57 Septic Inspection Form 2006 Important:
When fining out
fors on the
computer,use
only the tab key
to move your
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use the return
key.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Inspection results must be submitted on this form or on previously published DEP forms.
Inspection forms may not be altered in any way.
A. Certification
Property Information:
57 /174. ”.17i✓
(7i-,
Property Address
`D AIa 4 co SA CI
Owners Name
SAefla
Owner's Address
.7 10.<.cdcc 1014.
O,cD 4 ,
City/Town
Date of Inspection:
2. Inspector:
Ray Champagne
Name of Inspector
Whiteley Septic Service
Company Name
133 Middle Road
Company Address
Southampton
State
/-/d?D 6
Date
Zip Code
Cityrrown
State
Lp Code
413-577-1835
MA 01073
Telephone Number
Certification Statement:
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true,accurate and complete as of the time of 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
/4/P-c06
InspectAr'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.
t5insp.doc.doc•04/2003
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 1 of 1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
S7 4/.404-1././ .)r.
Prop/¢prp/Address
+/Ore UC!
City/Town
Alet �tceo-„ ,oe4r
Owner's Name
Notes and Comments:
Sepo c 41.9! .pG.//
T /bcg4c. &rt4 oc.-fle•f-
or
fflq'. Oro 6 of
State Zip Code
�hiv-O4
Date of Inspection
r rc — 7 -rrrk
C2K-4e r Co /w.✓t
6T Ce uer
iw/e"A • Za4escri irtfimu
r.4 3.1 r..lfn o Pew)twcs
t5lnsp.doc doc•04/2003
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 2 of 2
Commonwealth of Massachusetts
Title 5 'Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
Jam% .4t fu.n.c) De-•
Property Address
V/O re.0 c
City/rown
D. d S. .Sf1<n..
Owners Name
"4.
State
On, et
ad Code
Date of Inspection
Inspection Summary. Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not foun any information which indicates that any of the failure criteria described
in 310 CMR 303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated b w.
Comments:
B) System Conditionally Passes
❑ One or more system compo nts as described in the'Conditional Pass"section need to be
replaced or repaired. The tern, upon completion of the replacement or repair, as approved by
the Board of Health,will .ass.
Answer yes, no or not de -rmined (Y, N, ND)in the❑for the following statements. If"not
determined,°please ex. am.
❑ The septic tank i metal and over 20 years old*or the septic tank(whether metal or not)is
structurally un .und, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will p. s inspection if the existing tank is replaced with a complying septic tank as
approved b e Board of Health.
*A meta eptic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Com lance indicating that the tank is less than 20 years old is available.
ND Explain:
t5insp.doadoc•06/2003
The 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 3 of 3
-Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (coot.)
S7
a„
Prope/rty'1 Address ,�xA
/10•-•w..« /„R- O/OG ;-
City/Town State
bp Code
17 - AS. sea. 11- IA_d (Fs
Owners Name Date of Inspection
B) System Conditionally Pass (cont.):
❑ Observation of sewage ba up or break out or high static water level in the distribution box due
to broken or obstructed p' (s)or due to a broken, settled or uneven distribution box.System will
pass inspection if(with proval of Board of Health):
❑ broken pipe are replaced
❑ obstructio is removed
❑ distrib on box is leveled or replaced
ND Explain:
❑ The system required pumping mor than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(wi approval of the Board of Health):
❑ broken pipe(s)are rep ced
❑ obstruction is remo ed
ND Explain:
C) Further Evaluation is Required by the = .ard of Health:
❑ Conditions exist which require further
the system is failing to protect public
tSinsp.doc.doc•04/2003
aluation by the Board of Health in order to determine if
atilt, safety or the environment.
1. System will pass unless Boa • of Health determines in accordance with 310 CMR
15.303(1)(3)that the system is of functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy i. within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
Title 5 Official Inspection Faint Subsurface Sewage Disposal System•
Page 4 of 4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
s % , ,,4_.nw/ Dh.
ISinsp.doc.doc•04/2003
Property Address
City/Town
D. 4' S. Slo e o�
Owner's Name
/574-
State
I /8. 04
Date of Inspection
mia62
Zip Code
C) Further Evaluation is Required by the =oard of Health(cont.):
2. System will fail unless the Bo d of Health (and Public Water Supplier,if any)
determines that the system is fu ctioning in a manner that protects the public health,
safety and environment:
❑ The system has a sept tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface ater supply or tributary to a surface water supply.
❑ The system has - eptic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system as a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The sys
more f
m has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
m a private water supply well".
Meth-.d used to determine distance:
This sys m passes if the well water analysis,performed at a DEP certified laboratory, for
conform b cteria and volatile organic compounds indicates that the well is free from pollution from
that facia 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 orm.
3 Other:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 5 of 5
a Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cant.)
S %
/4‘0740•17.41 Dr.
Propel Address �/�
no rc.cJc ////9• O /o 4 a-
City//Town rr, State /� ZipCode
.Tip Uy/d 56 JL.a d Sf,JAr II/or)-O4
Owner's Name Date of Inspection
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No" to each of the following for all inspections:
Yes No
❑ ,o( Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ Er 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 'A day flow
❑ ❑ 2 Required pumping more than 4 times in the last year NOT due to clogged or
• obstructed pipe(s). Number of times pumped: .
El JET 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 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
'�'C 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility 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.]
Yes No
❑ 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.
t5insp.doc.tloc•06/2003 Title 5 Official Inspection Form:Subsurface Sewage Disposal pwPl gestem•
Page 6 of 6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
37 ,4t /omry Dr.
Property Address
Fie re.uc e
City/Town
U. S. Spear
Owners Name
t5insp-doc.doc•04/2003
ma • oio tho2-
State Zip Code
��-/P-Olo
Date of Inspection
E) Large Systems: To be con- dered a large system the system must serve a facility with a
design flow of 10,000 gpd to ,000 gpd.
For large systems, you must• dicate either"yes"or no to each of the following, in addition to the
questions in Section D.
YES NO
❑ ❑ e 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 =nswered"yes"to any question in Section E the system is considered a significant threat,
or answe -d"yes"in Section D above the large system has failed.The owner or operator of any large
system p.nsidered a significant threat under Section E or failed under Section D shall upgrade the
syste in accordance with 310 CMR 15.304.The system owner should contact the appropriate
regional office of the Department.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 7 of 7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
B. Checklist
.67 ,4r,7u■w V r
Property Address --
rho rewJe.e 040.6s2—
Ci /Town State Zip Code
.,•aid t Scis.omj sp..or AP-DA
Owners Name Date of Inspection
t5insp.doc.cloc•04/2003
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
YES NO
vS ❑
• Vlc
✓ ❑
Pum ing information was provided by the owner,occupant,or Board of Health
7E 4 •..._.0- /y n. .aso
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?
❑ ❑NA Were as built plans of the system obtained and examined?(If they were not
,--,/ available note as N/A)
U�- ❑ Was the facility or dwelling inspected for signs of sewage back up?
fit- ❑ 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(3)(b)]
"I trcr6% % .access Oc %,t arc- %Aw/c.
Give TO else An /.e✓e-/ •
Tole 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 8 of 8
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information
.57
�
P operty Address
cyrrow„
• t S. ...Si/e.9r
Owners Name Date of Inspection
/ila.
State
a /063--
Lp Code
Residential Flow Conditions:
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents:
Does residence have a garbage grinder?
Is laundry on a separate sewage system? [if yes separate inspection required]
Laundry system inspected?
Seasonal use? -
Water meter readings, if available(last 2 years usage(gpd)): P en
Sump pump?
Last date of occupancy.
Commercial/Industrial Flow Cgiiditions:
Type of Establishment:
Design flow(based on 310 • R 15.203):
Basis of design flow(sea persons/sq.f,etc.):
Grease trap present?
Industrial waste hol mg tank present?
Non-sanitary wa e discharged to the Title 5 system?
Water meter r:'dings, if available:
Last date of 'ccupancy/use'
Other(de ribe):
t5insp.doc.doc•04/2003
10/Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes g No
007099• Y/
¢.ads. w6
❑ Yes IX...No
oai!
Date
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Date
'title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•
Page 9 of 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
S/ then .. j ci
Property Address
pe
T /O re.0 c02--
CIi%y�/rown
,thic7R it _51.1.4,-,_51.1.4,- C13.4,u.1 JA✓
Owners Name
J7r.
State • O./o (hot
State Zip Code
177?-40 6
Date of Inspection
General Information
Pumping Records: /nom
Source of information: '"�' �y'Q Oar
Was system pumped as part of the inspection? ❑ YesS4 No
If yes,volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
(Septic tank, dis ibution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes,attach previous inspection records, if any)
❑ Innovative/Altemative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank.Attach a copy of the DEP approval.
Other(describe):
Approximate age of all components, date installed(if known)and source of information:
SG ± y.44
Were sewage odors detected when arriving at the site?
❑ Yes 4VNo
tsinsp.doc.doc•0412003
Titles Official Inspection Form:Subsurface Sewage Disposal System•
Page 10 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
67 44.4om.0 r
Propesr-rye Address
r0 re.ocQ
Ci /To
5.wn N S. SptnY
Owners Name
Building Sewer(locate on site plan):
Depth below grade:
Material of construction:
cast iron ❑40 PVC
State
ii Ib'•t%
creed G--t-
ap Code
Date of Inspection
❑ other(explain):
Distance from private water supply well or suction line:
feet
Cllr ate ler
feet
Comments (on condition of joints,venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade:
Material of construction:
54/concrete ❑metal
❑fiberglass
feet
❑polyethylene ❑other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of
certificate)
Dimensions:
Sludge depth:
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?
t5insp.doc.doc•04/2003
❑ Yes ❑ No
70
6 5
Abe- e.- 140t1
"
Ct-
\Tn 1#
TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 11 of 11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
d7 J¢r.W-u•rreci
Prrooerty Address
fr/OVt a 4C C.
City/Town
State Zip Code
J%• is- Speav
Owner's Name
Date of Inspection
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert, evidence of leakage,etc.):
Grease Trap(locate ybn site plan):
Depth below grad
Material of con uction:
❑concrete ❑ metal
feet
❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top f outlet tee or baffle
Distance from bottom of scum o 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.):
Tight or Holding Tank(tank mu be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ etal ❑fiberglass ❑polyethylene
❑other(explain):
t5lnsp.doc.doc•04/2003 Tde 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 12 of 12
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
Property Address
C'ifWown S. State
4J. 4 S• Spe# r ii- /i•Q(e
Owners Name I Date of inspection
�.4
Tight or Holding Tank(cont.)
Dimensions:
C/O/a t-
Zip Code
Capacity: /
gallons
Design Flow:
gallons per clay
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.):
Distribution Box (if present must be ope -d) (locate on site plan):
Depth of liquid level above outlet invert
Comments (note if box is level and • stribution to outlets equal, any evidence of solids carryover,any
evidence of leakage into or out of az, etc.):
Pump Chamber .cafe on site plan):
Pumps in wo
ing order.
Alarms i orking order:
tsmsp.doc.doc•0412003
❑ Yes
❑ Yes
❑ No
❑ No
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 13 of 13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cant.)
S7 4rnfri n,c' D.•.
Props Address
1-10rE Ce_ /net Oho 6L
Ci !Town State
Zp Code
Owner's Name Date of Inspection
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located,explain why:
lafsta6/e 71 ,4 etas+
leach
cn- 144 -,- 7 L —
fir % 45 a°ray esz / .— -Fh;a At.-e a
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.): / n /
i11(io S//C.r�s 0/ Su��r.R/C- - web^. ,�,� ,. ,/r/V r-c OdSC`YCCI
bc+ Sy�•1!L 7,t-L /ww71ca,eeC 7"Wi�rir'�-Y
t5lnsp.doc.dac•04/2003
refs 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 14 of 14
a Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
.s% .44.1g01,77/C-1 1%h•
Properly/tddress
r/Dr G.0 C.c
City/Town
D. 6 S. Sp-e4r
Owner's Name
`taleState
ii- 1P-66
Date of Inspection
O/426.7—
Zip Code
Cesspools (cesspool must b pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to it t invert
Depth of solids layer
Depth of scum lay
Dimensions of sspool
Materials of c nstruction
Indication of groundwater inflow
❑ Yes ❑ No
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
Privy(locate . site plan):
Materials of nstruction:
Dimensions
Depth of s. ids
Comment (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
t5insp.doc.doc•04/2003
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 15 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
.57 / .-,tc m.cu Dr.
Property Address
lo re NC e
City/Town
d7. eft S• Spear
Owner's Name
t5i nsp.doc.doc.04/2003
State Z p
/d'•Dl, code
Date of Inspection
Sketch Of Sewage Disposal System: Provide a sketch 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.
cjusi ec.e°
4c
e.:>.
Titles Official Inspection Form:Subsurface Sewage Disposal System•
Page 16 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
_s-7 4t-v,,n.o D•-
Property dress
HO -1ei +C•e- ///A. O/D62
City/Town
D. ft S. Spe Ar State/I. 0. 64, Zip Code
4-
Owners Name Date of Inspection
Site Exam:
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water.
LCfO NJ 4_
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:
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:
Jf(KSO CL).0 S.a--vd5 So. / .qr.e•s •
O 1-4 /. JSig eJ104h, /+cam i46-•e.r•
t5insp.doc.doc•04/2003
True 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 17 of 11
CONSTRUCTION NOTES: 57 Autumn Drive, Easthampton
Existing septic tank:to he pumped of its contents, crushed and removed Check building sewer and confirm structural
integrity.If necessary,replace with cast iron, schedule 40 PVC solid or the equivalent.
Existing garbage grinder must be dismantled and removed.
New septic tank: To he 1500-gallon single-compartment Underground Supply or approved equal set level on 6-inch
crushed stone base.Install schedule 40 tees centered within manholes as shown.Install manhole risers to within six inches
offinal grade to provide air gap for tees. Pipe from septic tank to pump chamber shall be four inch solid SDR 35 PVC with
watertight joints. Effluent tee filter is required: install Orenco 4-inch FT S0444-36. [Contact Bob Johnson,Atlantic
Solutions, Ltd. (401)293-01761 Maintenance instructions to be furnished to owners.
New pump chamber to be Underground Supply 1000-gallon pre-cast concrete or approved equal set level on 6-inch
crushed stone base. See attached notes for pump specifications and required settings. Line from pump chamber to d-box
must be 2-inch schedule 40.
New distribution box:to be U.S.L. DB-6 or approved equal with minimum 6-inch sump. Set evel on well-compacted base.
Minimum inside dimension of d-box must be at least twelve inches. DO NOT install speed levelers on outlets, adjust using
water test Four outlet lines to be utilized;distribution lines must be set level for minimum of24 inches from d-box. Pipes
from d-box to bed shall be SDR 35 PVC 4"solid with watertight joints.
Leach bed:Dimensions= 16'x 40'total area=640 square feet. Remove all topsoil,subsoil, and any filled materials if
encountered in leach bed area and 5 feet horizontally in all directions. Total excavation=26'x 50'. (Approximate total
depth=30 inches, actual depth may vary). Fill excavated areas to bottom-of-bed elevation 99.8 with clean,granular sand
that is free from organic matter and deleterious substances, must not contain any stones larger than 2 inches. Up to 45%
by weight of a representative fill sample may be retained on a 94 sieve. Total sand fill depth will vary with existing onsite
materials, as encountered Compact in six-inch l fs. Pipes in SAS shall be 501235 PVC 4"perforated set at 0.005 slope.
Lateral ends must be tied together and vented Excavated materials may be used on side slopes to meet breakout
requirements. Finish grading offinal leach bed cover to be crowned to 2%slope for runoff Site to be seeded immediately
upon completion of work by owner or contractor.
Precise location of all distribution laterals must be documented either by placement of magnetic tape along top surfaces,
rebar at both ends of all lines, or by accurate as-built distances in sketch provided to owner,Board of Health and
Designer.
Observation port(s)must be placed in SAS as per new requirement in code.Four-inch perforated PVC may be utilized,
set into sand beneath 6-inch stone brought to 3 inches below finish grade with removable caps.Precise location(s)from
two fixed points to be documented in as-built drawing.
Rubber Membrane:Install Miller Environmental breakout barrier membrane#MBE 40114 around all sides of 5-foot fill
perimeter. Top of membrane elevation=100.8, even with top ofpeastone.Bottom membrane elevation=96.8 minimum,
>one foot below existing natural grade.
Temporary Bench Mark= 100.0=top of concrete base of hatchway as shown.
GENERAL NOTES:
A pre-construction conference is required. Installer must contact Designer(413-527-3539)at least 72 hours prior to
commencing onsite construction.
Vehicular traffic must be precluded from travel over all system components to prevent damage to the system
No current survey was available at the time of this drawing;no property pins were located Property lines shown are
approximated from sketch on file at Northampton Assessor's office. This drawing is not a survey;the owner or agent is
responsible for ensuring that the septic system is installed on the subject parcel.
Percolation test and deep hole locations are as indicated on plan.
All construction shall be in strict compliance with Title V of the Massachusetts Environmental Code.
System as designed is not for disposal of wastes from a garbage grinder.
Installation of a lint filter on washing machine discharge line is recommended
To help ensure the optimum functioning and longevity of the system, the septic tank should be pumped every two(2)years.
No other underground examinations were made than as indicated, the exact locations of any subsurface utilities,fixtures
or drainage easements are unknown. Any related problems incurred during construction are the responsibility of the
owner or his designated agent.
System is for the disposal of sanitary sewage only.All storm water, cooling water, chemicals or other objectionable wastes
must be excluded
If field conditions(ledge, mottling,groundwater, etc.)are encountered other than as indicated on the plan, Designer
and Board of Health shall be notified immediately and construction halted until resolution is reached.
No changes to the plan will be allowed without the prior authorization of the Designer or Board of Health ; P`9H 0 F t.
No warranty shall be made by the Designer as to the installation,functioning or longevity of the system. 3
Rather, the plan is in compliance with all applicable rules and regulations as are in effect at the time offs
plan submittal.