HomeMy WebLinkAboutInspection Report 2009 Jan 30Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Frti v `F46ON JU9
Subsurface Sewage Disposal System Form Not for Volu i�ary,AssesS5 cents
HEALTH DEPT.
85 North Main Street 'J
Property Address
Fontneau
Owner's Name
Yarmouth
City/Town
MA 02664
State Zip Code
1/30/2009
Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important: When
A. General Information
filling out forms
on the computer,
use only the tab
1. Inspector:
key to move your
cursor - do not
Patrick McDowell
use the return
Name of Inspector
key.
PKM Contractors, Inc.
�
Company Name
P.O. Box 775
Company Address
East Dennis
City/Town
508-385-5993
Telephone Number
B. Certification
02641
Zip Code
I certify that I have personally insl L(j�A) ��� �s and that the
information reported below is true, OT the inspection. The inspection
was performed based on my traini In the proper function and maintenance of on site
sewage disposal systems.I am a Ur -P approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑Con ition Ily Passes E] Fails
❑_Needs,[= rth r Evaluato-byttie Loc ro ing Authority
Frx
Q 2
V`
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 is a shared system or
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 should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
""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.
T-5 85 North Main • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 85 North Main Street
D. System Information (cont.)
nnA nn GGA
1/30/2009
Date of Inspection
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 1 -bee hive
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
a-
1-2"
minimal
9' total, 6' below inlet
block
Indication of groundwater inflow ❑ Yes ® No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
ell etc.):
-� 18" of fluid in cesspool at time of inspection.
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
T-5 85 North Main • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 15
Property Address
Fontneau
Owner
Owner's Name
information is
Yarmouth
required for every
page.
City/Town
D. System Information (cont.)
nnA nn GGA
1/30/2009
Date of Inspection
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 1 -bee hive
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
a-
1-2"
minimal
9' total, 6' below inlet
block
Indication of groundwater inflow ❑ Yes ® No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
ell etc.):
-� 18" of fluid in cesspool at time of inspection.
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
T-5 85 North Main • 03/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 15