7 Septic Inspection 2006 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Certification
Property Information
)perry Address:
rner's Name:
ner's Address:
:e of Inspection:
ay to:
ness:
Inspector:
ne of Inspector.
npany Name:
'ling Address:
ephone Number.
7 Shepards Hollow. Northampton. MA
David Gundermann, Andrew Reskopi
c/o Delao Realty. 243 Kina St. , Northampton, MA 01060
9/6/06
Board of Health, Northampton;
Number: SSDS-1121
Thomas S. Leue
Homestead Inc.
1664 Cape St. . Williamsburgl MA 01096
(4131 628-4533
rtiticanon Statement:
rrtify that I have personally inspected the sewage disposal system at this address and that the information reported
ow is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
ping and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP
)roved system inspector pursuant to Section 15.340 of True 5 (310 CMR 15.000). The septic system condition
st be evaluated and classified into one of the following four conditions:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
system condition: Passes
Ipector's Signature:
��it¢p '11C Date: 9/6/06
System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
P)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
I or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
P. The original should be sent to the system owner and copies to the buyer, if applicable and the approving
hority.
es and Comments.
This report only describes conditions at the time of inspection and under the conditions of use at that
e. This inspection does not address how the system will perform in the future under the same or different
editions of use.
Q454-a400.aa3
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•page 1 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
:edification (Cont)
Jerty Address:
ler' Name:
of Inspection:
7 Shepards Hollow Northampton, Mh
David Gundermann, Andrew Resko j
9/6/06
section Summary: Check A, B, C, D or E/Always complete all of Section D:
System Passes:
I have not found any information which indicates that any of the failure criteria as described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
tments:
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. Answer yes, no, or not determined(Y, N, or ND) in the for the following statements. If not
determined°please explain.
N The septic tank is metal and over 20 years old`or the septic tank(whether metal or not)is structurally
wnd, exhibits substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if
?xisting septic tank is replaced with a complying septic tank as approved by the Board of Health. `A metal septic
will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank
ss than 20 years old is available.
axplain:
N Observation of sewage backup or break out or high static water level in the distribution box due to
en or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if
i approval by the Board of Health). _ broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
explain:
N The system required pumping more than four times a year due to broken or obstructed pipe(s). The
em will pass inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
explain:
N Other: explain:
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
ig to protect the public health, safety or the environment:
System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
tern 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.
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•page 2 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
:ertification (Cont)
erty Address: 7 Shepards Hollow Northampton. MA
a? Name: David Gundermann. Andrew Reskopf
of Inspection: 9/6/06
System will fail unless Board of Health (and Public Water Supplier, if any)determines that the system
nctioning 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
r supply or tributary to a surface water supply.
• The system has a septic tank and SAS and the SAS is within a Zone I 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
tr supply well"Method used to determine distance_
its system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and
:ile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia
gen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy
e analysis must be attached to this form.
Dther:
System Failure Criteria applicable to all systems:
must indicate either"Yes" or No as to each of the following for all inspections:
(Y)or NO(N)
N Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
N Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
V Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool.
N Liquid depth in cesspool is less than 6'below invert or available volume less than 1/2 day flow.
N Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of
times pumped
NI Any portion of the SAS, cesspool or privy is below high ground water elevation.
N Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water
supply.
N Any portion of cesspool privy is within a Zone I of a public well.
N Any portion of cesspool or privy is within 50 feet of a private water supply well.
N Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply
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.)
The System Fails: I have determined that one or more of the above failure criteria exist as defined in 310
15.303, therefore the system fails. The system owner should contact the Board of Health should be contacted to
nnine what will be necessary to correct the failure.
/WENT:
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•page 3 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Sewage Disposal System Form
:ertification (Cont)
'arty Address: 7 Shepards Hollow. Northampton. NA
tee Name: pavid Gundermann. Andrew Reskopf
of Inspection: 9/6/06
Large Systems:
e considered a large system the system must serve a facility with a design flow of 10,000 to 15,000 gpd.
must indicate either"Yes" or"No"as to each of the following:
following criteria apply to large systems in addition to the criteria above.
(Y)or NO(N)
the system is within 400 feet of a surface drinking water supply
N the system is within 200 feet of a tributary to a surface drinking water supply
N the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a
sped Zone II of a public water supply well)
u answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in
Lion D above the large system has failed. The owner or operator of any large system considered a significant
at under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The
em owner should contact the appropriate regional office of the Department.
Thecklist
ck if the followina have been done. You must indicate"yes"or no as to each of the following:
(Y)or NO(N)
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? Unoccupied
Have large volumes of water been introduced to the system recently or as part of the inspection?
Were "as-built°plans of the system obtained and examined? (lf not available note as N/A)
Was the facility or dwelling was inspected for signs of sewage back up?
Was the site was 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 septic tank inspected for the
condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and
depth of scum?
size and location of the Soil Absorption System (SAS) on the site has been determined based on:
a) Existing information. For example, a plan at the Board of Health.
b) Determined in the field (if any of the failure criteria related to Part C is at issue approximation of
mice is unacceptable) [15.302(3)(b)].
The facility owner(and occupants, if different from owner)were provided with information on proper
itenance of Subsurface Sewage Disposal Systems(SSDS).
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•page 4 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
terty Address: 7 Shepards Hollow. Northampton MA
iee Name: David Gundermann. Andrew Reskopi
of Inspection: 9/6/06
IDENTIAL
unknown
4
0
N
Y
N
N
N/A
N
one in 6
Months
FLOW CONDITIONS
DESIGN flow based on 310 CMR 15.203(gallons/day)
Number of bedrooms(design)
Number of bedrooms(actual)
Number of current residents_
Is there a garbage grinder?(Y or N)
Is there a Laundry Hookup?(Y or N)
Is the Laundry a separate system?(Y or N) (If yes, separate inspection required)
Seasonal use(Y or N)
Water meter readings, if available(last two years usage)(gallons per day)
Sump Pump(Y or N)i
Date of last occupancy
IIMERCIAL/INDUSTRIAL
of establishment:_
gn flow(based on 310 CMR 15.203):® gpd
s of design flow(seats/persons/sgft, etc.):
me trap present(Y or N):
strail waste holding tank present(Y or N):
=r meter readings, if available:
date of occupancy/use:
IER (describe):
GENERAL INFORMATION
ping Records: Source of information: Pumjped 4/21/04, says previous Title 5 report
N Was system pumped as part of the inspection(V or N)
If yes, volume pumped: ® gallons -- -
How was quantity pumped determined?
Reason for pumping:
.omment: PUMP on 3 to 4 year interval.
E OF SYSTEM:
_ Septic tank, distribution box, soil adsorption system.
Single cesspool
Overflow cesspool
Privy
Shared system (Y or N)Of yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach 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):
p.doc• 11/2004 Homestead Inc.
Tale 5 Official Inspection Form: Subsurface Disposal System
•page5 of 10
perty Address:
ter Name:
a of Inspection:
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
7 Shepards Hollow Northampton. MA
David Gundermann Andrew' Reskopf
9/6/06
PROXIMATE AGE All components, date installed, and source of info,
eptic plan: said to be 1985 system
urce of Info: previous Owner
N Were sewage odors detected when arriving at the site (Y or N)
11LDING SEWER (located on site plan)
36 Depth below grade (inches) Estimated Average
35 Distance in feet from private water supply well or suction line
9BS plastic Materials of Construction
rmments: No problems seen. Under floor slab.
:PTIC TANK (located on site plan)
Concrete Materials of Construction
12 Depth below grade (inches)
0 Riser depth (inches)
58 Septic tank width (inches) Interior dimensions
84 Septic tank length (inches) Interior dimensions
59 Septic tank height (inches) Interior dimensions
1,248 Calculated gross volume (gallons) Calculated
8 Air space in tank (inches)
1,000 Net Volume (gallons) Calculated
28 Baffle depth (inches)
4 Sludge thickness (inches) Averaae
4 Scum thickness (inches) Aynag
27 Top Sludge : Bottom Baffle (inches) Calculated
17 Bottom Scum : Bottom Baffle (inches) Calculated
5 Top Scum : Top Baffle (inches) Calculated
rmments:
i operational or structural problems seen.
iffles intact.
_
icommendations:
imp on 3 to 4 year interval.
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
perty Address: 7 Shepards Holz ow. Northampton MA
nee Name: David Gundermann, Andrew Reskopf
e of Inspection: 9/6/06
UMP CHAMBER
N Pump part of septic system: (Y or N)
Pumps in working order. (Y or N)
Alarms in working order: (Y or N)
omments:
ISTRIBUTION BOX (located on site plan) CD-box")
Y D-box part of septic system: (Y or N)
0 Depth of liquid level above outlet invert Incites
omments: Box appear approximately level and flow equal.
bout 30" below grade. Adjacent to PVC vent.
DIL ADSORPTION SYSTEM (SAS): Technology Used (located on site plan by estimate):
leaching pits&number:
leaching chambers and number:
leaching galleries and number:
Y leaching trenches, number, length: 3 at 50 foot each
leaching fields, number, dimensions:
overflow cesspool, number:
innovative/alternative system, Type:
omments: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
o surface problems seen.
SAS not located
plain why:
GHT OR HOLDING TANK (tank must be pumped at time of inspection)
N Tight tank part of system: (Y or N)
Depth below grade (inches) Measured
Tank width Tank length (inches)
Tank height Calculated gross volume (gallons;
Materials of construction
Design flow: gallons/day
Pumps in working order. (Y or N)
Alarms in working order: (Y or N)
Date of last pumping
omments: (conditions of inlet tees, condition of alarm and float switches, etc.)
:p.doc•11/2004 Homestead Inc. Title 5 Official Inspection Form. Subsurface Disposal System
•page 7 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
perty Address: 7 Shepards Hollow, Northampton, MA
lee Name: David Gundermann. Andrew Reskopf
e of Inspection: 9/6/06
IVY
N
(locate on site plan, if any)
Privy part of system: (Y or N)
Materials of construction:
Dimensions:
Depth of solids:
amments:
(soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
ESSPOOLS
N
(cesspool must be pumped as part of inspection)
Cesspool part of system: (Y or N)
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 infow(cesspool must be pumped as part of inspection)
amments:
(note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.
REASE TRAP
N
(Usually present in certain commercial systems)
Grease Trap part of system: (Y or N)
Materials of constriction:
Depth below grade (inches) Met awed
Dimensions:
Depth of solids layer
Depth of scum layer
Top of scum to top outlet Calculated Inches
Date of last pumping
Bottom of scum to outlet. Calculated Inches
Scum thickness (inches) Averaae
amments.
(recommendation and conditions)
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•page 8 of 10
perty Address:
ler' Name:
Et of Inspection:
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
7 Shepards Hollow Northampton. MA
David Gundennann, Andrew Reskopf
9/6/06
'ITE EXAM (Source of Information)
Y Slope Official Perc Date
N Surface water Official Plan Date
Y Check Cellar Other Official Source
N Shallow wells Other Source
>60 Estimated depth to ground water (inches)
'lease indicate (check)all the methods used to determine high groundwater elevation:
Y Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
'formation: Appears as very sand/ soil r dry basement without sump pump.
tESOURCES: Department of Environmental Protection, Western Regional Office,
36 Dwight St. Springfield MA 01103 (413)784-1100.Title 5 Hotline- (800)266-1122
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•page 9 of 10
reported by
others) ,t co' Seer eo. t
B vied propane tank with surface access cover.
NORTH Outline of House
4 `
\c\:
S�
Septic Tank
n
\1eN 4 Distribution Box
Leaching trenches, approximate layout
r
OF
As-Built Drawing
ts
Date: Owner: i oast to HOMESTEAD INC.
Existing Septic System 9/6/06 David Gundermann o LEUH se, Thomas S. Leue R.S.
Andrew Reskopf *1172
Scale: 1 : 30' Revision Date: 7 Shepards Hollow +a4 #.per! • wwa
Williamsburg, 01096
/II. Except as Noted
Leeds, MA 01053 hRED b� [413]628-4533