48 title 5 1997 HOWARD ENVIRONMENTAL SERVICES
TITLE 5 SPECIALISTS
750 NORTH PLEASANT STREET, REAR
AMHERST, MA 01002
PHONE: (413)256-8008 FAX: (413)549-1850
September 4, 1997
Gibbs Realty
Attn: Lisa Gibbs
90 Conz Street
Northampton, MA 01060
Re: Subsurface Sewage Disposal System Inspection,48 Country Way,
Northampton, MA.
Dear Lisa,
Enclosed please find a copy of my report for the referenced inspection. I have forwarded
copies of the report to the Northampton Board of Health per the requirements of 310
CMR 15.301-15.304.
Based on the results of my inspection in accordance with 310 CMR 15.301-15.304, I have
concluded that the system passes at this time. The Septic Tank, Distribution Box and
approximate Leaching Field locations have been clearly identified in the "As-Built"
drawing on page 9 of the Subsurface Sewage Disposal System Inspection Form.
Please call if you have any questions, and thank you for this opportunity to be of service.
Sincerely yours,
Dan Nitzsche
SE, Certified Title 5 System Inspector,
System Designer
cc: Northampton Board of Health
PERC TESTING • SEPTIC SYSTEM ENGINEERING • ENVIRONMENTAL CONSULTING
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or
due to a broken. settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health).
Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four 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
obstruction is removed
C) FUR 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
I) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE 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 water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
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 PROTECTS THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
3) OTHER
The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private
water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
Gee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
Method used to determine distance (approximation not valid),
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
AMHERST, MA 01002
(revised nansmn Pap 2 or la (413) 256 - 8008
WILLIAM F WELD
Governor
ARGEO PAUL CELLUCCI
Lt. Governor
Property Address:
Date of Inspection: /ys/ .+.T- O/O(o 0
Name of Inspector:a D approved ov 1J 11-25C14 NORTMAa'^O a
I am a DEP app system inspector pursuant to Section 15.340 of idle 5(310 CMR 15.000)
Company Name:
Mailing Address:
Telephone Number:
CERTIFICATION STATEMENT
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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance
of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617)292-5500
TRUDY CO/CE
Secretary
DAVID B. STRUMS
Commirvioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION a �f�s 7{/
. Caufffri.ty t.1 / / A)ORTIMA PTVA) Address of Owner: V/ '--"L /
8/ts 9} or different) 90 G`ovF Sr
e
Inspector's Signature: I /i4.f
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the
buyer. if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
Date: 9/7A9-
Al SYSTEbf PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any
failure criteria not evaluated are indicated below.
COMMENTS:
BI 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.
Indicate yes, no, or not determined (Y. N. or ND). Describe basis of determination in all instances. If"not determined', explain why not.
_ The septic tank is meal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
years prior to the date of the Inspection; or the
Compliance (attached)or indicating mto, is the tank was installed al y unsound,twenty shows(sub y p '
septic tank, whether or not meal, is crocked, structurally unsound, shows subsantial infiltration or exfiltra[ion, or tank failure
is imminent. The system will pass inspection if the existing septic tank Is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 01/25/97)
Page 1 or to
��Printed on Recycled Paper
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
AMHERST,MA 01002
(413)356-8008
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner:
Date of Inspection:
Check if the following have been done: You must indicate either "Yes' or *No- as to each of the following:
Yes No
_ Nr
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
ll
— The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
0--- The site was inspected for signs of breakout.
All system components, 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
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_✓ _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
surface Disposal System.
_ Existing information. Ex. Plan at B.O.H.
✓ Determined in the field (if any of the failure criteria related to Pan C is at issue. approximation of distance is unacceptable)
115.302(3)(b)]
(revised 04/25/971 Page 4 or 10
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
AMHERST, MA 01002
(413) 256 - 8008
Property Address:
Owner:
Dale of Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
4e Courtney
a/1s7y)-
DI SYSTEM FAITS:
You must indicate either 'Yes' or 'No' as to each of the following
ave determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due m an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6' below invert or available volume is less than 1/2 day flow.
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 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 a 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 analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
You must indicate either "Yes' or 'No' as to each of the following:
e following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97)
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
Page a of AMHERST, MA 01002
(413) 256 - 8008
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
rr
Depth below grade: DT
Material of construction: _cast iron_40 PVC, other (explain)
P.-.444gfr ta---
Distance fromprivale water supply well or suction line
Diameter
Comments: (condition of joints. venting, evidence of leakage. etc.)6� 0 65FL��
'to ivirs Tt o.HT 'nn Le'AkA
SEPTIC TANK:,
(locate on site plan)
oft
Depth below grade:/O
Material of construction concrete _metal Fiberglass Polyethylene_other(explain)
If tank is metal, list age Is age confirmed by Certificate of Compliance_(Y
es/No)
Dimensions:
Sludge depth /Zr' o
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: S
Distance from bottom of scum to bottom of outlet tee or baffle: /0 s�9Soe�
How dimensions were determined: S(,u46.e snc/4_4 Dye
" x f 4 K 6o r,
Comments.
(recommendation for pumping condition of inlet and outlet tees or baffles, depth�ofaliquid ev l in relation t��G invert, structural integrity,Dagger
evidence of leakage, etc.) C- TEFS` yN STF th a R �I m 6ij--t r to i.6
GREASE TRAP:
(locate on site pla Lilly
Depth below grade:_
Material of construction: _concrete metal Fiberglass Polyethylene_other(explain)
Dimensions:
Scum thickness:
from top of scum to top of outlet tee or baffle:_
Distance from bottom of scum to bottom of outlet tee or baffle:_
Date of last pumping:
Comments.
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage. etc.)
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
Imised 04/251971 Tae 6 of la AMHERST, MA 01002
(413) 256 - 8008
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
i operty Address: 1 ' CeuF' ay W°4'/
Owner: of 64
Date of Inspection: e/l5/9}
FLOW CONDITIONS
RESIDENTIAL:
Design flow: ' 2.d./bedroom for S.A.S.
Number of bedrooms: _5
Number of current residents:
Garbage grinder (yes or no):VPC
Laundry connected to system (yes or no): yeS
Seasonal use (yes or no)akti
Water meter.readings, if available (last two(2) year usage (gpd)
^"^9ump Pump y`ye"scor no):4th)
Last date of occupancy
COMMERCIAL/INDUSTRIAL:A/
Type of establishment:
Design flow:_ gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
/¢¢.o art
Last date of occupancy:
/THER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information: //�
7i n KrzaL1dr/
System pumped as pan of inspection: (yes or no)/V(
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Y' Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) Of yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components. date installed(if known)and source of information:
Sewage odors detected when arriving at the site: (yes or no)Ly
(revised 04/25/97)
Page 5 of10
/y(ds ytcr a-J4e
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
AMHERST, MA 01002
(413) 256 - 8008
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):I
(locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type.
leaching pits. number.
leaching chambers, number_
leaching galleries, number:
leaching trenches. numbcr,length:
leaching fields, number, dimensions.
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of coding. condition of vegetation, etc.)
�) St Ns or tic_ F-41 ✓&GET�1-710")(14ti.f/!)A-WM &
o . ' 1 •
5i -�.,4w1Ay Ln.4..
CESSPOOLS:A
(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 (cesspool must be pumped as pan of inspection)
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.)
(revised 0+(25(891
HOWARD ENVIRONMENTAL SERVICES
nee a of 10 750 NORTH PLEASANT STREET
AMHERST, MA 01002
(413) 256 - 8008
Property Address: 11 64,1
Owner: t/�� f(3(QSi
Date of Inspection:
8,//5/97—
TIGHT OR HOLDING T
(locate on site plan)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
(JAI
(Tank must be pumped prior to, or at time, of inspection)
Depth below grade.
Material of construction: _concrete _metal_Fiberglass_Polyethylene_other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level: Alarm in working order _ Yes; _ No
Date of previous pumping:
Comments
(condition of inlet tee, condition of alarm and float switches, etc.)
')/STRIBUTION BOX: £ rr WLW O'✓1"`-v
locate on site plan)
//
Depth of liquid level above outlet invert:
Comments
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
,Ud EV,b . of -Pala/A/6, /./gain ()Buie-LEO .-f7- ant..cr zaNEQr-
PUMP CHAMBER f
(locate on site plan
Pumps in working order: (Yes or No)_
Alarms in working order (Yes or No)_
Comments:
(note condition of pump chamber, condition of pumps and appunenances, etc.)
(revised 04/15/971
Page 7 of 10
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
AMHERST, MA 01002
(413) 256 - 8008
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
Depth to Groundwater >6 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
XObservation of Site (Abutting property, Qrvatioo hall, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
At 34CK-ita6 to (--t,f'ei) a T A G -4- C f /*le- afrsr1E
O I S. A . s . Aid t,JA{Tez oJ.A-S' OBkigEA -+i % f.
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
AMHERST, MA 01002
(413) 256 - 8008
(revised 04/25/971 Page 10 at 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
//'m A„2y w4y
Properly Address: '� c-�'[ 1
Owner: a( 3�S
Dale of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 1W (Locate where public water supply comes into house)
[Mr m 5 cAtfi
SAS
/8' x 3s' 4fP"Y)
JD' FawNA If/urns/0c
>uaawar PT. 1
;aril %Agile
39.5'
(earrc7()
P1-. 1
bet �� r
(revised 04/25/97)
SWJC tjA&2^Ya�
Teti 4AC
/odd 6AL.
co LA,AJTR'( (-`SAY
Pose 9 of 10
HOWARD ENVIRONMENTAL SERVICES
750 NORTH PLEASANT STREET
AMHERST, MA 01002
(413) 256 - 8008