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Home My WebLink About Title V Report 9.10.26'i-. CommonwealthofMassachusetts Title 5 Official lnspection Form RECEIVED ocr 0I 2026 HEALTH DEPT. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Prope.rtv eJds Deal Ownett ttanreOwner information is required lor every page lvla Stat" 9-10-26 Date of lnspection lmportant: When filling out forms on the computer, use only the tab key to move your cursor - do not use the retum key. Yarmouth Port Citynown Zip Code A. Inspector lnformation Douglas A Brown Name ol Inspector DA Brown lnc Company ruam- PO BOX 145 comparry laoress Centerville City/Iown 508420-4534 fetepnone ttl.rrnOer Ma State st 4297 License Number 02632 Zip Coa. B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 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 of my inspection; and the inspection was performed based on my lraining and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. I Passes 2. ! Conditionally Passes 3. ! Needs Further Evaluation by the Local Approving Authority 4. E Faits ns s Signature 9-10-26 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. 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 to the buyer, if applicable, and the approving authority. lsnsD.doc. rev. 5/l9/2026 Title 5 offi.ial lnspection Form: Subsurlaco Sewage DtsposalSysteh. Paqe 1 oi 18 lnspection results must be submitted on lhis form. lnspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. i$' Commonwealth of Massachusetts Title 5 Official lnspection Form Owner information is required for every page. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 N/ain St Property Address Deal Ownefs Narne Yarmouth Port City,'fown Ma 9-10-26 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: I 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: At time of inspection this system met all passing requirements. This report can not predict the future performance under the same or increased usage. 2) System Conditionally Passes: ! One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or'not determined" (Y, N, ND) for the following statements. lf "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is struclurally unsound, exhibits substantial infiltratjon 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. trY EN ! ND (Explain betow): tsinsp.doc. rev, 5/1 9/2026 Tlle 5 Offcial Inspalion Fom Subsudace Sewage Oisposal Syslem. Page 2 of 18 5f:,, GommonweatthofMassachusetts Title 5 Officia! lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Owner information is required for every page 939 Main St eroperty nOAress Deal Owners Name Yarmouth Port Citynown tv'ta Strt"Zip Code 9-10-26 Oate ot tnsp.ction C. lnspection Summary (cont.) 2) System Conditionally Passes (cont.): ! eump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. E 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): tr broken pipe(s) are replaced n Y fl N E ND (Explain betow): n obstruction is removed n Y tr N n ND (Explain betow): ! distribution box is leveled or replaced E Y ! N n ND (Explain betow): ! 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 ofthe Board of Health): tr broken pipe(s) are reptaced E y ! N E ND (Explain betow): tr obstruction is removed E y tr N n ND (Exptain below): 3) Further Evaluation is Required by the Board of Health: E Conditions exist which require further evaluation by the Board of Health in order to determine ifthe system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR15.303(1Xb) that the system is not functioning in a manner which will protect public health,safety and the environment: 15 nso.doc . rev 5/19/2026 Trli6 5 Otrcial lnsp6clion Form: Subsurface S€wage DisposatSystem- page 3 of 18 5|r Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Owner information is required tor every page. 939 Main St Froperty eOOress Deal Ownefs tlame Yarmouth Port Citynown lvla State Zip Code 9-10-26 bate of lnspection C. lnspection Summary (cont.) tr 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 fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner lhat protects the public health, safety and environment: n The system has a septic tank and soil absorption system (SAS) and the SAS is wathin 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 ol 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 waler 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: Yes tr n No ! Backup of sewage into facility or system componenl 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 Tite 5 Otrcial hspection Formr Sobsuriace S6wage Disposat Syslom. pag6 4 of 18ttnsp.do.. rev. 5/19/2026 4) System Failure Criteria Applicable to All Systems: You !08! indicate "Yes" or "No" to each of the following for all inspections: 4. Commonwealth of Massachusetts E Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Owner information is required for every pa9e. Property Address Deal Owner's Ntme Yarmouth Port -itynown 7ip coou 9-'to-26 Date tlnspection Ma St"t" G. lnspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No trE NE NE trE trE trU trE !n E Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.I The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. The system qi!g. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to thequestions in Section C.4. Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow Required pumping more than 4 times in the last year rVOf due to clogged or obstructed pipe(s). Number of times pumped: _. Any portion ofthe 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 po(ion of a cesspool or privy is within a Zone 1 of a public water supply well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. the system is wilhin 400 feet ofa 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 trn ntr trn lsinsp.doc. rev. 5/19/2026 T Ue 5 Oltcial hspeclion Fo.m Subsurface Sewage Disposal Syslem. Page 5 ol18 Title 5 Official lnspection Form E tr tr 5}. Commonwealth of Massachusefts Title 5 Officia! lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Owner information is required for every page 939 Main St eroperty eOOress Deal Ow,ert ttar.,e Yarmouth Port City/Town t\,,ta stit"Zip Code 9-10-26 Date of Gspeition 6 C. Inspection Summary (cont.) 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 approprjate regional office of the Department. You must indicate "yes" or "no" for each of the following for a/ inspections: Yes No tr E Pumping information was provided by the owner, occupant, or Board of Health tr E Were anyofthe syslem components pumped out in the previous two weeks? E tr Has the system received normal flows in the previous two week period? -l l-l Have large volumes ofwater been introduced to the system recently or as part of this inspectton? El n Were as built plans of the system obtained and examined? (lf they were not available note as N/A) E tr Was the facility or dwelling inspected for signs of sewage back up? E tr Was the site inspected for signs of break out? n E Were all system components, excluding the SAS, localed on site? E ! Were the septlc 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? E tr Was the facility owner (and occupants if different from owner) provided with informataon on the proper maintenance of subsurface sewage disposal systems? The size and location ofthe 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)] E tr lsinso.doc. rev- 5/1 9/2025 Tde 5 O,tcial lnspedion Formr Subsurt@ S€wag6 Oisposat Syslem. page 6 ot 18 E .'g-,. CommonwealthofMassachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address Deal Owner information is required for every page. Owner's Name Yarmouth Port ^,4a 9-10-26 City/Town State Zip Code Date of lnspection D. System lnformation '1. Residential Flow Conditions: Number of bedrooms (design)Number of bedrooms (actual) DESIGN flow based on 310 CMR 15.203 (forexample: 110 gpd x# of bedrooms) Description: Number of current residents: Ooes 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: Sump pump? Last date of occupancy: I Yes E tto E Yes E t'to EYesE !vesE !YesE No No No ! ves ! t'to Date lSnsp.d@. rov. 5/19/2026 TrUe 5 Olficial rnspecrion Forh:Subsurta.e S6wa96 Disposatsyslem. page 7ot 1B : ^ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address Deal Owner anformation is required for every page. Ownels Name Yarmouth Port t\4 a 9-'10-26 City/Town State Zip Code Date of lnspection D. System lnformation (cont.) 2. Commercial/lndustrialFlowConditions: Type of Establishment: Design flow (based on 310 CMR 1 5.203): Basis of design flow (seats/persons/sq.ft., etc.) Grease trap present? Water treatment unit present? lf yes, discharges to: lndustrial waste holding tank present? Non-sanitary waste discharged to the Title 5 system? Water meter readings, if available: Last date of occupancy/use: Other (describe below): Office condos see attached plan Gallons per day (qpd) see attached plan E ves fl No E ves E tto ! Yes E tlo E ves E tto attached to end of report 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: currently occupied Date fl Yes I No gallons tsnsp.dm. rev 5h 9/2026 Tite 5 Otfidal lnsp6ction Form Subsurfa@ Sewage Disposal Sysrem. page 8 of 18 .e.. Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address Deal Owner information is required tor every pa9e. Owners Name Yarmouth Port l\ila 9-10-26 City/Town State Zip Code Date of lnspection D. System lnformation (cont.) 4. Type of System: E Septic tank, distribution box, soil absorption system n Single cesspool n Overflow cesspool tr Privy tr Shared system (yes or no) (if yes, attach previous inspection records, if any) tr lnnovative/Alternative technology. Attach a copy of the cunent 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 conlract tr Tight tank. Attach a copy of the DEP approval. n Other (describe): Approximate age of all componenls, date installed (if known) and source of information: 2001 according to attached plan Were sewage odors detected when arriving at the site? 5. Building Sewer (locate on site plan): Depth below grade: Material of construction: I cast iron E 40 PVC ! other (explain) Distance from private water supply well or suction line:feet Comments (on condition ofjoints, venting, evidence of leakage, etc.) !vesUto feet tsinsp.doc. rev. 5/19/2026 Ifte s Oficial lnsp€ctioi Fo.m: Subsudae Sewage Disposatsysrem. pag6 9 ot 18 :f ^ Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address De?l Owner information is required lor every page. Owner's Name Yarmouth Port Ma StaG 9-10-26 Cily/Town Zip Code Date of lnspection D. System lnformation (cont.) 6. Septic Tank (locate on sile plan): Depth below grade: Material of construction: E concrete E metal 2 feet ! fiberglass ! polyethylene ! other (explain) lf tank is metal, Iist age years ls age confirmed by a Certificate of Compliance? (attach a copy of certificate) ! Ves ! tto 2000 gallon Dimensions: Sludge depth: 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? not much scum lightly clumping scour pole lsinsp doc. r€v 5/19/2026 Ti e 5 Olficial lnspection Forh: Subsudae Sewage Disposal System. p6qe jO of jB light sludge heaviest at inlet Commenls (on pumping recommendalions, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert, evidence of leakage, etc.): tank was functioning prpoerly at time of inspection with no signs of failure Tank had metal covers tograde ;{^ Commonwealth of Massachusetts Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address Deal Owner information is required for every page. Owner's Narre Yarmouth Port City/Towll l\ila 9-10-26 Stale Zip Code Date of lnspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: Material of construction: ! concrete ! metal feet ! fiberglass ! polyethylene E other (explain) Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of constructionl ! concrete D metal ! fiberglass E polyethylene ! other (explain) Date Dimensions: Capacity: Design Flow gallons gallons per day Tite 5 Otfcjal lnsp€.tion Form: Subsda@ Seago Oisposal Systeh. page 11 ot 1815nsp-doc. rev. 5/19/2026 Title 5 Official lnspection Form .€\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurrace Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address Deal Owner information is required for every pa9e. Owner's Name Yarmouth Port City/Town Ma Stut" 9-10-26 Zip Code Date of lnspeclion D. System lnformation (cont.) 8. Tight or Holding Tank (cont.) Alarm present: Alarm level: Date of last pumping E Yes ENo Alarm in working order E ves DNo Date Commenls (condition of alarm and float switches, etc.): - Attach copy of current pumping contract (required). ls copy attached?Yes n No 9. Distribution Box (if present must be opened) (locate on site plan) 0" 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.): Box is right off of parking area and has a metal cover lo grade riser is made of block. tSnsp,doc. r6v. 5/19/2026 li o 5 Olfcial lnsp€ction Fo.m: Subsurfa@ Sewage Dtsposal System. page 12 of iB :*. Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Owner information is required for every page. Property Address Deal O*ner's flame Yarmouth Port t\.4 a 9-10-26 City/Town State Zip Code Date of lnspeclion D. System lnformation (cont.) 10. Pump Chamber (locate on site plan): Pumps in working order: E Yes E Uo' Alarms in working order: ! Yes E r.lo- 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. 1 1. Soil Absorption System (SAS) (locate on site plan, excavation not required) lf SAS not located, explain why: Type: tr E tr tr tr tr tr leaching pits leaching chambers leaching galleries leaching trenches leaching fields overflow cesspool innovative/alternative system Type/name of technology: number: number: number: number, length: number, dimensions number: 15 infiltrators tsinsp.doc ' .ev. 5h 9/2026 Tits 5 Official lnsp*tjon Form: Subsudae Sea96 Djspoel Systen. Paq6 13 of t8 .€.' Commonwealth of Massachusetts Subsurface Sewage Disposal System Form - Not for Voluntary Assessmenls 939 Main St Property Address Deal Owner information is required for every page Owner's Name Yarmouth Port t\.4a 9-10-26 City/Town State Zip Code Date of lnspecllon D. System lnformation (cont.) 'l 1. Soal Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): lnfiltrators were dry at time of inspetion viewed by camera no signs of failure lher was some root infiltration 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 construclion lndication of groundwater inflow ! Yes ENo Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): lsinsD.doc. rev 5/19/2026 Title 5 Official lnspection Form TiUe 5 Otrcial hsF6clion Fom: Subsu.fa@ Sewage Oisposat Systen. paqe 14 ot j8 .e\ Commonwealth of Massachusefts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Volunlary Assessmenls 939 lVlain St Property Address Deal Owner information is required for every page. Owner's Name Yarmouth Port 9-10-26 City/Town Zip Code Date of lnspection D. System lnformation 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tsinsp,doc . .ev. 5/19/2026 Trdo 5 Olfoal lnspetio. Fom: Subsuda@ $wage Disposal System. Page 15 ot 18 Ma Stutu 5}., Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address Deal Owner information is required lor every page. Owner's Name Yarmouth Port t\,4 a 9-10-26 City/Town State Zip Code Date of lnspection D. System lnformation (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least lwo permanent reference landmarks or benchmarks. Locate all wells within '100 feet. Locate where public water supply enters the building. Check one of the boxes below: n hand-sketch in the area belowE drawing attached separately lsnsp.de. rev. 5/19/2026 Tit6 5 Offcjat tnsp€ction Form: Subsudaco S€wage Disposatsystem. page 16 oi 18 I I I I €\ Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessmenls 939 Main St PropeIty Address Deal Owner informalion is required tor every page. Ownels Name Yarmouth Port Ma 9-10-26 City/Town State Zip Code Date of Inspection D. System lnformation (cont.) 15. Site Exam: E Check Slope E Surface water E Check cellar E Shallow wells Estimated depth to high ground water: no gw encountered Please indicate all methods used to determine the high ground water elevation: E Obtained from system design plans on record attached lf checked, date of design plan reviewed:Date tr Observed site (abutting property/observation hole within 150 feet of SAS) tr Checked with local Board of Health - explain: Checked with local excavators, installers - (attach documentation) Accessed USGS database - explain: ! You must describe how you established the high ground water elevation: attached design plan Before filing this lnspection Report, please see Report Completeness Checklist on next page. t5insp-doc..ev. t19/2026 Iite 5 Offcial lnsp€cbon Fo.m: Subsurla@ S€wa96 Dispo$l System. Page 17 ol18 tr 1(^ Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Property Address Deal Owner information as required for every page. Owner's Name Yarmouth Port Ma 9-10-26 City/Town State Zip Code Date of lnspection E. Report Gompleteness Ghecklist Complete all applicable sections of this form inclusive of: E A. lnspector lnformation: Complete all fields in this section. E B. Certification: Signed & Dated and 1 , 2, 3, or 4 checked E C. lnspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed E D. System lnformation: For 8: TighUHolding 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 15.so.doc ' rev. 5/19/2026 TiUe 5 Offcial lnspection Fom: Subsudacg S€sage Oispoetsystem. page j8 ot 18 A. Commonwealth of Massachu6etts Title 5 Official Inspection Form Subsuface Sewage Disposal System Form - Not for Voluntary Assessments 939 Main St Rte 6A Yarmouth Port , MA ( all business condos) Property Addae6s Steven G Heslinga TR 1643 H annis Rd Owher informalion is required for evary page. Owher's Name Bamstable City/Town 02630 Siate Zip Code Oat6 of lnspection D. System lnformation (cont.) 15. Site Exam: X check Slope I Surface water X check cellar X Shallow wells Estimeted deplh to high ground water:37.5 feet Please indicate all methods used to delermine the high ground weter elevalion: X Obtained from syslem design plans on record '1ot2512001lf checked, date of design plan reviewed:Date D ObseNed site (abutting property/obseNation hole within 150 feet of SAS) ! Checked with local Board of Health - explain: SITE IS 64' ASL WITH A GROUNDWATER CONTOUR OF 13' ASL AND A MAX RISE OF 8', SEPARATION MATH: 64 - ( 13 + E + 5.5; = 37.5'. ALSO, DESIGN TEST HOLE SHOWED NO GROUNOWATER AT 12.0'. GROUNDWATER AOJUSTMENT lS 5.7'FOR A1W247 ZONE B for 10/2001 . GRADE TO SAS BOTTOM AT 5.5' SEPARATION MATH: 12-(5.7+5.5) = 0.8'. Bofore filing thas lngp€ction Report, please see Repod completeness checklist on next page. tr x You must describe how you esteblished the high ground waler elevation: 6n3p &. . r* 7D6l2014 ld.5 Onrcr hsp-ton Fo6 Sql6{n@ S6,ir. O6roel SFt n ' PalE r 7 ot 18 1t27 t2023MA Checked with local excavators, installers - (attech documentetion) Accossod USGS detabase - explain: GOOGLE MAPS, CCC GROUNDWATER CONTOUR MAP, FRIMPTER. !9i8n-E liil't s \8 I tr !l\t\ ( ,; 13 !lE ,H I E 5 !I I I rl I Ett t E i I I I I E l I I I I II I a !I I i I It 5! lr't IIx r , I Id l. f : I I F T II tI II € EE iir; 1rF t' qh F I L I i : c a II 2: I tL B Eiiig['i it T I I ,c t' I aA, t TP a -r!:o,IliIa F :!; IiiI!-c:3;).f;3g3c ! q 6 iiiiiiiiirli; !' 3, !#r! r;;!i i aif;E ti;,n;:t; !ri ,o,o,"i> lls a 2 8 I F n I 3II I eI 8 B !I I c g t [E[El: r tE;sL il"P t'^t; t; 6 -o - -..-. iiiliiiffilil IiiiiI'!!ffiE E iE $tE ;91i1 Eiii,il.ilrirl l;'!I Z' E 8 l; 6 F lr I IE 3 E E F Etr h E tst I n l3 ii. f; f;tri $iii ilrtrr!"rl !iiia-a-I6TTl9:;!l:lerl! ei: - r:l8lrlrl9 t trn IgE Ec!3,4 \t h(, ailp\: q !z I I q I L F I tsI D ocr ''1,oa I 8 II i !I * i s r!lliti i!iiiii iitiEi! ii!p;i t E I lt !t el1l B Fla I B II E ! r+ltar'-* FE lq 5!ti Ei Ttt ;I t +&- !i EE,9. 3 d I F ; I EI !r I ? I !r,;! 5l;">3o'P cIt ! Ei I t IitIt I!I I I :l I I I I A. Commonwealth of Massachusettg Title 5 Official lnspection Form Suburfacs 8.wrge Disposal Sy3t m Fom - Not for Volunt8ry Assessments 939 Main St Rte 6A, Yarmouth Port , MA ( all business condos) =r :r'.li Proporty Addr@ Stovon G Hoslinoa TR 1043 Hyannis Rd Omar lntCmdbn b! r.quir.d lq stry p.ea. Owner'a Nem. Bamstable 02030 1t27 t2023 Clty/To',Yn Strlr Zlp Cod!Data ol |rrlprdlon D. System lnformatlon (conr.) 14. Sketch Of Sowage Dispo3el System: Provide a visw ofthe sewage disposal system, indudino tlss to at least two permanent rBference landmerks or b€nchmarts. Locsts all wells within 100 foot. Locsts whEro publlc weter supply onters tho building. Chock one ofthe boxes bolow: B hand-skBtch ln the ar€e b6low! Orawing ettached s€parataly MA -U ilo*t aoo baiL I a Drter*es. -arr ilrr3' tta3[l 3Aple' t1:31I, Ag-lat'13:6f- o I -.it'ir{tiEaEltCElHi!Et t!EFLll' !ri.! @. rv 7,2a/2018 I){5 TE 5 Oicid r^.p.o!on Forft SubiJit o.g,rg.Olpo.rS]rdn.p.9.t!or16 9/13i26, 10:58 AM Xfinity Connect RE 939 Route 6A- 2 years Consumption Printout Laura Foss <lfoss@yarmouth.ma.us> RE: 939 Route 6A- 2 years Consumption To dabrown5@comcast.net <dabrown5@comcast.net> Here you go: A1 2024- 1,000 gallons 2025 - 3,000 gallons 8,1 2024 - 1,000 gallons 2025 - 1,000 gallons 82 2024 - 0 2025 -O c1 2024 - 3,000 gallons 2025 - 6,000 gallons c2 2024 - 7,000 gallons 2025 - 8,000 gallons D,I 2024 - 0 2025 - 3,000 gallons D2 2024 - 13,000 gallons 2025 - 10,000 gallons E1 2024 - 0 2025 - 1,000 gallons F1 2024 - 2,000 gallons 2025 - 2,000 gallons F2 2024 -20,000 gallons 2025 - 1,000 gallons T'lt*nbyo*Laurw Laura Foss DPWWater Division Customer Service Supervisor 508-771-7921X 1403 9t1112026 1 .45 PM https://connect.xnnity com/appsuite/v=7. r 0.6-59.20260806.131335/print.htmr?print 1789 31,r4gs273 1t1