HomeMy WebLinkAboutInspection Report 2022 Feb 10 a .
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Commonwealth of Massachusetts
Ba a=, Title 5 Official Inspection Form -- FEB 18z022
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_____ I', Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
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HEALTH .DF T.
�1/" 209 Blue Rock Road �" J ( f l
Property Address v.act• t ,5, <S ', I 1 I Z Z ` .0
Darren Drake! 9" ( � —
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Owner Owner's Name ,cr
information is South Yarmouth MA 02664 02-10-2022
required for every
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 ✓� 1. ^1
filling out forms "�
on the computer,
use only the tab Michael T Bisienere
key to move your Name of Inspector
cursor-do not Cape Septic Inspections
use the return
Company Name
key.
52 Rivers End Road
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Company Address ' 71,
Teaticket Ma. 02536iiIF 1a 04
City/Town State Zip Code
I iI 508-280-3356 SI3938
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: (kati� (v.�,,= p{z-
1. ❑ Passes4 r----c- o(_ N-fir i/ coc-c.) 7
2. ❑ Conditionally Passes 2-I` M�eik „�v t.4(t.4(vH.c
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(2,) 1-3 \. 64-
3. ® Needs Further Evaluation by the Local Approving Authority p �%—.4
AC.r/c.w
4. ❑ Fails may'' rlc.-c.' — N -aid,-) i y
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F fC'i '' 0 it - ,cam-t� cc-
02-14-2022 F' o C.--
Ins ctor's Signa ure Date c
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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
—r`) 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
i , ��i` \I1
, 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
\-' 6.0 in the future under the same or different conditions of use.
t
t5insp.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
(7.- "4:1.0._,__-_-•---------\I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
`'__-2l11==.
209 Blue Rock Road
Property Address
Darren Drake
Owner
Owner's Name
information is
required for every South Yarmouth MA 02664 02-10-2022
_- - - -- - _ - --- - -- - --- -
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.): cf c'-z , -I
At the time of the inspection each leaching pit had apx. 12 inches of ponding water and visible solids
carry over.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Nsl -
., Commonwealth of Massachusetts `r � ---CN
4 ;, Title 5 Official Inspection Form Y
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''i =-_ _ ` 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
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From: septicinspectormike@aol.com,
To: septicinspectormike@aol.com,
Subject: 209 blue Rock
Date: Fri,Feb 11,2022 3:09 pm
Attachments: IMG_5633.jpg(41K),IMG_5634.jpg(42K),IMG_5635.jpg(39K),IMG_5636.jpg(39K),IMG_5637.jpg(37K), IMG_5638.jpg(38K),
IMG_5639.jpg(38K)
Thank you
Mike Bisienere
Cape Septic Inspections
508-280-3356
7 Attached Images
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