HomeMy WebLinkAbout2015 Dec 07 - Vision Assessor's Info, Insp. Report Pages - Bedrooms F
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Cornmonwesllh of Massachusat�s
� • e�tion Form :�;.: ;, ,�.��,,
Titie 5 Offic�al Insp ,�.:.� t �.:.
Subsurfac�8rwa�DisP°���°�FO�'Not for Voiuntary Assessme�ffi �q(."[����
South Yatmouth M-60 P- ;
214 Oid Main � �?"�, k' .� '�
Prop�rh���
iG9nn@1h DO r
�� own�rs�ame .�a 28 �0'12 ` .
���y 214 Old Main Str+eet.South Yannouth � �� wa ot in�psaion s
P�• CNylT°wn �'
�nspaction resu�s must be submittsd on ri+is form•ln�sPs����y not be alt�ared in any ;
checkii�at tlts and o�the torm. ;
way.PNase sa� �
�,� A. General Information O p
��.�. C�O p� �
�
we onl�►the+m ,. ��sp�: ,,
k�ey tio mae Y�ur �I
aasa-ao na Tro Wilfiams
use ths r�tum N�ns of Impec� I
�' Tro V1�Iliams � � I
� �� I
� 19 Humme��rive '
�
� comparni�� � 02660
I i� South Dettnis � z�a�
c�r°""` s1682 ;
508 385•1300 �� ;
Tewphons N�nb� '
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B. Ce1t�flCatiOn �
�
at this aaldress and that thg �
I oertifY that I have pe�aonaNY��pac�ed ttte sswa9e disposa�$Y�� The insp� I
beio�w is true,aocurafie and comi�e as of the�me of the inspectbn- �on s�e '
Mfor�r�atlon��my trainu�and experience in tt�e proPer functi�on and�15.340 a� I
�age disposal systems.i am a DEP app�'oY�=Y�inspact�P��� �I
Title 5�310 CIiAR 15.000)•The sYs�m� I
Pa� [� �or�itlona{ly Passes ❑ Fa� '
�
[) Needs Further Evaluation bY 1he Local APPro+►in9 Autho�itY
, ' June 28 2012
S �,
,,�:s�.�.T �
The sys�em inspec�oc sh�N submit a copy of this inspec�ion.�ePort to the Ap�����m or
of He�th or DEP)with�n 30 days of comple�n9 this inspecGon.lf the sysbem
has a design flaw of 10�000 9Pd or 9�ea��.the���°f$nd tl�e systiem awner sh�t submi�tt�
• report�o tl�e appnoPriate r's9ionai ofFice af the DEP.The ong'�nal shoutd be seM tio the system awner
a���nt tio the buyer,if appilcebte,and the approving authority
'*""This n�w�t onhl d�scribss cond�a�r�ss Maw the syste►m witi�perfonn in ths future under
at that tUne.This 1r�pe��
the sam�or dlffennt conditio�o�use.
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TNM 5 OIIfdM��Subw+�t�o�S��Oipow SyM�n'P�p�t d 17
r�n.•��no
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t a
$� Commonweakh of Massachuset� '
Titie 5 Officiai inspection Form !
subsurf.ce saM►ag.oisposs�sysam Fom�.Not�Or vaunt�►asse�amencs '�
214 Old Main Stir�eet, Soutl�Yarrnouth M-80 P-243
��
Ks9f1�i9�11 DOY�B
�� Owners N�ms
���, 214 Oid Main Stroat. South Yarmoutl� MA 02664 Jwie 28.2012 �;
p�p. Ciq►/rown St� Zlp Cods Dw of irnipodion
C. Checkiist ;
,
Ch���IV������.You must indk�be"yes"or rn����IIC�A��4�o IVNV�II�. i
I
Yes No `
I
BI ❑ Pumping in�formadon was provided by the awner�oawp�rt.or B�r�d of Health
p � Were any of the syabem oompone�s pumped out�n the provbus twa weeks� i
,
❑ � Has the syatem reoehred nort�at flows in the pr+evious two w�eek period? I
Have teu�valumes of wate�been intr+oduoed to the sys�em revently or as part of �
❑ i� ���? C
Wer�e as bu�t pians of the system obtained and sxamined?(If they w�ere rwt I
� ❑ a�vailable no�e ss W/A) ,
� ❑ Was ths tac�lity or dw�g inapeded f�signs of sewage bsdc up?
� ❑ VVas the si6e inepecbed for signs of breek outi7 �,
,
� [] were aa sy�em oomponents,exduding�,e sns,�oc�ted on silce?
� p wene tl�,e Se�ic tank manriolea uncoverod,opensa,ana the in�ia at tne tank f
jn�d f�the t�ondi�i of ths b�s or�s�rt�o�oons�u�� �
dimensions,depth of liquid,depth of sludge and depTh of sc�im? �
Was the facN�yity owner(and oocupar�a if dif�enent trom owner)P��� I
� ❑ infortnatbn on the propar mairrtenance of subsurtaoe sewage disposd sys�ems? �
The sira and loc�tlon of tl�e Soil Absorptlon Systian(gAS)on the s�e has
baen detertninad�sed on: �
� ❑ Exisdn9 int�onma�on.For e�cample.a pian at the Bo�nd of Fteaith. '
�
� ❑ Oetiermined in the iield(if any of the fa�ure cxi�aria retatiad t�PaR C ia ffi issue ,
appnoximatlon of d'�tatx:e is unacveptabie)I310 CMR 15.302(5)] '
D. System tnfonr�ation
R�sid��Fiow cond�Ions:
Number ot bedrooms(�n): 4 Number of bedrooms(acd�al): 4
i
DESIC3N flaw based on 310 CMR 15.203(for examp1e: 110 gpd x�of bedrooms): ��
aw•»no na.aon�wwrp.abnco�e�wrha�.�.aownow a�n•v.o.ed n
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CONiMONWEAL'I'H OF M�,.SSACI�JSETTS
E�LECUTIVE OFFICE OF ENVIRANMENTAL AFF I� I�� C�O QO ��
rn�ax�.rrr oF Friv�orr�.rrrar.P���ox pC� 2 0 1999
ONE WII�TER 3TREE'1'�$03TON MA 02108 (61?)29'b5500 •
• HEALTH DEPT.
. �xvmr co�
s�
DAVID 8-STSUfiB
Il1tGE0 PAUL CELLUCCI C�r
� U S�lBSt�ACE SEWAGE DISPOSILL SYSTEII�NSP�CTIOM FORM
�/j/I�!� Z D�/� PART A
/���i r C�77F7ci►'[TOI�r
�a�.�:o?�� 6�l�'I Q rn St w,„.d o� -�'r�i�7�iy+a.-� � i
pO�� $O�'j► Ar�'7tJVf'� Addnas vf Ower: �
o.�.��= 9/�O�'� /�j. ar�`i+�s .S• �ra��o�l� mft- oZ66 y
M•�+•or�+�:�""�"� `�P ��s.�o o�n�s.s rs�o c���.000�
t�en a DEP sri� i
Coew�+t� c • Aq r.t A7� O.t6 L D I
���
T�Mpiw�Nisrib�: ` •-
���� N �t ti+is iddr.s:and tFMt th�intwmNlon►�Pa'hd bdow is uw.acwrst� ;
!e�rtlh�i h�w P�rton�IlY fnsP���s�w"�'dtfpO� �� in tl�P►aMr innction aad �
snd compiat�u af ttro dnu of insp�etlon. Th�insP��P�Ofm�d bas�d oa my t�ai�it�p�nd��
� msiritenau�ot on-sit�s�wap�disposd srata�s. Th�sysbm:
`� Pas:�s '
"— �y Pa:s� '
• � N�ds FuttMr Ev�tion B�1F►�Loe�f ApWovi�O Aud+ority '
_ Fsis � �: �?� � ,
� �
Iiu�p�eoPs
pibmit a copy ot tldss M�e�da^*�P°�tO tlu Approvi�+p Aathaitf►tBoud of H��Itl+or OEP1wHNn tl�iK11(30t•deYs ot
Th�Systen I�ap�oc is a shu�d srstan a hss s d�sl�n tbw of 10.000 ppd o�9nst�r.tl+�(n�etor u�d fhs systan owc�
compl�n0�s insp�etian. If tM syat�m etli�of th�OsP�=d�°���' Th��ntl shoufd�bt sent'to1lls
. -�ll submit tM rePort to the apProP�ate f�pio�u� • '
• systNn owt���nd eopi�s sent to th�bupK•i!sPP�•a�d tM s�rovi���Y'
iitpTES AND COMMB�'fS
,T', c Tq.,k Sys�e� w�s �v,rpp� �'r"e� '
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7�"t»P.s ♦r, /r!'9�
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'� S' !o w s W /�ovr`' /a✓� �r'y
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S �P t arN�n�� �►'�q i,�a l� Co v�r- Q � �au�2 ��.
' aC�¢�vew� Pv✓
! revised 9/2/98 � r.�`1�t1�
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i.�r+'iwed oe R«rdc�e►�pe�
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sussw+��c�sFwace asPosac sYs�wsr�n�w�w i
PItRT C
SYSTAR WFORMAIIQN
�h�= �
�� Z14 Old Manz St,South Yarmou�,1NA
ow of in.p.nien: T�� f
September 22,1999 p,pw�mo�ss ,
D���.p.d.lb�d►oorn.
�M b�droo�eis t Flom�r ot b�drooms(acatNl:�
Total DESION fbw 'P'D �I�
Nwnh�of a�er�nt rssld�e►ts•
oare.p�qrina�r iws or nol:�,0 `�,�"
�tundry ts�pKaR�tY�m1 h►y or no1��i�•��1rts,s�pw��nsP�cdon•r�quind
�wndr�►a�t�m Msp�ec�d �r�s a no1 �S W S��u A�—G4/M<�'�
�,�...�ris a�,•�.o �fP d�o9,a�o QGPl� �
,
Wsta nub.t��dG,ps.N.,,.�6t.uss!twu y�..�s�s�0.(W�d1: �S f
suRw Pumv tws o.no1:1�Q . �9 7���� ,.
�m d.t,�a�,►:��ec� �
Typ�of asN66shmerK: �
pKypn flow: aod t 6as�d on 15.203) I,
Bssis o!dyi�a tbw
Qtat!tr�p►fa�ntt t1►�s a no}
h�dustdM YYrst�Holda�Un1c pnsMt:(
Nonsa�ar�►wast�d=ehw�M to ' •b syst�m:(Y+s or no1_
• Wat�►nNt�r►��'i�s.if� r. �
Last d�n of occup '
i
_ se�ib�) �
d�t�of oa�tPu�e�►t Q61tERAL O�PORI{IIATTON ��
,v�r� e�-�-. '
� �:«�.�.of� � : � � • a? - �36V ' 99b� �35� l9�4 'ZZYS �
sr.�.m p,�P.e.:o.re ot�w�+�tr��o•�o�� Iq 46 --a�s9
N�r�s,�nns purnp�d:� aapons
R�ason fat pu�inp: �
rn�oF strS7� I
_L/ s.ptla tank�dfste�udoe boxboU.�:o�ption syse.m '
�,_ S�pt�e�sspod I
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SA�nd sYst�en fri=a no) p11r�s.att�eh P��+�PK����:•it anyi '
_� UA T�hnolo�►�ta.Atqch copy ot up to dat�op�ntfon and m�nt�nsnc�cannct
Tipht Unk Copy ot OEP APp►ovd
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APPRQ701AAZE GE at d eanpon�s.daa�nsW�d�it�cnownHnd aourw�tiMan��tbn:�Q�S• --..f�K ST��
no
.— 3 u�91 �2 sys r� ' L/hJ•J pR,� �A� p,,f- � a- y.��s
Swrp�adors d�t�et�d wMn•anivirq aR 1M aia:�ns a noS�� ' .�,�5�L��� ! N ��7.
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j SL�S1lRFJlCE SEIAIAtiE DISPOSJtL SYSIEY!lSPECTION FaRY
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81►5't'�II�iDlq�IlT10N fooeti�n��
�V Adb�s:
�1mp�c�on: ,Z�,�4�5�.South Yatmou�,lyq
� �ep�eml�a'22,1999
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SKETCH OF SEWAQE DRSPaS/��SY8'1'61�: �
� tnelud�W+to st but twc P�nna+ant��irr�ncs ia�dma►ks a Mndrnarlcs
loeat�att wNts whhM t00'tLoesb w�ar�pub6e wster nPp�Y eomes iMo hovsel
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