HomeMy WebLinkAboutInspection Report 2015 Apr 16 i '
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Title 5 Dificial inspection Form MAY 0 6 2015
SubsurFaee Sevrage D'esPoas�Syshem farm-Not fo�V°w"tarY��^� HEALTH DEPT.
148 Lewis Rd. � `� , �
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DoroUtY�P� �� � � ���
Oxmer owrers Name
����� W�Y��� MA 02673 4l16t2015
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inspeotion resuMs must be submitted on this form.�spacho�fomts maY nd be elbetet!in aoy
way.Please see��at flre end of t!�form. �- l �" � s^'
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��� A. Generat Information �� � ' �
�an n�e�. e�ti.. �J r�re 4.
use a�y the t� 1. inspector. 1� `J V4r, v Y• � '
tey w mo�e r�
Wfso[-do�rot PBU�M2(Elti W <.f �G t c J� S • �.
u�tl�C retum Name of Ir�spet�or �
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� Cape Cod Septic Services
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350 Main St
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r. W.Yamrouth MA 0�673
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�s �o�s--n�-acsa�_ siso�s
Tel��Me�e� . .� Li�ae N�er .
B. C@rtificahOn
�oertiry m�� t�ave perso�auy inspec�ed tl�e sew�qe d+sp�sal sYst�!at mis adaress andthat the
infortnatioo r�eported behvv is hue.a�ura6e and oompiete�of tl�e 4me of Uw insPecdon.The inspectio�
w�perforrr�ed based on my training atM experier�in the proper furx�ion a�tna�t�ce of on si�
sewage disPo��SYs�ms. i am a DEP approved syshm i�Pecior P�+�aM to Sacdon 15.340 of
Tkie 5(310 CMR 15A00►•The system:
� Passes ❑ Condrtiona��Y P�s� � F�
❑ Nee�Furtl�r Eyalua�on bY the Loc�APP�o��3��O�Y
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�nspec6or'ssignaWre � `
The sysbem inspechor shaN subrtrit a copy of th�inspection report to the Appeoving pwtlioriLY(Board
of HeaiEh a DEP)within 30��s�oompi�n9 tfus i�sp��. N ft�e system�s a shared system�
F�s a desgn tbvv of 10,000 gpd q greater,the Inspector and the system aNner�ail su�nit ihe
repo�t to tM�e aPProP���9ar�o#fice of the DEP.The oeg�shou�be s�t to the sys�em ovmer
and coPie.s sent to the�aYe�,if appl'x�ble, and Uie aPPro��9 authority.
""'This report only describes condidons at tl�e tune of Ir►spect�n and under the�of�e
at that thne.This n�spec�o�does not address hrnv tbe sys�m w�P�in tl�e firture under
tl�e sa�w diBerent condi�s of us�
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