48 Septic Inspection 2016 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Country Way
Property Address
Lisa Gibbs
'er Owners Name s
miation
ed forleve Northampton MA 01062 6/27/2016&7/20/2016
e, ry City/Town 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.
'pliant:When A. General Information
g out forms
he computer,
only the tab 1 Inspector:
to move your .
or-do not Alan Weiss
the return Name of Inspector
Cold Spring Environmental Consultants, Inc.
Company Name
350 Old Enfield Road
Company Address
Belchertown MA 01007
City/Town State Zip Code
413-323-5957
Telephone Number
Registered Sanitarian#933
License Number
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 Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
6/27/2016&7/20/2016
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 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.
'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.
rme 5 Othaal Inspecon Form.Subsurface eeweye Disposal System•Page 1 0117
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Country Way
Property Address
Lisa Gibbs
Owner's Name
ed fo is Northampton MA 01062 6/27/2016 &7/20/2016
ed for every
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:
The septic system had consisted of a 1,000 gallon concrete septic tank, a distibution box and three
leach lines serving a 3 bedroom dwelling. Liquid levels In the septic tank were below the outlet invert
indicating leakage, and a hole was noted in the tank sidewall. The septic tank was repaced with a
new 1,500 gallon concrete tank (permit and fee attached). The distribution box was level and in good
condition with equal flow to the outlets. The system now passes following tank replacement.
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):
The tank has been replaced as discussed with the Health Department and a permit has been
attached.
title 5 official Inspection Form Subsur*ace Sewage Dispose!System•Page 2 N 17
• Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
48 Country Way
Property Address
Lisa Gibbs
Owners Name
Northampton MA 01062 6/2712016&7/20/2016
City/Town State Zip Code Date of Inspection
tion Is
1 for every
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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):
❑ 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 O N E ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ exist
failing to protect public rhealth,safetyyorrthe environment. in order to determine if
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
Title 5 Official Inspection Rana:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Country Way
Property Address
Lisa Gibbs
Owners Name
ion is Northampton MA 01062 6/27/2016&7/20/2016
far every
Ci State Zip Code Date of Inspection
ryRown
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 sail 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 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:
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 1/2 day flow
s.3113
Title 5 official lnspecoon Form:Subsurface Sewage Disposal System.Page 4 of 17
r�
1 IS
1r every
s.3113
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 CountrLWay_
Property Address
Lisa Gibbs
Owner's Name MA 01062 _ 6/27/2016 8 7/2012016
Northampton State Zip Code Date of Inspection
City/Town
B. Certification (coot.)
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.
O ® 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.
o ® 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 pm,
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.
O ® 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) La flow of 10,000
Large er ystems: To be
gad considered ed large system the system must serve a facility with a
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
o 0 the system is within 400 feet of a surface drinking water supply
O 0 the system is within 200 feet of a tributary to a surface drinking water supply
Area� sensitive (Interim
IWPA)or a mapped Zone II of apublic water supply wehlead Protection
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 large
system considered a significant threat under Section E or failed under Section D shall upgrade an
system in accordance with 310 CMR 15.304.The system owner should contact the appropnate
regional office of the Department.
Tie 5 Dtdal InapeNOO Farm:subsunace Sewage Disposal System•Page 5 of v
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form•Not for Voluntary Assessments
48 County Wax
Property Address
Lisa Gibbs
Owner's Name
MA 01062 6/2712016&72012016
NOnham�lt00 Stale Zip Code Cate of Inspection
Jery Citvrrown
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
Were as built plans of the system obtained and examined? (0 they were not
inspection?
available note as N/A)
Was the facility or dwelling inspected far 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 bas ffle or tees,
and depth al of c construction,
material dimensions, depth of liquid,depth of
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(if any of the failure criteria related to Pan C is at issue
®
10 Determined of distance is unacceptable)[310 CMR 15.302(5)1
D. System Information
Residential Flow Conditions: 3
Unknown Number of bedrooms(actual): - --
Number of bedrooms(design): Unknown
DESIGN Flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Title 5 Olftoal Inspector,Form Subsunam Sewage Oispesal System Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
48 Country Way
Property Address
Lisa Gibbs 6/27/2016&7/20/2016
Norths Name MA 01062
Northampton state
Zip Code Hate of Inspection
.ry CityRown
D. System Information
Description:
The septic system had consisted of one 1,000 gallon septic tank,a distribution box and a leachfield
/18'x 35'from 1997 Title V reporti The tank has been replaced with a new 1,500�)lon tank.
Number of current residents:
Does residence have a garbage grinder?
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.)
Laundry system inspected?
Seasonal use?
Water meter readings, if available(last 2 years usage(gpd))
Detail:
Laundrywas connected to main system------------------
• Yes ® No
• Yes ® No
• Yes ❑ No
❑ Yes ® No
Yes ® No
Sump pump? Current_____.
Date
Last date of occupancy:
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15203): Gallons per day(5po)— — — —
Basis of design flow(seats/Persons/sot.,etc.): Yes No
Grease trap present? 0 Yes ❑ No
Industrial waste holding tank present? 0 Yes ❑ No
Non-sanitary waste discharged to the Title 5 system?
Water meter readings,if available:
Hue 5 Official nspec5on Form[sobaeaw sewage DLSPOeel system'Face 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary
48 CountryWay
Property Address
Lisa Gibbs 6/27/2016&7/2012016
North mpto MA 01062___
Zi Code Dateotlnspection-
Northampton State v Name
• GiryRown
D. System Information (cont.)
Last date of occupancy/use:
Other(describe below):
Pumping Records:
Source of information: ® Yes ❑ No
Was system pumped as part of the inspection?
1,000
If yes,volume pumped: gallons ____---
Measured______------
How was quantity pumped determined?
Insgection ______----------
Reason for pumping:
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)
❑ Attach a copy of the current operation of latest
❑
maintenance contract technology.obtained stem owner)and a copy
maintenance contract(to be bysystemrope�or under contract
inspection of the IIA system by y
Date
General Information
Pumped severalyears ago.
Tight tank. Attach a copy of the DEP approval.
Other(describe):
flue 5 eleaall Inspecmn From:Suosurt ace Sewage Disposal Stem Page 81117
Commonwealth of Massachusetts
Title 5 Official Inspection Form
for Voluntary FO Assessments
Subsurface Sewage Disposal System Form-
48 CountryWay_
Property Address
Lisa Gibbs MA 612712016&7120/2016
01062____ acti7n
Owner's Name
Zip Code Date of Insp
Northampton State
City(-Cowl
D. System Information (cont.)
Approximate age of all components,date installed Of known)and source of information'.
The septic system is more than 30years old. The leachfield was reportedly replaced in the 1980s.
Yes he
Were sewage odors detected when arriving at the site?
Building Sewer(locate on site plan)'.
Depth below grade:
Material of construction:
®40 PVC
cast iron
Distance from private water supply well or suction line:
Comments(on condition of joints,venting, evidence of leakage, etc.):
The building sewer was in good condition with no evidence of leakage.
❑other(explain)'.
1.5
feet
10' +_
feet
Septic Tank(locate on site plan):
Depth below grade:
Material of construction:
El metal
The 1,000 gallon concrete tank was
no evidence of high staining and no
place and functional on the old tank.
leakage&corrosion._ ---
1.0
tees
other(explain)
❑fiberglass ❑ polyethylene
In poor condition. Liquid levels were below the outlet invert with
corrosion noted. Concrete outlet bathe and PVC were inlet tee were In
The tank was replaced with a new 1,500 g all tape due to
years
If tank is metal, list age: Yes ❑ No
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate)
8.5 x 4.5 x 4.2'-___—-----
24"_ —_— ---_
The 501fical lnspeNUn For[Subsurf ace Sewage Disposal System page a of 17
Dimensions'.
Sludge depth'.
y 3■ 3
ommonwealth of Massachusetts Form 5 Official Inspection F orm Assessments
ubsurface Sewage Disposal System Form-Not for Voluntary
8 CountryWaY__—
roperty Address
_Ise Gibbs
MA_
01062 - 6/27/2016&7/2012016
owners Name Zip Code Date of Inspection
Northampton —-------- State cavrrown cont.
D. System Information (cont.)
31]
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
ttom of scum to bottom of
How were dimensions determined?
recommendations,Inlet and outlet tee or r baffle condition, structural integrity.
Comments(on pumping evidence of leakage, ):
liquid levels as related i to outlet invert, There was a hole in the side ui levels
the sepbc tank in the
were below the outlet Invert with no evidence l of high staining.leakage and some corrosion. Liquid eve
tank wall at the outlet bafFle____ ------- - ____
12°
6'
6
I tI a or baffle
Distance from bo out e e Measured
Grease Trap(locate on site plan).
Depth below grade:
Material of construction:
0 metal
0 concrete
feet
0 fiberglass ❑ polyethylene
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:
Date
Tile 5(Oa&Inspection Form:Subsurface Sewage Disposal system'Page 10 of 17
other(explain):
ommonwealth of Massachusetts On Form
'ale le 5 Official lnsp eCtNoiorVoluntaryAssessments
ubsurtace Sewage Disposal System Form
8 Country W aY----__— __
ropertY Address
isa Gibbs______---- ---- 01062 6127120168712012016
MA ction-
Jvmers Name ----— Date of Inspa
State
Zip Coda
Northampton ——--------
D. Sy cont.
D. Comments Information ( structural integrity,
recommendations,edence of leakage, bathe condition,
Comments(as pumping ----------------
liquid levels as related to outlet Invert,
Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction: polyethylene other(explain).
concrete fiberglass metal ❑ berglass
Dimensions:
gallons
Capacity:
gallons per day
Design Flow: Yes ❑ No 0
Alarm present: order:
Yes ❑ No
Alarm in working
Alarm level:
Date
Date of last pumping:
etc.
Comments(condition of alarm and float switches, : - -
- - - - - - - ---- ---- 0 Yes ❑ No
Attach copy of current pumping contract(required). Is copy attached?
rme
5 gfiOai Inspection Form.aubsmlaeg Sewage DisPO.tii system'Page n of 17
3l3
)mmonwealth of Massachusetts Corm
'Me 5 Official Inspection r
ubsurface Sewage Disposal System Form-Not for Voluntary Assessments t
8Country WaY—
r_—
roped),Address
isa Gibbs_______------------------------ 01062 612712016&7/2012016_
MA ection
YwnersName
Jo ---— Dale of Insp
rtham-ton —-------- State
Zip Code
Jity
D. System Information (cont.)
Of resent must be opened)(locate on site plan).
Distribution Box P @Outlet Inverts
Depth of solids carryover, any
Depth a liquid level above outlet invert distribution Comments(note if box is level and distreibcution to outlets equal, any
evidence of leakage into or out of 1997 7, a Minimal solids The ne box
was found un In the
level with equal flow to the outlets and no high staining. inimal sol The new carryover ass noted i the
e
sump. _____———— -
Pump Chamber(locate on site plan):
Pumps in working order.
• Yes
• Yes
[] Na"
D No*
Alarms in working order: sand appurtenances,etc.):
chamber, condition of pump
Comments(note condition of pump
"If pumps or alarms are not in working order,system is a conditional pass.
Soil Absorption System(SAS)(locate on site plan, excavation not required).
If SAS not located, explain why:
nee s Vassal nspeNao Form:Subs ace Sewage Disposal System•Page a ofd
313
,mmonwealth of Massachusetts Form
'itle 5 Official Inspection r Assessments
Jbsurface Sewage Disposal System Form-Not for Voluntary
6 Country WaY_ — _— ——
--- 6127120168712012016__
roperty Address
isa gorh —_—--- 01062_
's Name MA— ---
Cate of Inspection—
dorthampton __ —--- - state Zip coda
�'tY y cont.
D. System Information (cont.)
Type: number:
O leaching pits
number:
O leaching chambers
number:
O leaching galleries
number,length'.
O leaching trenches 31ine ?e'x35 +I-
El
number,dimensions:
leaching fields
number:
O overflow cesspool •
O innovativelalternative system
Type/name of technology:
Comments(note condition of soil, signs of hyad`ealvegetat on were observed. No evidence of
damp soil, condition of
vegetation,etc.):
No high staining,p onding, damp soil or imp _____ _------------
hydraulic failure was noted____ —--------— ___—
Cesspools(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 ❑ No
Me 5 Official.n33,33433 Form:subsurface sewage Disposal system''Page 13 at 11
flow
3113
rmmonwealth of Massachusetts Form
m
'itle 5 Official Inspection Voluntary Assessments
rbsurface Sewage Disposal System For -
3 CountrtW ay
ropertY Address
isa Gibbs___ __0101 0101--0101—0101--- 0101--0101 0101 01062 6/2712016&7120/2016
•lone Name MA 0106- Dateection_of_ - ——- Zip Code
dorthampton —0101---—
State
:ityRow^
Information (cont.)
evel of pending,condition of vegetation,
D. Comments hydraulic failure,
Comments(note condition of soil,signs of by
etc.).
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids level of ponding,condition of vegetation,
Comments(note condition of soil,signs of hydraulic failure, o -
etc.) — —
TS 5 014oal mspecum Form.Subsurf ace Sewage Disposal System•Page 14 of 17
>mmonwealth of Massachusetts On Corm
'itle 5 Official Insp eCtNoior Voluntary Assessments
>bsurface Sewage Disposal System Form
3 Country Way
tPedY Address ___----
D1062 _
------612712016&7/2012016__
isa Glbbs_ _—-----_—-- MA
wmer s Name -Zip Code Date of Inspection
Jodham�ton _—------—
State
)i D. System Cont.) ties to
D. System Information
including
Sketch Of Sewage Disposer System:provide a view of the sewage disposal system,benchmarks. Locate all wells
w
at here least two Pwater sup ply enters the building.ng.rCheck one of the boxes below:
100 feet. Locate
where public water supply
D hand-sketch in the area to ow
® drawing attache
rise 5 Official mspeNm Fun:Subsurface eeWage DLO '3Klem'Pa
1113
sof a
rmmonwealth of Massachusetts On Form
'itle 5 Official Inspection Assessments
rbsurface Sewage Disposal System Form-
3 CountrtWay
operty Address _
isa Gibbs______----------- --- 01062 612712016&7/20/2016
rtr's Name p MA ------ pate of Inspection
----- Zip Code
amton _______________ state
;itYRown
D. System Information (cont.)
Site Exam.
® Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water.
et
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: Date
Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
Previous 1997 Title V Report.______------------- —---
Checked with local excavators,installers-(attach documentation)
0❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Work in area,topography,BOH records and no evidence of high groundwater in area.
ort,please see Report Completeness Checklist on next page.
Before filing this Inspection Rep 1.6 of 17
Title 5 Official Inspection F .SuMUaace Sewage Disposal$ye,em'Page
113
Immonwealth of Massachusetts Form
itle 5 Official Inspection Voluntary Assessments
Ibsurface Sewage Disposal System Form
I Country Way__ — —
DpeM Address
sa Gibbs ____ —------—-------- ------ -- 6/27/2016&7/20/2016_
MA _01062 _
wners Name Zip Code Date of Inspection
lorthampton _—--------
State
:iryRovm
E. Report Completeness Checklist
® Inspection Summary: A, B, C,D, or E checked completed
• Inspection Summary D (System Failure Criteria Applicable to All Systems)comp
® System Information-Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
nee 5 Delia&Inspection rdm-Suewekro serage Disposal System Page 17 a(17
pna4fA6 SEWAGE DISTSALcSYSTEM FORM
SYSTEM INFfRMATOM kom ImiO
ea'
A4A Ally c'9-
s
}
1E DISPOSAL SYSTEM:
no Imo moo aurae
M� .ithM 1W' Docile.1.
a tacbmorks ,
narks
titer To 5 at./S
NEW 1500 GALLON
SEPTIC TANK
721 2016
Septic Tank Inlet
48 Country Way
Northampton, MA
06.28.2016
Septic Tank Outlet
48 Country Way
Northampton, MA
06.28.2016
Distribution Box
48 Country Way
Northampton, MA
06.28.2016
New Septic Tank
48 Country Way
Northampton MA
07.192016
New Septic Tank outet tee
48 Country WaY
Northampton MA
07.19.2016