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Home My WebLink About2015 May 13 - Floor Plan Sketch, Pages from Inspection Report , � V� � � �O o� `X � � � � � � � . � � � � _ , - � � � C� �a � � P � � ;� � � � —T o� a � �� , _ . '� P � � � � � � P V+ d +.' I � I � � �� `Z l V° � � �' � /� 9 N O -J � � � � � � � Y • � � � T. � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2 Nantucket Ave. Property Address � Richard Doyle �^ef Owners Name information is South Yartnouth MA 02664 9l30/2014 required for every page. City(fown State Zip Code Date of Inspedion Inspection results must be submilted on this form. Inspection forms may not be attered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information ,,,/// filling out fortns 1 �' � � on the computer, �/1 ,� use only the tab �, Inspector. �� \ � � key to move your � Q a,rsor-donot paulMartin O use the retum Name ot Inspec4or key. Nei hborhood Waste Water ` —V�I Company Name 350 Main St ` Company Address � W.Yarmouth MA 02673 Ciryrtown State Zip Code 508-775-2820 S15016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was pertortned based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP app�oved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: � Passes ❑ Condifionally Passes ❑ Fails ❑ Needs Further Evaivation by the Lopl Approving Authority 10/6/2014 Inspectors 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 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 the time of inspection and under the conditions of use at that time.This inspection dces not address how the system will pertorm in the future under the same or different conditions of use. t5i�rs•3H3 TNe 5 Olfiaal Inspection Fotm:Subsufidce Sexage Disposel System•Paga 1 M i] � , � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form -Not for Voluntary Assessments 2 Nantucket Ave. Property Address Richard Doyle Owner Owner's Name information is South Yarmouth MA 02664 9/30/2014 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check 'rf the following have been done. You must indicate"yes"or"no"as to each of the following: 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 infortnation. For example, a plan at the Board of Heatth. � � Detertnined in the field(if any of the failure criteria related to Part C is at issue appro�mation of distance is unacceptable)[310 CMR 15.302(5)) D. System Information � ��„d,,o � St�`��5�� Residential Flow Conditions: �'r'�`�T#`�J'S"-,,3 7 t�/C/�S^— Number of bedrooms (design): N�A Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N�A a� g�'� S—1,3/, s— �Sins•3113 TNe 5 Olfidal InspecOon Fortn:Subsurfsc¢g¢xa e Dis 9 posal System•Page 6 M 17