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135 (N'ton Country Club) Septic Inspection 2004 ENVIRONMENTAL DESIGN, INC. 101 OLD FERRY ROAD NORTHAMPTON, MA 01060 1-413-585-5020 October 29, 2004 Northampton Golf inc. C/o Bob Berniche P.O. Box 51 Leeds, MA 01053 Re. Septic System Inspection at 135 Main Street. Leeds, MA Dear Bob: Enclosed please find a copy of our report for the referenced inspection. We have forwarded a copy of the report to the Northampton Board of Health per the requirements of 310 CMR 15.300. Based on the results of our inspection in accordance with 310 CMR 15.300, we have concluded that the system does not fail to protect the environment and/or the public health. Please call if you have any questions, and thank you for this opportunity to be of service. Sincerely yours. Micha J. Laigne System Inspector COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: Owner's Address: Date of Inspection: 135 Main Street Leeds MA Northampton Golf Inc. P.O. Box 51 Leeds MA 01053 October 21,2004 Name of Inspector: (please print) Michael Lavigne Company Name: Environmental Design Inc. Mailing Address: 101 Old Ferry Road Northampton_MA 01060 Telephone Number: 413-585-5020 CERTIFICATION STATEMENT 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: _X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: „ ' �/ �- Date: /j/�/o V 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. tfthe system is a shared system or has a design flow of 10,000 epd 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 ****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. Page 2 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 135 Main Street Leeds, MA Owner's Name: Northampton Golf Inc. Dale of Inspection: October21. 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any ofthe failure criteria described in 310 CMR 13 303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: 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 ofthe replacement or repair,as approved by the Board of Health,will pass. Airdwer y or nor d i nett(Y N,ND) in di explain. for the following svatemenls if not detertnined please 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 it 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). ND explain: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than 4 times a year due to broken or obstructed pipe(=). The system will pass inspection if(with approval ofthe Board of Health): ND explain: broken pipets)are replaced obstruction is removed OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Proper[Address: 5 Main Street Leeds, MA Owner's Name: Noeham tor.Col`?nc. Date of Inspection: October 21.2004 C. Further Evaluation is Required by the Board of Health: Conditions ecist which require further evaluation by the Board of He all in order to determine it thr scam., Ianing to protect public health.safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMiR 15.30311ftbt 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 pi ivy is within 50 ice,.of a border/nit vevetated 'venand r 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 estem has a septic tank and soli absorption system(SAS)and the SAS is s --tin 100 feet of a snrfece water supply or tributan to a surface water supply_ The system has a septic tank and SAS and the SAS is within a Zone I ofa public water supply. The system has a septic tank and SAS and the SAS is within 30 feet of a private water supply ell. _ 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 anak sis.performed al a DEP certified laboraton_for colt form hnue to and )olatile organic compounds indicates that the well is free from pollution from that faciiit) anti 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 ! I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: tai Main Street Leeds. MA Owner's Name,: Northampton Golf Inc. Date of Inspection: October 21,2004 D. System Failure Criteria applicable to all systems: You must Indicate--yes'.or no to each of the following tor all inspections: Y., No Backup of sea age into facility or s)stern component due to overloaded or dogged SAS or cesspool Discharge or ponding of effluent to the surface ofthe ground or surface whets due to an overloaded a clogged SAS or cesspool X_ .Static liquid level in The distrihutron no ah_,e-wine! invert due to xn overloaded or etc_rid S^S ar cesspool N v1 Liquid depth in cesspool is less than 6'below in tic,t or available volume is less than ' dal. flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion ofthe SAS. cesspool or privy is below high ground water elevation. N A Any portion of cesspool or privy is within 100 feet of a surface water supply or rrihutary to a surface water supply_ N/A Any portion ofa cesspool or privy is within a Zone I ofa public well N'A Ary portion of esspool or pi n IN ■yith in 50 Feet ofa private water supply w eti_ N Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a psi sate'..ater supply well with no acceptable water quality analysis.(This system passes if the'nett 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.' _No_tY es/No)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. 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. You must indicate either yes'or"no"to each of the following: (The following criteria apply to large systems it addition to the criteria above., yes 110 the system is within 400 feet of a surface drinking water supply the system is within 200 feet ofa tributary to a surface drinking water supply the By stem is located in a nitrogen sensitise area(Iuteriin Wellhead Protection Area Zone II of a public water supply well or a mapped If you have answered"yes"to any question in Section F,the system is considered a significant threat,or answered 'yes'.in Section D above the large system has failed. The owner or operator f 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. Page 5 of II OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Proportj Address: 135 Main Street Leeds, MA Owner's Name: Northampton Golf Inc. Date of Inspection: October 21.2004 Check if the following have been done.You must indicate yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X Has the system received normal flows in the previous two week period X Have large volumes of water been introduced to the system recently or as part of this inspection X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up ' X _ Was the she inspected for signs of break out? X _ Were all system components; excluding the SAS, located on site X_ 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 X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems fhe size and location of the Soil Absorption System(SAS)on the site has been determined based on Yes no X Existing information_ For example,a plan at the Board of Health. X Determined in the field Of any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15302(3)(b)] Pace 6 o: .. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION "report; Address. 135 Main Street Leeds MA Owner's Name Northampton Golf Inc. Date of Inspection: October 21. 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow haled on 4 1 0 CMR 15.2n3 (for example: t i p..pd x x of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no). [if yes separate inspection required' Laundry system inspected Des or no): Seasefa! use:(yes or no): Water meter readings, if available(last 2 year usage(gpd))'. Sump pump(yes or no)- Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: 4c)_p Cr. a r5 c_ Design flow(based on 3't{) CMR I5.203): N/// apd Basis of design flow Iseatspersonssgft,etc): „r/4 Grease trap present(yes or no): Lo,E(erra,F Industrial waste holding tank present(yes or no). Vo Non-sanitary-waste discharged to the Title 5 system iyes or nu):/s o Water neter readings.if available'. /J/A Last dote of occupancy'-._ s ;Ar.- OTHER/describe)' .t���r b{ b�. r 4,4 k r-v P 'in cJ dad-r-G( 9/73 GENERAL INFORMATION Pumping Records Source of information'. 0.lu A)l4Q l l u r Was system pumped as part of the inspect-on (yes or no):NO If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping. TY1'E OF SYSTEM 7-Septic tank,distribution box,soil absorption system - die cesspool Overflow cesspool Prio- _ Shared system(yes or no)(if yes,attach previous inspection records, if any) InnovativelALtemative technology.Attach a copy of the current operation and main obtained from system owner) light tank Attach a copy of the DEP approval Other(describe} nance contract(to b Approximate age of all components,date installed(if kno}�tn)and source of information X99& per r;w�er f L97 ? 7 icp cL Were sewage odors deterred when arriving at the site('es or no): ;OO P, OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address Owner's Name: Date of Inspection: 135 Main Street Leeds. MA Northampton Golf Inc. October 21. 2001 RUiLDING SEWER tlocate on site plauj Depth be!ec grade:5Llb Slcb Materials of construction. )/ cast iron 40 PVC other(explain): Dirlance hum private water supple well or suction line' rV/%' Comments(on condition of joints.venting. evidence of leakage.etc.): nJo Oft cblenns 1„c+ed SEPTA : /(locate on plan)site Depot itIC eioTw NKgraue ,,.,,?� Material of construction: concrete metal fiberglass polyethylene othc r(e_plain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copA of cent F ore) Dimensions: 'Cot gp,'/oti -,t/443) Sludge depth: (n -P T t Distance from top of sludge to bottom of outlet tee or baffle: 7g20 f/ Scum thickness: ,c/- 'r Distance from top of scum to top of outlet tee or baffle: 7 y `r Distance from bottom of scum to bottom of outlet tee or able:_2/0 t low were dimensions determined_ its�-.J-;. Comments(on pumping recommendations_inlet and outlet tee or baffle condition,structural integrity_ liquid levels as related to outlet invert, evidence of leakage,etc.): /moo �.-,6/ci - n. e CREASE TRAPfi)/K{`locate on site plan) Depth below grade Material of construction: concrete metal fiberglass polyethylene outer (explain)' Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Dstance from bottom of scum to bottom of outlet tee or baffle. Date of last pumping: Comments(or pumping recommendations, inlet and outlet tee or baffle condition sir aunt integnq, .ydd oats as related to outlet invert. evidence of leakage_ etc y Pave 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 135 Main Street Leeds MA Owner's Name: Northampton Golf Inc Date of Inspection: October 21. 7004 TIGHT or HOLDING TANK: A1jA(tank must be pumped at time of inspection)(locate on suie plan) Depth below grade: Material of construction' concrete meta! fiberglass pol 'erhvlene -th .plain Dimensions: Capacity: gallons Design Flow: gallons'dav Alarm present(yes or no): Alarm level'. Alarm in working order(ves or no Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ in present inust he opened)llocate on sire plan) Depth of liquid level above outlet invert: u 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.): /VD 9vicflleMS AUOfed. PUMP CHAMBER: ✓ (locate on site plan) Pumps 'n swrki+g order(yes or no): ¢3 Alarms in working order(ves or no):_a) Comments(note condition of pump chamber. condition of pumps and appurtenances.etc WO✓.Cr . 4sA, rCC2tktP -e�-�( G<.e e�v^- 017o cur=l` or n ] L.r r+-� cir-c> ;'-r-y a Oti-c_i 'L�, n.c Pape 9 of I OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION tcoodmwd) Property Address: 135 Main Street Leeds MA Owner's Name: Northampton Goth, Date tit inspection: October 21. 200}4 SOIL ABSORPTION SYSTEM (SAS): V (locate on site plan,ucavaiion nut required) If SAS not located explain by ro.1-e4 v e Th- K >r dc:.v�" Type leaching pits.nu nher: leaching chambers,number: leaching galleries, number: v( leaching Uenches, number.length: 0 '75 1 leaching fields,number,dimensions. _overflew cesspool,number: innovative/alternative system Tvpe'name of technology: Comments!note condition of soil,signs of hydrant:failure, level of ponding„damp soil condition of caetatm etch CESSPOOLS: Vthfcess000l 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 o+=cum laser: Dimensions of cesspool: Materials of coastuction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure. level ofoonding. condition of vegetation_etc PRIVY; afiocate on site plan) Materials of:onto ction: Dimensions: Depth or splioc. Comments(note condition of soil. signs of hydraulic failure, level of pond ins, condition of vegetation,etc). OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P:acpert' 9ddres 132 Main Street Leeds. MA (hr ner'c Ve me: Northampton C olf Inc. Date at Inspection: Cciobel__ 'OIi4 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch ofthe se' atse disposal system includine ties to a[least too permanent reference landmarks or Hs-ark .calrali cells s■ahin IOU Feet locate uhcr LuhGC rsatei sne ph enters the hsilin \ .— Page II of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 135 Main Street Leeds. MA Owner's Name: Northampton Golf Inc. Date of Inspection: October 21. 2004 SITE EXAM Slope irfare water Check cellar Shallow ..ells E timated depth to ground water7�feet Please indicate(check)all methods used to determine the high gran nd water elevation Obtained from system design plans on record-If checked,date of design plan reviewed: y/Ohs site(abutting pr openy(vbservation hole within ISO feel.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. L)et ,2cs— /¢✓c( — Aa ^ ' -�i.F. YJ' c - J'J e/o&: sm s, Pra a NOV-229-2005 I(:52 7RCir:NORTF,ANFTON EDAOD ,(r 4(3 597122I CHECK OR FILL IN WHERE APPLICABLE No.6li,R -0:3141358236E: THE COMMONWEALTH 0G MASSACHUSETTS BOARD OF HEALTH Application far Disposal ttarks Qtuuntrurtinn fermit App nation is _ he , mode foe a P.�e:ppr6• a Cua s o-act ( ) or R epur ( L,dirlauu _Sewage >i,posal Syst®a: ppfreist Sat Type of F:uadin Di!ling—No. of Bed'(Kis Other—Ti pe of Building Other E mires Design Pow Septic"l:nk—Liquid capacity Disposal Trench—Mc Seepage:it No.. . Diameter Other D. trbution to. ) Dosing Percolat rn Test Resu'ts Ferformed by Fit @ . i sondes per inch Tm Pit Ho.2 _ m lures per ioc) w Lot No. Size sq. feet L passion Attic ( ) rx,ge Gtirues mr No. of per . E[owtm (a) —Cbn_ia(. ) person per day. Teti daily Pow .ength Welt _ D-meter Pepsi Total Length Total"melting nr© ctrl. lt. Depth bet o.e in Ten.] sol irg:cc• - L tank ( ) hate Depth of Test Pit Dept,to ground wan Depth of Tent Po Dcptt to ground man+_. Descrlpt on of Ssil Nature 1 Repairs glterat�ijorts,�—Answer pwl$n appl ra I epEa} Agree-mud:: _ ti 0as"”.4w1 lt�.. d The uncles-feigned agrees to install the afordescribed Individual Sewage Disposal System in orde ice with u provisions al At tide NI of the State SaNCry Code—The undersigned d further agrees not to yeratloa until a Ccrtii.ate ci Con g _ plum the system in ° Viiv¢c has uu�/9r��/�xu�N br mL • itEt. Si neic IV)Ctii Application Approved 1y ��S.T.T 5 .414, t4^ �. _.... . . .r. .0 ... a.W y{ ._.. Application Distpptoved for the following rei.onr o" -ctnit No 25312 Feetredw.��W�u1.�(9z�. by THE COMMONWEALTH of MASH SACOSETTS BOARD OF HEALTH CE Trrtifirate of Tanrplianre Th IS 15 TO CLiRrn,Y, That the Indi-ittd Sewage Disposal System eonstruct.d ( t C- Pepare! ( ) has hee, installed in e.ccorda ice with the provisions of Article Xr of The Star. Sanitary Code es(less-Shed in the appliat cn for Discoed Works Construction Permit No sided /Fr: ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A.GUARANTEE TN AT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE inspector THE COMMONWEALTH OF MASSACF'JSEIIS BOARD OF HEALTH No_..J..;>/ _ OF... itspuiaj 11I01;103 nttStrartlalt FFrRB1 Per,ission is bmiby grmted eraolgt to Constuct (_ or E :.L a )�9 I f dv1oase 2gy Disw sys �� at No tlGprJ(q, as shows.on the applimtion for Disposal Works Construction P SmitctNo. Dated DATE._ pzer/f Z3