135 Septic Inspection 2011 Timothy E. Maginnis R.S.
Registered Sanitarian
70 Montague Road
Westhampton,MA 01027
Ms. Suki Kramer
135 Dunphy Drive
Florence,MA.
Re: Title-5 Inspection
Dear Suki;
Enclosed please find a copy of a Title-5 Inspection Report for the subsurface sewage
disposal system at 135 Dunphy Drive in Florence,MA.
On October 18, 2011, I conducted a Title-5 inspection at this site. As a result of this
inspection I concluded that the system is not in failure and is operating in a manner which
protects public health, safety,welfare and the environment. I determined that the system
is in compliance with the State Sanitary Code Title-5 and no violations were noted. With
proper operation and maintenance this system should provide trouble free service in the
years to come.
Please be aware that this inspection report only describes conditions at the time of the
inspection and under the conditions of use at that time. It does not address how the
system will perform in the future under the same or different conditions. No warranties,
expressed or implied.
Please review the attached report and if you have any questions or would like any
additional information,please contact me at the above address.
Very truly yours; /,
r�
kar•km> =-
Timot agi
/c.c.Northampton Board of Health
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Inns•09/08
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owner's Name
Florence MA 01062 October 18, 2011
City/Town State Zip Cade 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.
A. General Information
1. Inspector:
Timothy E. Maginnis R.S.
Name of Inspector
Company Name
70 Montague Road
Company Address
Westhampton MA
City/Town State
Home: (413) 527-5291 Cell:(413) 575-8523 SI-1039
01027
Zip Code
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
� Passes
❑ Conditionally Passes ❑ Fails
❑ Needs F cis• -W�4B0 .y-L.: ocal Approving Authority
October 21, 2011
Inspectors 'Iffi`v VctyAYl Date
The system inspectl-8'tsl1811....1•: it 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.
Title 5 Official l nspecllcn Fenn
Disposal eysisir•Paaa 1 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18, 2011
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
N/A
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes","no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
N/A
Trim 5 Official Inspection Form:subs
Sewage Dlspos&System.Page 2 N 17
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t`sns•09/08
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18, 2011
City/Town State Zip Cade Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
N/A
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y O N O ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
N/A
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
Tolle 5 Moore!Inspection Form:Subsu,race Sewage Disposal system•Page 3 a19
Owner
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thins 09/00
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Tel: (413) 297-7029
Property Address
Suki Kramer
Owner's Name
Florence MA 01062 October 18, 2011
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance: N/A
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
N/A
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
11
Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than 6" below invert or available volume is less
than 14 day flow
Title 5 Official Inspection Form subsurf ace Sewage Disposal System•Page a of 17
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urn.woe
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18, 2011
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal conform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes°or"no" to each of the following, in addition to the
questions in Section D.
Yes No
p ® the system is within 400 feet of a surface drinking water supply
❑ ® the system is within 200 feet of a tributary to a surface drinking water supply
❑ ® the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—I W PA)or a mapped Zone I I of a public water supply well
If you have answered"yes" to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
Title 5 onictal InsgGlm Form:sueeunam Sane DI
sal System•Pape 5 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18,2011
City/Town State Zip Cade Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes°or"no" as to each of the following:
Yes No
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
Pumping information was provided by the owner, occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components, excluding the SAS, located on site?
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
Existing information. For example, a plan at the Board of Health.
Determined in the field Of any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4
Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
4
495 gpd
Sins•09106 The 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 M 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413) 297-7029
Owners Name
Florence MA 01062 October 18, 2011
City/Town State Zip Code Date of Inspection
D. System Information
Description:
1,500 gallon septic tank, distribution box and an SAS with 6 lines exiting the distribution box. The
type and size of the SAS was determined by review of existing septic system on file with Board of
Health.
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use ® Yes ❑ No
Water meter readings, if available(last 2 years usage(gpd)): 6659984 cu.ft.-
Detail:
This is a Sensus water meter in good working order.
Sump pump?
Last date of occupancy:
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non-sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
15NS•D9/08 Title 5 omo-al Inspection Form:Subsurface Sewage Disposal System.Page 7 of 17
® Yes ❑ No
Currently
occupied
N/A
N/A
Gallons per day(gpd)
N/A
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
N/A
Owner
information is
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i5lns•09/08
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form •Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18, 2011
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other(describe below):
N/A
N/A
Date
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
Suki Kramer
If yes, volume pumped: N/A
gallons
How was quantity pumped determined? N/A
Reason for pumping: N/A
Type of System:
❑ Yes ® No
Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) Of yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Title 5 Official In ton Form'.subsun S6wpe Disposal System.Page e of 17
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information is
required for
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owner's Name
Florence MA 01062 October 18, 2011
Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
System is approximately 6 years old. Source of information is approved plan on file with Board of
Health.
Were sewage odors detected when arriving at the site?
Building Sewer(locate on site plan):
Depth below grade:
Material of construction:
❑ cast iron
®40 PVC ❑ other(explain):
Distance from private water supply well or suction line:
❑ Yes ® No
47" +
feet
4"pvc solid pipe
NIA
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
4"pvc solid pipe from house to tank was installed new in 2005, it is in good working order. Pipe from
tank to distribution box is also in good working order. No eveidence of leakage. Venting is proper
Septic Tank(locate on site plan):
Depth below grade:
Material of construction:
® concrete
37"to top of tank(1-12" riser) -24"
to top of riser
❑ metal ❑fiberglass ❑ polyethylene
❑other(explain)
This is a 6 year old 2 compartment 1,500 gallon concrete septic tank.Tees are in place and are
operating properly. No leakage observed The tank shows no signs of deterioation and is good
working order.
If tank is metal, list age:
N/A
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
(10.5'L x 5'-W x 4'D)
Dimensions:
Sludge depth:
< 1"
15Iw•P1ta Title 5 0Ktlal Inspection FOR!! Subwaece Sewage Disposal System•Pape S of 11
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t5ins•MOB
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owner's Name
Florence
City/Town
MA 01062 October 18, 2011
State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
47"
1"
1'•
measured and observed
Comments (on pumping recommendations, inlet and outlet tee or baffle condition,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank is in good condition. At the time of this inspection, there was no leakage
condition. No leakage observed Recommend pumping this year and every three
structural integrity,
Tees are in solid
years hereafter.
Grease Trap(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete
❑ metal ❑ fiberglass
N/A
feet
❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
N/A
N/A
N/A
N/A
N/A
Date
Title 5 Official Inspedlon Form:Subsurface Sewage Disposal System•Page 10 N 17
Owner
information is
required for
every page.
Mins•pane
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18, 2011
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
N/A
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
N/A
Depth below grade:
Material of construction:
❑ concrete
N/A
❑ metal
❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
N/A
Capacity: gallons
N/A
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
N/A
N/A
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
N/A
`Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Title 5 official Inspection Form'.S4twdacs Sewage Disposal System•Page 11 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Fomt -Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18, 2011
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Liquid level was even with outlet inverts.
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Distribution box is 18" + below grade and in sound condition. There are 6 outlet pipes, each with
speed levelers on them. Liquid level was even with theoutlet inverts. There was no evidence of
carryover or leakage On or out) at the time of this inspection. .
Pump Chamber(locate on site plan).
Pumps in working order:
Alarms in working order:
❑ Yes ❑ No
❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
N/A
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
The top of the SAS is approximately 24" below grade. It consists of 6 lines of -4" pvc perf. pipe and
stone, 60'long. It is not in failure at this time. See plan on file with Northampton Board of Health by
this Inspector.
(Sins OOCO Title 5 oTieai Inspection rum:Subsurface Sewage Disposal Synam.Faye 12 of 17
Owner
information is
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence
City/Town
MA 01062 October 18,2011
State Zip Code Date of Inspection
D. System
Type:
Information (cont.)
❑ leaching pits
❑ leaching chambers
❑ leaching galleries
❑ leaching trenches
leaching fields
❑ overflow cesspool
❑ innovative/altemative system
number:
number:
number:
number, length:
number, dimensions:
number:
1 @ (60'Ix35'w)
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
This system is not in failure. It is 6 years old and is in good working order. There is no evidence of
ponding or damp soil. The vegetation is normal grass. No signs of hydraulic failure.
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
N/A
N/A
N/A
N/A
N/A
N/A
❑ Yes ❑ No
Title 5 Official inspection Fpm'.Subsurface Sewage Disposal System•Page 13 0117
Owner
information is
required for
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'Sins 09/06
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence MA 01062 October 18, 2011
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
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.):
N/A
N/A
N/A
N/A
ribs 5 Official Inspection Form Subsurface Sewage Disposal System•Page 14 N 17
Owner
information is
required for
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Ores•09/08
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
135 Dunphy Drive
Properly Address
Suki Kramer Tel: (413)297-7029
Owners Name
Florence
City/Town
MA 01062 October 18, 2011
State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
Title 5 Official Inspection Farm:Subsurface Sewage Di aPo aI System.Page 15o1 n
•
Existing 4 bedroom house
(nts)
E
co,?
ck /
La"
i.
/ A = •B^ xisting 1500 gallon septic tank
= pumping manhole
• o ( R
Title-5 sand (CD
4" pvc solid pipe 70ft /(701 x 45'W x 30"D)
r le-60ft.
:Title-5 sang'-:: -'1
Distribution box ("0") 601f of 4" vc_pert pipe q
p
�,� 601f of 4" pvc_pert pipe . �, Vent pipe
P __FiQf Qf 4_EwS_Utf
�'I� 601f of 4" pvc_perf pipe 3 ft. 4 ft.
601f of 4" pvc_perf pipe "77
S41f ¢f 4 p c_p&rf pipe__1
3/4" - 1 1/2" washed stone
•Olf ± of 40 mil poly liner
AS—BUILT DIMENSIONS
As—built plan
"A" to "C" = 24' - 5"
135 Dunphy Drive
Florence, MA.
"B" to "D" = 68'
Installer: JC & Co.
Date: October 13, 2005
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Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forrn -Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413)297-7029
Owner's Name
Florence MA 01062 October 18,2011
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
IX] Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water:
>4'
feet
Please indicate all methods used to determine the high ground water elevation:
• Obtained from system design plans on record
If checked, date of design plan reviewed: October 17, 2011
Date
• Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
• Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
1. Groundwater was determined to be> 4'as shown on test pit data of record. A Soil Evaluation
was not conducted at the time of this inspection.
2. No evidence of groundwater seepage into septic tank or distribution box.
3. Observed site for nearby wetlands.
4. As the original soil evaluator and sysem designer, this inspector has personal knowledge of the
groundwatrer elvations at this site.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5•09/00 Tile 5 GRical Inspection Fwm-.Subsurface Sewage Disposal System•Page 16 af 17
Owner
information is
required for
every page.
l5lns.09/00
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
135 Dunphy Drive
Property Address
Suki Kramer Tel: (413) 297-7029
Owner's Name
Florence MA 01062 October 18,2011
City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
Title 5 Official Inspection Form.Subsurface Sewage Disposal System.Page 17 of 17