549 Title 5 System Failure Notice and Inspection 2013 J t.
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tthns 11110
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel: (413) 585-0405
Owner's Name
Northampton
City/Town
MA 01062 August 31, 2013
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:
Timothy E. Maginnis R.S.
Name of Inspector
Company Name
70 Montague Road
Company Address
Westhampton MA
City/Town State
(413) 527 5291 SI 1039
Telephone Number License Number
01027
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 Passesllll�
❑ Needs Fu ion by the Local Approving Authority
Inspector
The sys
of Health
has a desig
report to the app
and copies sent to the buyer, if applicable, and the approving authority.
September 3, 2013
Date
a copy of this inspection report to the Approving Authority(Board
ys of completing this inspection. If the system is a shared system or
„pd or greater, the inspector and the system owner shall submit the
e regional office of the DEP. The original should be sent to the system owner
****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.
Tines Official Inspection Form Subsurface Sewage Disposal System•Page 1 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
549 North Farms Road
Property Address
Robert A. 8 Athleen K. Zimmermann -Tel: (413L585-0405
Owner's Name
Northampton MA 01062 August 31, 2013
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:
This system is in failure. The outlet baffel of the septic tank has deterioated and needs to be repaired
or replace the tank with approval of the Northampton Board of Health.
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):
N/A
isos.tvm Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17
•
2t Commonwealth of Massachusetts
Title 5 Official Inspection Form
Owner
information is
required for
every page.
,bins•11/10
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel: (413) 585-0405
Owner's Name
Northampton MA 01062 August 31, 2013
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):
N/A
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
N/A
❑ obstruction is removed ❑ 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
Pus 5 Official Inspecliw Form Subsurface Sewage Disposal System•Page 3 N 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
549 North Farms Road
Property Address
Robert A. 8,Athleen K. Zimmermann -Tel 413) 585-0405
Owners Name
Northampton MA 01062 August 31, 2013
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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: N/A
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:
N/A
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 11/ day flow
15ins•11/10 Title 5 Official Inspection Form:Sulsswfxe Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel: (413) 585-0405
Owner Owners Name
information is
ev ery Northampton MA 01062 August 31, 2013
required for page. City/Town State Zip Code Date of Inspection
every
B. Certification (cont.)
r•Le TtC.
13 t t2
isms•11110
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-
10,000gpd.
❑ ❑ 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.
Title 5 official Inspection Form Subsurface Sewage Disposal System•Page S of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. 8 Athleen K. Zimmermann -Tel: 113) 585-0405
Owner Owners Name
information is Northampton MA 01062 August 31, 2013
every page. State Zip Code Date of Inspection
every page. City/Town
Pis.nno
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)]
® ❑
Z ❑
Z ❑
D. System Information
Residential Flow Conditions:
Unknown Number of bedrooms (actual).
Number of bedrooms (design):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):
4
Unknown
Title 9 Official Inspecllon Form aubswa<e sewaQs Disposal System•Page 6 d 17
<N, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Owner
information is
required for
every page.
Ems tl10
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. 8 Athleen K. Zimmermann -Tel: j413585-0405
Owner's Name
Northampton MA 01062 August 31, 2013
City/Town State Zip Code Date of Inspection
D. System Information
Description:
This system is approximately 35 years old. A previous Title-5 inspection report indicates that it was
installed in 1978. There is a 1,000 gallon septic tank, a distribution box and a leach field
approximately 001 x 20'W)as stated onprevious Inspection report.
2
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
N /A
Water meter readings, if available(last 2 years usage (gpd)):
Detail:
Site is served by private water supply.
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 ® No
Currently
occupied
N/A
N/A
Gallons per day(gpd)
N/A
N/A
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Title 5 official Inspection Form:Sabsurface Sewage Disposal System•Page t of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel: (13) 585-0405
Owner Owner's Name
information is Northampton MA 01062 Auu_ ust 31, 2013
everyrequired for P
every page. City/Town State Zip code Date of Inspection
18ns•11/10
D. System Information (cont.)
Last date of occupancy/use:
Other(describe below):
N/A
N/A
Date
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
Type of System:
Home owner: Robert A. Zimmermann
N/A
gallons
N/A
N/A
❑ Yes ® No
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)
❑ 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):
Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page a of 17
Owner
information is
required for
every page.
15ns•11110
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel. (413) 585-0405
Owners Name
Northampton MA 01062 August 31, 2013
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed Of known) and source of information:
This system is approximately 35 years old. Previous Title-5 inspection report indicates that it was
installed in 1978. Source of info = Robert A. Zimmermann.
Were sewage odors detected when arriving at the site? Z Yes ❑ No
Building Sewer(locate on site plan):
Depth below grade:
Material of construction:
❑ cast iron
Z 40 PVC ❑ other(explain):
Distance from private water supply well or suction line:
2'
feet
4"pipe
</ 18'
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
The sewer line appeared to be in sound condition from house to tank.
Septic Tank(locate on site plan):
Depth below grade:
Material of construction:
12"- pumpout cover raised to
grade
® concrete ❑ metal ❑ fiberglass ® polyethylene ❑ other(explain)
This is a 1,000 gallon concrete septic tank. It has poured in place concrete inlet and outlet baffles.
The outside dimensions are 181 x 5'W x 4'D)_ Outlet baffel is is disrepair.
If tank is metal, list age:
WA
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate)
(8'L x 5'W x 4'D)
Dimensions:
Sludge depth:
❑ Yes ❑ No
N/A
Title 5 Official Inspeclicn Form Subsurface Sewage Disposal System•Page 9 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
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel: (413) 585-0405
Owner's Name
Northampton
City/Town
MA 01062 August 31, 2013
State Zip Code Dale of Inspection
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?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
This tank has recently been pumped by River Drive Execavators of Hadley, MA. At the time of this
inspection, sewage was overflowing the tank at the outlet end. Outlet baffel is in disrepair.
N/A
None
N/A
N/A
measured
Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal
N/A
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:
N/A
N/A
N/A
N/A
N/A
Date
I5ins.1 ulo Title 5 omual Inspection Form Subsurface Sewage Disposal System Page 10.0'17
Owner
information is
required for
every page.
stns•11/10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. 8 Athleen K. Zimmermann -Tel (413) 585-0405
Owners Name
Northampton MA 01062 August 31, 2013
City/Town 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.):
N/A
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
WA
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
N/A
N/A
Dimensions:
N/A
Capacity: gallons
N/A
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
N/A
Alarm level: Alarm in working order: ❑ Yes ❑ No
N/A
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
N/A
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Ties Official Inspection Form Subsurface Sewage Disposal System Page If of 17
Owner
information is
required for
every page.
Sins.11/10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
549 North Farms Road
Properly Address
Robert A. &Athleen K. Zimmermann -Tel (413) 585-0405
Owner's Name
Northampton MA 01062 August 31, 2013
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
N/A
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.):
The distribution box was located. At the time of this inspection it was full and overflowing. There are
two outlet pipes, both of which seem to be plugged. At first, a dark black effluent was observed
flowing backwards from the leaching field.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
N/A
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
The SAS at this site is believed to be a 401 x 201 leaching bed. A previous inspector indicated that
there are 4 distribution pipes in the leach field. This was not verified as part of this inspection.
Title 5 DXiael Inspection Font.Subsurface Sewage Disposal System•Page II of 17
Owner
information is
required for
every page.
inns 11110
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. 8 Athleen K. Zimmermann -Tel: (413) 585-0405
Owners Name
Northampton MA 01062 August 31, 2013
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
leaching fields number, dimensions: (40 L x 20W)
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
There were no signs of hydraulic failure, ponding or damp soil above ground in and around the SAS.
However, the septic tank was overflowing effluent at the outlet end..
1 @
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
N/A
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
N/A
N/A
N/A
N/A
N/A
❑ Yes ® No
Till e s ORiaaI Inspection Form suorvaew Sewage Disposal System•Page 1➢of
Owner
information is
required for
every page.
Dins.11/10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Propedy Address
Robert A. 8 Athleen K. Zimmermann -Tel: (413) 585-0405
Owner's Name
Northampton MA 01062 August 31, 2013
City/rown 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.):
N/A
Privy(locate on site plan).
Materials of construction:
Dimensions
N/A
N/A
N/A
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
Title 5 Official Inspenion Form'.Subsurface Sewage Disposal System•Page 14 of 17
Owner
information is
required for
every page.
15ms 11tl0
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel: 1413) 585-0405
Owner's Name
Northampton
City/Town
MA 01062 August 31, 2013
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
® drawing attached separately
jcE
Title s Of Inspection Form:Subsurface Sewage Disposal System•Page 15 of n
Test pit_\
Approximate area of leaching bed
(exact size and location unknown)
(20' x 40)
s
Distribution box '
N
s
N
N
N N
Barn
N N
N N
N N
N N
Garage
tad
AS-BUILT DIMENSIONS
'A' to 'C' = 23' 'B' to 'C' = 16'
Overhead utilities,
/T
Utility pole
/
h.
IT
Shop
'C
4' pvc solid pipe
o/
xlsting 1,000 gallon
eptic tank
—Pump-out manhole 'C
Patio
# 549 /
Existing /
3 bedroom /
house /
Existing well
P/L ---
AS-BUILT PLAN
NORTH FARMS ROAD - FLORENCE, MASSACHUSETTS
549 North Farms Road
Florence, MA. 01062
August 31, 2013
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel (413) 585-0405
Owner Owners Name
information
quir fn is
required for p Northam ton MA 01062 August 31, 2013
every pd
every page. City/Town State Zip Code Date of Inspection
t5ins 11110
D. System Information (cont.)
Site Exam:
Z 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:
N/A
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
N/A
❑ Checked with local excavators, installers-(attach documentation)
• Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
-Two test pits were excavated and no groundwater was observed.
- An upcoming soil evaluation will determine Estimated Seasonal Highwater table.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
Title 5 Official Inspection Form Subsurface Sewage Disposal System'Page 16 or 17
Owner
information is
required for
every page.
151ns•11/10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
549 North Farms Road
Property Address
Robert A. &Athleen K. Zimmermann -Tel' 565-0405
Owners Name
Northampton MA 01062 August 31, 2013
City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary. A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
• System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
Tine 5 Official Inspection Form Subsurface Sewage Disposal System•Page 17 of 17
CITY of NORTHAMPTON
PUBLIC HEALTH DEPARTMENT
BOARD OF HEALTH MEMBERS:Donna Salloom, Chair—Joanne Levin, MD—Suzanne Smith, MD
STAFF:Merridith 0Teary, RS, Director—Daniel Wasiuk,Inspector—Edmund Smith. Inspector—Jennifer Brown,R.N;
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September 3,2013
Robert and Athleen Zimmerman
549 North Farms Road
Florence, MA 01062
Dear Homeowners:
RE: Sewage Disposal System Inspection
549 North Farms Road
The Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System
Inspection conducted by Tim Maginnis at your property, 549 North Farms Road,on August 31, 2013.That
inspection report indicates that your subsurface sewage disposal system fails to protect the public health
and the environment as defined in Section 15.303 of CMR 15.000,State Environmental Code,Title 5.
Therefore,in accordance with the provisions of 310 CMR 15.000 of the State Environmental Code,Title 5,
and under authority of Massachusetts General Laws, Chapter 21A,Section 13,you (or the subsequent
owner of the property)are hereby ordered to repair the subsurface sewage disposal system at 549 North
Farms Road,within two years of the date of the original inspection, (August 31,2015). If further
degradation of the sewage disposal system occurs (e.g.sewage flowing to the surface of the ground),you
maybe required to complete the repairs sooner.
All work to repair/upgrade your subsurface sewage disposal system must be performed by a licensed
sewage disposal system installer,in accordance with the requirements of 310 CMR 15.000,and with plans
approved by the Northampton Board of Health.
Please be advised that you are entitled to a hearing on this order to upgrade your subsurface sewage
disposal system, provided that you file a written petition requesting such a hearing in the Board of
health office within seven (7) days of the receipt of this notice.
Please feel free to contact the Board of Health office,at 587-1214 if you have any questions concerning
this matter.
Thank you for your anticipated cooperation in this matter.
Sincerely,
Daniel Wasiuk
Health Inspector
212 Main Street,Northampton,MA 01060
Ph (413)587-1214 Fax(413) 587-1221