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70 Title V 2011 Owner information is required for every page. Important:When filling out forms on the computer, use only the tab key to move your cursor-do not use the return key v 0 flan Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Country Way Properly Address Gabrielle Hartley Owner's Name Florence MA 01062 3/19/2011 City/Town 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 form. A. General Information 1. Inspector: Thomas S. Leue Name of Inspector Homestead Engineering Inc. Company Name 1664 Cape St. Company Address Williamsburg City/Town 413-628-4533 Telephone Number MA State SI-130 License Number 01096 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: ❑ Passes ❑ Conditionally Passes Z Fails ❑ Needs Further Evaluation by the Local Approving Authority // April 19, 2011 Inspector's bi4narure 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. LSms.nno Tells Official nspecton Form.Subsurface Sewage Disposal System•Pagel of 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 70 Country Way Property Address Gabrielle Hartley Owner's Name Florence MA 01062 3/19/2011 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 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 Any failure criteria not evaluated are indicated below. Comments: Leaching tank was below the water level in the gravel media surrounding it. 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 old is available. ❑ Y ❑ N ❑ ND (Explain below) tsrts.1 vm Tine 5 Official nspeulon Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owner's Name information is required for every Florence MA 01062 3/19/2011 page. page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) 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(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 ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ 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 15.303(1)(b)that the system is not functioning in a manner which will protect public health, 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 t5ins.11/10 rule 5 Official Inspection Form Subsurface Sewage Disposal System.Page 3 of 17 Owner information is required for every page. sns.imo Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner's Name Florence City/Town MA 01062 3/19/2011 State Zip Code Date of Inspection B. Certification (tont.) 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 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. 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 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 to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow Title 5 official Inspection Form Subsurface Sewage o5gsal System•Page 4 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owner's Name required to is Florence MA 01062 _ 3/19/2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® Any portion of 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 1 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. [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 2000gpd- 10,000g pd. 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. rsms.■ no Title 5 Offc,al Inspection Form:Subsurface Sewage Disposal System•Page 5 or 17 Commonwealth of Massachusetts wrni Title 5 Official Inspection Form IL Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owner's Name reformation is Florence MA 01062 3/19/2011 Pageetl for every _ Page. COLT own State Zip Code Date of Inspection 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 systems? 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 Of 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): unknown 4 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660+ t5 ins.nn0 Tine 50HIaai mspeaion Form Subsurface Sewage Disposal Svsem•Page 6 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form/ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Cry Owner information is required for every page isms.11/10 70 Country Way Property Address Gabrielle Hartley Owners Name Florence City/Town MA State 01062 3/19/2011 Zip Code Date of Inspection D. System Information Description: Two interconnected 1000-gallon septic tanks and two leaching tanks. Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system?[If yes separate inspection required] Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage(gpd)) Detail: (brD cc 1" )cir i l s-ot p tZ( jek ® Yes ❑ No ❑ Yes ® No ❑ Yes ® No ❑ Yes Z No Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non-sanitary waste discharged to the Title 5 system? Water meter readings, if available: ❑ Yes Z No continuous Date Gallons per day(gpd) ❑ Yes ❑ ❑ Yes ❑ E l Yes ❑ No No No Title Official mipecilon Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts gr Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owner's Name information is required Florence MA 01062 3/19/2011 page. for every p Ddy/TOWn 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: Pumped September 2010, says owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, d utien-box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ 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. ❑ Other(describe): bins•11/10 Title 5 official Ins Form:Subsurface Sewage Disposal System.Page 8 of 17 Owner information is required for every page v5ms.nnc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner's Name Florence MA City/Town State 01062 3/19/2011 Zip Code Date of Inspection D. System Information (cons.) Approximate age of all components date installed Of known)and source of information: Age unknown. Septic tanks appear to be late 1960's style. Were sewage odors detected when arriving at the site? Building Sewer(locate on site plan): Depth below grade: Material of construction: Z cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 average feet ❑ Yes ® No 124 ft. feet Comments (on condition of joints, venting, evidence of leakage, etc.): No problems seen. Under floor slab in basement. Septic Tank (locate on site plan). Depth below grade: Material of construction. ® concrete 1.25 tank 1, 1.5 tank 2 feet ❑ metal ❑ fiberglass ❑ polyethylene Two tanks flow out to common sewer, about 1000 gallons each. If tank is metal, list age: years ❑ other(explain) Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Sludge depth: ❑ Yes ❑ No 58" tall, 86" long, 48"wide Tank 1: 3", Tank 2: 0" Title 5 Official Inspection Form.Subsurace Sewage Disposal Syslem•Page 9 o19 Owner information Is required for every Florence _ MA 01062 3/19/2011 page. City/Town State Zip Code Date of Inspection Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Properly Address Gabrielle Hartley Owner's Name 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 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tank 1, Tank 2 measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integ liquid levels as related to outlet invert, evidence of leakage, etc.): Tank structurally OK. New PVC outlet in Tank 2. Abandoned ceramic pipe found also in Tank 2 outlet. Replacement cover on tank 1 center. Y 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 baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Isms•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•P 100117 Owner Information is required for every Page, ns.nn0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner's Name Florence MA 01062 3/19/2011 City/fown 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) Capacity: gallons Design Flow: gallons per day Alarm present: ❑ 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 Tine 5 Official nspe'-ton Form Subsurface s ge Dispos System•Page 11 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owner's Name information is required for every Florence MA 01062 3/19/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box Of 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.): Pump Chamber(locate on site plan): Pumps in working order: Alarms in working order: ❑ Yes ❑ No ❑ 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: tsns.1 vm Title 5 Official Inspection form.Subsunace Sewage Dpsposal System•Page 12 of 17 • 70 Country Way Property Address Gabrielle Hartley Owner's Name Florence Ciry/own Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Owner information is required for every page. MA State 01062 3/19/2011 Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits leaching chambers ❑ leaching galleries ❑ leaching trenches ❑ leaching fields ❑ overflow cesspool innovative/alternative system number: number: number: number, length: number, dimensions: number: Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No surface problems seen. Gravel media around leach tank 1 saturated to above level of tank top. 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 ens 11110. isles Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owner's Name information is required Florence MA 01062 3/19/2011 page for every page. 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.): Title 5 Official Inspection Form:subsurf ace Sewage oispos I System•Page 14 of Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owners Name Florence City/Town MA 01062 3/19/2011 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 Z drawing attached separately t5 its•11/10 Titles Official Inspection Form:Subsurface Sewage Disposal System•Page is o Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owners Name information is rag Florence MA 01062 3/19/2011 cage. dfor every CAy/fown State Zip Code Date of Inspection srs.11110 D. System Information (cont) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 5 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: Date ❑ 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. Built-up yard to about 4 feet above original contour. Actual depth to groundwater to be determined during perc test for repair. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form:Subsudace Sewage Disposal System•Page 16 of 17 .: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Country Way Property Address Gabrielle Hartley Owner Owner's Name information is Florence MA 01062 3/19/2011 page.required for every pa City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked Z Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i5me•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page V of 17 :Die: -4:y kocAt.-u a'r k ;:./vaV;{ souices M1' -J .UU: rAUiOS. • Partial Outline of House NORTH 4 v 22I - 72 I e_ "6 /„.4, x Cu .- Cu c Y Y Y Y O C C C C CO CO CO CO CO H H F- H 0 U V 0) C -O a a L L d N 0 o o •' V co CO 0 O N COMMENTS: Recommend pumping on a 3 to 5 year schedule. Also, a copy of this plan posted in the basement/utility area would keep this information accessible in future years for maintenance. As-Built Drawing Date: Owner: HOMESTEAD INC. Existing Septic System 4/19/11 Gabrielle Hartley Thomas S. LeueR.S. Revision Date: 70 Country Way 1664 Cape St. Scale: 1 : 20' Williamsburg, MA 010% Except as Noted Florence. MA 01062 1413] 628-4533 Google maps Notes 70 Country Way located at center. i 1 02011.Google-Map data©2011 Google- Plan to Upgrade SEPTIC SYSTEM for Gabrielle Hartley Located at 70 Country Way in Northampton, MA 01060 Plan Number 561 Design Date: 5/10/11 Updated: Contents Site Plan: Perc Test Forms:. Specification Requirements: System Calculations: Cross Section: Plan Drawing: Separate Application for Construction Permit: Local Variance Application: 1 pages 5 pages 3 pages 1 page 1 page 1 page g pages 3 pages Septic System Designer: Thomas S. Leue R.S. Homestead Inc. 1664 Cape St. Williamsburg, MA 01096 (located in Ashfield) 413 628-4533 800 285-4533 fax: 413 628-3973 email: • IleahertC°_11mr.V cam == City/Town of Northampton 'm��rt�i Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal L{a '� Site Address: 70 Country Way, Northampton C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area 1 Deep Observation Hole Number 1 5/3/11 9:00 AM clear Perc date Time Weather 2 Land Use: mowing No % ' (e.g. woodland, agricultural field, vacant lot, etc.) Surface Stones Slope (% Vegetation Herbaceous Landform kame terrace Latitude: 42.35175 Longitude: 72.67625 Position on landscape (attach sketch) 3 Distances from: Open Water Body 150 Drainage Way 150 Possible Wet Area 150 Property Line 25 Drinking Water Well 150 Other: • feet feet feet 4 Parent Material: Galcial Unsuitable Materials Present: Yes If Yes: Disturbed Soil Fill Material Impervious Layer(s) Weathered/Fractured Rod Bedrock 5 Groundwater Observed: If Yes: Depth Weeping from Pit 0 inches Depth Standing Water in Hole 0 inches Estimated Depth to High Groundwater: 51 inches Depth ( Soil Soil Matrix Redoximorphic Features Soil Texture Coarse Fragments Soil Soil Other I l (In.) Horizon Color-Moist�_ _ (mottles ) -- (USDA) Cobbles Structure Consistency / Layer Depth Color Percent Gravel & Stones _. -(Moist) fine sandy 29 32 A 10YR 4/2 loam 5% blocky friable • 32 51 I Bw 10YR 5/4 loamy sand 556 blocky friable • fine sandy 51 82 C 110YR 5/2 _ 51 1OYR 6/4 • >5 loam 5% blocky friable • DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 2 of 4 . .gN • uommonwealthofMassachusetts City/Town of Northampton = City/Town of Northampton Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Site Address: 70 country Way, Northampton D. Determination of High Groundwater Elevation 1. Method used: Depth observed standing water in observation hole A. inches B. inches Depth weeping from side of observation hole A. = inches B. inches X Depth to soil redoximorphic features (mottles) A. 51 inches B. 44 inches Groundwater adjustment (USGS methodology) A. a inches B. inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes b If yes, at what depth was it observed? Upper boundary: 20 Min. inches Lower boundary: _112 Max. inches F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. I further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. I v 9� 5/3/11 signaluie _ Date Thomas S . Leue SE 1368 June 1995 Typed or Printed Name of Soil Evaluator/License Numbe Date of Soil Evaluator Exam Dan Wasiuk Town of Northampton Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2) this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 4 - .- uommonwealth of Massachusetts City/Town of Northampton r=te° =(i Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 1 Tillis I' °_._ FW Pi Site Address: 70 Country Way, Northampton C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) 1 Deep Observation Hole NumberZ 5/3/11 9:00 AM Clear Perc date Time Weather 1. 2 Land Use: mowing No 5% (e.g. woodland, agricultural field, vacant lot, etc.) Surface Stones Slope (%) Vegetation Herbaceous Landform kame terrace I Latitude: 42.35175 Longitude: 72.67625 Position on landscape (attach sketch) 3 Distances from: Open Water Body 150 Drainage Way 150 Possible Wet Area 150 Property Line 25 Drinking Water Well Other: feet feet feet 4 Parent Material: Galcial outwash Unsuitable Materials Present: Yes If Yes: Disturbed Soil Fill Material Impervious Layer(s) Weathered/Fractured RocF Bedrock I 5 Groundwater Observed: no If Yes: Depth Weeping from Pit 0 inches Depth Standing Water in Hole 0 inches Estimated Depth to High Groundwater: 44 inches Depth 1 Soil Soil Matrix Redoximorphic Features (Soil Texture) _ Coarse Fragments Soil Soil Other (In.) I/ Layer Color-Moist oi)t Depth ( ottles) Percent' (USDA) F Cobbles Structure Consistency 11/ _ Gravel & Stones (Moist) _ 0 201 fill fine sandy I I 120 - 29 A 10YR 4/2 loam 1 5% blocky 1 friable 29 - 38 Bw 10YR 5/4 loamy sandI 5% 1 blocky _. _ friable I 38 112 C i 10317 5/2 1 44 10YR 6/4 >5 loamy sand 5% blocky friable DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4 • CONSTRUCTION SPECIFICATIONS 70 Country Way. Northampton Title 5 Septic System Plan Number 561 1. General a No work on this system construction shall take place until a permit for the approved system plan has been received from the local Board of Health. A copy of the Disposal Works Construction Permit should be on site for inspection during the time of construction. Additional specifications may be included elsewhere in this design. b. Loading requirements are specified for the septic tank on the system calculations page. Loading requirements for any other component are on the drawing.Normal loading systems are designated H-10. If H-20 rating is specified on the drawing and/or on the page for system calculations, the tank or leaching facility shall be custom built to meet the increased loading requirements using additional rebar, greater wall thickness and/or other approved methods. Follow the manufacturer's rating system and installation procedures. c. Alternatives to these specifications should be discussed with the System Designer in advance at 800 285-4533. 2. Septic Tank a. The septic tank selected by the contractor shall conform with 310 CMR 15.223. The septic tank shall be a minimum effective liquid capacity of 1,500 gallons below the outlet invert, rectangular, and with a minimum length to width ration of 1.5:1. Liquid depth to be 48". Compartmentalized tanks are not to be used. b. Septic tank shall be installed on a minimum of 6"of crushed stone,leveled to grade and thoroughly compacted. Septic tanks shall have a minimum cover of 9". No structures shall be located directly upon or above the septic tank access locations which interfere with performance, access, inspection, pumping, or repair. c. All three access covers to the septic tank shall have risers at least 20"diameter, if round, tightly fitted to the tank to resist water infiltration, and terminated with a tight fitting cover no more than 6" below ground surface. If, with the agreement of the Owner, one or more of the risers are terminated flush with ground, these shall be secured against unauthorized entry with stainless steel hardware. d. Inlet and outlet tees shall be of Schedule 40 PVC and shall extend a minimum of 6"above the flow line of the septic tank and be on the center line of the septic tank located directly under the clean-out manhole. All fittings to be glued and secured against any movement due to horizontal or vertical impacts. Cross-sectional flow baffles shall not be used as substitutes for inlet or outlet tees. The inlet pipe elevation shall be no less than 2" nor more than 3"above the invert elevation of the outlet pipe. Inlet tee minimum of 10" length below water surface. The outlet shall be provided with a tee extending below the flow line 14" and be equipped with a gas baffle. There shall be an air space of at least 3"between the tops of the tees and the inside of the tank cover. Inlet tees may be modified or a 6" riser on inlet cover may achieve this spacing. The tops of the tees shall be left open to provide ventilation or separate ventilation shall be provided. The effluent tee shall be fitted with a removable plastic outlet filter, as manufactured by Polylok Inc., model PL-120, Zebco, or approved equal. Provide manufacturer's maintenance data, as boxed with the lifter, to the homeowner or the System Designer. Homestead Inc. Page 1 5/10/11, FORM 12 - PERCOLATION TEST Location Address or Lot No. 70 country way Northampton Homestead Inc. #: 561 COMMONWEALTH OF MASSACHUSETTS Northampton, Massachusetts Percolation Test* Date: 5/3/11 Observation Hole # Depth of Perc: (in.) Start Pre-soak: End Pre-soak: Time at 12": Time at 9": Time at 6": Time (9" - 6"): Rate - Min./Inch: Time: 10:06 AM 3 46 10:06 AM 10:21 AM 10:21 AM 10:37 AM 10:40 AM 0:03:00 0:01:00 (inches) * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passes/ Site Fails: Passes Performed By: Thomas S. Leue, Homestead Inc. Witnessed By: Dan Wasiuk, Northampton Comments: DEP APPROVED FORM - 12/07/95 CONSTRUCTION SPECIFICATIONS 70 Country Way. Northampton covered as shown on the drawing, fold excess material over at the bottom of the trench, or trim with upper edge level at appropriate elevation. 6. Inspection a. A minimum of two site inspections are required under the revised Title 5 code by the System Designer. First, after the site has been prepared with clearing, excavation and system site layout, but before the installation of the system sand. Second, the contractor shall notify the System Designer a minimum of 48 hours in advance of the anticipated completion time for a Final Inspection. The impervious bather will be inspected for approval at this time. This barrier will have to be exposed at any locations of overlaps or penetrations to confirm watertight installation. The system shall be essentially complete at the time of the final inspection, including all components in place,risers and covers installed, electrical components functional,etc. No installed system component shall be buried greater than 1" depth at the time of final inspection. The System Designer shall verify the system was installed as designed and authorize the final grading.Coordinate the timing of the Final Inspection so the System Designer and the representative of the local Board of Health may be on the site at the same time, if possible. b. If the System Designer finds the system is not ready for inspection after being called, or if serious deficiencies are discovered, the System Designer must be notified to return to the job site when it is complete. There will be a charge to the Installer of$50 for each return trip, payable directly to the System Designer at the time of the reinspection. c. Inspection and project closeout forms are usually generated within 24 hours of final inspection by the System Designer, when all other requirements are met. Signed Certificate of Compliance forms and As-built Drawings are sent to the Installer for a signature and date. One set of forms are then returned to the System Designer for final processing. The second set of forms are for the Contractor to keep as his project record. 7. Final Gradin a. At conclusion of work, loam and seed all disturbed areas to perennial grass mixture.Added loam may be required for adequate grass growth. Mulch slopes with hay, burlap or netting to minimize erosion. b. Surface over leaching facility shall be pitched so as to shed rainwater. Also pitch surface over all tanks to shed rainwater from any exposed covers. Do not allow surface water to puddle over any system component. c. Systems built late in the year, where the grass cover does not have a chance to establish itself, requires the contractor is to return after spring thaw and resurface final grades and add grass seed cover as required to equalize and stabilize all disturbed areas. Homestead Inc. Page 3 5/10/11, CONSTRUCTION SPECIFICATIONS 70 Country Way, Northampton e. Septic tank should be inspected by the Owner or his representative for solids accumulation annually. When the sum of the sludge and scum layer approach 1/4 the net working volume of the tank (net of 12" total thickness), as measured at the center of the tank, the tank is due for pumping. Septic tanks shall be inspected and maintained in accordance with 310 CMR 15.300 and applicable local requirements. 3. Distribution Box a. The distribution box selected by the contractor shall conform with 310 CMR 15.232. Material of construction shall be concrete or plastic lined concrete. A 6" sump is required in the d-box. b. The distribution box shall be placed on thoroughly tamped and compacted sand or peastone a minimum of 6"thickness, and shall be leveled utilizing a water flow test. Speed levelers shall not be used on a new installation to obtain level and equal distribution flow, but should be installed after leveling is completed in case uneven settling occurs in the future. c. For inlet pipe slopes of 5% or greater, or where there is a pumped flow, the distribution box shall have an internal cast baffle or solvent welded pipe tee to reduce the velocity of the influent flow. An internal pipe "Y" or an elbow are not acceptable. d. The first 2 feet of pipe out of the distribution box to be set dead level. Use a fernco connector to join to pitched pipes beyond first two feet. e. A riser to grade is required on distribution boxes buried more than 9 inches below grade. 4. Pining a Piping to the septic tank(the building sewer) shall be 4" diameter, PVC Schedule 40 or better. Slope new pipe installations at 1/4" per foot length. b. All piping from the septic tank to the end of the system shall be 4" diameter, SDR-35 or better, except as noted on the drawings. Slope pipe installations 1/8"per foot length as a minimum value. c. Place magnetic detectable warning tape pre-printed "Sewer Pipe Below" or similar wording approximately 12"above all new 4"diameter piping installed on this project. 5. Leaching Facilities a. General: All leaching facilities to be of the size and location shown on the drawings. b. Leach fields (Infiltration chambers): Arrange infiltration chambers on levelled ground. Parallel rows should be placed a minimum of 6" apart. Add end plates as per manufacturer's assembly directions. Fill spaces between rows with Title 5 sand to the level of the top of the chambers. c. Al I fill materials used on this project within five feet of the leaching chambers to be certified Title 5 sand, including any fill materials under chambers, between chambers and to the level of the top of the chambers. d. A reasonably current copy of the certification from the sand supplier is required to be submitted to the System Designer before the conclusion of this project. e. Breakout barrier, where required, to be minimum 40 mil thick continuous sheet. Install barrier vertically from bottom of excavation to height of top of leaching system. Seams of membrane material to be overlapped a minimum of 12 inches and glued with sealant as recommended by manufacturer. Material to be hypo]on, low density polyethylene, buna-N rubber.EPDM, or approved equal. Backfill in lifts of no more than 6"to assure minimal deformation of membrane. If material is wider than the vertical distance to be Homestead Inc. Page 2 5/10/11, 102 Stone Walls House — — 100 ,_ Leachfield Chambers Title 5 Sand RL 94 N .. 92 L ' �\_- Bank Run Fill 90 ID \ 88 86 Groundwater 84 82 Date: Owner: tNAB system Crosssealon 5/10/201 1 Gabrielle & Mitch Hartley ,+'°°� �% d, HOMESTEAD INC. ire Twins Thomas S. Leue R.S. Scale: 1 : 20' Revision Date: 70 Country Way t, • . :, I 1664 Cape St. Except as Noted Florence, MA 01 062 ���'>Fxeo sr.�`�P�� Williamsburg,(43 -4533 itlee 70 Country Way DESIGN CALCULATIONS Northampton Leaching Chamber type Leach Bed System Structure: Single Family House Flow Design Criteria: Calc. Design Flow: Garbage Grinder: Total Design Flow: Percolation Rate: Percolation Rate: Loading Rate: Area required for infiltration: Field Size Reduction Variance Ap Net Field Size: Bed Configuration: Model Used Effective Leaching Area: Length per chamber: Width per chamber: Invert height: Overall height: Leaching area/chamber: # Chambers required: # Chambers provided: # rows wide: space between rows: Total Field Width: # Chambers long: Total Field Length: Total Field Area: Effective Leaching Area: Net Calculated Capacity: Loading Not Allowed Measured Design Rate Class I Soil ication: Plan Number 561 4 bedrooms 110 gallons per bedroom per day 440 1.0 440 10.0 1 0.74 595 1 9.4% 479 Arc 36 made by ADS Corp. gallons per day factor gallons per day min. per inch min. per inch gallons/sq.ft./day sq. ft. sq. ft. Info Source Owner's information 310 CMR 15.203 multiply above 310 CMR 15.240 multiply above from perc test 310 CMR 15.105 310 CMR 15.242 divide flow by loading rate 310 CMR 15.504(d) multiply above Arc 36 4.8 sq ft/In ft 60 inches 34.5 inches 7.13 inches 13 inches 24.0 sq. ft. 20.0 20 2 6 inches 6.25 feet 10 50.00 feet 312.5 sq. ft. 480.0 sq. ft. 441 gals/day H-1 0 Homestead Inc. Manuf. Trade Name DEP technolory ratings Manufacturer's size Manufacturer's size Manufacturer's size Manufacturer's size length x leaching area field size divided by leaching area judgement average chambers + spacing judgement length of assembly length X width # chambers X rating area X loading rate iudgement 5/10/11