639 Title 5 Application/Permits 1998, Inspection 2005 COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 639 North Farms Road -Northampton, MA.
Owner's Name: Patrick & Rebecca Lang TEL. (413) 584 - 7882
Owner's Address: SAME
Date of Inspection: June 5,2004 (am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address- 70 MONTAGUE ROAD —WESTHAMPTON, MA. 01027
Telephone Number: (413) 527 —5291
CERTIFICATION STATEMENT
I certify that 1 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:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authori
Fails
Inspector's Signature: TIMOT,
MA INNIS RRtS. Date: June 6, 2
The system inspector shall submit a copy of this inspection report to the Approving Authority
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design $,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments. I RECOMMEND THAT THIS SEPTIC TANK BE PUMPED EVERY
YEAR. ALSO, I RECOMMEND LIQUID SOAP FOR WASHER AND DISH WASHER.
LIMITED USE AND GOOD COMMON SENSE DURING PERIODS OF SOIL
SATURATION.
WARRANTY: THERE IS NO WARRANTY EXPRESSED OR IMPLIED.
****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.****
Title 5 Inspection Form 6/15/2000
page 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 639 North Farms Road -Northampton, MA.
Owner's Name: Patrick& Rebecca Lang TEL. (413) 584- 7882
Owner's Address. SAME
Date of Inspection: June 5, 2004(am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD—WESTHAMPTON, MA. 01027
Telephone Number: (413) 527—5291
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_X_ 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: ROUTINE MAINTENANCE SUCH AS FREQUENT PUMPING AND
INSPECTION. GOOD COMMON SENSE DURING PERIODS OF HEAVY RAIN.
B. System Conditionally Passes: N/A
_ 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.
Answer yes, no or not determined (Y,N,ND) in the 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.
ND explain:
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
obstruction is removed
distribution box is leveled or replaced
ND explain:
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
obstruction is removed
ND explain:
Title 5 Inspection Form 6/15/2000 2
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 639 North Farms Road - Northampton, MA.
Owner's Name: Patrick&Rebecca Lang TEL (413) 584 -7882
Owner's Address: SAME
Date of Inspection: June 5,2004 (am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD —WESTHAMPTON, MA. 01027
Telephone Number: (413) 527—5291
C. Further Evaluation is Required by the Board of Health: N/A
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.
I. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(6) 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
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 ?
**This system passes if the well water analysis, performed at a DEP certified laboratory,
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, provided that no other failure criteria are triggered. A copy of
the analysis must be attached to this form.
3. Other:
Title 5 Inspection Form 6/15/2000 3
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 639 North Farms Road- Northampton, MA.
Owner's Name: Patrick&Rebecca Lang TEL. (413) 584 -7882
Owner's Address: SAME
Date of Inspection: June 5, 2004(am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD—WESTHAMPTON, MA. 01027
Telephone Number: (413) 527—5291
A. System Failure Criteria applicable to all systems:
You must indicate`}yes"or"no"to each of the following for all inspections:
Yes No
NO Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
NO Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
NO Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
NA Liquid depth in cesspool is less than 6"below invert or available volume is less than 'G day flow
NO Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped,
NO Any portion of the SAS,cesspool or privy is below high ground water elevation.
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
N/A Any portion of a cesspool or privy is within a Zone 1 of a public well.
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well.
N/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. [This system passes if the well water analysis,
performed at a DEP certified laboratory,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,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
NO (Yes/No)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.
Large Systems: N/A
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or`no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
NO the system is within 400 feet of a surface drinking water supply
NO the system is within 200 feet of a tributary to a surface drinking water supply
NO 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 Inspection Form 6/15/2000 4
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 639 North Farms Road -Northampton, MA.
Owner's Name: Patrick& Rebecca Lang TEL. (413) 584- 7882
Owner's Address: SAME
Date of Inspection: June 5, 2004 (am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD—WESTHAMPTON, MA. 01027
Telephone Number: (413) 527—5291
Check if the following have been done. You must indicate"yes" or"no" as to each of the
following:
Yes No
YES Pumping information was provided by the owner,occupant,or Board of Health (HOMEOWNER)
NO Were any of the system components pumped out in the previous two weeks?
YES Has the system received normal flows in the previous two week period?
NO Have large volumes of water been introduced to the system recently or as part of this inspection?
YES Were as built plans of the system obtained and examined? (If they were not available note as N/A)
YES Was the facility or dwelling inspected for signs of sewage backup?NO BACK-UP OBSERVED
YES Was the site inspected for signs of break out? NO BERAKOUT
YES _Were all system components,excluding the SAS, located on site?
YES Was 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?
YES 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:
Yes No
YES _ Existing information. For example,a plan at the Board of Health. Information from current
homeowner, installer and approved plan.
YES Determined in the field(if any of the failure criteria related to Part C at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
** The SAS was determined by this home owner, installer and the approved plan.
Title 5 Inspection Form 6/15/2000 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
PART C
SYSTEM INFORMATION
Property Address: 639 North Farms Road -Northampton, MA.
Owner's Name: Patrick& Rebecca Lang TEL. (413) 584- 7882
Owner's Address: SAME
Date of Inspection: June 5, 2004 (am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD —WESTHAMPTON, MA. 01027
Telephone Number: (413) 527— 5291
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd
Number of current residents: 4
Does residence have a garbage grinder(yes or no): YES
Is laundry on a separate sewage system(yes or no):NO[if yes separate inspection required]
Laundry system inspected(yes or no): YES
Seasonal use:(yes or no): NO
Water meter readings,if available(last 2 years usage(gpd): N/A
Sump pump(yes or no): NO SUMP PUMPS
Last date of occupancy: CURRENTLY OCCUPIED
COMMERCIAL/INDUSTRIAL N/A
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
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/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Rebecca Lang—HOME OWNER
Has system pumped as part of the inspection(yes or no):NO- last pumped one year ago.
If yes,volume pumped:_I500gallons--How was quantity pumped determined? SiZe of tank
Reason for pumping: REAL ESTATE TRANSFER
TYPE OF SYSTEM
_X_ Septic tank&soil absorption system-two 750 gallon leaching pits
Single cesspool
Overflow cesspool
Privy
_N_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)
Tight tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information: 21 YRS (1983)
Were sewage odors detected when arriving at the site(yes or no): NO
Title 5 Inspection Form 6/15/2000 6
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 639 North Farms Road-Northampton, MA.
Owner's Name: Patrick& Rebecca Lang TEL. (413) 584- 7882
Owner's Address: SAME
Date of Inspection: June 5, 2004 (am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD —WESTHAMPTON, MA. 01027
Telephone Number: (413) 527—5291
BUILDING SEWER(locate on site plan)
Depth below grade: 24"
Materials of construction: cast iron _X_40 PVC other(explain):
Distance from private water supply well or suction line: >50'
Comments(on condition of joints,venting,evidence of leakage,etc.): NO EVIDENCE OF LEAKAGE,JOINTS
ARE WATER TIGHT- VENTING IS OK—OUT WALL/ IN TANK=OK
SEPTIC TANK: X (locate on site plan) 16" risers on all covers over the septic tank.
Depth below grade: BELOW = 16"
Material of construction:X concrete metal fiberglass polyethylene ther(explain)
If tank is metal list age:
Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate)
Dimensions: (10.5'L x 5.5'W x 4' DEEP ) = 1500 GALLONS
Sludge depth: NONE
Distance from top of sludge to bottom of outlet tee or baffle: N/A
Scum thickness: NONE
Distance from top of scum to top of outlet tee or baffle:_N/A_
Distance from bottom of scum to bottom of outlet tee or baffle: N/A
How were dimensions determined: OBSERVED AND MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.): INLET & OUTLET BAFFLES ARE CONCRETE.
TANK IN SOUND CONDITION. NO LEAKAGE OBSERVED. EFFLUENT EVEN WITH
OUTLET INVERT. RECOMMEND PUMPING EVERY OTHER YEAR. RECOMMEND
THE USE LIQUID SOAPS AND GOOD COMMON SENSE DURING PERIODS OF HEAVY
RAIN.
GREASE TRAP: (locate on site plan) N/A
Depth below grade:
Material of construction: concrete metal 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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
Title 5 Inspection Form 6/15/2000
7
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 639 North Farms Road - Northampton, MA.
Owner's Name: Patrick& Rebecca Lang TEL. (413) 584 -7882
Owner's Address: SAME
Date of Inspection: June 5, 2004 (am)
Name of Inspector: (please print)TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD—WESTHAMPTON, MA. 01027
Telephone Number: (413) 527 — 5291
TIGHT or HOLDING TANK:--N/A (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level. Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: "D"box is 20" below ground. The liquid level is even with
outlet pipes.
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.)
"D"box is concrete with two outlet pipes. Liquid level at outlet invert is level. No evidence of
carryover, "D"box is level, No leakage in or out of`D" box observed.
PUMP CHAMBER: (locate on site plan N/A
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
WARRANTY: THERE IS NO WARRANTY EXPRESSED OR IMPLIED.
****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.****
Title 5 Inspection Form 6/15/2000 8
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 639 North Farms Road- Northampton, MA.
Owner's Name: Patrick& Rebecca Lang TEL. (413) 584-7882
Owner's Address: SAME
Date of Inspection: June 5,2004(am)
Name of Inspector: (please print)TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD—WESTHAMPTON, MA. 01027
Telephone Number: (413) 527— 5291
SOIL ABSORPTION SYSTEM (SAS):_X_(locate on site plan,excavation not required)
If SAS not located explain why:
Type
X_ leaching pits,number: TWO LEACHING PITS AKA (DRY WELLS)
_leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
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.):
NO SIGNS OF HYDRAULIC FAILURE,NO PONDING,VEGETATION IS DRY GRASS. THERE ARE
NO SIGNS OF FAILURE ABOVE GROUND.
CESSPOOLS: _N/A_(cesspool must be pumped as part of inspection)(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(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
PRIVY:_N/A_(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Title 5 Inspection Form 6/15/2000 9
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 639 North Farms Road - Northampton, MA.
Owner's Name: Patrick& Rebecca Lang TEL (413) 584 - 7882
Owner's Address: SAME
Date of Inspection: June 5, 2004 (am)
Name of Inspector: (please print)TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD—WESTHAMPTON, MA. 01027
Telephone Number: (413) 527—5291
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
SEE ATTACHED AS-BUILT PLAN
DATED: June 6, 2004
WARRANTY:
THERE IS NO WARRANTY EXPRESSED OR IMPLIED.
****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.****
Title 5 Inspection Form 6/15/2000 10
v� —
L
AS—BUILT DIMENSIONS
House
'A' to 'C' = 63'
'B' to 'C' = 56'
SAS Area
'D' to 'G' = 23'
'E' to 'G' = 14'
I II
/ /
PLAN VIEW /
/
/ /
/ O/
/ / L Existing 750 gallon
/
Well ( reference only)
4" pvc solid pipe
Pumping manhole
Existing septic tank
4" pvc solid pipe
oil in
Telephone pole
Stone wall
ng distribution
box
leaching pits
North Farms Road — Northampton, Massachusetts
cp
ail in 23°
maple tree
Title-5 Inspection plan
639 North Farms Road
Northampton, Massachusetts
For: Dr. & Mrs. Patrick Long
June 6, 2004
Scale: 1 ' = 30'
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUB SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 639 North Farms Road -Northampton, MA.
Owner's Name: Patrick&Rebecca Lang TEL. (413) 584 -7882
Owner's Address: SAME
Date of Inspection: June 5, 2004(am)
Name of Inspector: (please print)TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address 70 MONTAGUE ROAD —WESTIIAMPTON, MA. 01027
Telephone Number: (413) 527—5291
SITE EXAM
Slope NEARLY LEVEL -3 % - 5 %
Surface water NONE
Check cellaR: -NO WATER NOTED
Shallow wells NO SHALLOW WELLS ON SITE
Estimated depth to ground water 9.0' -
Please indicate(check)all methods used to determine the high ground water elevation:
X Obtained from system design plans on record-If checked,date of design plan reviewed: ( 6(5/04)
X Observed site(abutting property/observation hole within 150 feet of SAS)GRAVEL PIT
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
_X_ Accessed USGS database-explain: HAMPSHIRE COUNTY SOIL SERVICE
You must describe how you established the high ground water elevation:
GROUND WATER WAS DETERMINED BY:
A. EXAMINATION OF SOILS AROUND SEPTIC TANK
B. REVIEW OF HAMPSHIRE COUNTY SOIL SURVEY
C. NO INFILTRATION INTO SEPTIC TANK
E. LOCAL KNOWLEDGE OF THIS SITE,. NEARBY TEST PITS
F. REVIEW APPROVED PLAN AND TEST PIT DATA
Title 5 Inspection Form 6/15/2000 I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
SYSTEM INFORMATION (continued)
Property Address: 639 North Farms Road-Northampton, MA.
Owner's Name: Patrick&Rebecca Lang TEL (413) 584- 7882
Owner's Address: SAME
Date of Inspection: June 5, 2004 (am)
Name of Inspector: (please print) TIMOTHY E. MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD—WESTHAMPTON, MA. 01027
Telephone Number: (413) 527-5291
NOTE:
A. This system was installed in 1983. It consists of one 1500 gallon concrete septic tank and
two 750 concrete leaching pits. Each leaching pit is approximately( 10'1 x 5'W). Due to its age
and soils around the leaching pits, I recommend that the tank be pumped annually and good
common sense during periods of saturated soils.
Title 5 Inspection Form 6/15/2000 12
Prepared For:
Location:
PROPOSED DOMESTIC SUBSURFACE DISPOSAL SYSTEM DESIGN
AtoeSERT tciaoa
No¢Th Per Ron/ N roe.
Number of Bedrooms:
3
Garbage Disposal:
LEACH AREA DESIGN
.3 Bedrooms x 2 persons/bedroom = 4 persons
G Persons x 55 gallons of wastewater/person/day = .3.3cs total gallons of
wastewater/day.
/Z. 6. min/inch
Percolation Rate:
Gallon of wastewater/square feet of leach area for a Percolation Rate of:
/2. 4
min/inch =
0. 93 Gal/SF Sidewall Area
O441? Gal/SF Bottom Area
* If a leach bed is to be installed, no sidewall is allowed.
* If percolation rate exceeds 20 min/inch, no bottom area is allowed.
- SEPTIC TANK -
* WITHOUT GARBAGE DISPOSAL:
Gallons of wastewater/day x 150% =
capacity of septic tank.
REQUIRED effective liquid
RECOMMENDED: Septic Tank
* In no case will the septic tank be less than 1,000 gallons (effective liquid capacity
** WITH GARBAGE DISPOSAL:
33o Gallons of wastewater/day x 200% = 460 REQUIRED effective liquid
capacity of septic tank.
RECOMMENDED: /41C100 Septic Tank
** In no case will the septic tank be less than 1,500 gallons (effective liquid capacit
v Af 4 HT '\11 EN- IR. . & ASSOCIATES. INC.
LEACHING PIT DESIGN
Precast Pit Used: /0.0 ' Long x f o ' Wide x 2 .0 ' Effective Depth
Using 4.0 ' of stone all around and /• 0 ' of stone under pit.
SIDEWALL AREA:
_h' Long x 3.0 ' Effective Depth x 2 Sides = /06 SF
/3 ' Wide x 3. O ' Effective Depth x 2 Sides = 76 SF
Total of / 8<• SF (Sidewall Area) x 0. 83 Gal/SF = /S `/� Gal/Pit (Sidewall)
BOTTOM AREA:
it " Long x /.3 ' Wide = 23 4/ SF
2-3 el SF (Bottom Area) x O• Gal/SF = /fr Gal/Pit (Bottom)
rr y Gal/Pit (Sidewall)
//s Gal/Pit (Bottom)
2 G 9 TOTAL Gal/Pit (Designed)
* Without Garbage Disposal: Total Gal/Day (REQUIRED)
* With Garbage Disposal: 1.5 x 33 0 Gal/Day (Daily Flow) = 9' J Gal/Pit
(REQUIRED)
Using 49s Gal/Day (Daily Flow) Z 49 Gal/Pit = Z Pit(s)
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,:UOTE' •ELL WOPV W1/4( 56 LW5 /.V OCCOFD.A 'F WIT/+ THE 5T4 TE ENVIRONMENTAL.
CODE - 7/7LC 5 _
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GREATER.
ALMER HUNTLEY, JR. a ASSOCIATES , INC
REGISTERED LAIC SJRJEVORS L CIVIL ENGINEERS
125 PLEASANT STREET
NORTHAMPTON , MASS .
No /
THE COMMONWEALTH OF MASSACHUSETTS
_A-kgrattenCYTDO MASSACHUSETTS
cApplietttion for !isposat (*gstem CIonstrurtion Permit
Application is hereby made for a Permit to Construct o Repair( ) an On-site Sewage Disposal System at:
Locatign or Lot Nod. 1 /�..n 40
Owner WIAJ mss n_z, d Tel,V
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�Ardrd dress
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PLa zbG /' -
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Installers Name.Address.and Tel.No.
Designer's Name.Address and Tel.No.
-r PCI
rOrrE 1 fia o
Type of Building: _ /
Dwelling No. off Bedrooms Building Garbage Gri ('-
Other Type of B <1MSr Min No. per Persons 74I Showers( ) Cafeteria
OOtther Fixtures/ /
Design Flow Z3" gallons per day. Calculated daily flow �L�6 gallons.
Plan Date 5 ag- ? 7 Number of sheets a Revision Date
Title ��.�,/�
Description of Soil QTS - 5v/356)1/4s - C&AIRS& ✓+"`o ? amv&t-
ma)h4V1 S43' /0 ,-)7),Z
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected'
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance has been issued by this Board of Health.
Signed Date
Application Approved by ate y/4 7
Application Disapproved for the following reasons
Permit No Date Issued
THE COM MON/WEALTH OF MASSACHUSETTS
//t/12-f' ,a ) MASSACHUSETTS
Qlertifirate of Qlnmyliance
[4115/S.TO CERTIF4that�the On w
site Sewage Disposal System installe44 off paired replaced ( )on
/l0.) ;l i b K. r r 77 for 1� -r re ,
at
has beers constructed in
accorrdanc with he,rovisions of Title 5 and the for Disposal System Construction Permit No -1 - // dated
�� Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certi rcate hall o e ° as a guarantee that the system will function as designed. This
Certificate expires on q ° �� `°'
rk� s/
DATE- / / i inspector —
No. Q%-7
THE CO ONWEALTH OF MASSACHUSETTS
>—" MASSACHUSETTS
isposal !gstem Qlonstrurtion Permit
Permission is reby granted to c>✓ f n�
to construct ( or repair( ) an On-site Sewage System located at
F[[
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his.her
duty to comply with Title 5 and the following local provisions or special conditions.
i
J
All construction muss he completed within three years of the date below.
DATE �e`J=- �' /(7e7 Approved by
FORM 1255 Rev 3■95 AM.SULKl CO-BOSTON.MA