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HomeMy WebLinkAboutInspection Report 2020 Mar 12 NQS 4J2Yz aco�i=D Commonwealth of Massachusetts �PtL t APR 10 2020 * - -� Title 5 Official Inspection Form HEALTH DEPT. _4 i �'1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s ,. 4 31A&31B Baxter Avenue Map 37 Parcel 14 (410,u s-/y 97 9 99 Property Address ( " Geor•eGeor•ionis Ge OR - 4 7 ma I C . CO Al kf.4#1111$ ' L4 ;= Owner Owner's Name y— ;. ° i7. ,"•, information is required for every West Yarmouth Ma 02673 3/12/2020 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 �4, � �° fillingout ant:Wforms A. Inspector Information SCANNED on the computer, use only the tab JeffreyM. Wall zcizL Patog- b key to move your Name of Inspector 14-aa-_-i- -`. -PT R 1J cursor-do not Wall Septic Service use the return Company Name key. „r P.O. Box 771 4as Company Address ' Harwichport Ma 02646 City/Town State Zip Code /amX508 432 4908 673 ' 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. 0 Conditionally Passes 3. ® Needs Further Evaluation by the Local Approving Authority See SC, * f La (Z c.ockl, P R 31 i3 ceatiegotcle.,. f/cAse) Mail/ 4. 0 Fails FC002 CR4-outoc(eted GA(zoc.se' I9r7'.zec- 11 A, ,actors : -lure .4(9. ' °°. 7 l/r4 7W e, Dat 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. t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 ' Commonwealth of Massachusetts � Title 5 Official Inspection Form e� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,°�, 31A& 31B Baxter Avenuegi Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is required for every West Yarmouth Ma 02673 3/12/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. System Paries: . 0 I ha ••t found any information which indicates that any of the failure criteria described in 310 C .303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: ❑ ►•e or more system components as described in the"Conditional Pass"section need to be rep -, -d or repaired. The system, upon completion of the replacement or repair, as approved by the Boa ; of Health, will pass. Check the box for -s", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please e • ain. The septic tank is metal an. , er 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial in 1 -tion or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is repl -d with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is - cturally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 _-rs old is available. ❑ Y 0 N ❑ ND(Explain below): t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Force:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts = , = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31A& 31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is West Yarmouth Ma 02673 3/12/2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ 'ump Chamber pumps/alarms not operational. System will pass with Board of Health approval if p. ps/alarms are repaired. ❑ Observati• ' of sewage backup or break out or high static water level in the distribution box due to broken or ••structed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection ' (with approval of Board of Health): ❑ broken pipe - are replaced ❑ Y 0 N 0 ND(Explain below): ❑ obstruction is rem• ed 0 Y ❑ N 0 ND (Explain below): ❑ distribution box is level or replaced 0 Y 0 N 0 ND(Explain below): 0 The system required pumping more than 4 times a year • . - to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board o -alth): ❑ broken pipe(s)are replaced 0 Y 0 N ■ ND(Explain below): ❑ obstruction is removed 0 Y 0 N ❑ I (Explain below): 3) Furt r Evaluation is Required by the Board of Health: 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. a. System will pass unless 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: t5inep.doc•rev.7/28/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts * ► 14 Title 5 Official Inspection Form 1a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M . 31A&31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name Information is required for every West Yarmouth Ma 02673 3/12/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) Cesspool or privy is within 50 feet of a surface water 0 esspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System wi ail unless the Board of Health (and Public Water Supplier, if any) determines that = system is functioning in a manner that protects the public health, safety and environ - t: ❑ The system has a septi -nk and soil absorption system (SAS) and the SAS is within 100 feet of a surface water sup• or tributary to a surface water supply. ❑ The system has a septic tank - • SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SA - d the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and th= AS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP ce ' ed laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen a • itrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A cop, •f the analysis must be attached to this form. c. Other: 3/v ( e. ie ce9gRia6 e mouse) i111. fi /5 2 qe 7745 "'"ieS been Rem®ofeceoe a d I ncucd eS a 1s ao,v1, a 6�Q,=-: . .o.s-,44,(%' 44.7"- t Ge 6''e cfreGe 7 et s. A L 14a a 44,1 ? /c,?,S7,4 f e&,re !tea oil'? 091"004 4- ,rotX.r.de../ ¢,in,..rii'4C1 ego's.l !T/•Ti 'Ail 1fXt i* bong r✓I 11 leehe 044. el-at h s Tr a S© / C a"l09ie44 a 1,,,f1,1,,,f1, et 0 eve. bedea)AA A/2' r•i e4 i e0/ 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No / ❑ ,lll���,�,/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 2/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 1 • Commonwealth of Massachusetts w *, F Title 5 Official Inspection Form -op_-_ p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments It ° .. - 31A& 31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information Is West Yarmouth Ma 02673 3/12/2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ L2 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ -I/ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: . ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Ind' Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ tui/ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ / Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ EV Any portion of a cesspool or privy is less than 100 feet but greater than 50 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 that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ TA/ The system is a cesspool serving a facility with a design flow of 2000 gpd- Ecd/Lid' 10,000 gpd. ❑ 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 fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. n flow of 10,000 gpd to 15,000 gpd. For larg -ms, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Sec • Yes No ❑ 0 the system is within 400 feet o - - 4 ace drinking water supply O 0 the system is within 200 feet of a tributary to a su .- • inking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhe=• - • ection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.712812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I Commonwealth of Massachusetts � =64 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31A& 31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is West Yarmouth Ma 02673 3/12/2020 j required for every , page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i j 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 111 Were any of the system components pumped out in the previous two weeks? 0 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? 2 ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) 07 ❑ Was the facility or dwelling inspected for signs of sewage back up? [y� ❑ Was the site inspected for signs of break out? /•iGc.ccdz• 6 IV V ❑ Were all system components, Ing the SAS, located on site? 0 Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: 12/ 0 Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] CCoCo9io✓t d,ttry) t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i 1 Commonwealth of Massachusetts 0, - _ig Title 5 Official Inspection Form f ._ Subsurface Sewage Disposal System Form Not for Voluntary Assessments ' , 31A& 31B Baxter Avenue Map 37 Parcel 14 Property Address George Georsionis Owner Owner's Name information is required for every West Yarmouth Ma 02673 3/12/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedroom§(design): Numberof bedrooms(actual): z /-4 -i lodece.( 6'+giest., e.. /h 'a, F'GooKoo.*t 330 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: /S-at, C,l'i/Dat ee9%G -raw k� - t? , 3 Ai( - A-en5,7>e 1/IF/t a rook' -3'os`0 el ebi-S' Go.77, 3 c7.2 ' 577,i o,1. 5',crier / 'oma 6..04'S /A 'A' =k" -2. ' ffa - . Number of current residents: VCt if t. S" Does residence have a garbage grinder? 0 Yes BK-lo Does residence have a water treatment unit? 0 Yes [�No If yes, discharges to: NVe4 Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes �o information in this report.) Laundry system inspected? 0 Yes rij,4:lo Seasonal use? 9es 0 No ,0--0145=.9.7y /Q.%alia..5'#c Pc/ Water meter readings, if available(last 2 years usage(gpd)): Detail: la( $ a repo ,2e:pv 16-At. ye -% ?ms's'=,Z7 y6''fcl 2'c!= t" . Poo t5°Jl1..., y/2-k 7Cr .,2,2.5'4''f'.d Sump pump? 0 Yes [ *No Last date of occupancy: 3r / / QSTG7 d ec14 eel Se eh"e,2'. Se�a�tiak f�-- ‘04":4 0GC,.2Sc on a L o_F $eat Soot L4 e 3 l ,C3 4,2euct fic ce.R 4,4.12`Ti47e#T--i, Cce,Qe rfty QecftrjQ(, t5inap.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 • Commonwealth of Massachusetts t= , _co Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31A&316 Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is West Yarmouth Ma 02673 3/12/2020 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 2. Commerclellinduotrial Flow Conditiono: pe of Establishment: Design '•w(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design '•w(seats/persons/sq.ft., etc.): Grease trap present? 0 Yes 0 No Water treatment unit present? 0 Yes 0 No If yes, discharges to: Industrial waste holding tank present? 0 Yes ❑ No Non-sanitary waste discharged to the Title 5 system? 0 Yes 0 No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: 5-e/772- 7Z kik ia(AC/iA Source of information: Cus773/0 gecoft l.) Was system pumped as part of the inspection? Es 0 No If yes, volume pumped: gallons How was quantity pumped determined? 7� e ‘Ce'tff of iC "r Reason for pumping: ' .01' t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 • Commonwealth of Massachusetts , Title 5 Official Inspection Form .---_---Ilikt- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y, �' ,,. _ j 31A&31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis — Owner Owner's Name information is West Yarmouth Ma 02673 3/12/2020 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 4. Type of ystem: 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): Approximate age of all components, date installed (if known)and source of information: . s p* 96-0/0.z i //'7 S' —CmaS d ce i'. o, L''• Were sewage odors detected when arriving at the site? 0 YesNo 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: aast iron [2t'40 PVC ❑other(explain): /f)./ ' Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): /U o ...S.S'"Gc-e.r erokt ae•J Spe c.�C✓) Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Winsp.doc•rev.7/28/2018 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31A& 31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is required for every West Yarmouth Ma 02673 3/12/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): /. 3 ?'b ?b( 44.74 lei .r Depth below grade: cta t.�reov-e/S C" es cte feet Mated I of construction: concrete ❑ metal 0 fiberglass ❑ polyethylene 0 other(explain) If tank is mctel, Ii3t age /`)/X7- years >--{swage irfned-by-a ert eete.of Cet p'- . = _ .. _ = No no Dimensions: 6' .5- o 6'63y "..c) ,� .� e is ax D o/y /oZ'r' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle .2 c� Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle .- aec How were dimensions determined? T, � S Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid leve as related to outlet invert, evidence of leakage, etc.):, Goii; Aerya eLeifsavel 4444. r,s/e..GT owt a S .— 7101.). ' f 7Te• - /06( ,4/-t5 "tc a+i.0t.erted.ec� S��''S w eke- 6 Gude'', Sae 14 ,tos • /2-eif /d2405(c eh e ' `i "'U211'r / yi gS' We/40.04 4 OA'Q) /nrat erg.eoc rS cot;16 /) a',eok �f 'lr0•-frees Tan Ic (Re com . eSQO wee... rt,ce –e-A,c1 o, 761/4k 4 f e c ct:r ck:trt (, S € 7c &fte e)A– G,Qc(-)D 1-40 et.Qt°417esarr-cr ee okC, t5insp.doc•rev.7128/2018 No GeN� • . • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 jy1 Commonwealth of Massachusetts ►� *7, , _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4,0 31A&315 Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is required for every West Yarmouth Ma 02673 3/12/2020 page. City/Town State Zip Code Date of inspection D. System Information (cont.) 7. 'urease Trap(locate on site plan} p Dept' •-low grade: feet Material of co ruction: ❑concrete ` etal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle conditi• ' structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Dep - ow grade: Material of constr '• : ❑ concrete ❑ meta ❑ fiberglass ❑ polyethylene 0 other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/2612018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments !).'— 31A&31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is required for every West Yarmouth Ma 02673 3/12/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(oont.) Ala • esent: ❑ Yes ❑ No Alarm level: Alarm in working order: 0 Yes 0 No Date of last pumping: Date Comments(condition of alarm and float swi ,- etc.): *Attach copy of current pumping contract(required). Is copy attached? 0 Yes 0 No 9. Distribution Box(if present must be opened) (locate on site plan): VU CP Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t3a K :*5 G-Qa{,L L✓,?%9 D/tt. fj e?"'Cy e.1 "-Q o SaG/�Cc, Nd eih*d C - . t5insp.doc•rev.7128/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ),•=f-i-,. -=-= , ,- Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't,..",...."--, 31A& 31 B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is West Yarmouth Ma 02673 3/12/2020 required for every Page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): -• •s in working order: ❑ Yes ❑ No* Alarms in wor• • •rder: ❑ Yes ❑ No* Comments(note condition • • mp chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ���cr9�"�;F'�r+�ra� ❑ leaching pits number 34:),s-0's 4,,r4 STbN-. Et/ leaching chambers number: A(441-rrc,>((4VTC.24'x'2. 0 leaching galleries number: ❑ leaching trenches number, length: 0 leaching fields number, dimensions: ❑ overflow cesspool number: O innovative/alternative system Type/name of technology: t5insp.doc•rev.7/28/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form =IN- • Commonwealth of Massachusetts *- , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments \. 31A&31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is West Yarmouth Ma 02673 3/12/2020 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) Mater) if construction: Dimensions Depth of solids Comments(note condition of soil, signs • • draulic failure, level of ponding,condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 t5insp.doc•rev.7/26/2018 Commonwealth of Massachusetts NVeDS ►� ` ►-p Title 5 Official Inspection Form X27 _ — p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �V t'f�Uow 1 31A&31B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis . Owner Owner's Name information is West Yarmouth Ma 02673 3/12/2020 required page. for every City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the b ilding.Check one of the boxes below: ihand-sketch in the area below 0 drawing attached separately I /1 Neth° i tatti f 21 6 w /t ro .A .7%,27.7 1,...._ /9-9'b 3 = 3Y ,( i /3Ta ./,.- , S-i t� 3 6 rdiE III \ 13 ( k. II III r J ret �< g�j(74-e- . eze02., -.7 tbinsp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts M *---,_ Title 5 Official Inspection Form v Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v-'),:>.L 31A&31 B Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is required for every West Yarmouth Ma 02673 3/12/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site xam: heck Slope urface water IAG>eeck cellar Shallow wells ,J • /- . 47,44 Git)etr e"R V Estimated depth to high ground water: Q 701 47y 4.- et Please 'ndicate all methods used to determine the high ground water elevation: 117) Obtained from system design plans on record �7 If checked, date of design plan reviewed: co ` ©, Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high groundw ter elevationn: \ "-t off= rd-S' /�S7 ci' eJ G,z>•i�.. 7 c .�' "otrt .. S, 2a Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/28/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts T.-±..:4___-, Title 5 Official Inspection Form +1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments n,-,` 31A&318 Baxter Avenue Map 37 Parcel 14 Property Address George Georgionis Owner Owner's Name information is required for every West Yarmouth Ma 02673 3/12/2020 --- page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Comple all applicable sections of this form inclusive of: Inspector Information: Complete all fields in this section. . . Certification: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate I(Failure Criteria)and 6(Checklist)completed D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7128/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 . 3( 6 Bad tI-e,rz eui-c MAP S7 Rlec.c L 1 YVra( .© Gae hyo L4.5'C.. v..................... 0I-...Z A tU i rt ,f l'ie j 0 •L 1 ,......"".'. W/Iedry S14)40e ., (Z 00/1 .. J l , ND aooR 5'441-ItS dc25ed4oKT" ctgon-e iA)slCJe ;s t�k'yw^�A>> � /' C •rsee... 4J 0 e I �V r4{ t• 611(20.6-e- i> Oak ;Iii/ /4 r c CSA) Oc rcr k • . .Table 3-2 Do's and Don'ts of Private Septic System Management DO.., DON'T... Do have the on-site system Inspected and pumped by Do not use the toilet or sink as a trash can by a licensed professional approximately every 3 to 5 dumping non-biodegradable material (cigarette butts, years. Failure to pump out the septic tank can cause diapers,feminine products, etc.)or grease down the system failure. If the tank fills up with an excess of sink or toilet. Non-biodegradable material can clog solids,the wastewater will not have enough time to the pipes,while grease can thicken and clog the settle in the tank.These excess solids will then pass on pipes. Store cooking oils,fats, and grease in a can to the leach field,where they will clog the drain lines for disposal in the garbage. and soil. _Do know the location of the on-site system and drain Do not put paint thinner, polyurethane, anti-freeze, field, and keep a record of all inspections, pumping, pesticides, some dyes, disinfectants,water repairs,contract or engineering work for future softeners, and other strong chemicals into the references. Keep a sketch of It handy for service visits. system. These can cause major upsets in the septic tank by killing the biological part of the on-site system and polluting the groundwater. Small amounts of standard household cleaners, drain cleansers,detergents, etc.will be diluted in the tank and should cause no damage to the system. Do grow grass or small plants(not trees or shrubs) not use a Into the garbage gri dlf there er or spis onal s verely nick above the on-site system to hold the drain field in feeds place.Water conservation through creative limit its use.Adding food wastes or other solids pacity and increases e landscaping is a great way to control excess runoff. reduces pumsystem's e on-site tank. If a grinder Is used, um the system must be pumped more often. Do install 4vater-conserving devices in faucets, Do not plant trees within 30 feet of the system or showerheads and toilets to reduce the volume of water park/drive over any part of the system. Tree roots will running into the on-site system. Repair dripping faucets clog pipes, and heavy vehicles may cause the drain and leaking toilets, run washing machines and field to collapse. dishwashers only when full, and avoid long showers. Do divert roof drains and surface water from driveways Do not allow anyone to repair or,pump the system and hillsides away from the on-site system. Keep sump without first checking that they are licensed system pumps and house footing drains away from the on-site professionals. system as well. Do take leftover hazardous chemicals to an approved Do not perform excessive laundry loads with a hazardous waste collection center for disposal. Use washing machine, Doing load after load does not bleach,disinfectants, and drain and toilet bowl cleaners allow the on-site tank time to adequately treat wastes sparingly and in accordance with product labels. and overwhelms the entire on-site system with excess wastewater.This could flood the drain field without allowing sufficient recovery time. Consult with an on-site tank professional to determine the gallon capacity and number of loads per day that can safely go into the system. Do use only on-site system additives that have been Do not use chemical solvents to clean the plumbing allowed for usage in Massachusetts by MA DEP. or on-site system. "Miracle"chemicals will kill Additives that are allowed for use In Massachusetts microorganisms that consume harmful wastes. ! have been determined not to produce a harmful effect These products can also cause groundwater to the Individual system or its components or to the contamination • environment at large, _ rrtwth,ew.m .vovrdeywaeirmouro•.n►,pvaa,00c 3-17 J .?COS,