579 Septic Inspection 1999 ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
October 19, 1999
Archie Ducharme III
CIO Bob Berniche
19 Audubon Road
Leeds, MA 01053
re: Septic System Inspection at 579 Spring Street, Leeds, MA
Dear Archie & Bob:
Enclosed please find a copy of my report for the referenced inspection. I
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 my inspection in accordance with 310 CMR 15.300,
I 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,
�gne
MichapYJ.
Environmental Engineer
Certified System Inspector
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
MSPECTWN SUMMARY: Check A, B, C. or O:
A. SYSTEM PASSES:
✓ have not found any information which indicates that any of the failure conditions described In 310 CMR 16.303 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 of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no. or not determined (V. N, or ND). Describe basis of determination In all Instances. II "not determined",explain why not
The septic tank is metal,unless the owner or operator hes provided the system Inspector with a copy of a Certificate of
Compliance(attached) indicating that the tank was Installed within twenty 1201 years prior to the date of the Inspection:c
the septic tank,whether or not metal, Is cracked,structurally unsound,shows substantial Infiltration or exfltretion. or tan
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pipel
or due to a broken, settled or uneven distribution box. The system will pass inspection If(with approval of the Board of
Health).
broken pipelsl are replaced
obstruction is removed
distribution box Is levelled or replaced
The system required pumping-more than four limes a yesrdue to broken or obstructed pipelsl. The system willppea.
inspection If with approve] of the Board of Health): •
broken pipets'are replaced
obstruction is removed
revised 9/2/98
Pepe 2 or II
COMMONWEALTH OF MASSACHUSETTS OCT 22
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET,BOSTON MA 02105 15171 292-5500
GC^
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Comtwa.oner
Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
•
property Address:599 SPr in %. Name ofownerArc�hi�utharm2 ?7
teed ml'l o/o s3Adress of Owner X/or+ west Rd
Dune of Inspection: /O-6= q We SthomntuK) mA o/Od7
Name of Inspector:(Reese Print)LY)•L(2171 A1-e_
I an a DO'approved system inspectd/pursuant to Section 15.390 of TMe 5 1310 CMR 15.0001C/0 'Ka t. Pe/ann
Company Name: �AJ111`cia» IaL c_ d ,Ser.tit c4 19 F +l"^— -
Main Address: pC7 Anx .rs I So Le a L •• r n�N O 10
Telephone Number: .S P6 - -Yarn)
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 inspection. The Inspection was performed based on my training and experience in the proper function end
maintenance of on-site sewage disposal systems. The system'.
✓Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature:
The System Inspector shall subfiit a cop p6 this inspection report to the Approving Authority (Board of Health or DEPIwithin thirty 1301days of
completing this inspection. It the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner
shell submit the report to the appropriate regional office of the Department ofEnvironmentet Protection. The original should be sent talkie
system owner and copies sent to the buyer. If applicable, end the approving authority.
Dee: /0/./V199
NOTES AND COMMENTS
revised 9/2/98
Page I of II
0 rnniol on Recycled paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued,
Property Address:
Owner:
Dab of Inspection:
D. SYSTEM FAILS:
You must Indicate either "Yes' or No to each of the following:
I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this
determination is Identified below. The Board of Health should be contested to determine what will be necessary to correct the falls
Yes
No
y/ Backup of sewage Into/acllitrereyetem component Suede an overloaded artNgged SAS-orc•aspoof.
. 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 lass than 6" below invert or available volume is less than 1/2 day flow.
Y Required pumping more then 4 times in the lest year NOT due to clogged or obstructed pipets).
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.
J[ 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-then 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 copy of well water analysis for
-coliform bacteria,volatile organic compounds, ammonia nitrogen end nitrate nitrogen. -.
E. LARGE SYSTEM FAILS:
You must Indicate either "Yes" or No to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10.000 gpd or greater(Large System/end the system is a significant threat to pu
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.wlble 200 feet ofti-wiMdaryae a surfs ad.4.grater wryly - -��-
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area.IWPAI ore mapped Zone II of a publi
water supply well)
The owner Or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local region
office of the Department for further Information.
revised 9/2/98
Pape 4 aril
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of kupecBon:
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 11 the system le falling to protect the
public health, safety and the environment.
1) IS NOT FUNCTIONING W A MANNER WHICIL WILL PROTECT THEePUBLIC RHEALTH AND SAFETY AND THE ftB1tJBONMBR:SYSTEM
_ Cesspool or privy is within 60 feet of surface water
Cesspool or privy is within 50 feet of s bordering vegetated wetland or a salt marsh.
ZI
SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTBB f4
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system!SAM and the SAS is within 100 feet of a surface water supply at
tributary to surface water supply.
The system has a septic tank and volt absorption system and the SAS is within a Zone I of a public water su pply well.
_ The system has a septic tank and soil absorption system and the SAS Is within 60 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and the SAS H less than 100 feet but 60 feet or more from a
private water supply well,unless a well water analysis for conform bacteria and volatile organic compounds indicates that the
well Is free from pollution from that facility and the presence of ammonianitrogen
tr ge end nitrate nitrogen is equal to or leas
than 5 ppm. Method used to determine distance (approximation
31 OTHER
revised 9/2/96
pig.J of It
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner:
Data of inspection(
FLOW CONDOIONS
RESIDENTIAL: UJY
Design flow: c.o.d./bedroom
Number of bedrooms(design): Number of bedrooms tactual):_
Total DESIGN flow
Number of current resldenis:
Garbage grinder(yes or no):
Laundry (separate system/ (yes or not: ; If yes,sepeutelnspecllon.required
Laundry system Inspected (yes or no)
Seasonal use(yes or no):
Water meter readings,if available(last two year's usage(gpol:
Sump Pump)yes or no):_
Last date of occupancy:
COMMERCIAL/INDUSTRIAL:
Type of establishment: /f a Ch I AA? Sho p
Design Row: Lila pod I Based on 15,2031
Basis of design flow
grease trap a present: (yes a re p
Non-sanitary on Waste to Holding Tan present: itlet system:e A7O
Water me waste s,if available:to the Title 6 system: lyas or�r/JO
Water melee readings,if aveileble: T>//i
Last date of occuPencyr.0 r/��Z'.LLot 1
OTHER: (Describe) Sys eiv— curves 0_ SiM1Sj� 46i LT- ( SiIJ
Lest date of occupancy: /
GENERAL INFORMATION
PUMPING RECORDS end source of Information;
A)OA)! nuni) No
System pumped as part of inspection:(yes ore a)O
if yes, volume Pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
I/ Septic tank/diestlbdtion-bae/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (it yes, attach previous Inspection records,if any)
IIA Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components.date lnstaged40 l r ownband source efinlermetion.
Sewage odors detected when arriving at the site:(yes or no)KO
revised 9/2/98
Page 6 of N
Pc[L cyLumi
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART 8
CHECKLIST
Property Address:
Owner:
Date of Inspection:
Check If the following have been done:You must indicate either "Yes" or "No" as to each of the following:
Ye
es No
/s
Pumping information was provided by the owner,occupant.or Board of Health.
1L _ Nona of the system components haaabean pampsdderel lost two week*ardYerNstem h.sSwaeSaiq ems'Pow
during that period. Large volumes of water have not been Introduced into the system recently or as pert of this
inspection.
An As built plans have been obtained and examined. Note it they are not available with NIA.
The facility or dwelling was Inspected for signs of sewage back-up.
The system does not receive non sanitary or industrial waste flow.
N _ 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:
1./ Existing information. For example, Plan at B.O.H.
_ Determined in the field iii any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
06.30213/W11
_ The facility owner land occvpants.if cliff want homawnsr).wueprnsddedpuith Wnunallon.an Wspsopazsabztanapsanf
SubSurface Disposal Systems.
revised 9/2/98
rage 5 of O
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM WFORMATION(continued)
Property Address:
Owner:
Dude of bnpectior:
TIGHT OR HOLDING TANB:).))4 (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 otherlexplainl
Dim :
Capacity: gallons
Design now: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes _ No
Date of previous pumping
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION B0)(: )IA
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note If level and distribution is equal, evidence of solids carryover, evidence of leakage Into or out of box, etc.)
PUMP CHAMBER: A))4
(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,roc.'
revised 9/2/98
Pile or II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION feaNrued)
Property Address:
Owner:
Dote of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below u •r
u
Material of construction:
ZCast iron_e0 PVC_other lespleln)
Distance horn private water supply well or suction line F.)/R .
Diameter J
Cotrrmants: (condition of Joi a venting, evidence of leake.-etc.)
1V0 �Ltcbf ry
fms 130+rd
SEPTIC TANK:
Ilocete on site pisnl
Depth below Pnde:"• I fi
Materiel of construction:1oncrete_metal_Fiberglass Polyethylene_otherleeplainl
If tank is metal,list ego/_CC Is age.coonnlbmed by Certificate of Compliance (Yet/No)
in
Dimensions:y 'x,q P.) X '7 FX-7 II bL)
Sludge depth: 4 "-Se if
Dlstence from top of sludge to bottom of outlet tee or baffle:X_
Scum thickness: .v0
Distance from top of scum to top of outlet tee or baffle: yv/A
Distance from bottom of scum to bottom of outlet t or baffle: /40.79 How dimensions were determined: �
Comments: entity,
• (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, steulNrikreo t
evidence of leakage,etc.) /V C) Pro flit vv.s K. ri •
GREASE TRAP:U LS.
(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(exPleinl
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tae or baffle:_
Dote of lest pumping:
Comments:
)recommendation for pumping.condition of inlet and outlet tees or bafes,depth of liquid level In relation to outlet Invert,structural Integrity,
evidence of leakage.etc.)
revised 9/2/98
Page 7 of It
SUBSURFACE SEWAGE DISPOSAL SYSTEM MSPECTJON FORM
PART C
SYSTEM INFORMATION Icontisnd)
Property Address:
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to et least two permanent reference landmarks or benchmarks
Meets all wells within 100' (Locate where public water supply comes Into house)
f & w.�er�><,atiof
M✓satoac2N0 ry yJiy
revised 9/2/98
Page 10 of It
SUBSURFACE SEWAGE DISPOSAL SYSTEM MSPECTION FORM
PART C
SYSTEM INFORMATION Icondrued)
Property Address:
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): 17
(locate on site plan,it possible:excavation not required,location may be approximated by non-Intrusive methods)
II not located, explain:
u.0 aF
Type:
leeching pits,number:)
leeching chambers, number:_
leaching galleries,number:_
leeching trenches,number,length:
leeching fields, number,dimensions:
overflow cesspool,number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level 1 mantling, damp soil,condition of vegetation. etc.)
/ p1+ bu l i o6 Sto Lie - �'-Inme mat d e
CESSPOOLS:ti a
Closets on site plan)
Number and configuration-
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materiels of construction:
Indication of groundwater:
Inflow(cesspool must be pumped as pert of Inspection)
Comments:
(note condition of soil, signs of hydraulic failure,level of pending,condition ef,vegetetion, etc.)
PRIVY: g)iF1
(locate on site plan/
Materiels of construction:
Depth of solids:
Comments:
/note condition of soil, signs of hydraulic failure,level of pending condition of vegetation;etc.)
Dimensions:
revised 9/2/98
Page 9 0l II
Property Address:
Owner:
Dm or McPeo4m:
NRCS Report name
Son Type
Typical depth to groundwater
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icon uutdl
USGS Date w•bsite visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells //
Estimated Depth to Graundweterr> Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
✓Observed Site(Abutting properly. observation hole, basement sump etc.)
I/Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
✓Checked local escevetars,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
/JYGCt_S-V✓s ex - ter CdbP 6C IJ r.O/
■Lw/lr{i).e_ der ti/ e.FRac-ed 20-eve /y fli 7r/ %le
a.oJctee-ti•
revised 9/2/98
Pugs t1 of11