HomeMy WebLinkAboutU Inspection Report 2026 Apr 105s. Gommonweatth of Massachusetts
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248 Camp St. Foxwoods ll Blds U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma 02673 4-10-26
Cityffown State Zip Code Date of lnspeclion
lnspection results must be submitted on this form. lnspection forms may not be altered in anyway. Please see completeness checklist at the end of the form.
A. lnspector lnformation
Michael Sears
lmportant: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key
Name of lnspector
Jim The lnspector Man
Company Name
P O Box 784
Company Address
West Yarmouth Ma.02673
City/Town
508-364-4398
State
st 14430
Zip Code
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full comptiance with Section 15.340 of Tifle S(310 CMR 15.000); I 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 oi my
inspection; and the inspection was performed based on my training and experience in the proper functionand maintenance of on-site sewage disposal systems. After conducting this inspection I have determinedthat the system:
1. X Passes
2. E Conditionally Passes
3. E Needs Further Evaluation by the LocalApproving Authority
4. E raits
OF
J MICHAEL'1
TIF\c 5 trus
4-10-26
Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) with in 30 days of completing this inspection. lf 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 tothe 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 wil! perform
in the future under the same or different conditions of use.
SEARS -t--{*1 No. SI14430 co*
tsinsp.doc. Gu. 7 12612018 Title 5 Official lnspection Fom: Subsurtace Sewage Disposal System . Page 1 of 18
1$. Commonwealth of Massachusetts
Title 5 Official lnspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma.02673 4-10-26
City/Town State Zip Code Date of lnspection
G. lnspection Summary
lnspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6
1) System Passes:
X I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System meets minimum Massachusetts DEP standards, this lnspection is not a guarantee of future
working conditions.
2l System Conditionally Passes
E One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. lf "not
determined, " please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
E v n N f] trro (Exptain below):
tsinsp doc. rev 712612018 Title 5 Official lnspection Form: Subsurface Sewage Disposal System . Page 2 of 1g
5$. Gommonweatth of Massachusetts
Title 5 Official lnspection Form
subsurface sewage Disposal system Form - Not for Voluntary Assessments
248Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma 02673 4-10-26
City/Town State Zip Code Date of lnspection
C. lnspection Summary (cont.)
2l 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 approvat of Board of Health):
n broken pipe(s)are replaced tr V tr trt E ruO (Exptain betow):
tr obstruction is removed E V n ru E ruO (Exptain betow):
n distribution box is leveted or reptaced E y E u E ruo (Exptain betow):
! ffre 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):
tr broken pipe(s)are reptaced E v n ru n NO (Exptain betow):
tr obstruction is removed E V E N E ttO (Exptain betow):
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(1Xb) that the system is not functioning in a manner which will protect public health,
safety and the environment:
tsinsp.doc . Bv. 7 1261201 I Title 5 Official lnspection Form: Subsurface Sewage Disposal System . Page 3 of 18
5$' Commonwealth of Massachusetts
Title 5 Official lnspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page
Owner's Name
West Yarmouth Ma.02673 4-10-26
CityiTown State Zip Code Date of lnspection
C. lnspection Summary (cont.)
Cesspool or privy is within 50 feet of a surface water
tr Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fai! 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:
E ffre 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.E fne system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
f] fne system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.n fne 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:
4l System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
r-.r rv Backup of sewage into facility or system component due to overloaded orrJ r r clogged SAS or cesspool
t-.1 tvt Discharge or ponding of effluent to the surface of the ground or surface watersI L- due to an overloaded or clogged SAS or cesspool
tsinsp.doc ' rev. 712612018 Title 5 Official lnspection Fom: Subsurface Sewage Disposal System . Page 4 of '18
5$' Commonwealth of Massachusetts
Title 5 Official lnspection Form
subsurface sewage Disposa! system Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll BldgU
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma.02673 4-10-26
City/Town State Zip Code Date of lnspection
G. lnspection Summary (cont.)
4l System Failure Criteria Applicable to All Systems: (cont.)
Yes No
trxnxnxnx
trx
!x
trx
trx
tr x
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feetfrom a private water supply well wlth no acceptable water quality analysis. frhissystem 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 equa! 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.l
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 3'10 cMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will benecessary to correct the failure.
5) Large Systems: To be considered a targe system the system must serve a facitity with adesign 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 thequestions in Section C.4.
Yes No
xtr
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than 6" below invert or available volume is less
than /, day flow
Required pumping more than 4 times in the last year Nor 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 ortributary to a surface water supply.
Any portion of a cesspool or privy is within azone 1 of a public water supply
well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (lnterim Wellhead Protection
Area - IWPA) or a mapped Zone ll of a public water supply well
Title 5 Official lnspection Fom: Subsurface Sewage Disposal System . Page 5 of 18
trtr
ntr
trtr
t5insp.doc. tev. 7 12612018
5$. Commonwealth of Massachusetts
Title 5 Official lnspection Form
subsurface sewage Disposal system Form - Not for Voluntary Assessments
248 CampSt. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth 02673 4-10-26
City/Town State Zip Code Date of lnspection
C. lnspection Summary (cont.)
6.
lf 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 C.4 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 C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
You must indicate "yes" or "no" for each of the following tor all inspections:
Yes No
tr X Pumping information was provided by the owner, occupant, or Board of Health
! X Were any of the system components pumped out in the previous two weeks?
X tr Has the system received normal flows in the previous two week period?
tr X ilnirifl::,[?umes of water been introduced to the system recently or as part of
Were as built plans of the system obtained and examined? (lf they were notIAl LJ available note as N/A)
X n Was the facility or dwelling inspected for signs of sewage back up?
X n Was the site inspected for signs of break out?
X tr Were allsystem components, excluding the SAS, located on site?
X ! Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
x
Was the facility owner (and occupants if different from owner) provided with
rnformation 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)]n
Ma.
tr
tsinsp.doc. rcu. 7 12612018 Title 5 Official lnspection Formr Subsurface Sewage Disposal System'Page6 of 1E
x
x
5$. Commonweatth of Massachusetts
Title 5 Official lnspection Form
subsurface sewage Disposal system Form - Not for Voluntary Assessments
248Camp St. Foxwoodsll BldsU
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth
City/Town
Ma.02673 4-10-26
State Zip Code Date of lnspection
D. System lnformation
1. Residentia! Flow Gonditions:
Number of bedrooms (design):Number of bedrooms (actual):10 10
DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x # of bedrooms)
Description:
1 100
Number of current residents:
Does residence have a garbage grinder?
Does residence have a water treatment unit?
lf yes, discharges to:
ls laundry on a separate sewage system? (lnclude laundry system inspection
information in this report.)
Laundry system inspected?
Seasonal use?
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
NA
EvesX No
EyesX No
EvesX No
nvesXJ No
EyesX No
NA
Sump pump?
Last date of occupancy
!vesX No
Present
Date
tsinsp.doc . tev. 7 1261201 I Title 5 Offlcial lnsp€ction Form: Subsurface Sewage Disposal System. Page 7 of 18
5$' Commonweatth of Massachusetts
Title 5 Official lnspection Form
subsurface sewage Disposal system Form - Not for Voluntary Assessments
248Cam St. Foxwoods ll Bl U
Property rESS
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma.02673 4-10-26
City/Town State Zip Code Date of lnspection
D. System lnformation (cont.)
2. Commercial/lndustria! Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.)
Gallons per day (gpd)
Grease trap present?
Water treatment unit present?
lf yes, discharges to:
lndustrial waste holding tank present?
Non-sanitary waste discharged to the Tifle 5 system?
Water meter readings, if available:
Last date of occupancy/use:
Other (describe below):
EyesE No
Eves! No
I Yes f] No
fl yes fl No
Date
3. Pumping Records:
Source of information:
Was system pumped as part of the inspection?
lf yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
NA
!YesX No
gallons
tsinsp.doc . rc\. 7 1261201 I Title 5 Official lnspection Form: Subsurface Sewage oisposal System . Page 8 of 18
5s. Gommonwealth of Massachusetts
Title 5 Official lnspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
pa9e.
Owner's Name
West Yarmouth Ma 02673 4-10-26
City/Town State Zip Code Date of lnspection
D. System lnformation (cont.)
4. Type of System:
X Septic tank, distribution box, soil absorption system
tr Single cesspool
tr Overflow cesspool
n Privy
tr Shared system (yes or no) (if yes, attach previous inspection records, if any)
n lnnovative/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 l/A system by system operator under contract
tr Tight tank. Attach a copy of the DEP approval.
tr Other (describe):
Approximate age of all components, date installed (if known) and source of information
NA
Were sewage odors detected when arriving at the site?
5. Building Sewer (locate on site plan).
Depth below grade:
Material of construction:
n cast iron X +O pVC n other (explain):
Distance from private water supply well or suction line:
EvesX No
22"
feet
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
tsrnsp.doc. teu. 7 12612018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System ' Page 9 of 18
5s. Gommonwealth of Massachusetts
Title 5 Official lnspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Owner
information is
required for every
page
Owner's Name
West Yarmouth
City/Town
Ma. 02673 4-10-26
State Zip Code Date of lnspection
D. System lnformation (cont.)
6. Septic Tank (locate on site plan)
Depth below grade:
Material of construction :
X concrete ! metal
2000 gal tank
12"
feet
! fiberglass n polyethylene f] other (explain)
lf tank is metal, list age:years
ls age confirmed by a Certificate of Compliance? (attach a copy of certificate) tr Yes E No
Dimensions:2000
Sludge depth 1"
Distance from top of sludge to bottom of outlet tee or baffle 29"
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle 8"
Distance from bottom of scum to bottom of outlet tee or baffle 18"
How were dimensions determined?Sludge judge, tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
2000 gal tank with in and out tees in place, both covers at grade
t5insp.doc' rcv. 7 12612018 Title 5 Official lnspection Fom: Subsurface Sewaga Disposal System'Page 10 of 18
Property Address
Foxwoods Condominium Homeowners Association
5s' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface sewage Disposal system Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Blds U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth ItIa.02673 4-10-26
City/Town State Zip Code Date of lnspection
D. System lnformation (cont.)
7. Grease Trap (locate on site plan).
Depth below grade:
Material of construction:
f]concrete ! metal ! fiberglass E polyethylene f] other (exptain)
feet
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 E metal f]fibergtass E polyethylene E other (explain):
Dimensions:
Capacity:
Design Flow:
gallons
gallons per day
Title 5 Offlcial lnspection Form: Subsurface Sewage Disposal System . Page 1 1 of 18tsinsp.doc . teu. 7 1261201 I
5fu. Gommonwealth of Massachusetts
Title 5 Official Inspection Form
subsurface sewage Disposal system Form - Not for voluntary Assessments
248 Camp St. Foxwoods Il Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma.02673 4-10-26
City/Town State Zip Code Date of lnspection
D. System lnformation (cont.)
8. Tight or Holding Tank (cont.)
Alarm present:
Alarm level:
Date of last pumping:
Comments (condition of alarm and float switches, etc.)
EYes Eruo
Alarm in working order:Eyes Eruo
Date
* Attach copy of current pumping contract (required). ls copy attached?
9. Distribution Box (if present must be opened) (locate on site plan):
E Yes I tto
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 16x16 with 1 outlet line, cover is 2" below grade
tsinsp.doc . reu. 7 1261201 I Title 5 Official lnspection Fom: Subsurface Sewage Disposal System. Page 12 of 18
5$, Gommonwealth of Massachusetts
Title 5 Officia! lnspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth
City/Town
Ma. 02673 4-10-26State Zip Code Date of lnspection
D. System lnformation (cont.)
10. Pump Chamber (locate on site plan):
Pumps in working order: E yes E No"
Alarms in working order: E yes E No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
. lf 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):
lf SAS not located, explain why:
Type
tr
x
tr
tr
tr
tr
n
leaching pits
leaching chambers
leaching galleries
leaching trenches
leaching fields
overflow cesspool
in novative/alternative system
Type/name of tech nology:
number:
number:
number:
number, length:
number, dimensions:
number:
11
tsinsp.doc. teu. 7 12612018 Title 5 Ofiicial lnspection Form: Subsurface Sewage Disposal System ' Page 13 of'18
s. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248Camp St. Foxwoods ll BIdg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma. 02673 4-10-26
City/Town State Zip Code Date of lnspection
D. System lnformation (cont.)
1 1. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SAS is 11 Flow Diffusers, flows are dry with no sign of failure at time of inspection
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
lndication of groundwater inflow ! yes n ruo
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
tSinsp.doc . rev. 712612018 Title 5 Official lnspection Form: Subsurface Sewage Disposal System . Page 14 of'18
5fu. Commonwealth of Massachusetts
Title 5 Official lnspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma. 02673 4-10-26
City/Town State Zip Code Date of lnspection
D. System lnformation (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.).
tsinsp.doc. rev. 7 126D018 Title 5 Official lnspection Fom: Subsurface Sewage Disposal System'Page 15 of 18
5fu. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth ft/a
State
02673
Zip Coae
4-10-26
City/Town Date of lnspection
D. System lnformation (cont.)
'14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, includlng 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:
X hand-sketch in the area below
I drawing attached separately
bst J'I 46t
jqelrc.e.
lc
te
tsansp.doc. rev. 7 n612018 Title 5 Official lnspection Form: Subsurface Sewage Disposal System . Page 16 of 18
5s' Gommonwealth of Massachusetts
Title 5 Officia! Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248Camp St. Foxwoodsll BldgU
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma.02673 4-10-26
City/Town State Zip Code Date of lnspection
D. System lnformation (cont.)
15. Site Exam:
X Check Slope
X Surface water
X Check cellar
X Shallow wells
Estimated depth to high ground water:11',
feet
Please indicate all methods used to determine the high ground water elevation:
tr Obtained from system design plans on record
lf checked, date of design plan reviewed:Date
X Observed site (abutting property/observation hole within 150 feet of SAS)
tr Checked with local Board of Health - explain:
Checked with local excavators, installers - (attach documentation)
Accessed USGS database - explain:
tr
tr
You must describe how you established the high ground water elevation
No ground water per last report
Before filing this lnspection Report, please see Report Completeness Checklist on next page.
tsinsp.doc . tev. 7 12612018 Title 5 Official lnspection Fom: Subsurfae Sewage Disposal System . Page'17 of '18
5fu. Commonwealth of Massachusetts
Title 5 Official lnspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
248 Camp St. Foxwoods ll Bldg U
Property Address
Foxwoods Condominium Homeowners Association
Owner
information is
required for every
page.
Owner's Name
West Yarmouth Ma 02673 4-10-26
City/Town State Zip Code Date of lnspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
X n lnspector lnformation: Complete allfields in this section.
X e. Certification: Signed & Dated and 1, 2,3, or 4 checked
X C lnspection Summary:
1,2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) compteted
X O. System lnformation:
For 8: TighVHolding 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
tsinsp.doc . rcu. 7 12612018 Title 5 Official lnspection Form: Subsurface Sewage Disposal System . Page 18 of 18