HomeMy WebLinkAbout1783 MAIN STREET (COTUIT) - Health 1783 MAIN STREET, COTUIT
A= 016 025
TOWN OF BARNSTABLE.
LOCATION e17P A�� S;r- 7- SEWAGE #
VILLAGE �r�a. ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY W°&
LEACHING.FACILrI Y: (type)010" L-54s�9� � (size)
NO.OF BEDROOMS
s
BUILDER OR OWNER ��1 ,/
PERMPTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater`Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and gaching Facility(If any wetlands exist
within 300 fe o c acility) - Feet
Furnished b J�
V �L.
F,
_ A ,
\ 6;K
. �I
DATE : 5/18/98
PROPERTY ADDRESS:_1783 -Main Street Cotuit,Mass.
------------------------
------------------------
On the above date, I inspected the septic system at the above address.
This system consists of the following:
1 . 2-6 'x8 ' block cesspools.
Based on my inspection, I certify the following conditions:
2 . This is not a title five septic system.
3 . This is a sewage system that is in proper working
order at the present time.
4 . The system and the house are on a bluff high above the ocean.
5 . System is within 75 ' of the water.
6 . Nearest cesspool is 80 ' from the well.
SIGNATURPI
Name :- J .- -Macomber-Jr .
Macomber-Jr .
-- -- ------- -------
Company :losegh _p,_il_!5comt2er _3 Son, Inc . ". ' ' r q
A d d re s s :--Bqx- -------------
/VET
__Ct Y n -eriJ_Lp.,_M a _U632-0066 Af4Y 2
199
Phone : _------ 5_ 3338 _---_--_ q°TBo4NSTge 8
i H EPj [f
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WA FAIR�A N TYS.,
(JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775.3338 775-6412 .
` COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
_ DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON, MA 02108 617.292.5500
WILLIASt F 'ELD TRUDY COXT
Cos cmor Sc:rCl3r\
ARGEO PAUL CELLUCCI DAVID B STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissionc:
PART A
CERTIFICATION
Property Address: 1 783 Main Street Cotuit MASS. Address of Owner:Cambridge Trust Co.
Date of Inspection:5/1 1 /9 8 (If different) 1336 Mass. Ave.
Name of Inspector: Joseph P.Macomber Jr. A? ,�,Mass .021 38
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 C j 5�0
Company Name: J.P.Macomber & Son Inc.
Mailing Address: Box 66 Centerville,Mass _ n2632
Telephone Number: 50R_775_3338
CERTIFICATION STATEMENT
I cenify 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 function and
maintenance of on-site sewage disposal systems. The system:
XU Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Zf t Date:
The System Inspecto all 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
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A) SYSTEM PASSES: .
AS 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.
COMMENTS:
81 SYSTEM CONDITIONALLY PASSES:
NO 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.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined-, explain why not
NONE The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection, or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent: 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 04/15/97) Page 1 of 10
DEP on the World Wide Web: http:1twww.magnet.state.me us/oep
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR..m
PART A
CERTIFICATION (continued)
Propen7 Adcress: 1783 Main Street Cotuit,Mass.
O Cambridge Trust Company
0.Ie of Inspection:5/11 /98 .
BJ SYSTEM CONDITIONALLY PASSES (continved)
NONE _ Sewage backup or breakout or high static water level observed in the distribution box is evz orc'�z
pipets) or due to a broken, settled or uneven distribution box. The system will pass insp2ci.:) w +^
Board of Health). Describe observations:
broken pipets) are replaced
obstruction is removed
distribution box is levelled or replaced
NO The system required pumping more than four times a year due to broken or obstr cled p•;2 s '-z i.i:c_
Inspeci,on it (with approval o('lhe Board of Health)
broken pipets) are replaced
obstruction is removed
C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD Of HEALTH:
No Conditions exist which require funher evaluation by the Board of Health in order to determine :1 :ne
p,ol.c health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD Of HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNC1ION1-< ;
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
NO Cesspool or pr�ry is within 50 feet of a surface water
NO Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsn
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPRO?R:AT; Z)
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAF '1 ADD T-,.:
ENVIRONMENT:
_NO The system has a septic lank and soil absorption system (SAS) and the SAS is within 100 :e? o ;
tributary to a surface water supply.
NO The system has a septic tank and soil absorption system and the SAS is within a Zone ; o• :_o .; y.e ..._
_No The system has a septic tank and soil absorption system and the SAS is ith,n $0 lee: of y : .
-NO The system has a septic tank and soil absorption system and the SAS is less than 100 lee: c_: e-:
private water supply well, unless a well water analysis for col.form bacsena ano voix,le orgy-,: c
the well is It" from pollution from that facility and the p nce of ammonia nitrogen anc - . ;:e r :y
less than S ppm Method used to determine distance _ (approximation not val =
7) OTHER
XX System consists of two 6 'x8 ' hlonk CPSSpnnl All nn' s
tc7 paragraph r Dart i nn mho System J CAA—high—gEqund. -- -
,r—t..4 0.r2s/171 ➢.y• 2 of 1`9
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1 783 Main Street Cotuit,Mass .
Owner: Cambridge Trust Company
Date of Inspection: 5/1 1 /9 8
D) SYSTEM FAILS:
You must indicate ei;,•.er "Yes" or"No" as to each of the following:
NO I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
XX Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
NONE_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
XX Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow.
XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped 0 .
XX Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
XX Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
XX Any portion of a cesspool or privy is within a Zone I of a public well.
XX Any portion of a cesspool or privy is within 50 feet of a private water supply well.
XX 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
NO The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
fA the system is within 400 feet of a surface drinking water supply
NA the system is within 200 feet of a tributary to a surface drinking water supply
NA 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/75/97) Psgs_] of 10
V\
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1783 Main Street Cotuit,Mass.
Owner: Cambridge Trust Company
Date of Inspection: S/1 1 /9 8
Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following:
Yes No
XX Pumping information was provided by the owner, occupant, or Board of Health.
XX None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
XX As built plans have been obtained and examined. Note if they are not available with N/A.
XX _ The facility or dwelling was inspected for signs of sewage back-up.
XX The system does not receive non-sanitary or industrial waste flow.
XX _ The site was inspected for signs of breakout.
XX _ All system components, e+cluding the Soil Absorption System, have been located on the site.
_dlv ye. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
XX _ The facility owner (and occupants, if djfferent from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
XX Existing information. Ex. Plan at B.O.H.
XX _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b))
(revised 04/25/97) P&96 4 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Propeny Address: 1783 Main Street Cotuit,Mass .
o»ner: Cambridge Trust Company
Date of Inspection: 5/1 1 /98
FLOW CONDITIONS
RESIDENTIAL:
Design flo, 330 R.P.d./bed(oom for S.A.S.
.umber of bedrooms: 3
Number of current residents: 0
Caroage gander (yes or no). Yes
Laundry connected to system (yes or no)Yes
Seasonal use (yes or no). Yes
� ater meter readings, if available (last two (2) year usage (gpd): Vey. L t(��r,
Sump Pump tyes or no)VO
7- �,o s=T lam?:: *
Last date of occupancy Unknown fj)s /7�(,. tGi.
COMMERCIAUINDUSTRIAL:
Type of establit_ment. NA
Design flow: NA callons/day
Grease trap present: (yes or no)NA
industrial Waste Holding Tank present: (yes or no) NA
Non-sanitary %aste discharged to the Title S system: (yes or no) NA
Water meter readings, if available. NA
NA
Last date of occupancy: NA
OTHER: :Descrrbet NA
Last date or occupancy: NA
GENERAL INFORMATION
PUMPING RECORDS and sovt�e tf fformatron. Main cesspool for the kitchen should be
None avai ab
System pumped as pan of inspection: (yes or no) s present.
It yes. volume pumped: NA gallons
Reason for pumping NA
TYPE OF SYSTEM
NO Septic tank/distribution box/soil absorption system
1 Single cesspool
1 Overflow cesspool
---NQ PrrvY
No Shared system (yes or no) (if yes, anach previous inspection records• if any)
NA I/A Technology etc. Copy of up to date contract?
Other NA
APPROXIMATE AGE of all components, date installed (if knuwn) and source of information: 3 0—3 5 years old
Sage odors detected when arriving at the she: (yes or no) No
I
tr•v:•.d 0�/75/S7) y494 S of 10
t
I(�
BARNSTABLE COUNTY DEPARTMENT OF HEALTH & THE ENVIRONMENT
of e„qy� P.O. BOX 427
a SUPERIOR COURT HOUSE
BARNSTABLE, MASSACHUSETTS 02,530
o M
4.�s7 PHONE : 362 -2=1_
X . -3!
SAMPLING INSTRUCTIONS FOR PRIVATE WELLS
An improperly taken sample wastes your money and has neither scientific accuracy nor legal
acceptance.
1. Obtain sterile sampling bottle from the County Lab or Town Health Department.
Bottles sterilized at home are not acceptable.
2. It is recommended to use a straight faucet, preferably NOT swingtype.
3. Turn on the cold water and let it run for five (5) minutes.
4. Fill the bottle Laving one inch air space. Do not fill bottle to the top. Be careful not to to.:cr
the inside of the bottle or cap with the faucet, your hands, or anythiing else.
5. Fill out the reverse side of this form. The laboratory requires accurate and complete
information. The person filling the bottle must sign the form
6. The charge for a routine well analysis (coliform bacteria, pH, conductivity, iron, nitrate,
sodium and copper) is S25.00. Checks should be made payable to Barnstable Counrv.
Exact change is required if paying in cash. Additional tests require additional fees.
Consult lab or � price list for exact information.
7. Samples are accepted Monday - Thursday from 8:00 AM to 4:00 PSI and Friday 8:00 to
1:00 PM. They must be delivered to the lab within 6 hours of collection or 24 hours if
refrigerated.
8. Completion of:gists and results takes 7-10 business days. Results will be sent in the maii.
9. Special request.; such as results in 2 -3 days and sample acceptance on Friday from 1.00 P-NI to
4:00 PM are available for an additional charge. Contact the laboratory for availability.
NOTICE: WATER FROM THE SAME SOURCE CAN PRODUCE CONTR-ARY RESULTS
IF TESTED AT DIFFERENT TIMES AND/OR DIFFERENT LOCATIONS THE
COUNTY OF BARNSTABLE SHALL NOT BE LIABLE FOR DAMAGES
RESUI..TING FROM THE RELIANCE ON RESULTS OF WATER TESTS
ACCU:ATELY PERFOR%,fED
PLEASE COMPLETE REVERSE SIDE OF FORM
PLEASE READ INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING THIS FORM
BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
362-2511 X 337
DRINKING WATER ANALYSIS LABORATORY SHEET
Name Sampling Date: Time:
Matting Address: Sample Location:
(Street or Box) iS!Tee.
(Town or City) (State) (Zip) .�-
Telephone: Year House was Built:
Bottle identification Number: Well Depth Feet
(Taken from Bottle)
Reason for testing (Check one):
❑ suspect a problem ❑ required by DEgE
❑ for information only ❑ new well
real estate transaction' other: _
Note*: Some banks and mortgage companies may require additional testing which costs
more and requires more water. Check with Lab before bringing in the sample.
Distance of supply from possible contamination sources (check all that apply):
septic tank / cesspool _ feet ❑ farm ftt"
❑ salted highway feet ❑ burled fuel tank (_et
❑ land fill feet ❑ other feet
Treatment used:
❑ none
❑ water softener
❑ filter
SIGNATURE OF SAMPLE COLLECTOR
❑ Well Driller ❑ Owner ❑ Realtor ❑ Tenant
-------------------------------------------------------- __
- FOR LAB USE ONLY,-
i
-Total oUform / 100 ml
PH
Conductivity (micromhos / cm)
Iron (ppm)
Nitrate- Nitrogen (ppm)
Sodium (ppm)
Copper (ppm)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propertv Address: 1783 Main Street Cotuit,Mass .
O%ner: Cambridge Trust Company
Date of Inspection: 5/11 /98
BUILDING SEWER:
.ocate on site plan)
Depth below grade. 38"
tilaterial of construction: XXcast iron 40 PVC _ other (explain)
Oran eberpipe—,
Distance from privatewater supply well or suction line 0 +
D'ameter 4
Comments. (condition of)oints, venting, evidence of leakage, etc.)
._,Dints ap Par tight _ Thprp is nn Pvidpnrp of 1PAkagp System is Vented
_through the hmisp vent in the roof-
SEPTIC TAINK: Norte
;locate on site plan)
Depth below grade. NA
.material of construction: NAoncrete NAmetal NAF iberglass NA PolyethyleneNAother(explain)
NA
If tank is metal, list age NA Is age confirmed by Cenificate of Compliance NA (Yes/No)
Dimensions NA
Sluoge depth--NA
Distance from top of-sludge to bonom of outlet tee or baffle: NA
Scum thickness NA
Distance from top of scum to top of outlet tee or baffle: NA_
Distance from bonom of scum to bonom of outlet tee or baffle: NA
how dimens,ons were determined: NA
Comments
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invent, strunurai
integnn•, evidence of leakage, etc.)
Septic an is not present .
GREASE TRAP: NA
uocate on site plan)
Depth below grade NA
tisaterial of con slruction:NAconcretNA metaNA Fiberglass NAPolyethylene NAother(explain)
NA
Dimensions: NA
Scum thickness. NA
Distance from top of scum to top of outlet tee or baffle: NA
Distance from bonom of scum to bonom of outlet tee or baffle: NA
Date of last pumping: NA
Comments:
;recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invent, structurai
,nteg(iry, evidence of leakage, etc.)
Grease trap is not present.
Ir•vio•d Pag• 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1783 Main Street Cotuit,Mass .
Owner: Cambridge Trust Company
Date of Inspection: 5/1 1 /9 8
TIGHT OR HOLDING TANK:None(Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade: N/A
Material of construction:tLconcreteNLmetalULFiberglassNLPolyethyleneUkother(explain)
Nr A
N'/A
Dimensions: N/A
Capacity: N A gallons
Design flow: NIA gallons/day
Alarm level: N/A Alarm in working order MYes; _UANo
Date of previous pumping: NA
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
Tlgflt or Holding tanks are not present.
DISTRIBUTION BOX:None
(locate on site plan)
Depth of liquid level above outlet invert: NA
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
Distribution box is not present
PUMP CHAMBER:None
(locate on site plan)
Pumps in working order: (Yes or No) NA
Alarms in working order (Yes or No) NA
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
Pump chamber is not present
(revised 04/25/97) Pago 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1 783 Main Street Cotuit,Mass .
Owner: Cambridge Trust Company
Date of Inspection:5/1 1 /9 8
SOIL ABSORPTION SYSTEM (SAS): YES
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: 0
leaching chambers, number:0
leaching galleries, number:_p_
leaching trenches, number,length: fl
leaching fields, number, dimensions: 0
overflow cesspool, number:_
Alternative system: NA
Name of Technology: Chapter 11
Comments:
(note condition of soil, signs.of hydraulic failure, level of ponding, condition of vegetation etq.)
Loamy sand to fine san failure or ponding.
A vegetation is normal.
CESSPOOLS: Yes
(locate on sire plan)
Number and configuration: 2—
Depth-top of liquid to inlet invert: DRY
Depth of solids layer: DRY
Depth of scum layer: DRY
Dimensions of cesspool: 6 ' x8 '
Materials of construction:Cnnrrate hlnck
Indication of groundwater:No
inflow (cesspool must be pumped as part of inspection)
Did not pump cesspools. Cesspools are dry.
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Loamy sand to fine sand;No signs of hydraulic- ailurp- or nonding-
All yp2et-at-inn is nnrmal ,
PRIVY:Egne
(locate on site plan)
Materials of construction: N/A Dimensions: N/A
Depth of solids: N/A
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Privy is not present
(revised 04/25/97) Page 8 of 10
y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1 783 Main Street Cotuit,Mass.
owner: Cambridge Trust Company
Date of Inspection: 5/11 /98
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
SG �
I r �
Ih �
1
o
1 O
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Page 9 of 10
• SUBSURFACE SEWAGE DISP.. i. SYSTEM INSPECTION FORM
I C
SYSTEM INFOI. 'ION (continued)
Property Address: 1 783 Main Street Cotuit,Mass.
Owner: Cambridge Trust Company
Date of Inspection: 5/1 1 /9 8
Depth to Groundwater 20 Feet
Please indicate all the methods used to determine High Groundwaiv HL a:ion:
Obtained from Design Plans on record
bservation of Site (Abuning property, bservation hole, basenxni-sump etc.)
w
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
heck pumping records
I Ch/eck local excavators, installers
Use 'USGS Data
Describe in your own words how you established the High Grounctwa•crElevation. (Must be completed)
Used Water Contours Map/
Gahrety & Miller Model
12/16/94
(r.va..d 04/25/97) 10
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TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •-
11 CERTIFICATION
R•••Tf7�T••.'::a-T..If.-.�TT{,TtT.'RI.1..TT1 T+IlrlpTaf J1.�RT1'T5•I T'IIRTi.RN►-`ranlf..nigT TnRTRnTTiPafTT*TT•.�•'ttT•T'11�.•�
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 1783 .Main Street Cotuit,Mass . '
ASSESSORS MAP, BLOCK AND PARCEL # L
OWNER' s NAME Cambridge Trust Company
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & SG•w -Inc.
COMPANY ADDRESS Box 66 Centerville,Mass. 02632.
Street Town or Clty State ZIP
COMPANY TELEPHONE ( 508I 775 - 3338 FAX (508 ) 790 - 1578
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 :
XXXXX XXX Systeui PASSED ;
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 16 - 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
Tile inspection which I have con acted has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 310 CMR l5o303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature y Date 5/18/98
6z:
One copy of this certification must be provided to the OWNER the BUYER
( where applicable ) and the BOARD OF IIRAL1'JI.
* It the inspection FAILED, the owner or"O"Perator shall u
pgraaYete
within one year of the date of the inspection, unless alloweddorthe requiredm
otherwise as provided in 3.10 CMR 16 , 306 .
partd .doc
21
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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.
Julie 8. 199S
Acting Director of the 1)' ion of Water Pollutioll Control