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Home My WebLink About0115 GROVE STREET - Health 115 Grove Street, Cotuit 4 L = 019 - 025 — i TOWN OF BARNSTABLE LO(:AYION //h !!AVPZ VILLAGE Ld>/Cd/ / �e' ASSESSOR'S MAP & LOT �� fN NAME&PHONE NO. r SEPTIC TANK CAPACITY �� / L�CiS LEACHING FACILITY: (type) ZZ1a0a44A& (size) NO.OF BEDROOMS BUILDER OR OWNER 1 �ZV O A-� PEIIATE: 1 �� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa ility Feet Furnished by :`s % o } 0 � / is GRvv� s Loc- AT ION ,� SEWAGE PERMIT NO. S VILLAGE cc) I N S T A LLER'S NAME 6 ADDRESS B U I L D R OR OWNER � I \ DATE PERMIT ISSUED DATE COMPLIANCE ISSUED a �Y � .�_ K: .� � � �`�' . 1,. � s �� C� / '� `fir �-�'- � � � , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p �V............_0F................. !11,� G.. , pphratiun for Biupusttl Workii Tonutrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (e_�an Individual Sewage Disposal System at: ...�n�oS�..... 'v ... ......... .... ----------.... ------------------------ ..._... Location- r s or Lot No. r Adr _._ a __ 7 --• ess ---------------------------•---.........--- Installer Address dType of Building Size Lot............................Sq. feet V Dwelling 4ZNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ F..l Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-._-_--______-_---_____. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil...........V _J, •--•-•-•-------------•--••---•------•--•-----...--•----•---•-------------•------•-••----•---•••-•-----..... ,y U Nature of Repairs or Alterations—Answer when applicable......................... ......�1/ _T �,�CT.__..__._______._... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by t boar of health. Signed-.... . ¢ Date ApplicationApproved By-•-•-•••••••--•---••••••-••-•-----••..........-••---•....••••••--•-••-••-•--•-••-•----•---•--•••. ........................................ Date Application Disapproved for the following reasons-------------•----•-------------------------------------•--------------------------------._.........--••••....... ..---••---•--------••-------•----•-----•---•••-•••---•--•-••----•-•---•--•-•--•-•-----•---•-•••-•---...._••----•----••----•--••••••--------••----••-••-•••••--••---•-••---...•-----•-•••............... Date PermitNo...............•-..__._......---••-------•--•-••-------. Issued-....................................................... Date--------- -- - -- No.V............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /I J- 0 F /` Z........................................ ....... ................................-- ._........... Appliration for Disposal narks Tonstrurtion Vprrmit Application is hereby made for a Permit to Construct or Repair 011) an Individual Sewage Disposal System at: .............................. .......1�eZj. 4A 4 K,.l LocationS%_,ss fij or Lot 2, .................. ............ ........... .................................................................................................. . t130 4 lI Address . ...................A _ ................J;? ..... .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling -;"No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons._......_......___...__.____ Showers Cafeteria Other fixtures ...................................................... < Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width..._._........._ Diameter___-__...._..._. Depth................ Disposal Trench—No..................... Width.................... Total,Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter....____._......._.. Depth below.inlet.................... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank.( Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water____........_:__..._.__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit._.__..........__.... Depth to ground water..._._..........._____.. ................ ................................................................................................................. 0 Description of Soil........... ..........................................................................................................I......................... . U ................................................................................................_................................................................................................... ........................................................................................................................ --------------------------------------- ------------------------ U Nature of Repairs or Alterations—Answer when'applicable...Z-:.!?/-!�....e ...................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar of health.,' /jr Signed . ...... !A1,6k. on-4. ... .... ........... VDate ApplicationApproved By...........................................w...................................................... . ........................................ 1 1 Date Application Disapproved for the following reasons:.................................................................................................................. ......................................................................... .......................................................................................................................... Date PermitNo........................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , � ..................................I.......OF........ ............................ ................................. Trrtffiratp of Tautplitturp T YSSjl CERTIFY That the Indivi4ual Sewagg.-JUisposal System constructed or Repaired W-f by--- ............. ..S24�4..........��C, ............................. ............................................................................................ at.........Md....... .......!D&9............................................. has been installed in accordance with the provisions of TI'LE 5 of The State Sanitary C ve ,scribed in the application for Disposal Works Construction Permit ------------------------ ............. dated,0/�?__ &4" THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEMfl (_Z/! CTION SATISFACTORY. ..............DATE....... G/ ....................................... Inspector... ... ....................................................................... THE COMMONWEALTH OF NfASSACHUSETTS BOARD OF HEALTH ........ ..........OF.....��SU ................................ No ........ FEE.......................... Disposal TotuAr!vivit V Put Permission is hereby grant .?4 ed ......... ................................................ ....Z............f ..................................... to C onstruct or �e?air ( an JHdiv w idual Sewage Dispysal-,k. ,7 `� stem .......... .................................. ..................................................................................... Street as shown on the/appli Ion/for isposal Works-Construction Permit No......... Dated.......................................... .......................... ......... .............................................................. Board of Health DATE.-----`- ... .....2. ............/........................................ FORM 1255 A. M. SULKIN, INC., BOSTON �.� ova ✓ DATE; _ 2/13/97 PROPERTY ADDRESS: 115 0"rove Street' Cotuit �FC'IVEQ Mass . 02635 1 19g7 HFAt,y'Vpr (E On the above date, I Inspected the septic system at the above address This system consists of the following: ®6 1 . 1 -61x8l block cesspool. 2 . ' 1 -1.000 gallon precast leaching pit. Based on my Insruectlon, 1 certify the following conditions: 1 . This is not' a title five septic ssytem. 2% This is -a sewage system. 3 .�Th'e sewage system is in-proper working order ' at the n present time .-, � - _. :te ��.14u•...-'�^-'� 5IGNATUR!-,: G`i( Name: J . P .Macomber Jr.,--------------- Company; J. P.Macomber &- Son-Inc . , Address: __Centerville , Mass__02.632 Phone: ---50.8--..7..5-.333a------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY RM W- 4.1 10 JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds . Pumped & Installed Town Sewer Connections P.O. Box 66' Centerville, MA 02632-0066 775-3338 775-6412 .� Ul Commonwealth of Massachusetts ExecutNe Office of Environmental Affairs Department of Environmental Protection WUllam F.Weld GOV411 r Trudy Coxe Paul Celluccl Seals" David B.Struha e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Prop.AyAad,.e.a: 115 Grove Street Cotuit,Mass . Addressofowner. Barbara Oakes Date of Inspecuon: 2/1 2/9 7 (If different) H C R 35 Box 483 Name of Inspector.. Joseph P.Macomber Jr. Tenants Harbor Maine Company Name,Address and Telephone Number. 04860 J. P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper fm&1on and maintenance of on-site"wage disposal systems. The system: _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: cj��/� i'�/l ��/t'f ` Date: ` �✓'��/ The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner.-md copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: —A-V SSYg"T M E95-•— I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: _._ .lL One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passel inspection. Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all iaetances. If-not determined",explain why not) A'Li cfi The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exilltration,.or tank failure is +^'}*. ut. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 i� Primed on Recycled Paper • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: 115 Grove Street Cotuit,Mass . Owner. Barnara Oakes Date of Inapeotioa 2/12/9`] Bl SYSTEM CONDITIONALLY PASSES (continued) e' Sewage backup or breakout or huh static water level observed in the distribution boat is due to broken or obstructed pipe(,) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health: broken pipe(,)are replaced obstruction is removed distribution boat is kv*IW or replaood _Q The system required pumper more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed Cl 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 the public haalth,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMEN'I`. d'-4' Cesspool or privy is within 60 feet of a surface water ,,:Le Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh 3) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. (�Q The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well The system has a septic tank and soil absorption system and is Is"than 100 feet but 60 feet or more from a private water supply weil,unless a well water analysis for coliform bacteria and volatile organic oompounds indicates that the well is lee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or ku tban 6 ppm 3) OTHER I>2/ 4 (revised 11/03/95) 2 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 1 5 Grove Street Cotuit,Mass . Owner. Barbara Oakes Date of Inspection: 2/1 2/97 D) SYSTEM FAILS: • fl I have determined that the system violates one or more of the following failure criteria as daIInod in 310 CUR 16.303. The basis for this drurmination is idantified below. The Board of Health should be contacted to detarmins what will be necauary to correct the failure. ,dZ0 Backup of"wage into facility or system component dus to an overloaded or dogged SAS or cesspool. d_20 Discharge or ponding of effluent to the surface(,f the ground or surface waters due to an overloaded or clogged SAS or cesspool. 1'_.Static liquid levelAIn�tt�hs 'f ribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in oeesp6o6L leas than V below invert or available volume is leas than Ul day flow. J-:-1-1 dj? Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s), Number of times pumped 1_)�l Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. G� Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portiaa of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no adaptable water quality analysis. If the well has boon analyzed to be acceptable, attach copy of well water aaalya for ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: _ The sy*tam serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system L a sigaiScent threat to public health and safsty and the environment because one or more of the following conditions cdot: AGC� the system is within 400 feet of a rurtaos drialdng water supply Mthe system is within 200 feet of a tributary to a surface drinking water supply &A 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) The owns or operstor of ate such Byrum shall bring the system and facility into full compliance with the groundwater treatment program mquinm anti of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addsess: 1 1 5 Grove Street C o t u i t,Mass . Owner. Barbara Oakes Date of Ia Pwuow 2/12/9 7 ' Check if the following have boon done: 2p,x,ping information was requested of the owner,o=,pant, and Board of Health. Zone of the system compoas;ts have been pumped for at feast two weeks and the syrtam has been receiving normal flow rates d4rL4 that period. Large vohunes of water have not boon introduced into the system recently or as part of this iarpectiaa. 2A.built plans have boon obtained and examined. Now if they am not available with N/A. Z7_W facility or dwelling was inspected for signs of sewage back-up. ZT11 system does not receive non4anitary or industrial waste flow The site was inspected for signs of breakout. ZAlloom nenL k/ system po ,.excluding the Soil Absorption System, have been located on the site. x,,o4.L. Ths,ae�ptt 7t&4 manholes were unoovered, opened, and the interior of the septic tank was inspected for condition of bafnes or too",material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. , The eire and location of the Soil Absorption System on the site has been determined based on existing information or ap red by non-intrusive methods. The facility owner(and occupants, if di5arent from owner) were provided with iaformatfoa on the proper matatenaaoe of Sub- Surface Disposal System. (revised 11/03/95) 4 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Addrrsa: Owner. Date of Inspeotiow FLOW CONDITIONS RES I D ENTLAL• Design flow:4' dW y e Number of bedrooms: Number of aurent residents: Garbage grinder(yes or no):� Laundry ooaaected to system(yes or no): �1 Seasonal use (yes or no):ILef Water meter readings, if available: 9� - - 1t7 •U�,z_ l u Last date of occupancy: %iAM) COMMERCIAL NDLTSTRIAL• Type of establishment:_ A)t Design flow:_ LA gallo:.:!day Grease trap present: (yes or no)_&26 Industrial Waste Holding Tank present: (yes or no)P0 Non-sanitary waste dL.,-zar3ed to the Title 5 system: (yes or no)"I Water meter readings, is available:__ AM Last data of occupazcy-_42�— OTHER:- (Describe) /U4 Last date of oocupancy:_N GENERAL INFORMATION PUMPING RECORDS and source of information: 414 System pu=;: as post of inspection: (yes or no)_&8C ';y 1^Y If yes, volume pumped: tl'4 Rallons Reason for pu-::.ping:TYPE OF OF SYSTEM /, y Septic tazWL-trilyution boa/soil absorption system G L� Privy �1116 Shared systxa. es or no) (if yes, attach previous inspection records, if any) Other(ezplai:) AP'ROXIMATE AG i ull components, date installed (if known) I source of informs ' a: tf T C,v`�%f,�d %� ''= d+�-g�l /�3y@>�ry G<a►' 'TPYyh �,,, ,.>� Sewage odors dew hen urriving at the site: (yes or no) (revised 11/03/95) tT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C- SYSTEM INFORMATION (continued) Property Address: 1 1 5 Grove Street Cotuit ,Mass . Owner: Barbara Oakes Date of Inspection:2/12/97 SEPTIC TANK., 1f css e . (locate on site plan) Depth below grade:�� material of construction (concrete _metal _FRP—other(explain) Dimensions:_ IV Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:Ay.- Scum thickness: Distance from top of scum to top of outlet tee or baffler_ Distance from bottom of scum to bottom of outlet tee or baffle,-A(� Comments: (recommendation for pumping, condition of inlet and outlet tees or bafflee. depth of liquid IPvel in relation to outlet invert, structural rity, evidence of leakage, etc.) ep istank;No.t presen CREASE TRAP.tbWt- (locate on site plan) Depth below grade:,AV_ Material of constmrtionty�;oncrete _metal _FRP —other(explain) Dimensions Scum thickness. Distance from top vt scum to top of outlet tee or baffle: &/ Distance from bosom nl srum t^ bottom of outlet tee or D'afue .U/d ,or— Comments: (recommendation for pumping, condi—it of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et u � j Grease : rap: Not present (revised 6/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) PropertyAddroee: 115 Grove Street Cotuit ,Mass . Owner. Barbara Oakes Date of Iaspectlon: 2/1 2/9 7 TIGHT OR HOLDING TANH:A;Wd, 00mu on sit. plan) Depth blow Malaria1 of coZ'Vudba:�.)doo=vu_theta)_FRP_ot1wr(apWn) - 014 Dimaasioas: .yA capacity: as Decip aow ozwday ALrm level: commants: (oaadidoa of inlet tee,condition of alarm Lad aoat switches, etc.) Ti or holding tanks : Not present DISTRIBUTION BOX:�� (locate on&ite plan) Depth of liquid level&bow outlet invert: Commsats: (sou if level&ad distribution is equal, rvideace of solids carryover, evidence of laakap Into or out of bos,etc.) Ili c+ri lhiItj nn hnv- Mr)+pre t PUMP CHAMB ER. �.sJE? (locate on site plea) Pumps in working order.(yes or no) Commazu: (note coalition of pump chamber, coalition of pump+ Lad&ppurtenancw, etc.) Pump chamber : Not Dresen (revised 11/03/95) � U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORS[ PART C SYSTEM INFORMATION(oontimued) Property Add,,., 115 Grove Street Cotuit ,Mass . owner. Barbara Oakes Date of Iaipeotloa:2/1 2/9 7 SOIL ABSORPTION SYSTEM(SA9)r (locate an sits plan,if post' ;ascavtioa not required,but may be approximated by non•inbusiv methods) • If not determined to be preent,upW=. TYPK p4 number_ le.cain chamber,number: 0 1whin plbries, numbs-= iww" ' wenches,number,leagch: leaching dalds,number, dimensions: overflow cesspool, mumber; C) Comments: (note condition of soil, of l�uHc ukv level of poadiag, of v Sand:No signs of hydraulic I-allure or ponT-ng: n've normal. No repairs needed at the present time CESSPOOLS: (locate on site plea) Number mad coudguzation: Depth-top of liquid to inlet invert: Depth of solids ky*r Depth of scum Dyer. Dimensions of owspool: h I C Materials of constrxdon: Y Indication of groundwater. pumped as part of inspection) /I 5 T Comments: (note ooadition of soil, Wps of hydraulic&Burs,level of poncUn ,condition of vgetatioa,etc.) PRIVY: (beats on site plan) MatariaL of �!/ Dimensions: Depth of solids Ally Commrats:(nots c=didoa of soil, signs of hydraulic failure, level of po=Un&condition of vegetatba,itc) Privy: Not presen ` y (revised 11/03/95)• `8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE I=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Cotuit Water Company 428-2687 1,d � 0:2 0 � o i GR0 s DEPTH TO GROUNDWATER _1.6' + depth to groundwater rpthod of determinesion or �approximati,on: _Tnsta.11ed �`QOOf. g�ilon pr�e.-wt pi 8/.24 $G 'permit# 84-754 no water pn .onnt,Pred a•t, . 121 .. y .® r - 1 •n.mr-..—nrr�-r�..n. wnnr.wnn.n.wrmmn.+w�...-�.,..n..e*w•�+n--.r+�nw�+ .rn-rs-r-�—n—'..-..,_..,' I TOWN OF Barnstable BOARD OF HEALTH 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION I `� �^•�}71••.•••.—S.1I.^.�TTI.T T1n'...TT11'T1P RTt/11'�T'�:'I r1 TT•�1f11AT''!'nRlAr/R.-�'Rt�Tr\ Iwll .5�.•T1"^'I��. �..A -TYPO OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 115 Grove Street Cotuit ,Mass . ASSESSORS MAP , BLOCK AND PARCEL # 19-25 OWNER' s NAME Barbara Oakes PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & Sot 'INc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 3338 FAX ( 508 1 790 - 1 578 R A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .-inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : IXX.XXXXXXXX'Sys tedi-PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or Lhe environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED# The inspection which I have con ilcted has found that the system fails to protect the i)ublic health and the environment in, accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , - Inspector Signature Date 2 13/97 One copy of this c t,ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTII. e If the inspection FAILED, the owner or•"operator shall u d within one year of the date of the inspection , unless allowed ortrequiredm otherwise as provided in 3.10 CPIR 16 , 305 . partd .doc ��. .•t�a�-. SIC f r r^ r V) Jos �r sbj1f 3r�1� THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. t Junc 8, 1995 Acting Director of the ion of Water Pollution Control