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Home My WebLink About2019 Oct 09 - Letter from Atty. D. Reid and Attachments Re: Nitrate Restriction - • STONE & REID ATTORNEYS AT LAW A PROFESSIONAL ASSOCIATION* OCT 1 1 2019 SOUTH YARMOUTH PROFESSIONAL BUILDING 1292 ROUTE 28 SOUTH YARMOUTH, MA 02664-4452 HEALTH DEPT. TEL (508) 394-5648 FAX (508) 398-1699 DAVID S. REID, ESQ. MICHAEL F.STONE, ESQ. DSReid@verizon.net MFStoneEsq@comcast.net October 9, 2019 Yarmouth Health Division 1146 Route 28 S. Yarmouth MA 02664 RE: 23 Edgewater Drive - Nitrate Restriction Dear Director Murphy, I represent Mr. Donald Gauch, of 23 Edgewater Drive, South Yarmouth (formerly assessors map 81 parcel B4, now map 92 parcel 9). In 1992, the owners were issued the disposal works construction permit for their home with the restriction that it contain only three bedrooms based upon the then applicable Nitrate Regulations . A restriction memorializing this limitation was recorded in the Registry of Deeds in Book 8032 at Page 20 ( copy enclosed). We now understand that these particular regulations no longer apply and that the restriction may be removed. The system was installed with the capacity for four bedrooms, and it has recently been inspected and found to be in satisfactory condition ( see Title 5 Inspection report enclosed). We request that the Board of Health issue a release of the recorded restriction so that the home may contain the fourth bedroom that is desired by the owner. If you wish us to appear before the Board for purposes of this request, please advise. If you or the Board need any additional information about the property, please contact me at your convenience. Thank you for your assistance and attention to this request. Vegily urs, David S. Rei *Each Attorney in this office is an independent practitioner who is not responsible for the practice or liabilities of any other attorney in the office.Rule 7.5(d) .o :Y -- 3.1370 `- TOWN OF YARMOUTH o0 ':� rr%'. ne, s .^ � 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 Mwn --CA Tel(508)398-2231 —Fax(508)398-2365 ``" `` BOARD OF HEALTH NOTICE OF NITRATE REGULATION r• ' Notice is hereby given of the applicability of the Town of Yarmouth Board of Health Nitrate Loading Regulation adopted by the Board of Health on July 21, 1986, for the protection of the Town's drinking water, to 23 Edgewater Drive , shown in Town Assessors Book date 1992, Map 81 , parcel # B4 As Deed is recorded on Book 7555 , page 189, as shown on a plan of land en— titled Leeward Run Development Trust One , dated 04/29/88 , as plan of land is recorded on Book 451 , -page 48 . Such regulation requires a Nitrate Loading Calculation to be filed with the said Board of Health for proposed subsurface sewage disposal system(s) and limits the number of bedrooms and lawn area of a dwelling to be constructed. The Health Department has approved the Nitrate Loading Calculations prepared by Down Cape Engineering , dated 11/01/90 which allow: (1) the lawn area to be limited to 1,000 square feet; (2) the number of bedrooms limited to 3 (three) Bruce Murphy, Health Agent, R.S., MPH 0-2to 4 2. EXECUTED as a sealed instrument this date, , _ j . ... . Ad„,,_ _ 1 Co„q .4, .' Donald Gauch, er Gail A. Gauch, Owner COMMONWEALTH OF MASSACHUSETTS Barnstable, ss /6 , 1992 Then personally appeared the above named !!4hf 114-i 62AUc11 GAIL U A-UC t4 and acknowledged the foregoing instrument to be his free act and deed, before me. .'l•;- ', 1M I C i7 Avii Notary Publie-- __� � My Commission Expires: ;' '; '• t'`3A=w y ;, •• I x-/-1/q 2-- • '•• 2/92 mao It Printed on Recycled L_ Paper Commonwealth of Massachusetts *gip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. 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. Important:When A. Inspector Information filling out forms on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Allen Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 SI13747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); I have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my 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. 1J Passes 2. ❑ Conditionally Passes 3. 0 Needs Further Evaluation by the Local Approving Authority 4. 0 Fails 0.0.4D0..0M...wa.2 Brett Hickey DN cou.em m- 8-30-19 201900.00 110022.00'00 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 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 Commonwealth of Massachusetts _ F Title 5 Official Inspection Form v Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4---� 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth required for every Ma 02664 8-30-19 page. City/Town State Zip Code Date of Inspection C. 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 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: The system was in working order at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. 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. 0 Y 0 N ❑ ND(Explain below): ff t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts /4 Title 5 Official Inspection Form .41 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. 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 pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ 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 OYON ❑ ND (Explain below): ❑ obstruction is removed 0 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts fi Title 5 Official Inspection Form .,� Subsurface Sewage Disposal System Form -Not for Voluntary Assessmentsm-14 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection 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 (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. 0 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 ❑ 0 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:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments =Ili= 23 Edgewater Drive ATM Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ` ❑ 0 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 ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ O Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ o 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. ❑ El 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. ❑ 0 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•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. 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 C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes"or"no"for each of the following for all inspections: 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 two weeks? 0 0 Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? O ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) 0 0 Was the facility or dwelling inspected for signs of sewage back up? 0 0 Was the site inspected for signs of break out? O 0 Were all system components, excluding the SAS, located on site? O ❑ 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? ❑ 0 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: 0 0 Existing information. For example, a plan at the Board of Health. O 0 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 Commonwealth of Massachusetts Ii,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. lir - ,,. 23 Edgewater Drive `I' Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 3 Number of bedrooms (design): Number of bedrooms (actual): 443/GPD DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: 2 Number of current residents: Does residence have a garbage grinder? 0 Yes 0 No Does residence have a water treatment unit? 0 Yes ❑� No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection 0 Yes 0 No information in this report.) Laundry system inspected? 0 Yes 0 No Seasonal use? 0 Yes f1 No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: ***2018- 245,000gallons 2017- 298,000gallons*** Sump pump? 0 Yes El 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? 0 Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? 0 Yes 0 No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Owner- date of last pump is unknown Source of information: Was system pumped as part of the inspection? 0 Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. 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: 1992 per plans Were sewage odors detected when arriving at the site? El Yes ED No 5. Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑cast iron ID 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts =_ sel Title 5 Official Inspection Form _ = Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: 0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes 0 No 1000gallons Dimensions: 8" Sludge depth: 28"" Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 13" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle • Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: 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 Holding Tank(tank must be pumped at time of inspection)(locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ► _*� Title 5 Official Inspection Form 414_= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: El Yes 0 No Alarm level: Alarm in working order: 0 Yes El No Date.of last pumping: Date Comments(condition of alarm and float switches, etc.): • *Attach copy of current pumping contract(required). Is copy attached? 0 Yes 0 No 9. Distribution Box(if present must be opened) (locate on site plan): 0" Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. 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 . 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: D Yes ❑ No* Alarms in working order: 0 Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * 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: (1 ) 6'x4' pit leaching pits number: El leaching chambers number: El leaching galleries number: El leaching trenches number, length: ❑ leaching fields number, dimensions: O overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts • ► - , fi Title 5 Official Inspection Form = )= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments`�° 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): The SAS was in working order at the time of inspection. Pit had 1' of standing water with no higher staining when viewed. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): NA 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 0 Yes 0 No 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 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): • III t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. 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: LI hand-sketch in the area below ❑ drawing attached separately M ll 'r. lot elf 0, dt, ff . s1s ,40, 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: 0 Check Slope p Surface water 0 Check cellar ■❑ Shallow wells GW 4.5' below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 5-18-92 If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) O Accessed USGS database-explain: You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts , 1174 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Edgewater Drive Property Address Donald Gauch Owner Owner's Name information is South Yarmouth Ma 02664 8-30-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: I:j 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 p■ 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