58 Septic Inspection 2002 TITLE 5
OFFICIAL INSPECTION FOR-NOT FOR VOLUNTARY AS
SUBSURFACE SEWAGE DISPOSAL SYSTEM
PART A
CERTIFICATION
Property Address: 58 Sovereign Wav Northampton
Owner's Name:t_
t & A d Aro
Qwner's Address: 69 Western Drive
LongmeadowMA 01106
Date of Inspection: August 29,2002
Name of Inspector:Alan E. Weiss. R.S#933
Company Name: Cold SuringEnviranmental Inc
Mailing Address: 350 Old Enfield Road
Relehertown.Massackuseus 01007
Telephone Number: (4131323-5957 fax:413-323-4916
CERTIFICATION STATEMENT
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:
XX Passes
_Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Inspector's Signature: .�J/�� Date: August 29, 2002
The system inspector shall submit a opy 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.
Notes and Comments:
Septic Tank & leaching area was in good condition upon inspection. D. box liquid
levels were level and not above any outlet inverts. S. Tank was pumped May 15,
2002 Inspections found, all levels/stains were ok. Owner to place new covers on
risers over D. box and S.tank due to cracks.Garbage Disposal is not recommended
and condensate tubes from furnace and air conditioner should be disconnected.
****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
different conditions of use.
1
Page 2 of I I
OFFICIAL INSPECTION FORM—NOT TOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEHI INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 513 `.jO4c,(Xtc u LLIcsj
Owner: Armstc J
Date of Inspection: tjZ9tc1L
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
1 41tS I have not found any information which indicates that any of the failure criteria described in 310 CMR
303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
PIC 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,N7)in the for the folio int,statements.If"pct determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(wheth^r metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltradon or tank failure is immirvnt System will pass insertion 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.
NI)explain:
Observation of sewage backup or break out or huh 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)azir replaced
_ obstruction is removed
distribution box is leveed 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:
Sage 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Sea Saf •c(y u) J
Property Address:
Owner:
Date of Inspection:
Rr7)e15ia
ss l29le
C. Further Evaluation is Required by the Board of Health:
Alb Conditions exist which require further evaluation by the laid 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 rank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or nibutary 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 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:
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEMINSPECTION.FORM
PART A
CERTIFICATION(cammued)
Property Address: $g Srarern,y,J
Owner: yyScdv
Date of Inspection: $ 2_9 tOt
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
Afp 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
Ake Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
OA Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow
Nl4Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped .
t2
.Any portion of the SAS,cesspool or privy is below high pound water elevation.
Al(h Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
OD Any portion of a cesspool or privy is within a Zone I of a public well.
Ale Any portion of a cesspool or privy is within 50 feet of a private water supply well.
JD Any portion of a cesspool or privy is less than 100 feet but peater than 50 feet from a private water
supply well with no acceptable water quality analysis.(This system passes tfthe well water analysis,
performed at a DEP certified laboratory,for conform 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 thin Corm)
O (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15303,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 servea facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or`ho"to each of the following
(The following criteria apply to large systems in addition to the aitcrm above)
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.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: iii Sale 1'e,tl,,,r US.3
Owner: S033 Date of Inspection: t9(oz-
Check if the following have been done.You must indicate'Yes"or"no"as to each of the following'.
Yes No
t(e7- Pumping information was provided by the owner,occupant,or Board of Health
A, Were any of the system components pumped out in the previous two weeks?
V) _ Has the system received normal flows in the previous two week period?
ND Have large volumes of water been introduced to the system recently or as part of this inspection?
S Were as built plans of the system obtained and examined?(If they were not available note as WA)
>S_ Was the facility or dwelling inspected for signs of sewage back up?
/5 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 consutotion,dimensions,depth of liquid,depth of sludge and depth of scum?
Lies 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
Existing information.For example,a plan at the Board of Health.
Is05 Determined in the field(if any of the failure criteria related to Pan C is at issue approximation of distance
s unacceptable)[310 CMR 15.302(3)(b)]
5
Page 6 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL'SYS t EM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
92 cxxie2tq>J
Owner: A1?r\1SoJ
Date of Inspection: it 2._9 1O2-
RESIDENTIAL
Number of bedrooms(design): `I Number of bedrooms(actual): y
DESIGN flow based on 310 Cl 15.203 (for example: 110 gpd x14 of bedrooms): (o(n 6
Number of current residents: ti
Does residence have a garbage grinder(yes or rid): ye. . - No} Noce en x4 j•.Deo
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): —
Seasonal use:(yes or no): o
Water meter readings,if available(last 2 years usage(gpd)): 414
Sump pump(yes or no): Po
Last date of occupancy: --Wee*:
I
FLOW CONDITIONS
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis ofdesig..n flow(seats/persons/sgft,etc.):
Crease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-anitary waste discharged to the Title 5 system(yes or no
Water meter readings,if available:
act date of occupancy/use:
OTHER(describe):
Pumping Records
Source of information: Mho�(( 2 X3Z
Was system pumped as part of the inspection(yes ortQ
If yes,volume pumped: .I Cil r-p
0gallons--How was quantity pumped determined? ' 1 e ft
Reason for pumping:
GENERAL INFORMATION
TYPE OF SYSTEM
1/Septic tank,distribution box,soil absorption system
_Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach pi-evious 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:
9Prr s
Were sewage odors detected when arriving at the site(yes or no): loo
. Page 7 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: Sib aet +-9
Owner: {{SDNSC+J
Date of Inspection: $` 29\.'n
BUILDING SEWER(locate on site plan)
Depth below grade: ID "
Materials of construction:_cast iron _40 PVC other(explain):
Distance from private water supply well or suction line: l0 4
Comments(on condition of joints,venting,evidence of leakage,etc):
SEPTIC TANK: 'X5(locate on site plan)
Depth below wade: ZU
Material of construction:_ oncrete_metal fiberglass polyethylene
other(explain)
If tank is meal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: to .S K y.4 X ti• S
Sludge depth: 0
Distance from top of sludge to bottom of outlet tee or baffle: 40'
Scum thickness: 0 "
Distance from top of scum to top of outlet tee or baffle: C.
Distance from bottom of scum to bottom of outlet tee or baffle: It!
How were dimensions determined: Ple
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
a plc
aE C uJre
(-Pic c2 r`aPcrc. c 43' II %£(aW±)
GREASE TRAP:h14(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 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.):
Page 8 of 11
OFFICIAL INSPECTION FORM-?VpT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 5ociPrer/a t&1
Owner: 4
Date of Inspection: i'S z' c7
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):
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: I,{P �,
(if present must be opened)(locate on site plan) .tror -}a Ml(ctE
Depth of liquid level above outlet invert: elf tjc w&
Comments(note if box is level and distribution to outlets
leakage into or out of box,etc.):
q ccY x �.l?U-d .1,1s1 .
n'r Cater
equal,any evidence of solids cayover,any evidence of
PUMP CHAMBER:
locate on site plan)
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.):
rage9of I1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: Stuereie(JJ We
i i
Owner: l-rbm.sto
Date of Inspection: .6 Vitot
SOIL ABSORPTION SYSTEM(SAS): irs (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
_leaching chambers,number:
leaching galleries,number:
.3 leaching trenches,number,length: Y al ie 3'L it 2 'if
leaching fields,number,dimensions:
_overflow cesspool,number:_
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level ofpondine,damp soil,condition of vegetation,
mu):
ore
CESSPOOLS: A(/q (cesspool must be pumped as pan of inspection)(locate on sire plan)
Number and confimuation:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth ofscum 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 pondine,condition of vege
on,etc.):
PRIVY: id d(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of pending,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(=Sued)
Property Address: b2 5ct.`ef'2 (cr.1 ( ci
Owner: Any N;6n)
Date of Inspection: ttzYtcZ
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sew ge 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.
s - a-tlocf.ej 5k4 —
Page.11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: Sth SsJJor7 tc1A3(1uei
Owner:
Date of Inspection:
SITE EXAM
V Slope
Surface water
[/Check cellar
Shallow wells
Estimated depth to Bound water $to feet
Please indicate(check)all methods used to determine the high ground water elevation:
tab coed from system design plans on record-If checked,date of design plan reviewed:
Cbserved site(abutting property/observation hole within 150 feet of SAS)
hecked with local Board of Health-explain: (t cfsaS C P•11)
Checked with local excavators, installers- (attach documentation)
Accessed USGS database-explain:
You must describe hoc you established the high ground water elevation:
1996 7eSicha � T-bb tth'
7 t
KARL'S SITE WORK, INC.
327 RIVER DRIVE
HADLEY MA 01035
(413) 549-5396
To: JANET ARONSON
58 SOVEREIGN WAY
NORTHAMPTON, MA 01060-
•
TERMS:30 DAYS, 1-1%OVER 30 DAYS.
DATE
NUMBER
05/29/2002 1111n077513
Page: 1
Invoice
PLEASE PAY FROM
THIS INVOICE
STATEMENTS WILL NOT
BE MAILED.
DISPOSAL FEE 5/15
1485 GAL
PUMP &TRANSPORT
CONTENTS VERY HEAVY
1.0000
1.5000
148.5000 LOAD
Tax:
90.0000 HR
Tax:
Invoice Totals
Gross
Tax
148.50
0.00
135.00
0,00
283.50
0.00
Invoice Totals 283.50
WHEN REMITTING PLEASE INCLUDE INVOICE NUMBER ON CHECK.
Jun U5 02 03:03p Northampton BC or Health 413-587-1221 p. 1
AS 811ILT PLAN
SUBSURFACE SEWAGE DISPOSAL
SYSTEM
LOT-5 SOVEREIGN MEADOWS
4s OWCr 'NN' or $
SoVERE/GN ME-.ow
N MEADOWS
....•� .•., .•C w up
northampton Bd of Health 413-567-1221 p. 1
5-r<,.4C5 BED.,E:r.l Pcl,CS
A-C = /6 '
q - p= 24/4"
R- 6 c 39.6
13-C 27 H
3-q . 34 `"
13-5r 4 '
A F- 3
R 4 ' 74' .
-H = 41 '
.4-I = 8a'
A-7; SO.
Al-K= 83'
8-C.- U2.
r3-H= 45'
b S= 90:
11-7= Sc.Bl
3- K- 77'
3 TRENG-IES @ (45'C x 3w x 2H)
TO ROUTE 66 — NORTHAMPTON, MA. —7
SOVEF