228 Septic Inspection 2015 Owner
information is
required for every
page.
thins•3l3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON --( LEEDS ) MA. 01053 April 28, 2015
City/rown State 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:
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 ❑ N ❑ ND(Explain below):
Tick 5 Official Inspection Form:Subsurface$swaps Disposal Sys(
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thins 3/13
eV- St,/5 SS
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON —( LEEDS)
City/Town
MA. 01053' April 28, 2015
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.
A. General Information
1. Inspector:
PHILIP J. PASIECNIK
Name of Inspector
GREG'S WASTE WATER REMOVAL
Company Name
239 GREENFIELD ROAD _.
Company Address
SOUTH DEERFIELD MA.
City/fawn State
413-665-3989 511526
Telephone Number License Number
01373
Zip Code
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
'1�`bKtta[t 4
April 28, 2015
Inspect' s . ure 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.
hue s Official Inspection Form.Subweace Sewage DLSPes8I System Page 1 of
Owner
information is
required for every
page.
t5ins•3m3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner's Name
NORTHAMPTON —( LEEDS ) MA. 01053' April 28, 2015
City/Town State Zip Code Date of Inspection
B. Certification (coot.)
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
❑ N Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ z Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ N Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ N Liquid depth in cesspool is less than 6 below invert or available volume is less
than 1/2 day flow
The 5 orinal Inspection Form:Subsurface Sewage Disposal System•Page 4 of n
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON--( LEEDS) MA. 01053 April 28, 2015
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 E N E 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 E N E 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
Isns•333 /
Title 5Official Inspector Form Subsurface Sewage Disposal System•Page 3 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON --( LEEDS ) MA. 01053' April 28, 2015
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 Of 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): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
330 qpd
15ins•3/13 Tale 5 OMiaal Inspedion Farm Subsurface Sewage oisryul System.Page 6 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON --( LEEDS)
City/Town
MA. 01053' April 28, 2015
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.
❑ E 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.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
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.
❑ Z
❑ Z
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
❑ ❑ 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
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.
thins•313 / Title 5 nllltlal trspecbcn Form.Subsunaa Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner Owners Name
information is NORTHAMPTON-- LEEDS MA. 01053' Aril 28, 2015
pagerequired for every ( ) P
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
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
How were dimensions determined?
18"
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.):
Recommendation for septic tank
pumping is at least every three years. PVC Inlet and outlet tees were in place and appeared to be in
good condition. No outlet filter was in place as plan proposed. The single compartment septic tank
appeared to be in good structural condition. Design Plan proposed a two compartment tank. The
liquid level was at the outlet invert. No leakage was visible at this time. Covers were 10"deep.
Grease Trap(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete
N/A
❑ metal
N/A
feet
❑ fiberglass ❑ polyethylene ❑ other(ex am):
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:
N/A
N/A
N/A
N/A
N/A
Date
tams•3113 Title 5 Official Inspection Forth.Subsurface Sewage Disposal System.Page IC of 17
Z\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Owner
information is
required for every
Page,
15Ins•3/13
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON --( LEEDS.) MA. 01053' April 28, 2015
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed Of known)and source of information:
13 Years Old +/- / 2002 / Design Plan Dated May 28, 2002
Were sewage odors detected when arriving at the site?
Building Sewer(locate on site plan):
Depth below grade:
Material of construction:
❑ cast iron
®40 PVC ❑other(explain):
Distance from private water supply well or suction line:
1.5
feet
❑ Yes ® No
Entering Tank
Town Water
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
All visible building sewer appeared to be in good condition. Venting
was visible on the roof. No leakage was evident at this time.
Septic Tank(locate on site plan):
Depth below grade:
Material of construction:
® concrete
N/A
1
feet
❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
N/A
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
10'6"Lx5'8"Wx5'4"D-(Outside )
Dimensions:
Sludge depth:
15"
/site 5 mod Inspection Forts:Subsurface Sewage Disposal System.Page 9 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON--( LEEDS) MA. 01053' April 28, 2015
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other(describe below):
N/A
N/A
Date
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
Type of System:
System hasn't been pumped since installed
® Yes ❑ No
1500
gallons
Tank Dimensions aa,Outlet Invert
Tank Inspection 8 Solids Removal
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) Of 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):
Septic tank, pump chamber, distribution box, soil absorption system
L5Ins•3113 Title Official Inspection Fwm:Subsurface Sewage Disposal System•Page a o117
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON —( LEEDS) MA. 01053' April 28, 2015
City/Town State Zip Code Date of Inspection
D. System Information
Description:
1
Number of current residents:
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)): 78 gpd
Detail:
Last 2 years usage= 7600 cult. = 57,000 gallons/730 days=78.08 gpd average
Sump pump?
Last date of occupancy:
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 16203):
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non-sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
rsins.3113 Tae 561aoal Inspection Form Subwrtaoe Sewage Disposal System-Page 7 of 17
N/A
N/A
® Yes ❑ No
Current
Date
Gallons per day(gpd)
N/A
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
N/A
Owner
information is
required for every
page.
t5ins-3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner's Name
NORTHAMPTON —( LEEDS) MA. 01053' April 28, 2015
City/town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box Of present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Not Above
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.):
Box appeared level and flow was equal to the three
outlet pipes. No solids carryover was in the box when cover was opened. Root infiltration into the box
was cut out at this time. Two large trees nearby are the cause of the problem. No leakage was
evident into or out of the box. Box cover was 10"deep below grade.
Pump Chamber(locate on site plan):
Pumps in working order:
Alarms in working order:
® Yes ❑ No`
® Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber, pump and appurtenances appeared to be in good
condition. Pump and alarm were functional when tested manually by lifting float switches. Cover was
10" deep below grade.
` If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
N/A
Till 5 Official Inspection F .Subsurface sewage a sal System-Page 12 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner's Name
NORTHAMPTON --( LEEDS ) MA. 01053' April 28, 2015
City/rown 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.):
N/A
Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade: N/A
Material of construction:
❑ concrete
N/A
❑ metal
Dimensions:
Capacity:
Design Flow:
Alarm present:
Alarm level:
Date of last pumping:
N/A
❑fiberglass ❑ polyethylene ❑ other(explain):
N/A
N/A
gallons
N/A
gallons per day
❑ Yes ❑ No
Alarm in working order: ❑ Yes
N/A
Date
Comments(condition of alarm and float switches, etc.):
N/A
❑ No
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
lain.3/13 / Ti@�/' Subsunace Sewage Disposal System•Pale 11 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner's Name
NORTHAMPTON --( LEEDS ) MA. 01053' April 28, 2015
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
Privy(locate on site plan).
Materials of construction:
Dimensions
N/A
N/A
Depth of solids N/A
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
ins 3n3 rule 5 ofl'gel m:pedion Form.Subsurface Sewage Disposal System.Page to of 17
Owner
information is
required for every
page.
t5ins•3113
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owners Name
NORTHAMPTON —( LEEDS ) MA. 01053' April 28, 2015
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ 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.):
No evidence of soil clogging, hydraulic failure or ponding at
this time. Soil over leaching field wasn't damp or spongy under foot. Vegetation was mowed grass
which appeared to be uniform in growth over the leaching field.
1 -45' Lx 10'W
with 3 laterals
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
N/A
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
N/A
N/A
N/A
N/A
N/A
❑ Yes ❑ No
Title 5 0 a Inspection roan:subsurface sewage Disposal System•P 13 of 17 /
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner's Name
NORTHAMPTON -- ( LEEDS) MA. 01053' April 28, 2015
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water:
3 Below Bottom of SAS
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:
May 28, 2002
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.
Design Plan showed E.S.H W T. @ 21"and Local Upgrade Approval for 3' Seperation to High
Ground Water and Bottom of SAS
Before filing this Inspection Report,please see Report Completeness Checklist on next page.
Sins•3/13 Title 5 regal Inspection Form.Subsurface Sewage Disposal System.Page 16 of 17
Owner
information is
required for every
page.
�rsrs.ana
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner's Name
NORTHAMPTON--( LEEDS) MA. 01053' April 28,2015
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
See to s PU"14- n s
sin D YQU
ion Form:subsurface Sewage Dispose/Sys r¢m Page 15 of 1i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
228 AUDUBON ROAD
Property Address
SUSAN A. WARGA
Owner Owners Name
information is NORTHAMPTON—( LEEDS ) MA. 01053 April 28, 2015
required for every
page- City/Town State Zip Code Date of Inspection
Sins•2n3
E. Report Completeness Checklist
E Inspection Summary: A, B, C, D, or E checked
E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
E System Information—Estimated depth to high groundwater
E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
Tides Official Inspedion Form Subsurface Sewage Disposal 5Yyem.Page 17 of 17
2. SEPTIC TANK AND DISTRIBUTION BOX PIPES BE SCH. 40, 4'PVC SOLID.
DISTRIBUTION BOX OUTLET PIPES TO BE LAID LEVEL FOR AT LEAST TWO FEET.
1 PROPERTY LINES ARE SHOWN FOR REFERENCE ONLY. ALL SETBACK
REQUIREMENTS OF THE STATE SANITARY CODE TITLE-V SHALL BE MET.
NOT FOR CONVEYANCE
NO EXISTING WELLS LOCATED WITHIN 200' OF PROPOSED LEACHING TRENCHES
WATER LINE SHOWN FOR REFERENCE ONLY. POINT OF ENTRY MAY VARY.
6. EXPOSED SOIL TO BE LOANED, GRADED AND SEEDED UPON COMPLETION.
7. ALL WORK TO BE DONE IN ACCORDANCE WITH THE STATE SANITARY CODE TITLE-5.
8. LOCATION AND CONFIGURATION OF HOUSE IS SHOWN FOR REFERENCE ONLY.
ACTUAL SIZE, CONFIGURATION AND LOCATION MAY VARY,
9. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. THEREFORE A GARBAGE DISPOSAL
IS NOT ALLOWED.
10. EXISTING SEPTIC TANK TO BE PUMPED AND REMOVED FROM SITE.
IL EXISTING SOIL ABSORBTION SYSTEM TO BE DISCONTINUED AND REMAIN IN PLACE
WITH APPROVAL OF NORTHAMPTON BOARD OF HEALTH.
SLOPE =
r VENT PIPE
FINAL GRADE ELEVATIONS TO BE DETERMINED
BY HOMEOWNER AND CONTRACTOR.
EXISTING GROUND h,
END OF PIPES CO ELEV. 101.25
( CONNECTED )
TOM
BOT OF STONE 0 ELEV. 100.75
3/4" - 11/2",DOUBLE WASHED STONE
REPAIRI
PLAN OF
LEACHING BED SYSTEM
( 45'L x 10'W )
EP/ DF bq�9n .
TIMOTHY SG
E.
MAGINNIS
Nu.962
NIT AP
Y E. MAGINNIS R,S
PROPOSED SUBSURFACE SEWAGE DISPOSAL SYSTEM
228 AUDOBON ROAD - NORTHAMPTON, MA.
FOR GORDON SWIFT - ( 413 ) 585 - 0948
BY: TIMOTHY E. MAGINNIS - WESTHAMPTON, MA. 01027
(413) 527 - 5291
MAY 28, 2002 I PG, 1 OF 2 SCALE: AS NOTED
AUDOBON ROAD-NORTHAMPTON
EXISTING CONTOURS
PROPOSED CONTOURS
EXISTING
DWELLING
PROPERTY LINE
As ` Q
y7 AS-BUILT DIMENSIONS
%Nsy�ECTp+1 TO MEASURE REFERENCED POINTS
J..,Z., A,8, CJ P' D AND RECORD ON PLAN.
— —
/aa = 28' 3"
C. = 34' 6+;
2-0 . —Z1.3T_ .l --- -
z—A _ 5
2 8 = 34° b"
zC _ '18' yu
2--0
16W alifien
PROPOSED SEPTIC TANK
4 LF - 4" PVC SOLID PIPE ( S =
PROPOSED PUMP CHAMBER
(OOt anilan
D2 )
BM TOP OF STONE
( ASSUME ELEV. 100.00 )
_PF�ERTr L. c%L - -
m
76 LF + 2" FORCE { '
PP
EXISTING "0" BOX /
/
i
JSE
4
WATER LINE TO GARDEN
( CALL DIG SAFE )
Ap
Bw
_
2
TEST PIT / PERC TEST DATA
PERFORMED BY: DENNIS LACOURSE CSE. - (413) 527 - 7861
WITNESSED BY: PETER MCERLAIN - HEALTH AGENT - NORTHAMPTON, MA.
DATE: MAY 17, 2002
SOIL CLASS I - LOAMY SAND / SAND - CLASS I 0 0.74 SO. FT. / GAL.
ONE PERC TEST AND ONE TEST PIT ALLOWED BY BOARD OF HEALTH FOR THIS REPAIR
T.P. # 1
ELEV. 99.50 ±
SANDY
LOAM
10 YR 3 /
2
SANDY
LOAM
10YR 4 /
6
FINE
SAND
2.`Y 4 /
4
COARSE
SAND
0 - 8
21"
21 " - 36"
36" - 90"
STANDING WATER: 48"
ESHWT: 21 "
WEEPING: 48"
DEPTH TO BEDROCK: 90"
CONSTRUCTION NOTES
Ap
Bw
T.P. # 2
ELEV. 99.50 ±
SANDY
LOAM
10 YR 3 /
2
SANDY
LOAM
10YR 4 /
6
FINE
SAND
2.5Y 4 /
4
COARSE
SAND
0 - 8"
21"
21 " - 36"
STANDING WATER: 48"
ESHWT: 21 "
WEEPING: 48"
DEPTH TO BEDROCK: 90"
I. PROPOSED SEPTIC TANK, PUMP CHAMBER, AND DISTRIBUTION BOX TO BE INSTALLED
LEVEL AND TRUE TO GRADE ON A STABLE LEVEL BASE THAT
HAS BEEN MECHANICALLY COMPACTED AND ONTO WHICH 6' OF CRUSHED
STONE HAS BEEN PLACED TO MINIMIZE SETTLING.
2
PUMP MANHOE COVER
24" DIA. MIN.
DESIGN CALCULATIONS
3 BEDROOM HOUSE @ 110 GALS. / BEDROOM = 330 GPD = DAILY FLOW
MIN. S0. FT. REQ. = 330 GPD x 0. 74 GALS / SQ. FT. = 446 SO. FT.
BOTTOM AREA ONLY. ( 451 x 10'W ) = 450 S0. FT. x .74 GALS / SO. FT. = 333
SQ. FT. PROVIDED = 450 SQ. FT.
DAILY FLOW = 330 GPD
CALCULATED DAILY FLOW = 330 GPD
DESIGN LOAD = 333 GPD
76 LE 3 - 2" FORCE MAIN ( SCH. 40 )
EXISTING GROUND
LIMBER
BOTTOM OF POMP CHAMBER
ELEV. 9095
TDH = 12' +
INVERT IN "
CLEAN FILL MATERIAL
THE FILL MATERIAL SHALL NOT CONTAIN ANY MATERIAL LARGER
THAN 2 INCHES. A SIEVE ANALYSIS USING THE # 4 SIEVE
SHALL BE PERFORMED ON A REPRESENTATIVE SAMPLE OF THE
FILL. UP TO 45% BY WEIGHT OF THE FILL SAMPLE MAY BE RET
ON THE # 4 SIEVE. THE FILL MATERIAL SHALL BE CLEAN COAR
SAND OR OTHER COARSE GRANULAR MATERIAL FREE FROM CLAY,
DUST. ORGANIC MATTER, LARGE STONES. MASONRY, STUMPS, FRO
CLUMPS OF EARTH, WOOD, TREE BRANCHES, AND WASTE CONSTR
DEBRIS.
c5 - dg-9 9H3 4 43Nt f'd
ALMER HUNTLEY, JR., & ASSOCIATES, INC.
SURVEYORS . ENGINEERS - PLANNERS
May 18, 1976
P.O. Box 568
125 PLEASANT STREET
NORTHAMPTON, MASS. 01060
(413) 584-2444
Dennis Skrocki
G AQ2CkY 1\29Aw-
•
SAsIRAmdPTCw (AV\� 4
(Date)
On Mav 13. 1976 we completed percolation tests and obser-
vation pits for a proposed Individual Sewage Disposal System to be located at
Lot $5, Audubon Road, Northampton
RESULTS AND RECOMMENDATIONS
X See attached sheets for results of tests
X Soil should be suitable if system is properly installed
X 1500 gallon septic tank for a daily flow of 400 gallons
X 500 square feet of leach area for a daily flow of 400 gallons
More percolation tests should be taken
More observation pits should be dug
Soils are not suitable for a leaching area
X Contact your local Board of Health for additional information
X Application attached
X Plot Plan attached
X System detail sheets attached
Remarks:
Very truly yours,
ALMER HUNTLEY, JR. & ASSOCIATES, INC.
R4.\40., .ea,0 ..
Richard P. Brazeau U
THE ABOVE RECOMMENDATIONS DO NOT CONSTITUTE APPROVAL OR DISAPPROVAL OF SEWAGE DISPOSAL SYSTEM
WEST SPRINGFIELD OFFICE GREENFIELD OFFICE
PROPOSED DOMESTIC SUB-SURFACE DISPOSAL SYSTEM DESIGN
Prepared for: Dennis Skrocki
Location: Lot #5, Audubon Road
Northampton
Number of Bedrooms: 4 Garbage Disposal: yes
LEACH AREA DESIGN
4 Bedrooms X 2 persons/bedroom = 8 persons
8 Persons X 50 gallons of waste water/person per day =
400 total gallons waste water per day
1.67
Percolation Rate: 1.6 min./in.
Square feet of leach area required/gallon of waste water for a
1.67
Percolation Rate of 1.6 min./in. = 1 0 S.F./gallon
• If a leach bed is to be installed, one S.F./gallon is the minimum area
that can be used for a Pero. rate of 10 min./in. or less.
400 Total gallons of waste water per day X 1 .0
= 400 S.F. of leach area (required)
S.F./gallon
* If a garbage disposal is installed, leach area will be increased by 25%
400 S.F. of leach area X 125% = 1.0 S.F. of leach area
RECOMMENDED LEACH AREA: 700 5.F.
** Minimum area for leaching trench or seepage pit is 0.5 square
feet per gallon for a pert. rate of 2.0 min./in. or less.
ALMER HUNTLEY, JR., & ASSOCIATES, INC.
SURVEYORS . ENGINEERS • PLANNERS
TYPE OF SYSTEM
LEACH
Xi BED
Recommended Leach Area
L = 35'
W = 20'
700 S.F.
* The minimum lines per field is 2
** The maximum length per line is 100'
(75' when daily flow is greater than 2000 gal.)
LEACH
TRENCH
Recommended Leach Area S.F.
3' wide = feet of trench
trench lines, feet long
* The minimum lines per field is 2
** The maximum length per line is 100'
(75' when daily flow is greater than 2000 gal.)
LEACH
PIT
Recommended Leach Area S.F.
Check attached sheets for type of Pit and amount of stone
ALMER HUNTLEY, JR., & ASSOCIATES, INC.
SURVEYORS - ENGINEERS - PLANNERS
SEPTIC TANK
* without Garbage Disposal
Gallons of waste water per day X 150%
Required effective liquid capacity of septic tank
RECOMMENDED:
Septic Tank
* In no case will the septic tank be less than 750 gallons
(effective liquid capacity) .
** with Garbage Disposal
400 Gallons of waste water per day X 200% =
R00 Required effective liquid capacity of septic tank
RECOMMENDED: 1500 Septic Tank
** In no case will the septic tank be less than 1500 gallons
(effective liquid capacity) .
ALMER HUNTLEY, JR., & ASSOCIATES, INC.
OBSERVATION PITS
REQUESTED BY: A. W. Borawski
LOCATION: Audubon Road, Northampton
MAILING ADDRESS:
DATE: May 13, 1976 OBSERVER:
A
9'0
Lot #5
O.T.S.
Silty sand
and gravel
Layers
coarse sand
and gravel
Sandy till
0'6"
1'3"
5'3"
2'0"
Groundwater 7'0" seepage
1.67
Perc Rate 1.6
C.L.L./R.P.B.
v
Groundwater
Perc Rate
Groundwater Groundwater
Perc Rate Perc Rate
• Overnight Test
ALMER HUNTLEY, JR., Ei ASSOCIATES, INC.
SURVEYORS • ENGINEERS • PLANNERS
5EPTIC TANK
cI::TR!5UTICJJ {)X-
NL.ME EE GF 6UTLETS
:RED_
,:t7
18°MIN
3=0"MAX.
PLAN ALL U:'y - -
NATERTI3t-1 — S=°E ., FT. "% ':.
P P`5 F,i.1 v
CS�!E' ut N
.5_ C
a= NCK11 -rrr"=C: =1h/
NN!� -.ri E• 'EL rlt /1,
LE_45" ONE
TP= .
L-
Ic 'i F PI
•:U:'-?B�i'. OF PIPES S
ru W Dr4)
PLAN VIEW
EXISTING /
GROULID i1 4 FERFORA'E. Px S2 _ 4/ .,,,
l 'c-i.-;;//%/�/.i`. < //c�l 5^70frf OF--I Ek;- ` SE
SIDE VIEW
Ys° ToY-
WASPEI)STONE
3i4"To Oh"
W8 SH ED STONE
(LOAN' & SEED
„—
COVER j to"MIN•
—r:11:2711:1"rT' I N
.°'
00 4PERF
PIPE
V
•A • � • GnYIIN•
• a .° o
X- SECTION
NOTES:
ALL WORK TO 5E DUNE IN ACCORDANCE
WITH STATE SANITARY CODE-ARTICLE$[
ALMER HUNTLEY, JR. a ASSOCIATES, INC
REGISTERED LAND SURVEYORS B CIVIL ENO:*IFERS
125 PLEASANT STREET
Lot #6
h
N
N
LoT # 5
27 Z90 sF
119-'9 t K
4E::F,�, .. _ ,
c , M,A, f
` JAI TIC T/''J( ;
JO M/N
ra0U5E
4-
Lo+ 4
1Q3 Z5-001
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y.4
goA nANOFdi511954L SY5TEMF-0/2 `)
O N ON 4UpueeN Ad, k9R77/4MPTO// 17:4
PRCR'sREP R)R
PEX/A /S SKCOCK I
ALMER HUNTL EY,JR. S ASSOCIATES, INC.
RE3!STERE.D LAND SJR'JEYCRS 9 _ i . .'_ E'42 :c7
125 PLEASANT STREET
NORTHAMPTON , MASS.
,ere, S<..-: E
L:.TE. 5/i8- 7b