HomeMy WebLinkAboutTitle5pt2 (1)Aug 13 09 09:49p Ellis Brothers
5A \rlrl. .tt ava trrEidat I ilrt iqirsanaa tg-rral;!'
508-3626266 p.8
Title 5 Official lnspection FornSdqrfrce Sergr Dirnod Spra" foan _ ruot OrVotrntaryAsss$ents
256 Ob Main Sol.lth
Propcrty Addea MA
NAgffi1OutE
i&mdlon brtfl&rd E.tryDqE
Clrc,t l,Lmt
Soutt Yemloutrt
CIy/Tdn MA @Bq 07h6m@Sal€4 Code Dnr dllrtpdhnD. System lnformation
Descrip6on:
lqrmber d qffilfrt rElidor s
Cro.3 resilence i e I gEtilc grirder?
ls hundtr on s sap-de serege sy{en-?
Ler,l(ryslElsn,r$€cbd?
SeesonC ltse?
l,t&ier mcta. rE(ltgs, f aydsue (H2
TH*
Sump plmp?
t sl dab of occ(Dllcy:
cqrEl3 Gfrylniflsffir! Ftoa Colltroar!
Greas€ lr@ g€senl?
,ndu$id werte hotdtng tank presettt?
No*.saftary waste discDargEd to lho TiBe
l rdor m€ler r€adngs. f avuilaHe:Jool 3;B A-.
F8 $parde Erspectim reqriredl
usage (gpd)):
.fu
E ves U alo
D YesE lo
0ves615
EI ves E to
E. Yes E ruo
s sfi-ri-fr
Type ot qebfistmertd'iir;7{ht*nc*4t ruD€.ign flGr, (tssq, d{ ato CtR ls-aE): 'flt4*L sb g lhvt 52*41+lu Att-lBe*s of dcqtn [qtlsersDels6os,sq_fr_*c.i:
ll}'o S .(+-
oJo pa.try('pst
E vw {xo
D Tu{tu
n Y*,U/rb/*a
,5E.mt s..gr A?Br 9*n . fta. 7 d 1?
.Aug 13 09 09:50p Ellis Brothers 508-362-6266 p.9
l,(,ltllll.rttlttiattuf (,! lrtalDlrllcrr|]EaEtt:'
Title 5 Official tnspection,Form
SuDrllrfaa Scmge OispocalslldEll for"l - Uof Or fafsrtary AssessmenE
256 Old lrain Sodn ITAAIEE
Trust,P.O.Bc Sagamore uA 0256O,'strdlqr b,qllld turaqy Fge-
ort Datlr Nam6
Sqrt l Yarnouth MA 0256{cqarrdn ltt 4C.dr
1
D. System lnformation (wrt.)
Last date of co{arEtl^rsa:
O(tE (desqibe belga:
Tjoe
Dd.
6e/3 {
P(rftpang R.cor63
Souroe of hfuntdion:
Vl4as syCe.r Prfnp€d as part of fbs iospedbn?
tr yrs, llDluna pumped:
tloy u6 guenfly pur?ed d€Elriled?
Rsason for ElmplngL
B v*6o
0alolE rtlnst
fy?€otffim:
d Sedb tank, Asfibdion boc sol epdon strdsrn
tr slngle oasspool
O orlerfrorr casspool
D tuiw
E Sh$ed sysiem (!'sc or no) (f yes, stfscrr prEvlojs in8pedo.r recor(s, [sny)
n lnnodirdAltqndive bcfnrohgy- Athfi a copy of th6 orrrni operaUon erldmintemrce codrect @ Deobtaan€d tur qgLn amerl m jcopy f ui:stfttsfclim dfte UA syslill b, q,er openir under cocraa
tr Tlght taok..Aitrcfi e copy oftne DEp appro\ral.
D O$cr (descrlbe):
ra.5oitot tEF.tb.' F.h: slhr5 s.^Ee. !|t -t sF_n. hra 6 c 17
07fiamos87iffi'' - -.-
CeE al lnfolmatt n
Aug '13 09 09:50p Ellis Brothors
Cornmonwsdth of ilassachusetts
2s6 old Mainffi South Yamorlh MA
Title 5 Offieial lnspection FormSubgurtae Samgt D.rpd Sysfm fqrr - ,!bt fr Voluntary As€ssrerrc
508-362{266 p.1o
Prlpsrly Addr.$
Sanuil Trusl. P-O.Bo(602,Saoemoro .uA 02561OuErffioobrqutrd h..vetyB..CDfiffir 07n62.00s
the of tuEpdSoD. System lnformation 1conr1
Approdmare egp d €[ odnpo.r.nts, date hstalred (if krwn) and source ot inform€tion:
South Yamsth uA wuStaE apcod!
\rlbflr ssl,Ege o(lors (bHed when ,nivlng 8t otE sile?
BoiEhg Ser.rer (bcate on site plan):
Dep& berow orade:
Msls.id o, @nsbuctim:
fJ cast imn E4o pVC E anrer (ercrair):
OBfdncs horn pfirde eiater erpdy hdl or sucum Fnc:
tEt
ker
Ey6sDNo
CGnrn€nts (on corldtton ofjdnfs, vE rting, dilence of bal(aoe, eb.):
S6gt'rc Ter* (bcate on site dan):
Deplll below g,rade:
It/bteJinl of qEtuctioo:
d-n* Emerar
fEd
D nbergbss E ghgqn. I oure (eglein)
lf lonkh rlelat, H ago:./,q-
t€alB
4',
6lB.m
mb 5 Oid rBa-lbfah sl,la,fro 5.,!6 Di?_r s!_F. EfreC 17
b age codtrmed bya Csrffie of CorTlrnoc? (afladt a ory of cer6icato) fl Ves g peErirmnsicrs: a*til..*r.?Z a, 'Zk:"*rt
Sludge depth:
Aug 13 09 @:51p Ellis Brothsrs 508-3626266 p.11
Title 5 Official lnspection:Form
Sul,srrdhcs Sq,qE D&ryosd S),siE D form - fUof frr Votntary Assessrnents
wr. r r alr t. nrt;3tat r rrt lItaF latt;t tttatGar.s
256ffiMlad,rt qre€t sodh Yarnoolh, l/i4
PrEp.rty Adft.s
Oric.hO ntq' Ert$ldtr
EU.ryFga Cfy/ffir Z9'@
D. System Infonnatbn {ont.)
ScFdc T.rd( (conr)
Oistane trorn top of gudge lo bottorn of oslet lee or bdi6
SaJm thid(ngss
Distance traD lop dsolr,! lo top d odrea bo or balfe
Di*arEe forn bo(om of safl to botdn of oulr€t iee or bafie
tlor rera dmerCms .releodnod?
Comm€[lts(on F nCng
lk*|id 4l to txfiet iflverl, evideflce oa leqkaQE,
tt7**
,a y'*---=*zr*rue
Sodh Yarmouh
erase Trap (Iecde on sIE da[):
DeEl bdor gratet
iaab.ld of cqls&l.6on:
E comrete E]man tr
Dtrrnsims;
Sarn ihictness
DliilcB rqn top of scrrm to iop d qfict be
Eli{ance tuo t otlom of Sclm to r',*.--
rEarxnnrenddior6. inlet ard odld tee or bafre dlflion, stuctuEl int8g,ty,
02664 gl1vug
D#of hq€rfbt
3ok
O
O
<)
.E
H
E povethlGne E dher (exdaln):
l"t
oy'
(a
.' -.-. €..-!r.r l*r4 trrcr,*D.Fllercdtz
A${. -
P= 5
=l:t
P.o.Bo, 6sz sao8rnaE .sA @s6r
Aug 13 09 O9:52p Ellis Brothars 508-362S266
s-\ LorTBlloflvl,eatm or fiassGnusetus
Title 5 Gffic8ai ii:spectisr Form
Subsurfac€ S€liage Disposd St6iem For - l{ot for'Voiunbt-r, Assessnteds
256 OH Main Slreet, South Yarmcrth , 1IIA
p12
ErrEpq.ty Addr-68
Sarh.al Tru$,P,O-Box BgZ SaoamoIe . MA 02561
iJhrrndi, i ._,rli'nea'6 i,li'tnE
South Ytnnouttl offi1 tll16t2A@
Es"ir_Ep6.iiE-r
D. Sysbm lnfurmafion (conr)
co.rEnents (ofl p{.tnfitry reoommeldatbrE. inlel and ou0et tee or baEle condftion, $ruct{ral integrtty,i{.=rii A1''iis i6 !#.*Aj i9 orriief irnrerr. a,-.ij;=:r= .,f h=,t;ge, El,: ):
*-p_-.{*t
D nerislorE;
Capaclty:
Oestglll FloY
Alarm fesent
Alarrn leYet
Dde of iasl prrrping:
TiEari in- iisrdinE -i Elh ilAarh mtl$i i.G ptx
DeFhbdowrde:
ilatefial of €oflElrudion :
E concrete D met t
i LfoE of irrui,$i:nior)) (lor,ate irri sf.e iEaaii:
D E pollrcthylens El other (elc ain):
gdorE
ogltrrs prr day
[] ves fl No
Alarrnh w kinE ordefi D vee fl No
Co.iEnenls {ccrdaion of alann and floal sldtdl
TE
ebi):
".Att8ch cspy nf cljrelt p,rrnping contre€t (r=quirFo, Is oopy atte66gd7 ! yes I-'l No
-;i;.:r=:jt;nrtr.foi'ft :J6Bi-.*.aECi,..aaSF6. irF ; ;..i :i
Aug'13 09 09:52p Ellis Brothers 508€62S266
!s, lirrrrErTrvearrn or Gsacrrl'EeE
Title 5 Official lnspection Form
Sutsurface Serege [Xsposaf stl5tsm Fcul - Not lbrVofr ary Aloessrne.ts
256 Old Hain Sbed, South Yanno.rft ,llA
p.13
Prqcdye&e
OrlItt&'Irl.lisr b
rlqlilea, tttqyrc!.
Sout'l Ylr'ltoullr
CtyiToryrt
D. System lnfiormation 1corl.;
Disl'ihnion Bor ff prBseilt mrrst be opened) oocde o.t site plan):
Dep& of lhdd l€v€l eboye ouUet inve a Z1/O
Collrnents (nde tr bq is l€\nd ard dslrDrllon to outleG equal, ary et,Uence of solirs carryov€r.Tv/5erddeflce of bakage lnao 9f otIt d bq, elc.):t7
/zzd
,D 7
Pump CXamEer (bcale ofl sit€ dan):
SoI Abcoipti{u SysiE E (SAS, @caE on
lf 3{s not bode.l, €r(plarn utry:
E yes Eruo
EI Yes E ruo
colfiiqr of pl,rDs ard amrItenences, enc.):
Cen, €o6a\ralion nd ,equired);
i.lns- (E[a
qllt l N!.ar
MA ,@66"S.t Zpfc 6Tfiff?o@EafisFe.r---
PufiFhnfrlfirgonbn
Alanns in ucl(trg or(bc
@mmeIlts (note cdldfllar of Frrp