7 Septic Inspection 1998 (revised 04'15,97) --Page 2
SUBSSRFACE SEWAGE DISPOSAL SYSTEM INSPECTION =ORM
Part A
Certification (continued)
Property Address: 7 SHEPHERDS HOLLOW
Owner:
Date of Inspection:
LEEDS,MA. 01053
TRUDY HOOKS
APRIL 7,1998
B] SYSTEM CONDITIONALLY PASSES (continued)
Indicate YES, NO, or Not Determined (Y,N, or ND). Describe basis of determination in all instances. If not determined'
explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a
Certificate of Compliance (attached) indicating that the tank was installed within twenty(20) years prior tc
the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, show
substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the
existing septic tank is replaced with a conforming septic tank as approved by the Board of Health.
Yes Sewage backup or breakout or high static water level observed in the distribution box is due to broken or
obstructed pipe(s) or due to a broken, settled, or uneven distribution box. The system will pass inspection
(with approval of the Board of Health): Describe observations:
❑ broken pipe(s) are replaced
❑ obstruction is removed
Z distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s).The syste
will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
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
failing to protect the public health, safety, and environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT
FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THI
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 BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF
APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTEC'
THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a
surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public
water supply well.
❑ The system has a septic tank and soil absorption system and is within 50 feet of a private water sup
well.
❑ The system has a septic tank and soil absorption system and the SAS is less than 100 feet BUT 50
feet or more from a private water supply well, unless a well water analysis 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. Method used to
determine distance (approximation not valid).
3) Other
eN 04/25797) --Page I
William'F. Weld
Governor
Argeo Paul Celluci
Lt.Governor
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
ONE WINTER STREET, BOSTON, MA. 02108 617-292-5500
Trudy Coxe
Secretary
David B. Struhs
Commissioner
iperty Address:
:e of Inspection:
npany Name:
rnpany Phone:
TITLE V REPORT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR:
Part A
Certification
Address of Owner:
7 SHEPHERDS HOLLOW
LEEDS, MA. 01053
APRIL 7, 1998
Greg's Wastewater Removal
239A Greenfield Road
S. Deerfield, MA 01373
(413) 665-3989
(ONLY if different)
APR 15 1998
'„MpTON e0A6n OF HEAL.'
Name of Inspector: Gregory M. Gardner
rm a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
CERTIFICATION STATEMENT
ntify that I have personally inspected the sewage disposal system at this address and that the information reported below is
accurate, and complete, as of the time of inspection. The inspection was performed based on my training and
)erience in the proper function and maintenance of on-site sewage disposal systems. The system:
❑ Passes
® Conditionally Passes
❑ Needs Further Evaluation by the local Approving Authority
❑ Fails
iPECTOR'S SIGNATURE:
DATE:
e System Inspector shall submit a copy of this inspection report the Approving Authority within thirty(30) days of
npleting this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and
system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.
e original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
3PECTION SUMMARY: (Check A, B, C, or D)
SYSTEM PASSES:
❑ I have not found any information which indicates that the system violates any of the failure criteria as defined in
310 CMR 15.303.Any failure criteria not evaluated are indicated below.
)MMENTS:
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.
(revised 04/25/97) —Page 4
SUBS,;RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part B
Property Address: 7 SHEPHERDS HOLLOW CHECKLIST
Owner:
Date of Inspection:
LEEDS,MA. 01053
TRUDY HOOKS
APRIL 7,1999
Check if the following have been done: You must indicate either "Yes" or "No" as to end
the following:
Yes No
® ❑
Pumping information was requested of the owner, occupant, and Board of Health.
❑ None of the system components have been pumped for at least two weeks, and the system has
has been receiving normal flow rates during that period. Large volumes of water have not been introducer
the system recently or as part of this inspection.
❑ ® As built plans have been obtained and examined. Note if they are not available with an NA
O ❑ The facility or dwelling was inspected for signs of sewage back-up.
® ❑ The system does not receive non-sanitary or industrial water flow.
® ❑ The site was inspected for signs of breakout.
® ❑ All system components, excluding the Soil Absorption System, have been located on the site.
® ❑
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for
condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of
scum.
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner(and occupants, if different from owner)were provided with information on the proper
maintenance of Sub-Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable)(15.302(3)(b)}
14/25/97) --Pap 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part A
• Certification (continued)
y Address: 7 SHEPHERDS HOLLOW
Inspection:
LEEDS,MA. 01053
TRUDY HOOKS
APRIL 7,1998
YSTEM FAILS:
You must indicate either"Yes"or"No" as to each of the following:
❑ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an 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 the 1/2 day flow.
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 Soil Absorption System, cesspool, or privy is below the high groundwater
elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable,
attach a copy of well water analysis for colifonn bacteria,volatile organic compounds, ammonia
nitrogen and nitrate nitrogen.
ARGE SYSTEM FAILS:
You must indicate either"Yes"or"No" as to each of the following:
""THE FOLLOWING CRITERIA APPLY TO LARGE SYSTEMS IN ADDITION TO CRITERIA ABOVE:""
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a sgnificant
threat to public health and safety and the environment because one or more of the following conditions exist:
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)
owner or operator of any such system shall bring the system and facility into full compliance with the
indwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local
oval office of the Department for further information.
(revised 04/45,97) —Page 6
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade: T
Material of construction:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part A
Certification (continued)
7 SHEPHERDS HOLLOW
LEEDS,MA. 01053
TRUDY HOOKS
APRIL 7,1998
cast iron X 40 PVC other(explain)
Distance from private water supply well or suction line
Diameter 4"
Comments: (condition of joints.venting, evidence of leakage, etc.)
All good
SEPTIC TANK -
(locate on site plan):
Depth below grade: 12"
Material of Construction: ® Concrete ❑ Metal ❑ Fiberglass ❑ Polyethylene _Other(explain)
If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No)
9'x 5'x 5' Dimensions:
o Sludge Depth
43° Distance from top of sludge to bottom of outlet tee or baffle
o Scum thickness
5" Distance from top of scum to top of outlet tee or baffle
16" Distance from bottom of scum to bottom of outlet tee or baffle
i11E$6 UIPrb How dimensions were determined:
Comments: (Recommendations for pumping,condition of inlet&outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.) Pump septic tank every 3 years, Baffles OK, Liquid at but not above outlet invert, Tank appears in ON
condition, Starting to deterioate, but no signs of leakage.
GREASE TRAP - ❑
(locate on site
plan):
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/baffle
Distance from bottom of scum to bottom of outlet tee/baffle
Date of last pumping:
Comments: (Recommendations for pumping,condition of inlet&outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
04/25/97) -Page 5
ty Address:
t Inspection:
SJSSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part C
SYSTEM INFORMATION
7 SHEPHERDS HOLLOW
LEEDS,MA. 01053
TRUDY HOOKS
APRIL 7,1998
FLOW CONDITIONS
Jential:
In Flow: 110 g.p.d./bedroom for S.A.S.
er of bedrooms: 4
Der of current residents: 5
age Grinder (yes or no) No
dry connected to system (yes or no) Yes
onal Use (yes or no) No
Ir Meter readings- if available
st two (2) year usage(gpd) Well
p Pump(yes or no) No
Date of Occupancy: Unknown
mercial/Industrial:
of establishment:
an flow:
se trap present (yes or no)
stria!Waste Holding Tank present(yes or no)
sanitary waste discharged to the Title 5 system
or no)
:r Meter readings-- if available:
Date of Occupancy:
IER: (Describe)
date of occupancy:
gallons per day
GENERAL INFORMATION
(PING RECORDS and
ce of information: Pumped by Greg's 9/26/97-Greg's
em pumped as part of the
action: (yes or no) No
ES- enter volume pumped: gallons
Reason for pumping:
'E OF SYSTEM:
Septic Tank/D Box/Soil Absorption System
Overflow Cesspool
❑ Single Cesspool
❑ Privy
red system (yes or no) (if yes, attach previous inspection records, if any) No
Technology etc. Copy of up to date contract?
IER:)
'ROXIMATE AGE of all-components: Approx 1986
Installed, if Known: 1986
rce of Information:Trudy Hooks
rage Odors detected when arriving at Site: (yes or no) No
(revised 04/25/97) --Page 8
Property Address:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part C
SYSTEM INFORMATION(continued)
7 SHEPHERDS HOLLOW
LEEDS,MA. 01053
Owner: TRUDY HOOKS
Date of Inspection: APRIL 7.1558
SOIL ABSORPTION SYSTEM N
(SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
TYPE:
Leaching pits& number
Leaching chambers & number
Leaching galleries & number
Leaching trenches, number, length 3 trenches 50' long
Leaching fields, number, dimensions
Overflow cesspool, number
Alternative system:
Name of Technology:
Comments: (Note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Boney sandy gravel, No hydraulic
failure, No ponding, Vegetation small brush recommend cutting down small brush &trees starting to grow over area of S
CESSPOOLS ❑
(locate on site plan):
Number&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
inflow(cesspool must be pumped as part of inspection)
Comments: (Note condition of soil,signs of hydraulic failure,level of ponding,condition of ation etc.))
PRIVY El
(locate on site plan):
Materials of construction
Dimensions
Depth of solids
Comments: (Note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.)
04/25/97) —Page 7
ly Address:
1Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part C
SYSTEM INFORMATION (continued)
7 SHEPHERDS HOLLOW
LEEDS,MA. 01053
TRUDY HOOKS
APRIL 7 199
TIGHT/HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan):
Depth below grade:
Material of Construction: ❑ Concrete ❑ Metal ❑ Fiberglass ❑ Polyethylene Other(explain)
Dimensions:
Capacity in gallons
Design flow in gallons per day
Alarm level Alarm in working order Oyes ❑ No
Date of previous pumping
meats: (Condition of inlet tee,condition of alarm and float switches etc.)
rRIBUTION BOX: ®Yes ❑ No
ate on site plan):
it; of liquid level above outlet invert: Not above
Iments: (Note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)Distribution is slightly out of
I No solids carryover, D-Box is rotten and cracked, the system will pass with a new D-Box installed.
7P CHAMBER: ❑
ate on site plan):
Ips in working order:
or No)
ms in working order
or No)
invents: (Note condition of pump chamber,condition of pumps and appurtenances,etc.)
(revised 04/33/97) —Page 10
Property Address:
SUBSUR=ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part C
SYSTEM INFORMATION (continued)
7 SHEPHERDS HOLLOW
LEEDS,MA. 01063
Owner: TRUDY HOOKS
Date of Inspection: APRIL T,1998
Depth to Groundwater 4'6" Feet
Please indicate all the methods used to determine High Groundwater Elevation
N Obtained from Design Plans on record
® Observation of Site (Abutting property, observation hole, basement sump etc.)
® Determine it from local conditions
❑ Check with local Board of health
❑ Check FEMA Maps
❑ Check pumping records
❑ Check local excavators, installers
❑ Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.
(Must be completed): Sandy gravel in area of S A S, topography of land would
indicate Hi groundwater elevation would be well below S A S Also no sump pump in
cellar very dry, no stains on cellar wall see attached test pit data
04/25/97) --Page 9
ty Address:
f Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Part C
SYSTEM INFORMATION
7 SHEPHERDS HOLLOW
LEEDS,MA. 01053
TRUDY HOOKS
APRIL 7.1998
'CH OF SEWAGE DISPOSAL SYSTEM:
{INCLUDE TIES TO AT LEAST 2 PERMANENT REFERENCES,LANDMARKS, OR BENCHMARKS-
AND LOCATE ALL WELLS WITHIN 100 FEET}(Locate where public water supply comes into house)
**** { SEE EXHIBIT A} ****
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BOARD OF HEALTH
FIN T.JOYCE.Chairman
JNE BURES,M.D.
'NTHIA DOURMASHKIN.R.N.
TER J.McERLAIN,Health Agent
April 15, 1998
Trudy Hooks
7 Shepherds Hollow
Leeds, MA 01053
Dear Ms. Hooks:
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
Re: Septic System Inspection 7 Shepherds
Hollow Leeds
210 MAIN STREET
01060
(413)586-6950 Ext 213
The Board of Health is in receipt of a . rt on -wa•e • .osal5 -m ins.ec an
conducted at 7 Shepherds Hollow Leeds by Gregory Gardner on April 7, 1998. That
report indicates the following:
• Distribution("D") Box is deteriorated and tipped and must be replaced
Based on Mr. Gardner's report your sewage disposal system has been listed as` as
conditionally."In order for your sewage disposal system to be classified as "passed,"you
must do the following:
• Replace the deteriorated"D"box and level the lines out of the `D"box (1't 2ft)
All of the work described above must be done by a licensed septic system installer in
accordance with the requirements of 310 CMR 15.000 and a Septic System Repair Permit
must be obtained from the Board of Health office prior to beginning the work.
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 owners of the property) are hereby ordered to repair the subsurface
sewage disposal system at 136 Chesterfield Rd.,within two years of the date of the
original inspection, (by 3/14/2000). If further degradation of the sewage disposal system
occurs, (e.g. sewage flowing to the surface of the ground),the repairs will be required
sooner.
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.
•
Pg 2
Please feel free to contact the Board of Health office, at 587-1213 if you have any
questions concerning this notice.
Thank you for your anticipated cooperation in this matter.
Very thuly yours,
Peter J. Mc rlain, Agent
Northampton Board of Health
Cert. Mail #P 082 852 909
BOARD OF HEALTH
MEMBERS
JOHN T.JOYCE,Chairman
ANNE BURES,M.D.
;YNTHIA DOURMASHKIN,R.N.
TER J.McERLAIN,Health Agent
(413)587-1214
FAX(413)587-1264
May 18, 1998
Ms. Trudy Hooks
7 Shepherds Hollow
Leeds, MA 01053
Dear Ms. Hooks:
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
Re: Septic System Re-inspection
7 Shepherds Hollow, Leeds
210 MAIN STREET
NORTHAMPTON,MA 01060
This letter will confirm that on May 18, 1998, I conducted a re-inspection of the septic
system on your property, at 7 Shepherds Hollow, Leeds. That re-inspection revealed that the
repairs to your septic system had been completed, Licensed Septic Installer Bill McGrath had
replaced the "distribution box," and that the system was functioning properly.
Therefore the designation"Passed Conditionally"has been removed from your Title 5
Inspection report and your system is now designated as"Passed."
Thank you for your cooperation in this matter.
Very truly yours,
Peter J. McErlain
Health Agent
BOARD OF HEALTH
HN T_JOYCE,Chairman
JNE BORES M D.
'NTHIA DOURMASHKIN,R.N.
TER J.McERLAIN,Health Agent
October 2, 1998
Ms. Judy Boyle
1357 Burls Pit Road
Florence, MA 01062
Dear Ms. Boyle:
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
Re: Septic System Inspection 7 Shepherds
Hollow Leeds
210 MAIN STREET
01060
(413)586-6950 Ext 213
The Board of Health is in receipt of a report on a sewage disposal system inspection
conducted at 1357 Burls Pit Rd.. Florence by Pamela Bissell on August 20, 1998. That
report indicates the following:
• The septic tank outlet baffle is badly deteriorated and the septic tank has a heavy
sludge/scum buildup
Based on Ms. Bissell's report your sewage disposal system has been listed as"passed
conditionally" In order for your sewage disposal system to be classified as'passed."you
must do the following:
• Pump the septic tank and replace the deteriorated outlet baffle with an outlet a"T"
baffle.
The work described above must be done by a licensed septic system installer in
accordance with the requirements of 310 CMR 15.000 and a Septic System Repair Permit
must be obtained from the Board of Health office prior to beginning the work.
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 owners of the property) are hereby ordered to repair the subsurface
sewage disposal system at 1357 Burts Pit Rd, within two years of the date of the
original inspection, (by 3/14/2000). If further degradation of the sewage disposal system
occurs, (e.g. sewage flowing to the surface of the ground), the repairs will be required
sooner.
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.
Pg.2
Please feel free to contact the Board of Health office, at 587-1213 if you have any
questions concerning this notice.
Thank you for your anticipated cooperation in this matter.
Very truly yours,
Peter dais,Agent
Northampton Board of Health
Cert. Mail#P 573 708 233