151 Maple Ridge Rd Title 5 Report 2020t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
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
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
A. Inspector Information
Alan Weiss
Name of Inspector
Cold Spring Environmental Consultants, Inc.
Company Name
350 Old Enfield Road
Company Address
Belchertown
City/Town
MA
State
01007
Zip Code
413-323-5957
Telephone Number
Title V System Inspector #738
License Number
B. Certification
I certify that:I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000);I have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1.Passes
2.Conditionally Passes
3.Needs Further Evaluation by the Local Approving Authority
4.Fails
Inspector’s Signature
11/13/2020
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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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 at a single family residence was inspected and no evidence of failure was found.
Liquid levels were at the outlet inverts of the septic tank and distribution box with no evidence of high
staining. Property was occupied by 1 persons, and the system is approximately 28 years old.
Distribution box and septic tank were in good condition. Septic tank should be pumped every two to
three years and the outlet filter checked annually. The septic tank inlet and outlet risers were replaced
and flow levelers added to the d box. The pipe exiting the septic tank was also broken and repaired.
2) 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 N ND (Explain below):
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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):
3)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.
a. 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:
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
C. Inspection Summary (cont.)
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
b. 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.
c. Other:
4) 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
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
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 ½ day flow
Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped: .
Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of 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 1 of a public water supply
well.
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 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.]
The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
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.
5) 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 C.4.
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
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
C. Inspection Summary (cont.)
If you have answered “yes” to any question in Section C.5 the system is considered a significant
threat, or answered “yes” to any question in Section C.4 above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6.You must indicate “yes” or “no” for each of the following for all inspections:
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)]
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information
1.Residential Flow Conditions:
Number of bedrooms (design):4 Number of bedrooms (actual):4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms):733
Description:
Septic system consists of a 1,500 gallon septic tank with concrete baffles, a distribution box and four
trenches 30' L x 2' W x 1.25 H.
Number of current residents:1
Does residence have a garbage grinder?Yes No
Does residence have a water treatment unit?Yes No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.)Yes No
Laundry system inspected?Yes No
Seasonal use?Yes No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
it is recommended that the tree next to the septic tank be cut (stump left) and the garbage disposal
be removed.
Sump pump?Yes No
Last date of occupancy:Current
Date
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
2.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
Water treatment unit present?Yes No
If yes, discharges to:
Industrial waste holding tank present?Yes No
Non-sanitary waste discharged to the Title 5 system?Yes No
Water meter readings, if available:
Last date of occupancy/use:Date
Other (describe below):
3.Pumping Records:
Source of information:Owner: Pumped 2 Years Ago.
Was system pumped as part of the inspection?Yes No
If yes, volume pumped:1,500
gallons
How was quantity pumped determined?Measured
Reason for pumping:Inspection
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
4.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.
Other (describe):
Approximate age of all components, date installed (if known) and source of information:
System is approximately 28 years old based on construction materials & records.
Were sewage odors detected when arriving at the site?Yes No
5.Building Sewer (locate on site plan):
Depth below grade:2.5
feet
Material of construction:
cast iron 40 PVC other (explain):
Distance from private water supply well or suction line:Over 10'
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
6.Septic Tank (locate on site plan):
Depth below grade:2.0
feet
Material of construction:
concrete metal fiberglass polyethylene other (explain)
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:18"
Distance from top of sludge to bottom of outlet tee or baffle 18"
Scum thickness 6"
Distance from top of scum to top of outlet tee or baffle 6"
Distance from bottom of scum to bottom of outlet tee or baffle 12"
How were dimensions determined?Measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The 1,500 gallon septic tank was structurally sound with no evidence of leakage. Concrete baffles
(inlet and outlet) were in place and functioning as designed. Liquid level was at the outlet invert with
no evidence of high staining. New inlet and outlet risers were added.
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
7.Grease Trap (locate on site plan):
Depth below grade:feet
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:Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8.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
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
8.Tight or Holding Tank (cont.)
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 No
9.Distribution Box (if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert @ Outlet Inverts
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.):
Distribution box was located, inspected and found to be level with equal flow to the outlets. Minimal
solids carryover was observed. No evidence of leakage (box was 2.5' below surface grade). Flow
levelers were added to balance flow .
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
10.Pump Chamber (locate on site plan):
Pumps in working order:Yes No*
Alarms in working order:Yes No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11.Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
leaching pits number:
leaching chambers number:
leaching galleries number:
leaching trenches number, length:30'L x 2' Wx 1.25'
H
leaching fields number, dimensions:
overflow cesspool number:
innovative/alternative system
Type/name of technology:
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
11.Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
No evidence of hydraulic failure, ponding or damp soil conditions was observed. System was
functioning as designed.
12.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
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
13.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.):
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
14.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
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
D. System Information (cont.)
15.Site Exam:
Check Slope
Surface water
Check cellar
Shallow wells
Estimated depth to high ground water:4'+ Below Leaching Area
feet
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed:1992
Date
Observed site (abutting property/observation hole within 150 feet 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:
Based on topography & observed setting and records from 1992.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 18 of 18
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
151 Maple Ridge Road
Property Address
James Osofsky
Owner’s Name
(Florence) Northampton
City/Town
MA
State
01062
Zip Code
11/13/2020
Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
A. Inspector Information: Complete all fields in this section.
B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
D. System Information:
For 8: Tight/Holding Tank – Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
1
M 3 \ A I II it ONI‘ISI‘)(3
, \ •
1
A --- m
/
v."
— - - ,
vii>c — .A.713 AO/dOl i
1 1
CA+ 1
1
1 1
1
1
ovic 7T-roe-
N
1
I I
1 11
I
I
PLAN NEW CROSS SECTTOW.
PRECAST DISTRIBUTION anx BY
ROTCEDO OR EQUAL
TYPICAL DISTRIBUTION BOX
NOT TO SCES
II
71 1/r - TA WASHED PEASTOME
.1-
ItfliEv041tO—,9'
"1
ood T
PPE 0.0.„ 3/0 1/2T TVA.FD STD. • 25,
LEVEL NATURAL BASE
LEACH TRENCH DETAILS
NOT 10 SCALE
REMOVE ALL EPEREABLE SOIL AND PROVIDE
CLEAN, WASHED, AND COMPACTED SAN, BELOW TRENCH AND RAND IN ACCORDANCE WON Trrtz V REGULADONS.
TEST PIT
EL., 311.0
CROSS SECTION
TYPICAL SEPTIC TANK
NOT 10 SCALE
DATE 22-B6
BO. OF OILETT PETER TEMA.
ENGINEER: PHAR1AER ENG. CORP.
TEST PIT 1314(341.0;
SCE 0-12T TCPSGE
12"-14' SILTY SLIME t4'-BC COMPACT ALIN ILL
PERC RAM 3 MIN/112. 000 GE AT 50• (336.1y
RENO. ALL UNPLECABLE SOIL AND NEMEC
CLEAN. RASED. MO GLEIPACTED SNN BELOW T
WI
RENCH AND
V REGULA
TN 7.5. BAND P7 ACCORDANCE
TH TITLE TIONS
SEPTIC -AWL
DESIGN WITH GANDA MINDEN
• BEDROOTETT.ALLBORME2; • ROD GAL
USE 1500 CAL. TEPTIC_JEE_
ISACNWG 150101
USE 5 143./IN. FOR DESIGN
CRS. Flow: ¨ M.O., EALEFONNXT.S: • 060 SLOEVEL RATE/ 1.63 04.1119 SOFTEN RATE: 0.77 GAL/FX
uFE • TRENCHES - 10 LANG r 'WIDE - 1.25' DEEP
SOP1091,
30(2X1.25X183 GAL/S.(4) • 5E1 SAL
ROME
30(210-77 GAL/SEX. • TIER G.-
TOTAL GAL • 50/ ¨ 154.0 • 733 GAL > 660 HA TOTE AREA A 300 • 240 • 540 S.F.
DESIGN DATA — — — SOIL PROFILES
NOTES:
Sw
343
342
341
300
33•
3313
337
336
335
334
333
332
se
Q
n
•Are NAME
Mohr' IRTnIm
EKE
03.75
TRENCH LAYOUT 17=
SCES: • 10'
L.=
v2.2
r7,/
FETEErni• 2
T. WATER 11.1 SEAL BY .OUT. FOR PIPES ENTERING ON LEAN. CONCRETE STRUCTURES.
T. 113.03 STONE SHALL BE FREE CP TON. FEES, DUST. AND ORGANIC MATTER
3. NO MODIFICATIONS IMTHOUT APPROVAL OF ENGINEER ANO 90001 OF EALTE
I. ALL COMPONENTS TO BE INSTALLED N ACCORDANCE NTH TILE 5 OF DE STATE
ENNTIONIOITE CODE AND ALL APEX-ATE LOCAL WAND OE Am, RULES.
5 THE SYSTEM SHALL BE INSPECTED ERN LEA.ING AREA IS COMPLETE,
EXCAVATED AND AGAIN MIEN ALL COMPONENTS ARE IN PLACE. CONTRACT. SI1AU. NOTIFY THE 80AR13 OF HEALTH WHEN INIECTTON IS REQUIRED.
1. NO HEAVY FOLOPM7 IS TO OPERATE OVER THE UNITS OF THE SYSTEM DJFING N. AFTER THE COURSE OF CONSTRUCT. Of THE SYSTEM.
7. ALL MKS JOINTS Of THE BOLDING SETTER SHALL FE MEE WATERT.,
5 ALL SHIPLAP JOINTS IN SEPTIC TANK TO BE SF-A1.3 MTN NEOPRENE GASKETS OR ASPHALT CEMENT-
p.
A CERTFICATE OF COMPLIANCE AS oSSJED BY THE BOARD GP HEALTH MUST N. °STARED BY THE CONTRACTOR UP. COMPLETION Of DE SYSTEM.
Ha. Al ALL POINTS ET INTERSECTION OP WATER AND SETTER LINER cuss 150 PRESSURE PIPE SHALL BE 145TAL1ED FOR BOTH POPES 10 FEET EITHER SIDE OF NIERSECTION.
11. STRUCTURE 10 HAVE CAST RCN OR CONCRETE COMB BUILT UP 13111 BRICK AND MORTAR TO WITHIN IT NOES OF FINISHED GRADE.
LEGEND
DaSTING GROUND
FINISHED GROUND
SERT.0 TANK
DISTRIBUTION BON
DeSERVADON Hat
PRE EVERT ELEVATION
SCHEDULE 40 P. Pol.
LEACANG FIELD
RESERVE AREA
SEE OCT.. ATONE
FOR TR.. ELEVATIONS. PPE INER15 AND REVERSE
DIST. BOX INVERTS 3)
SEPTIC SYSTEM DETAILS
FOR
aMES OSOFSKY LEA. TRENCH
REMOVE NJ. UNPERDABLI SOIL WD PRoVitA CLEAN. WASHED.•OuPETED S., ...L TRENCH AND IN 25 BANO ACCOPOANGE ow WIN TELE V ...TONS
NORIFIAMPTON, HAMPDEN COUNTY. MASS
TYPICAL SYSTEM PROFILE 13440 MAY 5. 1192 502. SEE ABOVE Drawl. NE TlitrillWrIMMTM119.• NOT TO SCALE
JA-TF I DESORPTION
NNMP-106-117
00. .o.e. SHEET 2 OF 2
SYSTEM CROSS—SECTION
.
PROPERTY INFORMATION 10.1..,1 FROM Pao.
ENTITLED 'LAYOUT PLAN' BY THE BEft5NI0E DESIGN GROUP, DATED 5-28-87 SHEET
HOUSE LAYOUT AND NOUSE GRADING !MN
FROM PLAN PREPARED BY SUE RECD ENTRUT PLAN MTH GRADING" %TED 4 -9Z
r7; • 94
DATE
cR e N ,C a Ne1.1
DESCRIPTOR tIPPL
BENCHMARKS
BENCHMARK TOP Of HYDRANT - FROM Of LOT 15 318.05
BENCHMARK #1
TOP Of STARE 3.4 TREE ELEV. 021.98
0 DENCHLMAN 11
TOP Of STARE P1 TREE ODD. 340.41
OVERALL PLAN — LOT 15
FOR JAMES OSOFSKY
NORTHAMPTON, HAMPSHIRE COUNTY, MASS
091.- MAY 5, 1992 ISusic SEE ABOVE Drawl, No. k 111 leN.D4-110 D, 279-01 weee,„_,06-117
81015100. Mn eee 00199, 01060 SHEET 1 OF 2
1
Alan
From:Alan Weiss <Aeweiss@charter.net>
Sent:Wednesday, November 25, 2020 8:30 AM
To:Alan Weiss
Subject:151 Maple Ridge
2
Alan E. Weiss, LSP, MS, RS
Principal Hydrogeologist
Cold Spring Environmental, Inc.
P: 413.323.5957
EM: Aweiss@ColdSpringEnvironmental.com
1
Alan
From:Alan Weiss <Aeweiss@charter.net>
Sent:Wednesday, November 25, 2020 9:02 AM
To:Alan Weiss
2
Alan E. Weiss, LSP, MS, RS
Principal Hydrogeologist
Cold Spring Environmental, Inc.
P: 413.323.5957
EM: Aweiss@ColdSpringEnvironmental.com