279 Inspection Form 1995 ENVIRONMENTAL HELD SERVICES, /NC.
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
December 7, 1995
Estate of Pauline Walker
c/o Tom Hodgkins
Hodgkins Realty
East Main Street
Williamsburg, MA 01096
re: Septic System Inspection at 279 Haydenville Road, Northampton, MA
Dear Tom:
Enclosed please find a copy of my report for the referenced inspection. I
have forwarded a copy of the report to the Northampton Board of Health per
the requirements of 310 CMR 15.300 and to Attorney Robert Corash per
your request.
Based on the results of my inspection in accordance with 310 CMR 15.300,
I have concluded that the system does not fail to protect the environment
and/or the public health.
Please call if you have any questions, and thank you for this opportunity to
be of service.
Sincerely yours,
�e avigne
Environmental Engineer
Certified System Inspector
William F. Weld
Ooe,ne,
Trudy Cosa
Seneuy. EDEA
David B. Strolls
Commission,
Commonwealth of Mq>;sachusetts •
Executive Office of Environmental Affairs . .
Department of
Environmental Protection
Western Regional Office
ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518 LEEDS, MA 07053
1-413-586-7100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address- a191-Inrc&u-`✓i11c F.d - Nov-4L,o.T ress of (Rarer. Cs-1-,1c Gr-
Date of Inspection: 13 -V 9S (If different) C/0 rob._,-4dyk; `s
Name of Inspector: yyt r is 4_4✓ Si•w
Company Na' ,m Address and Telephone rwkrer: (p jy,✓c� rn/rk.nr-- Pen /{r
CERTIFICATION sraElo_xT IC),/lirvnn4u e9/MA O/09G
1 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:
V op Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Si yrnture:#.0 �, .N — Date: /0/•7/9,j'
The System Inspector shalt 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:
A) SYSTEM PASSES:
v/ 1 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. -
B1 SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the
replacement or repair, passes inspection.
Indicate yes, no, or not determined (T, N, or ND). Describe basis of determination in all Instances. If "not determined",
explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or enfiltration, 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.
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):
broken pipes) are replaced
obstruction is removed
distribution box is levelled or replaced
(revised 8/15/95) 1
436 Dwight Street • Springlield, Massachusetts 01103 • FAX • Telephone
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ..:.
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of inspection:
B) SYSTEM CONDITIONALLY PASSES (continued)
The system required pumping more a than four times a year due to broken or obstructed pipe(s). The
system will. pass inspection if approval of the Board of Health): • • .. ..•
broken pipe(s) are replaced
obstruction 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 THE SYSTEM IS NOT FUNCTIONING IN A MANNER UNICA WILL PROTECT
THE PUBLIC HEALTH AID SAFETY AND THE ENVIRmNENT:
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 PROTECT THE PUBLIC HEALTH NO SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorpti ofi system and is within a Zone 1 of a public water supply
well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply
well.
The system has a septic tank and soil absorption system and 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 free from pollution from that facility and the presence of ammonia nitrogen and
nitrate nitrogen is equal to or less than 5 ppm.
D) SYSTEM FAILS:
I have 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.
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 to 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.
(revised 8/15/95) 2
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SETNCE DISPOSAL SYSTEM INSPEOTIDN FORM
PAIT A
CERTIFICATION (continued)
Property Address:
caner:
Date of Inspection:
DI SYSTEM FAILS (continued):
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:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 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:
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
11 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'cansult the local regional office of the Department for
further information.
PANT a
CHECKLIST
Check if the following have been done:
p'7Ptmpi ng information was requested of the owner, occupant, and Board of Health.
/ None of the system components have been pulped for at least two weeks
Large volumes of water have not been Introduced Into the system recently or as
part of this inspection.
SA As built plans have been obtained and examined. Note if they are not available with N/A..
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow
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.
17-The size and Location of the Soil Absorption System on the site has been determined based on existing
information or approximated by non-intrusive methods.
L The facility owner (and occupants, if different from owner) were provided with information on the proper
maintenance of Sub-Surface Disposal System.
(revised 8/15/95)
ENVIRONMENTAL HELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Over:
Date of Inspection:
FLW FfINOITIQIS
RESIDENTIAL:
Design flow: gallons
Number of bedrooms: 3
Number of current residents:- .0
Garbage grinder (yes or no): list
Laundry connected to system (yes or no):t/ $
C
Seasonal use (yes or no): It a /
Water meter readings, if available:
Last date of occupancy: YWtttY I R�
COMMERCIAL/INDUSTRIAL:
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:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PAWING RECORDS and source of information:
Y'-s ado ) ➢ems puul - el— (t)c.�w� ion.-_k c r-� 'v �X Calla"-4 -NA
System pulped as part of inspection: (yes or no) y eS
If yes, volume pumped: /otr3 gallons . /
Reason for pulping: `To t, CP cc 4- m+trine— .
TYPE OF SYSTEM
Septic tank/di 4,4' <: .r' ,[/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other (explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information:
CS4,44-4-e& AE JO + YI-S
Sewage odors detected when arriving at the site: (yes or no) A,,
(revised 8/15/95) 4
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Diner:
Date of Inspection:
SEPTIC TANK:
(locate on site plan)
'I
Depth below grade: Y%
Material of construction: ✓concrete _metal FRP other(explain)
Dimensions: C ' L x U' u
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: ,1%//9
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: N//3
Distance from bottom of scum to bottom of outlet tee or baffle: ,a,(//c/
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.)
cR
oca[e on sire plan)
Depth below grade:
Material of construction: _concrete _metal FRP 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:
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.)
(revised 8/15/95) 5
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOS L STUBS INSPECTION rimm
PART C
SYSTEM IHFfRMATION (continued)
Property Address:
Owner:
Date of Inspection:
TIGHT INK TANK:
e Cl on site plan)
Depth'below grade:
Material of construction: concrete.
metal _FRP _ _other(enplain)
Dimensions:
Capacity:
Design flow:
Alarm level:
gallons
gallons/day
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRI BOX:
(la e 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.)
PIMP C R:
(l to on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95) 6
ENVIRONMENTAL HELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PMT C
SYSTEM INFORMATICS( (continued) -
Property Address:
Owner:
Date of Inspection:
SOIL ABsoRPTIUI SYSTEM (SAS): V
(locate on site plan, if possible; excavation not required, but may be approximated by non-Intrusive methods)
If not determined to be present, explain:
C x r ewe+ . n( lvts-p er.fr
Type:
leaching pits, number: / 9/B K 'th 'x ymr, L .- & to-'t& bin CAc ,
leaching chambers, number:
leaching galleries, number: /
leaching trenches, nmber,legth: / 2/4/ /o& ow r` c C heal- P -
leaching fields, number, dimensions: C
overflow cesspool, number:
level of ponding, condition of vegetati
etc.)
Comments: (note condition of soil, signs of hydraulic failure,
•
J.J.Pnr [5 / .0 - E Cc A%F, ex/ . dr Cnn, a/0'2
•
r.
.i irAnree
oca[e an 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 part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, Level of ponding, condition of vegetation, etc.)
Deere 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 8/15/95)
7
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FONM
PANT C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL STSTEN:
include ties to at Least two permanent references landaarks or benchmarks
locate all wells within 100'
/-4.1y ale Av//fie 2v( . (a L.a . Z5 le 9
DEPTH TO GROUNDWATER
Depth to groundwater: 7'A feet / / /
method of determination or approximation: %)/' g� ,{„/C. �uq C.n�� /"Slat><C� a t< �'cc�Yip,_ .f'hatW/w✓.
(revised 8/15/95) 8
EO[N.4 Rd 4(! YOUNG
s.
et‘.4a'E.
/42. 0
PE
o S
N
tcc
o/PE
N.d6°j0•w.
PE
Maopy
EDWARD W BARBARA YOUNG
HAYOCNV/LLE ROAD — LEEDS, MASC.
SCA LE : / /N. = Co i'7 ✓4/NE /9SS
EUGENE L . N/GG //VS c/V. EA/CR .