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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
APPENDIX
BREWSTER REGULATION
Map Lot
Property Address:
Owner Address:
Name of Inspector:
Company Name, Address & Phone Number:
Date of Inspection:
This inspection represents (check one) ( ) Real Estate Transfer ( ) Addition/alteration
__ __A) System Passes
_____B) System Conditionally Passes
Septic tank covers are more than 12 inches below the finished grade
C) Further evaluation is required by the Board of Health
______Records show excessive pumping three or more times within any eighteen (18) month period for residential or
Commercial property; except for required grease trap maintenance for commercial property.
The leaching facility or facilities are located within 300 feet of a pond or lake
_____D) System Fails (Brewster Real Estate Transfer requirements)
______The system is in a state of disrepair such that it cannot function as it was originally intended;
______The lack of a 4 foot protective zone between the bottom of the system and the groundwater;
______Any other problem as defined by the Board of Health or its Director;
______The sewage disposal system consists of a single cesspool, or cesspools.
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The Brewster Health Department has reviewed and accepted this report based on the informati on contained therein. This inspection reflects the
present condition of the Sanitary System and is not any guarantee as to the life or future condition of said system.
Approving Authority Date
Please be advised of ADDITIONAL BOARD OF HEALTH REGULATIONS:
1. All private wells are required to be analyzed prior to approval of the Subsurface Sewage Disposal
System Inspection form, and sixty (60) days prior to transfer of property.
Town of Brewster
Health Department
2198 Main Street
Brewster, Massachusetts 02631-1898
(508) 896-3701 Ext. 120
FAX (508) 896-4538