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671 Septic Inspection 2016 Commonwealth of Massachusetts Title 5 Official Inspection Form saiaarace Sends Disposal System Ponn-Not for Voluntary Assessments.. 671 North Farms Road.. Prolmalhiren Patrick Goggins Ovmrstimne a have y Florence Cayrraee MA - 01062 12/2/2016. Stilts ZIP cods Deb of(mpedian. tapectan MPS must be su opted an this foam Inmemdan aims may and be altered In any May.flesse see completeness checklist the end dtheta - 1ie. A. General Information —I N Co t 9. lnsPeator. move your -Snot Thomas S. Leue . Brehm . WmsofyMpedor.. . Homestead Engineering Inc. 1664 Cape St. Williamsburg 413-628,4533. MA 01996- B. Cer}Ificadon' I certtly that hews personally inspected the sewage disposal system at this address and that the information reported below m N e,accurate and complete as of the time of the.inspection.The inspection was performed based on my trainee;and experience in the Proper function and man emce ci on site Sewage deposal systems. t am a CO approved systemtnpector pursuant to Swam 15.340 otTIW 6(3sa CNN 15.000).The system: ® Passes ❑ Conditionally Passes 0 Fails 0 Needs further Evaluation by the Local ApPmverg'.Augmn*.. S December. 2, 2016 Dale The system inspector ehad submit a copy of this inspection report to the Approving Authority(Roard, of Health or DEP)within 30 days of completing this inspection. If the system*a shred system dr has a design flow of 10,000gpd or greater,the inspeolaraid the system owner and suture the report to the appropriate regional drys of the DEP.The anginal should be sent to Its system owner and copies sent to the buyer,if appdeffib,and the approving author ty. 3113 *••"This report only desafbss conditions at the Imo of inspecdon and under the conditions of use at Matting.tide inspection ft**not address how the system will perform In the Mite under the saw*-ordained undldons of use. MS eandtl td..Foam:oeensm Eeeoe COWS Mine'Peen I d.] Commonweatttt ti4:1! Form attic tt In Forth Subsurface •Disposal NNot�"' for Vokintary Assessments 671 North Farms.Road Papeete Aides Patrick Go ins i2/2�2oi_6_ stic NA 01062: atoms Plot-once a 7lc Code laspadioll B▪Car on (Mit.) Soundless Summary Check A,B,C,D or E 1 always comply all af SYM.n Passes: ® I have not found any infonmatio n that indicates that aM of are failure alteria desatei in 310 CMR 15.303 or in 310 CtAR 15.304 exist Any failure erase not 13 A Comments:: Section D B) System Conaway Passes: ❑ O ed oa f rrsspYpalaieS .kromponanas as desoriarl in T4 etarah The System,upon p n oita r or repair. approved by taBdot.MeathwhtWss aced'EY�N. )fatafotlkrvrn9atalemerts' If'rwt Chat to box fdr'yes',-no"or'trot determinate { fpt>@rymetal or not)is 'The static tank is metal and over 20 years old"or structurally avow*sans substantial alltIngilon or a failure laude is imminent t the wig pass inspeobon t tla a dslm0 tank a replaced alts a�! 'o Boat of Meath. •A metal septic latiwit pass inspection if it M skticturala sound,not legating nkB and it a Centf&ad Compfancs indicating tad the tank is Mss than is astale. 0 p N 0 ND(Explain below). p Pump Chmberpatios/alarms West not not operataal.System t with'Board of MealStepproval P a TM5toes InspalloriFeing&twlsa3M3M Most •Rioe 2 at1 C 671: No paa axNr+ Flores enceT B. (oont) (cant): a break out a tdph Nt or due Nt.f ,! of Board of fiselity (e)are feasted ❑Y. ON Nretnoved L7Y ON ONO( � fifar'isl6veded a replaced dY 'ON C3 WOOS ••D ❑ N O ND(F n tx Ci Y; p N O ND(E>9.si^S IW g) RrrMM:EV Is Re�Fdr�by tks,tilartep Publt goforpth'y• within 50 feet a8amacar• ..ertmeisft:elates(a Cesspool or--YNbw�m50 feet ofebotded�acetate' nu.3an 9113 .ommonwes +of "!"' Ei FQ rites forV 6/1 North Farina:Road .. Property Ate:. Patticl merit torts Florence B n3 ins 01062 12f2120i6 no Com Darts alwersue ptt:(tont) 2. union ;1D011WMW Ina qty and (SAS)�d 1he SAS is wmrs� p 100featcatws0 O(absaptionto septic tank and SAS and me SAS*w `a Zone 1 of apttilio'sa�. d The system taut° has a septic tenet and SAS and the SAS is within 60 feet of a plat°The system❑ s tYw t is less then 100 feet but 60feetn' ❑ systa„ORS a septic�*and and Me SAS more from a private water supply Method usedtO min'distance: health ' p ~ n1B tte sWPaT�caAified leb�a 'e eM'k'•t aDEP ur must orien ten other be aatadmd to 3. 'Other. 0) System PaNure Criteria Applicable10 Alf SYst onsf *Inspections: You mkt hrdGW"Yes'or"NO"to each of the fcIOWlrq YesxNO teeny or system eanponsns�°� � .Sadwp of sewage ❑ -a doggedM eRNerrttotheeurlsooc(theAroundors Wf ° ❑ the distribution ywenoue w+box*bore ❑ 5� or � volume loss noitioos '^ depth W.cessPea is less than 6'below imrortor available® than% flow . nreaaa:a.ww'Pmrm°°raMPaRer ^'•ws4an Oglt�h... .....-�T"'.�,-�-Fa...Mt tor Voluntary theocrats Sew102* i7 1 North Farms Road wires redrew patriot mow%toms Florence B. Certification (cont) Yea No Required cted pumping Number of times pumped: (WTdh»to elevation. Any portion tio pipe(s). :re below high ground water of cesspool or privy within 100 feet of a surface water supply°r Any portion tributary t0 a mutate water supply. Any portion of acesspool or privy is wi hin a Zone 1 of a public welt. Any portion of a cesspool or privy is within 50 feet of a private water simply well. .. is lees Bran 100 feet taut 9r than 50 Any portion of ie or wWtno acceptable water gq l analysis. MIS feet from a as mates absent passes If the certified laboratory,fw nryrogsn and a ci than no other presence g provided Aoof � mist be attached to this forra•1... The system is a cesspool serving a facility with a design flow of 2000 9pd" 10,000 gird TheraraWaasd I have in n�h CMR the system fad.The s owr�ree should contact the Board of Health to determine whet wNI be }necessary to correct the failure. large Systems: Tobecarrefperedala0esri01a the system must save a facility with o design flow cif 10,00010 to 15,000 YPd• FOI gyAems must indkmtaeitaryee'or and.m each of the billowing,in addition tote questions 0. Yes No drYturm water suppN ❑ the system is within 400 feet of a sudsua 0 ® she system is within 200 feet of a tributary 10 a surface drinking wm aonedlv.area(Inteim WelRfld ProteGicm a Are A) appa of a public vra supply threat #you have 'seam sYnn.0 above the f under Q ,A B contact system answered aid insadkfr SectIonEorfSd thmal pgtsea--L-a-011 threat Under a CMR 15304.7the system owner ho acairdence . set 113 ommonwealth of Massachusetts itle 5 Official Inspection Form Not for Voluntary Assessments ubsurface Sewage Disposal Sy s ;7 1 North F�--- --- 4opedyAdress --- ?atrick Goggins --- _ 12/2/2016 )mets Name 01062 Florence — state Zip Code Date 2Inspection GryRmvn C. Checklist Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No occupant, or Board of Health pumping information was provided by the owner, ® t 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 not available Were as-built plans of the system obtained and examined?Of they ® ❑ note as NIA' ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? boated on site? Were all system components, excluding the SAS, ® ❑ 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? nts if different from owner)provided with sewage disposal systems? ® ❑ Was the facility on he pro(and r maintenance System(SAS)disposal os site has been Thes size and d the proper maintenance of subsurface n S m SA The size and location of the Soil Absorption Sy 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)pi CMR 15.302(5)1 D. System ormation Residential Flow Conditions: 4 Number of bedrooms Number of bedrooms(design): (actual)-. DESIGN flow based on 310 CMR 1E203(for example: 110 gpd x#of bedrooms): 4 660 Qpd Me 5gficse Impea^n Forte'Subsurface Sewage Deposal System•Page 8 M t] !13 ommonwealth of Massachusetts Election Form ubsu a 5 Official Inspection ubsurface Sewage Disposal System -- 171 North Farms Road __--- toperty Address ?atrick Goggins — 12/2/2016 Tuners Name NA _ 01062 Florence State _ cti Zip Code Date of Inspeon C rrtow D. System Information Descriptionl i e s atone Nominal 1500-gallon septic tanks a distribution box and Ql? leachfield. 1 ---- Number of current residents: ® Yes ❑ No Does residence have a garbage grinder? ® No Is laundry on a separate sewage system?(Include laundry system 0 0 Yes Yes � No inspection information in this report) Laundry system inspected? 0 Yes ® No Seasonal use? __N/A - Water meter readings, if available(last 2 years usage(gpd))» Detail'. private well ---- Dnmetered p -- 0 Yes ® No Sump pump? Continuous.--- Date Last date of occupancy: Commercialllndustrial Flow Conditions: Type of Establishment: Gallons per day(gpd) Design flow (based on 310 CMR 15203): _ — —---- --- ---- Basis of design flow (seatslpersonslsq.ft, etc.): Yes ❑ No 0 Grease trap present? 0 Yes ❑ No Industrial waste holding tank present? 0 Yes ❑ No Non-sanitary waste discharged to the Title 5 system? Water meter readings, if available: _ 1lb 5q 1 acsn Form;su u c Sewage Disposal System Page 7 n tr 19 Immonweatth of Massachusetts Inspection Form itle 5 Official nS o Not for Voluntary Assessments Ibsurface Sewage Dispo Sys -- 71 North Farms Road —— operty Address atrick Goggins — _ 01062 12/2/2016 tuners Name MA Date of Inspection 'lllown E: —_ State Zip Code ityRown 3, System Information (cont.) Date Last date of occupancyluse. Other(describe below). General Information Pumping Records: Not pumped since new tank installed about 2 ears d O_ Source of information'. Oyes ® No Was system pumped as part of the inspection? gallons If yes, volume pumped: How was quantity pumped determined? Recommend pumping on 3 to 5 year - - ____ al_ -- Reason for pumping: Type of System. absorption system Septic tank, distribution box, soil absory ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ion record s, rf any) Shared system (yes or no) (if yes, attach previous inspeui ❑ Mach a copy of the current operation of latest ❑ maintenance Innovative/Alternative tto be obtained from system owner) and a copy msintcnonce contrAcs(to by system operator under contract inspection of the I/A system tank. Attach a copy of the DEP approval. ❑ Other(describe). The 5Otis!InsTdiol Fdm:SuWUNU Sewage OsWraI System•PIP eM 17 >mmonvlrealth of Massachusetts 'itle 5 Official Inspection uFormemente rbsurface Sewage Disposal System Form- — — 71 North Farms aperty Address 'atrick Go ins 12/2/2016 miner's Name 01062 pate of ln speon°^ Florence state Zip Code Wows D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Suit am 5/10/1977 deal n date_ Oyes No Were sewage odors detected when arriving at the site? Building Sewer(locate on site plan): feet Depth below grade: Material of construction: Ass pipe 0 cast iron ®40 PVC ®other (explain)'. Distance from private water supply Well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): No problems seen. Mostly below floor slab. 2 average Septic Tank(locate on site plan): 2.2 het Depth below grade: ® Material of construction: Polyethylene 0 other(explain) concrete ❑metal fiberglass Standard concrete se tic tank, about 1500-Gallons nominal. years If tank is metal, list age: ea certificate) Yes ❑ No a Certificate of Compliance? (attach a copy 126" long, 58" Is age confirmed by 59 ' wide, __ he�high -- Dimensions: Z Sludge depth: 13 TNe 5Official In,V^m"'Form.SwhuMp Se'✓:9a Ofxpavl SY510m•Pa9°9111 17 mmonwealth of Massachusett�s►ectlOn Form itle 5 Official Inspection tiforVolunlaryASSessments bsurface Sewage Disposal System �1 NorteFps Road — amity Address atrick Gog ins 12�y/2016 — loreame NA 01062 orence —� State Zip Code Date MInspection tyRown ) System Information (Cont.) Septic Tank(cont.) 30" — Distance from top of sludge to bottom of outlet tee or baffle Os Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 22" — Distance from bottom of scum to bottom of outlet tee or calculate�- baffle Cowmered(on p determined? structural integrity, recommendations,inlet and outlet tee or baffle condition, Comments(on pumping evidence of leakage, ): liquid levels as related to outlet Invert, 1500-•allon se•tic tank in •ood structural condiion. Tank installed in 2014 Liguid level at height of outlet. Outlet filter not si nif_cantl loaded. Risers to surface located over inlet and outlet. Grease Trap(locate on site plan): feet Depth below grade: Material of construction: other(explain): ❑fiberglass ❑polyethylene ❑ ❑metal �concrete 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: Date rS somawi!ao amForMSUMidx•ameope COY1 s'h••rt'.Par to A I1 mnmonyyealth of Massachusetts Official Inspection Form ubsuebsufa 5 Off• stem Form•Not for Voluntary Assessments rface Sewage Disposal System h Farms Road roperly Address ratrick 9219ins --- 1P/2/2016_—— »sersName NA 01062 Florence State Zip Lode 12 of Inspection aHRown D. System Information (cont.) structural Integrity, Comments(on pumping recommendations, inlet and outlet tetecor baffle condition, — —ri liquid levels as related to outlet Invert, evidence of leakage, ): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): — Depth below grade: Material of construction. other(explain). ❑metal ❑fiberglass ❑polyethylene ❑ ❑concrete Dimensions: gallons Capacity: gallons per day Design Flaw: Yes ❑ No Alarm present ❑ Yes❑ No _ r: Alarm level: Alarm in working order ——_------ Date Date of last pumping: Comments(condition of alarm and float swathes, etc.): _ _— — ' ❑ Yes ❑ No •Attach copy of current pumping contract(required). Is copy attached ride 5Official ImpeCW^Form:SUSaulace SeWtOe CKEeel System•Pepe 11 c117 13 immonweaith of Massachusetts Form 5 Official Inspection FO1Y1 bsurface Sewage Disposal System Form •Not for Voluntary Assessments 11 North Farms werty Address atrick Goggins_ avers Name lore_ce_ ingrown ). System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): 0" Depth of liquid level outlet invert Comments(n ote if box ilevel and dis to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, but this is not a significant Box in fait condition 3 pines out withi es d levelers. One�ears -� be acCe tin9_less an other two p�-'= problem in a leachfield configuration. MA State 01062 12/2/2016 ——---- Zip Code pate of Inspection Pump Chamber(locate on site plan): Yes ❑ No Pumps in working order. Yes No Alarms in working order. No. Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, Soil Absorption System (SAS) (locate on site if SAS not located,explain why: system is a conditional pass. plan, excavation not required): The 5 Offieyl I,yeNOn Fo,m:eubsodM eawNe Disposal system.Faye 12 of 17 mmonwealth of Massachusetts ale 5 Official SyInspection Form System o -Not for Voluntary Assessments bsurface Sewage Disposal 11 North Farms Road *city Address atrick Gins ——-- 12/2/2016 ,veers Name MA 01062 12e 2I/2016 niTovM e _ State Zip bode iryrTovm ). System Information (cont.) Type: number ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number, length: leaching trenches 60� x 2 0__– — ❑ number, leaching fields dimension s. ® number: ❑ overflow cesspool ❑ innovative/alternative system Typelname of technology -- soil, condition of Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp vegetation, etc.): No surface_p zoblems seen. 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 0 Yes CI No TO 5GM1 I inspection Fools Subs4atase sewage L®p058A System Page lad IT mmonwealth of Massachusetts official Inspection Form itle 5 Offi stem Form•Not for Voluntary Assessments osurface Sewage Disposal Sy 1 North Farms Road --- perky Address itrick Go _ 12/2/2016__ mete Name put 01062 LoretlC@ _-- State LP Code 12 2I/2 rylTown I. System Information (cont.) etacion, Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of veg etc.): Privy (locate on site plan). Materials of construction-. Dimensions —� Depth of solids condition of vegetation, Comments(note condition of soil, signs of hydraulic failure, level of p ondin etc.): —_— The 5 0S'S erPKS^n Form:sutsdxe Sewage Disposal sags^•Page 14 J 17 mmonwealth of Massachusetts itle 5 Official Inspection Form bsurface Sewage Disposal System Form-Not for Voluntary Assessments '1 North Farm= Road— — )pty Address strick Goers---- __ 01062 12/2/2016 __-- rner's Name MA — Date of Inspection 1rrowri � State tp Code ryRovm System Information (cont.) y including ties to Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, at least two permanent reference landmar s or benchmark Check one s the Locate e all below within 100 within Locate where public water supply enters 0 hand-sketch in the area below ® drawing attached separately Ttle 5 o1dS lrepeaee r '.sea.urace SawNr Deposal Systee'-Page 15 d 17 rmmonwealth of Massachusetts Inspection Form 5 Official 1 LIp1 stem Form -Not for Voluntary Assessments Ibsurface Sewage Disposal Sy 71 North Farms Road operty Address atrick Goggins woes Menlo •lorence iryRowo D. System Information (font.) Site Exam: • Check Slope ® Surface water ® Check cellar O Shallow wells Estimated depth to high ground water: Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 5/10/197 a If checked, date of design plan reviewed: El Observed site(abutting property/observation hole within 150 feet of SAS) 0 Checked with local Board of Health-explain -- MA Sate 01062 12/2/2016 Cede of Inspection Zip Code >4 feet pate Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain You must describe how you established the high ground water elevation: Perc test dates_ar1-9r e11y soils shallow leaching ystem. Before filing this Inspection Repoli,pl ease see Report Completeness Checklist on next page. Form'.Subsurface Sewage Disposal Srtem•Me 18 0111 Toe som�wl"+o°'^°" mmonwealth of Massachusetts itle 5 Official Inspection Form Form Not for Voluntary Assessments bsurface Sewage Disposal System rl North Farms Road__ ,perty Address atrick Go�lns 12/2/2016 al/ State veers Name MA 01062 lflown stare 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 The 5 pan Fam:SuMSace ISya•m•F.GB+T a 17 ell il"- -1111 \ 413 from House MECo pole 75-2 9 k slope 1500 gallon Title 5 septic tank to leachfield, approximately 300 feet lope with outlet filter NORTH v i 1 Distribution Box vs ♦ 0 s i Leachfield, approximate layout Driveway 4 / //- / 40117 ..I 20" diameter pine Owner: HOMESTEAD Date: ri HOMESTEAD S. AD INC.I R.S. As-Built Sep Septic Patrick Goggins : �- ,sue Existing Sept c Syste 12/2/2016 ,', ' 1664 Cape st. 671 North Farms Ro• .� Williamsburg,MA 01096 Scale: 1 : 20' Revision Date: / msb bz&MA z Florence, MA 01062 E,t� ` Except as Noted