surrounding multi-family uses. Attorney Alger also cited the Draft Comprehensive Plan which supports multi-family units in this area of the Town recognizing that they reinforce the economic viability of the commercial center of the village and the need for diversifying housing types. He summarized that the grant of this petition would not be in derogation of spirit and intent of the Zoning Ordinance and that a literal enforcement of the Ordinance in this particular case-which would require business-would be a substantial hardship and would be more detrimental to the neighborhood. Mr. Alger was requested to elaborate on the variance conditions and he stated that the lots cannot be used as a Business A Principal Permitted Uses because the access to the lots is so very limited and insufficient to accommodate traffic generated by a business. The nineteen foot wide road services a parking lot and is already at maximum traffic capacity. Additional traffic would be detrimental. The shape and configuration of the lots create an additional hardship. Attorney Alger submitted a letter to the file from an abutter supporting the appeal and the Board noted that there are currently seven letters from direct abutters who favor of the project. There is also a letter from the Fire Department that stated they have no problem with the proposal. The Board requested public comment and Phil McCartin, an abutter, stated he is not opposed to the petition on the whole, but feels this is not an appropriate use of the land. He reminded the Board that residential dwellings are clearly not allowed in this zoning district and a Variance should not be granted as it would derogate from the allowed uses in the Zoning Ordinance. He also concluded that the sale of the land is contingent upon this Variance and if it is not granted the sale will be voided and therefore there is no hardship to the Petitioner. Geoffrey Lenk stated that that he felt the whole process was wrong for the village of Osterville. Jay Larmon was concerned with the impact on the community. The Board closed the hearing to public comment and continued the hearing to July 10, 1996 at 7:30 PM. The continuance was to allow the Board Members time to review the materials and testimony and to permit the Members an opportunity to question the material if needed. At the continuance, the Board rendered its decision. Finding of Facts: Based upon the testimony given during the public hearing on this appeal, the Board unanimously found the following findings of fact: 1. The property in issue is located on Map 117, Parcel 64, in the Business A District and Urban Business District, located on Pine Lane, Osterville, MA. 2. The petitioner, James H. Crocker, Jr., is currently the purchaser in a Purchase and Sales Agreement for said property, thus providing standing for this appeal. 3. The land involved was recently divided into two lots by an ANR plan. The lots themselves are .36 and .44 acres. The proposed use of the property is two duplex units for a total of four residential units. 4. There are multiple business uses allowed in the Zoning Ordinance for this particular Zoning District. 5. The petitioner has provided for on-site septic system for these lots. 6. Pine Lane is a small road not appropriate for large scale commercial use, uses which could be allowed as a matter of right on these lots. 7. The lot itself is somewhat unique in that it is bordered on the majority of its sides by residentially zoned property in and along Pine Lane, which separates it from the business district. However, it is part of the business district. 8. The lot is irregularly shaped, a shape that is unlike most other lots in this particular area and as a result the lot had to be divided in two lots to comply with the existing configuration of lots in the area. 9. The allowance of duplex residential family dwelling units on these lots would not be in derogation of the spirit and intent of the Zoning Ordinance. 10. In view of the fact that these uses would be significantly less in terms of overall impact on the area, granting the relief being sought would not be detrimental to the neighborhood affected. 2 Zoning Board of Ap►)eals-Decision and Notice Appeal No.96-54-Use Variance-James H.Crocker,Jr. Decision: Based upon the positive findings a motion was duly made and seconded to grant the relief being sought in Appeal No. 1996-54 with the following conditions: 1. The duplex units shall be as located as shown in Plans titled "Plan of land in Barnstable, MA for James H. Crocker, Jr. Trustee Pine Lane Realty Trust" and as illustrated on drawing entitled "Pine Lane Realty Trust, Osterville, MA'Osterville Commons"'which consists of four pages containing the elevations of the building, the first and second floor layout and the site plan. A copy of which has been retained in the file. 2. The height of the structures as measured to the roof ridge shall not exceed 26 feet in height from the ground to the roof ridge. 3. The private way known as Pine Lane shall be improved as illustrated in site plan submitted to the Board entitled"Osterville Commons". Details of construction shall be reviewed and approved by the Building Commissioner and all Site Plan improvements shall be done in accordance with the Town's subdivision controls and regulations. 4. All maintenance, including snow plowing and landscape maintenance and sweeping of Pine Lane for the distance bordering the lots shall remain the responsibility of the applicant and his successor(s)entitled. An association of the owners bordering this lane in the locus shall be established and dues collected as needed to assure proper maintenance of the way and a replacement/repair account for use for long term improvements to the roadway. 5. Public access for walking and non-motorized bicycles along and between the paved sections of Pine Lane shall be maintained. 6. If and when any public or group treatment of waste water becomes available in the locus, the units shall be required to tie into that system within 6 months of its availability. In the interim, the petitioner shall utilize an on-site septic system which would be"state of the art", and would provided for denitrification at the highest possible levels for residential uses. 7. The buildings to be built shall not be expanded in the future beyond that being proposed without prior permission from the Zoning Board of Appeals. This\includes both footprint and total gross square footage. 8. Neither the petitioner nor his successor(s)shall rent;lease any of the units for less than a period of 6 months, so as not to have the units rented out as vacation units" . 9. The garage space shall not be converted into living space and shall only be utilized for parking of vehicles, storage and resident's work area as garages are customarily used. 10. All parking shall be contained on-site for residents and their guests only. No commercial parking shall be permitted on the locus. The Vote was as follows: AYE: Gene Burman, Emmett Glynn, Richard Boy, Ron Jansson, and Chairman Gail Nightingale. NAY: None Order: Use Variance Number 1996-54 has been granted with conditions. This decision must be recorded at the Registry of Deeds for it to be in effect. The relief authorized by this decision must be exercised in one year. Appeals of this decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17, within twenty (20) days after the date of the filing of this decision in the office of the Town Clerk. 1996 Gail Nightingale, Chairman Date Signed I Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that twenty (20)days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the decision has been filed in the office of the Town Clerk. Signed and sealed this day of 1996 under the pains and penalties of perjury. Linda Hutchenrider,Town Clerk 3 WELLER & ASSOCIATES P. O. BOX 417 CENTERVILLE, MA. 02632 (508) 775-0735 Date: May 8, 1997 Jerry Dunning Barnstable Health Department 367 Main St. Hyannis, Ma. 02601 Re: "Osterville Commons" Condominium, Pine Ln., Osterville, Ma Dear Jerry: Please be advised that we have inspected the installation of the subsurface sewage disposal system at the above referenced property and find that it was done in accordance to the approved plan. If you have any questions, please do not hesitate to contact us. ;��eAtrulyou , Tristram M. Weller s rfl d 71' �P'd1 LOT NO. ADDRESS:"' ,,JE OWNERS NAPiE: � SEWAGE PERMIT NO. :�� NEW:- X REPAIR: DATE ISSUED: /_—1 DATE INSTALLED: %3/3i/j�, w INSTALLERS NAME INSTALLATION OF: Sir-ic s WATER TABLE: FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : CA-* ohc* cegqet�Gr . f C =10`� ,� l �0 ,LOT NO. : ADDRE S:_ OWNERS NAME: SEWAGE PERMIT NO. : NEW; 'z' REPAIR: DATE ISSUED: // _l,2, - DATE INSTALLED:,16;/3//f& !NSTALLERS NAM: S�AlC�4 fiPJ�' �rleJ� ,l✓ I' INSTALLATION OF: pTrC WATER TABLE: FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE: o v _ - i—�Jauf� 5�0 0 .1 ' �V� D��� y OSferv.(l� Cbti+a+pnSTOWN OF BAMSTA.BLE p LOr^ATION o�d�'f'aI f iAS' 1AAJL edfT. SEWAGE # VILLAGE OSTcrv�lle ASSESSOR'S MAP.& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY <9 LEACHING FACIL=:' (type) (� GAl�e ys (size) NO.OF BEDROOMS ((�� BUILDER OR OWNER P,rSI Prop` ti MAilA'Re 4&n PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within`200 feet of leaching facility) Feet Edge of Wetland`and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) JJ Feet Furnished by -CASpc,, uV, S FOrC. r r r / 30 (6 a 3+V TOWN OF BARNSTABLE 94' ( 1/ : LOCATION R*it, 1AAt- E47. SEWAGE # 56 VILLAGE try,'I� ASSESSOR'S MAP & LOT /17 ' 0.1 S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CA l SUu 4 . LEACHING FACILITY: (type) G4AA%�V! (size) NO. OF BEDROOMS IoZ BUILDER OR OWNER OSTcryJ IC' COMIVInns PERMITDATE: COMPLI NCE 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 lea chi g'facility) Feet Furnished by�n Fps vn T Foi cl �b 34 30 !b clos- VA 1�! � TOWN OF BARNSTABLE LOCATION �� `�p� ] ( Fy iQ, SEWAGE#. VILLAGE_� �� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. C SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER 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 facility). feet FURNISHED BY Y i t•"t�dyhk�i`t_j�L }t AN 3f ask*r'y r"Till �`y��et;,,�t a 3 TOWN OF BARN STABLE LOCATION r�- moo SEWAGE # VILLAGE` /� D/I�J�d�D � ASSESSOR'S MAP& LOT S0 INSTALLER'S NAME&PHONE NO,- 1114 SEPTIC TANK CAPACITY LEACHING FACILTTY: (type) U (size) 1 NO.OF BEDROOMS BUILDER OR,OWNER2D PERMTT DATE: 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 I ` Furnished by v t - � j TOWN OF BARNSTABLE �y LOCATION 7.©� ,��:h�. �" SEWAGE# VILLAGE 4 C,J c-r V;IC P ASSESSOR'S MAP & LOT -7 — 651 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ICJ ® 9-2 0 ' � C i LEACHING FACILITY t 0 (size) NO.OF BEDROOMS BUILDER OR OWNER 72, ti C- Y-v G PERMITDATE: 6 G _ �7 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 � � r 2-6 .� M ti �� 'eQ L�1*i.R TOWN OF BARNSTABLE T LOCATION en Sir�✓1�/'��� v 41n A,% mot, < SEWAGE # VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY G Sa° LEACHING FACILITY: (type) (size) NO.OF BEDROOMS. BUILDER OR OWNER PERMTTDATE: 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 166 i z APPLICATION FOR PERCOLATION TEST AND OBSERVATION' PITS J LOCATI�N /� m.J c NO. VILLAGE G DATE APPLICANT � FEE cis ADDRESS TELEPHONE N0. (Non-refundable) ENGINEER t�Y� TELEPHONE NO. K? DATE SCHEDULED S (Applicant's signature) ASSESSOR'S M & LOT NO: `lo:� � SOIL LOG SUB-DIVISION NAME / DATE EXPANSION AREA: YES �►�L x9 ENGINEER ?; TOWN WATER 2 ,PRIVATE WELL BOARD OF HEALTH T:�-,r> Hclir ,'jtpi� EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: PERCOLATION RATE TEST HOLE NO: t ELEVATION: TEST HOLE NO: �-- ELEVATION: 1P=. 2 2 3 3 �n 4 �� 4 5 M 7 �� 8 8 9 _ 9 1 G � 10 11 11 12 12 13 13 14 14 15 15 v SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEEIRING,PLANS MUST SHOW. NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P.- JE.L AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT