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0010 VANDUZER ROAD - Health
lvc Ili I� is : a r W4 B , 1 r w, r +r i i h No. 4210 1/3 BLU ESSELTE 10% O O 0 0 35a-�35- aoc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "Iv Vanoluze.,r" r� Harbor Point Road (System#1) Aso Property Address rQ eZ° Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name —Q information is -0 required for every Barnstable (Cummaguid) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information �J 3 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Roger W. Bacon use the return Name of Inspector key. P.E. Civil No. 31510 ,y Company Name 281 North St Company Address Belchertown MA 01007 City/Town State Zip Code 413-256-8988 SI 4774 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 P��- �fl, rjl�rv�� — Q 7 ,z/ Inspe or' ignatur Date The em inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 IL0#6k.J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t arnsae umma uid required for every B ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t arnsae Cumma uid required for every B ( q ) MA 02673 07/21/17 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t arnsae umma uid required for every B ( q ) MA 02673 07/21/17 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 t ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ® ❑ Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 16 Number of bedrooms (actual): 16 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1,760 GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: System#1 consists of one 9,000 gallon concrete tight tank that services 8 cottages. The tight tank has an alarm triggered at 60% capacity. Alarm is functional and in proper working order. Number of current residents: 16 -32 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Not Applicable Detail: Private well. Cottages are not metered. Location of well (GPS)41degrees,42 minutes, 42 seconds North; 70 degrees, 16 minutes, 2 seconds West. Sump pump? ❑ Yes ® No Last date of occupancy: Seasonal (April- Oct) Commercial/Industrial Flow Conditions: Type of Establishment: Not Applicable Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 l Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t arnsae umma uid required for every B ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): Seasonal use. Tank is emptied in the fall after the village is closed and the water is turned off. Periodic maintenance involving confined space protocols by a licensed contractor. Next scheduled maintenance is October, 2017 General Information Pumping Records: Source of information: CCVA records and on site observation Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: —4,000 gallons gallons How was quantity pumped determined? Site tube on truck Reason for pumping: Tight tanks are routinely pumped all season Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ® Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'cwM Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t Barnsae umma uid required for every ( q ) MA 02673 07/21/17 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: Tight tank system was installed in 1987/88. Upgraded in 1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Pipes— 52" below grade Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ® other(explain): Schedule 35 PVC Distance from private water supply well or suction line: > 250'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Cottage sewer lines are in good condition. No evidence of leakage. Gravity flow, no pumps. Septic Tank (locate on site plan): Depth below grade: See Section D 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: Sludge depth: 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t Barnsae umma uid required for every ( q ) MA 02673 07/21/17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is idt Barnstable Cumma u required for every ( q ) MA 02673 07/21/17 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.): None Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: —36" Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 18' -7"X1VX9' -2.5" Capacity: 9,000 gallons Design Flow: 1,760 per day Alarm present: ® Yes ❑ No Alarm level: 60% Alarm in working order: ® Yes ❑ No Date of last pumping: Current Date Comments (condition of alarm and float switches, etc.): Alarm and float swithces are funtional. Tank is strucually sound with no evidence of leakage. *Attach copy of current pumping contract(required). Is copy attached? ® Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is Barnstable Cumma uid MA 02673 07/21/17 required for every ( q ) page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every � q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t Barnsae umma uid required for every ( a ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: [hand-sketch in the area below ❑ drawing attached separately lorA-noN of 1L'lon1 WA i L k SUPW SAP jc 6 Nr XA"i'2- j/' rANIL S1AAJa P1PC K ; M A A - M t i 0 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 11' during seasonal use 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: Original design drawing dated 11/86 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: Design drawings and original borings. Checked well pit which is - 10 feet below grade. No evidence of ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M Harbor Point Road (System#1) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is Barnstable Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 : I . , i �— LL.. I r ,I , , I 1 1 _ I ._....... ..J.... ...._.. ..__ �.._. _.#_.. ! i LIFU I , r , _— I , ' � I I ! i I r ... ..:.� .... ..• 1. , I 1 1 , f , , , 1 1 ; I I 1 I � i y I � I , i 1 i , i f s , r I I Z I —j I I r 0 • , I , - - - ��"�oIN /}j I : I. i i , i r I t , Pic/, i ! i , i I " I • i I I . I i 1 i CCV Pumping Totals (gallons) 160,000 _... 140,000 - 120,000 -- -- ---- -- _------- _ - -- - - -- 100,000 gallons pumped 80,000 full period average 60,000 _ __ 5-year average 40,000 _ .. 20,000 _ .._... ___..._ 0 1999 2001 2003 2005 2007 2009 2011 2013 2015 ck, Pumpinq Totals by Year gallons $/per gal cost 1999 107,500 $0.11 $12,550 2000 107,000 $0.11 $11,593 2001 100,500 $0.11 $11,231 2002 140,758 $0.11 $15,302 2003 103,008 $0.11 $11,615 2004 107,278 $0.11 $11,948 2005 126,700 $0.11 $13,577 2006 128,386 $0.12 $15,200 2007 119,705 $0.125 $14,570 2008 96,000 $0.165 $15,806 2009 117,400 $0.175* $20,847 2010 125,000 $0.174 $21,750 2011 108,146 $0.150 $16,234 2012 121,258 $0.150 $18,189 2013 148,981 $0.146 $21,736 2014 133,460 $0.149 $19,909 2015 102,121 $0.197 $20,105 2016 thru 4.1 35,000 $0.199 $6,965 rage 117,247 5-year average 122,793 `includes truck fuel surcharge J� S.Russell Sylva Gilbert commissioner.Jol Gilbert T.Joly Regional Environmental Engineer : -47-7.237 C�xt 680-68.* June 22, 1987 Baxter & Nye, Inc. 7 Parker Road RE: BARNSTABLE--Subsurface Sewage Ostervillb, Massachusetts 02655 Disposal--Proposed Tight Tank for Cape Cod Condominium Village, ATTENTION: : Peter Sullivan, P.E. Harbor Point Road Gentlemen: .;s. ;a.. .. The Department of Environmental Quality Engineering is in receipt of dated May 8, 1987, and plans dated June 9 1987 re for the instal p you letter Of two (2) tight tanks at the referenced location. questing approval lation The plans consist of three (3) pages, the- first of which is titled: " SITE PLAN -CAPE COD CONDOMINIUM VILLAGE CUMMAQUID BARNSTABLE ' ' SCALE: 1"=40 DATE: APRIL 13, 1987 REV: APRIL 22, '1987 REV: APRIL 28, 1987 r_ . REV: MAY 4, 1987 REV: MAY• 6, 1987 REV: MAY 8, 1987 REV: JUNE 1 1987 . REV 6t9,87 BAXTER & NYE INC. REGISTERED LAND SURVEYORS & CIVIL ENGINEERS OSTERVILLE MASS SHEET 1/3 The plans propose to dispose of an average of 4840 gallons from the referenced site .by meads of two. (2) tight tanks Per day of sanitary waste set at three-fifths capacity. equipped with an audio=visual alaz The Department is of the opinion that there is no other feasible alternate subsur face sewage disposal system that could be installed at the referenced location. Therefore, the Department hereby approves the plans with the following provisions: 1. The local Board of Health must certify that the system will be monitored by them to see that it is being properly operated and ;y maintained. ? � - i 2. Failure, of the owner or person having.control of the tanks to keep the tank installation from overflowing and properly maintained will constitute grounds for revocation of approval for the use of the tight tanks. 3. Construction shall be in strict accordance with the approved plans and Title 5 of The State Environmental Code and no further changes will be made in the approved plans without the prior written approval of this Department. 4. A Disposal Works Construction Permit must be obtained from the Board of Health prior to the start of any construction. 5. Written certification that the tight tanks have been constructed in accordance with the approved plan shall be submitted to this office with a copy to the Board of Health. Said certification shall be submitted by a Professional Engineer who is registered in the Common- wealth of Massachusetts. Nothing in this provision is intended to interfere with the right of the Board of Health to inspect the tight tanks at anytime during construction in order to assess compliance with the final plans, as approved by the Department. 6. The tight tanks shall not be utilized until a Certificate of Compliance is issued by the Barnstable Board of Health. 7. A copy of the contract for pumping is to be submitted to this office upon renewal with the hauler. No Environmental Notification Form is required to be submitted for this project since it is exempt under the Environmental Protection Regulations of the Executive Office of Environmental Affairs and the project has, therefore, been determined to cause no significant damage to the environment. Enclosed herewith, are stamped approved copies of the plans, a copy of which must be kept on-site and used for construction purposes. If the Department can assist you further or you need additional information, please feel free to contact Mr. Brett Rowe at the above telephone number. Very truly yours, obert P. Fagan, Deputy Regional Environmental Engineer F/BR/ Enclosures cc: Board of Health Town Hall 367 Main Street Hyannis, MA 02601 -00c, Commonwealth of Massachusetts --,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .; alb VGA r►A cr t, Harbor Point Road (System#2) � Property Address I`-0 Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name 1 information is i. required for every Barnstable (Cummaguid) MA 02673 07/21/17 � page. City/Town State Zip Code Date of Inspection :: Gk)!e 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 q General Information s� filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Roger W. Bacon use the return Name of Inspector key. P.E. Civil No. 31510 rab Company Name 281 North St Company Address � n Belchertown MA 01007 City/Town State Zip Code 413-256-8988 SI 4774 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 P�� 1141192�4� D7At/-/7 Ins e o 's Sign ture Date Th ystem inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 bee VS Commonwealth of Massachusetts _W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is Barnstable Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System #2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t Barnsae umma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is ( q )required for every uid Barnstable Cumma MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl arnstae umma uid required for every B ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ® ❑ Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 28 Number of bedrooms (actual). 28 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3,080 GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts —W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is idC bl t Barnsae umma u required for every ( q ) MA 02673 07/21/17 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: System#2 consists of one 16,000 gallon concrete tight tank that services 11 cottages and a 2,000 gallon septic tanks connected to 3 cottages that is pumped into the larger tank via a 2"line. The tight tank has an alarm triggered at 60% capacity. Alarm is functional and in proper working order. Number of current residents: 28 -36 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d Not Applicable 9 ( Y 9 (gp ))� Detail: Private well. Cottages are not metered. Location of well (GPS)41degrees,42 minutes, 42 seconds North; 70 degrees, 16 minutes, 2 seconds West. Sump pump? ❑ Yes ® No Last date of occupancy: Seasonal (April - Oct) Commercial/Industrial Flow Conditions: Type of Establishment: Not Applicable Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts ^W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): Seasonal use. Tank is emptied in the fall after the village is closed and the water is turned off. Periodic maintenance involving confined space protocols by a licensed contractor. Next scheduled maintenance is October, 2017 General Information Pumping Records: Source of information: CCVA records and on site observation Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: —4,000 gallons gallons How was quantity pumped determined? Site tube on truck Reason for pumping: Tight tanks are routinely pumped all season Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ® Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a Harbor Point Road (System #2 Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t Barnsae umma uid required for every ( 4 ) MA 02673 07/21/17 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: Tight tank system was installed in 1987/88. Upgraded in 1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: Pipes— 52" below grade feet Material of construction: ❑ cast iron ❑ 40.PVC Schedule 35 PVC ® other(explain): Distance from private water supply well or suction line: > 200'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Cottage sewer lines are in good condition. No evidence of leakage. Gravity flow, no pumps on the 11 cottages flowing directly into tight tank. One pump and spare on 2,000 gallon septic tank. All pumps are functional Septic Tank (locate on site plan).- Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Lift station for 3 cottages. Septic tank is considered a component of System#2. All effluent is stored in 16,000 gallon tight tank for removal. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: Standard -2,000 gallon septic tank Sludge depth: Not Applicable t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts _W Title 5 Official Inspection Form W Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Not Applicable Scum thickness Not Applicable Distance from top of scum to top of outlet tee or baffle Not Applicable Distance from bottom of scum to bottom of outlet tee or baffle Not Applicable How were dimensions determined? Design Drawings Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - � 9 p Y Y Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is required for every Barnstable (Cummaquid) MA 02673 07/21/17 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.): None Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Top of tank at grade Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 33' - 11"X1VX9' -2.5" Capacity: 16,000 gallons 3,080 Design Flow: gallons per day Alarm present: ® Yes ❑ No Alarm level: 60% Alarm in working order: ® Yes ❑ No Date of last pumping: Current Date Comments (condition of alarm and float switches, etc.): Alarm and float swithces are funtional. Tank is strucually sound with no evidence of leakage. *Attach copy of current pumping contract(required). Is copy attached? ® Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System #2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is C bl t arnsae umma uid required for every B ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Type: Y ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 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.doc•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts —W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System #2) Property Address Cape Cod Village Condominium Association (CCVCA Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts —W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,- Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is required for every Barnstable (Cummaquid) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. Check one of the boxes below: and-sketch in the area below drawing attached separately L I A I ®a _ �14a A fAfacL W/ 4110T' ZOO t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts =Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System#2) Property Address Cape Cod Village Condominium Association (CCVCA Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 11' during seasonal use 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: Original design drawing dated 11/86 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: Design drawings and original borings. Checked well pit which is — 10 feet below grade. No evidence of ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Harbor Point Road (System #2) Property Address Cape Cod Village Condominium Association (CCVCA) Owner Owner's Name information is bl t Barnsae Cumma uid required for every ( q ) MA 02673 07/21/17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r _ : t_.. .._____. ._.._..... tzi : i I ' i I ._ ----...._- --- ---- -----'---'--'i--'-- ! I f t t : J i , i i I t ,.__.._.....-..._........_ ,_..._ I I 4 , ! : I I , -j- 1 t d • I , - , { .i . I 1 I ! I _ .. � I ! I� I iI I I I I , I- : I i I � I I ..... .... . .. , I I ; , CCV Pumping Totals (gallons) i 160,000 -- ---- -_.----- --._ . -- ----- ---- - 140,000 --- -- --------------- ---- - - -_ i I 120,000 ------ -- - - - -- - --- N0001, 100,000 - gallons pumped 80,000 -- ----__- _-. -_ _. _-.---------------------- I full period average 60,000 i i 40,000 - ---- -- ------- ---- - --- -- - --------- 20,000 1999 2001 2003 2005 2007 2009 2011 2013 2015 Pu_mping Totals by Year gallons $/per gal cost 1999 107,500 $0.11 $12,550 2000 107,000 $0.11 $11,593 2001 100,500 $0.11 $11,231 2002 140,758 $0.11 $15,302 2003 103,008 $0.11 $11,615 2004 107,278 $0.11 $11,948 2005 126,700 $0.11 $13,577 2006 128,386 $0.12 $15,200 2007 119,705 $0.125 $14,570 2008 96,000 $0.165 $15,806 2009 117,400 $0.175* $20,847 2010 125,000 $0.174 $21,750 2011 108,146 $0.150 $16,234 2012 121,258 $0.150 $18,189 2013 148,981 $0.146 $21,736 2014 133,460 $0.149 $19,909 2015 102,121 $0.197 $20,105 2016 thru 4.1 35,000 $0.199 $6,965 rage 117,247 5-year average 122,793 . *includes truck fuel surcharge lop S.Russell Sylva Commissioner Gilbert T.Joly Regional Environmental Engineer June 22 1987 ` Baxter & Nye, Inc. 7 Parker Road RE: BARNSTABLE--Subsurface Sewage Osterville, Massachusetts 02655 Disposal--Proposed Tight Tank for Cape Cod Condominium Village, ATTENTION: ' Peter Sullivan, P.E. Harbor Point Road Gentlemen; The Department of Environmental Quality Engineering is in receipt of your letter dated May 8, 1987, and plans dated June 9, 1987, requesting approval for the installation Of two (2) tight tanks at the referenced location. The plans consist of three (3) pages, the- first of which is titled: SITE PLAN . i ` ' CAPE COD CONDOMINIUM VILLAGE CUMMAQUID BARNSTABLE ' SCALE: 1"=40 'DATE: APRIL 13, 1987 " REV: APRIL 22j 1987 REV: APRIL 28, 1987 REV: MAY 41 1987 REV: MAY• 6, 1987 REV: MAY 8, 1987 REV: DUNE 1, 1987 . r.` REV 6.9,87 BAXTER & NYE INC. REGISTERED LAND SURVEYORS & CIVIL ENGINEERS OSTERVILLE MASS SHEET 1/3 The plans propose to dispose of an average of 4840 gallons per day of sanitary waste from the referenced site -by meads of two. (2) tight tanks equipped with an audio-visual ala: set at three-fifths capacity. The Department is of the opinion that there is no other feasible alternate subsurface sewage disposal system that could be installed at the referenced location. Therefore, the Department hereby approves the plans with the following provisions: 1. The local Board of Health must certify that the system will be monitored by them to see that it is being properly operated and ;y -, maintained. 2. Failure- of the owner or person having.control of the tanks to keep the tank insta llation m fro overf lowing and maintained g properly aintained will constitute grounds for revocation of approval for the use of the tight tanks. 3. Construction shall be in strict. accordance with the approved plans and Title 5 of The State Environmental Code and no further changes will be made in the approved plans without the prior written approval of this Department. 4. A Disposal Works Construction Permit must be obtained from the Board of Health prior to the start of any construction. 5. Written certification that the tight tanks have been constructed in accordance with the approved plan shall be submitted to this office with a copy to the Board of Health. Said certification shall be submitted by a Professional Engineer who is registered in the Common- wealth of Massachusetts. Nothing in this provision is intended to interfere with the right of the Board of Health to inspect the tight tanks at anytime during construction in order to assess compliance with the final plans, as approved by the Department. 6. The tight tanks shall not be utilized until a Certificate of Compliance is issued by the Barnstable Board of Health. 7. A copy of the contract for pumping is to be submitted to this office upon renewal with the hauler. No Environmental Notification Form is required to be submitted for this project since it is exempt under the Environmental Protection Regulations of the Executive Office of Environmental Affairs and the project has, therefore, been determined to cause no significant damage to the environment. Enclosed herewith, are stamped approved copies of the plans, a copy of which must be kept on-site and used for construction purposes. If the Department can assist you further or you need additional information, please feel free to contact Mr. Brett Rowe at the above telephone number. Very truly yours, 01,11 obert P. Fagan, Deputy Regional Environmental Engineer F/BR/ Enclosures ` cc: Board of Health Town Hall 367 Main Street Hyannis, MA 02601 July 21, 2017 Board of Health Town of Barnstable �a -n 3'. 200 Main Street Hyannis MA 02601 Enclosed are two Title 5 Inspection Reports for the Cape Cod Village Condominium Association (CCVCA).f/ I was requested to carry out the inspection in support of a pending property transfer. The CCVA operates a tight tank system comprised of two tight tanks. Each tank has been inspected separately. I have also included the first page of the last two inspections that were done at three year intervals (2013 and 2016) in support of these current inspections. Since there are two separate reports I have included a $25 check with each report. If anything is a miss or you need to contact me about these inspections my contact information is below. Thank you for your attention on this matter. Best Regards, Roger W. Bacon, P.E. Civil No 31510 281 North Street Belchertown, MA 01007 Home Phone: 413-256-8988 Cell Phone: 413-348-8248 Email: rwbaconl(@aol.com Enclosure: Two Title 5 Inspection Reports. f S Commonwealth of Massachusetts Title 5 Official Inspection Form ry Subsurface Sewage Disp I System, -Not for Voluntary Assessments r- wa -fee 410 Va4241-�� r�a Harbor Point Road(system#1) rZ Property Address 41D Cape Cod Village --- Owner Owner's Name ` informationris CummNu"id MA 02637 05/15/13 required every page. Cdyfrown 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. Im n fiffingout A. General Information forms on the computer,use 1. Inspector only the tab key to move your Jason P Burnie cursor-do not Name of Inspector use the return key. Neighborhood Waste Water Company Name WC] 350 Main St Company Address CRYITO" M� Zip Code -- CitylFown 508-775-2820 S15011 Telephone Number License Number B. Certification I certify that 1 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 05/16/13 Inspedor'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•3f13 'rMe 5 Official Wspecftn Fom..subsurtace Sewage Disposal System•Page 1 a:17 1 * Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _Harbor Point Road(system#2) - - Property Address Cap2 Cod Village Owner Owners Name information is Cummaquid MA 02637 05/15/13 required for State Zip Code Date of inspection every page. Cityrrown Inspection results must be submitted on this forma. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the forms. Important A. general Information When fillirig out forms on the computer,use 1. Inspector only the tab key to move your Jason P Burnie cursor-do not Name of Inspector use the return key. Neighborhood Waste Water --- Company Name 350 Main St Company Address Yarmouth MA 02673 Citylrown State Zap Code 508-775-2820 S15011 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 DE'P approved system inspector pursuant to Section W40 of Title 5(310 CMR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 05115/13 Inspector ure 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 DER 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 systems will perforate in the future under the same or different conditions of use. Title 5 Official lnspection Form:subs�rrace sewage Disposal System-Page 1 of 17 t5ins•3113 i y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments m 7- RoA z) operty Address 4-1 Owner Own As Name information is > required for every � B c�(� ! /t' l 11 —M 0e6a 6, /�31 page. City/Town "State Zip Code Date of lr%pectioff Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector. key to move your _ cursor-do note use the return Name of Inspector key. !i/9^. a. c3Z5-1 Company Name .28I ; De2I-V S� Company Address tr �'L-C CU 7-0 w City/Town State Zip Code 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 In ect s Signature Date The tem inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ni Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments //AR 13-09 PONUT &AD 6Y�7� H z� Property Address ' C , C©b V/r4!-� & j s C 1 7-®� Owner Ow"r's Name information is ® -^ required for every �� �L (�_ _ ' ��� 61513 f�� 12d�� page. City/Town State Zip Code Date of Indpectiorf Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector key to move your cursor-do not ® �� RACo &l use the return Name of Inspector key. �/fl a II Company A , �I Company Address `; A /�c� 7 CItyTTown State Zip Code 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(31(310 CMR 15.000).The system: 9 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inifpe Vstern Signa ure DateThe inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Historic Pump Rates per Month-Capewide Services is the waste hauler 2013 2014 2015 2016 date gallons $ $/gal date gallons $ date gallons $ $/gal date gallons $ $/gal 12-Apr 20823 $ 3,123 $ 0.150 10-Apr 4500 $ 675 $ 0.150 26-May 3500 $ 591.50 $ 0.169 25-Jan 8000 1592 0.199 3-May 2500 $ 375 $ 0,150 14-Apr 4500 $ 675 $ 0.150 2-Jun 7055 $ 1,192.30 $ 0,169 1-Apr 27000 5373 0.199 1-Jun 9000 $ 1,350 $ 0.150 1-May 8725 $ 1,309 $ 0,150 25-Jun 13266 $ 2,639.93 $ 0.199 25-May 11000 2189 0.199 5-Jun 4500 $ 675 $ 0.150 24-May 2000 $ 310 $ 0.155 2-Jul 4500 $ 895.50 $ 0,199 16-Jun 9500 1890.5 0,199 12-Jun 8675 $ 1,301 $ 0.150 29-May 18255 $ 2,720 $ 0.149 6-Jul 5000 $ 995,00 $ 0,199 30-Jun 4269 849.53 0.199 19-Jun 4638 $ 696 $ 0.150 6-Jun 2397 $ 357 $ 0.149 14-Jul 7500 $ 1,492.50 $ 0.199 8-Jul 13392 2665 0.199 26-Jun 8072 $ 1,211 $ 0,150 12-Jun 1782 $ 266 $ 0.149 21-Jul 6500 $ 1,293.50 $ 0.199 15-Jul 4989 922.81 0.199 2-Jul 9044 $ 1,357 $ 0.150 20-Jun 611 $ 91 $ 0.149 28-Jul 5000 $ 995.00 $ 0.199 22-Jul 2700 537.3 0.199 9-Jul 4143 $ 621 $ 0.150 7-Jul 13913 $ 2,073 $ 0.149 5-Aug 7500 $ 1,492.50 $ 0.199 28-Jul 7000 1393 0.199 16-Jul 4000 $ 600 $ 0.150 11-Jul 1159 $ 173 $ 0.149 11-Aug 9000 $ 1,791.50 $ 0.199 5-Aug 5283 1051.32 0.199 23-Jul 4500 $ 675 $ 0,150 15-Jul 3646 $ 537 $ 0.147 21-Aug 5500 $1,095 $ 0.199 12-Aug 6264 1246.54 0.199 18-Jul 1866 $ 278 $ 0.149 26-Aug 3500 $697 $ 0.199 rest of yr 28711 5713.49 0,199 22-Jul 1622 $ 242 $ 0.149 1-Sep 3500 $697 $ 0.199 7-Aug 9251 $ 1,387 $ 0.150 8-Aug 14936 $ 2,225 $ 0.149 13-Nov 20800 $4,239 $ 0.204 12-Aug 2000 $ 300 $ 0,150 18-Aug 12074 $ 1,799 $ 0.149 14-Aug 3695 $ 554 $ 0.150 22-Aug 4584 683.02 30-Aug 9300 $ 1,395 $ 0.150 2-Sep 6276 935.12 20-Aug 9200 $ 1,380 $ 0,150 28-Nov 26774 3989.33 30-Sep 14900 $ 2,235 $ 0.150 11-Nov 9100 $ 1,365 $ 0.150 21-Nov 3500 $ 525 $ 0.150 Total 140841 $ 21,125 129620 $ 19,337 102121 $20,105 total 128108 25423 Total to date after spring ;4x puinpout 67,825 $, 10,173' _ -62 187 $ 9 272, ,, _ 68,821 $ 13.379' _ _ =64,397`.$-, 12,745', Total after e 'sprngi pumpout J1A7518! ,176268- _ 1p118951,667819" ', ;' 102121 20105.43 _ 9310818458', v':