377 Septic Inspection 2011 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo
Owner Owner's Name
information is Northampton
required for every Pon
page. City/Town
Important:When
filling out foss
on the computer,
use only the tab
key to mote your
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EX
ans.osoe
377 Coles Meadow Rd
Ma 01060 10/11/11
State 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 for.
A. General Information
1. Inspector
Tom Martin
Name of inspector
Turkey Hill Field Services
Company Name
140 Easthampton Rd.
Company Address
Westhampton
City/Tram
413-527-5311
Telephone Number
Ma
State
S1499
License Number
01027
Zip Code
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:
▪ Pa<ors
❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
10/11/11
Date
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 is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This Inspection does not address how the system will perform in the future under
the same or different conditions of use.
v H
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1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner Owner's Name
information is
required for every Northampton Ma 01060 10/11/11
page. City/Town State Zip Code Date of Inspection
eim•09106
B. Certification (cont.)
Inspection Summary:Check A,B C D or E/always complete all of Section D
A) System Passes:
0 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 My failure criteria not evaluated are
indicated below.
Comments:
Please remember to pump your system every 2-3 years. This system has an outlet filter that needs to
be cleaned periodically.
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 ofd is available.
❑ Y ❑ N ❑ ND (Explain below):
rm.
5 Oica Fpm Form:Subsurface Sewage Disposa System Page 2 an
C);
Owner
intonation is
required for every
page.
Owners Name
Northampton
City/Tan
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Properly Mdress
Susan and Jerome Camposeo
377 Coles Meadow Rd.
Ma 01060 10/11/11
State Zip Code Date of Inspection
B. Certification (cont.)
8) 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(wig;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 O N ❑ ND(Explain below):
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
16.303(1)(b)that the system is not functioning In a manner which will protect public health,
safety and the environment:
❑ Cocspool 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
Title 5 q cis Y spedan Fen:Subsurface Sewage pgpy System.Pip,3 rl t7
0 0 Commonwealth of Massachusetts
__ _ Title 5 Official Inspection Form
-_'� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner Owners Name
information is Northampton required for every P Ma 01060 10/11/11
page. City/Tom 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 MS 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 welI.
❑ The system has a septic tank and SAS and the MS is less than 100 feet but 50 feet or
more from a private water supply well'.
Method used to determine distance:
"This system pates if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.
3. Other.
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
dogged MS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged MS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or dogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6°below invert or available volume is less
than %day flow
TAr5 Official Pu Fora&burs"Serve pgwl Syyn.Peve 4 et 17
Owner
information is
required for every
Page.
n:.•osae
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Acspssments
377 Coles Meadow Rd., Northampton
Properly Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner's Name
Northampton
City/rown
Ma 01060 10/11/11
State Zip Code Date of Inspection
B. Certification (cunt.)
Yes No
El 0
• 0
Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
Any portion of the SAS,cesspool or privy is below high ground water elevation.
My portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
My portion of a cesspool or privy is within a Zone 1 of a public well.
My portion of a cesspool or privy is within 50 feet of a private water supply well.
My 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 coliforn bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.)
❑ (81 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 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 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.
Tea 6 Mail kepemm Fort sW°ro Savage Deposal Bram•Pile 6 on
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner Owner's Name
information is Nh
required for every ortam pton Ma 01060 10111111
page. City/Town State Zip Code Date of Inspestion
e;ns•cam
C. Checklist
Check if the following have been done. You must indicate'yes'or°no'as to each of the following:
Yes No
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
® ❑
Pumping information was provided by the owner, occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components,excluding the SAS, located on site?
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees material of construction,
dimensions,depth of liquid,depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner)provided with
information on the proper maintenance of subsurface sewage disposal systerus?
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): 3
Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
3
330
nib 5 phial I apxLm Form&Wfb Se gal Disposal sytwn•Page 6 0117
Owner
information's
required for every
Page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner's Name
Northampton Ma 01060 10/11/11
City/Town State Zip Code Date of Inspection
D. System Information
Description:
Standard gravity feed system comprised of 1500 gal tank(twin compartment)with leaching galleys.
Number of current residents:
Does residence have a garbage grinder?
Is laundry on a separate sewage system?[d yes separate inspection required]
Laundry system inspected?
Seasonal use?
Water meter readings, if available(last 2 years usage (gpd)):
Detail:
water usage between 100-125 gpd
2
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
not available
Sump pump?
Last date of occupancy:
Commerciaglndustrial Flow Conditions:
Type of Establishment
Design flow(based on 310 CMR 15.203):
Basis of design flow(seats/persons/sgR.,etc.):
Grease trap present?
Industrial waste holding tank present?
Non-sanitary waste discharged to the The 5 system?
Water meter readings,if available:
❑ Yes ® No
currently
Date
Gallons per day(gpd)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Teo 5 O'Neal I ysYm Fame Sbala,e Sewage Disposal System Page of 17
Owner
information N
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Praperty Mdress
Susan and Jerome Camposeo
Owner's Name
Northampton
City/Town
377 Coles Meadow Rd
Ma 01060 10/11/11
State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other(describe below):
Date
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes,volume pumped:
How was quantity pumped determined?
Reason for pumping:
Type of System:
El 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 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):
Septic Tank with leaching galleys
Owner: not pumped since installed in 2000
® Yes ❑ No
standard 1500 gal.twin compartment tank
galas
plans and measurement.
upon inspection sludge levels in first compartment
found high enough to warrant pumping.
The 5 Mast Y5petim Form:rata/face Swge Dipal*Om•Page8✓17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner Owner's Name
Informations Northampton required for every P Ma 01060 10/11/11
page. City/Town State Zip Code Date of Inspection
ISirs-Does
D. System Information (cont.)
Approximate age of all components, date installed(if known)and source of information:
2000 date installed(see attached Certificate of Compliance)
Were sewage odors detected when arriving at the site?
Building Sewer(locate on site plan):
Depth bebw grade:
Material of construction:
❑cast iron ®40 PVC ❑other(explain):
Distance from private water supply well or suction line:
❑ Yes ® No
1.9
feet
Town water
feet
Comments(on condition of joints, venting,evidence of leakage, etc.):
Fine
Septic Tank(locate on site plan):
Depth below grade:
Material of construction:
®concrete ❑ metal
tank is accessible below patio pavers.
1.1
feet
❑ 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'x6'x 5'
Dimensions:
Sludge depth:
12-16"(first compartment only)
The 5 Official FywMn Form:SLawa.sewage Diposs sys4an•Pe98 9 CO 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form•Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo
Owner's Name
Northampton
City/Town
377 Coles Meadow Rd
Ma 01060 10/11/11
State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
6-6 inches(pumping warranted)
2 inches(pumping warranted)
Distance from bottom of scum to bottom of outlet tee or baffle 16
Now 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.):
No evidence of leakage of infiltration. Stuctural integrity fine. Some minor settling of outlet pipe. Outlet
tee is fitted with filter.This filter should be cleaned annually. Fitter cleaned and replaced.Tees in
good shape.
measured
Grease Trap(locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑metal
feet
❑fiberglass ❑polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or bathe
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
The 5 Official hapedion Pen SWVf®Sews 011001.5d Sy*m•P{p 10 an
Owner
information is
required for every
Page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owners Name
Northampton Ma 01060 10111/11
Cdyfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert evidence of leakage,etc.):
Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal
❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity:
Design Flow:
Alarm present:
gallons
gallons per day
❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ 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
T65 Official rupcyb,Fare.OJMSa Save dWsd Sys tn•Rp it of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
O^ner Owner's Name
information is Northampton required for every P Ma 01060 10/11/11
page. City/Town State Tip Code Date of Inspection
D. System Information (cunt.)
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.):
no d-box indicated on as builts.A single line of leaching galleys used as SAS.
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.).
Soil Absorption System(SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
rM 5 0W Fpre•Lon rmrt SWerca Se+ape DiyoW System•Page 12 or 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Aeeessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner owners Name
information required re Northampton Ma 01060 10/11/11
Par. tl far every
Page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Type:
❑ leaching pits number
❑ leaching chambers number.
leaching galleries number
❑ leaching trenches number, length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number.
❑ innovative/altemative system
Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of
vegetation,etc.):
No evidence of hydraulic failure within the field. Excavated one of the leaching galley's access cover,
but unable to open due to lack of real seam around the cover. 125 gallons of water were introduced
into the system as part of this inspection and no rise in static levels in tank
6
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 ❑ No
The 5 MIA W padon Form Subsystem smp aiWoS SyTm•Pp 13 3/17
Owner
information is
required for every
page.
rs:..rem
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Fonn-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner's Name
Northampton Ma 01060 10/11/11
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):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
r,N S fluids InsPecticm Font&bffes&Nage Disposal System•Page 14 do
Owner
information is
required for every
page.
15:..MOO
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd. Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner's Name
Northampton
Cayfrown
Ma
01060 10/11/11
State Zip Code Date of inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
rw 5 Official tape liar Fpm SbNn Smogs rxwma Sy.Mi•MVP 15 of 17
Omer
infoenation is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owners Name
Northampton Ma 01060 10/11/11
City/Town State zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water:
78 inches
feet
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed: see attached(owners copy of soil
evaluation from 1998)
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators,installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
See attached .
Before piing this Inspection Report, please see Report Completeness Checklist on next page.
Tubs NNW wpecian Raw$Wax1p Sexy pyotl System.Page 18 of 17
Owner
intonation is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
377 Coles Meadow Rd., Northampton
Property Address
Susan and Jerome Camposeo 377 Coles Meadow Rd.
Owner's Name
Northampton Ma 01060 10/11/11
City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
El Inspection Summary:A, 8, 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
1111e5 Official Hpnnn Flat adulate Sewage pgai System•Pap 17 of 17
OltNi 3A • CERTIFICATE OF COMM ANCE
COMMONWEALTH OF MASSACHUSETTS
Board of Health, /VOA 4-1wmphs" , MA.
CERTIFICATE Of COMPLIANCE
Individual Component(s) L3 Complete System
The undersigned hereby certify that the Sewage Disposal System;
/� / Constructed (Repaired 1 ), Upgraded ( L Abandoned 1 )
by:.. 9C/Qrkf accaym`f'r Yf, �J //T
at. 377 Cotes �64daM f<'oq4 1 ThrOmf 1 ompoSeo,
has been installed in accordance with the provisions of 310 CMR 1100{#Ile 5)and the
approved design plans/as-built plans relating to applicahori No.
dated 6 o
/S o
/ - . Approved Design Flow Sol (god)
rw
Installer
Designer:
Date 71/1 lot
The Issuance of this permit shall not be conslrued as a guarantee that the system will
tuner as designed.
Inspector
A
3 BEDROOM
HOME-
500 GAL.
SEPn4'WNK
•
1
I..,l
ACCESS
OVER
SEPTIC:TAW-
' cemTER-covet
Fitot^
12 4X55' LEAC.H1NG
GAU,ER/
'D05T, fej M
CORNER.B
IG' 31'
• -LEA41 TANK
AKESS: CoVEC.
44( 7 " 504 "
DIP APPROVED rORA1.5(94
115 arnarreim LS 9fPVra�A.
Access covee< or., LSACH 'rINKs
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MN VIRVNITICF6 InL r u+r1nn.v
SOUTH DEERFIELD 01375 413/ 665-7903
TITLE 5:DRAFT PRINT SEPTEMBER 20. 1993 APPENDIX 4 PAGE 2
DATE: 8/20/98
LOCATION: Coles Meadow Road NAME: Walter Michalowski
Northampton, MA
ON-SITE REVIEW
DEEP HOLE NO.:3 DATE: 8/20/98 TIME: 9:00 a.m.
LOCATION: Lot 4(SEE SITE PLAN)
LAND USE: Forested SLOPE: 12%
VEGETATION:
LANDFORM: Ground Moraine
POSITION ON LANDFORM:Western part
DISTANCE FROM:
OPEN WATER BODY: None
POSSIBLE WET AREA: 115'
DRINKING WATER WELL:>200'
DRAINAGEWAY: 130'
PROPERTY LINE: 18'
OTHER:
WEATHER: clear
SURFACE STONES' Few
DEEP OBSERVATION HOLE LOG
Depth from
Soil
Soil
Soil
Soil
Other
Surface
(inches)
Horizon
Texture
(USDA)
Color
(Munsell)
Mottling
(Structure, stones, Boulders,
Consistency, %Gravel)
0-6'
0
10YR/4/4
Sandy
None
Loose
Loam
6-16°
A
10YR/6/8
Sandy
None
Loose
Loam
16-21°
B,
10YR/6/8
Sandy
Loam
None
Loose, Friable with stones to 1.5°
diameter -
21-35"
62
10YR/2/3
Sandy
None
Loose, friable with 15% cobbles
Loam
Fine roots to 50°
35-83°
C
5YR/2/2.5
S
dy
am
2.5YR/6/4
>5% @ 78'
Co pact,friable with a few cobbles
PARENT MATERIAL:Ablation Till
DEPTH TO GROUNDWATER: STANDING
ESTIMATED SEASONAL HIGH GROU
LSR06697
E5• . G'VV
DEPTH TO BEDROCK:>83"
WEEPING FROM FACE: None
r EL. 85.0
SOILS EVALUATION FORM
2
Sewage Disposal System
Walter Michalowski
Coles Meadow Road
Northampton,MA
Sheet Li of 15
"5.5
T.R.A.K. SEPTIC PUMPING
60 Hyde Hill Road
WILLIAMSBURG,MA 01096
(413) 26133168
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