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480 Title 5 App;lication/Permits 1967, Inspection report 1995 Ptitne,=.4 _ . . rine SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 4O NicRil-1 CARPS fwav Owner ' s name Rosa Date of Inspection Roc,' __ 3 filet PART A CHECKLIST Check if the following have been done: _i. 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 . Larae volumes of water have not been introduced into the system recently or as part of this inspection. WA 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. AlAll system components, excluding the SAS, have been located on the site . fxn� S't t tLoc q-r�o.J of sns NoT DEV R'^,ur'o. sef+r�c- rn,.,K o•+4I %aen V/ 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 approximated_by non-intrusive methods. V// The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. NIMUMMW m#IIMSO OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential a- number of bedrooms I number of current residenjxs h16 garbage grinder, yes or (� yet laundry connected to stem, yes or no Nd seasonal use, des or Q� If nonresidential , calculated flow: µ/p• - TL..,s is A 2e'rikoe"Tn �n,1 water meter readings , if available: Last date of occupancy GENERAL INFORMATION I• /A Pumping records and source of information• hi • _K. 0 , 0Cc "`n WAS pudie'6 I v r.R_ FTQO '/ GSSyster pumped as part cf inspection, c5Dor no if yes , volume pumped X WOO 6c.( Reason for pumping: RG'H C �sTFt1� TIT Type of system. Septic 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. Date installed, if known. Source of information: !� I YeAPs 011) . So.., to 6P lN-Fa CAn ,a•J whs c'SC ft' LL X? - OLVNL$ /oc tapf-v F.,R ©n,) kb }/l-Y;P-S ph odors detected when arriving at the site, yes o PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) IL /1 depth below grade: - � material of construction: oncret metal FRP _other(explain) dimensions: • a c e " r/ QX6" KS) sludge depth distance from top of scum thickness 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 fo: repairs, etc. ) 4' - o rt. RPFF-E SrMULn nE REPCACCY) - Sc=ct.c i PrAAC Han VP r✓/ F7e.i.JJ Sr/cl X)C - - - M c-%T(i7 Lek w,4-S1e DISTRIBUTION BOX: (locate on site plan) 41-1a13inLON P3oc IJai L.icl3\ C) depth cf 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. ) PUMP CHAMBER: ki Ik (locate on site lan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs, etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION YORK PART B SYSTEM INFORKATION continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not approximated by non-intrusive methods) If not determined to be present, explain: T rYE. required, but may be Srt5 (.W'.5 NSF- Lo°NW, y[ IS ' ' ► E S C.�A () SIf-. NS- -Pelt LOR.G Jr-2 G Flo rima T' 1\4crP •c, sN v As WE AncrrtotS U..E2e Type leaching leaching leaching leaching -leaching overflow pits and number chambers and number galleries and number trenches, number, length fields, number, dimensions cesspool , number .e t � Ot VE( •VE A, Lei cm0. + (p ' x 2c) Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) N2 5. 6NS of FQLCVRG IV OD Gists CESSPOOLS (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. ) 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, recommendations for maintenance or repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 1001 0- b /004 Hous6 Septic Ti1uK. n� OR-nr1 F4R»13 R os9 DEPTH TO GROUNDWATER M/i depth to groundwater method of determination or approximation: - f-az) AmluPr-n-t et-G-V nThb)5 W E c - PJ 01 D grei2Rn bu5'C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) NO Backup of sewage into facility? No Discharge or ponding of effluent to the surface of the ground or surface waters? P2 Static liquid level in the distribution box above outlet invert? 0/A Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? P O Required pumping 4 times or more in the last year? number of times pumped A fe_septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: P .> below the high groundwater elevation? NO within 50 feet of a surface water? P O within 100 feet of a surface water supply or tributary to a surface water supply? • 6 within a Zone I of a public well? P O within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, pot the SAS)? t•) C.) within 50 feet of a private water supply well? p d 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector T' 6t a . iAAn&INN ' s Company Name Company Address 00 MO° cro Rolm) W i itlPt-AnFZ TJ AAA O io 2.7 €t! 5Z7-52 °, I 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. ChecA: one : 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 se • of this form. ��HOFM Inspector 's Signature Date Rpp-1 27 i1'g5 Original to system owner J Copies to: TSOAitc OP H-SAI-1}j Buyer ( if applicable) Approving authority /4/-7nn.,c.\a Pn R'r 2 p P.C. 6 c6C S TIMOTHY E. MAGINNIS, 16 Environmental Consultant • Registered Sanitarian 70 Montague Road Westhampton, MA 01027 (413) 527-5291 Goggins & Whalen Real Estate Co. King Street Northampton, MA 01060 Attn: Kim Goggins Re: Northampton - Septic System Inspection - 480 North Farms Road April 5, 1995 Dear Mrs. Goggins: On Monday April 3, 1995, I conducted a sanitary survey of the individual subsurface sewage disposal system at 480 North Farms Road in Northampton, MA. The purpose of this inspection was to determine the integrity of the system and ascertain its ability to perform in a satisfactory manner. This dwelling exists as a 2 bedroom single family have and is currently occupied by a single elderly woman. Its daily wastewater load is 220 gallons per day and there is no garbage disposal . The soils at this site are classified by the U.S. Department of Agriculture, Soil Conservation Service as Gloucester fine sandy loam. The Gloucester series consists of deep, somewhat excessively drained soils on glaciated uplands. These soils are formed in glacial till . River Drive Excavating of Hadley, M4. was on site and pumped approximately 1000 gallons of sanitary waste. On this date there was a negligent scup layer and an insignificant layer of sludge. All sanitary waste was disposed of in accordance with the State Sanitary Code Title - V at the Town of Hadley Sewage Disposal facility. River Drive Excavating last pumped this tank in April 1994. The sewage disposal system at this location was installed at least 18 years ago. It consists of a + 1000 gallon concrete septic tank located at the rear of the house. The waste pipe exits the foundation wall + 6' from the top of wall . The removable inlet and outlet baffles of the septic tank were inspected and shown to be in working order. However, the outlet baffle has shown some deterioration and was cracked at the time of this inspection. There was no evidence of leakage into or out of the tank and it appeared to be in good working order. The leaching facility at this site is also located at the rear of the house. The exact type of system is unknown. Intrusive methods to locate the distribution box were not employed because it could not be determined that one existed. Nevertheless, there were no obvious signs of hydraulic failure or vegetative encroachments nor were there any odors emanating from the system. ■ At the time of this inspection, the individual subsurface sewage disposal system appeared to be in good working order. However, considering the age of the system and the factors mentioned above, 1 recamiend the following: - a garbage disposal not be installed at this site. - annual pumping of the septic tank. - the daily wastewater load of 220 gallons per day (2 bedrooms) should not be increased until such time that an•updated system can be designed and installed according to the State Sanitary Code Title V. - the outlet baffle of the septic tank should be replaced The findings set forth in this report are strictly limited in time and scope to the date of the inspection Such findings shall not be used by any one other than the client and shall not apply prospectively, nor shall they be used for any other purpose than that set forth herein. No other warranty, expressed or implied, is made. If you have any questions or would like any additional information please do not hesitate to contact me at the above address. • Very truly ours; Timothy inn c.c. Roesmond Miller 480 North Farms Road Florence, Ma 01060 c.c. Northampton Board of Health City Hall Northampton, Ma. 01060 Attn: Mr. Peter McErlain Health Agent c ADDENDUM I, Timothy E. Maginnis, a Registered Sanitarian,do hereby state that I have inspected the septic system at the property known as 480 North Farms Road,Northampton on April 5, 1995 and that said inspection was conducted pursuant to all the requirements of the Title V standards which became effective March 31, 1995. After inspecting the septic system per the Title V requirements, I certify that said system is in good working order. I acknowledge that this addendum will be attached to my recent inspection report dated April 5, 1995 for the above referenced property. 4/z7/Pr CHECK OR FILL IN WHERE APPLICABLE No• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF - - Application for i3is#Inattl P Application is hereby made for a Permit to Construct System at: Location-Address • ler Fitz arks Oianatrurtiatt Hermit or Repair (Kan Individual Sewage Disposal or Lot No. Address Address Type of Building Size Lot Sq. feet llwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons Showers ( ) — Cafeteria ( ) Other fixtures Design Flow gallons per person per day. Total daily Pow gallons. Septic Tank—Liquid capacity gallons Length Width Diameter Depth Disposal Trench—No. Width Total Length Total leaching area sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Description of Soil Nature of Repairs or.Alterations An wer,when appllitble 1 ,ij :. 7 `ri Crotd:.....ti7wi,^t <<:.R .Ek.,.'�^ St 'fr,-!J -LI p #,1,7:0--L Agreement: V The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed- ) ..t e, Application Approved By Application Disapproved for the following reasons• Date Permit No - - Issued Date i L . Date by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Qlrrtifiratr of Tamp liana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer at has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector No 'NI THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .ri... -`I.. Oispesal i;arks (tonntrurt au l3rrmit Permission is hereby granted," r ` -Ir to Construct ( ) or Repair (') an Indic' D)sposaiSystem at No `.t� Street as shown on the application for Disposal Works Construction Pertpit No t%i! Dated.._.,: FEE DATE FORM 1255 HOBBS & WARREN. I NC.. PUBLISHERS BoIrd of Health