HomeMy WebLinkAboutInspection Report 2019 Apr 26 Commonwealth of Massachusetts P7Cyek
M=*� Title 5 Official Inspection Form
.,= Subsurface Sewage Disposal System Form-Not for Voluntarysm
Assesents MAY 1 6 2019
s"_ 1Fr r
°� 84 Debs Hill Rd. Yarmouthport MA, 02675 �/}} HEALTH DEPT.
X9'46 1
Property Address LA ' ..;- te.ciJ ?ii,tiz.`
Franccesca Hayes PO Box 827
Owner Owner's Name
information is West Dennis
required for every MA 02670 4/26/2019
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. Inspector Information /Y/a-R4'0filling out forms P / t/ u�Aon the computer,
use only the tab Paul C. Martin (7 <GlLi
—.
key to move your Name of Inspector
cursor-do not Cape Cod Septic Services Inc. t C c,✓v-e..X—
use the return Company Name / r
key. eel-el.C.e. r T`.
350 Main St.
a► Company Address
���_VVVV . West Yarmouth MA 02673
City/Town et,(1'-'(' . State Zip Code
,war X% 508-775-2825 c SI5016
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system Inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); I have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
_' 6•5 "- 5/7/2019
Inspector's 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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
In the future under the same or different conditions of use.
t5lnsp,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
# , = Title 5 Official Inspection Form
-=51Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
84 Debs Hill Rd. Yarmouthport MA, 02675
Property Address
Franccesca Hayes PO Box 827
Owner Owners Name
information is West Dennis MA 02670 4/26/2019
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
"10.-`4-
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
1DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 10xpd
330gpd
Description:
Number of current residents: Unknown
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes tEl No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? El Yes ® No
2017=216gpdWater meter readings, if available(last 2 years usage(gPd))
2018=230gpd
Detail:
Sump pump? 0 Yes ® No
Last date of occupancy: Unknown
Date
t5inep.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18