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HomeMy WebLinkAboutInspection Report 2020 Feb 14 04/03/2020 PRto(L-T° I r RECEIVED Commonwealth of Massachusetts ' , P1 �._ Title 5 Official Inspection Form `'AR °g 2020 '.;3 ---L:------‘ _ e1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments HEALTH DEPT Property Address 1/ �fjjf� // ::>: l i'" it i lliia A rs Owner Owner's Name ,j�, [� information is 5;G "1/ ©d 6 6 T /i /d 0 required gered for every City/Town State Zip Code Date of Ins ectio 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 filling out forms A. Inspector [nfor tion on the computer, use only the tab ,f-i),-Q /// A k..//,/ keyto move your Name of Inspector „!, !/0 J,_ t 4--c cursor-do not 7A1�/Y// use the return Company Name key. PO &)4 F/— I f 1 V Company Address S 14.0.0.7 ,M //f/I Qd c i_ City/To State �� �� Zip Code ,MO _ _ o-� MO '''—/ 79Q License Number Tefepho umber B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); I have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the s . 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails a7/Y7010 inspe9T42/4W gnatDate 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 form should be sent to the system owner and copies sent to the buyer, if applicable. and the approving authority. Please note: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. The 5 Df5cai tr.specton Form.Subsurface Sewage O,sposai System•Page 1 of 18 t6insp.doc.rev.7!26/2018 Commonwealth of Massachusetts *_ Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 Cross Si— Property Address /11aes4 Owner Owner's Name s information is /�� Dog /� /� required for every SOcilki Oti7 C '!L 64 T 010 page. City/Town p� State Zip Code Date of In pecti n C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Pa 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: 2) 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. ED Y ❑ N ❑ ND (Explain below): r e 5 OffaarFora. a�,nspeon Suosurface Sewage D sposa System•Page 2 of 18 t5,nsp.tloc•rev.7/26/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 OocJ sf Property Address art 4 Owner Owner's Name rL information is 1 /1/ QQ 61(e (.41/59e7)0 required for every IMOD i r� / %/" ` page. CityfTown State Zip Code Date of Iti C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. O 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): ❑ 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 ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: 0 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. a. 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: . 'ine 5 Qffida;nspecoon Form:Suosurface Sewage Disposal System•?age 3 of 18 t5insp.doc•rev 726120'I S • ......N. Commonwealth of Massachusetts ,I * _4 Title 5 Official Inspection Form t . = Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ., /0 /'os$ S71-- Property Address Owner Owner's Name a es ti / ' information is 6 2 required for every ,Se 014 � wiN + 011/ " o page. City/Town State Zip Code Date of Inspe n C. Inspection Summary (cont.) ❑ 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 b. 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: El 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ckup of sewage into facility or system component due to overloaded or ❑ clogged SAS or cesspool Discharge or pending of effluent to the surface of the ground or surface waters 71 Li due to an overloaded or clogged SAS or cesspool Title 5 Of ctai'nspectlon Form:Subsurface Sewage Disposal System•Page 4 of 18 t5insp.doc•rev.7/25/2018 Commonwealth of Massachusetts —_ Title 5 Official Inspection Form _= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r /0 Goss s. Property Address, eled Owner Owners Name information is S // (w ice/ Ael _ Od66 �� �0 required for every �G► r/�4"�a'� h page. City/Town State Zip Code Date lnsp tion C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No —1 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool E.: Liquid depth in cesspool is less than 6" below invert or available volume is less than'/z day flow D Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: . U 27... obstructed portion of the SAS, cesspool or privy is below high ground water elevation. E Any portion-of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. E Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. • [pfr- Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ LAny 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 2000 gpd- Ill /10 000 gpd. 1,721 / The system falls. 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. 5) 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 C.4. Yes No Q 0 the system is within 400 feet of a surface drinking water supply O 0 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 • L Area–IWPA)or a mapped Zone II of a public water supply well 'ire 5• ca;nspecaor.For.Subsurface Sewage Disposal System•Page 5 of 18 t5insp.tlOc•rev.7252018 • Commonwealth of Massachusetts i __*_ Title 5 Official Inspection Form '_��y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -7•1#- (�' /0 Ce0f5 Si-- Property Address /11441'4(4 Owner Owner's Name information is , Dal 6TG� .t 0 required for every Pe. City/Town S0��� �� State Zip Code Date of In pecti Page. C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section C.4 above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ mping information was provided by the owner, occupant, or Board of Health ❑ ere any of the system components pumped out in the previous two weeks? Q s the system received normal flows in the previous two week period? CI 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) 2/72 Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? 222,----j Were all system components, excluding the SAS, located on site? XI❑ 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 VVD 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: [iYI/X 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 IIV El approximation of distance is unacceptable)[310 CMR 15.302(5)1 "rite 5 Ottciai inspe.-5or"orn:Subscrace Sewage Disposal System•Page 6 of t8 t5insp.dcb•rev.72262018 rCommonwealth of Massachusetts1 - Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71:4 = /O Cross Si — Property Address 14r.0 Owner Owners Name ,r�� information is 5oi4AOIMOU �� c i 66(‘ a /it4ai O required for every «..JJ page. City/Town State Zip Code Date of spec� n D. System Information .1. Residential Flow Conditions: 3 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3/0 Description: /0 `000 A/ION cco'fT/G. % 6. &✓ ii fl'i'tii-It io,.r 0( 02. ` s (A/ 01.14.- �3V' O� S'7o`e_ 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: 60-' 0 J 0 6ii oOO Sump pump? ❑ Yes No /7' Last date of occupancy: Date Tile 5'Tical:^specaon Fcrr.Stmstztece Sewage O+sposai System•Page 7 of 18 t5insp.0oc•rev.7126!2018 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name zo a information is required for every mews �� lfia6 6(0 01/64,p page. City/Town State Zip Code Date of Icti D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: ♦/ Source of information: /" Was system pumped as part of the inspection? ❑ Yes [±'�No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Tine 5 aifiaai insoeaion Form.S.bs.rface Sewage Disposal System•Page 8 of 18 t5inap.0oc•rev.7126/2018 Commonwealth of Massachusetts __ Title 5 Official Inspection Form • --,i*,-) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments N,m/9' /0 Gioc Si- Property Address / ArS4 Owner Owner's Name information is required for every So 4 fk ovfli fi4 cc(o(,y a- �� a,0 page. CitylTown State Zip Code Date of Inspe 'on D. System Informs ion (cont.) 4. Type of S . Septic tank, distribution box, soil absorption system ❑ Single cesspool O Overflow cesspool O Privy ❑ 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. 0 Other(describe): Approximate age of all compQts, date installed (' kr�oyun) and source of information: L t345 f/u Were sewage odors detected when arriving at the site? ❑ Yes No / // 5. Building Sewer(locate on site plan): /► Depth below grade: feet (O Material of construction: 0 cast iron 40 PVC ❑ other(explain): V Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Tae 5."'tfioai nspecnon Foss.Suosurface Sewage Disposal System•Page 9 of 18 t5insp.doo•rev.7/26/2018 Commonwealth of Massachusetts w Title 5 Official Inspection Form ,_ >a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C/o55 Property Address aes Owner Owner's Name �� !G i9 0)0 information is VI required for every c G page. City/Town State Zip Code Date of Ins ction D. System Information (cont.) 6. Septic Tank (locate on site plan): /d " Depth below grade: feet Materi 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 Dimensions: Cr Sludge depth: 3S`/ Distance from top of sludge to bottom of outlet tee or baffle Scum thickness /1/0 0 — J C Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle , Pac,24,/cle / v r 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.): eb iN2. �/Jd7 14eee • / a N e u ,(90 Cooc44.4 . ol_tocdt.5 $2vf7 S �- t5insp.dac•rev.72612018 Tme 5 Offic4ai Inspecnon Foran.Suosurtace Sewage Disposal System•Page 10 0118 Commonwealth of Massachusetts t- --4 Title 5 Official Inspection Form '= is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments k.L,_, /O Cross Si- Property Address /#6?fr 4 Owner Owner's Name ,,�E� information is SO(q�� CYt/10(l/VI /¢ 00 6 6c( c4-77/(ter/do required for every page. Cityftown State Zip Code Date of in o D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete ❑ meta( ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day. Title 5 Of`aa..rspacuon Eon:Sucsurface Sewage Disposal System•Page 11 of 18 t5insp.doc•rev.7126%2018 Commonwealth of Massachusetts * ;� = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / /49..0 Property Address ars 4 Owner owner's Name elf /�� �� information is Socit4D2a. v"/�1 (i required for every page. City/Town State Zip Code Date of Ins ction D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes 0 No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Jet'e// /t/0 Jo/ell' frb ecvk rue 5 Oi0ca!nspecson Form.Suos::rface Sewage Disposal System•Page 12 of 18 t5insp.00c•rev.726/2018 Commonwealth of Massachusetts gi __ Title 5 Official Inspection Form - ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 Cccc S5 S4- Property Address Aiae,r 4 Owner Owner's Name information is A Alo 6 6 T L.5:914� �/1f0(,� �p�-Q required for every page. City/Town State Zip Code Date of inspe 'on D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site pian, excavation not required): If SAS not located, explain why: Type: CI ales w� 901^e ❑ leaching pits number: ❑ • leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: O leaching fields number, dimensions: ❑ overflow cesspool number: O innovativeiaiternative system Type/name of technology: —_— Tme 5 Otftaa.mspe Son=or:Suos..rtace Sewage Disposal System•Page 13 of 18 t5insp.doc•rev.7/26!2018 Commonwealth of Massachusetts ti--=-.-='- • Title 5 Official Inspection Form __ -�t_ �� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :: - rio55 51 -- Property /0 Property Address /Yew-S*4 Owner Owner's Name ! information is required for every C, - 140.14 - D.).66y 62-- � f page. City/Townfr State Zip Code Date of Ins echo D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 0 1/ &1 c'I n . /1/0 t '�<- L • SI Ns l . h 0414 I c I CI LcIe Ge f*; Ile_ C4jf 12. 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 ❑ Yes D No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 'Ne 5 Otfoa;nspecuon Form.Sccs dace Sewage Dasposai System•Page 14 of 18 tSinsp.doc•rev.7282018 Commonwealth of Massachusetts --, Title' 5 Official Inspection Form it'- ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /O Coss Si-- Property Address Zig()ir 4 Owner Owner's Name information is �04 ,.YOGA ,q/¢ O-c� �y oto required for every page. City(rown State Zip Code Date of nspe 'on D. System Information (cont.) 13. 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.): 'me 5 Ofnca'.rnspecnon Form Suosorface Sewage Dispose!System-Page 15 of 18 t5insp.doe•rev.7126/2018 Commonwealth of Massachusetts f * _ Title 5 Official Inspection Form -= - r" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v /0 Ccoss ,/- Property Address Owner Ala rSf� Owner's Name ,/ information is ¢�p 7/. /� 0.3 6 6(F a-- �� required for every SO�'1 '��ff page. City/Town �. State Zip Code Date of In pecti D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or b hmarks. Locate all wells within 100 feet. Locate where public water supply enters the build' . heck one of the boxes below: and-sketch in the area below ❑ drawing attached separately I i 1 /roc Gc,ll04 serffc 7-..4/ I / 2L 6:0.41- I o.4f- 1 g 1 __ 1 I 1 0-• LO- 6 a-(f i Al —l3,6 0 �a,6 \i fd07-I g),- /� 4-3. 32,.E e.3- �` • 1i 1 Tine 5 C-05mi Irspecaon Form.Subsurface Sewage Disposal System•Page 18 of 18 t5insp.00c•rev.7/28/2018 • Commonwealth of Massachusetts h 1 Title 5 Official Inspection Form '_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c /o - --Civic SI- Property Address /114e5 4 Owner Owners Name information is ./� / required for every 0 vl/ �1 A'�OK'rN �/¢_ WC 6 p� page. City/Town State Zip Code Date of I pectin D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells id y41- �� Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ bserved site(abutting propertyiobservation hole within 150 feet of SAS) Checked with local Boar 4-iG alt h�explain: �,_ rii- frh 4 S 14 ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe h`�o�a-fou establish d the hi h ground water elevation: r,�tG�n�A VA/ (til P i/uka 6C11012c 672......40 On (i_ j-/ 4/:,(12 ci C‘96- Gale ci. 46. 7--A/4V1 6,c-, /f-Cc:7 _ � I cf 61,(014/ (,/•••icie• i nif-ia ail j.e. ricfri , s, �-S if na1s 4 irat.ric4,ved•dek, , Before filing this Inspection Report, please see Report Completeness Checklist on next page. tie 5 TScra�rspeon Form.Suosurface Sewage Disposal System•Page 17 of 18 5insp.doc•rev.72512018 • Commonwealth of Massachusetts Title 5 Official Inspection Form ,_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •