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565 Septic Inspection 1997 assn F.WId geese. Arise Paul CYked aeewww Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection !6LLi MAY 51997 ON F.OAR;OF HEAL'F. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Addis CDLES ME.4eta+ £e&O, M0Cf440.4 P yt:>✓ Data of Immediate MARC-9 Et,/99 7 Name of Inspevtae R4YMaJl MI Et34gaa+WI Company Name,Address and Telephone Number. w Er.wS CERTIFICATION STATEMENT I certify that I bave pusonaly inspected the sewage disposal system at this addraa 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 npenence• the proper frmcticm and maintenance of umu•swan disposal rystema. The system Passes _ Conditionally Pasty _ Needs Further Evaluation By the Iced Appro,tg Authority Inspector's slg aturt; // /'/I�l Data Il 'EU it/97 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of=pitting this inspection. It the system is•shared system or his a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the sppmprian regional a ce of the Department of Environmental Protection. The original should be cent to the system owner and copies sent to the buyer, if pplicable and the approving authority. Address of Owner. (If different/ . Bo4&'1 ( 4R�5-19-GV/i Hno�.MA , olfi Trudy Cam aesvew David O.Sines Camises INSPECTION SUMMARY: Check A B,C,or D: Al 9Y8' 1 PABSM5: I have not frond any iMormation which indicates that the system violates any of the failure criteria es defined in 310 CMR 15301 Any failure criteria not evaluated an indicatd below. BI SYSTEM CONDITIONALLY PASSES: Om or mom system components need to be replaced or repaired. The system upon completion of the rapla cant or npae,perms Indicate yin,u,or not datermm.d(Y,N,u ND). Describe basis of determination in all instavrr flat determined*,aplam why not) The septic tank is metal,cracked structurally unsound,shoo substantial infiltration or adiration,.o tank lirTur•is inninent. The system will pass inspection if the misting septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Stet • Boston,Maaandwady 02109 • FAX(517)551.1049 • T•tephce•(917)212.9909 0 Ponied en Rarnse our SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(amtineed) Property Addtaac Owner Dm of Impeetioa B1 SYSTEM CONDITIONALLY PASSES (continued) - Sewage backup or breakout or high ask water level demand in the distribution been doe to Bohan or obstructed pfp(s) or don to a benbn,settled or at distribution boa The system MU pawl impend=if(with approval of tin Bard of Health): beano pipets)In replaced charmed=is.®ond distribution bon is Imaged er replaced - me system nquved pumping moo than facer tfmes a year don to broken or obtnsced pipes). The tycoon will pass . inspection if(with approval of the Hoard of Health): _ broken pipes)an replaced obtnmtioa is removed CI 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT TEE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. Cesspool or privy is within 50 feet of a surface warm Cesspool or privy L within 50 feet of a bordering vegetated wetland or a salt mush. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT The system has ptic tank and soil absorption system and L within 100 feet to a surface water supply or=binary to• ark=water supply. - The imam has•septic tank and soil absorption system and is within•Zone I of•public water supply well. - Tin"stem hen septic tank and soil absorption amino and is within 50 fat of•private water supply well. The system her a septic tank and soil absorption spasm and is Les than 100 feet but 50 bet or more from•private water apply well,unless a wall water analysis for oliform bacteria and volatile^Moist compounds indicates that the well is free from pollution from that facility and the presence of mamma ninegen and nitrate=roam le goal to ce lair than 5 lark 3) OTHER (revised 11/0365) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address Owner. Date of Inepeetles DI SYSTEM FAIL& I have determined that the sync violate.one or more of the following failure atria as defined in 310 CMR 15303. The basis for this determination is identified blow. The Board of Health should be contacted to determine what will be me.ary to corns the _ Backup of sewage into hclity or system component due to an overloaded or clogged SAS or oespepcoL Discharge or pouding of effluent to the surface of the ground surface waters due to an overloaded or dogged SAS or owe pool Static liquid level in the distribution bar above outlet invert due to an overloaded or coned SAS or cesspool. - Liquid depth in cesspool is less than r below invert or available volume is le.than 1/2 day flow. Required pumping more than 4 times in th last veer NOT due to clogged or obstructed pipers). Number of times pumped Any portion of the Soil Absorption System.cesspool or privy is below the high groundwater elevation. - Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of•private water supply well. _ 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. If the well has been analysed to be acceptable,attach copy of well water analysis for colitis=bacteria,volatile organic compounds, ammonia nitugen and nitrate nitrogen. El LARGE SYSTEM FAILS: Tha fallowing atria apply to large systems in addition to the criteria above: The system serves•nudity with design now of 10,000 gpd or greater(Large Sync)and the sync is•sign:reent threat to public be.lth and safety and the environment bemuse one or more of the following conditions net - the sync is within 400 feet of•surface drinking ester supply _ the enfant L within 200 feet of a tributary to a surface drinking eater supply _ the system is)mead in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or•mapped Zona D of a public eater supply well) The°moor or ablator of ay such system shall bring the system and facility into hill compliance with the gtamdwnc treatment program requirement of 314 MR 5.00 and 6.00. Please consult the local regional office of the Department far hneher information.. frevised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Pm/mete Addreaa 5"tS Oo LFMBMO». RoAO, Do£fla -a PIV,J DW tm�IS PZIe1GE of lv.p l 3-27-'77 Clack if the fallowing have been done: YPrunping information was requested of the owner,occupant,and Sow of NWth. 1 None of the system components have been pumped for at least two weeks and the oyster=has been receiving normal flow rates '1I during that period. Large volumes of water have not been inn oe as adnd into the system recently ar part of this inspection. •'L Ayboilt plane have been obtained and examined Note if they an not available with N/A. �T e reality dwelling was inspected for signs of sewage back-up. ' T!y system does not receive nonwemWy or industrial waste flow _Ti/eAta was inspected for signs of breakout. / ✓All rym®mmponmm,excluding the Soil Absorption System,have been located on the site. The septic tank manholes were uncovered,opened.and the interior of the septic tank was inspected for condition of baffles or s},material of construction.dimensions,depth of liquid,depth of sludge,depth of scum. _✓ The S.and location of the Soil Absorption System on the site has been determined bast'on aiming information or yappv�atd by non-intNave methods. The facility owner and occupants, of different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Pt party Address j r C'o C E N E„o ow ,'?gyp ,Jp(C7)44mpro,J °In D I�.p.147U/5 P�ew6 L 3 Z7-t7 FLOW CONDITIONS RESIDENTIAL: Design flow) ;TO pike. Number of bedrooms: 'Z Member of carat coda: / Garbage pander(yes or non Wb Iamdry v.e d to system(yes or ion ✓aS Seasonal use(yea or ml:e) Water mere reeding,if available. Oil War tr weld- IAA data f oeeupanny: / .veeENTLY Ctzv 4s j COMMERCIAL/INDUSTRIAL) Tyne of establishment Design Dow, plans/day Grass tram prawn=Vs or no)_ Industrial Waste Holding Tank present (yes or no)__ Non-sanitary waste discharged to the Title 5 system:(yes or nod_ Water meter reading,if available: Let date of occupancy)_ OTHER:(Derain last data of occupancy: GENERAL INFORMATION PUMPING RECORDS and eon of in formation: System pumped as part of inspection) (yes or no t"--.$ If ys..odnma pumped: 91n tLnilon. Reason for pimping aide-hoc Tit N/e ,Mrm.L TY' TYPE}IP SYSTEM ✓ Septic tankidisimbamn bat/soil abmrptio)system - S_orpml Overflow l - prier .�Shared natant(yes or no) (Lys,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of W components,date installed(if known)and ewn of vrfsmaton: LANK AMU 1602 t-' Sewage odes detected when arriving at the mite:(pa or no) (revised I)/03/95) 5 LtauH Flat) - /`%89 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION POEM PART C SYSTEM INFORMATION(o®tlewd) Property Addres GtE /14 67 icw0 Vt719v/ ? ✓Pen r3/)vs P,e,✓6cE Date of Inspeetiom 3-Z7-97 SEPI7C TANK: ✓ (loure on site plan) Depth below ped.:Z3lr Material of COES1711 edam J n=eta metal FBP_mhane:Plam) 7.5-X 3, Sbrdg dept! Y" Distance from top of sludge to bottom of outlet ter or baffle Z/c�r Sam thielm.s: 7" _ Distance from top of scam to top of outlet to or baffle: Distance from bottom of scum to bottom f alert. bete. / 7 Comments: (recommendation for pumping,condition of inlet and outlet ten or bates depth of liquid lewd in relation to outlet invert,structural integrity, evidence of leakage,etc.) rAdk W e) c tLe,VT caiJOmat/ —RAF's AP,t3I,t 7V AF W04Kmlc 62i2R47tY - um✓fo I£U:+t. /s eV 49.-1 All RI Y"ell/2-I Cr//iE — Fi/ng1/7)lrn/6 IA;Tit twit Cw—Frl J4 A 90owC to BC ;IN tRoaltIG pceFat y — No S/c✓S or RgC/c t/P GREASE TRAP. 1 - (loate on site plan) Depth below grade__ Material of mvscomon_onmete metal_FRP_othererplan Dimensions: Sum thicaneer_ Distance from top of sawn to top of outlet tee or baffle:_ Disano from bottom of sum to bottom of outlet tee or bate (recommendation for pumping.®ditim of inlet and outlet ten or barn,depth of liquid level in relation to outlet aeon,.summaff integrity, evidence of leakage,etc.) • (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL BYBTEI(INSPECTIONFORM PART C SYSTEM INFORMATION(oontbaud) Property Amts 5-6C COLE mei-004 Roe VotniAk Omer. Psfra S ,if/NCLC %Oj/ D.S.of Inspeoriam 3-27-57 TIGHT OR BOLDING TANE:4( Ocoee on site plm) Depth below made:_ Materiel at mnstrosbo: comet metal FRP orbnlnpLin) Di nsosionc Cepaciey- gallons D.oi.So.r_p,masiday Alarm level: Comments: (candition of inlet w,condition of alarm end Got.witches,etc.) DISTRIBUTION BOR ✓ (lout on sit plan) Depth of liquid level above outlet invert: Comments: lame if level and distribution s equal,evidence of solids carryover,evidence of leakage into or out of boc etc.) 41•bo1/4 E.rS77 it CWLO • 07 RE 40C471» DORWC MIS ,rr$Paflas/ Cap PUMP CHAMBER: moo on site plan) Pumps in ecating°Sarlyes or m) Comments: (not condition of pumps dumber.condition of pimps end pp rtmays,etc) Invited 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oat tamed) Ptapety Address S-6f COLk"I"1E-N-DOU Rct49, N 1-7W4mP'=r✓ Data ) MMus AmicLe- -L7-y7 SOIL ABSORPIYON SYSTEM(SAS). fleee on site Pisa if=sulk;...bore not requited,bet may be approsimated by rem-baut.s methods) If not determined to be prasmt aplsie: Type lambing pits,number_ teaching oheObRa number loathing galleries,.saber_ teaching ttanebes,nombenlen the leaching bids,numb,dimensions: /FA 20 W X VO t LONG overflow oepool,number S,9.K wA1 40✓0 IN S L✓4.n�S WjT4 /JO s.-74.„.0100‘ aAPat w'Til Comments:(note condition of ail.signs of hydraulic failure,level of pending,condition of vegetatioaett) 4/0 °Dots -A/O S/1/W(V Sots S /ta0 5U,(j-/ICS 4TOteour - 5/TE /5 AOFGk/A7f[✓ J//® YD fNcnore r .0 cC 2)(C4(MACE 3 7-€ r pro Exc.*VA rut — .vu S/cA/C OF If✓ORAtL/C a10-(19i S✓4 re-I Afmre-mec rz LW" Alocn•w,✓c Ploinz AY CESSPOOLS:��Ai/ (locate on site pWt) Number and configuration Depth-top of liquid to inlet invert: Depth of solids layer. Depth of.cum layer Dimensions of osespaol, Materials of ommuction: Indication of groundwater. inflow Ineepaol must be pumped as put of inspection) Comments:(note=edition of soil,signs of hydtettlic failure,level of poeding condition of vegetation,etc) PRIVY:A (locate on ate plan) Mnuisk of omatrmtim: Dmmsims: Depth of solids:_ Comments:(note aveditim of sail,signs of bydtnle faihve,Mel of pending.omditioe of.yetaeoa me) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM"INFORMATION(mataued) Property Addrme r(pS COLCHE,t J Raab ,A/08-7)i9MProd On.r. PHni/j AU./6 L Date of Impmlisrc 3-Z7-9 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: =de ties to at least two prominent references landmarks or benchmarks locate ail well within 100' SEE 4TMegg) DEPTH TO GROUNDWATER Depth to groundwater 7/ feet method of determination or approximation (revised 11/03/95) 9 0 - z 0 A 0 N __--- � .---' ,reirmsekst:sksksi tea,. n fel ��/ I>! �r 6pA h P� D� GZ 13 zn -n.3 Zti-, Z-vm Z-i-i oom 00n oom SN o-i ao� ioo-M o p ' T V ` fl o� No' o N ri z r n .1 NZ N_ ziN r Iz SEPTIC SYSTEM LAYOUT AG1 „c, 1-4g Eg OWNER: PHILLIS PRINGLE CO 51 n ,fl ADDRESS: 565 COLES MEADOW ROAD ro NORTHAMPTON, MA. DATE: MARCH 27, 1997 INSPECTOR: RAY MIECZKOWSKI o 0 A m at_ a • A, ou LP,GIf FIELD 15 MPROMIATELY zPO FEET WIDE BY 40 FEET LONG SEPTIC SYSTEM LAYOUT OWNER: PHILLIS PRINGLE ADDRESS: 565 COLES MEADOW ROAD NORTHAMPTON, MA. DATE: MARCH 27, 1997 INSPECTOR: RAY MIECZKOWSKI RIORDON ASSOCIATES Sample No.. 7543 P.O.Box 178 176 BROOKSIDE CIRCLE FLORENCE, MA 01060 (413)586-1060 AGREEMENT FOR WATER TESTING CERTIFICATE OF WATER ANALYSES Date: April 19, 1997 Client: Sample Location: Phyllis Pringle Drilled Well &Distrib. System 565 Coles Meadow Road Pringle Residence Northampton, MA 01060 565 Coles Meadow Road Northampton, MA 01060 On. 3 Apr 1997 at, 9:30 a.m., John P. Riordan sampled the water at the above location. The water samples taken at that lime were analyzed, under the direction of John P. Riordan, RIORDON ASSOCIATES Scientist, using standardized APHA, EPA and ASTM methods. The following agreed upon analyses were performed by Mass. Lab Cert.No. MA100. TEST RESULT E.P.A LIMIT Ammonia ND <0.2 mg/I. Total Coliform 0/100 ml. 0/100 ml. Nitrate/Nitrite .0.730 mg/1. 10 mg/I. me/L. millizrams per liter ND =Not Detected, ml. =milliliter COMMENTS: (at this time):The above results obtained from the analyses performed on the submitted water sample(s) MEET E.P.A. and United States Public Health Service approved sanitary standards for drinking water. Retest Coliform Count Annually. Please call RIORDON ASSOCIATES at retest time and if you have questions regarding this report. John P. Riordon, Director. CONSULTANTS TO HOME AND BUSINESS WATER-AIR-ENVIRONMENTAL TESTING&SERVICES -04/14/9'7 page 2 of 6 Purchase Order Number: 980252 LIMS-BAT g: LIMS.28825 Job Number: 28825 Sample Matrix: DKG WATER Sampled: 04/03/97 0KG WATER 7543 Date SPEC Units 97805654 Analyzed Analyst MDL LIMIT P/F cis-1,3-Dichloropropene ug/l ND 04/10/97 OFF 0.5 t-1,3-D)chlaropropene ug/l ND 04/10/97 OFF 0.5 Ethyl Benzene ug/l ND 04/10/97 OFF 0.5 700 P Fluorotrichlorcmethane ug/l ND 04/10/97 MFF 0.5 Nexachlorobutadiene ug/I NO 04/10/97 MFF 0.5 Isopropylbenzene ugh ND 04/10/97 MFF 0.5 p-Isopropyltoluene ug/l ND 04/10/97 MFF 0.5 Methyl tett-Butyl Ether (MTBE) ughl ND 04/10/97 NFF 0.5 Methylene Chloride ug/l 0.11 04/10/97 MFF 0.5 5.0 P Naphthalene ug/l ND 04/10/97 MFF 0.5 n-Propylbenzene ug/l ND 04/10/97 MFF 0.5 Styrene ug/l ND 04/10/97 NFF 0.5 1,1,1,2-Tetrachloroethane ug/l ND 04/10/97 MFF 0.5 1,1,2,2-Tetrechloroethane ug/L ND 04/10/97 MFF 0.5 Tetrachloroethylene ug/L ND 04/10/97 MFF 0.5 5.0 P Toluene ug/L ND 04/10/97 NFF 0.5 1000 P 1,2,3-Trichlorobenzene ug/l ND 04/10/97 NFF 0.5 1,2,4-Trichlorobenzene ug/t ND 04/10/97 MFF 0.5 70.0 P 1,1,1-Trichloroethane ug/l ND 04/10/97 NFF 0.5 200 p 1,1,2-Trichlaroethane ug/I ND 04/10/97 NFF 0.5 5.0 P Trichtoroethylene ug/I ND 04/10/97 .MFF 0.5 5.0 P Trichlorofluorciethane ug/L ND 04/10/97 MFF 0.5 1,2,3-Trichloropropane ug/l ND 04/10/97 NFF 0.5 1,2,4-Trimethylbenzene ug/l ND 04/10/97 MFF 0.5 1,3,5-Trimethylbenzene ug/l ND 04/10/97 MFF 0.5 Vinyl Chloride ug/l ND 04/10/97 MFF 0.5 2.0 P p&m-Xylene ug/l ND 04/10/97 MFF 1.0 o-Kylene ug/t - ND 04/10/97 MFF 0.5 MOL • Method Detection Limit NO • Not Detected BOL • Below Detection Limit NM • Not Measured SPEC LIMIT • a client specified, recoil ended, or regulatory level for comparison with data to determine PASS (P) or FAIL (F) condition of results. JOHN CORDON RIORDON ASSOCIATES P.O. SOX 178 FLORENCE, MA 01060 Purchase Order Number: 880252 Project Location: COLES MEADOW RD., NORTHAMPTON, MA. Date Received: 04/03/97 Sampled: 04/03/97 DKG WATER 7543 D4/14/97 page 1 of 6 LIMS-BAT 0: LIMS-28825 Job Muster: 28825 Sa pla Matrix: DKG WATER Date SPEC Units 97505654 Analyzed Analyst MDL LIMIT P/F Benzene ug/t ND 04/10/97 MFF 0.2 5.0 P ercmobenzene ug/t ND 04/10/97 MFF 0.5 Bromochloromethane ug/t ND 04/10/97 NFf 0.5 BrmudichLOromethane ug/t ND 04/10/97 NFF 0.5 Bromamethane ug/t ND 04/10/97 MFF 0.5 Bromofonh ug/t NO 04/10/97 NFF 0.5 n-Butytbenzene ug/i NO 04/10/97 MFF 0.5 sec-Sutylbenzene ug/t ND 04/10/97 MFF 0.5 tert-Butytbenzene ug/t PO 04/10/97 NFF 0.5 Carbon Tetrachloride ug/t NO 04/10/97 MFF 0.5 5.0 P Chlorobenzene ug/t ND 04/10/97 MFF 0.5 100 P ChLorodibrommethane ug/l ND 04/10/97 MFF 0.5 Chloroethane ug/L ND 04/10/97 MFF 0.5 Chloroform ug/l ND 04/10/97 MFF 0.5 Ch[oromethane ug/L ND 04/10/97 MFF 0.5 c-Chlorotoluene ug/l nap 04/10/97 MFF 0.5 p-Chtorototuene lg/L ND 04/10/97 MFF 0.5 Dibromoowthane ug/t ND 04/10/97 NFF 0.5 1,2-Dichlorobenzene ug/l ND 04/10/97 MFF 0.5 600 P 1,3-Dichlorobenzene ug/t NO 04/10/97 MFF 0.5 1,4-Di chlorobenzene ug/t ND 04/10/97 MFF 0.5 75.0 P Dichlorodifluoramethane ug/L ND 04/10/97 MFF 0.5 1,1-DichLaroethane ug/l ND 04/10/97 MFF 0.5 1,2-DichLoroethane ug/L NO 04/10/97 MFF 0.2 5.0 P 1,1-Dichtoroethylene ug/t ND 04/10/97 MFF 0.5 7.0 P cis-1,2-DichLoraethylene ug/t ND 04/10/97 MFF 0.5 70.0 P t-1,2-DichloroethyLene ug/t ND 04/10/97 NFF 0.5 100 P 1,2-Dichtoropropene ug/l NO 04/10/97 NFF 0.5 1,3-Dichloropropane ug/L NO 04/10/97 NFF 0.5 2,2-Dichloropropane ug/t ND 04/10/97 Mff 0.5 1,1-Dichloropropene ug/l ND 04/10/97 MFF 0.5 1,3-Dichtoropropene ug/l ND 04/10/97 MFF 0.5 MDL = Method Detection Limit ND = Not Detected BDL = Below Detection Limit NM • Not Measured SPEC LIMIT • a client specified, recommended, or regulatory level for cwparlson with data to determine PASS (P) or FAIL (F) corditimn of results. r * 9 �� if 1/ Ntist THE COMMONWEALTH OF MASSACHUSETTS , DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT • Raymond Mieczkowski Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. May 25, 1995 • Acting Director of the ).4 of Water Pollution Control