600 Septic Inspection Form 1996 TIMOTHY E. MAGINNIS, RS
Environmental Consultant • Registered Sanitarian
70 Montague Road
Westhampton, MA 01027
(413) 527-5291
Mr. Christopher Lovett
600 Haydenville Road
Northampton, MA 01060
Re: Northampton-Title-V inspection
April 5, 1996
Dear Mr. Lovett:
On April 3, 1996, I conducted an inspection of the individual subsurface sewage
disposal system at 600 Haydenville Road in Northampton, MA.
Enclosed for your records please find a completed inspection report.
Based on this inspection I have not found any evidence that would indicate that
the system is failing to protect public health or the environment. In my opinion,the
system does not violate any of the failure criteria as defined in the State Sanitary Code
Title-V. However, I recommend that the system be pumped this year and at least every
two years in the future.
If you have any questions or would like any additional information please contact
me at the above address.
Very truly yours.,
t
Timothy
■ c.c. Northampton Board of Health
WWWn F.Weld
mama
Ar9aa Paul Cellucel
Memo
Commonwealth of Massachusetts
Executive Office of Environmenlal Affairs
Department of
Environmental Protection
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Trudy Com
ascwsn
David B. Strolls
comes o,e
Property Addresst 600 Ngyoamu.l.r= RD. - Noe7-.- r -M , ,nq Address of Owner. SRAuCF
Date of Iupeoioi. rF- 3- 94 (If different)
Name of Inspector.I'Awn -% E. Mc i si Mu
Company Name,Address and Telephone Number
7U /ltdWTPt(r d k-1)
Lies.tw-wfrW , AA." 52'1-5291
CERTIFICATION STATEMENT
I certify that I have personally impacted 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 onelt.sewege dupmal systems. The system:
Passe
_ Conditionally Passes
_ Needs Further Evaluation By the local Approving Authority
Fails
Inapt.:toes Signature:
Date: r{-- 3-96
The System Inspector shall submit abody of thbr.iosdection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is•shared system or has a deign 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 shouts 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:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CUR 15.303.
Any failure criteria not evaluated an indicated below.
B) SYSTEM CONDITIONALLY PASSES:
Ova or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes
— inspection.
Indicate yse,no,or not determined(Y,N,or ND). Describe basis of determination in ell instances. If"sat determined",explain why not)
The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfltration,or tank failure is
imminent. The system will passe inspection if the existing septic tank is replaced with a ponformiu gig septic teak as approved
by the Board of Health.
(revised 11103/95) 1
One Winter Street • Boston,Massachusetts 021011 • FAX(517)556-1049 • Tsteybons(617)292-5500
1a Pnnted on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Admwc (aoG f-w7Da,V■t.L RD Nfxrnlavvro AAA_
Owner. GHms-rapt-VCR. StbHN (yvcrr
Date of Inspection .-3- 96
Di SYSTEM CONDITIONALLY PASSES (continued)
N/k
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets)
or due to•broken,settled or uneven distribution bor. The system will pass inspection if(with approval of the Board of
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
distribution box L levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipets). The smears will pass
inspection if(with approval of the Board of Health):
_ broken pipes)an replaced
obstruction is removed
CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
I N A Conditions exist which require hither 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.
g) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AM)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 a septic tank and soil absorption system and it within 100 feet to a surface water supply or tributary to a
surface water supply.
_ The system has•septic tank and soil absorption system and is within•Zone I 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 ham•septic tank and soil absorption system ands less than 100 feet but 50 Wt or more from a private water
supply well,unless•well water analysis for coliform bacteria and volatile organic compounds indicate,that the wall is free
from pollution from tha facility and the presence of ammonia nitrogen and nitrate nititgen it equal to or as than S ppm
3) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Addree : 4,0 0 NAyousu.t.Le -R . - 40(414k.1:9-w vv.t9
Owner. GH4z..7bc Q Susk.) Lavt7T
Date of Inspection: 4"7 <
DI SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 910 CMR 15.303. The bun for
this determination is identified below. The Board of Health should be contacted to determine what will be 12.01101527 to correct the
faWrra.
NO Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
I O Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
141: Liquid depth in cesspool is less than 6"below invert or available volume is less than 1i2 day flow.
�Jd Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets).
Number of times pumped it/i ye-s
SO Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy u within 100 feet of a surface water supply or tributary to a surface water supply.
41` Any portion of•cesspool or privy is within a Zone I of a public well
gifr Any portion of•cesspool or privy is within 50 feet of a private water supply well.
i
p A 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 his been analyzed to be acceptable,attach copy of well water analyse for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
Ni
The following criteria apply to large systems in addition to the criteria above:
The system serves•facility with•design Sow of 10,000 gpd or greater(Large System)and the system is•significant threat to public
health and safety and the environment because one or more of the following conditions mist:
the system is within 400 feet of•surface drinking water supply
the system is within 200 feet of•tributary to•surface drinking water supply
the system is located in•nitrogen sensitive area(Interim Wellhead Protection Area (IWPAI or•mapped Zone U of a public
water supply well)
The owner or(Venter of any such system shall bring the system and facility• to Rill compliance with the groundwater treatment program
requuaments of 914 CMR 5.00 and 6.00. Please tonn a the local regional office of the Department for further information.
(revised 11/03/95)
9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Owner: si.60 fd `" �LNi conks
Date of Inspection: 4 3 ..1.‘
Check if the following have been done:
y,s ,Pumping information was requested of the owner.occupant,and Board of Health. 3 j/RS Abd
✓ None of the system components have been pumped for at leant two weeks and the system has been receiving normal flow rats
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
5 As built plane have been obtained and examined_ Note if they are not available with N/A.
Yg The fissility or dwelling was inspected for signs of swage beck-up.
'The system dos non-sanitary receive non- nitary or industrial waste flow I/
R25lDekIwt c44119
±AWE 1q13
f/ei_The site was inspected for signs of breakout.
yej All system components,excluding the Soil Absorption System, have been located on the site.
/iLL The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or
tea,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 skirting information or
approximated by non-intrusive methods.
'/g/y The facility owner(and occupants,if 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
Property Address((o0O WY/C)c?-1v ILLE RO -- NORT)1ANTT-oN, MA
Owner. GHRtSOprSc'(:' E S V SAN Love TT
Date of Inspection
4- 3 - 96
• FLOW CONDITIONS
9IDENTIAL•
Design flow:Sig.L c 9pllone
Number of bedrooms: 4-
Number of current residents: 3
Garbage winder Gs m 6
Lmmdry®oacted or no):XLS
Seasonal use(yes .AS
Water meter readings,if available:
Last date of occupancy: Cu#g6nITLy )N t St
COMMERCIAL/INDUSTRIAL:
Type of establishment: W%4
Design flow: galbuAday
Grease trap present; (yes or no)_
Industrial Wssta Holding Tank present: (yes or no)
Nooraoifary waste discharged to the Title 5 system: or no)_
Water meter readings,if available:
Last data of compmry:
OTHER(Descritel `U
Last date of occupancy-
GENERAL INFORMATION
St Qc.G of- tar Cd'. = Ci-*ai i prlYfi, L.-•JETT-
PUMPING RECORDS and source of information:
f.feC ()Lance() nu ik(i6rZT Irfrt3 3y CLEAN 5 Lc, 11/2C. 0( AM rite rap,
System pumped as part of inspection:(yes o (i
If yes,volume pumped: I%3 Alloys
Bann for Amping: P,.mp,-r) I .1 icicit AS Sh:kJaTyQS f •A,NT>s>-"1/4C�
TYPE OF SYSTEM
V Septic tankMitrtrdion box/soil&Sorption system ]fur(LTF-ATaK, Sy` TEKA-LGPC,Hlw)Cr 62X'
Sind&welled
Overflow cesspool
Privy
_Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(&plain)
if+wc = lu yentz>
APPROXIMATE AGE of all components,date installed(if known)and source of information: SAS - '- 3 yS g `
Nana SAS rw>TWLLrdG cz • GI.O
Sewage odors detected when arriving at the site:(yes yo) (J.Sik..f»il uN 'i3c!� �u p.J&, Ici`13
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address 400 b4tsyDa vtlte RA - /JORi %b* fTdu, Mtat
owner. CHRttsa?ham t SvsAN Loveter-
Date of Inapeotioo: 4- 3-4(
SEPTIC TANK: t•'"--
(locate on sit*plan)
Depth blow grade:
Material of construction:
r esnmet. )stet FRP No EC) sin)
I e,t.cT fh Tg eat IN hi.)Hale cress aAUK) 'Ts W iT1143 (.,err GR-pD<
Dimension /(L' X 5 X S'
Sludge depth: .Z G '•
Distance from top of sludge to bottom of outlet tee or baffle:_
Scum thickness:Y S' •
Distance from top of cum to top of outlet tee or bask: .
Distance from bottom of scum to bottom of outlet tee or bale:_
15._. 'TTACAZD 5Eric Thole- DESAI 1
Comments
(recommendation for pumping.condition of inlet and outlet ten or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) Reco.v. tr...f) livv..'bald and 1994 • OJTLEI Q'c cC Seta_
ap•uIc MntJb- nLZ ecVYQ ks CGAnxr•Titn CL• .t,C OTIf.S- ('s&FF (., . nris O
iLrweVQ.Q ?MGYF Lass ■ () FV.O: m' oof CAKR-y (v IN ,sTRtB i1a4.) C? •
GREASE TRAP._ N)rO
v1
(locate on site plan)
Depth below grade:_
Material of construction:_concrete meta FRP other(explain)
Scum Stickmen:_
Distance from top of scum to top of outlet tee or bale:_
Distance from bottom of scum to bottom of outlet tee or bale:_
Comments:
(recommendation for pumping,condition of inlet and outlet ten or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: GOO H1V-DFJJ+■+/-£ ga -MOR.11IAMF . N.A
Owner. LHf1+STOPi1ZL. E SL6AN VVe r
Date of loaner:Mon:
4--3-4 6
TIGHT OR HOLDING TANK: NSA
usayna.a.parr
Depth below
_FRP other(explain)
grade:_
Material of 000.tmmion: concrete joatai
Dwaodou:
Capacity: gallons
and float switches,etc.)
Design flow: gallon/day
Alum Im l:
Comment.:
(condition of inlet tee,condition of alarm
\'
DISTRIBUTION BOX
(buts on site plan) yt
Depth of liquid level above outlet invert: N/A
Comments:
(note if level and diptribution is equal, evidence of solids carryovler,evidence o ea age into or out of box,etc.)
st D IAV.. IN Dtvfl2 b 0. SIX tS IC�/el-•• j#1 BITIv+A of w"trT• NO EV yDP.jL2 o
(A2ari &Lief air— tecOraje . D•ST(a- BTION Rase- why i w31-f.LL,Y) New AO Au4. 1493
PUMP CHAMBER_ N/A-
(locate site plea)
Pump.in working order:(ye.or{no)_
Comments:
(note condition of pump ebambe ,condition of pumps and appurtenance. etc.)
(revised 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Addn.c 6 0 0 M*7oe-4 ta
Owner GI1-2:s-p Q%IA. <, Susan)
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS)✓
(lacaq on cote Plan, if p2401"10;anntion not required,but may be approximated by non-intrusive methods)
20.•
If cot determined to be present,explain:
SA5 AT ifs (”45 I tS5Th Iled u¢w 10
AEI) W,TW tZ to ttgo:tots
1473. y"f is Aaf :Xth24-f41-
Type:
leeching pits,number:_ /+
leeching chambers,number: /1 l2 Tay-C 1112/148g..9
leaching galleries,number:
leaching leafing fends number, rdimemona ( B K �2/X L.S)'A) 1- -:
• \ NW�ToR eeACH:NG SvS7uv1
ov.r0ow carpool, number_
Comment.: (note condition of soil,yens of hydraulic failure,level of po ,condition of wtion,e .)
j Pend -" 5 6435M. - t SANG Cnov¢ Pole[ �e-
N.■r.iv ed -r-
Nd pow()tNC at L✓4Drsee of hf1drasLtf VP
CESSPOOLS:_ N'✓l-
(locate on site plan) )V
Number and configuration-
Depth-top of liquid to inlet in
Depth of solids layer
Depth of.cum layer:
Dimension.of cesspool:
Material of oonstnsawn:
Indication of grouddwnter:
inflow(cesspool must be pd as partof inspection)
Comments: (note condition of soil,signs of hydraulic failure,Orel of podding,condition of vegetation,etc.)
PRIVY:_ $.%I A'
(locate site plan)
Materials of construction.
Depth of solids:_
Comments: (note oondSion of soil, of hydraulic failure,level of pending,condition of vegetation,etc.)
(revised 11103/95) s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Addre..: ( 00 I'MA'/DEtA/LIA.E. CD. — AL0(LTt'i Alt..QTJ av� MA
Owner. Cfrift..STef p 4- Sus9rJ (.../✓c11
Date of Inspection:
'1 -3-9L
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include tie.to at least two permanent references Landmarks or benchmarks
locate all well.within 100'
L✓:arcrt ru4
IZ
6>..tsnMG 2. 166.0Roorl
HaysE
4Oo 1-17;yDemo /e kD
No2hntrp-PA),film
794Woo.,,
A
1111101111•111111r.
rain
---
D(Sra.11,TaaNI Lie
DEPTH TO GROUNDWATER X
Depth to groundwater.t(e.$ feat
method orrd.t.rotationor approximation: Tea/ P/l /A/>rcelivman/ F¢a 9pozo.'s 2cAN
ai Suasc.R.FRct 5RuevKF 1)11p03A2 5icr DATED (-1O-9)
`:\ cat Fq
TIMGrHY
E.
'GINN1j
.EC�
(revised 11/03/95)
9
S&?nc TAN EiAL ( KIT S5
bUO HAN D&JV LLL& RO
NoQT a.t.-pTUN , w..^ .
w
24"
1
NLCV
CoNUCCSt
(LOSER
CoNU4srTE
R.3 Eft
I
± 24" at
SAME
CY] 151
CONGREm SEPT'C.
Tf+r em_
CONCRETE 34 LC.
o ± /01
SLLi6 VIEW (,NTSJ