HomeMy WebLinkAboutInspection Report 2015 Nov 241
� ti�v 27 2015 10:58 Jim The Inspector Man 5085349919 page 1 ' 4
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; ■� � Cammonwealth of Massachusetts
. � Title 5 C,lfficiat inspection Form :._._. ���: _: : __�:.�..�. _,....
� Subsurtace Sewage Di�posal Syatem Farm-Not for Voluntary Assessments
°' 79 Ellis Cmcle _.._— —_. — — — --������J V
Property Address �
Li{lian O'brien --- — — — — .— ,. — --- — — .—.—.. —
Owner Owne�'s Name
information is Yarmouth ort MA 02675�. 11-24-15_. _ _ ._
roquired for evey ��y�� -e---- --- -- -- - State Zip Code Date of I�spection
P89e•
Inspectian resuits must be submitted an this forrn.inspection forms may not be altered in any
way. Please ses completeness checklist at the end ot the farm. -
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ImpoKant:wna� A. General information � '�„ q�3 �.��.� �����
fiiling vut forms � � t-�3 ,�..,� � �C}
on the cx�mpuier, ��� � c,�'" �� -�" ,f J <'�
use oniy the tab �. Inspector. u��Z '�j� �„�
key to move your � � �vg'j �
cursor-donot JamesD.Sears ---� �--,�,`=
use the retum —— —— — ,�-—— f— — -- ._--...— �_. _—_._.. �
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ksy Nama of Inapeator G � �.,�� 1�
Capewide Enter�risesLl.LC __�t_�_ _ _._ _ �__� — —��� -�-
� ComPany Name �,.�. �.�✓� ✓
153 Cornmercial Street __._ —�a- ����
� CompanyAddresa — —^ -- — --- 3 �
i � Mash e�e _ --- --. MA _----_.� 02649 �'
Criyffown State Zip Cade ,
508�F77-8877 S1623 _ — — �' ��
� Telephone Numbar � � License Number
iUt''� ..a ( -� -
----�-= �
B. Certification
1 certify that I have personaily inspected the sewage dispos system at this address and that the
information �eported below is true, accurate and cornpiete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal sysierns. 1 am a DEP approved system inspector pursuant to Section 15.340 of
Tltl�5(310 CMR 15.000�.The system:
� Passes ❑ Cond�tionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
.,
� �.----- — _ 11-24-15 _ --.__..._ �
� spector's Sgnature 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 systern is a shared system or
has a design flow of 10,000 gpd or greater, the inspecto�and the system owner shall submit the
report Eo 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 onty describes condltions at the time af inspectfon and under the conditions oi use
at that time. This inspectlon does not address how the system witl perForm in the ftrture under
the same or different conditions of us�.
lSins•9HJ r�ne 5 Ortwal Mspectlon Form:SubsuAaoe Sewape D'aposal System•Pape t of'7