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HomeMy Public PortalAboutBOH01.04.23packetBoard of Health Penny Holeman Annette Graczewski Kimberley Crocker Pearson David Bennett Casey Chatelain Health Director Amy von Hone Assistant Health Director Sherrie McCullough Senior Department Assistant Tammi Mason Town of Brewster Board of Health 2198 Main St., Brewster, MA 02631 brhealth@brewster-ma.gov (508)896-3701 BOARD OF HEALTH MEETING AGENDA 2198 Main Street January 4, 2023, at 6:30PM Pursuant to Chapter 20 of the Acts of 2021, this meeting will be conducted in person and via remote means, in accordance with applicable law. This means that members of the public body may access this meeting in person or via virtual means. In person attendance will be at the meeting location listed above, and it is possible that any or all members of the public body may attend remotely. No in-person attendance of members of the public will be permitted, and public participation in any public hearing conducted during this meeting shall be by remote means only. Members of the public who wish to access the meeting may do so in the following manner: Phone: CaII (301)715-8592 or (312)626-6799. Webinar ID: 820 4394 4509 Passcode: 979174 To request to speak: Press *9 and wait to be recognized. Zoom Webinar: https://us02Web,zoom.us/1/82043944509?owd=Mytl)M2kvUExKbUlRSOhmMOlZb3dQZzO9 Passcode:979174 To request to speak: Tap Zoom "Raise Hand", then wait to be recognized. When required by law or allowed by the Chair, persons wishing to provide public comment or otherwise participate in the meeting, may do so by accessing the meeting remotely, as noted above. Additionally, the meeting will be broadcast live, in real time, via Live broadcast (Brewster Government TV Channel 18), Livestream (livestream.brewster-ma.gov) or Video recording (tv.brewster-ma.gov) 1. Call to Order 2. Chairman's announcements 3. Citizen's forum: Members of the public may address the Board of Health on matters not on the meeting agenda for a maximum 3-5 minutes at the Chair's discretion. Under Open Meeting Law, the Board of Health is unable to reply but may add items presented to a future agenda 4. Request for determination of number of bedrooms at 141 Long Pond Road 5. Variance Request — 38 Captain Baker Road, 300' Setback to Pond 6. Request for extension to BOH Variance Approval (expires 1/05/23) at 89 Byfield Cartway 7. Consent Agenda a. In -House Variance Approval — 58 Pilot's Way 8. Review and Approve BOH Minutes of 7/20/22, 8/17/22, 9/21/22, 10/05/22, 10/19/22, and 11/02/22 9. Liaison Reports 10. Matters not reasonably anticipated by the Chair 11. Items for next agenda 12. Next meeting: January 18, 2023 13. Informational items: a. Information on Delta -8 THC from MDAR b. Remote Participation Policy and January 2023 Board and Committee Schedule C, DEP Announcement — Extension of public comment period to 01/30/23 for Title 5 Revisions d. Inspection Report for 72 Johnson Cartway e. Inspection Report for 75 Johnson Cartway f. Inspection Report for 255 Robbins Hill Road g. Inspection Report for 26 Nancy May Path h. Inspection Report for 45 Warrens Road i. Inspection Report for 19 Cedar Hill Road j. Inspection Report for White Rock Commons 14. Adjournment Date Posted: 12/29/2022 Date Revised: Received by Town Clerk: N:\Health\BOH Agendas and Minutes and Remote Schedule\BOH Agendas\01.04.23a.docx Hello, RECEIVED DEC 23 2022 A variance is requested for the Subsurface Sewage Disposal System at 141 L n6P h R RHEA TH TMENT The home was purchase in 2014 as a 3 bedroom home with a passing Title V repo or bedrooms. The home and outbuilding have not been modified in any way since that purchase in 2014. The outbuilding has never been used by the owner and the property only occupied by one single person. There are many inconsistencies in the past reports. From what we can tell: The original plan states that the flow is 457.3 GPD, 6x6 pit 1992 new pit installed 6x6 with 1' stone 2005 Inspection report 4 bedrooms 440 GPD, 6x6 pit 2013 Inspection report says 457 GPD 3 bedrooms, 6x6 pit 2022 Inspection report says 427 GPD flow As a result of the outbuilding not being used and the system seemingly being at the 440 GPD threshold (give or take depending on the report being looked at) that would be necessary for a 4 bedroom (although it is not felt to be a 4 bedroom), and the owner purchased the home in its current state as a 3 bedroom home with a passing 3 bedroom Title V, a variance is being requested. Thank you for your time and consideration. iOA A l els r c r�✓I 3 yd 10 IQ Urrs • le D rLt lb � a U� ► - .mss (yic ��✓� 44¢6 �ff 4 uLop (1, tJl i cDrRqAJ 3 P cam) .n Address: 1 PropertyAddxess: 1'-i,16 Town of Brewster Health Department 2198 Main Street Brewster, Massachusetts 02631 1898 (508) 896-3701 Ext, 120 FAX (508) 8964538 P C r+ ►qjs s 2 SEE: $A*.OA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM APPENDIX BREWSTER REGULATION Owner Address: Sege.. Name of Inspector: rr delc Company Name, Address & Phone Number: Date This inspection represents (check one) _ A) System Passes B) System Conditionally Passes Real Estate Transfer OAddition/alteration 0 c66 Septic tank covets are more than 12 inches below the finished grade � , ' . � - ..- e t7 JI it C) Further evaluation is required by the Board of Health ~ � ��(, � /L �,� C, 'la, 1�' '� � � l Records show excessive pumping three or more times within any eighteen (18) month period for residential or Commercial property; except for required grease trap maintenance for commercial property. t The leaching facility or facilities are located within 300 feet of a pond or lake D) System Fail s (Brewster Real Estate Transfer requirements) The system is in a state of disrepair such that it cannot function as it was originally intended; The lack of a 4 foot protective zone between the bottom of the system and the groundwater; Any other problem as defined by the Board of Health or its Director; y 1� 5�r)b The sewage disposal system consists of a single cesspool, or cesspools. `C ,+,ti,:;::k:kt:kk.. ,t "� � �,t�k�#*okhem�''.:kd:�'•d:+�:k:#:%ffi':%#:%>;<;k ekk:k'.<:%:k:kek:k �:e>k>t'.<:%�::#; :k#✓,t:%:k a<,k�k�sk k:%�rm+k %k:% Wit:%Bt gtfF:k:k:%>:<:%:Y.:k gt:%:#M,t;�,kfk:%Y,t e'F,k�t:�i:%8t1%:%$:k4u%m:Itek�skY,t:it*:k+k:k:Yj*:k�k_�', The Brewster Health Department has reviewed and accepted this report based on the information contained therein. This inspection repp sjthe present condition of the Sanitary System and is not any guarantee as to the life or fixture condition of said system. Approving Authority Please be advised of ADDITIONAL BOARD OF HEALTH REGULATIONS: L 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 Date v t 1� � carp 1 5�vf Owner info�maiion is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 100 Cotx>Imonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster MA City/Town State 02631 Zip Code 11 /22/2022 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information � Armando Panto Name of Insaector Joe Martins dba Accu Sepcheck LLC Company Name 17 Northside Drive Company Address South Dennis CltylTown 508-385-5891 Telephone Number B. Certification MA State SI 14296 License Number 02660 Zip Code 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 training 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. ❑ Passes 2. ❑ Conditionally Passes 3. ® Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 11 /30/2022 Inspector's Si The system inspector shall submit a copy of this inspection report to the Approving Authority (Board oT i-leaTrh or D��j within 3i7days of completing `chis inspec%ion. If the system Yeas 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. 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. t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 1 of 18 Owner ininrmaiion is required for every page. Gornrnonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster MA 02631 11/22/2022 City/Town State Zip Code Date of Inspection Co Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indi in 310 CMR 15.303 or in 310 CMR 15.304 indicated below. i Comments: 2) System Conditionally Passes: that any of the failure criteria described Any failure criteria not evaluated are ❑ One or more system components as described in the "Conditional Pass" section need to be reVlaced or repaired. Tiie system, upon completion of Elie 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. If "not determinedI" please explain. /f The septic tank is metal and over 2P'years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infilt tion or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is r placed with a complying septic tank as approved by the Board of }ieaIth. 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. ❑ Y ❑ N ❑ ND (Explain below): t5insp: doc'�'rz�. 7/28/2018. Title 5:Official:I nspaotion: Eorm; Subsurface.Sawaga DisposaLSystemx Page 2 of.18. Owner infflrmation is required for every page. �Qmmonvucalth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thom Owner's Name Brewster City/Town n TTEE 141 Lon% Pond Rd C. Inspection Surnlm0lry (cont.) 2) System Conditionally Passes (cont.): MA State ❑ Pump Chamber pumps/alarms not operational .pumps/alarms are repaired. 02631 Zip Code 11 /22/2022 Date of Inspection System will pass with Board of Health approval if ❑ 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): ❑ broken pipes) are replaced ❑ obstruction is removed ❑ distribution box is leveled ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): placed ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): Fu h r 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. Systemwill pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 3 of 18 Owner inforrhation is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster MA 02631 11/22/2022 City/Town State Zip Code Date of Inspection ❑ Cesspool or privy is within 50 feet of a surface water ❑ 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 that protects the public health, safety and environment: ❑ The 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of 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 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. - MISMATCH FOR BEDROOM COUNT, CURRENT DWELLING HAS 3 BEDROOMS FOR MAIN HOUSE AND A 1 BEDROOM COTTAGE CONNECTED TO SEPTIC SYSTEM. TOTAL COUNT OF 4 I EDROOMS, DESIGN PLAN 1S FOR A 3 B— DROOM SYSTEM-. 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters dh e to an overloaded or clociaed SAS or cess ol. t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurf ace Sewage Disposal System •Page 4 of 18 4 Owner iriformal:ion is required for every page. torr monwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Sheila Thon Owner's Name Brewster City[Town TTEE 141 Lonq Pond Rd MA State 02631 Zip Code 4) System Failure Criteria Applicable to All Systems: (cont.) 11 /22/2022 Date of Inspection - 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 % day flow ❑ ® Required pumping more than 4 times in the last year N®idue 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 or tributary to a surface water supply. ❑ ® Any portion 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. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well witfi 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.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- iC.OQO gpd, ❑ ® The system fails. 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. If 5) Large Systems: To be considered a large system the system must serve a facility with`a �r�Egf� fl«�n; rf 105900 gpd t.o 15,000 glad= _ ,. For large systems, you must indicate either "yes" or "no" to each of the foil ing, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400ffedCo f a surface drinking water supply ❑ ❑ the system is wittiin 200 feet of a tributary to a surface drinking water supply El [Ithe systemI is located in a nitrogen sensitive area (Interim Wellhead Protection we Area= IWPA) or a mapped Zone II of a public water supply well t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 18 0 Owner information is required for every page. �ormmonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster MA 02631 11/22/2022 City/Town State Zip Code Date of Inspection If 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 CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed �- urluer Section CA s 4ll 1 i -pig ade the systei�� Itr aceuruat�ce with 310 CNIF A.5 .304. re s-ys=reirr 6wf1ei should contact the appropriate regional office of the Department. 6. You must indicate "yes" or "no"for each of the following for all inspections: / Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, exelgifing the AS, located on site? ® ❑ 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? ® ❑ Was the facility owner (and occupants if different from owner) provided with information 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)] t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 6 of 18 C4 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster MA 02631 11/22/2022 City/Town State Zip Code Date of Inspection 1. Residential Flow Conditions: � Number of bedrooms (design): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t6insp.doc •rev. 7/26/2018 000 GAL SEPTIC TANK, DBOX AND ONE 6'X6' LEACHING PIT WITH 1' OF STONE. Number of current residents: Does residence have a garbage grinder? Does residence have a water treatment unit? If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: 2021: 18,000 G 2020: 41,000 G PER BREWSTER WATER DEPARTMENT Sump pump? Last date of occupancy: 3+1 BED APT = 4- 000 _ 1 ❑ Yes ® No ❑ Yes ® No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No 81 GPD ❑ Yes ® No 11 /22/2022 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 7 of 18 Owner in%rmation is required for every page, commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster City/Town 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): MA 02631 State Zip Code Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Water treatment unit present? If yes, discharges to: Industrial waste holding tank present? Non -sanitary waste discharged to the Tile 5 system? Water meter readings, if available: Last date of occupancy/use: Other (describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: 11 /22/2022 Date of Inspection Gallons per day (gpd) PUMPED 6/2/2020 PER OWNE gallons ❑ Yes ® No t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 8 of 18 0 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster City/Town ®. System Information (cont.) 4. Type of System: MA 02631 11 /22/2022 State Zip Code Date of Inspection ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of aH components,. date installed (if known) and source of information: ,,\ ORIGINAL SEPTIC TANK INSTALLED IN 1978,44 YEARS, DBOX AND LEACHING PIT INSTALLED IN 1992, 30 YEARS- PER BREWSTER HD. Were sewagedo_ ors detected when arriving at -the _site? - 5. Yes No Building Sewer (locate on site plan): �2 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other (explain): Distance from private water supply well or suction line: >10 feet Comments (on condition of joints, venting, evidence of leakage, NO EVIDENCE OF LEAKAGE. t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 9 of 18 C\ Owner Inf9ffnafion is required for every page. �ormrmonwaalth of Massachusetts title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Lonq Pond Rd Brewster MA Sheila Thompson TTEE 141 Long Pond Rd Brewster City/Town *1111 Go I 6. Septic tank (locate on site plan): Depth below grade: Material of construction: ® concrete MA 02631 State Zip Code ❑ metal ❑fiberglass 11 /22/2022 Date of Inspection 1 feet ❑ polyethylene ❑other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5'X6'X5'3 1000 GAL 5" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 29" 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? CORETAKER Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): HAS A PVC INLET TEE AND A PVC OUTLET TEE WITH 14 10 LEG, LIQUID LEVEL IS 48" AT OUTLET INVERT, NO EVIDENCE OF LEAKAGE. Ir'� t5insp.doc •rev. 7126/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 10 of 18 Owner information is required for every page. �omtmonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 141 Long Pond NO Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster MA 02631 11/22/2022 City/Town State Zip Code Date of Inspection 7. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal Dimensions: Scum thickness Distance from top of scum to top of Distance from bottom of scum Date of last pumping: ❑ fiberglass tee or baffle om of outlet tee or baffle feet ❑ polyethylene ❑other (explain): 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 Wolding Tank (tank must be pu Depth below grade: Material of construction: ❑ concrete ❑metal Dimensions: Capacity: Design Flow: at time of inspection) (locate on site plan): NOT APPLICABLE ❑ fiberglass ❑polyethylene ❑other (explain): gallons gallons per day t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 11 of 18 Owner inform. is required for every page. �olrmmonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster MA 02631 11/22/2022 City/Town State Zip Code Date of Inspection 8. Tight or Molding Tank (cont.) Alarm present: Alarm level: Date of last pumping: Comments (condition of alarm and float switches, Alarm in working order: ❑Yes ❑ No *Attach copy of current pumping contract (required). Is copy attached? 9. Distribution fox (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert AT 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.): ;" DBOX IS IN GOOD CONDITION WITH 1 PIPE IN AND 1 PIPE OUT, NO EVIDENCE OF SOLIDS CARRYOVER. t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner Owner's Name information'is required for every Brewster page. City/Town D. System Information (cont.) 10. Pump Chamber (locate on site plan): MA 02631 1 State Zip Code C of Inspection Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ Nom Comments (note condition of pump chamfer, condition of pumps and appurtenances, etc.): �` If pumps or alarm�'are not in working order, system is a conditional pass. 11. Soil Absorptigri System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® 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: 1,6'X6'W1'OF STONE. 15insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 13 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thom Owner's Name Brewster City/Town TTEE 141 Long Pond Rd 11. Soil Absorption System (SAS) (cont.) MA State 02631 Zip Code 11 /22/2022 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS TYPE: ONE 6'X6' LEACHING PIT WITH 1' OF STONE. LIQUID LEVEL: 0" STAINLINE: 1' CONDITION OF STONE: CLEAN/VISIBLE GRADE TO SAS BOTTOM: 8.6' 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 Indication of groundwater inflow Comments (note conon of soil, signs raulic failure, level of ponding, condition of vegetation, t5insp.doc •rev. 7/26/2018 Title 5 Official Inspeciion Form: Subsurface Sewage Disposal System •Page 14 of 18 Owner information is required for every page. Cormmonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster City/Town 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids MA 02631 State Zip Code NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE 11 /22/2022 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NOT APPLICABLE t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 15 of 18 Owner ino frmation is required for every page, commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form On Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thon Owner's Name Brewster n TTEE 141 Lonq Pond Rd MA 02631 11 /22/2022 State Zip Code Date of Inspection 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference �'landmarlcs or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters � / the building. Chec; one of the boxes below: I ® hand -sketch in the area below ❑ drawing attached separately t5insp.doc •rev. 7!26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 16 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thom Owner's Name Brewster CitylTown n TTEE 141 Lona Pond Rd ®e System Inf®rmati®n (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Checic cellar ® Shallow wells MA 02631 State Zip Code 11 /22/2022 Date of Inspection Estimated depth to high ground water: 26.4 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting propert y/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database -explain: GOOGLE MAPS, CCC GROUNDWATER CONTOUR MAPS OR JOHNSON & DAVIS MAP. FRIMPTER. You must describe how you established the high ground water elevation: SITE ELEVATION 54' ASL WITH A GROUNDWATER CONTOUR OF 24' ASL. GROUNDWATER RISE CGW138 ZONE B IS 3.8 FOR 10/1987.'. GRADE TO SAS BOTTOM IS 8.6'. SEPARATION MATH: 54- (24+8.6+3.6) = 17.8', j -/'I( , Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc •rev. 7/26!2018 Title 5 Official Inspection Form: Subsurtace Sewage Disposal System •Page 17 of 18 Owner information is required for every page. �olmmonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd Brewster MA Property Address Sheila Thompson TTEE 141 Long Pond Rd Owner's Name Brewster City/Town ►ITi/_1 JIQIC 02631 11 /22/2022 Zip Code Date of Inspection Complete all applicable sections of this form inclusive of: / ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tanlc —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 t5insp.doc •rev. 7/26/2018 Title 5 Official Inspectlon Form: Subsurface Sewage Disposal System •Page 18 of 18 TQ WN cF BIZEWSTER ADDENDtTM TO DEP SEPTIC INSPECTION IZEPOTtT Inspection Location TflP or FOUNDATION �+=i�cOr4a4 Map & Parcel 978 code) or 5' separation (1995 code) Yes �No e Soil Absorption System (SAS) and adjusted groundwater? 6. Town )ijater k ) or Private w ell (_ ) % Distance from nearest septic system component: f 7. Wetlands or surface water within 100' of septic system? Yes No Distance from nearest septic system component. 8. 9. Groundwater flow Type of pine used in system: P�7C 1/ �,Sanitaty-toes- oi- haffl:es hl place (Y o� 10. (l Septic tank inlet i Septic tank outlet yy// Pump chamber inlet ^4 D"Box inlet Grease trap inlet Grease trap outlet N Misers —197-8 code within 12 inches of grade on septic tank�'� Risers -1995 code within 6 inches of grade on all components 4 One inspection port on SAS (1995 code) �� lnstsectiail rl FI YYL`I Vd' 3��Rh-l:trY17���J./� 2198IVlhIN S'i'ltt:C'i' Bttr'*��s't�i:i;, MA 02631 gilaNQ: {508} 8�G•374 f Bxr t i2Q . FAx: {St18}89G��t5�8 t3ttilt?�1t,Ttilt ESfiBtiVS9'F.R•MA�GiaV pra�tcH or ti1:AL'fH IJL'1�A11ThlfiNT ADDEN1�iJM TO �EI3TIG IAISP�CT'IOI�T R��'{�P,T �j �j � I Map �4: Pttt�et:`� � I t. I�tantiat l'rope� _� ✓ Cg�1111erct f Pt'o er # of roattts J � �tttlrtoyees �,r-, i�edroonls � , ,.,�.� Ta%Iets l?hnitly Rc+ai�ts � - Roams wit(t battl Living Rooms ��""" Square l�®ct $Aftil'OD117S IzIlllttg [iflcltrls ICiteitens � � Qther: M'ti `l'oi81: 3, 4. `� l;loor {'lean: Shown!t 1'ioors iltcludirt�"Ir�setllcnt: ��, �'r�� '� _ _ . !;� ``� � � t ��.�� , -�� r`1 -'-'-1 `r ee ��, • � -` _-y Cd:�u' ��pFvl�ft?_ • - d - , , is the septic system, t1s inspecte itt fiat! eattttttictlae �vtth c` her the ! 97150 c�i' t 995 {) 't'Itto S Gode7 Yos 1`l0� [Fnot,llst�iefiaie}lcies; r�� tYl�s�na (� is ttte system iu tkie Matte tI (Wetttieact l?rotecitan A�ren} Ves lie V trot size: oZ • �� l7 �c�r+�-.S W ti's 1�V,Ta WN, l3REWS'I`ER,NlA,U S r r- EOH 0106 05 Old: Of Brewster Department 2198 Main Street Massachusetts 02631-'1898 08) 896-3701 Ext. 120 FAX (508) 896=4538 FEE: $25.00 �MM��� �19Ga�C= G�Dp�P�aG�� �57� ��Cy� 6C9�G'�CTION APPENDON Ovrner Hnoress: �_-• I � ^ � �i Name of Inspector. Company Name, Address & Phone Number: - 1 This in �,tion represents (check one) ( ) Real Estate Transfer () Additiorilalieraiion t A) System Passes _B) System Conditionally Passes Septic tank covers are more than 12 inches below the finished grade R�CEIVE.p JANIa2014 NSTER H—�A TH LT ENT C) Further evaluation is required by the Board of Health Records show excessive pumping forth e f eyed greasetrap maintenance for commercial ohteen (1 a) month p enod for residential or Commercial property; except , 4u P Arty. The leaching facility or facilities are located within 300 feet of a pond or lake D) System Faits (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; 1 Any other problem as defined by The sewage disposal system CO' Board of Health or its Director, of a single cesspool, or cesspools. i The Brewster Health Department h a w system andpsenothany guaranies as to th life atrfuiure condition of said system pection reflects the present condition of the Sanitry/ //� Nancy � ri is �, Health ®hector Approving Authority Please be advised of � All private wells are required System Inspection form, and Z, All underground tanks must I requirements. Date I analyzed prior to approval of the Subsurface Sewage Disposal (60) days prior to transfer of property. Gstered with the Board of Health and are subject to testing Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Long Pond Rd. Property Address �IiUIV�h Owner ob^nary Name (V1A 02631 _ ®ecember 20, 2®13 information fs BreW�t�r Zip Code Date of Insps�4on required for every State page Giiylfown Inspection results must be e� checeklist at tht: e d of the form�o�s may not be altered in any way. Please see completer Important; When A, General Information filling out forms on the computer, use only fire tats � . Inspector. key to move your cursor -do not Linda Pinto use the return Name of Inspector key. ®CeanSlde Se tiC, {nc. j Company Name . �},�- P.O.13ox 201 Company Address �� ®2631 rr�� . Brewster Slate Zip Code City/Town 4432 508-896-1513 �icanse Numbzr Telephone Number tgln� = 3713 M10 o ���s�i�`t�flCc]`i���(11l 1 certify that I have personally inspected the sewage disposal system at this address and chat the information reported below is True, accurate and complete as of the time of the inspection. The inspection was performed based on my training and a OYe� � steminspector pursuer t aSection 15.340 ofe sewage disposal systems. t am a DEP app Y Title 5 (3'10 CMR 75.000). The system: '�_ - ❑ Condidionall�f laasses ❑Fails ❑ R9eeds Further Evaluation by the Local Apg�roving l�uthori$y Signature The system inspector shall submit a copy of this inspection report to the Approving Authority (board of Health or DEP) within 3fl 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 DEP_ The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. �. *��This report only describes conditions at tete time of inspection and under the conditions a use at that time. This inspection does not address how the system wilt perform in the future under the same or different conditions of use. Ti@s 5 omaal [nsperaion Form: Subsurraos Sewage Disposal Sy�em ^ F=ga 1 of 97 Owner information is required for every page. l5ins • 3/13 Commonwealth of Massachusetts fficial Inspection Form Title 5 O Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments 141 Long Pond Rd. Property Address Sullivan Owners Name �a CW.1"Iflcatl011 (tont.) MA 02631 6ecetrtbee 26, 2013 Sfiate Zip Code Date of Inspection Inspection Summary: Ghcsck A,P,CP or E 1 abul(r W5 complete all of Section D 0 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. ❑One or more system components as described in the "Conditional Pass" section need too e� b replaced or repaired. The system, upon completion of the replacement or repair, as app y the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, M, � D) door 14 e following statements. If "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 flank 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. ®v ❑ N ❑ ND (Explain below): CUs 5 055aa1 IrpseSon Form: Suosurfara Ss:rga Dispoa2l System ^ Paga 2 of 17 �;= owner information is required for every page. t61ns • 3r13 Commonwealth of Massachusetts '���le 5 Ofificial Inspection Form Su6surFace Sewage Disposal System Form -Not far Voluntary Assessments 343 Lang Pond Rd. property Address Sullivan owner's Name MA 02G33 December 26, 2033 State 7 P Gods Date of Inspection B. Certification (cont.) ❑ bump Chamber pumps/alarms not operational. System will pass wish Board of laealtit approval if pumps/alarms are repaired. C3) ��i��Js �®nditi®na61y basses (cont.); ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. System will pass inspection ifi (with approval ofi Board of Heaittl): ® y ❑ i�3 ❑ N© (Explain below): broken pipes) are replaced ❑ ❑ y N ❑ N6 (Explain bel®w): obstruction is removed ❑ ❑ ❑ distribution box is leveled or replaced ❑ V ❑ N ❑ ND (Explain below): ❑ 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. of the Board of Health): ❑ broken pipes) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ � ❑ N® (Explain below): G) Further Evaluation is Required by the Board of Health; ❑ Conditions exist which require further evaluation by the Board of Heath in order to determine if the system is failing to protect public heatth, safety or the environment. 3. System will pass unless Board of Health determines in accordance with 3i� ��R 15.303{3)(b) that the system is not functioning in a manner which will protect public health, safety and the environment; ® Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within a0 feet ofi a bordering vegetated wetland or a salt marsh iitla 5 Offrcial Inepaclian Form: 3ub`urrece Scra�rga Di=para! System • Piga 3 of 17 Owner information is required for every page. t5inc • 3193 Commonwealth of Massachusetts Title � official Inspection Form Subsurface Sewage Disposal S�►stem Form -Not for Voluntary Assessments 141 Lon Pond ltd. Properly Address Sullivan Owner's Name 2013 Brewster MA 0263`1 ®ecember 26, catyiTown State Zip coli± Date ofilnspedaon B. Cer't�fication (cone.) �a system �iiG9 Gz�aO �ru9��� is�ac ���G�, �� C'�e�G7iJ� Q�W �� p����B� C",��L� ��aC�Bier, G� �nSYI� deteemines that tree syotem as f�ncadCl��au�,�, ora � ���uU�cff fili�t� ���Q���...�'�� �G�c >.° �bGfi� G�e�GiSG;t, safety and environment: ❑ The system has a septic lank and soil absorption system (SAS) and the SAS is within 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 of a public ureter supply. ❑ The system has a septic taralc a�ad S�zS and the SAS is wiihin 50 feet of a pria9�te c^mater supply well. ❑ The system has a septic f�a�lc grad SAS and the SAS is less than 100 feet but 50 fc=et or more prom 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 fess than 5 ppm, Provided that no other failure criteria are triggered. A copy of the ane►ysis must be attached to this form. 3. ®ther: ��) �y�?��u G��iBeAr� �Gi��ca� G�6��0¢�nC<�9� �o AGt �y�C�aU��o u �� Gini GSL 6�u�0��r�'`' sGii��oa �� �, seC�O97 ts�L--'U�G1� Gu ii�v �I ���G�u�76(Il��� u�� �f;G QGIS u���9�W�e 1'� � ❑ ❑ Backup of sewage into facility or system component 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 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 tip below invert or available volume is fess than'/2 day flow Ti6a 5 Offiaal Inspection Fnmr S,+bsiaiace SErga O'�� S��tsm • Pags 4 of 97 RM Owner information is required for every page. 15ins • 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Loi Properly Own®r'§Name MA 02631 ®ecember 26 2013 State Zits Dods Date of Inspection ® �\ Required pumping more than 4 times in the last year OOT 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 or tributary to a surface water supply. ❑ ;C Any portion of a cesspool or privy is within a Zone 1 of a public well. ® :< Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ X 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 forma ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 101000gpd. ❑ The system faits. 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. u 0 4� COJaMt��7ec�-,�� a 0a�°do �gya3GF�a ruI ��t e�r�e a facilli;� e^,r6tl� a For large syetems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Seciion D. Yes C'3o ❑ [] 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 (Interim Wellhead Protection Area � IWPA) or a mapped Zone II of a public water supply well if you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yesD in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall uru nate he system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department "iiUa 5 OinciJ [napscfion Farm: SubsuriGce Ssysga Uispo=Si System ° Pap 5 ai 17 M Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Lo Property % a r V 11YU a Owner Owner=s Name MA 02531 December 26, 20'8 3 information is Brewster required for everystate Zip Code Date of fnspaction page CitYMOIvn C. Checklist Check if the following have been dome. Y®u FfiR65� indicate "yes" or "no" as to eacta of the following: l5ins ^ 3113 Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ :< Were any of the system components pumped out in the previous hva weeks? �< ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? }� EJ Were as built plans of the system obtained and examined? (If They were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? [yj ❑ Was the site inspected for signs of break out? �< ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? © Was the facility owner (and occupants if different from owner) provided with information on the proper mai El information 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 Pari C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)1 Rw@iic7cReQPifl0 FI®Vv CORO9iEWRO o 3 Number of bedrooms (actual): Number of bedrooms kaG`01911): ®ESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 3 4a� fiitfs 5 Obi ci_I Inspection Form: Subeurfer� Ssr:a6a OisposJ System ^ Pe,a 6 o'r 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd. Property Address Owner Owners Name 02631 inMA is Brewster required for emery state Zp Code page City/Town Information D. System i5ins • 31V3 qiji �_ ;- _ Number of current residents: ®ecember 26, X013 Date of Inspectian ®oes residence have a garbage grindet�? !s laundry on a separate sewage system? (include laundry system inspection information in this report) Laundry system inspected? ❑ Yes >< No ❑ Yes ❑X No Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): ®etail: 2013: 99,000 gallons (271 gpd) 2012: 72,000 gallons 211 d ❑ Yes �® Sump pump? ( ast date of occupancy: Date �oovgnu occiaillndustrlai Flow C®ndltionse ype of Establishment: ®esign flow (based on 310 �6U1� 15.203): Ganoras parc�ay (gpd) basis of design flow (seats/persons/sq.ft., etc.): Crease trap present? ❑ Yes ❑ No ❑ ❑ Industrial waste holding tank present'? yes No Non -sanitary waste discharged to the title 5 system? ❑ Yes ❑ NO Water meter readings, if available: Ti11a 5 official lnspscUon Form: Subsufiace EVNE9e MSPO�90 Syst.sn • Pegs 7 of 97 KS Of mmonwealth of Massachusetts Ville 5 official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments 141 Long Pond Rd. Property Address Sullivan Owner owners Name information is Brewster required for every Cityrrown page. D. system Information (cont,) «a�a�p (d�crik�e below): Source of information: C,1A i}2631 Beate Zip Code General Information �IUas sy�,t�m pumped as part of the inspection? If yes, volume pumped: Now was quantity pumped determined? Reason for pumping; u yn09 s g�ster�o � gallons ® Septic tank, distributi®n bobs, soil absorption system Overflow cesspool December 26, 2013 Date of inspection ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ innovative/Alternative technology. Attach a copy of the current operationd maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ® Tight tank. Attach a copy of the DEP approval. ❑ ®that (describe): t5in= ^ 3113 iiL'a 5 Ofiicel Inepac4ion Form: fiubsurfacs �ewag� Disposal System • Page B of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd. Property Address Owner Owner's Name MA 026_ 3� December 26, 2013 '"tOm'�i°" `� Brev�tster required for every State Zip Code Dale of Inspection page CityFrovm t�. System Information (pont.) Approximate age of all components, date installed (if known) and source of information: 35 Years old per Board of kieaith Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): � - 1/ • Depth below grade: feet Material of construction: cast iron ®40 PVC ❑other (explain): ®istance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): �r�.,h+ Yes None Septic `Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal ❑fiberglass If tank is metal, list age: 10" ❑ polyethylene year Is age confirmed by a Certificate of Compliance? (attach a copy of cerbficate) 1000 gallon Dinnensions: 1" Sludge depth: t5ins •3113 ❑ other (explain) ❑ Yes ❑ No Tula 5 Offidat 4nsp=r�ion Form: Subsurface Sewage QisP�l System •Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form SubsurFace Sewage Disposal System Form - Not for Voluntary Assessments 141 Long Pond Rd. property Address gunwan Owner OumePs Name Mp 02631 Decemtser 26, 2013 information is Brewster required far every ��� ate Zip Code Date ofi tnspeotion page. D. System Information (cont.) Septic lank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" 1" Scum thickness 6" ®latents from top of scum to top of outlet tee ®r baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" Tape measure __ plow were dimensions determined? Comments (an pumping recommendations, intet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The structural integrity of the septic tanks appears sound. The inlet has a concrete cover 10" b.g. There is a sch. 40 PVC pipe with PVC fee. The outlet has a concrete cover 12" b.g. There is a sch. 40 PVC pipe with PVC tee. The liquid level is at the outlet invert with no sign of backup or leakage. Grasse Trap (locate on site plan): Material of construction: ❑ concrete ❑metal Dimensions: Scum thickness ❑ fiberglass 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 ©f fast pumping: t5ins • 3l13 feat ❑ Polyethylene ❑other (explain): Date Tills 5 Offiaal Inspection Form: Subsurface Sswsge Disposal System ° Psgs 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System �°� -Not for Voluntary Assessments 141 Lo Property Pond Rd. ownWS Owner's Name MA 02631 December 26, 2013 information is Brewster required for every state Zip Code Date of Inspection page. cityrrown D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5iru • 3l13 light or Bolding lank (tank must be pumped at time of inspection) (locate on site plan): ®epth below grade: Material of construction: ❑ concrete ❑meta! Dimensions: Capacity: Design Flow: Alarm present: Alarm level: ®ate of last pumping: ❑ fiberglass ❑polyethylene ❑other (explain): gallons per day ❑ Yes ❑ IVo A{amn in working order: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). is copy attached? T[Ue 5 Qtfic�i Inspection Form: S�svrf2cs Sewage Disposal Sy�t+:tn • Page 71 of t7 Owner Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage DiisE►osai System Form -Not for Voluntary Assessments 141 Lon n. 5. O.d Property Addre Sullivan owner's Name information is Brewster requiredfioreve>}t Citylrovm page. ®. System In#ormation (coot.) 45ina ° 3I93 MA 02631 ®ecember 26, 2013 State Zip Code ®ate of Inspection ®i�CriC�rn�6 � �� ���r (if present must be opened) (locate ort site pBan): 0" ®epih 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.): The D -box appears to be in fair condition wish no sign of solids carryover. There is a concrete cover 18" b.g. There is one inlet and 1 outlet_ The liquid Level is at the outlet invert with no sign of backup or leaks e. �a�6ul�� C��a���C�er (lo�`�te on site plan): ❑ Yes ❑ N®' Alarrrts in a�^corking order. ❑Yes ❑ No* C®rr�r�er�°a:� (note condition o� piimi� charrrher, condition of pur�aF�s and appurtenances, etc.): '` If pumps or alarms are not in working order, system is a conditional pass. Sohl l4f�sorpti®a� �S�tem (SAS) (locate on site plan, excavation riot requires): if SAS n®t I9cated, explain why: Tina 5 Ofiiaal tnspsdton Foam Subaurrsca Sa^�ags Disposal System ° Paga 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System �°'� - Not for Voluntary Assessments 141 Long Pond Rd. Property Address Sullivan Owner Owner's Name information is required for every er Ci Brewster page. Ds System Information (cont.) t5ins • 3113 Type: ® teaching pits ❑ leaching chambers ® leaching galleries ❑ leaching trenches ❑ leaching fields ❑ overflow cesspool MA 02631 December 26, 2013 Ste% ZP Code Date of Inspection ❑ innovative/alternative system number: number: number: number, length: number, dimensions: number: one 6'x6' Typelname of technology: Comments (note condition of soil, signs, of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The teach pit appears to be in good condition. There is a concrete cover 10" b.g. and the top of the pit is 36° b.g. The bottom of the pii is 114" b.g. and the pit is dry. There is no sign of hydraulic failure in the area �f the SAS. 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 ®epth of scum layer Dimensions of cessp®ot Materia{s of constnaction Indication of groundwater inflow ❑ Yes ❑ No 7gy 5 Offiaal Inspection Form: Subsurfacz Sewage Dispo-$� System •Page 13 ar 17 Commonwealth of Massachusetts Title 5 Official ��spe�tior� Form Subsurface Sewage Disposal Sys%m Form o Not for i/oluntary Rssessments 141 long Fond Rd. Property Address Owner Owners Nacos irrforrnation is MA 02631 Decemt�er 26, 2013 required for every Brewster State Zip Code Date of Inspection page Cityrrown D. System information (cont•) Comments (note condition of 640il, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): L�ra�y (locate on site plan): i�l�aterials ®f construction: ®epth of eolids Co6n�nents (note condifiio�a of soil, signs of i�ydraulic 4ailure, level ®f ponding, condition of vegetati®n, TiUa 5 Omaal lns�sction Fam: Subsufiaa3 Ssysga Disposa{ System • Paga 14 of 17 t5ins ^ 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Nat for Voluntary Assessments 141 Long Pond Rd. Property Address Owner Owner's Name information is Brewster required for every Citylfown page. ®. System information Sketch �f Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least bac wa�teansupply e t rs the bu'Iding. Cheek one of the boxesibeloiwW��n 100 feet Loeate where p t5ins • 3113 N!!q 02631 December 26, 2413 gtate Zip Code Date of tnspeC{ion (con#.) ® hand -sketch in the area below _...�. V tlrawmg attacrrea seNd�a«�y �� �.i �� � P�-'-� Li 2 t �3 -�+�" � b2 13 � �'' 6 u� 3�t 3" ;� o0 3 �i Q-i�? ! � J-1U^.Jl� Ct �'`�) ala 5���� ��-����.� Title 5 Ofriasl Inspection Forrn: Suh:utra� Sewage Disposal System •Page 15 of 17 Commonwealth of Massachusetts Title 5 Official �nspectior� ���' SubsurFace Sewage Disposal System Form - tdot for Voluntary l�ssessments 141 Long Rond Rd. property Address Owner Owners Name information is Brewster �' 02639 required for every CitylTaWm State dip Code page. �a �y���n� tnf®Irrrr�tian (cont.} t5inn ^ 3113 �Oe:� �E"s£]6u�i ® Check Slope ® Surtace water ® Check cellar December 26, 2093 Date of lnspsctiora X Shallow weAs >7' below the bottom of the SAS Estim ted depth to high ground water: feet Pleas indicate all methods used to determine the high ground water elevation: �� ❑i♦ You Obtained from system design plans on record if checked, date of design plan reviewed: 7113178 Date Observed site (abutting property/observation hole within 1a0 fleet of SAS) Checked with local Board of Health -explain: Checked wish local excavators, installers - (attach documentation) Accessed USGS database -explain: describe how you established the high grflund water elevation: Test oles were completed on site #0 96.5' b.g. and no groundwater was encountered. The bottom ofi the I ach it is 9.5' b. . so there is at least a 7' se aration to roundwater rus 5 Oifid>I tncpsciion F017n: Subsurfees 5�: Aga Di^possl Syttzm • Pega 16 of 17 ©umer information is required for every page. ;ommonweaith of Massachusetts "tie 6 Official dnspection Form Subsurface Sewage Disposal System Form o Not for Voluntary Assessments 141 Long Pond Rd_ Property Address Owner's Name BrewsterMA 02631 December 26, 2013 Cityrrown state Zip Code Fate of inspection Report Completeness Checklist inspection Surarnary 0 (Systern Failure Criteria Applicable to AH Systems) completelf ® System Inforrraation - Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn an page 16 or attached in separate file t5ins � 3/13 Tids 5 Oiiiael Insp'yction Forttl: Subsurtaco Ss�•rgn Oispfla=_t Sys?sm ^ Feg� 17 of 17 t_:.. � OR�w O c� �` 2 �♦ , O �o MD _ _ ti -�— �o �o�r- �s.�so� Town of Brewster '� u' �► SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM APPENDIX BREWSTER REGULATION Map' Lot Property Address:_ j� Owner Address:��?oh�2�i This inspection represents (Check Onej A) System Passes B) System Conditionally Passes ,� Real Estate Transfer (�•j�AlterattoNAddltion Septic tank c®vers are more than 9� 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. . D) System Fails (Brewster Real Estate Transfer Regulation 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. The Brewster Health Department has reviewed and accepted this report based on the information 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. ryeai�n uirector Approving Date . Please be advised of ADDITIONAL BOARD OF HEALTH REGULATIONS: 1. All private wells are required to be analyzed prior to approval gf.the Subsurface Sewage Disposal System Inspection Form, and sixty (60) days prior to transfer of property. 2. All underground tanks must be registered with Board of Health and are subject to testing requirements. OFFICE OF: BOARD OFHEALTq tsaaf a�.rrot Exr.�zo IEwS9` _ _ �a Y N BREWSTER. MASSACHUSETTS 02631-1898 GREW COMMON 0 OA coRPONJOINSPECTOR'S GUIDE TO fees I+•190% BREWSTER REAL ESTATE TRANSFER REGULATION AND THE STATE ENVIRONMENTAL CODE, TITLE 5 OFFICE OF: BOARD OF HEALTH (Sal a9&3701 E7Cr.a20 The Town of Brewster, Board of Health first adopted a Real Estate Transfer regulation in May 1987. Since that time it has been revised to its current form. The Brewster regulation was one which was used as a model in creating this type of program in the new Title 5 regulations. There are however a number of things in the Brewster regulation which are stricter than Title 5, and are still enforceable and valid for Real-estate transfers. These differences do not apply to inspections done for the purpose of building aIterations. This document is meant to act as a guide in combining the two regulations. WHO CAN DO APd INSPECTION? The Brewster regulation has been recently changed to allow DEP approved inspectors to do inspections within Brewster, IF that inspector has met the requirements of the Brewster Board of Health which include: a) being qualified in the eyes of tho approving authority to do such inspections; b) having one year documented experience in the satisfactory performance of such inspections; .. . _ ..__ ...... . --,. . c)has used and gained the skills that demonstrate sufficient competence to perform such inspections. ARE TFiEt�E ADDITI®tUAL FAILURE Ct1;tiERIA It`d iF�E f�t��IHSiEI� REGULATION? The Brewster regulation deems a system failed if any of the following conditions exist: 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. ARE THERE ANY DIFFERENCES IN HOW LANG THE INSPECTION IS VALID FORT . Title 5 allows condos to go three years between inspections. This inspection would be valid for all real estate transfers occurring within this time period. Title 5 allows for residential systems to go three years if the system has• been pumped annually during the timeframe. The Brewster regulation limits the validity of the inspections to two years in all cases. WHAT IS REQUIRED IF THE SYSTEM FAILS? Title 5 calls for the system to be upgraded within 1 year. The Brewster regulation requires that the buyer and seller agree in writing that the system will be upgraded. It also calls for an.engineer to be hired and that the preliminary site work be done. Be aware, neither Title 5 nor the Brewster regulation hold up the sale. We have been told that many banks are setting additional requirements. ARE THERE ANY OTHER ADDITIONAL REQUIREMENTS IN THE BREWSTER REGULATIONS? Title 5 does not require the reporting of "voluntary assessments" to the Board of Health. The Brewster regulation does require the reporting of all inspection results. The Brewster regulation also calls for the inspector to report any evidence of sewage on the surface or draining into any waterways or wetlands to the Board of Health or its director within 24 hours. The Brewster regulation requires a test boring or deep hole on all systems under elevation 15(feet) and/or within 100 feet of a wetland to determine groundwater level. The measured groundwater must then be adjusted using 11e Frimpter method. ', `'L Y w: C • 1 I • ►► • �1/ • �, � X11 • • It � f _�� 1 1 ��?J � • � � � � '��"'- ' . �• t L � '� ' - • � • - � _ 1 .1 i n 111 , 1 �1' 1 • 1 - .1 IIr 1 - - . , + 11 _ 11 _ , 1_,11 , 1 . . 11 11 . . 11 . 11. 111. „• 1 ,. - 11 11 1 . -1 .. _ - 1 I. .�I 11 1 . 1 1 11 . " _ - 1 1.11.11 1/ 11. ' 11 •► �. 1 , 1 M 1[ 1 1.11.. 1 - 11 . . 1 - �- /1 - 1 1 • 1 11 1 1 111 .. Inspector's Signature: �� � . 11 v• . II . 11 .. /1 1 1 - �.. ft /I _ . .� . 11 11 . 1 II . .1 . . 14 •11 II 11 . . 1 11 •1til• 1 •i• • • 11 • II 1 11 . 1_ •1 � -111 1 1 I � 'II I I 1 1 1 1 1 yy 1 • II ' 11 M• 1 - • '♦ I 1 1• • 1 /I 1 � 1 11 - .1• • / • .1 - '1 •11 1 11 - • II -111 • • I -� .11 . • • - ti 11 11 1 1• 1 I• 1- :1. • 1 I - I 1 • 11 11 -11 l ''''•*This report only describe rondiHons •t the time of Inspection and under the conditions of ose �t ibat time. Tbb inspection dna not addrw how the system will perform is the liiture ander the cams or different conditions of use, �1L30 A off a a O. OR VOL LLL `f _ PAWR !. fa (Chc.2R �cYBO cff��nD ©ga�,�Ws�l�sJ a3�s�-� pyo �g�;� bag5��o e a mtd:i:,u�m• t' sw °s i'• � ,_v., tips +' "� , n fnibnw 111 complying -•tictm* - t111 1. IePla ( • 1. .• not - 7qpx)ved by 7d 7 L .1.. ��.. on if it is &ucbway tank -P991 _. 11 1 , ecti 1m 1 yeir)n old is availabl& ., • 1111 ' that tho I , • • • L _ L It .un• I '1 kg's IYD sxplaun: . The system requued pumping pass Inspestio8 if (wilt aproval of the Board ogHw qyiiiqtj U, E21014 INSPEMON NTs SUBSURFACZ `t , ' ' f VOLUNTARY ' ,1 t ; �: PART A FORM CZRTMCATIQjj ,,.lul PrOP"Addr - m ofTurl s Board Is &ftS�wMa= exist which raP*w 1, _ 6valuatim by die Baud to Protect public heaW saffty or the GfHCafth in order to determin if*@ Sysug Will Pau gavesg Board Of Iffulth dotern&gs 10 Protect I1 11SI*q and the ha cess.., ' 1. wkhfn 1 Aw ofa vases - 1 i1, . 1- 1 - Of - ng .a,_. 1 � ' ., 1' •., f@IY and 1 MYS u rwaw .1'u •l. u.•. � • I _ • . 1� do Water ThAlrystomhasasgPda tank amd SAS =d 1iis WithinaZme 716 system has A sePtIc tmk =d SAS md the SAS is within 50 fee ofa 'waW supply. u 110 *'stem has & sqxk.tank md SAS =d the SAS Iess thm 100 f Privas Water supply woll** IS ad but So &a or mom am a Method used to detamift disame 1bactWsystem a and volatile GfPnk waw 11 Pas" if the well the Preswco Of 1 , I •1. r, • • • 1, Wure I• 11 . I 1 , . _ and 1 �. If_ , , • , am 1 . . 1 .. . � •from •1 1 E N111 1 &PW or lea MW^h - • n . 3. Other. r A - G 11 11 1. 11 son so I • .I nl. . _ •• • _ ' M \11• •I - II .11 f 1111 - 11 '1� I to .I1 — ■1 \ . . nnl. Y. �1 •-.* IN If as 1146� ..;,, _ 1 t `. • f _- � I . • U_. 11 1 1—_ � • . • I , : 1. .•l.. 111 1 . •1 f 1 1 , M_ •, 1. , _. 1 c 1 l l �.0 Eye � /i • l '1 ... 11 I 1 'r II • � 1 I 1 iI - PI 1'r �, 11 : • � ''I1� h 'a":Y 1S �, 1 hail_ IC 11 — •"u1 ,1- r we 11 r - ?o bs considered n V sys�' i ° gpdLerM Its foll�n8 criterm apply to �Ma Wa��� E�d�i ° � ? is above) fps 1 I 1 .- fl 1 1 . Iv; c ... .. u n 11 allwithin u " l _ .1 IY zone 1 f a public watwell wered / .. .11 n • 1 • e. •a i 1' - . .1, questionSection 11 11 ., .a 1 . answeredIf you have ; y system 1TheOwner Accordance ith - uyee in Section D above the WV • •1 r. / •• •• _ papsofil OFF7CL4L INSPECnON FORM - IYOT FOR VOLUNTARY SUBSURFACE STWAGE DISPOSAL SYSTEM WSpECTIO �NT3 PART B N FbRIM CHECKLIST e� I,ddrwa L'-1 � 104\J tooNn 2r� Date Of bsPectjpli 111. 11 I1 11 11 \ - 1 1• 111 11, I1 11 .1,1 111• . 1 _,,la 1111. _ II •1 - - - 1 . 11 • • I1 •( 111 _ , 11 •11 1 -lob II • Al I M I - I _ 1 f• '11 1 _1 1_• •II I CPR 1 -111 • 11 • • 111 I _ 1 • 11 I/vj�vmrs 411 11 1 1 � 1111111 11 1 •1 I 1.•11 11•-I1 1I1 I ' - - 11- •• •II Of 1*14 depth ' ' hUIP ad depth\ 11/1 'as the "ciHtyow]mer OccWub (11 11 1 : 1 I j. _ 11, •, • -11 1 1 II-W-dr) 1 r •1 • • • 1 1 •1 II .1• • I • 1 • -proper f 11 Yes . 1 r 1• I v 1, 1 _ 11.iiII -f \.1 • 1 1 � 1 .: I I . T I1 U y` i-3(C� szwAwkm.jO��� nsAL Q�Q�� IP1� ' l� O� ®SVA YAW C x �q Joh OO WJM`TB©rm .. • 1 M - D' 1 . of cuffed 11 -1 • -Uls - ix i -5:1. •-.1 - 1 (you or _ • 1� 11 jo n 11 .ulk c`'' of 1-- is Tl, - - •I,fi -.� 110 (Yes Or nON La"d of Occupwwo 1 a N 1 1 .11 •. . 1 1111. 1 N 1 _.,1 •n flow • l.. 111 -•J.. Basi of dwip / aw it eIr or an 9) 11 tank 111 • 1 • . 11 - 1-.=f`S'f ! 0? go) 1 Ir 1 • 1 maw readingk of 11• 11 hLw :I:d' ).. . 1 n • n n n •••n Y 11111. Ira: s • nn/.. 111 - _ • , 1 111U 11 - r 11 • �• 11 •�:1 _ _ _ • 11 V +• 11 � 1 1 • --`i, ti ! n! / 1 1 .. 1. S. 1 � � a. Z 1. C a. � '� 1 I .111 ••• d IIID /•r. n -1 i 111 1 -In 1 1 Will r / • -111.. 1 ti 'i _ •. C` Pap 7 of 11 • « SUBSURFACE SEWAGE DISPOSAL SYSTEM Jt PART C ' •` ,- ' FORM SYSTEM • ( i rop•rty wddra:: ! 1 �w - 1°0Iv � Jkj Oso aQ k,4 R,,e �r 3820 eq, Impecdowe XAMM ftom pivm water supply well or suction lizw 1 I •., 1 1 - 1 • � • 1 .11ftmtop of slud—ge to bot . 11 /i w11. om of outlet too or-baer. 6 1, .. from 14'of 1111to , 1 /• OfOWd we or •j DUN= ✓ 1 bottomofscum to bottom of OWeg too - •1 II - 11 1 _ wL uI-: a COIDmCIIb (OII pu[npe11#111 n� � nElitG� LO outlet IIIVgS1 � •'1/111 -1 •F.11 . 1 11 . . I 1• 111 -. 1 1 1,IT, 1 •1 Tfanll from • n • I u, to • . Of outlet �% •r baffle, . • II I - . n IIILC��. ll� IOYOLf • 11 11 ti/ • 1 I III • 1 • 1/ 11 •iI • • • 1 11 I • 1 - • 1 11 -1 • - farouOffA8 OOr-1 ICIAL UjSFECnON YO ve AM FOIA V AMV X -A �P�M`��A�6) SUBSURFACZ SEWACB PYO ASAL SYb -VVA MSFY1C';X"V OO \'vA YAM 1 C��ly�s� kJ0 ic�J<r ?00C1D CO Yns ss 000 Ag- - GR J VaImu9 0 n b DD QOIC�o3 Y19'00 Cox 0) r Ess � err �, cpr� f3 Czcck3 WO C3 K00)5 . DaW ®f last pumping ® (CM(lithm ®f alffm mJ flOfi3 aVJWIC� 0@3 4?a if is level and ilLftizFELion to CQ"rm�k; CitILL09 LILY eakage into r e° Pap 9 of 11 rSUBSUUACZ SZWAGZDOPOSAL SYSTEM INSPEM• ORM PAW C SYSTEM 1 • • • ti 1�ro116rt7 JWU&W*s: t l orr (r P 8 r�W Sher owner: '3 n ti 2 & E _ Does of inspfetlou? t L L o f -- �J� ovalkm. cesspml, 1 I1, . „ .. _. (now conditionsoil, signs of hydmuHc fifflum level of . . , . damp soil, caadition Depth of solids layer. Depth of scum Dimensions . ... dataials of constmdon: ndleadon of groundwawinflow,. .1111. Iil 1 . 1- r. ,.. 1 . 1 .4,AriLq. I Y• 1 - i .i 1 . 1 ' . 1 . . 1 ✓ •.. PRIVY:sits plea) Dimea�ionx Depth of solids: Cemmeab (note Coaditiaa Orson: aigas ®fby+draulic fair leve! ofpoadiag. COM170a of vegetation, etax par 10 as 1l r s • • s t DISPOSAL SYSTEM INSPECnON• SYSTEM •- • VIA "-- r .., • �l' psi• 11 0! 1 � • I • f • f f ! / • 1 ! ! I • • �i. • • � � � un �_. .� - �--- c -. n � 1. � -nt• - �- VV �_ y P Ce � � �tA;r III 'A �BCl��1 Cr369t t0 � J(�0��4�PC��(� a�C`UQ�� ®I�P6a�6ui7��f3F7 APPENDIX PI RVIATIM A- COULAYO N Mope �8 ®wnr?e �dtlro�©: Nano ®P I�oAu�t®r:� �on, pany Napo roc—� DCS Lp op I='A!T- pc�> ag S�o3 Mon a da�� �' gA 6g petv51p6ct �'Hta I�a�oryQt�ci vo�voDoha6o g�ti©�t3 ®nag � �; �`�oal �neato �ear3�,4oe �) C�BB.o�ott®raPlad�iet®sa a yato�+ Paoaoa gg yntn�t Condiflonelly P00000 %eI tC]sif3 C-iV®Pp are M etA tH®R 9% IRP;FIAfl b01©tJ 4i10 PiniGH�A {�PDdO. - - - -- - c. ? gat 7 r' - JNWIW �illsoll RIM. 1 �) Syfltofn F®I19 (Brewster Boal Rstoto qP©Hetet Regulation tsq Iiiromonts) mI system Its iso 3t9to of diflPnpair auch that It cannot 4[dsjcti©R ®9 it v vaa ®PI�IR�IIy intdnded; liiR �PA3;f:9W P-i9E31111 V6-PflHrii9fl1 11+3(3 eQVIUV11Sd afid flU�Upt9� tfil8 Pup®r@ �p9©� FSR tH9 IRfB1Fi�D41®n �nteln(ttl they©in. iiia InapeCtl®n teflest® the pree®nt condition ©f the Qanitery QyOlom 0R6 io r�®t Dny ®uarantee as is tha Me or future PAnditi®n gf oeid oyot®rn. Nanev Ellis IceWealth Director Date ' t i MMOMVEALTH OF s xEcuTrvE OFFICE OF ElfflRONMENM AFFMIRSIIIIIIIIIII P i • O i• � :x. •sac ;o.,¢r �• _: �:�:_� IITAWT, r��. i G6 • 1 - r elow is true, r1mrste and complete ea of the time of the inspection, The inspection was pvdiormod bae�M on my azining and expenienci: in the proper function and filaintanance of on site sewage dispostil systemom I aw a DEP ppyxavod ortem Inepecter pairsuant to SURio 5340 of Title 5 (310 CMR 15.000). The system: r ..t Conditionally 1di.4_ ..tsse The systeminspector shall submit n copy of this inspection r®pato to the Approving Authority (13pard of 1"IeaJtlt or 17�P) within 30 days of comptctir►� this inspection. If the system is n sh®rod sy�eet� or hes a design flow of 10,000 gp4 or g ester, the inspector and the system owner snail submit the report to the appropriate regional office of the ®EP, The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ���°"�Ca� ;!ip�r,� ©nCy �co�i�bQs cco��i8boca a� the tB�c �G luaap�¢e®�a a�ad csWe�Qc true corar7asu®�s ®G rtaQ �e 91r;,q tack, ll Calla ��ac�;:�i�ra d®� raoa n��lc�a C�a�� C uc oyae��� criBO pQ���� 0rd e6a� L'�tt�� e�u�d�c ata s�rns Qr dfi�'e���o c©�adato©na oP N��� E�P�p��rr3 CCS +HC;AWRON (continued) iF ill 15.303 aik ka 3 10 CMR 15304 exist. Any failure_ 1 aot cvalualed are Indicated ,.:c 1 pGl. Slyaeegi Conditionality Paoaem r" one or more system components as described in the "Conditional Pass" section need to be replaced or r aired, The system, upon completion of the replacement or repair, as approved by the Board of Health., will pass. T' septic tank is moral and over �0 years old® or the septic tank (whether metal or not) is structurally unsound, hibits substantial in titration or exf Itration or tank failure is imminent. System will p®s® inspection if the existing it is eeplaceld with a complying septic tank as approved by the Board of Health, °A metal Sep taiwill pass inspecti on if it is structurally sound, not leaking and if a Certificate of Cornplianca indicating that a tank is less than 20 years old is available.la M iti -GI i'�- ! i '. s T-1�' :.�. J i � � lt. Vit•` ".11'-. •- broken p1pal are 'i 2-e obstruction i•. - { :/ distribution box is leveled or replac*d The wily requiredd pumpir pass inspection if (with approval cf ND explain; than 4 times a year due to broken cr obat�acted pipe(s), The sgs¢em will rd ®f 4iealth): s . ! c� `5YRURAL 01 c uA Rul 1 DUMNA = Nv A RIM VU MIN, A mM�.i IAWJM�10Pvw��� TM Pc©pQ�s DOu 0� p�. �aAfr$bc�r� ly�nlana¢0®� i_n �egeaerr�-� by C�� QOorr.� SDP L�cGdaV�o 1v editions osaat which require further evaluation by tho Doord of Health in order' to determine if the system i failinx pri public health, safety or the environment, 1!. �yst�o �r�41 pn� ctea�ao BOa�ifl 0� ��iBf� d¢6e�hca to nc�®a�h�c� lith �Q� ��L� �a�-s���Iljgf�) 4L�aR ¢�o syst011ili 19 o0Q fidWiRO lag � a 011152nW VjhIPL) VjgI prrORc�Q P�abllc �aea04b! sofQay nna7 Qh)Q 0©�r6r�ortiaeo�a ,� C sol or privy is witltin 5o teat of a surfbce water Cess t or privy ie within 30 feel of a bordering vegetated wriiiand o? 3 stilt 6ataesi3 �e Sysge g will rhI iUP01he Roni®f HOOK QOnd l?ublic W8W UMP®OW9 If any) deRerm0nkeg RN9 Me at¢dIs Tafletioning 1� a mania®ae ¢lea¢ pr0¢c-to the public Nonifli, snfil nead cdvhniiii The system ha® li tank and soil absorption system (SAS) and the SAS is wN ithin 100 feet of a surface water supply or%tribut€ ty to a surface water supply. IIIIIIIIII Ili 1; 111 1 Jill 111 I'll slystis, performed at a DEP certified laboratory, for colifbrm analysis must be attached to this form. �DJFirDCjLAj,, U\45)P2CC 11 Ri©I4 rAUMVAoNUIL u UE'S V UIU UINA A A nS0i10�����J�� pA1V 311 I�1 �C, RY RCCA.°Il RON (continued) Il�OQ¢ 01T �, ayst¢o 1; nfl(leid� c�r�tee�13 �p�ll•�n�Ee ¢c a91 ayste�:aa; Cora �M indicate °'yes°° or "n®' to Bch of the following forlel inspections: `� ! !, r 1.! - •/ is �? L f'.; '� •1 '../ !� .i �. �, h� 'f'I __ s: f f 'iii f i— 11 _ f - ti. 1 � i' — �• 1•. f ll il' L''i i� I' '1• .,-'r:r'. -- - 'i - - i Cr If I.'. 1iE I tt�: i. 1l - L1. IAt., !iu r•. !; t: $ti i' ! i :n'r �'o h¢ c®ilei®eta n Dliv�¢ s�vaEeir� 3�ie �yatQ� ,a ��t a¢��e a Paculi3�� �,�6t1� r� dc�l�� G�u�� ®Q Il®,®tl� �Qd t€a 1gi0li� You ust indicate either "yes" or "no" to each of the following: . (`[ hhe flouring criteria apply Be I�rge systems in addition to the criBeeia abov®) yea no i e system is within 400 feet of a surface drinking water supply the stem is within 200 feet of a tributary to a surface drinking water supply the sys in is located in a nitrogen sensitive area (interim W ellhead Protection Area — I�NI�f�) or a mapped Zone II a public eater supply well Ify,r ou have answered es" to any question in Section E the system is considered a significant threat, or answered yes in Section 1D a; the large system has filed. 'The owner or operator of any large system considered a significant threat under ion E or failed under Section D shall upgrade the system in accordance with 310 CMR 19.3040 The system owner should corttcret the appropriate regional office ofthe Depaftment. C] li+yII�> J®jLJVlj\q Lf fA� Mij�oIgo l 1�p�37i' D �IPII�(CIl�Il��' t✓b�4c if t6ae fall®t+r6n� E�sve heesa dorso Yo�s m�6Q endlcate'°yed' or °°no" � to ash of the fa8lo�,vie�, I�rnpitag i�bt�tnati®n wn9 pFar�idEd by tl�� ©�°r�te�, ©�aparat, c� B��rd ®f ili�tth vwmear© [,.fly of die aysterl, oompoRowu pumped out in the peov+oua two vrWta ? HU tW syotem received nomial nowo in eho previous two week period ? V0404flave large volumes of water been introduced to the system recently or tia part of this inspection ? b� Were as built plans of the system obtaineA and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up Was the site inspeaod for signs of br�ls out? Were all system components, excluding the SAS, located on site? was the facility owner (and oocupants if different from owner) provided with information on the propff .� a existing infoefnation. For ettsample, a plan at Bhe ®Deed of Fleslth. _e_ Determined in the field (if any of the failure criteri® r®let®d to Ptd C is n¢ issue approximation of distance is unacceptable) [3 10 CMR 13.302(3)(b)] 2Er. 1' SU� SUM, ACE S', WAGE DMOSAL SYSTEM 05 ° 11"�ICUMGN P MA G�9(�QP3jt A(��Pi��98 �[JG�Qu I�1fiw 0q S�ISTEM INIF,O `�IiY�[ATIIOW �®I`JD�7I'd®i�1S umberumber of bedrooms (design): , ) Number of b rooms (actual): ESIGN flow based on 3 10 C R, 15.203 (for example: 110 nd x 0 of bedrooms) 0 of current roBidents: laundry on a sepitrato Gewage System (Y 8 or no): 1062 [if V03 0soafate hiapogdoa VCquWAI .aunft system lnspeuicda 1 1 �F ' 1 (+ ype 01 )MIP flow (based on 3)Q CMR 15.203): pd asis of design flow (acat"ns/sqft,atc.): ! 1 1 • i a{ f went (yes or n®); __... e the Title 5 system (ye' ar no): G'f,-' rY LW [Il`SULJ Mu ORVA A10 Reason for pumping MajUTALAY661 V10 Privy Shared system (yes or no) (if yes, attach previous inspection records, if gny) �e►ProvAtive/AlteensYive techr�olo�y. Attach a copy of the current operation And mAintenanre eontPAct (to be ed from system owner) ight tu* Attach a copy of the DEP approval 4=Jiw� Maw C STlOTEH HIF(DMATI ROM (continued) QP��i3Guy SddUaaoe �,ancpa DDeg oq w�l DI�1(�a �r�CrJ�y3 (loe-ate 0ua site ply) AP �ZTth DC10w gPede: jt R&tcdala of 0stt5tructiora: �0�! koa _40 PVC Pthw (expleiia): �iqj n ce from privato water eupply Weil or suc6011 line: �ontDi eiita (©n wndition of joigi, vontiog, Wdencc of leakaAF, Ac. e4 �Iv � u �1IJESa ( o on cite plan) Aeptb below grade: p Iv�aterial of eonsarxiction;concrete metal _fiberglass polyethylene ludger istance from top 0 bottom of outlet tee or baffle; GU M thicknew OR i8tafice ftom top of &MM to top of outlet tee or baffle: '.• e1 /- _ &a_. es. 1 /f__—_- �L�.�/aS� a ° � , �(IOr�Ye 0sa bite ply►) �CUn1 Y111GlCft®98: tion: ®Concrete metalfiberglass polyethylene other i : 1 i 1 � / - m®ndation®, inlet and Duel®B tee or baifite condition, structure! iitt®grity, liquid 1®vela ace ell eekuge, A i' �L /i�Ill�.!!-filtS.v 1.SAVnyIS luLy IIVBV '4j/ � AN OU iS SLIIl'3fF CII, SEWAGE DROW iI 0OWS ll I PW IT45P 21 MON 7MI'�/li AW C SYST rJOA I NVO ✓Ii gTi'HON (continued) RIGHT op H®LDRIG TMTJ UP (tank must he pumped Fit time of inspgctionxic"to on Site plan) > )epth below grade: A�lateria! of constmcgion: *oncrete mew fiberglass polyethylene �other(explain): opacity; a' oniA 1)eSign Flow:r Jarm present (yea or no)d JUM level: in • •_ or Iate of pumping: - iepth of • above outlet invert: zei� eakage r or out o -lox, C)4 41A 410 'AO p AVLWr %vbtP%1va10 ly-a L. (locate on site plan) limps in working or (yes or no). Alarms in working orde es or no): Comments (note conditio of pump chamber, condition of pumps and appurtenances, etc.): PAR Y C �C T M iTTIF© ?TAA 7 F 0 N (continued) Q�pQ� Qddcc�flao Dade 0GP spvtestfi000 C �V �ORL ASSU ` ' ll' GN 5VO EEvd (SAO)a� 9¢sn¢e on Dd¢¢ D9nR, QIIeavn¢ao r40¢ PC�"lrtid) tf S�a� not locatsd explain why: teaching pits, tYutnijor: leaching chambers, number: leaching galleries, numbor: _ leaching trenches, number, length: leaching fields, number, dimensions: _ overflow cesspool, number: _ innovative/alternative system Type/name of to Comments (note condition of soil, signs of hydraulic fhil ure, Number and depth — top of I %depth of solids L t)epth of scum le Dimensions of ca i 4aterials of con: Indication of gro Comments (note In ���it'�c�P.S�� (cessp8ol must be pumped ae part of inspeitioA)(l�te onsite pian) cd inlet invert: inflow (yes or no): of sail, signs of hydraulic failure, level of ponding condition of vegetation, etc.): (locate on site plan} signQ of hydraulic failure, level of ponding, condition of veg®taYion, etc.); CLAURNAMM t� hIiI�UkAII. MNOX � A %Y 111�RUVIA � \�Wv � 3 TIL d1�d u`3�1 f��� �WA��s�� PARS( (C MWO v ll ROM (continu®d) �G'u+��3t"r3� �1dde3a0a ���crepo �4 • I I �' - ® f Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or b mchn, arks. Locste all wells within 100 feet, bete where public water gimpply atera the building. suss -Off, ACE SE, WAGE, DOI 051 J�L myn Wd MOVE CTROM 1171 0 RM VART CC SWOUPWi 1M1FOWWAY ON (continued) G'c�,�t2�ra IJdl�le���o �nvt a T) cr Vono slat sUrace WaWr AJO check �,uar U Shallow WOUG /ApIgl � ,•e -iIb .i '.f fes. -_ _ �-a.:^S - . ►. i.. Vii; :r. :'i— _ _. �-a, _;,i.t c .�-_. _�.- - :i r:, •: �:���.: L - � CheckedObseiNed site (abutting property/obamation hole within 150 fbet of SAS) with localBoard of E _ :� y�q�n THE COMMONWEALTH OF MASSACHUSETTS ���eF�® �F !—IEA�TH ..�=• . ,����°����� �a�- �g�����I ?i�.��k� Cn��t��r�r#tart ����� Application is hereby made for a Permit to Construct Syst�I at C�F't=.. n_7' � � �� /�I ,�L c�nr c� 'lea rye � D .-• Location -Address ,� Owner Installer or Repair (� an Individual Sewage Disposal l -� +� � ! /� f� or�lLot No. ��+ 1 _�} y� 11 b±:?.^�..__[�l �'.!.2-.7.>�.1.�:.� �r#�-mac �.�U.t_....C._�!� l��J i �. /7.. Address Address Type of Building r� Size Lot.��j. � _��.._ �'._._Sq. feet Dwelling — No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other —Type of Building ____________________________ No, of persons_.__.__._____.__.__.___.____ Showers ( ) —Cafeteria ( ) Otherfixtures .-----•-•--••----•--•---•----•-••--•-------•--•---•-•-------------------•---••------------....---•-----•----•----•---••---•-----••-----...----------- ' ..� � _._..__.__..gallons per person per day. Total daily flow____________________________________________gallons. Design Flow--------�-t-'�----•------•-•--- Septic Tank —Liquid capacit�✓4'%v C%.gallons Length________________ Width_____.____._..._ Diameter_________.__.._. Depth___.__-___..._.. Disposal Trench — No_ ____________________ Width_.._.____.___._._... Total Length..._._._.__..._..._. Total leaching area___.__..._.__...__..sq. ft. Seepage Pit No.___.___l._______._ Diameter.__.__��T Depth below inlet_._..._.. Total leaching area__________________sq. ft. Other Distribution box (�� Dosing tank ( ) Percolation Test Results Performed by---------------------•--•--.------•--_----•---.----.-----.....----_---._-- Date---.-.---..---_----•--------_-------.... Test Pit No. 1 ________________minutes per inch Depth of Test Pit.._.__._..___.______ Depth to ground water.._..._-________..._.__. Test Pit No. 2................minutes per inch Depth of Test Pit_._____.__..___.._.. Depth to ground water...•__._.._.__..__.__._. ----•----------•------- ---•--------•-•---•---•-•-----------r----------------------------------------------------------•-----------------••-------------•- . o� z.. f�fi �i� �S h L� �-1,�;�t"�?��v_s/�„a.__ f.! .�'fi..�./.�_/�a�. /�?ea/.�v <<�s� Descrlption of Soil.---•---•-------�-------•-----•�-•-----`'----•------•-----•� `- ------- Nature of Repairs or Alterations —Answer when applicable._ �M�__ g t- �_._.___N �"�_____!-�__""/� �?�________________________ -��._._.S':�anl.4�------------111:¢c.7__��1�--��_-.�__------�'-�--�`�--�'------------------------------------------------------ Agreement The undersigned agrees to install the aforedescribed the provisions of iITt � 5 of the State Sani�ry Co operation until a Certificate of Compliance 13�� b � Individual Sewage Disposal System in accordance with un ersigned further agrees not to place the system in e boat•d of health. ry��®� A lication A roved B � ) � t_: �..3.. -��` -- �.�_ �r.:4 � :!•.---=�='= � :r-: l� ��_:=•-- -ch/� �_.L_ Date--•-----•-•--- =��,�i,t� ����'-` Date Application Disapproved for the following reasons:--•----•---------•-•---••-----------------------•------•--------••----------•--•-------•----...-------•--------- Permit No. ---- Issued.... Date THE COMMONWEALTH OF MASSACHUSETTS �� oF....��.....��<..-�....�� .............................. ����a���� .�� ��������� Date ' IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�} Install at.���--•---o�-�? w.��__.•--.�.�..�?�.1�...-- - -- - ---•---------���--'n`'--�----�'..s� x'17 --p �=-t�-'tv' Q --------------------•_..------•----- r Y�' --- has been installed in accordance with the provtstons of TITTLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ dated___._______._______.____.__._____....__._...... ��� 8��&�l�R��� qtr �1�1� �ER`���O�;A�E �B 8��.� N' ®�' EE �®NSTRUE® AS A GeJAR�►NiEE TFiA4 iFYE �'��°C�EP� �lB�.�, �MN69�'@�N �A'�IS�A�`1'®Rlf. DATE .......................................... Inspector-------------------- ......-----------...........--- ...- ---------------------------- - `TOWN OF BRFWSTER OR E N, 029 T OFFICE OF 4 ..••• HEALTH DEPARTMENT o +' 'b�9 2198 MAIN STREET 3: . > BREWSTER, MA 02631 r - _• c: PHONE: (508) 896-3701 EXT 1120 k�L° —�¢ FAx: (508) 896-4538 �+mo•�nnowao` BRHEALTH n,BREWSTER-MA.GOV W W W.BREWSTER-MA.GOV Received: I AU q' Zi� Pai :� Application for Board of Health Variances Abutter Dead ine: DIn-House Local Upgrade Approval ,1Public Hearing Date: SUBJECT PROPERTY ADDRESS: 1 P r Map: �Z Parcel: Book: l I Page: i,�G LC Certificate: LC Plan: Lot: jq Name of Applicant: n Mailing Address: � � Q�CV cy (/l Telephone # ,� � � ���)�) Email: drL n m cc, �6 om cc S h �' Owner(s) of Record : C 1 IAC'✓ 'I Lid t l" i LtC `1 1457 Mailing Address: :k2f Vlon):"; Pec A L2e o� / V �t /� c' G- 0 Design Engineer/Sanitarian: Aim 4y Firm/Company Name: Mailing Address: Telephone #: Email address: New Construction ❑Voluntary Upgrade ❑Addition/Alteration ❑Failed system ❑Real Estate Transfer,' Design flow of existing system: Design flow of proposed system: Reason for failu Total sewage flow of site: Conservation Commission approval required: yes El no Order of Conditions/Det. Of Applicability attached El ❑ Total lot size (sf): Date of ConCom hearing: pop List of all variances from State and Local codes (add sheets if neededl TITLE 5, Sec. #: Descri tion of Variance s Brewster Reg. #: Description of Variance(s) Approved by: Health Department N:\Ilealth\BOH regs\InHouse Septic Local Upgrade Approva12019\Varianceapplication FINAL NONFILLABLE FORM 12.18.19.docx R rreae�►eM K s� s � wl. L &CLI Isc i harX -I Kg C1 Approved by: Health Department N:\Ilealth\BOH regs\InHouse Septic Local Upgrade Approva12019\Varianceapplication FINAL NONFILLABLE FORM 12.18.19.docx W S j /i/� 0 �F• nF 9 t� ;� Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508. 896.3701 EXT. 1120 FAX: 508.896.4538 brhealth@brewster-ma. gov WWW.BREWSTER-MA.GOV BOH Variance Agenda Item In -House Local Upgrade Approval Other: Health Department Amy L. von Hone, Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Board of Health Meeting Date: January 4, 2023 Project Location: 38 Captain Baker Road Map & Parcel: 72/19 Owner's Name & Address: Oliver Family Quality Personal Residence Trust of 2012 c/o George R. Oliver, Sr. 966 North Penn Oak Road Lower Gwynedd, PA 19002 Applicant: Kent Dinshella 39 Old County Road Harwichport, MA 02646 Date Requested: December 14, 2022 Title 5 Variance Request: Yes ❑ No ❑x Board of Health Variance Request: Yes© No❑ 300'Pond Setback Other: Yes ❑ No X 1. Outside Zone II/DCPC, Existing Town Water 2. In ESA— Entire Site within 300' of Wetland (Long Pond) 3. Title 5 Septic Inspection Report for a Real Estate Transfer dated September 12, 2022 Assistant Health Director's Comments: 1. The property consists of an existing 5 -bedroom dwelling serviced by town water and a 2002 Title 5 septic system consisting of a 1500 -gallon septic tank, an H-20 distribution box and three (3) 35' X 3' X 2' leaching trenches. 2. The lot is subject to septic flow restrictions per the Brewster Environmentally Sensitive Areas (ESA): 1 bedroom per 10,000 sf of land area. The existing lot is 29,600+/- sf which is N:�liealth\BOH Meeting Notes�BOH Hearing Notes�38 Captain Baker Road M72 P19 Agenda.Variance Action Item Form 12.14.22.docx grandfathered for the existing 5 -bedroom dwelling but may be undersized for any additional flow. 3. Per the proposed engineered site and sewage plan, the leaching facility is approximately 240' from the edge of Long Pond/Inland Bank. 4. Map References: Cape Cod Water Resources Classification Map I, 6/18/2010 (Map referenced in approved BOH Regulation Regarding Variance Requests for On -Site Sewage Disposal System Applications): lot and septic system are located within the Freshwater Recharge Area. Water Resource Atlas Fresh Water Ponds, Brewster MA: the septic system and lot are located within the proposed 300' septic system setback delineated boundary. Water -Table Map of Brewster and Harwich, 1987 (Map referenced in approved BOH Regulation Regarding Variance Requests for On -Site Sewage Disposal System Applications). 5. The following variances are requested. Title 5: a. None. Town of Brewster: a. Reg. 19 Sect. 4: Leach Facility Setback Regulation: 60' variance, proposed 240' separation between the existing SAS facility and Long Pond/Inland Bank. 6. Discussion Points: a. Groundwater Flow determination b. Entire lot lies within 300' of pond c. Existing leach facility is greater than 12.0' above groundwater/pond elevation d. Existing leach facility is located parallel to the pond boundary e. Property is outside Zone II and the District of Critical Planning Concern (DCPC) 7. Minimum Recommended Conditions: a. Maximum 5 Bedrooms, no additional bedrooms allowed without further BOH review. A copy of the BOH Approval Letter to be recorded at the Barnstable County Registry of Deeds prior to issuance of the Certificate of Compliance upon completion of the septic system installation. A copy of the recorded letter to be placed on file at the BOH. b. Variance will expire one (1) year from the date of the BOH Approval. N:\Health\BOH Meeting Notes\BOH Hearing Notes\38 Captain Baker Road M72 P19 Agenda. Variance Action Item Form 12.14.22.docx u 4 0 r 10 � 'QiYm �a Ego of Pavement L 60 a Buildings ' O I}0 ph DEP WellandsaParcels no ..0 Weland '���� • n�nnnnnnnn�nnnn aR'� .. n�r�nnn�41 0 go PP FF "� .nil . � _� .�► r' �iil)(111 • � rRinlin.� �o I}�111i11f.0 • ' The data shown on Ws site are provided for Informational and planning purposes oNy. The Town and Its consuhar. are not res pomlek for tha mtanso. misrepresentation of the data. 0 390 780 ft Printed on 12/2212022 at 04:01 PM ale MapsOnline by PeopleGIS LJ core ort cnp• a"� npe o""p �nppeo or mpeMptl entl le not eM1own an IM1i" map. Cape Cod Water Resources Classification Map I D Regional Policy an (Effective January 16, 2009) Amended — Effective July 3, 2009 Cape Cod Water Resources Classification Map I ro Explanation and Data Sources: Water Quality Impaired Areas: include "development" such as j. unsewered residential lots less than 20,000 square feet, marinas, landfills, septage and wastewater treatment plant discharge sites; commemial and industrial areas. (determined from digital parcel and assessors' data and MacConnell land use.) Identified Wellhead Protection Areas: (Zones of Contribution) 1:25,000, Department of Environmental Protection and MassGIS 2008, CCC Water Resources staff. and various private consulting firms. Freshwater Recharge Area: Areas shown are those identified TO DATE by USGS (see reports 2004.5014 and 2004-5181) MEP, and CCC Water Resources Staff, 2008, Madne Water Recharge Areas, which are shown on Map II Potential Plume from Landfill, Treatment Plant or Haz. Waste Sile Mlloa Presence of Landfill, Treatment Plant, or Haz. Waste Site Public Water Supply -Wellhead Protection Areas (Zone 11) ( Identified Freshwater Recharge Area later Quality Impaired roes: Development (Parcel and MacConnell Categories) Primary Resource Areas: - Potential Public Water Supply Area Water Quality Improvement Area: Overlap of Water Quality Impaired Areas on Primary Resource Areas Public Supply Well Small Volume Well 0 Water Body 0 Mass, Military Reservation — Major Roads --- Railroad D Regional Policy an (Effective January 16, 2009) Amended — Effective July 3, 2009 Cape Cod Water Resources Classification Map I ro Explanation and Data Sources: Water Quality Impaired Areas: include "development" such as j. unsewered residential lots less than 20,000 square feet, marinas, landfills, septage and wastewater treatment plant discharge sites; commemial and industrial areas. (determined from digital parcel and assessors' data and MacConnell land use.) Identified Wellhead Protection Areas: (Zones of Contribution) 1:25,000, Department of Environmental Protection and MassGIS 2008, CCC Water Resources staff. and various private consulting firms. Freshwater Recharge Area: Areas shown are those identified TO DATE by USGS (see reports 2004.5014 and 2004-5181) MEP, and CCC Water Resources Staff, 2008, Potential Public Water Supply Tracts: From the "Priority Land Acquisition Assessment Project" (PLAAP), June 1999, updated 2008 and 2009. Lower Cape data from the Lower Cape Water Quality Task Force, 2001. Small Volume Wells: include registered and unregistered water supplies which are likery to serve 25 or more persons per day for more than 60 days per year. (CCC Small Volume Well Inventory and Prioritization Project, DEP FY92 604(b) grant. 1996 MacConnell land use: (digital) 1999, source of the categories: medium and high density residential, multi -family residential, commercial, industrial, transportation, waste disposal, and marina; from aerial photo interpretation (1:25,000 scale). Digitized by the Resource Mapping - Land Information Systems Dept. of Forestry and Wildlife Management, U Mass, Amherst in cooperation with the EOEA MassGIS project and the Cape Cod .I Commission. Non -digital data was automated by the Cape Cod Commission GIS staff using the ARC/INFO GIS software. x 10M Ci \\�✓�1 � This Map was produced by the Cape Cod Commission's Geographic Information System Departrnent for the Regional Policy Plan update, effective January 16, 2009, with any amendments listed below: Data amendments effective July 3, 2009 including DEP Zone Il, DEP Public Supply Wells, and the Cape Cod Commission PLAAP. The Cape Cod Commision is a division of Barnstable County. y Corrections are welcome at the Cape Cod Commission office or Y contact gis@mpecodcemmission.org. This map is Illustrative and all depicted boundaries are approximate. It is intended for planning purposes only -- not site specific purposes. �e`� N GL / Mlloa Potential Public Water Supply Tracts: From the "Priority Land Acquisition Assessment Project" (PLAAP), June 1999, updated 2008 and 2009. Lower Cape data from the Lower Cape Water Quality Task Force, 2001. Small Volume Wells: include registered and unregistered water supplies which are likery to serve 25 or more persons per day for more than 60 days per year. (CCC Small Volume Well Inventory and Prioritization Project, DEP FY92 604(b) grant. 1996 MacConnell land use: (digital) 1999, source of the categories: medium and high density residential, multi -family residential, commercial, industrial, transportation, waste disposal, and marina; from aerial photo interpretation (1:25,000 scale). Digitized by the Resource Mapping - Land Information Systems Dept. of Forestry and Wildlife Management, U Mass, Amherst in cooperation with the EOEA MassGIS project and the Cape Cod .I Commission. Non -digital data was automated by the Cape Cod Commission GIS staff using the ARC/INFO GIS software. x 10M Ci \\�✓�1 � This Map was produced by the Cape Cod Commission's Geographic Information System Departrnent for the Regional Policy Plan update, effective January 16, 2009, with any amendments listed below: Data amendments effective July 3, 2009 including DEP Zone Il, DEP Public Supply Wells, and the Cape Cod Commission PLAAP. The Cape Cod Commision is a division of Barnstable County. y Corrections are welcome at the Cape Cod Commission office or Y contact gis@mpecodcemmission.org. This map is Illustrative and all depicted boundaries are approximate. It is intended for planning purposes only -- not site specific purposes. �e`� N GL / G Sheep Pond y � Ob r ace . `3 a xy asp '�` �4 vs pa Isbw V3 1 .a•Y,•' Va .. • .• a. .4. r ♦r + PW p 1 10, we 0 %' Cahoon Pond ry Greenland Pond"�'i s tiy,_ , Harwich R -1 a SAW ft Griffiths Pond - - ac G Sheep Pond y � Ob r ace . `3 a xy asp '�` �4 vs pa Isbw V3 1 .a•Y,•' Va .. • .• a. .4. r ♦r + PW p 1 10, we 0 %' Cahoon Pond ry Greenland Pond"�'i s tiy,_ , Harwich R -1 a SAW ft ac be e �Ubb - - a � A Vag 60 ,♦1 ba • Tucker's Pond be •.-. • • — a. . w r , Vmc G Sheep Pond y � Ob r ace . `3 a xy asp '�` �4 vs pa Isbw V3 1 .a•Y,•' Va .. • .• a. .4. r ♦r + PW p 1 10, we 0 %' Cahoon Pond ry Greenland Pond"�'i s tiy,_ , Harwich R C�{� ���� (`r,� Property ,4ddress:_ Owner Address:_ Name of Inspector: Town of Brewster Health Department 2198 Main Street Brewster, Massachusetts 02631-1898 (508) 896-3701 Ext. 120 FAX (508) 8964538 Pd cls 885 ow 0 j9 FEE: $25.00 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM APPENDIX BREWSTER REGULATION 7�_ /'/,_ 0 Date of Inspection: G This inspection represents (check one) Real Estate Transfer O Addition/alteration XA) 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 LA n f Records show excessive pumping three or more times within any eighteen (18) month period for residential or �S m rcial property; except for required grease trap maintenance for commercial property. CLThe 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. The Brewster Health Department has reviewed and accepted this report based on the information contained therein. This inspection reflects the present condition of the Sanitary System and isnot any guarantee as to the life or future conon of said system. Approving Authority Please bo advised of ADDITIONAL BOARD OF HEALTH REGULATIONS: All private wells are required to be analyzed prior to approval of the Subsurface Sewage Disposal System Inspection form, and sixty Date (60) days prior to transfer of property. Date inspection TOWN Or l3REWSTER 2198 MAIN STRUT B►Rrws•rrR, MA 02631 Pnorle9 (508) 896-3701 Ex7. 1120 PAX: (508) 8964538 [IRIIEALTH [! nRa\VSTER-MA4GOV OFFICE OF (IEr\LTH DEPARTMENT ADDENDUM TO SEPTIC INSPIJCTION REPORT I. Residential Property II of rooms Bedrooms (:artily Roonis Living Rooms Bathrooms Dining Rooms Kitchens /' l Other: B Jt s+'� a✓ndl1 'total: 2, Map &Parcel; A ms Commercial ProperlX Employees Toilets Rooms with bath Square Peet Ploor Plan: Show all floors including basement: �� fi/�C� �� 3, (s the septic If not, list d as inspected, in fill) compliance with either the 1978( ) or 1995�'itle 5 Code? Yes No x1. Is the system in the Zone 1l (Wellhead Protection Area) Lot size: a� . G GG s4 �, 1V11��V.'I'C 4VN.I31t1;1VS•I•C;R.P�tA.US 4 I y�aa "isr Kama Komi 1111'i1N` ' TI., . srs to Total scanned area: 8421 sql ft Size and dlmenslons are approximate, Actuals may vary, TOWN OF BREWSTER ADDENDUM 1'O DEP SEPTIC INSPECTION REPORT Inspection Location 16 ;,; DpAy� Map & Parcel y�Ar 5. Is lliere a 4' separation (1978 code) ora 5' separation (1995 code) YesW0000No Between the bottom of the Soil Absorption System (SAS) and adjusted groundwater? TOP OF FOUNDATION 6. Town Wat r or Private Well (_) i Distance from nearest septic system component: 3G 7, Wetlands or surface water within 100' of septic system? Yes No Y. Distance from nearest septic system component: 8. GroundwatPit t7owdirectloll : sa 9. Type of pipe used in systenn: PVC Orangeberg Other, 10. Sanitary tees o• baffles in place (Ye �oft eptic tank inlet � Septic tank outlet Pump chamber inlet D -Box inlet w 4 Grease trap inlet Ail k... trap outlet y Risers — 1978 code within 12 inches of grade on septic tank Risers — 1995 code within 6 inches of grade on all components s! One inspection port on SAS (1995 code) N Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. t.r�fA �aGon Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments # 38 Captain Baker Road Drushella Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A: Inspector Information A. Riker Name of Inspector Cape Dig Inc. Company Name PO Box 726 Company Address South Yarmouth City/Town 508-776-6460 Telephone Number B. Certification MA State 45 SI 90 License Number 02664 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 training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: Passes 2. ❑ Conditionally Passes 3. ❑ Needs Furt her Evaluation by the Local Approving Authority 4. ❑ Fails 09/12/2022 Date The system inspector shall submit a copy of this inspection report 4- 01000 0,000 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. 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 III the future under the same or different conditions of use. t5insp.doc •rev. 7/28/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 1 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster C. Inspection Summary MA 02631 State Zip Code Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: 09/12/2022 Date of Inspection ��® 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: Septic tank ,distribution box and leach field were observed to be operating with no failures obsered. The site has a signoifigant rear slope to pond with veg.wetlands before water edge. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be reVlaced 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. If "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. ❑ Y ❑ N ❑ ND (Explain below): t6insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 2 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) 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 approval of Board of Health): ❑ broken pipes) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc •rev. 7/2 612 01 8 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 3 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection �o uns)pecd " Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ 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 that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SA(Z ) and the SAS is within 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 of 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 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: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or No to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component 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 t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurf ace Sewage Disposal System •Page 4 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster City/Town C. Inspection Summary (cont.) MA State 02631 09/12/2022 Zip Code Date of Inspection 4) System Failure Criteria Applicable to All Systems: (cont.) 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 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT 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 surf ace water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any port ion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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.] ❑ ® 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 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 the questions in Section C.4, Yes No ❑ ❑ 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 (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well t5insp.doc 9 rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 18 N Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If 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 CA 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 CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or "no" for each of the following for all inspections: V Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? ® ❑ Was the facility owner (and occupants if different from owner) provided with information 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)] t5insp.doc •rev. 7!26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 6 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster City/Town D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): MA 02631 State Zip Code Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Water treatment unit present? If yes, discharges to: Industrial 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): Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: homeowner n/a 09/12/2022 Date of Inspection Gallons per day (gpd) t5insp.doc •rev. 7/28/2018 Title 5 Official Inspection Form: Subsurface Sevrage Disposal System •Page 8 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster City/Town D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 oiare 02631 09/12/2022 Zip Code Date of Inspection Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? Does residence have a water treatment unit? If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: I 55U, GPD E ❑ Yes ®' No ❑ Yes ❑ No ❑ Yes ® No 2020=436gpd 2021=321gpd Sump pump? ❑ Yes ® No current Last date of occupancy: Date t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 7 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: installed 2002 Were sewage odors detected when arriving at the site? 5. Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron 0 40 PVC ❑other (explain): Distance from private water supply well or suction line: 2 feet town water Comments (on condition of joints, venting, evidence of leakage, dry with no stains or leakage : ` t5insp.doc •rev. 7/26/2018 Title 5 Official inspection Form: Subsurface Sewage Disposal System •Page 9 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Brewster City/Town D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal Dimensions: Scum thickness MA 02631 09/12/2022 State Zip Code Date of Inspection ❑ fiberglass 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: feet ❑ polyethylene ❑other (explain): 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 ❑metal Dimensions: Capacity: Design Flow: ❑ fiberglass ❑polyethylene ❑other (explain): gallons gallons per day t5insp.doc •rev. 7/26Y1018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 11 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Capi Property Ad Drushella Brewster City/Town in Baker Road D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: Material of construction: MA 02631 State Zip Code ® concrete ❑metal ❑fiberglass H-20 Concrete 1500 gal. Septic tank ��; 09/12/2022 Date of Inspection 2 feet ❑ polyethylene ❑other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1016"x6'x6' Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.)r I,. , Recommend biannual pumping based on use and frequency UJi t6insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 10 of 18 '\ Commonwealth of Massachusetts CAY� Owner information is required for every page. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella ' Owners Name Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑Yes ❑ No Alarm level: Date of last pumping: Alarm in working order: ❑Yes ❑ No Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert ual to outlet inverts 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, Distribution box was viewed with camera with carrty over or leakage observed. Flow line / stain line did not exceed outlet inverts. �%i t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 12 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster City/Town D. System Information (cont.) 10. Pump Chamber (locate on site plan): �raie 02631 09/12/2022 Zip Code Date of Inspection Pumps in working order: ❑Yes ❑ No* Alarms in working order: ❑Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If 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): If SAS not located, explain why: Type: ❑ leaching pits ❑ leaching chambers ❑ leaching galleries ® leacho g trenches ❑ leachinglef lds ❑ overflow cesspool ❑ innovative/alternative system Type/name of technology: number: number: number: number, length number, dimensions: number: �J 3x35'Lx3'Wx2'D t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Farm: Subsurface Sevrage Disposal System •Page 13 of 18 L\\ Commonwealth of Massachusetts Owner information is required for every page. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster MA Cityrrown State D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) 02631 Zip Code 09/12/2022 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils dry above SAS and camera in vent did not indicate any high water stain lines above normal flow 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 Indication of groundwater inflow Comments (note conon of soil, signs of hydraulic failure, level of ponding, condition of vegetation, t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner Owner's Name information is Brewster MA required for every page. City/Town State D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions 02631 Zip Code 09/12/2022 Date of Inspection Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 15 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owner's Name Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including 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: ❑ hand -sketch in the area below ® drawing attached separately t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 16 of 18 cry Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Drushella Owner Owner's Name information is Brewster MA 02631 required for every page. Cityrrown State Zip Code D. System Information (cont. 15. Site Exam: ® Check Slope ® Surface water ® Check cellar 09/12/2022 Date of Inspection ® Shallow wells >12'// Estimated depth to high ground water: Please indicate all methods used to determine the high ground water elevation: /1 Obtained from system design plans on record If checked, date of design plan reviewed: 04/14/2002 Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: test hole on file ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole on file and Fong elevation at rear lot line Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 17 of 18 Owner' N information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments # 38 Captain Baker Road Property Address Drushella Owners ame Brewster MA 02631 09/12/2022 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding 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 t5insp.doc •rev. 7!26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 18 of 18 December 29, 2022 To: Town of Brewster Board of Health 2198 Main Street Brewster, MA 02631-1898 Re: 89 Byfield Cartway Brewster, MA Map: 50 Parcel: 8 / Book: 33689 Page: 178 / P1. Bk: 142 Page: 155 Lot: 8 Owner of Record: Jon & Ellen Gezotis Dear Members of the Board, I am writing to respectfillly request an extension to the variance for the above referenced property, which was approved on January 5", 2022. The reason for this request is due to a delay in receiving a building permit which lead to not being able to start the project until November 151. The site is extremely limited for space and now that the project is currently in the early stages of framing, it will not be possible to install the septic system until after framing is complete, and after the variance expires. Given that we are now into winter, the system will most likely not be installed until the spring. However, if there is an opportunity to install it sooner, we plan to do so. I hope you will consider this a reasonable request, and allow the extension without having to re -file for a new variance. Childs Patriot Builders, Inc. 537 Route 28 — Harwich Port,11IA 02646 — www.natriotbuilders.com Office: 508-430-0771 - rax: 508-432-7789 m N 0 a� a3i ro i� cu U �cs a� m rn co U J 00 r~ m n' a rn co M M 0 0 m a� m ti •Z Y w-+ Ojor p _ t 1 , 21-2022 tib 11 : �i cx Town of Brewster 2198 MAIN STREET 13REWSTER, MASSACHUSETI'S 02631-1898 PHONE: 508,896.3701 EXT. 1120 FAX, 508.896,4538 brlhealtli a.b•ewster-uia,gov W W W,I3I2EWSTEIZ-MA,GOV Health Department Anry L, von Hone, Director Sherrie McCullough,lt.S• Assistant Director Tammi Mason Senior Department Assistant Notice of Board of Health Variance Approval/Deed Restriction January 12, 2022 Jon &Ellen Gezotis 24 Meadow Drive Hanover, MA 02339 RE: 89 Byfield Cartway, Brewster, MA Map: 50 Parcel: 81 Book: 33689 Paged 1781 Pi. Bk: 142 Page: 155 Lot: 8 Owner of Record: Jon & Ellen Gezotis Dear Mr. &Mrs. Gezotis On January 5, 2022, the Brewster Board of Health reviewed and approved the following variance for the septic system upgrade at the above address per engineered plans by J.M. O'Reilly & Associates, Inc. dated Ilovember 19, 2021: Title 5: 310CMR 15.211 a. 5' variance, proposed 5' separation between the Leach Facility and the South property line b. 2' variance, proposed 8' separation between the Leach Facility and the West property line c. 2' variance, proposed 8' separation between the septic tank and crawl space Town of Brewster: X19 Leaching Facility Setback Regulation a. 32' variance, proposed 68' separation between the Leach Facility and the Coastal Bank )n granting the above variance, the Health Department imposes the following Order of Conditions: 1. The property consists of an existing four (4) bedroom dwelling. No additional bedrooms allowed without further review by the Board of Health. 2. Prior to Issuance of the Certificate of Compliance this Variance Approval Letter must be properly recorded at the Barnstable County Registry of Deeds and a recorded copy of same shall be furnished to the Brewster Health Department as proof of the recording. 3, Variances shall expire within one (1) year of the date of this approval. Please feel free to contact me If you have any comments or questions on the above. I can be reached at the Health Department, 508-896-3701, ext. 1120. Slncere���G`�`'f C.H.O. birector of Health cc: J.M. O'Reilly & Associates, Inc. PO Box 1773 Brewster, MA 02631 File N:\Health\BOH Decision Letters\Septic Variance BOH Decisions\89 Byfield.doc BAkN�ilAFit,lr itEGIS1'RY 0� DE�US Jahn F, Meader Register GENERAL NOTES: A) NFItHER ORNEWAYS NOR PARKING APER ARE ALLOW EO OVER SEPTIC SYSTEM UNLESS H-20 COM"ENTSARE USED. LITHE DESIGNERVALLNOT BE RESPONSIBLE FOR THE SYSTEM AS DESGNED UH- LESSOMSITIJa DASSIKAYN. ANY CHANGES SHALL BEAPPROVEO IN WRITING. C) CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE LOCATION OF ALL UNOERGROUYD AND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORL CONSTRUCTION NOTES: 14ALLCONSTPUCFpN SHALL CONFORM To THESDUE ENWROMMENTALCODE, TITLE 5, AND THE REQUIREMENTS OF THE LOCAL BOARD OF HEALTH. 2.)SEFIIC WIK(5), GREASE TRAP(S), DOSING CHAMBERS) AILD DISTRIBUTION EMES) SHALL BESET ON ALEVEL STABLE BASE WHICH HAS BEEN MECHANICALLY COMPACTED, OR O4 A 6INCH CRUSHED STONE BASE, 31 SEPTIC TANK(S) SHALL MEET ASTM STANDARD 03127.93 AND SMALL HAYE AT LEAST THREE 2O OIAMETER MANHOLES THE MINIMUM DEPTH FROM THE BOT- TOM OFME SEPTICTMXMTHE FLOW UNE STALLSE 48•. 41 SCHEDULE40FVC NMETAND OUTLET TEES SAL FXTENDA MINIMUM OF 6% ABOVE THE FLOW UNE OFTHE SEPTIC TANK AND SHALL BE INSTALLEDON THE CEHTF E OF THE TANK DIRECTLY UNDER THE CLEANOUT MANHOLE. S) MSE COVERS OF THE SEFTIC TANK AID DISTR BUTION BOX WITH PRECAST CONIOIETE WATERTIGHTRISERS OYER INLET AND OUDETTEESTO WITHIN 60 OF TIMM GRAM OTASAPPROVED BYTHE LOCA. BOARD OF HEALTHAGENT. 64PVNGSWLLCON95T OF 4%SOTEDtULE 40 PVC W EQUNALEIIT. PIPE SHALL BE WDON A MINIMUM COYTNUOUSGMDE OF NOT LFSSTHAN 1%. 74 DSTKBUTION LINES FOR SOIL ABSORPTION SYSTEM IAS REQUIRE01 SMALL BE C DVJ&7ERSCHEDULE 40 PVC LAIDATQO05 FT/FT. UNE SHALL BE CAPPED ATENOORASHOTEO. B.)OUTC P9ES FROM DISTRIBUTION BOK SMALL REMAIN LEVEL FDRAT LEAST V MFORE NTC PIG TO SOIL ABSORPTION SYSTEM. WATER TEST DISTRIBUTION B01(TOASSURE EVEN DISTRIBUTION, 9.) DSMUFOON BO(SHALL RAVE A MINIMUM SUMP OF 6* MEASURED BELOW THE OUTLET INVERT. 10.) aMAGGMG4TE FORTHE LEACHING FAOUR SUILCONSIST OF 3/4' TO 1-1/2' DOUBLE WASHED STONE FREE OF IRON, FINES AND DUST AND SMALL BE NSUNUED BELOW THE CROWN OFTHE gSTABV110N UNE TO THE BOTTOM OF THE SOLAB50RPITON SYSTEM. BASEAGGREGATE SFMLLSECOVERED WITHA r DYER OF 11W TO 3/2' DOUBLE WASHED STONE FREE OF IRON, FINESAND DUST. 114 WNTSOLAB50RPTION SYSTEM WHEN DISTRIBUTION LILIES EXCEED 50 FEET, WHEN LOCATED EITHER IN WHOLE OR N PMT UNDER DRNEWAYS, PARKING AREA, TURNING ARIAS OR OTHER IMPERIOUS MATERIAL: OR VAIN PRESSURE DOSED. IL) SOL ABSORPTION SYSTEM SHALL BE COVERED WITH A MINIMUM OF 9% OF CLEAN MEDIUM SAND (EXCLUDING TOPSOI). 131 FINISH GRADE SHALL BEA MAXIMUM OF 36% OVER THE TOP OF ALL SYSTEM ODMPOTIEMS INCWONG THE SEPTIC TANK, DLSTABURON BOY, DOSING CHAMBER ANDSALAESOPPTIO N SYSTEM. SEPTCTANKS SHALLHAVER MINIMUM COVER OF9'. 14)FROM THE DATE OF INSTALLATION OF THE SOIL AS -W RPTION SYSTEM UNTIL RECEIPT OF ACERTDICATE OF COMPLIANCE, THE PERMETEA OF THE 50LARSORP- TKNN SYSTEM9WiSE STAKEDAND FLAGGEOTO PREVENTTHE USE OF SUCH AREA FOR All ACW TI ES THAT MIGHT DAMAGE THE SYSTEM, IS)SUSSMFME COMPONENTS OF A SYSTEM SMALL HOT BE BACKFILLED OR OTHERWISE CONCEALED FROM VIEW UNTIL FINAL INSPECTION HAS BEEN CONgK7EO BY THE APPROVAG AUTHORITY AND PERMISSION HAS BEEN GRANTED BY THE APPWVIRG AUTIONN TO SACKFUL THE SYSTEM, THE DESIGN ER SMALL INSPECT THE CONSTRUCTION AFTER THE NITIAL EXCAVATION, PRIOR TO BACKFIWNG, AND DINNG EACKFIWNG, N ADOTKXN, THE FINAL INSPECTION OF THE SYSTEM SHALL BE CONDUCTED BY THE APPAOIING AUTHOR" THE SYSTEM INSMLLER AND DESIGNER PRIOR TO THE ISSUANCE OFACERITFICATEOFCOMPt aPURRMNTT0310CMA15.023(3I, AMYCOMPONENT OF THE SYSTEM WHICH HAS BEEN COVERED WITHOUT SUCH PEMUSSO4 SHALL BE UNCOVERED UPON REQUEST OF THE APPROMNG AUTHOPM OR THE DEPARTMENT. 16) OWNER/BULDERSHM REYIEW HWSELOCATION, GMDING ANDTOP OF FOLW U NELEVATK)NPWRMVARTDFCONSTRUCTION. 171 FASTINGSEPM SYSTEM TO BE REMOVED. ANY CONTAMNATED SOIL WITHIN 5' OF THE PROPOSED SOLASSLIMTIOH SYSTEM SHALL BE REFMOVEDANO REPLACED WITH CIFANSAN4 AREA TO BE COMPACTEOTO MINIMIZE SETTLING, IB) INSTALLER TO CONFIRM LOCATION OF ALL UNDERGROUND AND OfcRHEPD UTILITIES PMR70 STAT OF CONSTRUCTION. 19) WATER SERVICE REEVE WATER ME SMALL BE REEVED IN SCHEDULE 40 PJC PIPE YAM94 30 FEET OF SEPTICTANKAND SMASSCMPTION SYSTEM. FLOW PROFILE: NOT TO SCALE TOP OF FOUNDATION EL=49,01 T3'11 ISOOGALLON SEPTIC TANK X-20 SOIL TEST LOGS: TESTHOLE I: EL=SOOc imam TABLE: EASING SDE COVERAGE ASSESSORS' MAP 50 PARCELS 00-501 BUFFER ZONE t'SEma -- - ® r2.nn.9GPLi rr3T MLICA(© SF EdsWy DeJs, 2711 4 TOTALCOVERAGE: 6242 4 W -3W BUFFER ZONE OVERHEAD UTILITY SERVICE —U— Ertrtlne DNe%n1: 381 4 TOTAL COVERAGE: ----�- 9 PROPOSED SITE COVERAGE DB DISTRIBUTION BOX 0-57 BUFFER ZONE -fi—I_f♦— Reserve PROPOMDUWclUNG: 653E 4 PROPOSED DECK: TESTHOIE2: EL=5062 rjV M H�0.EiRTGT OH URE COLOR MOTTLING SER BNO+E51 RAMI LMPAKEW U I 2 1 •• B San 1 3 WE PERCOW.RATF<2MINAN w1w C3 I w!ectunulCo4me Sand I TIMEMS,<9' IN PEW DATE OF TESTING: 6/29/21 PERCOLATAN RATE: LESS THAN 2 MWANCH IN OC' LAYERS. WITNESSED ST. MATTHEW T FARRELL, ER I.M. D'REILLY & ASSOCIATES, INC AMYVON HONE, DIRECTOR BREWSTER HEALTH DEPARTMENT NOWATERENCOUNTEREO WE AL04NNG RATE OF 0.74 GPD/SF FDR SIZING OF SOIL ABSORPTION SYSTEM. CONSERVATION AREA TABLE: EASING SDE COVERAGE ASSESSORS' MAP 50 PARCELS 00-501 BUFFER ZONE LEGEND -- - ® �s 5532 SF EdsWy DeJs, 2711 4 TOTALCOVERAGE: 6242 4 W -3W BUFFER ZONE OVERHEAD UTILITY SERVICE —U— Ertrtlne DNe%n1: 381 4 TOTAL COVERAGE: 3Bt 9 PROPOSED SITE COVERAGE DB DISTRIBUTION BOX 0-57 BUFFER ZONE SOILABSORPTION SYSTEM Reserve PROPOMDUWclUNG: 653E 4 PROPOSED DECK: 1652 4 TOTAL COVERAGE: 6161 4 50' -1W BUFFER ZONEI DRAINAGE MANHOLE PM MDDEL NG: 37034 TOPOFBANK PROPOSED PORCH: ISN 4 TOTALCOVFMGE: 4301 4 TOTAL PROPOSED AREA CHANGES N BUFFER ZONE& D-50'BUFFERZONEI REDUCED DWELLING Is REWCTIM 50-107RFFERZONE INCREASE DWELLING &PECKS=130-38 a392SE INCREASED LOT BUFFER ZONE NET INCREASEa 39214 .6tSF=38Gt4 38614 MIT)GATION PPOPTSEN INVASIVE VINE REMOVAL: 4601 4 LAWN REMOVAL: 2301 SF TOTAL MITIGATION: FAIN 4 CONSERVATION NOTES: 14 W.9TOF WORKSMLL BE M SHOWN. A STAKED94 BOUND STRAW WATTLE SMALL BECONSTRLUCROMONG THEUMR OF WORK UNE PRORTOTHE COMMENCEMENT OF OF ANY LVORL WATTLE SMALL BE BACKED WITH rSTAKED CLOTH SILT FENCE. 2) MDF FIM -OFF FROM ONE W NG SNAll BE CONTROLLED BY GUTTERS, DOWNSPOUTS AND DRYWEl15OR STONE TRENCHES UNDER DRP UN ES. SIM Distru HoAPEASAROLUNDTHE NEW DWELLING SMALL BE PLANTED WITH GRASS SEEDAND APPROXIMATELY E OF TOPSOIL 4)CQNTMCTOy SINOERAND OWMERSIAL REVIEW THE ORDER Of CMINTIONS PRIOR STAIUOF CONSTRUCT OM. PLANTING DETAIL 5CALE: 1" = 10' INSPECTION NOTE W DIAMETERHHI NIICAETE COVET6 pHO&TONNAl NSPECTNHI BYTHEENGINEE0.5YS1EM NEEDSTO RA15ED10 WRHN 6'Of FIN H2 &ECgµHET MMCMNGBURWPMRCOVERS. GN OE (ORA NOTED). RISERS TO BE HEI MEED NO REE COVEM FUSTIC RISERS TO BE USED rPWVENT TIIPEE[OVERS 1 OtITtETST,1 D3 & 35TH &CA' BY 1WEETAIr 95A'2/ d5.63 11II1 IN/AStVEREMOVAL LAWN SYSTEM DESIGN CALCULATIONS: SEWAGE DESIG��NmFLr01n 7'BE&M1CRR.TOWERrr@ 13OGPD • 440 GPO LEACHING BEDROOMS (MAXI'RFQUIpEOt GPD=MO GPO REQUIRED SEPTC TANK CAPAO TY REQUIRED MW TE5W _m4Z "FJ V2 WW BBO GAL REQUIRED M MIC TANK CAPAOTY PRO VIDE N 14AplII6fI3EPTfCTARKtMAALLD W EO) LEACIHING CAPACITY PROW DEN SEER CAN LEACH: W= 275'X11A (12.0 X 13B1e 275'X 2A')a(119'X 2.CK)2+(15.7 X 2E)e 1�3A' %2.V)7 X D74GPD/SF=4�.OGPO 479GPD> 440 GPD REQUTAED NOTE: A GARBAGE DISPOSAL IS NOT PERMITTED MITI THIS DESIGN. NSTAUI ISODGALLONSEPFICTANK WOE I Rio3 OUTLET DISTRIBUTION BOKIN-20Plted) 500 GALLON LEACH CHAMBERS WITH 3S OF STONE ALL AROUND. SEE SASOETAL g NINETEEN (191 SHRUBS SEE PtANTNG NOTE 2 3i GALLON, SURE) FEET ON CENTER MITIGATION AREA 69024 INVASIVE REMOVAL 4WtSF PESTOR 230 N i 24'SF PLANTING NOTES: 1) EXSTN6 LAVA AREA AND INVASIVE SPECIES TO BE REMOVED. ABEAM BE PREPAREOVATH SDN51TOPSOL,'HAAMWY GRASS SEEW AND COVERED WITH STAKED 900GRAM COIR BLANKET. SHRUBSS AILTHEN BE PIANTEDM PER THE PLANTING PETAL& NOTES HATH.. 2.)AFFROKMATEW NINETEEN (19) SHRUBS SHALL BE PLANTED. SHRUBS INCLUDE BAl'BEMY BCCI PLUM, INMEM ARROWDOO, AND/OR BEMBERR/ OTHER SPECIES MAYBE BE USED M FOUNDONTat UST BYCAPECOD COOPEMTM EXTENSION ANO VOM THE PERMISSION OF THE CONSERVATION AGENT. 3) NVAS1VE SPECIES IDENTIFIED ON THE COASTAL BANK: BIRD SWEET VINE, PRAT HEDGE NOYFYSUCKtE SHRUB. 4) MASK SPECIES REMOVAL AND REVEG ETATION SMALL BE DONE BY AN ACCEPTABLE ONURAC10RAPPROVED BY CONSERVATION. CONTPACTORTO REVIEW EXKCTMETHODi ANOSPECI STO BE USED WITH OWNER & CONSERVATION AGENT PRIOR TO STAIN OF PEMO'AALS HERBAODE MAYBE USED IN A CUT & WIPE METHOD CONTACTOR TO HAVE HAVE VAUD HERBACOE LICENSE. S) IHWk5MVPMS & HONESUCKtE SHALLBE TRIMMED ANNUALLY, BY HMD, M NEEDED TOKEEP NATIVE VEGETATION CLEAROF VINESAND RE EMERGING INVASIVES.SEE NOTE 4 TIMING: X2022 OR SPRING 2023: • D1STILLBMUGWEETS4ALLBECU MDuAMOVED.EASTINGLAWNMGTO BE REMOVED. • OPDINtE/SWHHRNTHECOASFALBANKSNLLSECOVEAEDYMA SWEDSKOGRAM CWBLW KEEL THIS VALLMANTAN THE SIASRNY OF THE COASTAL MNK VMILF VEGETATION ESTABUDNS. • TEMPORABI GROUND IRRIGATION MY BE USED DURING THE FIRST THREE GROWING SEASONS TO ENSURE VEGETATION SURx1VAL FALL OF 2023: RE SPROUTING BITTERSWEET SHALL BE CUT AND REMOVED. MNEY9Nl1E SPROUTS SHALL BE TRIMMED AND REMOVED. • REVIEW EAtiRYGS1RUB PLANTINGS FORAM DEAD OR DYING SECIMANiANY OEM OR DYING SHRUBS SMALL BE REPLACED. ONGOING MANAGEMENT: • TEMIRWAYDRIP IRRMTIO4 SYSTEM MAYBE ESTABLISHED WAS TO IRRIGATE THE NEW PLANTINGS • SPRING ANDFALL PRUNING ACTIVITIES, SEE PLANTING NOTES • SITING AND FALL INVASIVE SPECIES MANAGMENT, SEE NOTES SAS PLAN VIEW SCALE: r VENT 'SIS' Proposed iEt 465t (9'Min-3WMU) 21 LATEROF I/e%- 3/r STONE 4550 b 3/4'-1-I/2'SIDNE 4350 LSETHR1OHLE CHCH M__ _ 500 GALLW NEAROUND 1 ImGest Run 350FSM — 13 (UOOWEM LEACHING CHAMBER —Ea3B3 BOTTOM OF TEST HOLE SEE DETAIL FOR OIMMStONS IF20 CAPE COD BAY x 05 Tdal Flats as XM 0 iI 1 0 PLAN SCALE 1"=20' .® Bcttam Tap SEE SEI9-1678 TOCONFIPM COATAL SRIKDEUNGTION BITTERSWEET VIM ES & OTHER INVASIVE SPECIESMAY BE PRUNED BY RAND TO REMOVE VALES FROM EXISTING NATIVE VEGETATION 41 Parcel 8 T FUE01 LoM Cl, CZ & El Area =13,52725F Catrud Beach iV tU EmtlnB Beach VKIa AACTss StaNSray TO BE REPAIRED ASNEEDED 262 R2A4 y66 18 26 " 3T �p Q • 132 vG am Consist Bank L 1 L I a Y 66an _AzErstIn648edmom wa tter Zone 10d&eeTcy C1 ( Abu" Cottage 61S NOT Used In Sdevnl }� - achy r Ukulatlon I I Q ki j 1.5 41' 1 35' BS• 3S' 23a' A/ I E.eCO3 Senxde D#03al System mPer Heahh Records ILt G to Y / I � I ZONING TABLE ZME:(RESIDEHTHAI) AAI FRI)KYMDSETBACt •40FEET SIDE YAM SETBACKS •2SFEU AIA YAAD SETBACKS •25 FEET BINDING HEIGHT 30FEET MAX BALDING COVERAGE 25% FLOOD ZONE: ZONEVE, EL=IS' 'LOTH CREATED FEBRUARY 1946 PER SUBDPASQY PIAN, BARNSTABLE ODUNNAEG6-MA DEEDS, PLAN BOOK 142 PAGE 155, SETBACKS MAYBECAWIDFATHEREDT020 FROM & 104SDE & REAR TO BE CONr'9aMEDBY THE MEWSTER BUILDING COMMISSIONER E>MVag BuPd'ng Cmeaa&e:lnclutlin House, Reps & STRUCTURE AREA AREA RICO e634 X30D=&4% 13,5274 PROPOSED BUILDING COVERAGE: Includes House, Reps, Decks, From Entry & Aocl OverhanBF STRUCTUREARFA LOT AREA X100 1}374 Xloon 99% 13,5275E TORE REMOVED SEE NOTE 17 J) I 16&t PrCF:FING'WIMNIO OF SLS & SEPTANK s 100'BuOec 2raae I2.9't x � s / v EWORIVEWAXSHALLBEGRMALLPAVE /8 NEW DRVE VEtIOFGRASSMVE Ib4•" 39T- CBFND NEY/DAVE SALL BE I,3CO SF OR E55 X4%7 IDINYIA9 BREWSTER, MA LOCUS NOT TO SCALE PIAN BOOK 142 PAGE 155 CERTIFICATE 11004365 ASSESSORS' MAP 50 PARCELS LEGEND -- - ® EXISTING CONTOUR -32 PROPOSEDCONTOUR EXISTING SPOT GRADE 24as PROPOSED SPOT GRADE — w— WATER SERVICE UNE —D— OVERHEAD UTILITY SERVICE —U— UNDERGROUND UTILITY SERVICE —4— GAS SERVICE LINE 0 TEST HOLE/ BORING LOCATION ST SEPTICTANK DB DISTRIBUTION BOX SAS SOILABSORPTION SYSTEM Reserve RESERVED FOR FUTURE w UTILITY POLE IB CATCH BASIN v FIRE HYDRANT ® WELL ® DRAINAGE MANHOLE CONCRETE BOUND, FOUND — r — TOPOFBANK —•—'— UMITOF WORK FENCE EDGEOFCLEARING HEALTH VARIANCES REQUESTED 310 CM 15100 & BREWSTER REGULATIONS 310CMR 15213Stbseks & BmmterHeaRh PA&utadm I)E�IAMorpBm S,Henl(SAS) net la Foam Property Line, South WHIIII 2) So/Absvmeon System (SFS) not lO From Property Unit Wen r Held TVadance 31 SolAtnarp0al System (SAS) not 1011 From Coastal Bank 68'HeM 32'Yamme 4) Septic Tank Not 30 From CmM Space BHdd 2'Wdance Permit valid for REPAIR OF SEPTIC SYSTEM ONLY, due to ta! Se and Local septic variances. Board of Hoalth review and approval is required for any future additions/renovations/ulte rat ions to sewage futilities and/or structures/dwelling. Brewster Health Department PPROVED Z__... _. Date 0 20 40 60 SCALE 16=20' G:UAbbalGelotls 990TH -89 ByResd Ch" 6R'mteAOWGL1903ASDSdn I Jon & Ellen Gezods 24 MEADOW DRIVE, 14ANOVER MA 02339 PROPOSED SITE & SEWAGE DISPOSAL DESIGN 89 BYFIELD CARTWAY, BREWSTER, MA 02631 J.M. O'REILLY & ASSOCIATES, INC. Professional Roginearing & land Surveying Services 1676 Male Street - Beets 6A P.O. Box 17M (600)890-6601 Office Bressler, MA 02681 (606)896-0602 Pax AE: SCALE: BY.CN{CC NOd NUMBER:11/19/21 As Noted MTF 1M0 1M0 -8903A TOWN OF BREWSTER 2198 MAIN STREET BREWSTER, MA 02631 PHONE: (508) 896-3701 EXT 1120 FAX: (508) 896-4538 BR HEALTH 2BREWSTER-MA.GOV WWW, BREWSTER-NIA. GO V Received: 1n 31 ?.?� Paid: �R 75 CK41[ n0f0LP2 Abutter Deadline: 11 11) U/ Date: October 27, 2022 SUBJECT PROPERTY ADDRESS: 58 Pilots Map: 79 Parcel: 101 LC Plan: 12014-B Lot: tkjlL Name of Applicant: Glaife Lemoyitz Mailing Address: Telephone # Owners) of Record Mailing Address: 6FIIEOF HEALTH D$PARTMENT OCT 31. 2022 E>f; E\/V5l ER HEALTH DC-PAI;T F N T Application for Board of Health Variances I�In-House Local Upgrade Approval ❑Public Hearing Book: Page: ss 20 Williams Road, Norton, MA 02766 Email: Claire Lemovitz 20 Williams Road, Norton, MA 02766 Design Engineer/Sanitarian: Mailing Address: Telephone #: John L. Churchill Jr 2854(.r 508-273-0377 Hi _ LC Certificate: 221682 - jdv Firm/Company Name: JC Engineering, Inc. East Wareham, MA 02538 Email address: mpimentel@jceng.org Signature: 4d P&Ue9fd Applicant or Engineer New Construction ❑Voluntary Upgrade ❑Addition/Alteration � Failed system ❑Real Estate Transfer ❑ Design flow of existing system: 330 Design flow of proposed system: 330 Reason for failure; Unknown Total sewage flow of site: 337.0 Conservation Commission approval required: yes ❑ no Order of Conditions/Det. Of Applicability attached ❑ Total lot size (sf): 6,176 s.f. Date of ConCom hearing: List of all Variances from State and Local codes (add sheets if needed) TITLE 5 Sec. #: Descri tion of Variance s 310 CMR 15.211 A 4.8' waiver (10.0'- 5.2' for the setback from the SAS to the front property Brewster Reg. #: Description of Variance(s) line. Approved by: Health Department N:\Health\BOH regs\InHouse Septic Local Upgrade Approval 2019\Varianceapplication FINAL NONPILLABLE FORM 12.18.19.doca December 28, 2022 Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth�,brewster-maw-maw WWW.BREWSTER-MA.GOV Health Department Amy L. von Hone, Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Notice of Board of Health Variance Approval/Deed Restriction Clare Lemovitz Trustee 58 Pilot's Way 2020 Trust 20 Williams Road Norton, MA 02766 RE: 58 Pilot's Way, Brewster, MA Map: 79 Parcel: 101 / LCC 221682 / LCP 12014-B Lot 88 Owner of Record: Clare Lemovitz Trustee 58 Pilot's Way 2020 Trust Dear Ms. Lemovitz: On December 28, 2022, the Brewster Health Department reviewed and approved the following variances fdor the septic system upgrade at the above address per engineered plans by JC Engineering, Inc. dated October 26, 2022: Title 5: CMR 15.211 Maximum Feasible Compliance a. 4.8' variance, proposed 5.2' separation between SAS Facility and the front property line Town of Brewster: None In granting the above variance, the Health Department imposes the following Order of Conditions: 1. The property consists of an existing three (3) bedroom dwelling. No additional bedrooms allowed without further review by the Board of Health. 2. Prior to issuance of the Certificate of Compliance, this Variance Approval Letter must be properly recorded at the Barnstable County Registry of Deeds and a recorded copy of same shall be furnished to the Brewster Health Department as proof of the recording. 3. Variances shall expire within one (1) year of the date of this approval. Please feel free to contact me if you have any comments or questions on the above. I can be reached at the Health Department, 508-896-3701, ext. 1120. Sincerely, Sherrie McCullough, R.S. Assistant Health Director cc: JC Engineering, Inc, 2854 Cranberry Highway, East Wareham, MA 02538 File N:\Health\BOH Decision Letters\Septic Variance In -House Decisions\Title 5 Brewster Approvals\58 Pilot's Way InHouseApproval 12.28.2022.doc VV CX ��\ok �f R `�°I>, 4$* Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 rhealth@brewster-ma.gov W W W.BRE W STER-MA. GOV AGENDA ACTION ITEM FORM BOH Variance Agenda Item In -House Local Upgrade Approval Other: Board of Health Meeting Date: January 4, 2023 Project Location: 58 Pilot's Way Map & Parcel: 79-101 Owner's Name & Address: Clare Lemovitz Trustee 58 Pilot's Way 2020 Trust 20 Williams Road Norton, MA 02766 Health Department Amy L. von one, Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Applicant: Clare Lemovitz Trustee 58 Pilot's Way 2020 Trust Date Requested: October 27, 2022 Title 5 Variance Request: Yes ❑X No ❑ Board of Health Variance Request: Yes❑ No❑x Other: Yes M No ❑ 1. Outside Zone II, District of Critical Planning Concern (DCPC), and the local ESA. 2. Existing 3 -Bedroom Dwelling serviced by a 1950+/- cesspool 3. Applicant is proposing to upgrade to a current Title 5 compliant system Assistant Health Director's Recommendation: Approve with following comments and conditions 1. The property consists of an existing 3 -bedroom dwelling serviced by a 1950 +/- cesspool with town water. The lot is approximately 6,213 sf and is outside the Zone II, DCPC and the local ESA. 2. The applicant is proposing to upgrade the existing cesspool with a current Title 5 compliant system consisting of an H-20 Septic Tank, an H-20 D -Box, and three 500 Gallons Leaching Chambers, H-20 rated. 3. Due to lot size constraints a minor setback variance (5.2' setback vs. 10' setback requirement) from the SAS to the front westerly property line is being requested. 4. The following variances are requested: N:\Health\BOH Decision Letters\Septic Variance In -House Decisions\Title 5 Brewster Approvals\58 Pilot's Way Action Item Summary 12.28.2022.docx Title 5: CMR 15.211 Maximum Feasible Compliance a. 4.8' variance, proposed, 5.2' separation between SAS facility and to the front westerly property line Town of Brewster: None 5. Approval: a. Approve the proposed septic variance as requested above with the following conditions: i. The existing cesspool must be pumped, filled with sand, and abandoned. ii. If the property in question is a rental, the owner must agree to limit the number of occupants based on the size of the system. ill. A copy of the BOH Approval Letter to be recorded at the Barnstable County Registry of Deeds prior to approval of the Building Waiver by the Health Department. A copy of the recorded letter to be placed on file at the BOH. N:\Health\BOH Decision Letters\Septic Variance In -House Decisions\Title 5 Brewster Approvals\58 Pilot's Way Action Item Summary 12.28.2022.docx CERTIFIED MAIL RETURN RECEIPT REQUESTED BREWSTER IN-HOUSE SEPTIC LOCAL UPGRADE APPROVAL NOTICE: Date: October 27, 2022 Re: 58 Pilots Way Map• 79 Lot: 101 Subject Address Dear Abutter: Please be advised that an application for septic local upgrade approvals from the regulations of the Massachusetts Department of Environmental Protection, Title 5 and/or the Town of Brewster Regulations for Subsurface Disposal of Sewage, has been submitted to the Brewster Health Department for approval. The following variances are requested. List of all variances from State and Town Codes Title 5, Sec # Descri tion of Variances) 310 CMR 15.211 A 4.8' waiver 10.0 - 5.2' for the setback from the SAS to the front property line. Brewster Re . # Descri tion of Variances) The application and plans are available for review and comment at the Brewster Health Department, Brewster Town Offices, 2198 Main Street Brewster, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:00 p.m. Sincerely, Applicant /Representative CC: Brewster Health Department N:\Health\BOH reqs\InHouse Septic Local Upgrade Approval 2019\inhousevarianceabutternotification NONFILLABLE FORM 12.11.19.docx Certified by: James M. Gallagher, MAA Sew � OQ, ciioe� tF,D TOWN OF BREW STER, MA Deputy Assessor _�:• BOARD OF ASSESSORS 3 ' = 2198 Main Street Brewster, MA 02631 O1 N 000 6 Abutters at Within 65 feet of Parcel 79/101/0 p pN /0 y 79!100!0 CF�ORS AW RO D 6 PILOTS WA - `1 1 79/92/0 79/1WANC ORSAWEIG R D 8 PILOTS WA �r 79/91/0 3 ANCHORS AWEIG OAD N 40 0 Oft Key Parcel ID Owner Location Mailing Street Mailing City ST ZIpCd/Counlry 1545 79.91.0-R FLEMING JAMES C III TRUSTEE 43 ANCHORS AWEIGH ROAD RITA K FLEMING BREWSTER MA 02631 (15-22) FLEMING IRREVOCABLE TRUST 43 ANCHORS AWEIGH ROAD 680 79-92-0-R MUHLANGER ERICH 8. MICHELLE 55 ANCHORS AWEIGH ROAD i CARL ROAD ARLINGTON MA 02474 (6-74) 679 79-93-0-R DEFORD COOPER D 0ANCHORS AWEIGH ROAD 3616 SW HANFORD STREET SEATTLE WA 98126 (6-73) 682 79.100-0•R DEFORD COOPER D 66 PILOTS WAY 3615 SW HANFORD STREET SEATTLE WA 98126 (6.76) 681 79-101-0-R LEMOVITZ CLARE TRUSTEE 58 PILOTS WAY 20 WILLIAMS ROAD NORTON MA 02766 (6-75) 58 PILOTS WAY 2020 TRUST Additional Abutter Notifications: Sea Pines Condominium Association c/o Mercantile Property Management Attn: Craig McGowan PO Box 790 Buzzards Bay, MA 02532 10/25/2022 Page 1 )6�9 -r\ TY\ 3 tl� JO 4/ j f�un0il� PREPARED BY: '440 pF x mr 0 Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth@brewster-ma.gov W W W.BRE W STER-MA.GOV Board of Health Meeting Wednesday, July 20, 2022 at 7:00PM Hybrid Meeting Health Department Amy L. von Hone, R. C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Board members attending: Annette Graczewski, MT (ASPC), Chair; Kimberley Crocker Pearson, MS, MD, MPH, Vice Chair and Dave Bennett Board members absent: Penny Holeman, MPH, MA, MS Others attending: Amy von Hone, R.S., C.H.O., Health Director and Tammi Mason, Senior Department Assistant Others attending remotely: Chris Miller, Natural Resources Director 1. Call to Order Meeting was called to order at 7:OOPM 2. Chair announcements On July 13, 2022, the State Department of Public health announced the first incidence of West Nile Virus (WNV) detected in mosquitoes in Bristol County Massachusetts. As of that date, no incidence of human or animal cases of West Nile virus or Eastern Equine Encephalitis (EEE) had been reported in Massachusetts. However, this is the time of year when we do expect to see WNV in mosquitoes and it is recommended that the public take steps to protect themselves by avoiding mosquito bites especially individuals over the age of 50 who are at higher risk for disease. Precautions include avoiding outdoor activities during peak mosquito hours at dusk and dawn, applying insect repellent and wearing long sleeve shirts, long pants, and socks when outdoors. In addition, the public should take care to drain standing water around their homes and install or repair screens on their windows. More information regarding WNV and EEE can be found on the State's Arbovirus Surveillance Information web page at www,mass.gov/mosquito-borne-diseases The Brewster Police Department will be hosting a blood drive tomorrow, July 21st from 11:00 AM to 5:00 PM at the Brewster Police Department, 631 Harwich Road in Brewster. Appointments are required. You can make an appointment by calling 508-862-5663 or online www.capecodhealth.org/give-blood The Brewster Health Department has noted an increase in COVID cases in Brewster consistent with trending increases on the Cape and across the State. The increase may be attributable to increased travel during the holiday/vacation season and/or possibly the relaxation or absence of mask mandates nationally and internationally. Though the current variants appear to be resulting in milder symptoms, they are highly infectious. At home COVID tests are still available through the Brewster Health Department. In addition, if you require PCR testing, you may schedule a test at Cape Cod Hospital by calling 508-534-7103 or Outer Cape Health Services at 508-905-2888. 3. Citizen's forum None. 4. Discussion on Pleasant Bay Watershed Permit with Chris Miller, Director of Natural Resources N:\Health\from Shari\MSWORK FOLDERS\MEETINGS\BOH\Ju1y2022m.doc DB- asked CM if the Town was participating in the monitoring program and if Brewster was paying for it. CM- The monitoring program is being done by the Pleasant Bay Alliance and the lab in Chatham is mostly the one they're using. The Town has also done quite a bit of testing and modification to the model through some SNEP (?) grants from the southern New England EPA program. Brewster has an assessment to the Present Bay Alliance and part of that is for the testing under this watershed permit. DB- asked if the Town was seeing reductions from the golf course. CM -the time of travel of the water that's coming from septic systems in town or from the golf course is extremely long so we're not going to see any changes for the watershed for many years after any changes in treatment or changes in fertilizer. AG -asked if CM could explain about 208 Plan. CM- Section 208 of the EPA Clean Water Act is a requirement to address degraded water. Cape Cod did a 208 plan a number of years ago before the estuaries and came up with a lot of recommendations and at the same time we came up with the first Water Shed Permit which we've been discussing and killed compliance with the 208 Plan. Brewster's a little different than many towns in that we don't have a formal wastewater treatment study because we never proposed to do things that would require permits. The things that we're doing with fertilizer management with innovative alternative systems, purchasing land, those kinds of activities don't raise the level where you need a permit. We have we have had our plan judged as consistent with the 208 Plan by the Cape Cod Commission. AVH- asked CM for clarification on what the role of the Cape Cod Commission is related to the 208 Plan. CM- I think the Cape Cod Commission worked with the county, so they were the regulatory body that ran the program so because we have Barnstable County that covers the Cape, they defer some things for that so the 208 Plan was run through the county using the Cape Cod Commission as the parent organization to do that. I'm not sure what the regulatory authority officially is, I know it was under Section 208 and I think it was originally brought on by a lawsuit that was against the Barnstable County. DB- asked CM why the Town wasn't looking a grant money for small wastewater treatment plants (example: Thousand Oaks area. CM- That's certainly been a topic of discussion over the last year, we're trying to see what we can use those different funds that have been established for. Initially and under the 208 Plan, they pushed us to consider the cheapest overall costs, which really focused a lot of the towns on these innovative systems, either alternative septic systems or shellfish or other means to save an awful lot of money because of the huge cost to treat the estuaries and to bring back the water quality. There's been a lot of discussions at the Select Board meetings and with the Town Administrator as well as with others. I'm not sure where they stand so I'm not ready to report to you which funds we could use for what. I think the idea is to certainly apply for planning money to develop a wastewater treatment plant for one of those neighborhoods if that's the decision we make to move forward, and you know if we could use those tax dollars versus raising or appropriating at town meeting, I think everybody would be very happy. DB- I think we need to find a project that will use those funds to advance our Comprehensive Wastewater Permit and satisfy the DEP's requirements. I really do not want to put the burden on solving the wastewater problem on individual homeowners when I think that it's really a community need of all the taxpayers. Making somebody put in a $30,000 I/A system with quarterly testing just kind of seems misguided. CM- tonight's focus was on the Pleasant Bay Watershed where a package treatment plant might make sense up in the upper reaches, but if we were to do that treatment the water that we're treating up there would probably have a 30 -year time of travel before it helps improve the watershed of Pleasant Bay. The bigger question that they've been discussing with these different funds, is whether we can use those type of alternative systems to treat our water quality issues in other parts of town, because we know that Pleasant Bay we've got mostly handled by the Captains course. It's not the only water quality issue we have in town. We have tremendous freshwater bodies, many of them are starting to show impairment, and I think if we are restricted to using traditional sewering the costs are going to be astronomical just because of the development patterns in town. AVH- spoke about a CCC study to see how different types of projects are going to fit into the tier structure of the different funding mechanisms to essentially better our chances of getting funding depending on the type of project we ultimately go with. 5. Update by Health Director on DEP meeting with Brewster staff regarding proposed Title 5 revisions AVH —stated that she did previously talk a little bit about what the proposed changes were that are coming down from DEP with regards to Title 5 revisions and that is any of our estuaries that have an established TMDL are going to need to be under an approved DEP Watershed Permit that would be for a 20 -year period. This is something new that DEP is establishing. If we don't have an approved Watershed Permit through DEP, then any septic system within that specific watershed will need to be upgraded with an I/A technology system within the next five years starting from the date of the promulgation of the new Title 5 revisions. Brewster has two watersheds that we need to be concerned about, Pleasant Bay and Herring River. DEP is meeting with all the towns across the Cape to discuss these proposed revisions and explain where they at. Their primary purpose is to get feedback from all the towns in addition to any of the N:\Health\from Shari\MSWORIC FOLDERS\MEETIN GS\BOH\Ju1y2022m.doc VV fr1`1,41e 0 own of Brewster /L I Y 0 IV] 11N 3 1 r= I �EWSTER, MASSACHUSETTS 0263 1 � 1898 FAX: 508.896.4538 )rhealth@brewster�ma,gov I ednesday, August 17, 2022 at 7:OOPM Town Hall, Room A Chair; Penny Holeman, MPH, MA, MS, David Bennett and Casey D. Chatelain Tammi Mason, Senior Department Assistant and Emily Michele Olmsted, MASSTC/Innovative Environmental Project Assistant h Depattmem. ,von one, Director b � I I Assistant Director r Department Assistant C Liu uUOU UH UVV" a" "�:J zi Association kayak launch area. The advisories were based on a recommendation by the MDPH due to a visible Algal bloom indicative of elevated levels of Cyanobacteria. Testing of the ponds continues at this time with current results expected later this week. Until further notice, people and pets should avoid contact with the pond water, MPDH announced incidence of West Nile Virus detected in mosquitos in Barnstable County. There have been no reports the time of year when we expect to see EEE and West Nile Virus in mosquitos and it recommends the public take steps to avoid mosquito bites. Precautions include avoiding outdoor activities during peak hours, at dusk and dawn, applying insect repellent and wearing long sleeve shirts, long pants, and socks when outdoors, In addition, the public should take care to drain standing water around their homes and install or repair window screens. Brewster Health Department reports the number of new Covid cases in Brewster remains low and somewhat steady at this are still available through the Brewster Health Department. In addition, if you require a PCR test, you can schedule one at CCH by calling 508-534-7103 or Outer Cape Health Services at 508�905�2888. Acknowledging that while Covid is still with us, but also for the majority of people, it no longer severely disturbs daily life. The CDC has updated its guidance for individuals who know they have had an exposure to Covid. If you have been exposed, regardless of your vaccination status, they recommend that instead of quarantining, you wear a high-quality mask for 10 days and get tested five full days after exposure, on day 6. If you have Covid, regardless of your vaccination status, you should isolate from others for five days. If after 5 days you are fever free for 24 hours without the use of medication and your symptoms are improving, or if you've never had symptoms, you should test on day 6. If the test is negative, you may end isolation but should continue masking around others in public. If the test is positive, you should continue to isolate. Individuals with moderate or severe N:\Health\from Shari�MSWORK FOLDERS\MEETINGS\BOH\Augl722m.doc AVH-according to GIS maps, parcel 2 falls within the DCPC, so the lot would be subject to those regulations. Motion: Continue the meeting for 60 days so that Mr. Casale has the opportunity to provide: proof of ownership of second lot, nitrogen loading calculations and a commitment to put an I/A system in with a revised plan. Motion: David Bennett Second: Penny Holeman Vote: 5 yes Action: Motion carried 6. Brewster I/A Technology presentation — Emily Michele Olmstead & Tracy Long from MASSTC A power point presentation was shared with the Board. TL- explained to the Board that she tracks the compliance of all I/A systems in Town. The information is put into a database where it is kept track of. They make sure that an O&M contract is always in place. She went over what the procedure is for when someone falls out of compliance. EMO- went over what is required for I/A system sampling. There are 39 total I/A system sin Brewster. The power point shows the frequency of testing, what types of systems they are, and which ones have nitrogen removal technology. The data was pulled from January 1, 2000 through July 13, 2022. There is only data from single family homes. She went over how the data was read and evaluated. The median limit is 19ppm (50% of the systems are meeting that median). She spoke about Zone II nitrogen sensitive areas and that DEP was going to be reclassifying them, watershed permits and I/A systems that may be required when reclassification is done. There may also be new requirements for testing. AG -asked about any requirements above and beyond what DEP requires. EMO -additional sampling and possibly phosphorus removal systems. AG -spoke about addressing systems that are not performing properly. EMO -some towns may require homeowners to come before the BOH, may increase testing, levy fines, etc. AF -spoke about the threshold for nitrogen reduction requirements changing. EMO -Nitro and Nitrex systems are 2 provisional ones that could get it as low as 11 ppm. CC -The Nitro system is just now getting to the 50 systems required to start the timeline of 3 years to get general approval. DB -would like to see more enforcement on the end of meeting standards. He asked about the "0" numbers in the testing date. EMO- "0" can mean that it was reported as 0 or "none detected", or it was not sampled. DB -is concerned that the results may be skewed with those "0"'s in the mix. EMO- will forward the excel sheet to the BOH for their review. N:\Health\from Shari\MSWORK FOLDERS\MEETINGS\BOH\Aug1722m.doc D Etc 4$4 ,,<Ocxx� own of Brewster LI�Ialvj IIN3II\-ZZI �EWSTER, MASSACHUSETTS 02631-1898 FAX: 508.896.4538 brhealth@brewster-ma.gov 0 ednesday, September 21, 2022 at 7:OOPM Virtual Meeting MPH, Vice Chair; Penny Holeman, MPH, MA, MS; David Bennett and Casey D. Chatelain Ii Departmem, ,von one, Director Assistant Director or Department Assistant Heather McElroy, Cape Cod Commission, Ron Essig, Natural Resource Advisory Committee, Chris Williams, Natural Resource Advisory Committee, Elizabeth Taylor, Natural Resource Advisory Committee, Konrad Shultz, Brewster Ponds Coalition, Susan Bridges, Brewster Ponds Coalition and Marty Burke, Natural Resource Advisory Committee Registration and appointments can be made at We UUNU websILe aL capecodhealt o, riflv�nlc fnr"m KCP�called the Brewster Natural Resource Committee to order at 7:07PM. A quorum was present (Ron Essig, Elizabeth I I Tim Pasakarnis is a Water Resources Analyst for CCC, and Heather McElroy is the Natural Resource Director at CCC. A slide show was presented to the Board. HM� spoke about the work they do at the C There are 890 freshwater ponds and lakes on Cape Cod. The key to regulating water quality is to manage nLALrIenLS The ponds are at risk from pollutants from precipitation, stor N:\Healt ffom�!)nari\tvi;!)wuiu�,ruLL)nm3�iv-tnri,,NuoNE)uF,\oepL Mh Oc Economic Analysis, Legal & Jurisdictional Analysis and Engagement & Outreach *Pond network *Technical advisory group *Community outreach & input *Stakeholder engagement Pond Water Quality Monitoring Program *Develop & implement a plan for coordinated and consistent regional pond monitoring *Date collection *Centralized database *Integrated Planning On going data management and analysis. DB- asked what the BOH's role was. HM- In the process of contracting the Town Administrators to see who the point of contact will be. Stakeholder groups will also be engaged. PH -What is the next role out that we will see? HM -It is hared to predict. There are a few things in process: survey effort, identifying potential strategies for addressing a variety of pond water quality and other health concerns, which will likely be shared through the stakeholder process. CC -The Water Quality Date Portal is an incredible tool. The CCC has a GIS open data hub that has a ton of data from across the cape and she encourages everyone to look at it. AG -Asked about the Freshwater Initiative Plan that was shared with the Board in June of 2022 and whether there had been changes to it. TP -It would be hard to give a list of changes. Most are on pond water quality data. AG -Asked the Natural Resources Committee if they had any questions. RE -Asked about the water quality monitoring time frames and if any of the sampling would be done in 2023. TP -2023 will be the 1St monitoring season. RE -Asked if anyone knew the number of ponds that the funding would reach. TP -The budget was built on 3 years of full funding and aonce-a-year sampling schedule. It would be hared to pin down a number. ET -Asked what kind of information coloration there was going to be with all the different parties testing. TP -The hope is that the monitoring program will be coordinated with the Town. KCP-Would like to see, as part of the initiative, a very clear way for the towns to input any management strategies that have been taken. KS (Brewster Pond's Coalition) -Asked how this was "actionable" TP -It would go back to the questions that keep coming up: now do we get started — make answers more clear *When do we have enough information to make a plan -pathways to strategies N:\Health\fi •om Shari\MSWORK FOLDERS\MEETINGS\BOH\Sept2122m.doc 10. Next meeting: October 5, 2022 AG- Let the Board know that she would not be at this meeting. Informational items were noted. Meeting adjourned at 8:30PM. N:\Health\from Shari\MSWORK FOLDERS\MEETINGS\BOH\Sept2122m.doc \\\\`\� .,. IpcoVV s O �fnF 8g4i�'Q Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 026314898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth@brewster-magovmagov W W W.BRE W STER-MA.GOV Board of Health Meeting Wednesday, October 5, 2022 at 7:OOPM Virtual Meeting Health Department Amy L. von Hone, Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Board members attending remotely: Annette Graczewski, MT (ASPC), Chair; Kimberley Crocker Pearson, MS, MD, MPH, Vice Chair; Penny Holeman, MPH, MA, MS; David Bennett and Casey D. Chatelain Others attending remotely: Amy von Hone, R.S., C.H.O., Health Director; Sherrie McCullough, R.S., Assistant Health Director and Tammi Mason, Senior Department Assistant 1. Call to order Meeting was called to order at 7:OOPM 2. Chair announcements Flu season is coming up and the CDC recommends that anyone 6 months or older get vaccinated. Ideally before the end of October. The Brewster Flu/Covid clinic is full, but residents can call CCHC pharmacy appointment number: 508-862-7000, option 3 for additional clinic information on the cape, or fill a cancelation spot if available. There are a number of retail places that have the vaccine also. 3. Citizen's forum None. 4. Habitat for Humanity —fee waiver for Red Top Road property (DWCP & Perc fees) Beth Wade from Habitat for Humanity was present virtually. They are looking for fee waivers for the DWCP ($110 each) and perc fees ($85 each). AVH-The Board typically waives fees for not-for-profit companies. Motion: Approve the fee waiver requested by Habitat for Humanity. Motion: Penny Holeman Second: Kimberley Crocker Pearson Vote Da Ca An 5. Brewster Farms Tobacco Violation Saumil Patel, Owner, Brewster Farms was present virtually. Penny Holeman —yes Action: Motion carried Kimberley Crocker Pearson —yes vid Bennett — yes sey D. Chatelain — yes nette Graczewski - yes AG- Spoke about the inspection done by the Cape Cod Regional Tobacco Control Program on August 24, 2022. At that inspection, there were 3 state and local violations noted, including the sale of a flavored tobacco product, observation of an unlocked humidor (open LOLhe public for self-service) and missing signage. A verbal warning was given for the missing signage. SP -Stated that the store is not selling any flavored tobacco products. In the violation noted, it says "sale of flavored Delta 8 product". Delta 8 has no nicotine in it. He sated that he did have a discussion with the inspector and removed all the Delta 8 products from the shelf. N:\Health\from Shari\MSWORK FOLDERS\MEETINGS\BOH\Oct522m.doc AR -went over her requests for the Board and noted that the neighbor at 26 Seamans Lane had submitted a letter of support to the Board. She is adopting two rescue donkeys. She is not becoming a "rescue". She gave some scientific and personal reasons for having the donkeys at the property. She has manure management plan and has gotten advice from George Heufelder from Barnstable County. The manure plan is to prevent nitrogen from getting into the ground water. She explained how the flooring in the barn will work. The paddock and stalls will be mucked out 1 to 2 times a week and the waste will be taken to another farm. She believes that the nitrogen that would go into the ground would be insignificant. She gave a brief description of the barn and spoke about an elevation map that showed the barn is at the highest point of the lot. As for noise, animals make noise, this won't be any different than having a dog. The sounds are a normal part of life. Rodents- hay and grain will be in sealed containers. She went on to explain how donkeys are different from horses. The average urine in a day is less than or average to a large dog and the smell is much lighter. The donkeys will be inside 1 0-1 2 hours a day. She explained that she purchased this lot to keep it from development. The lot is large enough to allow this structure. KCP-asked if Ms. Rhodes had ever had donkeys before, asked about the drain in the barn and where it would be going, asked about the manure and bedding and where the water supply was. AR -liquid will be removed from the barn and taken off site, believes her manure management plan is more than adequate and the water will come from a faucet on the adjacent property. AG -reminded the Board that the request before them was for variances and noted that the Town has 2 animal inspectors who check on the type of things KCP was asking about. SM -Ms. Rhodes has a good plan in place. Not concerned. -- DB-asked about the well, where it was and if there were any testing results and about the vacant lot. AG -the well, which is Ms. Rhodes, and the vacant lot, owned by Ms. Rhodes, is where the barn sits currently. DB -asked about the "hardships" associated with these variance requests. AR -stated that in order to stay outside of the 100' buffer to the pond and to keep the barn at the highest location, this was the only spot it could be built in. She offered to test her well yearly if that was a concern. KCP-worried about the water in the winter and that this request is before the BOH "after the fact". Nicole Vesey- Owner of the farm where the donkeys are currently. She wants the Board to know that AR is very dedicated to these animals and has learned a lot from her time at the farm. She has no doubt these animals will be well taken care of. Meredith Wertz -160 Old Red Top Road -she fully supports this and believes it would be a great asset to the neighborhood. Morgan Kelly -55 Seamans Lane. Stated that he opposes this request. He spoke about the variance regulations. He doesn't believe the variance request are accurate (measurement wise). He spoke about setbacks and frontage. He stated that he went to the property and did his own measurements. He is concerned with the pond. Doesn't believe there is a hardship and that this lot is not suitable for this purpose. Heather and Todd Cornell -145 Old Red Top Road. Stated they were in full support of this and think the donkeys will be a welcome asset to the neighborhood. Melisa Rais — co-worker of Ms. Rhodes. She spoke on behalf of her and believes she is going to take great care of the animals and land. She also stated that Ms. Rhodes is a very dedicated person. Janice Reily &Steve Spear -32 Old Red Top Road. Stated they are in full support of this and look forward to having the donkeys in the neighborhood. Mr. Spear spoke about the manure plan and the fact that she got advice from George Heufelder, which makes him comfortable with the whole thing. N:\Health\from Shari\MSWORK FOLDERS\MEETIN GS\BOH\Oct522m.doc po 0 •n 9~il Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 026314898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealthgbrew ster-ma. gov W W W.BREWSTER-MA.GOV Board of Health Meeting Wednesday, October 19, 2022 at 7:OOPM Town Hall, Room A Health Department Amy L. von Hone, Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Board members attending: Annette Graczewski, MT (ASPC), Chair; Kimberley Crocker Pearson, MS, MD, MPH, Vice Chair, Penny Holeman, MPH, MA, MS, David Bennett, and Casey D. Chatelain Others attending: Amy von Hone, R.S., C.H.O., Health Director and Sherrie McCullough, R.S., Assistant Health Director 1. Call to order Meeting was called to order at 7:OOPM. 2. Chair announcements Flu season is coming up and the CDC is recommending that everyone 6 months and older get vaccinated. Ideally before the end of October. The Health Department operated a successful clinic this week, administering 181 doses of Flu/Covid vaccine to residents. In addition, 114 doses were administered to town staff and family members earlier this month. Several retailers in the area still have vaccine or people can register for an appointment at capecodhealth, oro Peter Lombardi, Town Administrator will be convening a new task force to advance water quality planning and implementation efforts in Brewster, recognizing that these are complicated and impactful decisions that will affect the entire community. In addition to Town staff, Mr. Lombardi has requested participation from the Chair's of several committees and boards in town, including the Board of Health. Based on his expertise in the field, his knowledge of Brewster and prior history on the Town's Water Quality Planning Committee, I have asked David Bennett to represent the BOH on this task force in my stead. Mr. Bennett will keep the Board apprised of the task force progress towards addressing the needs of the community. 3. Citizen's forum Janice Riley, 32 Old Red Top Road. She spoke about the clinic the Town held. She also spoke about ARPA funds that are being used for non -health related issues such as Cape Cod Sea Camps and the boardwalk at Wing Island. She wanted the Board to know that the residents are upset by this. AVH-while the Health Department doesn't have plans to hold another flu clinic, the Brewster Baptist Church will be holding a clinic in November. 4. 0 Seamans Lane —Abigail Rhodes —continued Animal Regulations variance request, discussion &vote AG -Ms. Rhodes supplied the Board with a revised site plan and results of the well water test. Based on the addition information the variance requests have been amended to: 1. Request fora 31.1' variance from the 50'required distance between the barn and the abutt er's property line. 18.9' held. 2. Request for a 14.2' variance from the 100' required between the barn and the property owner's potable well at 6 Seamans Lane. 85.8' held 3. Request for an 8', 14' and 58.5' variances from the required 100' distance between the barn and the abutters dwelling. 92', 85.3' and 41.4' held There was discussion back and forth about these variance requests. Motion: Grant the requested variances with the conditions that no more than 2 miniature donkeys be sheltered on the property, any change in the kind of or number of animals will require further review by the BOH, no composting of excess food or waste anywhere on the property, must stick to the manure management plan (which states all waste will be removed from property), another well analysis must be done prior to re -issuance of the next years permit (2024) and inspector must verify that the enclosure has been moved as per revised plan. Motion: Penny Holeman Second: Kimberley Crocker Pearson Vote: 4 yes, 1 no Action: Motion carried 5. Brewster Farms continued Tobacco Violation discussion & vote No one was present from Brewster Farms. Motion: Continue hearing until November 1, 2022 meeting. Motion: David Bennett Second: Penny Holeman Vote: 5 yes Action: Motion carried 6. Septic variance request — 40 Elbow Pond Road John O'Reilly was present virtually as well as Robert Christy, Homeowner and Maryellen Fabiano (daughter of owner) JO —stated that a septic inspection for the sale of the home failed. The house was built in 1988 and has a current system comprised of a 1000 -gallon tank, a d -box and 2 trenches. They would like to remove the failed component and replace with a new one. The following variances are being requested: 1. Proposed SAS to be 5' from property line 2. Proposed 3soil removal around field 3. Allow the proposed SAS to be 184' from Elbow Pond 4. Estimated high groundwater — 3.4' separation provided The property is on the south side of Elbow Pond with a southerly groundwater direction from the pond. There is no town water in this area and no expansion of flow proposed. AG- asked about the perc tests done in 1987. JO —ground water was at 14' this time and was just shy of 10' back in 1987. The soil testing that was done recently was done in the same area as the perc testing in 1987. KCP —asked how this year's drought is influencing the interpretation of the data. JO -groundwater that was encountered at 116" leads to an elevation of 25.4'. The wetland across the street has an elevation of about 28.3'. That is the 3' that may be attributed to the drought conditions. AVH-said to keep in mind that the Frimptor Method that is used on Cape Cod is a calculation that is done by looking at wells that may or may not be in the town the project is in. DB -questioned the difference in soil testing. AG- noted that this property is in Zone II and is probably in the Herring River Watershed. Motion: Approve the variances requested with the following conditions: 1. Maximum 3 bedrooms. No additional bedrooms allowed without BOH review 2. Copy of the BOH approval letter is to be recorded ++k Barnstable Registry of Deeds with a copy sent to the Health Department 3. The variances will expire one (1) year from date of BOH approval 4. Existing well must be tested with results submitted to the Health Department prior to an installation permit being issued. Motion: David Bennett Second: Penny Holeman Vote: 5 yes Action: Motion carried 7. Eversource/MDAR proposed 5 -year plan — discussion and vote on proposed letter of opposition 'dill F :CA;ixxY.x�Y frE,LD,ER 9�� Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth@brewster-ma.gov WWW.BREWSTER-MA.GOV Board of Health Meeting Wednesday, November 2, 2022 at 6:30PM Town Hall, Room A Health Department Amy L. von Hone, Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Board of Health members present: Annette Graczewski, MT (ASPC); Kimberley Crocker Pearson, MS, MD, MPH; David Bennett and Casey D. Chatelain Others present: Sherrie McCullough, R.S., Assistant Health Director and Tammi Mason, Senior Department Assistant Board members absent: Penny Holeman, MPH, MA, MS 1. Call to order Meeting was called to order at 6:30PM 2. Chair announcements Flu season is upon us. The CDC estimates there have already been 880,000 report of flu illness this year with increasing infections year over year as of October 22, 2022. They recommend vaccination for everyone 6 months and older. If you have not yet gotten a flu shot, you can obtain both the flu and Covid 19 vaccine at various retailers in the area or you can register for an appointment at CapeCodHealth.org. The Town of Brewster is now using a new on-line permitting process called "View -Point", for all health, building, electrical, plumbing and gas permits. The new system allows for permit application, submission of supporting documents and on-line permit fee remittance. The system can be accessed at https://brewsterma,viewpointcloud.com The Health Department will be accepting on-line and paper applications through the end of the year, after the first of the new year, applications will be accepted on-line only. A reminder that effective November 1, 2022, there is a ban on mattresses and textiles across Massachusett s. Towns must use a recycling process for these things. 3. Citizen's forum None. 4. JC Engineering —Title 5 and local variance requests for 280 Sheep Pond Drive Sam lamele from JC Engineering was present remotely. AG- the applicant is proposing Title 5 and Local variance requests. They are proposing to locate the SAS 6' below grade and are seeking a 3' variance from the 3' maximum cover over the SAS. They are also requesting that the SAS remain 139.5' from Sheep Pond. The existing 3 -bedroom property is into in a Zone II or DCPC area and is served by public water. The property is served by Town water. The existing SAS is in failure. N:\Health\from Shari\MSWORK FOLDERS\MEETINGS\BOH\Nov222m.doc KCP-voiced her concern with the owners knowing what may be coming down the road with the new DEP Regulations. 6. Brewster Farms Quick Pic — continued discussion on tobacco violation Saumil Patel was present remotely. AG -reminded the Board that Mr. Patel was here because an inspection conducted by an inspector from the Tobacco Control Program identified three violations of state and local town tobacco regulations on August 24, 2022, including the sale of a flavored vape product, observation of an unlocked humidor accessible to the public for self-service and missing signage. On October 5, 2022 Mr. Patel stated that he believed the violation for the sale of a flavored tobacco product was not correct because Delta -8 is not a tobacco product. He did state that the humidor was left unlocked. At that time, the Board requested to continue the hearing to get additional information on the Delta -8 product. She noted that she did reach out to the Tobacco Control Program and did find out that Delta -8 is not a tobacco product and doesn't contain nicotine, but it is a product manufactured from a hemp derived cannabidiol (CBD). It is not cannabis, but a synthetically derived product of hemp, and while the sale of hemp is overseen by the MDAR, the retail sale of hemp products is not. The sale of the Delta -8 product is prohibited generally in Massachusetts because it is a controlled substance by the Federal Government. She believes that because Delta -8 is a flavored vaping product that it is a violation of the regulations. Mr. Patel stated that he did remove all the Delta -8 product from the shelves and will not sell in the future. He asked that the fine be waived because of the confusion with this product. AG -asked the Board's thoughts on the fine. The last time Mr. Patel was before the Board for violations he was not fined. CC & DB —believe it would constitute a 15' fine. Cr — believes that it would constitute a4 fine. Motion: Issue a $2,200 fine for a second offence to Brewster Farms for the sale of a flavored vaping product and for an unlocked humidor with a 7 -day suspension of the Tobacco License. Motion: Kimberley Crocker Pearson Second: Casey D. Chatelain Vote: 4 yes Action: Motion carried Mr. Patel would prefer the suspension take place the first week of January. The Board agreed to this. 7. Discuss and approve final draft of Bedroom Definition AG -this is back before the Board with comments from Town Counsel. Motion: Approve revised Bedroom Definition with comments from Town Counsel Motion: Kimberley Crocker Pearson Second: Casey D. Chatelain Vote: 8. Consent Agenda -Title 5 variance for 117 A P Newcomb Road Motion: Approve consent agenda. 4 yes Action: Motion carried Motion: David Bennett Second: Kimberley Crocker Pearson Vote: 4 yes Action: Motion carried 9. Eversource/MDAR proposed 5 -year plan — discussion and vote on proposed letter of opposition from BOH AG -there were a few typos. Motion: Approve the letter to Eversource with noted corrections. Motion: Casey D. Chatelain Second: David Bennett Vote: 4 yes Action: Motion carried 10. Liaison Reports DB- spoke about the new regulations from DEP and noted that on Cape Cod there are roughly 80,000 homes that will be impacted. N:\Health\from Shari\MSWORK FOLDERS\MEETIN GS\BOH\Nov222m.doc THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY AND ENVIRONMENTAL AFFAIRS -- Department of Agricultural Resources 251 Causeway Street, Suite 500, Boston, MA 02114 617-626-1700 fax: 617-626-1850 www.mass.gov/agr JDAR pF ASSACHUSE AGRIULTfS LRESOURCES 5 CHARLES D. BAKER KARYN E. POLITO BETHANY A. CARD JOHN LEBEAUX Governor Lt. Governor Secretary Commissioner FROM: Massachusetts Department of Agricultural Resources, Hemp Program REGARDING: Delta -8 THC DATE: December 12, 2022 The Massachusetts Department of Agricultural Resources, Hemp Program ("MDAR") has jurisdiction over the production and processing of hemp and hemp -derived products as set forth in M.G.L.c. 128, 330 CMR 32.00 and CFR Part 990. Recently, hemp derived -products containing delta -8 THC have been seen in the marketplace. Delta -8 THC is a psychoactive chemical found in cannabis, which includes both marijuana and hemp. Delta -8 THC can occur naturally in a cannabis plant but is not found in significant quantities. Consequently, concentrated amounts of delta4 THC (such as those seen in consumer products) are typically manufactured synthetically from hemp -derived CBD. While the 2018 Farm Bill did remove hemp from the Controlled Substance Act, it did not impact the control status of THC or other synthetically derived cannabinoids, thus delta -8 THC remains a controlled substance regardless of the source. M.G.L.c. 128, Section 117 specifically authorizes MDAR to determine the reasonable commercial uses for hemp. As a result, MDAR has prohibited the sale and manufacture of any hemp -derived delta4 products within or in the Commonwealth. Additionally, the United States Food and Drug Administration "FDA" .L has provided information regarding delta - 8 and that is not an approved ingredient in any product which falls under the jurisdiction of the Federal Food, Drug, and Cosmetic Act. FDA has also advised that consumers should be aware that products containing delta -8 THC have not been evaluated or approved by the FDA for safe use in any context and may be marketed in ways that put public health risk. For more information, please visit us online at: www mass gov/industrial-hemp-program or email us at mahe!m= mass. gov. ' S Things to Know about Delta -8 Tetrahydrocannabinol —Delta -8 THC I FDA Amy von Hone From: Erika Mawn Sent: Wednesday, December 21, 2022 12:48 PM To. Amanda Bebrin- BPPC; Amy von Hone; Andrea Nevins- COA; Andreana Sideris; Golf Commission; Annette Graczewski- BOH; Brewster School Committee; Beth Devine; Brian Harrison-ZBA; Chris Easley- NRSC; Clare O -Connor Rice; Cynthia Baran WQRC; Denise Rego; Diana Lamb; Diane Pansire - Housing Part; Doug Erikson; Doug Wilcock- PPPC; E Taylor; Ellen Murphy; Emily Sumner; Faythe Ellis; Frank Bridges; G Howard Hayes - BOA; George Boyd; hminis1 @gmail.com; Honey Pivirotto; James Gallagher; Jay Packett; Jessica Gelatt; Jill Scalise; Jim Trabulsie-HDC; Joan Pernice-BLL; Joseph Sullivan; Katie Miller Jacobus- School Committee; Kim Conn -BHA; Kim Crocker Pearson; Kyle Hinkle; Lynn St. Cyr; Madalyn Hillis Dineen- Planning Board; Meg Morris (brewster.recycling@gmail.com); Michael Tobin- Conservation; Pete Dahl; Peter Herrmann; Roland Bassett; Sean Parker - Human Services; Sharon Tennstedt _COA; Sherry Theuret; Suzanne Bryan; Tammi Mason; Tim Hackert; Tom Rogers; townadmin Subject: Board and Committee Meetings Update Attachments: #45 Remote Participation- Amended 6.10.22.pdf; January 2023 Board and Committee Schedule.pdf Good Afternoon, At the Select Board meeting on December 19th, the Board discussed the board/committee meeting formats and voted to allow in person public attendance starting on March 1, 2023. With this vote, boards/committees will need to follow the guidelines below and will no longer have the option to meet fully remote starting March 1, 2023: 1. Hybrid option but a quorum of committee members must be in person (must meet minimum requirements, see below) 2. In person (with no restrictions) 3. Public is allowed to participate in person or by remote means Along with this change in format, the Select Board policy on Remote Participation will apply. Please note the minimum requirements for remote participation: • A quorum of the body must be physically present at the meeting location. The chair is responsible for ensuring that this requirement is met in order to hold the meeting. Committees cannot meet if a quorum of members are not in person. • The Chair, or in the chair's absence, the person authorized to chair the meeting must be physically present at the meeting location. • Members of any public body may participate remotely in meetings but are required to physically be present for at least 50% of meeting in a given fiscal year. • Members of regulatory boards (Planning, Zoning Board of Appeals, Board of Health, Conservation Commission, Historic District Committee and Select Board) must be physically present for at least 75% of meetings of that public body in a given fiscal year. It is incumbent on the Chair to manage attendance. • The Chair at the start of the meeting, must announce the name of any member who will be participating remotely. Scheduling of meetings will continue to be completed through the Town Administration office in coordination with BGTV as all board/committee meetings will be broadcast on BGTV Channel 18 and/or livestreamed on the Town website. All meetings will be assigned to Room A or B in Town Hall. E! Please review the attached policy in full and let me know if you have any questions. Thank you, Erika �ri(a .7vla'wn Executive Assistant to the Town Administrator 2198 Main Street Brewster, MA 02631 (508) 896-3701 ext. 1100 www.brewster-ma.gov Brewster Town Offices are open to the public Monday -Thursday from 8:30 to 4:OOpm, and by appointment on Fridays. For the latest updates on Town services, please visit www.brewster-ma.gov 2 January 2023 MONDAY Jan 2 9 5:00pm Cultural Council- In Person (RmB) 6:00pm Select Board- Virtual RM A 7_OOpm HDCRm Bj 16 23 3:30pm Vision 30 TUESDAY 3 4:00pm Bay Property Planning Committee (RmB 4:00pm Golf Commission- Virtual (Rm A) 6:00pm Cons Comm -Virtual (Rm WEDNESDAY 4 4:OOpm PPPC- Virtual _(Rm A) 6:OOpm Finance Committee- in Person (RmA� S:OOpm 0pm Board of Health�Hvbrid RmB January 2023 Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 THURSDAY 5 S:OOpm Affordable Housing Trust - Bicycle & Pedestrian -Virtual February 2023 Su Mo Tu We Th Fr sa FRIDAY 6 11:OOam Water Commission- Virtual 10 11 12 13 SPECIAL ELECTION -NO MEETINGS 4:009m BOA- In person (Rm B). _ 3_00pm Re cline Commission -Virtual 4:OOpm CPC- Virtual (Rm A) 4.00pm 0 Den Space- Virtual Rm B 6:00pm FinComm Joint w/ SB- Virtual 6:00pm Nat Resources Advisory 17 11:00am Crosby Mansion -Virtual 4:00pm BPPC- In Person RmB 4:OOpm Golf Commission- Virtual (Rm 6:OOpm Cons Comm_ -Virtual (Rm A) _7AOpm ZBA- Virtual RmB 31 18 Opm PPPC- Virtual Rm A 6:OOpm Finance Committee- In Person 3:OOpm _(RM A) �-68 mBoard of Health- Hvbrid RmB 6:OOpm 6'3� 25 10:OOam Historical Commission (RmAL' 4:OOpm BOA- In Person (Rm B 4:OOpm CPC- Virtual Rm A 6:3Opm Planning Board- Virtual Rm A Feb 1 Energy Committee -Hybrid Housing Partnership -Virtual _6;30pm Brewster School 26 5:OOpm Recreation 2 20 19 2:OOpm Cemetery Commission -Virtual 27 3 Donna Kalinick 1 1Z/Z1jLOZZ 9:43 AM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 FRIDAY 6 11:OOam Water Commission- Virtual 10 11 12 13 SPECIAL ELECTION -NO MEETINGS 4:009m BOA- In person (Rm B). _ 3_00pm Re cline Commission -Virtual 4:OOpm CPC- Virtual (Rm A) 4.00pm 0 Den Space- Virtual Rm B 6:00pm FinComm Joint w/ SB- Virtual 6:00pm Nat Resources Advisory 17 11:00am Crosby Mansion -Virtual 4:00pm BPPC- In Person RmB 4:OOpm Golf Commission- Virtual (Rm 6:OOpm Cons Comm_ -Virtual (Rm A) _7AOpm ZBA- Virtual RmB 31 18 Opm PPPC- Virtual Rm A 6:OOpm Finance Committee- In Person 3:OOpm _(RM A) �-68 mBoard of Health- Hvbrid RmB 6:OOpm 6'3� 25 10:OOam Historical Commission (RmAL' 4:OOpm BOA- In Person (Rm B 4:OOpm CPC- Virtual Rm A 6:3Opm Planning Board- Virtual Rm A Feb 1 Energy Committee -Hybrid Housing Partnership -Virtual _6;30pm Brewster School 26 5:OOpm Recreation 2 20 19 2:OOpm Cemetery Commission -Virtual 27 3 Donna Kalinick 1 1Z/Z1jLOZZ 9:43 AM ,ea�w8r Town of Brewster ': 2198 Main Street Brewster, MA 02631 -1 898 Phone: (508) 896-3701 Fax: (508) 896-8089 REMOTE PARTICIPATION POLICY Minimum Requirements for Remote Participation Office of: Select Board Town Administrator Policy no. 45 Date adopted:12/16/13 Amended: 06/10/22 (a) Members of a public body who participate remotely and all persons present at the meeting location shall be clearly audible to each other; (b) A quorum of the body, including the chair or, in the chair's absence, the person authorized to chair the meeting, shall be physically present at the meeting location, as required by M.G.L. c. 30A, sec 20(d); (c) Members of public bodies who participate remotely may vote and shall not be deemed absent for the purposes of M.G.L. c. 39, sec. 23D. The All Citizens Access Committee shall be exempt from these provisions. Since Brewster has adopted the provisions of 940 CMR 29.10(2), a member of a public body shall be permitted to participate remotely in a meeting, in accordance with the procedures described in 940 CMR 29.10(7), if the chair or, in the chair's absence, the person chairing the meeting, determines that the member's physical attendance would be unreasonably difficult. The chair shall be responsible for ensuring that a quorum is physically present at the meeting location. Members should not select a chair that regularly expects to participate remotely. Frequency of Remote Participation (a) Individual members of any public body shall be permitted to participate remotely in meetings but must be physically present for at least 50% of meetings of that public body in a given fiscal year. Members of regulatory boards (Planning Zoning Board of Appeals, Board of Health, Conservation Commission, Historic District Committee, and Select Board) must be physically present for at least 75% of meetings of that public body in a given fiscal year. (D) The Town will strive to provide opportunities for both in-person and remote participation at Board and Committee meetings to the greatest extent practicable. (c) All board and committee meetings will be broadcast on BGTV Channel 18 and/or livestreamed on the Town website to the greatest extent practicable. Technology (a) Remote participants shall use video conferencing media (ie. Zoom). (b) When video technology is in use, the remote participant shall be clearly visible to all persons present in the meeting location. (c) The chair or, in the chair's absence, the person chairing the meeting, may decide how to address technical difficulties that arise as a result of utilizing remote participation, but is encouraged, wherever possible, to suspend discussion while reasonable efforts are made to correct any problem that interferes with a remote participant's ability to hear or be heard clearly by all persons present at the meeting location. If technical difficulties result in a remote participant being disconnected from the meeting, that fact and the time at which the disconnection occurred shall be noted in the meeting minutes. Procedures for Remote Participation (a) Any member of a public body who wishes to participate remotely shall, as soon as reasonably possible prior to a meeting, notify the chair or, in the chair's absence, the person chairing the meeting, of his or her desire to do so and the reason for and facts supporting his or her request. (b) At the start of the meeting, the chair shall announce the name of any member whW will be participating remotely. This information shall also be recorded in the meeting minutes. (c) All votes taken during any meeting in which a member participates remotely shall be by roll call vote. (d) A member participating remotely may participate in an executive session, but shall state at the start of any such session that no other person is present and/or able to hear the discussion at the remote location, unless presence of that person is approved by a simple majority vote of the public body. (e) When feasible, the chair or, in the chair's absence, the person chairing the meeting, shall distribute to remote participants, in advance of the meeting, copies of any documents or exhibits that he or she reasonably anticipates will be used during the meeting. If used during the meeting, such documents shall be part of the official record of the meeting, and shall be listed in the meeting minutes and retained in accordance with M.G.L. c. 30A, sec. 22. Approved by the Brewster Select Board on June 13, 2022 David Whitney, Chair Kari Hoffmann, Clerk C.SMuGa.� Cindy Bingham �do✓V-f Ot 8 Gl a�T ela;h Ned Chatelain, Vice Chair Mary Chaffee Amy von Hone From: Viveiros, Jennifer (DEP) <jennaer.viveiros@mass.gov> Sent: Wednesday, December 21, 2022 12:11 PM To. Viveiros, Jennifer (DEP) Subject. Proposed MassDEP Title 5 and Watershed Permitting draft regulations - Additional Information Sessions & Public Hearings Good Afternoon - As you know, MassDEP recently extended the public comment period for the proposed Title 5 and Watershed Permitting draft regulations through January 30, 2023. The Department hopes to solicit additional feedback from the public, municipal leaders, and other stakeholders during the extended public comment period. To date, MassDEP has held two public Information Sessions and three Public Hearings. Recordings of those sessions and hearings can be found on MassDEP's website here 310 CMR 15.000: Septic Systems ("Title 5") 1 Mass.gov MassDEP will be holding two additional public Information Sessions and two Public Hearings as follows: MassDEP will conduct two additional Information Sessions: Remote Only, January 17, 2023, at 6:00 p.m. Register in advance at: https://us06web,zoom.us/webinar/register/WN N ugiwyuTYStvyKhHkAU5Q In-person &Remote, January 18, 2023, at 6:00 p.m., at The Marketplace (second floor), UMass Dartmouth, 285 Old Westport Road, Dartmouth, MA, 02747 Register for remote session in advance at (it is not necessary to register if you will be attending in-person): https://us06web.zoom.us/webinar/register/WN 9hhEmYWWTSgq UZf8suOgQ MassDEP will conduct two additional public hearings: Remote Only, January 24, 2023 at 6:00 p.m. Register for remote session at: https://us06web.zoom.us/webinar/register/WN_veLVS545RCgGZhl6tuN2rQ Remote Only, January 25, 2023 at 6:00 p.m. Register for remote session at. https://us06web.zoom.us/webinar/register/WN_ls2pAS_cR_uXvNhhs5r3oQ The draft regulations are published on the MassDEP website at: https://www.mass.gov/service-details/massdep-public- hearings-comment-opportunes and at: 310 CMR 15.000: Septic Systems ("Title 5") I Mass.gov and 314 CMR 21.00: Watershed Permit Regulations I Mass.gov . Please refer your constituents to the above web pages for information pertaining to these draft amendments and regulations. Written comments can be submitted via email to dep.tall<s@mass.gov Please put Title 5 and Watershed Permitting in the subject line. If you have any questions or would like to request a copy of the proposed amendments, please contact Marybeth Chubb via email, marybeth.chubb@mass.gov Sincerely, Jen Viveiros Jennifer Viveiros Deputy Regional Director- Administrative Services MassDEP Southeast Regional Office 20 Riverside Drive Lakeville, MA 02347 J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO: Brewster Board of Health 2198 Main Street Brewster, MA 02631 Shipping Method: Regular Mail 0✓ Federal Express ❑ Certified Mail El UPS Priority Mail ❑ Pick Up Express Mail F�] Hand Deliver DATE: 12/07/2022 LETTER OF TRANSMITTAL JOB NUMBER: 8553W COPIES For review and comment: For approval: F7 As Requested: F�] For your useFT � DATE DESCRIPTION 1 12/01/22 Perc-Rite Maintenance Checklist REMARKS: cc: John M. O'Reilly P.E., P.L.S Client Oakson, Inc. From: GJB If enclosures are not as noted, kindly notify us at once : ROUTINE OPERATION AND MAINTENANCE CHECKLIST FOR PERC-RITE DRIP DISPERSAL SYSTEM Address: 72 Johnson CartwayI Brewster Homeowner: Bruce Johnson Operator: Greg Brehm WWTO Lic #:16149 .70b .�': 8553W HISTORICAL DATA and CURRENT READINGS Previous flow meter reading: ss,z�s Current flow meter reading: 104,175 Start-up dose rate ZONE 1: GPM ZONE 2: ZONE 3: ZONE 4: FIELD CONDITIONS Date : 12/01 /2022 Design flow: 330 Calculated water usage: Current dose rate 1.s GPM Date of last visit: �y3oi2o2� 104.27 GPD A. Drip dispersal field: visible wet spots YES ❑ NO D Comments: B. Air release valves: erosion YES ❑ NOD leakage/spraying YES ❑ NO❑✓ Comments: PUMP CHAMBER/FLOAT OPERATION A. Floats match pin lights in control panel YES❑✓ NO❑ Comments: B. Alarm float working YES❑✓ NOD Comments: C. Solids or scum present YES NO❑✓ Comments: CONTROL PANEL A. Switches in AUTO position YES❑✓ NO❑ Comments: B. Peak Level light on YES❑ NO❑✓ Comments: C. Power and Run lights on (microprocessor) Comments: PUMP and VALVE OPERATION A. Pump in HAND position: flow meter running Comments: B. Zones 1-4 (one at a time): flow meter running dose rate correct flush rate > dose rate Comments: C. Disc filter back flushing: working properly Comments: D. Disc filter inspection: excessive residue cleaning required Comments: E. Switches returned to AUTO position Comments: F. RESET/CYCLE START: functioning properly Comments: G. Hydraulic Unit: leaks, crimps, or other issues Comments: SEPTIC and/or PRE-TREATMENT TANKS A. Examine and clean effluent filter: excessive residue Comments: B. Septic tank pumping recommended 1. Sludge depth: 5" 2. Scum depth: o" Comments. C. Service pre-treatment system Comments: NIA Operator signature =' Comments/Observations: System is operating correctly mechanics YES❑✓ YES❑✓ YES❑✓ YES ❑ YES ❑✓ YES � YES❑✓ YES ❑ YES ❑ YES ❑ YES ❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NOD NO❑ NO❑ NO ❑ NOD NO❑ License No. �s�as J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO Brewster Board of Health 2198 Main Street Brewster, MA 02631 Shipaina Method: Regular Mail �✓ Federal Express Certified Mail 0 UPS El Priority Mail F] Pick Up Express Mail [71 Hand Deliver DATE: 12/07/2022 LETTER OF TRANSMITTAL JOB NUMBER: 8520W COPIES For review and comment: F7 For approval: 71 As Requested: FVI DATE DESCRIPTION 1 12/01/22 Perc-Rite Maintenance Checklist cc: John M. O'Reilly P.E., P.L.S. Oakson, Inc. Client From: GJB If enclosures are not as noted, kindly notify us at once For your use: REMARKS: ROUTINE OPERATION AND MAINTENANCE CHECKLIST FOR PERC-RITE DRIP DISPERSAL SYSTEM Address: 75 Johnson CartwayI Brewster Homeowner: Craig &Carolyn Colgate Operator: Greg Brehm WWTO. Lic #:16149 ]Ob #: 8520W HISTORICAL DATA and CURRENT READINGS Previous flow meter reading: 28,os1 Current flow meter reading: 58,111 Start-up dose rate ZONE 1: 2.2 GPM ZONE 2: ZONE 3: ZONE 4: FIELD CONDITIONS Date : 12/01 /2022 Design flow: aao Date of last visit: 1v2ai2ozl Calculated water usage: 78.449Pd Current dose rate 2.25 G P M A. Drip dispersal field: visible wet spots YES ❑ NO p Comments: B. Air release valves: erosion YES ❑ NOD leakage/spraying YES ❑ NO❑✓ Comments: PUMP CHAMBER/FLOAT OPERATION A. Floats match pin lights in control panel YES❑✓ NO❑ Comments: Peak float bad, replaced. B. Alarm float working YES❑✓ NO❑ Comments: C. Solids or scum present YES NO❑✓ Comments: CONTROL PANEL A. Switches in AUTO position YES✓ NO❑ Comments: B. Peak Level light on YES❑✓ Comments: Peak float bad, replaced, working correctly C. Power and Run lights on (microprocessor) YES❑✓ Comments: PUMP and VALVE OPERATION A. Pump in HAND position: flow meter running YESD Comments: B. Zones 1-4 (one at a time): flow meter running YESD dose rate correct YES ❑✓ flush rate > dose rate YES ❑✓ Comments: C. Disc filter back flushing: working properly YES❑✓ Comments: D. Disc filter inspection: excessive residue YES❑ cleaning required YESD Comments: E. Switches returned to AUTO position YES ❑✓ Comments: F. RESET/CYCLE START: functioning properly YES❑✓ Comments: G. Hydraulic Unit: leaks, crimps, or other issues YES ❑ Comments: SEPTIC and/or PRE-TREATMENT TANKS *No covers @grade. Did not inspect. A. Examine and clean effluent filter: excessive residue YES 171 Comments: El B. Septic tank pumping recommended 1. Sludge depth: 2. Scum depth: Comments: C. Service pre-treatment system Comment Operator signature Comments/Observations: System operating correctly mechanically. YES YES ❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NOD NO❑ NO❑ NO ❑ NO❑✓ NO ❑ NO ❑ NO❑ License No. �s�as J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 Brewster Board of Health 2198 Main Street Brewster, MA 02631 Shipping Method: Regular Mail �✓ Federal Express Certified Mail El UPS F1 Priority Mail ❑ Pick Up F] Express Mail ❑ Hand Deliver El COPIES I DATE I DESCRIPTION 1 � 12/06/22 � Perc-Rite Maintenance Checklist DATE: 12/07/2022 LETTER OF RAIN JOB NUMBER: 6907W For review and comment: � For approval: � As Requested: � For your use: REMARKS: cc: John M. O'Reilly P.E., P.L.S Oakson Inc. Client From: GJB If enclosures are not as noted, kindly notify us at once ROUTINE OPERATION AND MAINTENANCE CHECKLIST FOR PERC-RITE DRIP DISPERSAL SYSTEM Address: 255 Robbin's Hill Road, Brewster Homeowner: Hayes Residence Operator: Greg Brehm WUVTO Lic #:16149 ]Ob .#: 6907W HISTORICAL DATA and CURRENT READINGS Previous flow meter reading: 3s6,161 Current flow meter reading: 608,483 Start-up dose rate ZONE 1: 2.2 GPM ZONE 2: ZONE 3: ZONE 4: FIELD CONDITIONS Date : 12/06/2022 Design flow: 550 Calculated water usage: Current dose rate 1.2 GPM Date of last visit: �zi��izoz� 628.03 GPD A. Drip dispersal field: visible wet spots YES ❑ NO D Comments: B. Air release valves: erosion YES ❑ NOD✓ leakage/spraying YES❑ NO❑✓ Comments: PUMP CHAMBER/FLOAT OPERATION A. Floats match pin lights in control panel YES❑✓ NO❑ Comments: B. Alarm float working YES❑✓ NO[:] Comments: C. Solids or scum present YES[Z] NOF] Comments: CONTROL PANEL A. Switches in AUTO position YES❑✓ NO❑ Comments: B. Peak Level light on YES❑ NO❑✓ Comments: C. Power and Run lights on (microprocessor) YES❑✓ NO❑ Comments: PUMP and VALVE OPERATION A. Pump in HAND position: flow meter running YESD NO❑ Comments: B. Zones 1-4 (one at a time): flow meter running YESD NO❑ dose rate correct YES ❑✓ NO ❑ flush rate > dose rate YES ❑✓ NOD Comments: C. Disc filter back flushing: working properly YESD NO❑ Comments: D. Disc filter inspection: excessive residue YES❑✓ NO❑ cleaning required YES E] NOR Comments: E. Switches returned to AUTO position YESD NO❑ Comments: F. RESET/CYCLE START: functioning properly YESD NO ❑ Comments: G. Hydraulic Unit: leaks, crimps, or other issues YES❑ NOD Comments: SEPTIC and/or PRE-TREATMENT TANKS *No Covers @grade, did not inspect A. Examine and clean effluent filter: excessive residue YES ❑ NO ❑ Comments. B. Septic tank pumping recommended YES ❑ NO ❑ 1. Sludge depth: 2. Scum depth: Comments: C. Service pre-treatment system YES El NO❑ / �4r � Comments: NiA � �' Operator signature Comments/Observations: System is operating correctly mechanically. High GPD usage. License No. is14s J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO: Town of Brewster Board of Health 2198 Main Street Brewster, MA 02631 Shipping Method: Regular Mail Q✓ Federal Express Certified Mail El UPS F1 Priority Mail F Pick Up F1 Express Mail ❑ Hand Deliver El COPIES I DATE I DESCRIPTION 1 � 12/06/22 � Perc-Rite Maintenance Checklist DATE: 12/07/2022 REGARD 26 Nancy May Path Brewster, MA 02631 LETTER OF TRANSMITTAL JOB NUMBER: 6507AW For review and comment: � For approval: � As Requested: � For your use: REMARKS' cc: John M. O'Reilly P.E., P.L.S Oakson, Inc. Client From: GJB If enclosures are not as noted, kindly notify us at once ROUTINE OPERATION AND MAINTENANCE CHECKLIST FOR PERC-RITE DRIP DISPERSAL SYSTEM Address: 26 Nancy May Path, Brewster Homeowner: Gillespie Residence Operator: Greg Brehm WWTO Lic #:17746 HISTORICAL DATA and CURRENT READINGS Previous flow meter reading: �3�,035 Current flow meter reading: 1523100 Start-up dose rate ZONE 1: 1.5 GPM ZONE 2: ZONE 3: ZONE 4: FIELD CONDITIONS Date : 12/06/2022 Design flow: 330 Calculated water usage: Current dose rate GPM Date of last visit: ��izaizozi 59.67 GPD A. Drip dispersal field: visible wet spots YES ❑ NO Q Comments: B. Air release valves: erosion YES ❑ NOD leakage/spraying YES ❑ NO❑✓ Comments: PUMP CHAMBER/FLOAT OPERATION A. Floats match pin lights in control panel YES❑ NOD Comments: Peak &Enable float need replacement B. Alarm float working YES[Z] NOD Comments: C. Solids or scum present YES NOS✓ Comments: CONTROL PANEL A. Switches in AUTO position YES❑✓ NO❑ Comments: B. Peak Level light on YES❑✓ Comments: Peak float reading up when down. C. Power and Run lights on (microprocessor) YES❑✓ Comments: PUMP and VALVE OPERATION A. Pump in HAND position: flow meter running YES❑ Comments: Low level in tank could not run B. Zones 1-4 (one at a time): flow meter running YES ❑ dose rate correct YES ❑ flush rate > dose rate YES ❑ Comments: C. Disc filter back flushing: working properly YESD Comments: D. Disc filter inspection: excessive residue YES ✓❑ cleaning required YES ❑✓ Comments: cleaned filters E. Switches returned to AUTO position YES ✓❑ Comments: F. RESET/CYCLE START: functioning properly YES❑ CommentS: could not run, low liquid level G. Hydraulic Unit: leaks, crimps, or other issues YES❑ Comments: SEPTIC and/or PRE-TREATMENT TANKS *No covers @grade. Did not inspect. A. Examine and clean effluent filter: excessive residue YES❑ Comments: El B. Septic tank pumping recommended 1. Sludge depth: 2. Scum depth: Comments: C. Service pre-treatment Comments: N/A Operator signature Comments/Observations: YES YES ❑ NO❑ NO❑ NO❑✓ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO ❑ NOD NO ❑ NO ❑ NO❑ License No. �s�as J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO Brewster Board of Health 2198 Main Street Brewster, MA 02631 Shipping Method: Regular Mail Federal Express 0 Certified Mail El UPS ❑ Priority Mail F] Pick Up Express Mail F-1 Hand Deliver DATE: 2/21/2021 LETTER OF TRANSMITTAL JOB NUMBER: 6642W COPIES DATE For review and comment: 71 For approval: F7 DESCRIPTION 1 11/24/21 Perc-Rite Maintenance Checklist cc: John M. O'Reilly P.E., P.L.S Client Oakson, Inc. From: GJB As Requested If enclosures are not as noted, kindly notify us at once For your use: REMARKS: ROUTINE OPERATION AND MAINTENANCE CHECKLIST FOR PERC-RITE DRIP DISPERSAL SYSTEM Address: 45 Warren's Road, Brewster Homeowner: Pamela Lloyd -Baker Operator: Greg Brehm WWTO Lic #:16149 JOb #: 6642W HISTORICAL DATA and CURRENT READINGS Previous flow meter reading: z33,7sa Current flow meter reading: 261,180 Start-up dose rate ZONE 1: 2.3 GPM ZONE 2: ZONE 3: ZONE 4: FIELD CONDITIONS Date : 12/06/2022 Design flow: 330 Calculated water usage: Current dose rate 3.1 GPM Date of last visit: 11-z4-zozl 77.65 GPD A. Drip dispersal field: visible wet spots YES ❑ NO Q Comments: B. Air release valves: erosion YES ❑ NOD leakage/spraying YES ❑ NO❑✓ Comments. PUMP CHAMBER/FLOAT OPERATION A. Floats match pin lights in control panel YES❑✓ NO❑ Comments: B. Alarm float working YES❑✓ NOR Comments: C. Solids or scum present YES❑ NO❑✓ Comments: CONTROL PANEL A. Switches in AUTO position YES❑✓ NO❑ Comments: B. Peak Level light on YES❑ NO❑✓ Comments: C. Power and Run lights on (microprocessor) Comments: PUMP and VALVE OPERATION A. Pump in HAND position: flow meter running Comments: B. Zones 1-4 (one at a time): flow meter running dose rate correct flush rate > dose rate Comments: C. Disc filter back flushing: working properly Comments: D. Disc filter inspection: excessive residue cleaning required Comments: cleaned filters E. Switches returned to AUTO position Comments: F. RESET/CYCLE START: functioning properly Comments: G. Hydraulic Unit: leaks, crimps, or other issues Comments: SEPTIC and/or PRE-TREATMENT TANKS A. Examine and clean effluent filter: excessive residue Comments: B. Septic tank pumping recommended 1. Sludge depth: 2" 2. Scum depth: o° Comments. C. Service pre-treatment system Comments: N/A ,, Operator signature Comments/Observations: System is operating correctly mechanically. YESD YES YES � YES 0 YES FV1 YES � YES ❑ YES 0 YES � YES Q YES ❑ YES ❑ YES ❑ YES ❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NOD NO❑ NO❑ NO ❑ NOD NO � NO � NO❑ License No. �s�as J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 Brewster Board of Health 2198 Main Street Brewster, MA 02631 Shipping Method: Regular Mail 0✓ Federal Express Certified Mail El UPS F1 Priority Mail F] Pick Up F] Express Mail F-1 Hand Deliver F1 COPIES I DATE I DESCRIPTION 1 � 12/06/21 � Perc-Rite Maintenance Checklist DATE: 12/07/2022 REGARDIN 19 Cedar Hill Road Brewster, MA 02631 LETTER OF TRANSMITTAL JOB NUMBER: 6518AW For review and comment: � For approval: � As Requested: � For your use: RFMARKSB cc: John M. O'Reilly P.E., P.L.S Oakson, Inc. Client From: GJB If enclosures are not as noted, kindly notify us at once B. Peak Level light on YES❑ NO❑✓ Comments: C. Power and Run lights on (microprocessor) YES❑✓ NO❑ Comments: PUMP and VALVE OPERATION A. Pump in HAND position: flow meter running YESD✓ NO❑ Comments: working correctly B. Zones 1-4 (one at a time): flow meter running YES ✓❑ NO❑ dose rate correct YES NOD flush rate > dose rate YES ❑✓ NO❑ Comments: C. Disc filter back flushing: working properly YESD NO❑ Comments: D. Disc filter inspection: excessive residue YES❑ NOD cleaning required YES El NOD Comments: checked filter E. Switches returned to AUTO position YESD NO❑ Comments: F. RESET/CYCLE START: functioning properly YESD NO ❑ Comments: G. Hydraulic Unit: leaks, crimps, or other issues YES❑ NO❑✓ Comments: SEPTIC and/or PRE-TREATMENT TANKS *No covers @grade. Did not inspect. A. Examine and clean effluent filter: excessive residue YES El NO ❑ Comments: B. Septic tank pumping recommended YES ❑ NO ❑ 1. Sludge depth: 2. Scum depth: Comments: C. Service pre-treatment system YES NO❑ Comments: N/A f Operator signature /Y- Comments/Observations: System is operating correctly mechanically. License No, is�as ROUTINE OPERATION AND MAINTENANCE CHECKLIST FOR PERC-RITE DRIP DISPERSAL SYSTEM Address: 19 Cedar Hill Rd, Brewster Homeowner: Neumann Residence Operator: Greg Brehm, WWTO Lic #:16149 ]Ob .#: 6518AW HISTORICAL DATA and CURRENT READINGS Previous flow meter reading: �1,s93 Current flow meter reading: 803884 Start-up dose rate ZONE 1: 2.14 GPM ZONE 2: ZONE 3: ZONE 4: FIELD CONDITIONS Date : 12-06-2022 Design flow: 330 Calculated water usage: Current dose rate 2.2 GPM Date of last visit: lyzaizozl 25.19 GPD A. Drip dispersal field: visible wet spots YES ❑ NO � Comments: B. Air release valves: erosion YES ❑ NOD leakage/spraying YES❑ NOD✓ Comments: Placed re -bar next to valves, V below grass PUMP CHAMBER/FLOAT OPERATION A. Floats match pin lights in control panel YES❑✓ NO❑ Comments: B. Alarm float working YESD✓ NO❑ Comments: C. Solids or scum present YESD NOD✓ Comments: CONTROL PANEL A. Switches in AUTO position YESD✓ NO❑ Comments: J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO Department of Environmental Protection Attn: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 ShippincJ Method: Regular Mail �✓ Federal Express Certified Mail El UPS F] Priority Mail F�] Pick Up ❑ Express Mail F-1 Hand Deliver El COPIES I DATE DESCRIPTION 1 11/22/22 DEP Approved Inspection Form SeptiTech Form Lab Results DATE: 12/16/2022 LETTER OF TRANSMITTAL JOB NUMBER: 8082W For review and comment: � For approval: � As Requested: � For your use: .. i173�i/e\7:631 cc: John M. O'Reilly, P.E., P.L.S. Board of Health Client From; GJB If enclosures are not as noted, kindly notify us at once Site/Address: White Rock Commons Subdivision White Rock Road Brewster, MA 02631 Date: 11-22-2022 Time: 8:20 am Rep: Greg Brehm 1. Remove lids &covers on processor. Visually inspect media &spray pattern. GJB (Initial) 2. Exercise entire system in maintenance mode. GJB (Initial) a. Recirculation pumps) b. Pumpback pumps) c. Discharge pumps) 3. Perform maintenance/cleaning tasks required for proper operation of unit. GJB (Initial) a. Spray headers b. Media c. Screen 4. Take effluent sample from sample tube GJB (Initial) 5. Record following values from controller read-out (Discharge Pump) GJB (Initial) Days Runtime: � 1 � � Hours Runtime: �� 17 Seconds Runtime: Zso3.5'6'.3 6. Record controller program version: Commercial GJB (Initial) 7. Record conholler fumware version: V121 GJB (Initial) 8. List parts and supplies used: GJB (Initial) 9. Return system to "run" mode GJB (Initial) 10. Re -install covers and lids on processor. GJB (Initial) 11. Check au• intake muffler for obshuction and proper draw. GJB (Initial) General Notes and Remarks: The system is operating correctly mechanically. Effluent quality passed field tests. Effluent sample collected for lab analysis. Septic Tank sludge levels: Inlet: 10" sludge, 1"scum, Outlet: 5" sludge, 0" scum. C:\Users�dm\AppDatn\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\LQ2TPOQY�eptitch.doe Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. teb Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation White Rock Commons Subdivision Owner White Rock Road Facility Street Address Brewster City Mailing address of owner, if different: P.O. Box 3843 Street Address/PO Box: New Haven 031 312 - 3484 ext. one Number CT State B. Authorized Service Provider O'Reilly &Associates, Inc. O&M Firm 1573 Main Street - P.O. Box 1773 Street Address Brewster 508) 896 - 6601 ext. Telephone Number Greq Brehm Operator Name MA State C. Facility/System Information BREW-Sou157-Se DEP ID Septitech Unknown Installation Date 02631 Zip 06525 Zip 02631 Zip 16149 Certification N M3000N Manufacturer ID Model Number Janua 2016 Start of Approval Type: ®General ❑Provisional ❑Piloting Seasonal Residence — used less than 6 mo./year: ❑ Yes D. Operating Information 11/22/2022 Inspection Date 10" Sludge Depth (to be checked yearly) n ❑ Remedial /1 • 09/01 /2022 Previous Inspection Date Pumping Recommended ❑ Yes ® No t5aiom.doc •rev. 04-11-13 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and OW Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑brown ❑ Other (specify): Odor: ❑musty ®earthy Effluent Solids: ® no ❑ some ® clear ❑turbid ❑ moldy ❑offensive ❑turbid pH 6.5 SU DOTurbidity 1.57 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Inf®rmati®n Samples Taken: ❑Influent ®Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: Parameters sampled: ❑ pH ®BOD ❑ CBOD ®TSS ®TN ❑Other (list below) See attached lab results Other 1 Other 2 G. Inspection and Maintenance Other 3 Description of any maintenance performed since previous inspection &during this inspection: Maintenance completed per manufacturer's checklist. Notes and Comments: The system is operating correctly mechanically. t5aiom.doc •rev. 04-11-13 Page 2 of 3 Lj) Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 IIA Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified orator in accordance with 257 CMR 2.00. Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health as follows for each inspection performed: Remedial Use — by January 31 st of each year for the previous calendar year Piloting Use -within 45 days of inspection date Provisional Use — by March 31th of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 t5aiom.doc •rev. 04-11-13 Page 3 of 3 I �� I � � i -� i I � • _ � Recipient: Greg Brehm Order No.: 622236044 JM O'Reilly Assoc. Report Dated: 12!12/2022 PO Box 1743 Submitter: JM O'Reilly Assoc. Brewster, MA 02631 Description: 80i32W Laboratory ID#: 2223604��01 Matrix: Water -Waste Water Sample #: Sampled: 11/22/2022 8:45 By: GJB Collection Address: White Rock Rd HOA, Brewster Received: 1112212022 14:00 fay: Sample Location: Turn Around: Standard 7 eSf PaPamO�@PS ITEM RESULT UNITS RL MCL METHOD # TESTED Nitrate as Nitrogen 9.5 mg1L 0,10 10 EPA 30D.0 11/23/2022 BOD (5 DAY) TEST 6.4 mg/L 2.0 SM 521D B 11/23/2022 Nitrite as Nitrogen 0.23 mglL 0.050 ,1.0 EPA 300.0 11/23/2022 TKN 2,� mglL 0.25 EPA 351.2 12/05!2022 Total Suspended Solids N� mglL 2.0 SM 254oD 11!29/2022 Attached please find the laboratory certified parameter list. TIME 10:D1 Approved By: -�-�- (Lab Director) ND =None Detected RL =Reporting Limit MCL =Maximum Contaminant Level 3195 Main Street, P®. Box 427, Barnstable, M,A 02630 Ph: 500-375x6605 Page: 1 of 1