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315 Title 5 8-29-16 . Commonwealth of Massachusetts J" ' Title 5 Official Inspection Form wa Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e.-MIT a io-* 315 Sylvester Rd., Northampton _ __ -_ Property Address -- 315 Sylvester Rd. d Owner Owners Name __—.- —_-�._ ---.------_/1/4 informationeis Northampton Ma 01060 14342.6)14* Q tVo required for every p2'9 page. City/Town State Zip Code Date of Inspection /� D. System Information (cont.) Cb Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ® drawing attached separately N ci it Sc P L Z GI too • I 2� pS�"t� �* �\C L "/ E G h.-Ct i l E 5 (3) ytwt! tat © �_ L coi t500 .h. .1 I, Ato c l ` Ato Z6 1 V ilAn C t5.5-1 JzJJ I.; +c D 'ii `V; t ' 4 -Y, E1 45 /( f340El 421 t tSins•3113 Title 5 Official tl spatt on Farts:Subsurface Sewage Disposal System•Page 15 of 17 • -.;::or PI 1411 R.. ice.' .... �..,,,.,:,�.�. ^--.... ( . irE PLAN LEGEND I t .•• . ,a s;ma vjt 4 I SYSTEM PROFILE I -___.._._._ ` I ! ,• l_,_ ,/UlERV DLTA1L ,k l 1 ,• I s .. .Fi S I I ' _______J HILL TOWN ENVIRONMENTAL CONSULTING11 1 __ . li. 5E4YA('K DISPOSAL SYSTEM 1 , f Y k4 Oa r,f•.. ' 'r„,. P.0 BOX 22C, NORTH HATFIELD MA 0106( PARal nCIea1nrttE9} t }L r. e:r ; r eriYEBTERROAD 7 riCE.MA viv.i . ,:�y ✓�'' (41 )247-5464 F:tucni MPTGIL,. , t 11 «:,.so"'. -� Septic Tank Outlet 43 Long Plain Road Leverett MA 08.24.2016 • S • 1 • !t. {' t' ti.��► -rr rr, �tynsc:_ tea:- . 4).' '''''''''17 ... ,. T iPtt P ', a` : 3 ..1 .."� r .91.}1,-9% , , 1,,, ...1;. ':', -;.' ..:',.,., t . " '' ,........,..c ., , -.•. \ , jj A 4r`7 ,{\.c.> Ci.x... • 3 F 4,.. r r Commonwealth of Massachusetts a= Title 5 Official Inspection Form 15-111t_ 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 315 Sylvester Road Property Address c/o Linda Rotti: Jones Group Realtors: 200 Triangle Street: Amherst, MA 01002 Owner Owners Name information is Northampton (Florence) MA 01062 8/29/2016 required for every P ( page. City/Town Slate Zip Code Date of 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: The septic system consists of a 1,500 gallon concrete septic tank connected to three, 750 gallon leaching tanks connected in a galley formation (15W x 38'L x 2'H). Liquid levels in the septic tank were at the outlet invert with no indication of leakage or high staining. The septic system serves a 4 bedroom home with no residents at the time of inspection. The leaching tanks had no standing liquid below the inlet pipe and no high staining was noted into or above the inlet inverts. The septic tank was pumped as part of the inspection. 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. Check the box for"yes", "no"or"not determined"(Y, N, ND)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. ❑ Y 9 N 9 ND (Explain below): isms'3113 Title 5 omoa inspeclion Form Subsurface Sewage Dlsposai System Page 2 of 17 cts Commonwealth of Massachusetts Title 5 Official Inspection Form 1.4 ii Subsurface Sewage Disposal System Form- Not for Voluntary Assessments iii 315 Sylvester Road Property Address c/o Linda Rotti: Jones Group Realtors: 200 Triangle Street: Amherst, MA 01002 Owner Owner's Name information for is Northampton Florence MA 01062 8/29/2016 required for every P (Florence) - -- page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1 Inspector: key to move your cursor-do not Alan Weiss use the return Name of Inspector key Cold Spring Environmental Consultants, Inc. 4 O Company Name ��-��-VVVVVV 350 Old Enfield Road Company Address Belchertown MA 01007 City/Town State Zip Code 413-323-5957 _ Registered Sanitarian #933 Telephone Number License Number 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 `--- 8/29/2016 Inspector's Signature Date 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. tsms.3/13 Tule 5 Official Inspection Form Subsurface Sewage D.sposal System.Page 1 of 17 Commonwealth of Massachusetts — Title 5 Official Inspection Form -�'- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments * , - 315 Sylvester Road Property Address do Linda Rotti: Jones Group Realtors: 200 Triangle Street: Amherst, MA 01002 Owner Owners Name information is pag .required for every Northampton (Florence) MA 01062 8/29/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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. ❑ 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 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 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 1/:day flow 151ns.3113 Title 5 Olfiaal Inspector)romm Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Ngl - Title 5 Official Inspection Form C +y, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "' 315 Sylvester Road _"' Property Address c/o Linda Rotti: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owner's Name information Is Northampton (Florence) MA 01062 8/29/2016 required for every ( ) .__ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 runs•3/13 The 5 omraal Impec4on Form:subsurface sewage olsposa System•Page 3 of 17 Commonwealth of Massachusetts Sri p Title 5 Official Inspection Form -�__ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments tl Mt-41 s a 315 Sylvester Road Property Address c/o Linda Roth: Jones Group Realtors: 200 Triangle Street: Amherst, MA 01002 Owner Owners Name information is Northampton (Florence) _ MA 01062 8/29/2016 page. for every P page. City/Town 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) ® ❑ 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? ® ❑ 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: ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 516 bins•3/13 Ties orfiaa IOspecton Form:Subsurface Sewage Dispose!System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ( Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 315 Sylvester Road _ Li Properly Address Wo Linda Rotti: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owner's Name Inquired for is Northampton Florence MA 01062 8/29/2016 equina far every P (Florence' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: . ❑ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Z Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z 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.] ❑ Z The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ Z 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. 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 O ❑ the system is within 400 feet of a surface drinking water supply ❑ 0 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. r5ms•3113 idle 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts rg Title 5 Official Inspection Form F Ark Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 315 Sylvester Road Property Address c/o Linda Rotti: Jones Group Realtors: 200 Triangle Street: Amherst, MA 01002 Owner Owners Name information is required for every Northampton MA 01062 8/29/2016 (Florence) Page. GitylTown State Zip Code nate of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? 0 Yes ❑ No If yes, volume pumped: 1,500 gallons How was quantity pumped determined? Measured Reason for pumping: Inspection and need. Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative 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. O Other(describe): Septic tank and leaching tanks. ts,os.3^10 Mlle 5 Official Inspection Fom[Subsurface Sewage Disposal System•Page 8 0117 Commonwealth of Massachusetts Title 5 Official Inspection Form I,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 315 Sylvester Road Property Address - - c/o Linda Rotti: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owners Name reformation Is every Northampton (Florence) infomitlfor eve P ( orence MA 01062 016 Date of page. City/Town Slate Zip Code Date of Inspection D. System Information Description: The septic system consists of one 1,500 gallon septic tank with three 750 gallon leachtanks in a galley formation. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes Z No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Laundry was connected to main system. Sump pump? ❑ Yes Z No Last date of occupancy: Vacant Over a Month Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): -- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Isms.3113 Tire 5[Mad mspscton Form:Subsurface Sewage Disposal System.Pagel or 17 Commonwealth of Massachusetts r-= Commonwealth of Massachusetts Title 5 Official Inspection Form 11u Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 315 Sylvester Road Property Address — do Linda Roth:iJones Group Realtors: 200 Triangle Street: Amherst, MA 01002 Owner Owner's Name information is required for every Northampton (Florence) MA 01062 8/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System is 15 years old based on BOH Permit from 2001. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1.75 Depth below grade: feet feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10' + feet Comments(on condition of joints, venting,evidence of leakage, etc.): The building sewer was in good condition with no evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 1.25 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) The 1,500 gallon concrete tank was in fair condition with no evidence of leakage. Intact PVC inlet and outlet tees with risers to 6"of surface were present. Liquid levels were at the outlet invert with no evidence of high staining. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5'x 5.5'x 4.2' Sludge depth: 12" 151m.3113 Lee 5Official Inspection Form'Subsurface Sewage D spoaal System•Page 9 of 17 Commonwealth of Massachusetts S,-. 'Il 7 Title 5 Official Inspection Form • Commonwealth of Massachusetts Title 5 Official Inspection Form -�1,I'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `r 315 Sylvester Road Property Address c/o Linda Rotti: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owner's Name information is required for every Northampton (Florence) MA 01062 8/29/2016 page. 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, 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): 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 E No t5ns•3/13 llk 5 Olual mepenon Form.Subsurface Sewage Dleposa System.Page n of 17 Commonwealth of Massachusetts , - 1__� Title 5 Official Inspection Form ! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o 315 Sylvester Road Properly Address C/0 Linda Rotti: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owner's Name required for Is Northampton (Florence) MA 01062 8/29/2016 page.etl(or every ,pp9e. City/Town Stale Zip Code Dale of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of pending, 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.): 15ns•3n3 Tine 5 omtlaunspe000n Form Subsurface Sewage Disposal System•Page 14 of IT Commonwealth of Massachusetts 5 2 Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ar 315 Sylvester Road Property Address - - c/o Linda Rotti: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owners Name information is required for very Northampton (Florence) MA 01062 8/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: leaching chambers number: 3: 750 Gallon ❑ leaching galleries number: ❑ leaching trenches number, length: - ❑ leaching fields number, dimensions: - ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: -- Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leaching tanks had no standing liquid with 24"of effective height. No high staining or ponding was noted. No damp soil, impacted vegetation or evidence of hydraulic failure were observed. 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 ISins.3/13 Tine 5 Official Inspecton Form:Subsurface Sewage msoosel System•Par 13 of 17 Commonwealth of Massachusetts iiiiTitle 5 Official Inspection Form /- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.`�' , 315 Sylvester Road Property Address do Linda Rotti: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owner's Name inb fired fNorthampton or every (Florence)o is required fMA 01062 8/29/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Z Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: ffeeet Please indicate all methods used to determine the high ground water elevation: Z Obtained from system design plans on record If checked, date of design plan reviewed: 2001 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Attached record from 2001. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Work in area, topography and no evidence of groundwater in leaching tank in the high groundwater season. The septic inspection report from 2014 was also referenced. Before filing this Inspection Report, please see Report Completeness Checklist on next page. thins.3113 Title 5 Official Inspection Fenn.Subsurface Sewage Disposal System.Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ryl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 315 Sylvester Road Property Address c/o Linda Roth: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owners Name information is Northampton(Florence)) required for every MA 01062 8/29/2016 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately Rens•3/13 mae 5 Official Inspection Fore:Subsurface Sewage Disposal Syslem•Page 15 of 17 .`�du1` p tt r Basement Sewer Outlet 315 Sylvester Road Northampton, MA 08.28.2016 Commonwealth of Massachusetts Title 5 Official Inspection Form =11- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 315 Sylvester Road Property Address c/o Linda Roth: Jones Group Realtors: 200 Triangle Street:Amherst, MA 01002 Owner Owner's Name requiralionis every Northampton (Florence)inforr anon eve P ( orence MA 01062 8/29/2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, 8, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information–Estimated depth to high groundwater • Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file tslns•3/13 Title 5 Official msparnon Form:Subsurface Sewage Disposal Syslem•Page 17 of 17 ` t0 it R " .' b C4 H. 0 x H * i �u a moi" Fy ' 9 .. fix i v < .`P _ a µf 4f ` " k " " ' _ t M a "�,}*' tt-�Q' At syy 1 � i pF';�: ;; y.4 + *gf Septic Tank Outlet Tee 315 Sylvester Road Northampton, MA 08.28.2016 3 - � W • _ ,.. r w u L� b „m, Septic Area 315 Sylvester Road Northampton, MA 08.28.2016 Commonwealth of Massachusetts 1. -ft Title 5 Official Inspection Form ll 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 0 •°".,; „:d ' 315 Sylvester Rd., Northampton _ Property Mantes , _315 Sylvester Rd_ Ovmer Owner's Name rMuired for Is Northampton Ma 01060 1&264+ Q 2jta page- for every CaV/Town State Zip Code Date of Inspection (PO Pr D. System Information (cont.) Sketch Of Sewage Disposal System' Provide a view 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.Check one of the boxes below: ® hand-sketch in the area below O drawing attached separately Net i- SCALE (4 loo k / i 0 c 1 o J v -1 caT t3 eL�J� L tSaoc,M IN,-to..) / / ! T A roitis w I Ato C i .A to > 264-f V 3to C 1$.S' ) � 13 tc D NI 1 �� t 4G Es 421 i r IS'ns•yla TWO 50n arrivalImpaction Fam: +nib.Sewage Disposal Syeun.Page 15 N 17 i ,E} `•"p„" .t _.meq, x 4Kyp•��q ; Pt i.^"^�} +. t• tvtlr f "gyp F .rr'f r .+„� '•yW .x t . a a .,.,.,..:• ..ifs f "^ 3 sC::�'��fY4"' x 4 -m44• +a 1 .. 4,0704 faf " • u rva Septic Tank Outlet 43 Long Plain Road Leverett MA 08.24.2016 • / _ ' \ / . \ � \Z • \ » . \ . . . . . Y .����