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1114 Title 5 2017 , ,; `, Commonwealth of Massachusetts _ =__ �� Title 5 Official Inspection Form =I kl= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1.114 Florence Road Property Address Scott& Lauren Magoon Owner Owner's Name information is required for every Florence MA. 01062 __Sept. 7. 2017 page. City/Town a tate Zip Code 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. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Timothy E. Maginnis use the return — key. Name of Inspector 4,147 Company Name v 70 Montague Road Company Address nes Xt Westhampton MA. 01027 City/Town State Zip Code (413) 527- 5291 SI 1039 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: 2 Passes ❑ Conditionally Passes ❑ 1 ❑ Needs Further Evaluation by the Local Approving Authority g E_ d i a IAGINNts '. I f, No.9112 Timothy E.Maginnis eptem,er9. 2017 ClSIV Inspector's Signature 6.- -' �/lr% 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 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. tS:cs doc•rev.6.'"6 Title 5 Official Inspection Fon Subsurface Sewage Disposes System•Page 1 of 17 Commonwealth of Massachusetts t,.- ,-�,P Title 5 Official Inspection Form Siiiir. ubsurface Sewage Disposal System Form - Not for Voluntary Assessments 1,1 4 1114 Florence Road z_ Property Address Scott& Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B.C,D or E I always complete all of Section 0 A) System Passes: RI 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: No violations noted. This system passes the Title-5 Inspection on this date 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 t5i-is dog•rev.6/16 Title 5 Official Inspection Form Subs.uface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts -74-110,---4) x=4ria Title 5 Official Inspection Form _ , y) Ciihciirfa, Ccw�na flicnnaal Cuctam Form _ Not for Voluntary Assessments ---1- Scott& Lauren Magoon Property A&fress. 1114 Florence Road Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 j Y 121 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 Z N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ON ❑ 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 t5irs dcc•rev.6116 T ne 5 Official Irspecticn Form SJbsuyface Sewage Dispose Sys:err•Page 3 of 17 Commonwealth of Massachusetts == P .w Title 5 Official Inspection Form -=_ _ ,. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ___-/; JCS' 1114 Florence Road Property Address Scott & Lauren Magoon Owner - - - ------ ---- - Owner s Name information is Florence MA 01062 Sept. 7, 2017 required for every page. 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: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal 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 ❑ ® 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 1/2 day flow 15ins.doc•rev 6115 Title 5 Officia Ins pection Fern.Suosurace Sewage C sposal System•Page 4 cf'? Commonwealth of Massachusetts Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1114 Florence Road Property Address Scott& Lauren Magoon Owner ----- - --- ------ Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year HOT due to dogged 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. ❑ 0 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 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 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 ❑ ® the system is within 400 feet of a surface drinking water supp4y ❑ ® 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— IWPA)or a mapped Zone II 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. 15 ns dcc•rev 6(16 T:le 5 Official Insoecten Form.Sutsurface Sewage Disposal System•Page 5 of 17 • Commonwealth of Massachusetts „,....,110,-:------ ; Title 5 Official Inspection Form ii _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments msM 11-14 Florence Road Property Address Scott&Lauren Magoon Owner - ------- — — ---------- Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every - page. City/Town State Zip Code Date of Inspection C. Checklist Check 4f.the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No WI ❑ 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? ® 1W1 Have large volumes of water been introduced to the system recently or as part of this inspection? W1 ❑ 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? EZ ❑ 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 (if 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): }— Number of bedrooms (actual): 3 495 gpd DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Actual design: 509g t5ins.doc•rev 6116 Title 5 Office.Inspect cr Form:Subst.rface Sewage Disposal System•Page 6 o`17 Commonwealth of Massachusetts Title 5 Official Inspection Form S7/1. q Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1114 Florence Road Property Address Scott& Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every — page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 gallon (2 compartment) septic tank, distribution box and a stone and pipe Leaching bed with 3 lines @ (43'L x 16'W) Number of current residents: Does residence have a garbage grinder? Q Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? 2 Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: NiA-There is a private water supply at this site> 100'to SAS. Sump pump? [0 Yes ❑ No Last date of occupancy: Currently occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.dx•rev.6/16 Title 5 Off c at Inspedicr Fotm Subsurface Sewage 0,saosa'System•Page 7 o`17 Commonwealth of Massachusetts tY=- ,w Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /t 1114 Florence Road Property Address Scott &Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 2017 required for every Sept. " page. City/Town State Zip Code Date of Inspection D. System Information (cont.) NIA Last clave of occupancy/use: Date Other(describe below): General Information Pumping Records: Pumped in 2015- Lauren Magoon- owner Source of information: Was system pumped as part of the inspection? LI Yes ® No N/A If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Prvy ❑ Shared system (yes or no) (if 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): t5ir<_dcc•rev.6!"6 Title 5 Offcial Irspedior Fon SJbsuzface Sewage Dispose Sys:err•Page 8 o`17 Commonwealth of Massachusetts FAOTitle 5 Official Inspection Form - = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /' 11.14 Florence Road Property Address Scott& Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information. Designed by Cold Spring Environmental Consultants Inc. in 2004. Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): 1°.5'+/- Depth below grade: feet Material of construction: ❑ cast iron W1 40 PVC ❑ other (explain): > 50' Distance from private water supply well or suction line: feet Comments (on condition of.joints, venting, evidence of.leakage, etc.): Building sewer is in good working order. All joints are sound and not leaking. Venting is proper Septic Tank (locate on site plan): 1'= 12"+/_ Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No 10.5'L x 5.5'w x 4'D Dimensions: Sludge depth: 1„ :5i'15.cOC•re. 5,15 Title 5 Officio:Inspection Fcrn:Suosurface Sewage D.sposal System•Page 9 of 17 Commonwealth of Massachusetts *�z Title 5 Official Inspection Form x:11— vi Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 1114 Florence Road! PAopentgf Aridness. Scott&Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every • page. City/Town 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 47" Scum thickness 1" - negligable 3,, Distance from top of scum to top of outlet tee or baffle 1" Distance from bottom-of scum to bottom of outlet tee or baffle: Measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 'T'he°tank is in good working order. No-evidence of teal-age into or out of this-tank. The inlet,outlet and center tees are 4"pvc solid pipe and operating properly. The liquid level was even with the outlet invert. The tank was last pumped by T.R.A.K Septic Pumping about 2 years ago - (2015). Recommend pumping at least every 3 years Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑-concrete ❑-metal ❑fiberglass ❑polyethylene ❑other(explain): N/A Dimensions: Scum thickness N/A Distance fromtop of scumto top of outlet tee or baffle / N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: Date t5 ns.00c•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts • - z Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.'-F—' 1114 Florence Road Property Address Scott& Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee orbaffle condition, structural integrity, liquid Jewels as laced to odtlet invert,evidence of leakage,etc.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): N/A Dimensions: N/A Capacity: gallons N/A Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: 0 Yes 0 No 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? 0 Yes ❑ No 15ins.doc•rev.6/16 Tile 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 • Commonwealth of Massachusetts r � Title 5 Official Inspection Form ==�1 �,�j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1114 Florence Road Property Address Scott &Lauren Magoon _ Owner Owner's Name information is required for every Florence MA 01062 Sept. 7, 2017 page. City/Town 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 3 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.): The distribution box is about 12"below grade and in good condition. There are 3-pipes leaving the box and no solids carryover. No evidence of leakage into or out of the distribution box. The distribution box is in good working order. Pump Chamber(locate on site plan): Pumps in working order: 0 Yes 0 No* Alarms in working order: 0 Yes 0 No* Comments(note condition of pump chamber,condition of pumps and appurtenances,etc:); N/A *if pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form tts— rl Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` —,c= 1`tt4-Florence Roan EPtropevty Address Scott& Lauren Magoon Owner Owner's Name information is Florence MA 01 062 Sept. 7, 2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length:. I (43 1 x I6'w; 2 leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: — — Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The soil at this site is a fine sand. Vegetation is lawn grass. There are no signs of hydraulic failure, ponding or damp-soil_ This leaching field is.working as designed and not in failure_ Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration - A 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 ❑ Yes ❑ No [Sins doc•rev.6,15 Title 5 Oflicia•Inspection Form:Suosur'ace Sewage D sposal System•Page 13 0'17 Commonwealth of Massachusetts 1I Title 5 Official Inspection Form _. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1114 Florence:Road Property addrees Scott&Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. 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.): Privy (locate on site plan): N/A Materials of construction: Dimensions Depth of solids Comments no cru d tion of soil.,signs of hydcautic failure, tevek of ponding, condition of vegetatkon, etc.): t5ins.doc•rev.6/16 Title 5 Official Insoect on Forrr Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts =1=fi-1 Title 5 Official Inspection Form 'F(MAO= ''i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments tom __§' 1114 Florence Road Property Addcess Scott& Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7. 2017 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Cf 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 1 1 See next page attached. I5ins.doc•rev.6/16 T tIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ' f o-'�—=YIST.',J=-- 1 , • I EXISTING AS BUILT SEDRoow IE ! SCALE:1"=30'11 DWE_L:!�G I, 3.1±Ac. I l _ 9-28-2005 I1 ILL=TBM1 VIAslsE =100' 2•of L 1 ! . . 1C. • «M • a 5uB I i 6 .5 • M'MN. i i i y Fyn 1tr i 9o' I i II . \ -EW 1500 0.S TANK , 5.00+SEPARATIO I I 8-----------5, ____A ��� / Ij4H�$ /�i�USE4"ID CLEAN OUT XIST.CONTOUR 1 \ __________...-----;„ \ 70 - SE NEW 16'WX43*L 1 p :EACH FEUD PLE Ti PER DEE— — — 65 s.BOX - ROP.CO�1TCUR � i Inswi_i i �. i n, AIL IN TREE_ I 35' '/ TBM2=63. ocel f NOT AN ACTUAL SURVEY! LINES DRAWN AS APPROXIMATE TYA' STRUCTURE LOCATION ONLY. • GRAVITY SLOPE SEPTIC SYSTEM OPERATION AND MAINTENANCE NOTES FOR HOMEOWNER. --410'scf<40 Prc 1.)HAVE TANK PUMPED EVERY 2 YEARS. from si by°Limber. 2.)MAINTAIN AREA OVER SEPTIC SYSTEM AS GRASSY cartractnr must OR SIMILAR GROUND COVER. confirm.0211 pitcl 3.)DO NOT PLANT ANT TREES OR DEEP ROOTING from sal to s.Mnk SHRUBS WITHIN 5 FEET OF SYSTEM. frosch.40PVC 4 1 I ISF rim Y 1nun f1FTFRf;FNTC IN WASHFR.S "., Commonwealth of Massachusetts q_.-- Title 5 Official Inspection Form _ i . I=; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k•= T9 1114 Florence Road Property Address. Scott&Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) site Exam: 0 Check Slope Z Surface water 0 Check cellar Ell Shallow wells Estimated depth to high ground water: e Leet feet Please indicate all methods used to determine the high ground water elevation: 12 Obtained from system design plans on record Sept. 7.2017 If checked. date of design plan reviewed: Date RI 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) IZI Accessed USGS database-explain: You must describe how you established the high ground water elevation: The soil at this site is.a fine sand. Personal knowledge of soils in this area. Review of USGS Soil Survey book. Observed no GW infiltration into septic tank or distribution box. Small test pit within 20' of distribution box. Reviewed original test pit data on 2004 design by Cold Spring Environmental Consultants Inc. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6715 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 cf,' .``: Commonwealth of Massachusetts _,_-*: Title 5 Official Inspection Form -istffi r1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Wittgg q 1.114 Florence-Road Property.Addreeis Scott& Lauren Magoon Owner Owner's Name information is Florence MA 01062 Sept. 7, 2017 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ' #nspectioni Summary:A.B.,C.a, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed IZ System Information —Estimated depth to high groundwater gl Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev 5116 Tale 5 Official Inspection Form Subsurface Sewage Disposal System•Page 17 of 17 DESIGN NOTES: • 1. 3'BR X 110 GAUPERSONS/DAY =330 GAL/DAY (3 bedroom design) -330 GPD X 1.5 (AS REQUIRED BY nOHO. BOH) =495 GPD -Use ONE Leachlield 16'wide x 43' LONG W16" of.5'of DBL washed stone below invert. Bot. Area: 16'wide x 43' long 88SF. Side Area: N.A. Total Area:688 sf x 0.74 gal/sf.=509 GAL./DAY. 3. GARBAGE DISPOSAL NOT ALLOWED 4. ALL D. BOX OUTLET PIPES LEVEL FOR FIRST 2' , 15. NO OTHER PRIVATE WELLS WITHIN 150 FEET OF SAS. ' 6 NO WETLAND WITHIN 100 FEET OF SAS 7. PRE& POST CONTOURS NOTED AS NECESSARY, RESERVE AREA NOT REQUIRED. 8. INSTALL NEW DBL CHAMBER 1500 GAL S. TANK AS NOTED &MAINTAIN 0.02 PITCH FROM SILL TO S. TANK. 9 . SLOPE CALCS (SEE CONTOURS). SUBGRADE INSP. REQ'D. 10. 2% MIN. SLOPE OVER SAS, CLEAR TOP AND SUB TO 24" MIN.AS NEEDED. CLEAR TO BASE OF B (MIN. 24") UNDER BED PRIOR TO TITLE V SAND PLACEMENT. 11. SOIL EVALUATION BY A.WEISS, RS. 06 AUG 2004(ERNIE MATHIEU, AGENT). 12. DEPTH OF PERC.44" BY A.WEISS 06 AUG 2004 13. PERC RATE= 3 MIN/1N, CLASS 1 SOIL RATING(L. SAND) 14.INSTALUINSPECT SCH.40 TEES/BAFFLES(10" INLET, 14"OUTLET), AS NEEDED, . 15. PLACE SCH 40 TEES UNDER OPENINGS OF S.TANK W/ PROPER GAS BAFFLES IF NEEDED/POSS. ""MUST HAVE 2 CHAMBER 1500 G TANK. 16. USE APPROVED(1 1/2") DBL.WASHED STONE UNDER BED & D.BOX FOR 6". CONFIRM STONE PROPERLY WASHED (WITH BUCKET/H20 TEST) PRIOR TO PLACEMENT. 17. NO TREES WITHIN 10 FT. OF NEW LEACH FIELD. USE TITLE V FILL 5'OUT. 18 ENGINEER TO INSPECT SUBGRADE, REMOVEIFILL& OLD FILL/SYSTEM WHERE INTERFERES WITH NEW SAS. "REMOVE ALL OLD SYSTEM IN SAME AREA OF NEW SAS, PUMP CRUSH AND FILL OLD S. TANK.. 19. T.B.M1. 100.00 AT SILL, CONFIRM PROPER PIPE SLOPES USE NEW SCH. 40 PIPE FOR PIPE FROM HOUSE TO NEW TANK 20. GRADE MULCH AND SEED OVER LEACHFIELD AS NOTED. 21. USE LEACHING BED INSTEAD OF TRENCHES DUE TO TOPOGRAPHY AND SPACE OF LOT WITH RESPECT TO LOCATION AND ELEVATION OF RESIDENCE (310 CMR 15.240). ALLATION IN LOW GROUNDWATFR SFASON RFCOMMFNDFD - TEST PIT LOG: TP.1 EFF.EL.64.50' EFF.ELEV. TP.2 LI104" k FRIABLE LOOSE FSL (10 YR 313) 0.8' 8-26" BW: FRIABLE(10 YR 516) 8-24" 26-126" C1: FINE SAND (2.5 YR 516) 24-36" OXIDES. NOT OBS ESH WT: 96" NOT OBS" STAND NG Ii20 NOT OBS" WEEPING FROM FACE 126"+ BEDROCK SEPTIC SYSTEM REPAIR PLAN FOR STEVE MARSH 1114 FLORENCE ROAD NORTHAMPTON, MA. COLD SPRING ENVIRONMENTAL CONSULTANTS INC. yN� BELCHERTOWN, MA. PHONE: (413) 323-6957 EMAIL: AEWEiSS CHARTER.NET FAX: (413) 3n-4916 DATE: DRAWN BY: REV'SED: 16 AUG 2004 ALAN V,IEISS SCALE: DRAWING NUMBER: A I!_nnI 11 no 'f I .4 n A nnnn nnnr