HomeMy WebLinkAboutInspection Report 2015 Apr 02 t
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� Commom�rea�tt of Nlas�.sachusetts � . _- _ �_.�.
-� T�#�e 5 t�ffici�l lnspection Form � Ar R �' 7 ZQ95
': Subaucfaoe Sewaye Dispoaai Sy�em Form-Not f�r Vai�ary Assessmerrts �
' 83 Seavi�w Ave S Yarmouth MA � t E; -,��-+-
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' `'r°�ry"dd"�Elaine M Grandolfi c/o Robin M 1ay 465 Commerce DR
Owna Ownds IJ�ns
�°�°"� Fort Washington PA 19034 4f 2/2015
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� inspectlon results anust 6e wbmitbed on this Wnn.tnspedion farms may notii��et��n anY ��
� way.Please see c�omple�eneas d�eddiat at ihe e�d af the 1bnr�. ,`: ..
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� r�«�r� A. Generat In�rma�ian
a,cne corrp�aer.
use or�r�e t�b 1. �spect�
Iaey�move yar
cusar-do not
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Teleptane IW�mber t.icerme Nuriber
B. Certification
I cedify tl�at 1 hav�e person�ly inspected the sewage dispos�system�this address and that the
information reparrt�bebw is true, accuta�te�d complete�ofthe ti�ofthe inspe�tion.The inspection
was perfamed b�ed on my training�d experier�e in the proper Tunction and maintenance of�site
sewage disposai systems.!am a DEP appe+�red s�►�em i�spector p�usua��Section 15.3A0 of
Tit�e 5(310 CMR 15.000}. The system:
❑ Passes �Ca�ditiat�ly Passes ❑ Fails
❑ Needs Fuctl�er Evaluation by the local Approving Authority' J Z
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The sys#em inspector shaM s�a copy of this inspection report to the Approving Authority(Board
of Heelth a�DEP)w�hin 30 days of cotr�piexing Uus inspection. ifthe systenn is a shared system or
l�as a design Aow of 1Q,Ot10�d or�e�ater,the inspector�d the syst�n owner sheil submit the
repat to the approptiate regionai offiee of the DEP_ The original should be sent to the syst�n owner
and copies serrt to the buyer. if��cabk, and the approving authorit�/.
""'This report�ly des�xibes oondieions at the time of inape�tion a�u!unde�the oonditions of use
at that t��.Thia inspec�on dces not addrsss how�e system will perinrm in the future under
t�e aame or d#f�er�eM oanditions of use.
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� � Commonweaith of Massachus�ts
- Tit1e 5 Offici�l inspection Far�m
Subauriace Sewage Disposesi Systism Fom�e-I�c i�va untary assessmerrts
83 Seaview Ave 5 Yarmouth MA
�°�``''A°°"�Eiaine M Grando{fi cjo Robin M 1ay 465 Commerce DR
�� Ownds I�ars+e
'"'°�"'�°"� Fort Washington PA 19034 4/2j2015
r�tor every �tTown S� 2�Code D�e d hspecfion
B. Cer�ificatbn (c�ort.)
inspection Summary: Check A,B.C,D w E 1 alwsyscompiete afi ofSection D
A) Sysbem Passes:
❑ 1 fiawe not�und any in�m�t�n which inc�cates that any of the failure criteria described
in 310 CMR 15.303 ar in 310 CMR 15.304 exist.Ariy failure crit�ia not evaluated are
indica�ed below.
Comments: .
B) Sys�em Conditionally Passes:
L�One or more system componeMs as described in the'Candiqonai Pass'sedion need to be
repiaced or repaired. The system. upon compigtion ofthe repNacement or r�epair, as approv�ed by
the Board of Heaith,wifl pass. '
;
CF�eck the box�nr'yes', 'no'or'nat deterrr�ned'(Y, N, NO)for the fotbwing statemerrts. iF"not i
de�erntined�'pisase expiain. ,
The septic taMc is met�and ov+er 20 y�rs old"or the se�ic tank(wh�her met�w nctj is shucturaliy
unsound, �cfii�ts s�starr�t in�ra�ion ar ex6ltra�ian or tank failure is immineM. Syst�n will pass
irispection if�e existing F�k is replaced vwth a compying s��t�►k as approved by the Board of
Heafth. '
•A tnetal septic tank wili pass inspection if it is structureNy sourui, rrot le�cing and if a Certifica�e of
Comp�ance indicating that the t�tk is tess than 20 years otd is availaWe.
❑ Y ❑ N ❑ ND(Explain iie�^w� '
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� T�tle 5 Offici�l inspection Form
Subaudaee Sewa��sposal SysOem Farm-iVot for Volwi#ary Assessments
83 Seaview Ave 5 Yarmouth MA
1 �a`�laine M Grandvifi c/o Robin M Jay 465 Commerce DR
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p�g�. cSi�,rraam s'�Ee z;p coae o.oe or r�pection
� B. CB�hf Ca't1011 (oont.)
❑ Pump Chamber pumps/al�ms not operational. Syst�n will pass w�h Board of Health approval if
pumps/�anns are r+epaired.
B) Syabem Conditionally Passes(cont):
❑ �rs�ion ot sewage backup or txealc out or high sta�ic waker lewei in the�stribuiro�box due
to broken�obstructed pipe(s}w due to a broken, setEled or unev�en�stribution bo�c. System will
pass inspecti�if(with approva�of Board of He�th�
❑ broken pipe(s)are replaced ❑ Y � N ❑ ND(Ex�ain below�
❑ obst�uction is removed ❑ Y ❑ N ❑ ND(Explain below�
❑ distribution t�c is te�eled o placed ❑ Y ❑ N ❑ ND(Expiain below�
' ❑ The stem required p�xnping m�e th�`4 ' a year�e to broken or ob.structed pipe(s} The
s tem wilt pass ins�i�(wiM a� ofthe Boarti of He�thj:
broken ppe(s)are Geptac ❑ Y ❑ N ❑ ND(Explain betov�j� . '
❑ obstruction is rem ❑ Y ❑ N ❑ ND(Explain bdfyq/�
Cj Further Evaluation is t�equired by the�ioard of Hesith:
❑ Carf�tions exist which req�re iurther evatuatit�by the Board of Heetth in oNerto determine if
the system is isiling to protect public h��th, safi�y or the enurormtent
1. Sys�em wit pass uMess BoaM o#Heaith defemri�ia aocardsrn�e with 310 CMR
15.303{1){b)that the system is rat iunctioriing in a mannerwhtch wili proLed pubiic heaith,
sat�ety and the envaronment
❑ Cesspool or privy is within 5d fe�of a stuface water
❑ Cesspoal or pdvy is within 50 feet of a bordering�egeta�ed wetiand or a sait mars h
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? � Cormmonwea�h of Ma�sachusetls
3 Title 5 C}ffici�l inspection Farm
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j 83 Seaview Ave S Yatmouth MA
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; �'`�'�taine M Grandolfi c/o Robin M 1ay 465 Commerce DR
; �� Qanah Nla�rie
��^� �ort Washington PA 19034 �/2/2015
� ���� c�y/Town S�e Zip Code t3aie oi hspection
; B. Ce�tification (cor�.)
� g, gy�lem wil�hi1 auNessthe Bos�d ot HeaNh(and Pubiic Waler Su�lier,if an�
j de�ern�iqes that the sS/s�em ts iwnctioning in a manne�tlwt pro�ects ihe public heallh,
�
� safety and envi�onEnent -
� ❑ The system t�as a septic t�k and sal absorption system(SAS}ar�d the SAS is within
� 10Q ket of a stuface wate�supply ar tributary to a surface u .
❑ The system tms a se�ic ta�k and SAS and t is w�hin a Zone 1 of a pubiic water
s�pty_
j ❑ The system has a septic ta�k and S ar�d the SAS is within 50 feet of a private water .
� � supply welL
� ❑ The sys#em t�as a se�ic t� SAS and the SAS is less than 1�0 feei b�50 feet a
� more from a private watet phl w�ell".
i Method t�s�to det dist�ce:
�
� *'Ttris system pas if tt�e weN water an�lysis, perfcxmed a�a DEP certified I�roratory, ia tecal
� coGbRn b�tetia' ' �absetrt and tl�e Presence of a�rnnonia nitrogen and nitra�e mtrogen is equai
to or less tt�n m. provided that no ether failure critetia sre tri�ered.A copy ofthe a�lysis must
j � be attached th�tbrm
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D} Sysbem Faiiure Ceiie�ia Applicable bQ All Syslems:
� Yai�indicate"Ye�' or"No"�escfi dithe iioflowing tbr�,inspections: '
Yes No !
� R,( Backup of sewage i�o�acility or system component due to ov�erbackd or
y� ctog�d sAS a c�sspa`ot
� � discharge ar ponding of ef�uent to the surface of the�ound or surface waters
due to an ov�edoaded or clogged SAS a cesspool
� Stat�tic�id level in the�listrib�ion box abave o�let invert due to an ove�loa�d
; � or cicgged SAS or cesspool
' � � tiqttid depRh in cesspoa�is tess tt�an 6'below inve�t or availabie vdume is less
itF�an'r4 day�ow
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� • � COI'r11110i'IWaBa1�t Of�B�aCttU8@�S
� - Title 5 C?fficiallnspectian Farm
� Subaurtace Sewage Disposal Syslem Form-Nd br VoluMary Assessmerrts
; 83 Seaview Ave S Yarmauth MA
{ ���laine M Grandol�i % Rabin M Jay 465 Commerce DR
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page. �yRc�wn st�e zrp cxae oa�e of r�pxuon
B. Certification (cor�.)
Yes No
� � r� Required pumping mo�e tha�4 times in the tast year NOT due to clogged or
�' P�l abstn�cied pipe(s}. I�mber oftimes pumpad:
❑ � Arry portion ofthe SAS, cesspod or privy is beianr high ground water elevation.
� � Ar€y pordon of cesspaoi or privy is w#hin 100 i�t of a surface wa�er suppiY or
tn'twtary to a s�face waker s�ply.
❑ � Arsy portion of a cesspool or privy is within a Za�e 1 of a pub�c weil.
❑ � Ar�y poFtion of a cesspa�or priyt is within 50 fe�of a private w�e�s�ply w�eit.
❑ � Arry portion of a c�sspooi or priyt is�S.s than 100 fieet but greater tl�art 50 feet
�-om a privake water supply weil with no acc�tabie wat�quality analysis. [This
sys�em pasaes if ihe well waler anatyaia►Per�rmed at a DEP certified
lal�oratiory,ti�r t�ec:at ooli�orm baale�ia incfica�es absent ar�d ihe preaence
of ammonia�trc�n and nitrate nitrogen!s equai 10 or iess than 5 ppm,
provided that no ofher faiture��ia a�e trigger�ed.A copy of tf�analysis
and chaie ofcus�ody mu�be s�ed�lhis form.j
� � The system is a cesspool serving a facifity with a des�n flaav of 200�d-
10,0009Pd-
� � Tha systiem� I t�v�e detemn�ed that one o�more ofthe above failu�e
crite�ia exist as described in 310 CMR 15.303,therelbre the system faits. The
system ahrt�er should cpntact the Board of Heatth to d�ermir�wha�witi be
necessxyt to cxir�eCt the�tute.
� La�+ge Sysiemx To be oa�aidered a la�sys0em tbe syslem must sen�a faci�tty with a
deaign flaw of 10,d00�gpd to 15,Q00 gpd.
For la�ge systems, yau rrnist ind�a�e either'yes'or'r�"to e�Nowing, in additia�to the
questions in Section �.
Yes No
❑ ❑ tt� is wrttun 400 ieet�a surtace drinking wate�suppty
;
❑ ❑ the system is within 200 te�of a tributary to a s�e drinking water supply '
❑ ❑ the syst�n is locaked ir�a nitrogen sensitive ar�ea(Interim Wellh�d P�ection
Area—MIPAj or a map�ed Zone �of a public water supPly wel�
!f you hav�e answered`yes'to a�r�tia�in S�tion E the system is conside�ed a s�ificant threat,
or answ�ered'yes'in Sectiae O abovee tfie large system has failed The own�or oper�or of ar�y targe
system considered a sigrti#carrt fluest under Section E or fiailed under Sectiai D shatl upgrade the
syste�n in accorc�nce with 310 CMR f5.304.;Tt�syst�n owner shoWd car�tact tt�appropriate '
regionai af6ce of the Departmer�t.
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. �, Commone�realth of Ma�sachusetts
�� T�tle 5 Official Inspection FQrm
Subsurtaoe Sewage Diapoaa!SYsoem Form-Nat 1br VoluMary Rssessrr�ds
83 Seaview Ave S YarmoutM MA
���)aine M Grandolfi c/o Robin M 1ay 465 Commerce DR
Q""� °iwn�"� pq 19034 4/2/2015
�°""'�°"'� Fort Washin�ton
reyuirca ror even► � �� mee a�specuon
p�, �rlrown
Ci. �i�'Ck�$#
Checic ifthe fioliowing hav�e been done. You muat indicate'yes'or'no"as to each oftt�foilawing:
Yes No
Q� ❑ Pumping information was provided by the owner, occupatr[. �B�rd of Hesith
❑ ['� Were arty of the sYstem compone�s pumped �in the previous iwo weeks?
❑ ((� Hss the system received normai Aows in the previous finro vresk period?
❑ e/ Havae Ia[+ge volumes of vKater be.en�kroduc�d to the system�c�ty�as p�t of
this inspectioet?
�-./ ❑ Wene as buiit p�r�s ofthe system obtained and e�c�nined?{Itthey vMsre not
��J" a����e►,a�B as wa�
�� ❑ Was the facility or dwei�ng inspected fa si�of sewage t�ack up?
0� ❑ Was the site it�p�ted�r'signs of bnaak ait?
/1G
"� ❑ Wec+s�t systern compo�errts,�.inditAg the SAS. i�ated on site?
❑ ❑ We�e ttte se�ic tank manhofes uncov�ed, opened. and the ir�terior ofthe tank
i�pected lforthe condition ofthe baf�es ortees, material ofc�nstruction,
d'anensions� depth of tiquid. depth of skidge�d depth of sc�n?
i� ❑ W�the iac��y awner(and occ�anta if�f�ereM from own�)proWded with
info�nati�on the prap�mair�ena�ce of subsurtace sewage�sposai systems?
The size and location of tf�e So�Abacrpt�n Sysbem(SAS)on the site has
been detemm�inned based bn:
� ❑ Existing infotmation. For�cample, a�rt a�the Board of H�ith.
�/ � Determ�ed in the�eid('rf any of the faiiure c�eria related to Part C is�issue
- a�roocimatio�ofdistanc�is �accept�te)[310 CMR 15_302(5)J
D. Syst�n I�f+arma�iort ;
Reaidentis� Fiow conaitlon� � �
N�unbef of bedroans(design}: Nwnber of bedrooms(actuaix n
oZ o��
DESiGN�ow based an 31t�CMR 15.203(for exa�ie: 110 gpd x#of bedrooms�
�B•�3 71Cs5�f Wi InspeCMmFom[3�rhee 9lrwpeDhpay System•Page 8ot t7
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. � Co�nwea�of Ma�sachusetfs
Ti#le 5 Off'ici�l lnspection Form
Subaudaae Sewage Disposat Sya�em fcsrm-Not�Vol�tary Assessments
83 Seaview Ave S Y$rmouth MA
�"'�"Etaine M Grandoifi c/o Robin M Jay 465 Cammerce DR
aM�r ow�rs n�
�^��''D"� fort Washington PA 19034 4/2 2015
`e�d for even` �NTawn Sf�e� Zia Code Dsle of r�spectbn
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D. Sys�n Infiorrrratian
oes«ipfian: ' l O!�( /�ar. / GI�''+ �
" dr� yG� ��f�.ti.. �r
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N�nber ofcumer�resider�s: � -
Does res�lence have a 9��9�5��� ❑ Yes� No
ls laundry on a separate sewage system?(tnclude laundry system inspection � y� (�( No
iMortnation in this report.} r
�u�ry Syst��S�t�a? it1 fA"'O Y� ❑ No
II� Seasonal�se? � Y� ❑ No
I �
j Wat�meter r�dings. if avait�le(Nast 2 years usa9e(9Pd?}�
' Detad' � j t� : s��� �
� ��V i � ���
� S�p P��� a ,res � No
; oZ 1
� Last aate of ocra,pancy: oaee
Commer+raa!llndustrial�laar Condition�
7ype of Estab�shment:
Design�ow(based on 310 CMR 15.�3): �y
,..�:.�_
Basis of desi�Aow(seats/persons/sq.ft.,etc.}:
Grease trap pr�esent? ❑ Yes ❑ No
Indusbi�waste holcN nk preserrt? ❑ Yes ❑ No
! Non-5� te discharged to the Title 5 system? ❑ Yes ❑ No
Watermet�r�dings, �availabie:
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� COtnmonw+ea�h af Massachusetts
Ti#1� 5 Ufficiallnspection Form
Subsurfaae Sewage Disposai Sybtem Form-iVot ior Volw�tary AssessmeMs
� 83 Seaview Ave S Yarmouth MA
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' �"°d"�laine M G�andolfi c/o Robin M 1ay �65 Commerce DR
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r�ra.ever,► ��rawn st� zQ code oeta of r�speeuo�
D. Systern in#orma��on {c�or�t.}
l.ast date of occupancylUse: p�
Ofher{dessxibe belaw�
: ���������� or 9y� ��u,I�� �vao5
� r
Pumping Records: �j�2� �� Q9 /�O� Y/t7 �y
-cr �F�: � �
Sou►Ge of iniortnation_ � �
Was system pumped as�t of the inspechion? ❑ Yes Na
if yss, wlurr�pumped: 9��
Howvv�4��Y�P� determir�d? .
R�son for pumping: '
Type of Sys�em: �
(� Septic t�k, dist�ution box, sal absor�ion system
❑ Single cesspooi ; �
I
p Ove►�Aow cesspoot
❑ Privy
❑ Shared system{yss or noj(if yes, attach previous in.spe�tion records, if a�yj '
❑ M�ovetiv�e/AltemaRiwe technology.Attach a capy of tl�e cune�operation�d
mairrtenance co�ract(ta be obtained fi�m system owner)ar�a capy of fatest
inspection oftt� YA syst�n by system apera�or under contr�t
❑ Tight tank.Attach a copy ofthe�P a�roval.
❑ �h�(describe)_ '
LSNs•3It3 TYMS�ItnpefanPar�9uEsrfare9�wopsOilpoYtS�pn•Paa8oflT �
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� � Commonweafth of NlassachuseUs
- Tit1e 5 C�fi�i�l tnsp�ction Form
3ub�u�oe Sewage DisFwsal Sya�em Form-Not tbr Yoluntary Assessme�s
83 Seaview Ave 5 Yarmouth MA
�14�laine M Grandolfi cJo Robin M 1ay 465 Commerce DR
°'""� °�'"�"� pq 1�3q. 4/2/2015
�Or"�'°"� Fort Washington
req`e"ea rar even' � r�p Code aa�e ot r�spection
�, ClylTown
D. Systern inforrr�a#ion (c�ont)
Approximate age of aN componerts, date instalied(if known)and sounce of in�rmation:
�. Cars � �� Q�-- 8 �
Were sewage odo►s detected when ar►iving at the site? ❑ Yes� No
Buiidir�Sewer(ixa�e on site pl�):
n. 2 '
Depth belaw grade: fe�
Material of construction:
( � �ast iron �40 PVC ❑ other(explai�x
Distance from private waier supply well or suctia�W�e: f� 'v
Comme�ts(on condition af jartts, venting,e�idence of lealcage, �c.): .
��
Septic Tank(iocate on site plan): ' � ;
oepth belaw gra�: f�
Mat�l of construct�n: I
[�ca�crete ❑ metal ❑ fbe�ass ❑ pdy�ttylene ❑ other(explain)
� �
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IftaMt is metal, tistage: y�,s
Is a�canlirmed by a Cerd6c�e of CompGance?{altach s copy of cefificat�� ❑ Yes ❑ No
g'�� x ' � �� �j� �
Dimensions: ��� '
Sl�ge depth
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. i � Cidtiti�tD�a�i O��fiS'dC�'tli88�S
- -� Tit�e 5 Of#�ci�l lnsp�ction Farm
subsu.race sewa�aaposa�sys�em Fo�m-Na io�vd�ary nssessm�s
83 Seaview Ave S Yarmouth MA
�°�"""�laine M Grandolfi c/o Robin M Jay 465 Commeree DR
ownv owr�er�Mame
�f�°^� fort Washington PA 19034 4/2j2015
reyuirea�oreverr � �� oale a r�specmn
�, Ciy/Town
� D. System infarrrrafi� (c�ont-)
� Septic Tank(cont.} ..�
�, ��
Distance,fr+nm top of sludge to bdtom of o�l�tee or bafae
�
Scum thickness
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Dista��ce from top�scum to top of o�let tee or bafAe i—��
�
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pistance#rom bo�totn of scum to b�.fam of oudet tee or ba1Ae i
�
��� ��
� ians detemnined?
How were�mens
'ion struct�sl ir�t
condd .
Comments{on pumping r�ommendations, inl�end a�tigt tee or baMe . e9MY ,
liquid lev�eis�related to autle�invert, eWdence ofileakage, �c.}
G '�-2
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C�+ease Trap(locarte on site plan):
Depth below grade: teet
Materiai af construction:
❑ concrete ❑ tnet� ❑ 6berglass pdyethylene ❑ other{expiainx
Dimensions:
Scum tluckness
Dist�ce frwr�#ap of scum to t of arttet tee or bafle
pistance from bottom o cum to bottom of o�i�tee or baiRe
O�e of last pumpng p�
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Tit1e 5 Offficial lnspec#ion Form ;
s�w���sews�aK���sy��F�.-�r�c t�v��nr M� S�
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�A�Elaine M Grandolfi cjo Robin M Jay 465 Commerce DR ;
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D. Syst�n inforrrra�ion tc�ont-} '
Comments(on PumpnB recarunendations, ir�and outt�tee or bafAe ia�, structural i�e9�Y�
liquid�v+eis as rdated tc out{�inv�rt. evidence of leakage� �c.k
Tight or Ho�ing Tank(tank must be ed at tane of i�pectiort){IocaRe on site pian): '
[�pth belaw grade:
Mat�ial o#constructian:
❑ concr+ete ❑ ❑ 6ber�ass ❑ P�Y�Ylene . ❑ other(exPlainx
Dirr►ension.s:
C�acity: gaMo�s
Design Fic�u+r. qamns�da�r
;
Alarm pres : ❑ Yes ❑ Na �
Aiamn le : Atarm in wa�i6ng oider. ❑ Yes ❑ No
' DaRe of t pumpin9: De�ee
Com ents(candition of alarm and Roat svatches, etc.x
•Att�h copy of current pumping contract(required} is copy attached? ❑ Yes ❑ No
TMsSOMtialbpcYmFa�[8u0wrho�9sr+Ys�sY��'�De 71 d 17
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� Commonwea�h of N�t�sachuaetls
Tit1e 5 t�ci�l inspe�tion Form
� Subsutiaoe Sewa��sposai Sysbem Form-hbt for Voiwrtary Assessmerrts
! 83 Seaview Ave 5 Yarmouth MA
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p�ye. Q�l�tRcwn Smfe Zip Code Del�of i�spection
D. Sys�n inforrrtatiat (oont)
Oiatributlon Box (if�eserrt must be opened)(locate on site plan j:
i
� Depth ot Ciquid ternei �ov�e ouNet inv�ert
� Commer�ts{rrote if box is le�e!and t�stribudon to o�l�s equ�, any evid�ce ofsdic�carryov�er, any
eudence af le�cage ir►to or o�of b�c, �c.):
Q/� � 2 ���e�.
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Pump Cfiamber(locate on site ptan): .
Pumps in woricing ortier. ❑ ❑ No'
Alam� �workir�g order_ ❑ Yes ❑ Na*
Canments{nate aondiqon of pump chamber,c�d'' p�unps�d appurte�nces, etc.):
'if ptenps or are n�in vMorking order, system is a ca�ditianai pass.
Sal Sys�eee�(SAS)(lac�e on site plan, excavatian rat r�equired�
If nck bca�ed, c�cplain why:
ISMs•3ft3 TdNSQLeh1 iro �
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i 83 Seaview Ave 5 Yarmou#h MA
;
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' D. Sysi�n in�rrra�ion (oont)
�
; T��:
❑ leaching pits number.
❑ leaching chambers number:
i
�� ❑ ieaching g�ieries nwnber.
. {�ching trenches n�anber, length: � 1� { �t��� ���
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, ❑ teaching�elds nurrtber,dimens�s:
1 ❑ overiow cesspod n�nber:
� ❑ innovative/�ema�ive systern
,
� TYPdaame oftechndogy:
i
Commer�t.s{note conditian of sail, signs of hydrauiic fa�ufe, tevel of pond'mg,damp sal, con�tion o#
veg�atioa, etc.}:
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Cesspools(cesspoo!rrwst be pumped as part of inspectionj(iocate on site Pian�
Nixnber and configutation
Depth—top of 6quid to iniet inv�ert
Oe�h of sdids layer
Depth of scum layer
Dimensions sp�l
M of construction
�td'+cationo#grcwndvKaterin�w ❑ Yes ❑ No
Q�s•3rsa rwssaneirsap.cYonFanc sumuraa.8�vrgeOhvm►syaem•wps t3a n
� � corr�rnrn��eafct,of nsassacrwsetts
; Titie 5 G?#ficial lnspection Farm
� Subsurtace Sewage Disposai Syabem Form-Nd ii�vdurrtary Assessmerrts
; 83 Seaview Ave S Yarmouth MA
; �"�laine M Grandoffi - c/o Robin M 1ay 465 Commerce DR
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� �O""�0�'� � o Washington PA 19034 4/2/2015
� ���� Ciyr/fawn Staie ZiP Code Oo1e d
� D. Sysfie�n Iniorma�ion (aor�t.)
,
� Camments{nde condition ofsa{, signs ofihydraWic fai�re, level o ding, condition of vegetakian,
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Materiais o#construction:
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Comments(�te c '- n of sal, signs of hydr�lic fa�re, lerr�of ponding,cond�ion of vegetati�,
etc.):
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, Title 5 Offici�l lnspection Form P�ss
Subau�aoe Sewage �isposat Sysiem Form-Not br Voiw�tary Assessrt�ents
� 83 Seaview Ave 5 Yarmouth MA
i
i �"�taine M Grandolfi % Robin M !ay 4GS Commerce DR
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�''°"'�°"� Fort Washi�gton
���� �ly/�own Staie Zip Code Oale af tispection
D. Systern lnformation (c�ont)
Sketch�Se�wage Dispasaf System: Pr+�vide a view ofthe sewa�dispc�sat system, ir�luc5ng ties to
at least two pertn�ent ref�e�e l�dmarks or benchmarks. Locate�i w�elis within 180 feet. Loca�e
v�fiere put�c vv�er suppiy enters the b�ng. Check one ofthe baoces beloar.
� �hand sketch in the ar�ea bdow
❑ drawing atfiached separatety
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= Ti#le 5 Official lnspection Form
; subsurtace sewage uis�osal syseem Fo�m-n�at t�vau�tary Assessments
i 83 Seaview Ave 5 Yarmouth MA
3
' ��laine M Grandoffi % Robin M 1ay 465 Commerce DR
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' reQ�rred f°r every S�e ZiP C�ode Qa1e of i'ispec�on
j p�_ �r/Tawo
' D. Sys�ern infa�r�i�on (c�orrt.}
;
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� Check Siope
�Surface waker N,�''
; [[t�Check cellar :
I �✓ .
� tsi Shaibw wells /t��.�. � �
I Estimated de�h to high ground water. f� •
�
� Please indicate atl m�hods�ed ta detemdt�e the i�gh g�nd vrater e�vation:
�
�
� ❑ Obt�ned �rom system�ign pians on record
�
'' IF checked, date of design�an teuewed: �
((� Obsenred site(abutting prc�erty/observation hole within 150 feet af SAS)
/i
❑ Checked vwth loca!Board of Heaith-expiain:
' Q Checked wiEh 1«�i excavatars, inst�lers-(attach documeMati�}
� Accessed 11.SGS da�abase-expi�n:
;
F%�.t ixpt'�----
You must describe how you estabUshed the t�gh ground vvater elev�ation:
�• � S 2�QV a S ��t
a- d� r�l �
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i �• u.��► � a 2 — @ti- � f-� . ! = Z.�S
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Belbre tiling lhis tRapecfiar laep�t, pteaae see Report Compiete�ess Checklist on next page.
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�
; � Title 5 �cial lnspection Form
! subs�,�l`ace sewage as}�osa1 syst�m FOrm-Nac ta va�tary Assessmerrts
' 83 Seaview Ave S Yarmouth MA
�''°P°``''"�'°"Elaine M Grandoifi cjo Robin M Jay 465 Commerce DR
aN� o�►�s r�me
��^� Fort Washington PA 19034 4j2/2U15
��� GSty/Tawn b'd0e Ztp Code oaoe af hspeetion
E. Report Complel�r�ess Checklist
Q�Mspectan Surrr�r�ary: A, B, C, D. or E checked
[�6hspection Summary D(System Faikire Ctite►ia Applicable to All Systems)aompleted
C'�Syst�n�bm�ation—Estir�ted depth to h�h groundwater
� �Sketch of Sewage[�spos�Syst�n either drawn on page 15 or ai#ached in separate file
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