79 inspection report gay C`lj 7totaelmxttaa, Weaddac&de
212 ilia& Street
7104thariztoa. 712,04 01060
lee 41S-587-1214
tax WS-587-1221
Title V Certification of Compliance
TO BE FILLED OUT BY THE SYSTEM INSTALLER
INSTALLER SIGN-OFF
Pursuant to 310.CMR 15.00 of the State Environmental Code:Title V,Minimum Requirements for the
Subsurface Disposal of Sanitary Sewage,Section 15.021 (3),the Installer of a system is required to sign
this form as a condition for issuance of a Board of Health Certificate of Compliance for the onsite septic
system.
This is to certify that the onsite sewage disposal system that I installed as: new construction
at
79 Country Way
(Adds)
tc
repair(existing system)
on 10-1 3-05 ,DWCP number
(Date)
has been constructed in compliance with 310 CMR 15.00, and all local requirements.Any changes to the
original approved plans have been reflected on an as-buih plan that has been submitted to the Board of Health.
Mark LaValley & Sons 207 Sylvester Road, Florence
Mass. 0 1**city,and Zip code)
r uc lc Wig/Installer's name)
10-27-05
(Date)
NOTE:This certification represents no warranty,expressed or implied as to the functioning or longevity of the on-site
subsurface disposal systeu.Rather,the plan and installation are in compliance with all applicable rules and regulations as are
in effect at the time of plan submittal.
6d 71-cnat
212 7114en sheet
72att4iam i, 7101 01060
7d 413-587-1214
?ax 413-58?-1221
Title V Certification of Compliance
TO BE FILLED OUT BY THE SYSTEM DESIGNER
DESIGNER SIGN-OFF
Pursuant to 310.CMR 15.00 of the State Environmental Code:Title V,Minimum Requirements for the
Subsurface Disposal of Sanitary Sewage,Section 15.021 (3),the Designer of a system is required to sign
this form as a condition for issuance of a Board of Health Certificate of Compliance for the onsite septic
system
This is to certify that the onsite sewage disposal system that I designed as: new construction
Xrepair(existing system)
at 1 (9{-4, %/,p_ on /]' 2•li� DWCP number
(Address) "d �(pule)
has been constructed in compliance with 310 CMR 15.00, and all local requirements.Any changes to the
original approved plans have been reflected on an as-built plan that has been submitted to the Board of Health..
C (KO CrP. �uPi-, is
tDe c)
t U l°{ (Address)
amore (Date)
NOTE:This certification represents no warranty,expressed or implied as to the functioning or longevity of the on-site
subsurface disposal system.Rather,the plan and installation are in compliance with all applicable rules and regulations as are
in effect at the time of plan submittal.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address.
Name of Owner:
Address of Owner:
Date of Inspection:
Name of Inspector:
Company Name:
Mailing Address:
Telephone Number:
79 Country Way
Florence,MA
David Premo
79 Country Way
Florence,MA 01062
July 29,2005
Gregory J.Newman
Newman Environmental Engineering
P.O.Box 395,
Worthington,MA 01098
413-238-5383
CERTIFICATION STATEMENT
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 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
Needs Further Evaluation By the Local Approving Authority
Inspector's Signature: Date:
The System Inspector shall submi 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.
Notes and Comments:
1. Replacement of entire system required,including septic tank and leach field.
2. Recommend removal of existing garbage disposal.
****This report only describes conditions at the time of inspectionand 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.
Prepared by Newman Environmental Engineering Page 1 of 11
Based on DEP form revised 6/15/2000
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
79 Country Way
Florence, MA
David Promo
July 29,2005
Inspection Summary: Check A,B,C,D,or El ALWAYS complete all of Section D
A. System Passes
N I have not found any information which indicates that any of the failure conditions described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes
N 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.
Answer yes,no or not determined(Y,N,or ND) in the for the following statements. If"not determined",please
explain.
N The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is stmcturally 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 ifa Certificate of Compliance
indicating the tank is less than 20 years old is available.
ND explain:
N Observation of Sewage backup or breakout or high static water level observed 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 the
approval of the Board of Health): 0-box not found during inspection.
N broken pipe(s)are replaced
N obstruction is removed
N distribution box is levelled or replaced
ND explain:
N The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with the approval of the Board of Health):
N broken pipe(s)are replaced
N obstruction is removed
ND explain:
Prepared by Newman Environmental Engineering Page 2 of 11
Based on L EP form revised 6/15/2000
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 79 Country Way
Florence, MA
Owner: David Promo
Date of Inspection: July 29,2005
C. Further Evaluation is Required by the Board of Health:
N Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect the public health,safety,or the environment.
1. System will pass unless the 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:
N
N
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of bordering vegetated wetland or salt marsh
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 the environment:
N 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.
N The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply well.
N The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
N 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:
3. Other:
N
**This system passes if the well water analysis,performed at a DEP certified laboratory,for conform bacteria
and volatile organic compounds indicates that the well is free from pollution from that facility 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.
Prepared by Newman Environmental Engineering Page 3 of 11
Based on DEP form revised 6/15/2000
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 79 Country Way
Florence, MA
Owner: David Premo
Date of Inspection: July 29,2005
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool. shallow dug hole near low end of leach field found sewage backup.
N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool. D-box not found-system failing 8 D-box(If present)will be replaced
N Liquid depth in cesspool is less than 6 inches below invert or available volume is less than%day flow.
N Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped:
YES
Any portion of the SAS,cesspool,or privy is below high groundwater elevation. "'probable,to be
confirmed by site testing for repair to failed leach field
N Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
N Any portion of a cesspool or privy is within a Zone I of a public well
N Any portion of a cesspool or privy is within 50 feet of a private water supply well.
N 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility 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.)
(Yes/No)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: NOT APPLICABLE
To be considered a large system,the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above.)
Yes No
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-IWPA,or a mapped
Zone 2 of a public water supply well).
If you 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.
Prepared by Newman Environmental Engineering Page 4 of 11
Based on DEP form revised 6/15/2000
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner:
Date of Inspection
Check
Yes
X
X
X
79 Country Way
Florence, MA
David Premo
July 29, 2005
the following have been done. You must indicate either"yes"or"no"as to each of the following:
No
X
x
N/A
Pumping information was provided by the owner,occupant,or Board of Health
Were any ofthe system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two-week period? except family away 7/25-7/29
Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as-built plans obtained and examined? (If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage backup?
Was the site inspected for signs of breakout?
Were all system components,excluding the SAS, located on the site? except D-box not found
Were the septic tank manholes were uncovered,opened,and the interior ofthe septic tank inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,
and depth of scum? Unable to open outlet port,Inspected pipeline outside of tank
Was the facility owner(and occupants,if different from owner)provided with information on the
proper maintenance of subsurface disposal systems.
Copy of "Your Septic System-A Reference Guide for Homeowners" (prepared by DEP)submitted to
Owner with this report.
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
X Existing information. For example,plan at B.O.H.-no plans available per Owner&BOH
Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of
distance is unacceptable) [15302 (3)(b)]
Prepared by Newman Environmental Engineering
Based on DEP form revised 6/15/2000
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner:
Date of Inspection:
79 Country Way
Florence, MA
David Premo
July 29,2005
FLOW CONDITIONS
RESIDENTIAL:
Number of bedrooms(design): unknown Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms) 330 gpd
Number of current residents: -3
Does residence have garbage grinder(yes or no): yes REMOVAL RECOMMENDED
Is laundry on separate sewage system(yes or no): no (if yes,separate inspection required)
Laundry system inspected(yes/no): n/a
Seasonal use(yes/no): no
Water meter readings(gpd),if available(last two years usage): not available
Sump pump(yes/no): no
Last date of occupancy: currently occupied
COMMERCIAL/INDUSTRIAL:
Type of establishment: NOT APPLICABLE
Design flow(Based on 310 CMR 15.203) gpd
Basis of design flow:
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(Describe):
GENERAL INFORMATION
Pumping Records
Source of information: Owner-system pumped every 2-years,last pumped in April-04
Was system pumped as part of the inspection(yes or no): No
If yes, volume pumped(gallons): nla How was quantity pumped determined?
Reason for pumping: maintenance
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Altemative technology. Attach copy of current operation&maintenance contract(obtained from owner)
Tight Tank Attach a copy of the DEP Approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information: System is more than 35-years old
(house built in late 60s,per Owner)
Were Sewage odors detected when arriving at the site(yes or no):
no
Prepared by Newman Environmental Engineering Page 6 of 11
Based on DEP farm revised 6/15/2000
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
QNneC
Date of Inspection:
79 Country Way
Florence, MA
David Premo
July 29,2005
BUILDING SEWER(locate on site plan):
Depth below grade: -32"
Material of construction: x cast iron 40 PVC x Other(explain)
CI pipe in basement switches to Orangeburg outside wall
Distance from private water supply well or suction line: >50-ft
Comments(condition of joints,venting,evidence of leakage,etc.):
Piping appears sound in basement,venting appears o.k.(located directly over sewer thru wall),there Is no evidence of leakage
SEPTIC TANK: yes (locate on site plan)
Depth below grade: -33 inches
Material of construction: x concrete metal fiberglass _ polyethylene _ Other(explain)
-1,200 gallon septic tank
If tank is metal, list age n/a Is age confirmed by Certificate of Compliance(yes/no): n/a (attach copy of certificate)
Dimensions: internal dimensions:8'x 4'x 5' liquid depth
Sludge depth: >12 inches
Distance from top of sludge to bottom of outlet tee or baffle: unknown unable to open outlet port without breakage
Scum thickness: -2-3 inches at center of tank
Distance from top of scum to top of outlet tee or baffle: unknown unable to observe
Distance from bottom of scum to bottom of outlet tee or baffle: unknown unable to observe
How dimensions were determined: measured
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert, evidence of leakage,etc.): Access risers over center port and inlet port were opened,unable to open outlet port;
tank shows signs of significant surcharging over top of tank and up into access risers,scum observed over top of tank at inlet
riser; tank shows significant spelling(deterioration of concrete)at underside of cover/top,structural integrity of tank maybe
compromised; no signs of leakage into or out of tank(except at risers); observed outlet pipe outside of tank-poked hole in
crown to snake pipeline-liquid level In tank at outlet pipe Invert(normal); pumping of tank should be conducted during repair of
system(and abandonment of this tank).
GREASE TRAP: N/A (locate on site plan)
Depth below grade:
Material of construction: concrete metal _ fiberglass 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:
Comments: (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
Prepared by Newman Environmental Engineering
Based on DEP form revised 6R5/2000
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection
79 Country Way
Florence,MA
David Premo
July 29,2005
TIGHT or HOLDING TANK: N/A (Tank must be pumped prior to,or at
Depth below grade:
Material of construction: concrete
metal fiberglass
me of inspection)(locate on site plan)
polyethylene Other(explain)
Dimensions:
Capacity(gallons):
Design flow(gallons per day)
Alarm present(yes or no):
Alarm level:
Date of last pumping:
Comments: (condition of alarm and float switches,etc.):
Alarm in working order(yes or no):
DISTRIBUTION BOX: NO (if present must be opened)(locate on site plan) --NOT FOUND-determined leach field
Depth below grade: in failure as described on page 9.
Depth of liquid level above outlet invert:
Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
PUMP CHAMBER: NIA (locate on site plan)
Depth below grade:
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.):
Prepared by Newman Environmental Engineering Page 8 of 11
Based on DEP form revised 6/1512000
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
79 Country Way
Florence,MA
David Premo
July 29,2005
SOIL ABSORPTION SYSTEM(SAS): yes (locate on site plan,excavation not required)
If SAS not located,explain why:
Type
Estimated system to be leach field based on grass coloration and contours
leaching pits, number:
leaching chambers,number:
leaching galleries,number: dimensions:
leaching trenches,number: dimensions:
X leaching fields,number: 1 dimensions: -32'x-17'
overflow cesspools,number:
innovative/alternative system: Type/name of technology:
Comments:(note condition of soil,signs of hydraulic failure,level ofponding,damp soil,condition of vegetation,etc.):
no pending nor damp soils noted initially; noted that grass is slightly greener and more consistent in this area of yard;under
close inspection some blackness observed at top of soil under grass blades at south(low)end of leach field---blackness may be
sign of past breakout;dug hole at south end of leach field(see plan,attached)to about 9-inch depth and observed sewage rising
up to within 2-inces of surface grade;concluded that leach field is in obvious failure(especially considering the low load
conditions with the family away for the week).
CESSPOOLS: N/A (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(yes or no):
Comments: (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
PRIVY: N/A (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
Prepared by Newman Environmental Engineering
Based on DEP form revised 6/15/2000
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
79 Country Way
Florence, MA
David Premo
July 29,2005
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locale all wells within 100-ft(locate where public water supply comes into house)
SEE ATTACHED SITE PLAN
Prepared by Newman Environmental Engineering Page 10 of 11
Based on DEP form revised 6/15/2000
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
79 Country Way
Florence,MA
David Premo
July 29,2005
ESTIMATE OF SEASONAL HIGH GROUNDWATER ELEVATION:
NRCS Report name:
Soil Type:
Soil Survey of Hampshire County,Massachusetts,Central Part,prepared by USDA
Soil Conservation Service,December,1981
Paxton(PcC)
Typical depth to groundwater: Paxton(PcC)=1.5-2.5 ft (perched Feb-Mar)
SITE EXAM Slope downward slope south of SAS
Surface water no surface water observed in area;no damp soils
Check cellar finished cellar appears dry,no water marks; does not have groundwater sump(per Owner)
Shallow wells not available
Estimated Depth to Groundwater: -3.0
feet based on observed mottles when locating pipeline to leach field
Please indicate(check)all methods used to determine the high groundwater elevation:
no Obtained from system design plans on record-If checked,date of design plan reviewed not available,per BOH
yes Observed Site(abutting property/observation hole within 150 feet of SAS)-dug holes near pipeline 8 septic tank
yes Checked with local Board of Health-explain: no information available
no Checked local excavators, installers(attach documentation)
no Accessed USGS database-explain:
You must describe how you established the high groundwater elevation:
High groundwater elevation is based on observed mottles when locating pipeline to leach field;dug holes to 4-ft depth
(for locations,see dug holes at pipeline on plan,attached). The depth of ESHWT will be confirmed(or modified)based
on site evaluation test pits conducted by others for the repair of the failed leach field.
Soil Absorption System(SAS)elevation relative to seasonal high groundwater
It is estimated that the bottom of the SAS stone may be 2.5-k to 4.5-k below grade and is probably located within the seasonal
high water table.
Prepared by Newman Environmental Engineering Page II of II
Based on DEP form revised 6/15/2000
Se tic System Permit Payment Rece1Q
Permit#&5 ate:t� OS Const_iReepair(/
Amount: g53 ea Cash 7
Check# I ( 2-
Address:
Owner:
4
SYLVESTER ROAD CONSTRUCTION ACCOUNT
DAVID A PREMO
CLAIRE A PREMO
79 COUNTRY WAY
FLORENCE,MA 01
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Date: _ 9 O/ Amount: S
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Property Address
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FLORENCE,MA OIO
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Transmittal Cover Sheet
From: Greg Newman
NEWMAN ENVIRONMENTAL
ENGINEERING
To: Board of Health 21 Guard Road,P.O. Box 395
210 Main Street Worthington, MA 01098
Northampton, MA 0W60
Date: August 8, 2005
Subject: Title 5 Septic System Inspection—D. Premo
Tel: 413-238-5383
Fax: 413-238-4276
79 Country Way, Florence, MA
CONTENTS:
Number of copies:
Title 5 Septic System Inspection report
❑ Please reply ASAP
Other --
For your files.
❑ Please send your comments ® Please review
Please call if you have any questions.
Very truly yours,
Newman Environmental Engineering
Gregory J. Newman, P.E.
SEPTIC TANK
/
RR GIG
GRASS
SLOPE
N
O
LEACH FIELD
(APPROX LOCATION)
LAAP
N
- XSii\ WOOLS
N
Y
NA-
6 SHRUBS
LAWN & GARDEN
REBRWGrH
N
N
LA wN
DUG HOLE(TYP)
AA GE
SITE PLAN
APPROX.SCALE: 1" =20'
CEP-1 TEST PIT No.1
OPERC-1 PERC TEST Na.1
— •• — PROPERTY LINE(APPROX.LOCATION)
WELL
m EXISTING CONTOUR(REL TO SITE B-M)
PROPOSED CONTOUR
— - STREAM/WETLANDS BOUNDARY
- -.— BURIED WATERLINE(APPROX.LOCATION)
— —T— BURIED ELECTRIC LINE(APPROX.LOCATION)
— —*— BURIED GAS LINE(APPROX.LOCATION)
FENCE
0 ROCK WALL
SEPTIC SYSTEM INSPECTION- 7/29/05
79 COUNTRY WAY, FLORENCE, MA
FOR DAVID PREMO
NEWMAN ENVIRONMENTAL ENGINEERING
P.O. BOX 395, 21 GUARD ROAD, WORTHINGTON, MA 01098
TEL: 413-238-5383 FAX: 413-238-4270