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HomeMy WebLinkAbout2013 Apr 11 to May 15 - Info Re: Discrepancy of BedroomsC� L� Y'I. i''� • _ Like it never even happened.® Fire & Water - Cleanup & Restoration' i Tom &Lisa Balcom �- - -& wt 76 JS �CL- i - .��t.,�� a` �`�. � M �5 �. ��- � Commonwealth of Massachusetts �33 �— � Title 5 Official Inspection Form ��zo�3 Subsurface Sewage Disposal System Form-Not��,�fq�un� H • , ,_ ti � , EALTH DEPT. A� a � 54 Clifford Street ""' k� ti t ;� ^ ' 1" ��-1 �-�le �lr-c� He nLaedress � {��8� U l_^(w//�1o4�/ ! ��S � Owner � pwn�'$Name imom,atirn is � ��I '� w Rcs�� required for every South Yarmouth MA 02664 0329l13 � ��� Pa9e. City?ovm State Zp Cede�c... � W Inepedion �- �<-��,� Inspection results must be submRted on this fortn.inspection forms may not be alEered in any way.Please see comple�aness checklist at 1t�e end of fhe form. � � /��IJ(S -Q Important:When A. General Information � ,� " filling out forms . ontFicca�nPWer. . � r �i/G�+�-�l? �. use oNy the tab �, Inspector. . key to move your �- °'r$°''d°^d Michael Kellett � use the retun Nmne ot Inspeetar . key. ��7� /�2ff�WdfiC EfIVIfOfNIIE(ld� fIS �A�„� �� ComPanY Narne ��'V PO Box 8� Camp�y Ad�eas � East Dennis MA 02641 S ��' ';�� cAy�rown state vv� (e N � i� 508-385-7fi08 513742 �� Telephone NwnEer Licer�se Number ^�.,����� t`t� B. Certification I cerUfy that I have personally inspected the sewage disposal system at ihis address and that the infomration reported below's true,acwrate and compkte as of the�ne of the i�pection.The i�pection was pertortned based on my trai�ing and e�erience in ihe proper function and maintenance of on site sewage disposal systems.l am a DEP appro�ned system inspector pursuant to Sectio�15.340 of TRIe 5(310 CMR 15.000).The sysbem: � Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by Uie Local Approving Aufhorily �.� « ,� E�..�f.�1 03/30/13 Inspedors Signature Dffie The system inspector shall submit a copy of ths insper�on report to the Approving Authority (Board of Health or DEP)within 30 days of canpleting this�spection.If the system is a shaied system or has a design flow of 10,000 gpd or gr�ter,ihe a�specUor arM the sys[em owner shall submit the report to the appropriate regional office of the DEP.The original shouki be sent to tl�e system owner and copies se�t Uo the twyer,'rf app6caWe,and the approving authorily. "*"'This report only descriees conditions at the tane of insped'wn and under the cond'rtions of use at that time.This inspQction do��wt address how the system wii perform in the future under • the same or drffereM conditions of use. L5ma.11l10 Tib 5011bW MapeNm Fam:&punc�e'Jewage�upoml Sys4m.Pape t M 11 r � Commonwealth of Massachusetts Title 5 ffi i I i O c a nspection Form SUDsurface Sewage O(sposel5ystem Form-Not for Vohmtary Assessmenl5 54 Clifford Street Roperty Address Helen Lally Owner pwner's Name inf«mation is South Yamwuih MA 02664 0329/13 requred fa every Pe9e. CitYlTavn Sta� Z.q Cotle Oate d Inspection C. Checklist Check if ihe folbwing have been done.You must indicate'yes"ar"no"as to each of ihe following: Yes No � ❑ Pumping information was p�ovided by the owner,occupant,or Board of Health ❑ � Were any of the system componen�pumped out in the pre�rious iwo w�ks? � ❑ Has the system received nomial Aows in ihe previous two week period? � � Have large volumes of water been introduced to tl�e system recenUy or as part of Uiis inspection? � � Were as buiR p�ns of the system o6lained and eramined?(If ihey were not available note as N/A) � ❑ Was the faality or dwel6ng inspected for signs of sewage back up? � ❑ Was the site inspected for signs of break out? � ❑ Were all system compa��enls,excluding ihe SAS,located o�site? � ❑ Were the septic tank manholes uncoveied,opened,and ihe interior of the tank inspec�ed for the condition of the baftles or tees,material of construction, dimensions,depth of Ipuid,deplh of sludge and depth of scum? � � Was the�al�y owner(and occupanis'rf d'rfferent from owne�provided with infortnafion on ihe proper mainterrance of subsurface sewage disposal systems? The sae and locatia�of tl�e Soi Absorption Systiem(SAS)on the site has bsen detertnined based on: � ❑ Existing information. For e�mple,a plan at ihe Boarti of Healih. � � Detertnir�ed in ihe field(rf arry of the failure criteria re�to Part C is at issue apprmdmation ofdistance is unacceptable)[31U CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedroans(design): 3 Number of bedrooms(achial): 3 DESIGN flow based on 310 CMR 15203(for e�mple: 110 gpd x#of bedrooms): 330 L5Vre.1 t/10 lik 501fi[iai MaqWim Fpm:SiOgu�Iace 8avepe qspawl5ys[em•Page 6 oi 1] , I N � „ -�-- o � � .. a .:: N S' O � .i, O Q ++ O ':'', � � � Q ? d w� _ � a � � ��'. t r .. � � I , � �, f a m .� 4 N N N p Y ri'. V , N p � �' ., 8 f N � � � N N � ` � � ' � �� . ,; f C4 N �. � o ` ' ., . .. . ..., . r �ewnr� 3���� � '. v '�.� .;...1�N� .�.. �.. `� . . Q = : g' i .. a � �� :' m� ,�-. ti.'.R$ � m ��... 4 .: y� � �� ti ,J M � � 4 � m e �`.� ..�o�v a O '. 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