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46 Septic Inspection 2008 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owner Owners Name ieui fors Northampton Ma 01060 5-13-2008 every page. City/Town State Zip Code Date of Inspection Important; When filling out forms on the computer,use only the tab key to move your cursor-do not use the return key. Inspection results must be submitted on this form. Inspection forms may not be ahered in any way. A. General Information 1. Inspector: Tom Martin Name of Inspector Turkey Hill Field Services Company Name 140 Easthampton Rd. Company Address Westhampton Ma City/Town State 01027 413-527-5311 S14199 Telephone Number License Number Zip Code B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority °V / In • . s Signature Date 5/16/08 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. Cc. r tAp1a. Bo&od-�Lki 111 l I,iCnn"S elap i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owner Owner's Name re Northam ton Ma 01060 5-13-2008 requirequire o d for P every page. Ctlylrown State Zip Code Date of Inspection Omen 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: Underground sprinkler system on this property. Recommend limited use of this lawn sprinkler system. Overuse may cause premature failure of the leachfield. Recommend pumping every three years. 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. 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 rM s OffisetesPesbon Fmm'.Subvulace surrey Dispose System•Pepe 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green /caner Owners Name equirehon s Northampton Ma 01060 5-13-2008 :very page.for State Zip Cede Date of Inspection very Ps9e. CkyRavn Veen inspect, B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. TAB 5 Mote Inspemai Form:SubMlace Sewage Disposal Systen'Pepe 3 of 15 weer formation is Nuked for ANY pale. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owners Name Northampton Ma 01060 5-13-2008 City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 %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 SAS, cesspool or privy is below high ground water elevation. ❑ E Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ree 5 mom Inepodon rmn'.Subsurface Swag Disposal System•Pap 4 of is gear mapman,spo tare•03/05 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green weer Owner's Name fonnatlfn is payednary Northampton Ma 01060 5-13-2008 for page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system faits.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. preen inspection repxtda•03/08 The 5 Mad Inspection Font Subsurface Scone Dapwl System•Page 5 of 15 ner notation is luired for ery page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owner's Name Northampton Ma 01060 5-13-2008 City/loam State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® p Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ M Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? green implon,q,xUbc'0303 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 Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)1 The 501509 Y,WMwn Fwm:Subv.Nace Sw'4 Systun.Pepe 8 N15 ner =anon is luired for try page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owners Name Northampton Cityrtown Ma 01060 5-13-2008 State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): co] sys{<.m5 IN kh ril+e/sirliedo Sas 0 :co% . -g 1,S• Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system?[if yes separate inspection required] Laundry system inspected? Seasonal use? Water meter readings, if available(last 2 years usage(gpd)): Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non-sanitary waste discharged to the Title 5 system? Water meter readings, if available: Last date of occupancy/use: Other(describe): green may don reportdoc•0.'Nw 4 440 +50% 45 Fa' tote m ails 5 ❑ Yes ® No ❑ Yes Z No ❑ Yes ❑ No ❑ Yes ® No ❑ Yes ® No currently Date Gallons per day(gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Date NM 5 OMaa Inysdon Form'Subsurface Sewage Oieraaa SyMem•Pepe 7 G 15 nor motion is wired for sy page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owner's Name Northampton Ma 01060 5-13-2008 City/Tam Slate Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No 1500 If yes,volume pumped: gallons How was quantity pumped determined? conversion of cubic space to liquid volume Reason for pumping: part of post-inspection, owners selling house C TA.rk 7c ln )xr O edi ?welt)Skirt /islo& Type of System: f (1 ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) Of yes, attach previous inspection records, if any) ❑ Innovative/Aitemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Septic Tank, Pumping Chamber, Distribution Box, and S.AS Approximate age of all components, date installed Of known)and source of information: installed in 2003-(as per C.O.C.from Board of Health) Were sewage odors detected when arriving at the site? ❑ Yes 0 No Steen inseeddun e4atdx•03/08 TMe S Official Inspection Fmrt Sutn+lacs Swage Oitpx9 System•Pose El of 15 ner matron is uired for Ty page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owner's Name Northampton Ma 01060 5-13-2008 City/ own State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan). Depth below grade: Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 1.8-2.0 feet 43 feet Comments(on condition of joints, venting, evidence of leakage, etc.): Evidence of settling of the sewer line between house and tank.Work done on this sewer line to re- establish proper pitch into the tank Septic Tank(locate on site plan): Depth below grade: Material of construction: ®concrete ❑ metal 1.9-2 feet ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or bathe How were dimensions determined? ram',inspection woaad=•axe 10'x 6'x 5.5' 4 inches 32 inches .5 inch at inlet chambered tank. no scum at outlet no scum at outlet measured WO 5 CTd&I bW acilge Faa:Subsurface Sewage Disposal System"Page 9 of 15 ner rmation is cited for 7 Page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Proeedy Address Scott and Naho Green Owner's Name Northampton Ma 01060 5-13-2008 City/town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, [quid levels as related to outlet invert, evidence of leakage,etc.): no evidence of leakage. outlet tee o.k. relative liquid levels appropriate. inlet and tee showed evidence of settling of the line just outside the tank.work done to correct this problem and re- establish the propert pitch of the sewer line from the house through the inlet tee. Grease Trap(locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): greu„nspedon repotOx-OalB TCe S(Adel Inspection Fan:Stt.atem Savee.Disposal System•Peps 100115 rer motion is Wed for ry page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owners Name Northampton Ma 01060 5-13-2008 City/town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): d-box in fine shape. 3 lines. sas vented .tee on pump line in good shape. flow to lines equal.speed levelers present. no solids carryover. no signs of leakage or intrusion. Pump Chamber(locate on site plan): Pumps in working order ® Yes ❑ No Alarms in working order ® Yes ❑ No mem Inspection repot doe•03/08 nye 5 015 S Im%yon Fo n:SbAstnz Seems Disposal System'Pepe 11 d 15 ner ration is uired for ny Page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owners Name Northampton Ma 01060 5-13-2008 Ci y/Town State Zip Cale Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): pump chamber in good condition. electrical connections fine.water of appropriate clarity. water level shows that pump and floats are working at appropriate setting Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 3, 60' Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no signs of hydraulic failure. not pending. soils dry. no breakout. green invention ro , ratac'R'16 T,tle 5 OfdS Inwcn Form.SuMUlea Swaps flieposal System Pepe 12 of 15 ner imration is uired for .ty Page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owners Name Northampton Ma 01060 5-13-2008 Cityftown State Zip Code Date of Inspection D. System Information (cont.) 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 ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(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.): green Inspector rwdnnmc•OS" n1N 5 Official h W°dion Fwm.subeulo Swage Disposal Syntwn•Pag 13 N 15 ner =aeon is uired for in/page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owner's Name Northampton Ma 01060 5-13-2008 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. TowN f�� °t� rl �'I*'f� / 0 T e \, ,th\tci o1/4„ Il tkpitdei 3J\, preen inspection rayon.doe•NTd Title 5 0fitla Inspection Form:Sateen Sewage Disposal •page 1ad15 ner rmation is used for 'Pi paPe. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Sovereign Way, Northampton, Ma. Property Address Scott and Naho Green Owner's Name Northampton Ma 01060 5-13-2008 City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: > 10 feel Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record reviewed 4/25/2008 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: please note attached perc test data obtained for this parcel from Board of Health files. I have conducted deep observation pits in adjacent lot and found no redox features within 10' below grade within this large sand deposits. green lnsWuban rnpal.KC•0308 Tile 5 OIMY Nlpetim Form.subsurface Sewage Deposal System Page 15 of 15 : E L L U R A G F CO N S T R U C T I O N . k 03 C C.o.c. Distribution Box am. 361+ AS BUILT SEPTIC PLANS 46 Sovereign Way Florence MA Scott & Naho Green Pump Chamber Septic Tank 1 24' 6I' f 18' 7"— •,. i B A — F = 83' B — F = 84' A — C = 49' 5" B — C = 36' 6" House 26' 2"—÷ A Garage A — E = 54' B — E = 43' 10" A — D = 89' B — D = 102' 2"