83 Septic Inspction 2000 ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
June 19, 2000
Sam Brindis
83 Sylvester Road
Florence, MA 01062
re: Septic System Inspection at 83 Sylvester Road, Florence
Dear Sam:
rirpl
JUN 2 3 2000
-s
NOFT'r:AMPTON BOARD OF REALM
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,
Mic J. vigne
System Inspector
SuosunrACE.SEWAGE DISPOSAL SYSTEM INSPECTION rORM
PART A
CERTIFICATION(continued)
Property Address:
Ow
Date of Inspection:
INSPECTION SUMMARY: Chock A, B, C, or D:
SYSTEM PASSES:
I heve not found any Information which Indicate, that any of the fallma conditions described in 310 CMR 15.303 exist. Any
criteria not evaluated are Indicated below.
COMMENTS:
Y
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described In the "Conditional Pees"section need to be replaced or reported. The system
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes. no. or flat detemdned(Y. N. or NDI. Describe basis of determination in ell Instances. If 'not determined', explain why tit
The septic tank is metal, unless the owner or operator hem provided the system Inspector with a copy of a Certiflc•l
Compli note)attached)indicating that the tank was installed within twenty 130)years prior to the date of the Inepan
the septic innk, whether or not meter. Is cracked. structurally unsound, shows substantial Infiltration or exfillrstion.
failure is imminent. The system will pass inspection 11 the existing septic tank is replaced with a complying septic tt
approved by the Board of Health.
Sewage backup or brenitom or high static water level observed in the distribution box is due to broken or obstructed
or due to a broken, settled or uneven distribution box. The system will pass inspection If with approval of the Been
Heellhl.
broken plpelsl are replaced
obstruction is removed
distribution box Is levelled or replaced
The system required pumping',nore then Jour-times a'yeardue to broken or obstructed pipers!. The system writ pm
inspection If(with approval of the Board of Health):
broken pipers) are replaced
obstrucifon ie reu,oved
revised 9/2/98
Pepe l Sol I
ARGEO PAUL CELLTICCI
Governor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 IBIS) 2926600
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
1 U
Property Aileen: y13J J� it)t%)tLf (2,id Name of Owner JO "r -10al S
)Op T- -1-4' yin()WV? r n SI Address of Owner, 7D SC. v rZO U A QS‘
Name el Inspects:Insane Print) r L U
I /=)t,1znce. 11IA oloa
Date mbwpection: 6/w10(..) i
I ern•On eppoved system Inspects).
to Section 16.300 of Title 61310 CMR 16.0001
Company Neme:C.KIN-)i rc Q F\�S d.CC TO i TT O
Mean Address: -Po 2c & .51 5'. G.eed4) al A 0/053
Telephone Number: 'i K(o- 7 r:) Y>
CERTIFICATION STATEMENT
I certify that I have personally Inspected the sewage disposal system at this address and that the Information reported P ep w I.true, accurate
and complete as of the time of Inspection. The Inspection was performed based on my training and experience In the proper function and
maintenance of on-site sewage disposal systems. The system:
-X Passes
_ Conditionally Passes
— Needs Further Evaluation By the local Approving Authority
Fails /' /.f1
Inspectors SignaSignature: Dete: 6A/de
System Inspector shall submit a Spy of this Inspection report to the Approving Authority (Board of Health or DEPiwithin thirty 130)days of
completing this inspection. If the system is a shared system or has a design flow of 1Q000 gpd or greater,the Inspector and the system owner
shall submit the report to the appropriate regional office of the Department onewlronmanM Protection. The original should-be sent IoTM
• system owner and copies sent to the buyer, If applicable,and the approving authority.
TRUDY COXE
Secretary
DAVID B. STRUMS
Contents :obe?
NOTES AND COMMENTS
revised 9/2/98
rote I of I I
0 rthood on Recycled rapt•
SUBSUNf ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PANT A
CERT IFICATTON(eontineed)
Properly Address:
Owner:
D.I•of Inspection:
D. SYSTEM FAILS:
You roust indicate either "Yes" or No to each of the following:
I have determined thet one or more of the following fait Pro cond0ions exist as described in 310 CMR 15.303. The bests for this
determination Is Identified below. The Board of Ilealth sbuadd be contacted to determine what will he neces ery to correct the fir
Yes No
Backup of sewage Into 4ecilitror-erstem component due ao an overloaded or-clogged SAS orcnesponl.
Discharge or muffling of effluent to the a prIncp of the gerund or cur fees waters due ra en overloaded or clogged SAS o
cesspool.
Stalin liquid level in the disbibu don hos alcove millet )rovers due to an overloaded or clogged SAS or cesspool.
Liquid depth In cesspool is less Man 6" below iimert or available volume Is less r
s a,nl 1/2 day flow.
Required pumping more than 4 times in re O Iasi year NOT due to clogged al 0bstructed pipet sl.
Number of tines pumped
Any portion of lie Son Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of n cesspool or privy is within 100 feel of n surface water supply or tributary toe surface water
supply.
Any portion of a cesspool or navy Is within n]are I of a public well.
Any porlion of a cesspool or privy is within 50 feet of a nrivole weber supply well.
Any portion of a cesspool or privy is let -1 ion 100 feet but greater then 50 feet from n private water supply well with it
acceptable water qunlny analysis. If One well has been an nlyeed to be acceptable. all nch copy of well water analysis fo.
cnliform bacteria, volatile orgnnlacmioovnds. anrnonrn nitrogen and nitrate nitrogen
E. LARGE SYSTEM FAILS:
You 1111151 11/11155111 sillier "Yes" or No to ench of rte following::
Ilia following crilerin apply to large systems in addition to Mr criteria 'Move.
The system serves a facility with n design flow of 10,(III0 4gd or greater Merge Sysl and end the system Is n significant threat to I
heNlh and safely end the environment because one or urore of the following conditions esisL
Yes No
Om system is within 400 feel of n.surface(MOM
or supply
the system iewltMn 200 feet of w.lribulary to a aurinwdrNdrMg wider arY -- — . —
the system Is located Ile n nitrogen 11/1115i live wee(Inlerhn Wellhead Protection Area.IWPAI or mapped Zone II of a put
water supply welt/
The owner or operator of nny such system shrill IIpgrarin the 'wen)in nccordencn with 310 OAR 16.30412). Plea se consult the local let/10 office of the Deportment for further Information.
revised 9/2/99
Parr 4 of D
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTINCATION Icon6nued)
Property Address:
Ow
Date or Inspection:
FORMED EVALUATION IS REQUIRED BY TIT BOARD OF I WWII:
Conditions exist which require further evaluation by the Board of Health In order to determine If the system Is felling to protect the
public health. solely and the environment. I
H SYSTEM WILL PASS UNLESS WARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303 111(6)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WTI.PROTECT THE PUBLIC HEALTH AND SAFETY AND TIE FNWBDNMEPT:
_ Cesspool or privy Is within 50 feet of eudece water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh.
21 SYSTEM WILL FAIL UNLESS TIE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: -
_ 1 he system has a septic lank arid soil absorption system ISA5)end the 5A5 Is within 100 feel of a surface water supply or
tributary to a surface wafer supply.
The system hes a septic tank end soli absorption system and the 5A5 Is within a Zone 1 of a public water supply well,
The system has a septic tank and soil absorption system and the SAS Is within 50 feel of a private water supply well.
_ The system has a septic tank and soil absorption system end the 5A5 Is less than 100 feet but 60 feet or more from a
prlvals wafer supply well.unless a well water analysis for coliform bacteria and volatile organic compounds Indicates thst the
well is free from pollution from that facility and the presence of ammonia nitrogen end nitrate nitrogen Is equal to or less
than 5 ppm. Method used to determine distance (approximation not vdidl.
3) OTHER
revised 9/2/98
I' e3 et II
Properly Address:
Ow 0013
Dote of Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
ROW CONDITIONS
RESIDENTIAL:
Design flow:/)/0 uA.d.(bedrnors.
Number of bedrooms'design): 1-11/2 Number of bedrooms IecmntL,3_c/
Total DESIGN flow_ar II
Number of current residents: y
Garbage grinder(yes or no):
Laundry(separate system) 7yee or ; II yes, aepsuselnspectlom mg red
Laundry system Inspected lyee�s
Seasonal use lyes or no):
Water meter readings.If evaileble Iles(two year's usage lggtl): 1J I A
Sump Pump(yes or nol:IJC)
Last dale of occuperteV:CALI/I .1re
COMMERC W LIINDUSIDIAL:
Type of establishment:
Design flow: gpd 1 Based on 16.2031
Basis or design flow
Grease bap present: (yes or no)__
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 6 system: (yes or no)
Water meter readings, II availed/el
Lest dale of occupancy:
OTHER:(Describe)
Last dote of o cupeucy:
GENENII INFORMATION
PUMPING RECORDS and source of information:
-3c-IRa rcs t I99 'J
System pumped as part of ids pection: (yes or n0 *to
It yes. volume pumped: /SOO gallons
Reason for pumping: re ca. (AA/At),
rY •E OF SYSTEM •/
Septic tank kilt i4w1t Trberboil abs nrption eyes em
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) Of yes,attach previous Inspection records,If any)
OA Technology etc.Attach copy of up to date operation end maintenance contract
Tight Tank Copy of DEP Approves
Other
APPROXIMATE AGE of all components, date InetegadB(4nownbend source a4Mlermstiori:
S•wage mb•s detected when arriving at the Ole' (yes or no) FJ
revised 9/2/98
rap 6 of I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Address:
Ysspectien:
the following have been done:You must Indicate either "Yes" or No es to each of the following:
No
Pumping information was provided by the owner. occupant.or Board of Health.
,None of the system compeewda.haaabean puentradrterat least two weeks and Ws eysum hobasaa calalepesamael now
rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this
inspection.
As built plans have been obtained and examined. Note I1 they are not available with NIA
The facility or dwelling was inspected lot signs of sewage backrup.
The system does not receive non-sanitary or Industrial waste 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 wan inspected for condition of belles.
or tees.materiel of construction, dimensions,depth of liquid. depth of sludge, depth of scum.
The size end location of the Soil Absorption System on the site hes been determined based on:''
Existing information. For exempla, Plan m B.O.H.
Determined in the field lit any of the fallyre criteria related to Part C Is at Issue,approximation of distance Is unacceptable)
I I5.30213/(b11
The facility owner land occupents.11 dlfaant hmsuownerl.waaprasddsd.wid lolatmWeuon thaptaparasaInlossamarbrof
Subsurface Dispose?Systems.
rised 9/2/98
Pegs 5 of
suBsunrACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icongruedl
Pfoprty Address:
Owner:
Del.of In.peehon:
TIGHT On HOLDING TANK: (Tank must be pumped prior In, or at time or. Inspection)
(locale on elle plan)
Depth below grade:
Materiel of construction:_concreie petal Fiberglass_Polyethylene otherlexplebd
Dimensions.
Capacity: gallons
Design flow.. gellonelday
Alarm present__
Alenn level: Alarm In working order: Yee No
Date of pre r us Pumping:
Comments. o
(conition of Inlet tee, condition of alarm and float switches,etc.)
olSYGIBUliON nox,il n
novelle on elle plenl
Depth of rmdd level above outlet Invert'.
ColnmemS
(nale II level end dietribulion is equal, evidence al solids carryover, evidence of leakage Into or out el box, etc.)
PUMP CIIAMBEB: NjF
(locale on file plan)
Pumps in working order:(Yee or No)
Alarms in working order(Yes or No)
Commends'.
(note condition or pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98
Pepe 4 or I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION!continued!
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER:
(Locale on site plan)
Depth below grade:5 GO 5)a b
Material of construction:_cast Iron 40 PVC_other leepleinl
Distance from private water supply well or suction line V I it
Diameter
Comments:(condition of joints,venting, evidence of leek ee-etc.I
No FLeololevr S N0}-ed
SEPTIC TANK:
!locate on site plm0
Depth below grader) 'p
Materiel of constructionyf concrete metal_Fiberglass Polyethylene_otherlexplalnl
If tank is petal,list age p_ 1s.ageconOrnad by Certificate ol Compliance_IYeefNo)
Dimension: b CCM 10 /d 1(51/) '£5
Sludge depth cf 1 is.9T 1$
Distance from t p ol sludge to bottom of outlet tee or baffle: 9)L)
Scum thickness: O r'
Distance from top of scum to top of outlet tee or baffle:A)1 19
Distance from bottom of scum to bottom of outlet for or baffle'Lids
Dow dimensions were determined:Q im frintl. f1
Comments:
(recommendation for pumping,condition of Inlet end outlet tees of baffles, depth of l0luid level In relation to outlet Invert,struoture4Mtep tY•
evidence of leakage,etc.) i1.0 w1 ON)t=m S A )C) l eri
GREASE TRAP: (T
)locate on site plan)
Depth below grade:_
Material of construction: concrete natal Flberpinse Polyethylene otherleapleln)
Dimensions:
Scum thickness:
Distance from top el 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:
(recommendetion for pumping,condition of inlet and outlet tees or bellies. depth of liquid level in relation to outlet Invert,structural Integrity,
evidence of leakage,etc.)
revised 9/2/98
Per of II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION IconGoosl
Property Address:
Owner:
Dere of hnpeclion:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at best two permanent rn lerenc.landmarks or benchmarks
locate ell wells within 100' [Locale where public water supply comes into house)
revised 9/2/98
lake IB er l l
SUBSURFACE SEWAGE OISPOSALSYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property AtIckess:
Owner:
Oats of Inspection:
SOIL ABSORPTION SYSTEM(SAS):V'
(locate on site plan, II possible;excavation not required,location may be approximated by non-Intrusive methods)
Iverioce,d, explain:
rnn)enuereA (-AY) A. Ifu,,pec,Fed
Type:
leaching pits, number:—x{-770
leaching chambers,number:_
leaching galleries,number:_
leaching trenches. number,length:
leaching fields, number, dimensions:
overflow cesspool.number:
Alternative system:
Nerve of Technology:
Connnenes:
Mote condition of soli, signs of hydraulic failure,level of pending. demo soil.condition of esp.station. etc.)
Orjj1 apPear5 to ho (- Xcc )le.c)t cnnSA )ti cm.)
CESSI0DLS: nL%q
(locale on site plan)
Number end configuration!
Depth-top of liquid to Inlet Invert:
Depth of solids layer
Depth of scum layer:
Dimensions of cesspool:
Materials of constsucron:
Indication of uroundweler:
Inflow(cesspool must be pumped as part of Inspection)
Comments:
Inoto condition of soil.signs of hydraulic failure,level of pending.condition of'vegetation.etc.)
PRIVY:NM
)locals on silo plan)
Meterfel*of construction: Dimension:
Depth of solids:
•
Comments!
Inure condition of soil,signs of hydraulic tenure,level of pending, condition of vegetation,etc.)
revised 9/2/98
Pose 9or II
Propwty Arkkese:
Owner
Date of■epeetion:
BRCS Report name
Soil Type,
Typical depth to groundwater
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION leonthwsd)
USGS Date website Welted
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells``
Estimated Depth to Groundweter8Feel
Please Indicate all the methods used to determine High Groundwater Elevation:
Obtained horn Design Plans on record
V70, Site IAbutting properly,obaervatlon hole.basement eump etc,)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
y� II -- ,, A v 2[f V C /0 u
S_/'FS- is, 'OiA'F'�J\ 1 k` F'LLI �Xy\ 0.-6>L �� f-
e f._ok ewsAf nr 0.a- CL-b- '-"LV IS.;'
evised 9/2/98
Per 1I of II