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Home My WebLink AboutInspection Report 2016 Feb 28 - ON HOLD; MUST UPDATE - See BGM Notationsi �` � - � � C � � U� � � � � . � � N � � � � � C�' � � � � � � ; i � � � o o � Q , .-�� G � f , � , , i O��Y`9� �� :- .�o TOWN OF YARMOUTH � '3 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 ��s MATTACMEES `G\ M�oq�a�,T�O`6�'� Telephone (508) 398-2231, Ext. 1241 -- Fax (508j 760-3472 .�a B O A R D O F H E A L T H March 16,2016 Robert Paolini Robert Paolini Septic Service 17 Playground Lane Yarmouth Port MA 02675 , RE: Septic Inspection Report, 55 Maushops Path, West Yarmouth Dear Mr. Paolini: A potential buyer of the above referenced property brought in a copy of the septic inspection that you performed to be reviewed by myself. After reviewing it, I found the following discrepancies in the report that will need to be addressed before you turn in the report to this office: 1. Swing ties for the distance to the septic tank and the leaching field on the asbuilt drawing on page 15 are missing. ' 2. The condition of the stone and the depth of stone were omitted on page 13. 3. Under depth to high groundwater on page 16, the total depth of the test hole, location of the test hole, what was the USGS adjustment, the site profile diagram and distance to wetlands were omitted. 4. A new test hole must be dug so that groundwater can be observed by this department. 5. Need floor plan with the rooms labeled. All of these items will be included in the final copy of the report that you submit to the Health , Department. If you should have any questions, please contact me at the Health Department. Sincerely, ruce Murp , PH ' Health Director BGM/mar ; Cc: File � ; ��,� �� ,�-� �,5- �� i � I7 �L r � ��-� � wl�y� � �� ,� ��U -- �..a..�v i�-�-�( ✓L — �- ra� � � i � G3C�CC�QMCD �""'"'""� MAf� i 5 2016 � ,� Commonwealth of Massachu� ,�, � Title 5 4fficial Inspec an Farm H�`�-TH DEPT. ; � $ubsurface Sewage Disposal System Form-Not for Voluntary Assessments ��4�� at�l� R�,� ' S5 Maushops Path �_��_ �� a�a�...._ _,��_.�.. � �d�.�� _ ... � Nropetry Address Tom F Y Owner _. .�_�_ - -�— inforrnafion is �ryBrs Nams , required ior every w•YsRnouth MA Q2'664 2l28N 6 �_m..,..a..�� .�.�..�a, _.�. page. City/Tovm State Zip Code Date of inapectlon ; ln��ect?�!+!�e�1!!t m�s!he�sbm�tted��+Lhis for►n.lnsRect4�!�forms may ne!be altered in��y . � way.Pieaae see compieteneas checktist at the end of the fortn. �m��:When A. General Information ' i61Nnp out forms i on the computer, � � use on�r Ihe teb �. Inspector: ,� key to move your I, cuBor-do not Robert Paolini � use the retum -a.:.�.�� _� ��_.v__�__._�-��, �— .... key. Name of Inapector Robert PaaHni Se tic SerYice ,� �__mM__ ,��_� Y �� Company Name , 17 F�'lay�tfttt�rtd E.�tiB Company Address � m. � Yarmoufh�ort � � �� MA 02675 ' CilylTown State Zip Code �� 508 362-3555 SI4454 ' �____, _ .e ___ ..��.��,. Telephone Number 4icense Number B.Certification i cert�ry that I have pe�sonally inspected the sewage disposal system at this adciress and that the iMormatfon reported below is true, accurate and complete as of the time of the inspectian.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved aystem Inspector pursuant to Section 15.340 of Tide S(310 CMR 15.000).The system: n QA$CQC rl �nnd�►.i�nally passes n F�I�S ❑ Needs Further Evaluation by the Local Approving Authoriry , � 2/28116 _Y..t _ �..��..�.� _.�.,. ��.. �. lZ:q^.�CfO�`��yr�:'�:C L��.0 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. tf 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�egional 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. ��R�IYkThis report only describes conditions at the time of inspection and under the conditions of use . at that time.This inapectian doss not add�s haw the syatem will perform in the future under the same or dHferent conditions of usa. tSt�•3lt3 ThN S 011lasl linprctlon Fam:Subw�faos Snraps pitposd SyaNm•papa 1 d 17 �� Commonwealth of Massachusetts ; �. w Title 5 Official Inspection Form ' Subsurface Sewage Dispasal System Form -Not for Voluntary Assessments =_ � ::��,�.`�' S5 Mausho�s Path � Property Address � Tom Foley Owner flwner's Name ,! information�s W Yarmouth MR 02664 2128/16 ,� requued for every ' page. C�Ffawn �Siate Zip Code Date of Inspection B. Certification (cant.} ❑ Pump Chamber pumpslalarms not operatianal. System will pass with Board of Nealth approval if pumpslalarms are repaired. B} System Conditionally Passes(cont.}: ❑ Observation of sewage backup or break out or high static water levei in the distribution box due to broken or obstructed pipe(s)ar due to a braken, settled or uneven distribution box. System will pass inspection if(with approvai of Board of Health}: II ❑ 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 inspectian if{with appraval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ hJ ❑ ND (Explain below}: C} Further Evatuation is Required by the Board af Heatth: ❑ 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, 1. System will pass uniess 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: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspoal or privy is within 50 feet of a bordering vegetated wetland or a salt marsh tfins•3li& Title!i Oif:caa!InsPecu�n Forir? Subsu.rface Sowage Dispesai Syslern•�i�age�3 of T7 ' t� Commonwealth of Massachusetts j Title 5 C�fficial Inspection Form j SubsurFace Sewage Qisposal System Form-Not for Voluntary Assessments � � . % 55 Maushops Path � Property Address __. Tom Foley Owner pwrer's Name +nformation is ,/,/.Yarmouth MA 02664 2/28/16 required for every � page. C�JTown � State Zip Code Qate of In,=,s�ection j B. Certification (cant.) �� 1 2. System will fail uniess 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(SRS)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 SRS is {ess than 100 feet but 50 feet or more from a private water supply well"". Method used to determine distance: *" This system passes if the weli water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of amrnonia 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. 3, Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"o�"No"to sach of the following for all inspections: Yes No ' � � Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspaol � � Discharge or ponding of effiuent to fhe surtace of the ground or surface waters due to an overloaded or clogged SAS or cesspool � � Static Rquid level in the distribution box above outlet invert due to an overiaaded ; or clogged SAS or cesspool � � Liquid depth in cesspool is less than 6" below invert or available volume is less than YZ day flow t5ms•3!53 ... .. . . . .. .. . . � -ii!le S OiFi..�al InspecUon Form Subs«rface:iewayc�Dt9posai Sysl�m�t��ge h o1 7? �. � ,,,�„ Commonwealth of Massachusetts �� . Title 5 Ufficial Inspection Form � , ��,° Subsurface Sewage Dispasai System Form-Not for Voluntary Assessments � `q�' i �'-�,;,� 55 Maushops Path Property Address Tam Foley Owner pWnePs Name information is �Yarmouth MA 42664 2128/16 required for every � page. C�tfbwn State� Zrp Code Date of Inspectinn < B. Certification {cont.) Yes No � � Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Rfumber of times pumped: ❑ � Any portion of the SAS, cesspool or privy is below high ground water elevation. i � � Any portion of cesspool or privy is within 100 feet of a surface water suppiy or tributary to a surface water supply. I t ❑ � 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 5Q feet of a private wate�supply weli. ❑ � Any portion of a cesspool or privy is less than 100 feet but greater than 5Q 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 fhat 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 2000gpd- 10,OOOgpd. � � 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 faiis. The system owner should contact the Board of Health to dekermine what will be necessary to correct the failure. E} Large Systems: To be considered a large system the system must serve a facitity with a design flow of 10,400 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 D Yes No ❑ ❑ the system is within 400 fest 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{lnterim 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 "yes" 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 upgrade the system in accordance with 310 CMR 15,304, The system owner should contact the appropriate regional office of the Department. � i5ins•3lq3 llt�e 5 OPfc�al Ihspeet�Qn Porsr SuLsuduca Sew6ge DispoBal SYstetrt•Paqn 5 at 57 ! Commanwealth of Massachusetts � � � ;A�� : ,� Title 5 Official Inspection Form � `��_ a ��= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l � �� II ' �:��i 55 Maushops Path Property Address Tom Foley I Qwner Owner's Name 1 informatinn is required far every W Yarmouth MA 02664 2/28/16 page. Cit�own� State Zip Code Date of Ins action .� ___ ___ .W C. Checklist Check if the following have been dane. You must indicate"yes"or"na" as to each of the following° Yes No �; � ❑ Pumping information was provided by the owner, occupant, or Baard of Heaith ❑ � Were any of the system components pumped out in the previous twa 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 abtained and examined? (If they were nat 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, ope�ed, and tha interior of the tarik inspected for the condition of the baffles or tees, materia! of construction, dimensions, depth of liquid, depth of sludge and depth of scum? � � Was the facility owner(and accupants if different from awner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location af 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 �elated to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] ._� e D. System Information Residential Flow Conditions: Number of bedrooms {design}; � Number af bedraoms (actual): � DESIGN flow based on 310 CMR 15.203 (for�xample: 110 gpd x#of bedroams}: 330 r v 2- P1/,/�� e5�ns�3!^�3 'I'i!ie 5 CY3iciat lrisuactian Form�5ubsurtse¢b'ewcayc�C;�sp�sat Sys!orn•Fr�ge 6 01 i�� f ( � I Commonwealth of Massachusetts ; � � Title 5 Official Inspection Form � " Subsurface Sewage Disposal System Farm-Not far Voluntary Assessments ,;;�� ,� ;�� 55 Maushops Path I Property Address i Tom Foley � Owner Qwner's Name intormation is W Yarmouth MA 02664 2128/16 rsquired for every • page. Git�/Town State Zip Code Rate of Insoection D. System Information Description: I 0 Number of current residents: � Does residence have a garbage grinder? ❑ Yes � No I � Is laundry on a separate sewage system?(Include laundry system inspection �] Yes � No information in this report.) Laundry system inspected? � Yes ❑ Na Seasonal use? ❑ Yes � No 2014: 11,000 Water meter readings, if available(last 2 years usage {gpd)): 2015: 4,000 Detail: Sump pump? ❑ Yes � No NR Last date af occupancy: oate Commercial/lndustrial Fiow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personsisq.ft:, etc.): Grease trap present? ❑ Yes Q No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: i5ms�3i i3 7�tle 6 0lfiriai Inspecfam Form��5ubsvrt�ce Sewsye UiaRasal Systern�Ptapa 7 car 17 � i i � w�� Commonweaith af Massachusetts �� y ;� ,� Title 5 C3fficial Inspection Form J , i�°' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i -- �� 55 Maushops Path ; -� � I Property Address ; i Tom Fofey � Owner pwner's Name information is W.Yarmouth MA 02664 2128/16 required for every page, CitylTown State Zip Code Date of InsQection D. System Inforrnation {cant.) Last date of occupancyJuse: Date Other(describe below): J � �� General lnformation Pumping Records: Source of information: g�� Was system pumped as part of the inspection? ❑ Yes � No if yes, volume pumped: gallons How was quantity pumped determined? - Reason for pumping: - 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}: � ISrns•31�3 Titis 5 Otl€c+a!I�spectior{'r�cm.Subsurlace 5ewage Caisposai Sysiem•?a�v fl r,.r i7�. . . i ! � � � Commonwealth of Massachusetts x : 3�:� Title 5 Official Inspection Form ��' ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � � �� ;_'� 55 Maushops Path � Property Address Tom Foley ; ' Owner pwner's Name ; intormat�on is W Yarmauth MA 02$64 2l28/16 rsquired for every � page. C�t�JTown State Zip Code �Date of Inspection � D. System Information {cont.) Approximate age af all components, date installed{if known} and source of information: Unknawn Were sewage odors detected when arriving at the site? ❑ Yes � No Building Sewer(locate on site plan}; 1' Depth below grade: fest Material of construction: � . • ', ❑cast iron �40 PVG ❑other(expfain}: - - �p�+ Distance fram privake water suppiy well or suction line: teet Comments (on condifion of jaints, venting, evidence of leakage, etc,): Joints appear tight No evidence of Ieakage.System vented through the building vents. Septic Tank(locate on site plan), � �,� Depth below grade: f�� Material of construction: � concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other{explain} If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?{attach a capy of certificate) ❑ Yss ❑ No Dimensions: 1000 gl. 3" Sludge depth: i5ins�3ft3 Tdir�5 i?;iicittl lnspeci�at F'arm 8ubsu+'�'aee Sewage Jisposai 5ystan�Paye 5 of 17 � � � �` se � }�� Commonweaith of Massachu tts � E�� .� ��.k Title 5 C}fficial Inspection Form ' _, . � Subsurface Sewage Qisposat System Form-Not for Valuntary Assessments �� 55 Maushops Path � Property Address i Tom Foley �' dwner Owner's Name informatio�is W,Yarmouth �/� Q2664 �f28196 � required for every page, ��k/Town St�t� Zip Code bate�af 1nSpeG#tt�n b. System Information (cant.) Septic Tank (cont;) I Distance from top of sludge to bottom of outlet tee or baffle 36" 0" Scum thickness Distance from tap of scum t�top of ouklet tee or baffle 7 Distance from bottom of scum to bottom of outiet tee ar baffle �2 How were dimensions determined? Measured Comments {on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid (evels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.lnlet and outlet tees are in place:Tank appears structurally sound. Grease Trap (locate on site pian): Depth below grade: NA feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain}: Dimensions: Scum thickness Distance from top af scum to tap of outlet tee or baffie Distance from bottom of scum to bottom of outlet tee ar baffle Date of last pumping: Date l5ins•3113 TitW 5 C}�fcial lnsPo��on�orm Strbsurfiac�Sewa�7a Uisposal Sysiem�Pay�10 af i 7 � i I � f i �. Cammanwealth of Massachusetts ; � . � Title 5 C7fficial Inspection Form � Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,t� :,°�$'� 55 Maushops Path ��-` Property Address ' Tom Foley UW�� pwner's Name � informatwn is W.Yarmouth MA 02664 2128J16 required for every page_ Cit lTo� _ State Zi�Gode Date of Ins ect�n _, 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.): I i I i 1 � i � 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: galions D2Sig� FIOW: galions per day Alarm present: ❑ Yes ❑ No Afarm level: Alarm in workir�g order. ❑ Yes ❑ No Date of last pumping oate Comments (condition of alarm and float switches, etc.}: *Attach copy of current pumping contract{required}, Is copy attached? ❑ Yes ❑ No ; t5�ns�3?i 3 Title 6 U{'io�ai�nspecnon Fc�rm SubsuAace Seway��[lisGe�a3 Sysiem�Pa��11 c�f 17 . � ( i ;'�°� Commonwealth of Massachusetts ' � �� Title 5 Official tnspection Form " }� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '� �� $,_ � ;,�'` 55 Maushaps Path � Property Address I Tom Faley � Owner Owner's Name information is W.Yarmouth MA 02664 2/28/16 ; required fior every � ' page. Cit�lTown �_ _� w _ m_ State Zip Code Date of InsQection �,� D. 5ystem Information {cont.� Distribution Box (if present must be opened) (lacate on site plan): Depth of liquid level above outlet invert NO Comments {note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage mto or out of box, etc.): Na E3-Box pressnt. , Pump Chamber(locate on site plan). Pumps in warking arder: ❑ Yes ❑ No' Alarms in working order: ❑ 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. , Soii Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ts�n5•3713 'ifle b Off�aaV Enspection Form:Subsu�faoa Sewage Uisposal Sysiem•Paqcs 12�af 1? f ;� Commonwealth of Massachusetts ,R- . --. . �- �� T�t�+� a t�fficial inspectian Form �ubsurfac�S+�wage Disposal System Form-Not for Voluntary Assessments Y �5 ivlaush�ps�ath _ _ � � Proper'y Address � Tom Foley , Owner Owner's Name ' infarmatian is W Yarmauth MA 02664 2/28/16 required for every page City/Town State�� Zip Code Date of Ins ection D. System Information (cont.) � Type: ❑ leaching pits number: [� leaching chambers number: [] {eaching galleries number: 1 2'x20' � leaching trenches number, length: : [� leaching fields number, dimensions: [� overflow cesspooi number: � innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of panding, damp soil, condition of vegetation, etc,}: Sandy soil.No signs of hydraulic failure, `l i , Cesspools (cesspooi must be pumped as part of inspection) (locate on site plan): NA Numbe�and canfiguration Qepth—top of liquid ta inlet invert Depth af solids layer Depth af scurn layer Dimensians of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ Na TRIe 5 OHiciai Irispoctiun Form Subsurtece Sewago O�sposai SYstem�PaQe'13 of 17 �� 15�n9•3i13 � � ( 1 �� ,�� Commonwealth of Massachusett� � �� Title 5 C�fficial Inspectian Form � � � W � Subsurtace Sewage Disposal System Form -Not for Valuntary Assessments r� , ,,;,,_ �� 55 Maushops Path � Property Add�ess � Tom Foley Owner Owner's Name � informativn is W.Yarmauth (t�A 02664 2/28/16 ; required for every � pag�. Cit l7own State Zip Code Date of Inspection � __.._ D. System Information (cont.) � Comments{note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): � Privy (locate an site plan}: Materials of construction: NA Dimensions Depth af solids ' Comments(note conditian of soi1, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tSirtis•5/13 '''1ll0 5 Offiaal inspuctlori Earm:Subsurface Scrv��a�a t7isposat Syst�sm�Page 14 crf 17 � � Commonwealth of Massachusetts 1-� � j � , Title 5 Official Inspection Form � �, � SubsurFace Sewage Disposal System Form-Not for Voluntary Assessments �� 55 Maushops Path Property Address Tom Fowley Owner pwner's Name information is �Yarmouth MA 02664 2/28/16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least twa 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 /� � ac��ad�� 1 /� � A�f� U �i Z016 � ,2� 3 � HEALTH DEPT. 3 �3 � ,� �l 3� �Q � 3�, 3a ti � z � � < � � ti° � � �� - l° ; o �� ; _____ �; _ .Co C � � � ° ' --_ ��. �-, _ . __ S .�, ` ;,, .� � �'�� .�� j� ►�`�,��, . `s' ' � t L- �l�,,, ' �-�� L� 'C�' / � f i �'ms'3/�3 Title 5 Official Inspection Fmm:Subsurface Sewage Disposal Sysbem•Page 15 af 17 . � f � Commonwealth of Massachusetts �� T"��t� � C7fficial In ' _ � spect�on Form ��e�rf�tce�wvage Disposa(System Form-Not for Voluntary Assessments 55 M�tusht�s�Path _ _��_�_��__: _�_�. � _.��_a��.;��e.�.. __ � ' �r Tom Farvley ._._.... � w�_e._�.e _ ._�.�� .._� � �m.. �� . 6wner informatbn is �cr'a Name � requiredtorevery W:,Yermouth �_ � ., _ . __� _�,� �� - �� . s 2/28/16 , _��..._�_�,� � page. G lTow�r; Skate Zip God�a i�te a� [[7►. ��n Irtfc�t�m��c�i1 {�ant.) Sketch Uf 5ewage Uisposal System: Provide a view of the sewage disposal system, Including ties to at least two permansnt reference landmarks or benchmarks. Locate aIl welis within 100 feet. Locate where public water supply enters the buiiding. Gheck one of the boxes belaw: 0 hand-sketch in the area below I ❑ drawing attached separately � _ ! i ! ��y�� , i .�. �.�--�- s K t5ins•3113 TiEe 5 ORicial Insp�ction Farm:SWsutfaeo Sewapo p�epasel Sy�em•Papa 1S�t7 � . �°�� Commonwealth of Massachusetts � �� -�� 3�� Title 5 C?fficial Inspection Form ` � --�� Subsurface Sewage Disposal System Farm- Not for Voluntary Assessments -�� `✓f 55 Maushops Path *� Property Address � Tom Foley ' Owner pwner's Name information is W Yarmouth MA 02664 2/2$/16 ' required for every a e. Git 1Town 5ta;e Zip Cade Date of Inspection ! P 9 ~ .��.��......,�....��_.�.� _,�. D. System information (cont.) � i Site Exam: � �� S 4 � � � Check Slope � � �� , � � i � Surface water ' ❑ Check cellar �> \� ❑ Shallow wells `/` � Bottom of leaching 4' � Estimated depth to high ground water: feet I 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: oate I ❑ Observed site(abutting property/observation hole within i 50 feet of SAS) � � Checked with local Board of Health -explain: As-Built � ❑ Checked with local excavators, installers-{attach documentationj [—'j Accessed USGS database-explain: I i You must describe how you established the high ground water elevation: , USED:U5GS abservation well data.USED:Technical bulletin 92-0001 annuai ranges of groundwater i elevations.Nand au�ered 5' below Ieaching.No groundwater observed. i .�--- �� II � Before filing this Inspection Report, please se� Report Compieteness Checktist on next page. Tille 5 Otiii�al Inspeet�an Form Subsur�ace Sewage Disposai Sysiam�Page 16 of 17 CSin5•3dt3 � I ! �� Gommonr�vealth of Massachusetts .,�� ' �� : �� Title 5 t�fficial Inspection Form � z Subsurface Sewage Disposal System Form-Not far Vo(untary Assessments 55 Maushaps Path i f�roperty Rddress { Tom Foley Owner pwner's Name information is W Yarmouth MA 02664 2/28/16 ', r2quired for every � ; page. Ci�l7own � State Zip Code Date ofi Inspectio� _____ _ �..i____.� . � E. Report Completeness Checklist � I � Inspectian Summary: A, B, C, D, or E checked I � � Inspection Summary D(System Failure Griteria Applicable to Ail Systems)completed � System Information—Estimated depth to high groundwater , � Sketch of Sewage Disposaf System either drawn an page 15 or attached in separate fife i I i I �I !��15�y�� 'i"i;la b Otf�.r.i;�i trrspaetE�n�crr! Subsurhrca SawcagQ[)�s�osa�:System•Pc��c+17 ot;7 , � � ._ r K� �� c� � G � � � (� � �► � � a 6 L d � � � � � � � � � � � � � $ � � �. fi � . g� � �' � � ~ � � � � � � � G� c � � � � � � � _ � � v ,�, � -mv _`� �1 r-I � � ' i I I