94 Title 5 Inspection 1995 ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
July 10, 1995
Elizabeth Schuster
P. 0. Box 514
Williamsburg, MA 01096
nI N � �1
[Ill JUL 3 1 1995
G
NORIHM PION BOARD OF H(AUN
re: Septic System Inspection at 94 N. Farms Road, Florence, MA
Dear Elizabeth:
Enclosed please find a copy of my report for the referenced inspection. I
have forwarded copies of the report to Dana Pasquale per our discussion
and to the Northampton Board of Health per the requirements of 310 CMR
15.300.
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,
-Michael J. avigne
Environmental Engineer
Certified System Inspector
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 SYSTEM
LEEDS, MA 01053 1-413-586-7200 INSPECTION
Address of property CH N . f a o...c k'owA) F6,-ci e j 4
Owner's name E` , 0.L <lI` l-c•-
Date of Inspection Z _ � o - 9S
PART A
CHECKLIST
Check if the following have been done:
✓ Pumping information was requested of the owner, occupant, and 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 part of this inspection.
/.44g 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 site was inspected for signs of breakout.
✓ All system components, excluding the SAS, have been located on the
site. No d-Lou fow.■ol,
✓ 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 SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053 1-413-586-7200
If residential
FLOW CONDITIONS
number of bedrooms
number of current residents
garbage grinder, yes or no
laundry connected to system, yes or no
seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available:
Cut-•--e,..>L Last date of occupancy
GENERAL INFORMATION
Pumping
SEPTIC
SYSTEM
INSPECTION
records and source of information:
S--91 1993 � 'pi-es- i-eK-a,,c.
✓ System pumped as part
if yes, volume pumped
Reason for pumping:
T
of inspection, yes or no
'v 600 9.0. r.
ellar:/ wit rc�ion--
Type of system
lYSeptic tank/distribution box/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.
information:
Date installed, if known. Source of
/97>j.-ox;.na c /Cyea.-s / P e.—t1&»t er
nip Sewage odors detected when arriving at the site, yes or no
ENVIRONMENTAL HELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053 1-413-586-7200
SEPTIC TANK: V
(locate on site plan)
depth below grade: /1'y
material of construction: 1Z-concrete
SEPTIC
SYSTEM
INSPECTION
metal _FRP other(explain)
dimensions: SACS' x
A> is"
: scum sludge depth
distance from top of
thickness
0" distance from top of
.?" distance from bottom
sludge to bottom of outlet tee or baffle
scum to top of outlet tee or baffle
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, recommendations for repairs, etc. )
r.
2- /r a we/( ntac% /,.rn rnzn arinc,..t ,+a— appear-4- h 4c
/ 1nrirhy WC//. 2DµMr/M r bodLGhodnJerr every .2 - 7 edrr /.r /-!Cc wC..IC <
DISTRIBUTION BOX: / /L2ZO<ac/eo(
(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, recommendation for repairs, etc. )
7-LK /r' nos.; ev,c%ncc o/ a- r/r,.j,* d.8.._ 6c x a...--o( afIC 1-
C�'ev c.--at o-r6.2.1 - /6 /ac ate or.c / tl c e/Xor-E /oar d,scc,-{ii.c.,c of
n4 s— tear o / dru..a c;,:-j• ,f Lc. nr,a,�yehr 4 p 'Pt. / Ac.ai'/our
"124_,_?tart/. ..(q /c<.,.E.
PUMP ER:
ocate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs,etc. )
ENVIRONMENTAL HELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053 1-413-586-7200
SEPTIC
SYSTEM
INSPECTION
SOIL ABSORPTION SYSTEM (SAS) : ✓
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explain:
e it
ti
Type
leaching
leaching
leaching
leaching
leaching
overflow
Y
76 -v 2"A c/u , %';pc/ r lA,At r-/Co,.
pits and number
chambers and number
galleries and number
trenches, number, length
fields, number, dimensions
cesspool , number
Comments:
(note condition of soil ,
condition of vegetation,
ev1 1e c
5fAS' QPpCwrS
anaca.-r h l e
# aazi S•d r c u.._k,ww. vrl. 3o'x ,2C"
signs of hydraulic failure, level of ponding,
recommendations for maintenance or repairs,etc. )
2sr be
•
- e
d<
1.1orkiti ,-)ell
C$SS-P06LS (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
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
(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, recommendations for maintenance or repairs,etc. )
ENVIRONMENTAL HELD SERVICES, INC. SEPTIC
P.O. BOX 518 SYSTEM
LEEDS, MA 01053 1-413-586-7200 INSPECTION
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
erm
P� <L
/e
'eP/'C
<`
g C
/U „ / .S:
".e
sa._../y /oAn+
w/Y,/t
des e
DEPTH TO GROUNDWATER
r
11 - % depth to groundwater
method of determination or approximation:
S 0 me 0 x•dry n z? H'/i/>O e 7 c? L4 .
ENVIRONMENTAL HELD SERVICES, INC. SEPTIC
P.O. BOX 518 SYSTEM
LEEDS, MA 01053 1-413-586-7200 INSPECTION
indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined", explain why not)
-V Backup of sewage into facility?
Al Discharge or ponding of effluent to the surface of the ground or
surface waters?
/I/fl Static liquid level in the distribution box above outlet invert?
N0 d-An
x
Liquid depth in cesspool <6" below invert or available volume< 1/2 day
flow?
A/ Required pumping 4 times or more in the last year?
number of times pumped 0
Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is any portion of the SAS, cesspool or privy:
below the high groundwater elevation?
/'/ within 50 feet of a surface water?
within 100 feet of a surface water supply or tributary to a surface
water supply?
Al within a Zone I of a public well?
-Nie within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
within 50 feet of a private water supply well?
Al 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 analyE
for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053 1-413-586-7200
Name of Inspector /p'%,C /pie / LowOve
Company Name
CLt ov e
Company Address
SEPTIC
SYSTEM
IN&PE_ IJQN
Certification Statement
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true, accurate and
complete as of the time of inspection. The inspection was performed and
any recommendations regarding upgrade, maintenance and repair are
consistent with my training and experience in the proper function and
manitenance of on-site sewage disposal systems.
Chec k one:
1 I have not found any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 CMR 15. 303 . Any failure criteria not evaluated are as stated in
the FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and
the environment as defined in 310 CMR 15. 303. The basis for this
determination is provided in the FAILURE CRITERIA section of this
form.
Inspector's Signature
Date 7 - -
Original to system owner
Copies to:
Buyer (if applicable)
Approving authority