192 Septic Inspection 1999 ENVIRONMENTAL HELD SERVICES, INC. -_
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
December 17, 1998
David Korash
192 Coles Meadow Road
Northampton, MA 01060
JAN 4 19.'0
re: Septic System Inspection at 192 Coles Meadow Rd, Northampton, MA
Dear David:
Enclosed please find a copy of my report for the referenced inspection. I
have forwarded a copy of the report to the Northampton Board of Health per
the requirements of 310 CMR 15.300.
Based on the results of my inspection in accordance with 310 CMR 15.300,
I have concluded that the system does not fail to protect the environment
and/or the public health.
Please call if you have any questions, and thank you for this opportunity to
be of service.
Sincerely yours,
Mcha . Lay. ne
Environmental Engineer
Certified System Inspector
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION'continued)
Property Address:
Owner:
Due of Inspection:
INSPECTOR SUMMARY: Check A, B, C, 0 D:
A. SYSTEM PASSES:
V I have not found any information which indicates that any of the failure conditions described In 310 CMR 16.303 exist. Any failure
criteria not evaluated ere Indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or m a system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health, will pass.
Indicate yes, no, or not determined IY, N. or ND). Describe basis of determination In all Instances. If not determined". explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of
Compliance/attached)indicating that the tank was Installed within twenty 1401 Years prior to the date of the inspection:or
the septic tank,whether or not metal,Is cracked,structurally unsound, shows substantial infiltration or esfiltrstion,or tank
failure is Imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
_ Sewage backup ar breakout or high static water level observed in the distribution box is due to broken or obstructed Opals)
or due to e broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health/.
broken pipets)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping-move than four-times a yeasts to broken or obstructed pipets). The tyetam wIll-pe s
inspection If(with approval of the Board of Health): ---- .
broken pipets)are replaced
obstruction is removed
revised 9/2/98
Page 1 of II
ARGEO PAUL CELLUCCI
Governor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Prepetty Address: I )e'i /Y1 Pc•C heri IZ.c1 Name of Owner Da S h
Na.- y Address of Owner: IC' _ -
Dneoflnspection: la -go'r%8
Name of Inspector:Meese Printl M -LuU 14 n IP
1
am a DEP approved system inepectM+urwwrt to Section 15.340 of Title 51310 CMR 15.0001
Cwrpany Nerve: FA10 IroA,n 1 {-cJ Fie ld Seroices
hns
MOMS Ad : Po ex , .5 t. Lc cd S r9- c vo3-3
Telephone Number: ,5.76 7d!'v1
TRUDY COXE
Secretary
DAVID B. STRUHS
Commiss:aner
2f ,(JOr}/inyngfr
CERTWICATION STATEMENT
I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
meintenenee al on-site sewage disposal systems. The system:
✓ Passes
Conditionally Passes
Needs Further Evaluation By the local Approving Authority
Fails
Inspector's Signaso
The System Inspector shell --•mit a copy of this inspection report to the Approving Authority(Board of Health or DEPlwithin thirty 130)days of
completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greeter,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department ofEnvkonmental Protection. The original should be sent MIMI
system owner and copies sent to the buyer.if applicable, and the approving authority. •
Date: , % 2.
NOTES AND COMMENTS
revised 9/2/98
Page 1 of II
ei Pond on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner:
Date of Inspection:
D. SYSTEM FAILS:
You must indicate either "Yes' or No to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage imo faciltyur-system cemponentdeevo en overloaded or-egged SASor'eeupool. -9--a-`-•-•
Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6' below invert or available volume is less than 1(2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed Opals).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic-compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or'No" to each of the following:
The following criteria apply to large systems in addition to the criteria above: -
The system serves a facility with a design Bow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 900 feet of a surface drinking water supply
the system iewitkie 200 f eat afa-tributeryiea eurNwdrialdgwwtrwryly ' -- --
_ _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304121. Please consult the local regional
office of the Department for further information.
revised 9/2/98
Page 4 ofI I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERT1FICATION(continued)
Property Address:
Owner:
Data of Inspection:
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 the
public health, safety and the environment.
1i SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES N ACCORDANCE WITH 310 CMR 15.303(1111,1 THAT THE SYSTTit
IS NOT FUNCTIONING N A MANNER WHICHWILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE BIVIRONMECT:
21
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feel of a bordering vegetated wetland or salt marsh.
SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.N ANTI DETERMINES THAT THE SYSTEM IS
FUNCTIONING N A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: •
Tho system has a septic tank and soil absorption system ISAS)end 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and the SAS Is less than 100 feat but SO feet or more from a
private water supply well,unless a well water analysis for conform bacteria and volatile organic compounds imitates 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. Method used to determine distance (approximation not veldt.
3) OTHER
revised 9/2/98
Poke 3 of 11
Property Address:
Owner:
Date of Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDDIONS
RESIDENTIAL:
Design flow: AM-1 g.p.d.lbedroom.
Number of bedrooms(designl:Uhl' Number of bedrooms lactuall:3
Total DESIGN IIowA '_
Number of current residents:0e
Garbage grinder(yes or no):N
Laundry(separate system) (yes or no)VV: If yes. separateinapectiom required
Laundry system Inspected (yes or
Seasonal use(yes or nol: .°
Water meter readings.if available(last two years usage(god):
Sump Pump(yes or no): /JQ
Lest date of occupancy:C.-L.i r rear E
Il �Fi
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: qpd 1 Based on 15.203)
Basis of design flow
Grease trap present: )yes or no)_
Industrial Waste Holding Tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system:!yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: )yes or nolb(d
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Septic tank/distribution boxlsoil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records.if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components.date InstalledNl known)and source efialermetion
Sewage odors detected when arriving at the site: )yes or mike)
revised 9/2/98
Page 6 of tl
Y�2 - s 'et.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART
CHECKLIST
Property Address:
Owner:
Dins of Inspection:
Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following:
Ye
q No
V e Pumping information was provided by the owner,occupant, or Board of Health.
- _✓ _ -None of the eystemsomparms_hao been pompaddecinlaaat Iwo weeks weeks Aystem hesbraceiary sisal Sow
rates during that period. Large volumes of water have not been Introduced Into the system recently or es pert of this
inspection.
N/Q As built plans have been obtained and examined. Note If they are not available with NIA.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
Z _ The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System,have been located on the site.
The septic tank manholes were uncovered,opened, and the interior of the septic tank was Inspected for condition of baffles
or tees, material of construction,dimensions,depth of liquid,depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:•
_ Existing information. For example, Plan at,B.O.H.
Determined in the field lif any of the failure criteria related to Part C is at issue,approximation of distance Is unacceptable)
Ii6.302(3)Ibn
The facility owner land.occupaals,if different from.owner),wnptnuided.withldowpuon.on.t he.propurmaloLOaooe.—f
Subsurface Disposal Systems.
revised 9/2/98
Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM WFORMATION(continued)
Property Address:
Owner:
Date or Inspection:
TIGHT OR HOLDING TANK:N1A(Tank must be pumped prior to, or at time of, Inspection)
(locate on site pion)
Depth below grade:
Material of construction:_concrete_metal Fiberglass_Polyethylene_other(explain)
Dimensions:
Capacity: gallons
Design flaw: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches,eta)
DISTRIBUTION BOX: (/
(locate on site plan) (� 1
Depth of liquid level above outlet inverC,-c.0 3c)dt"
Comments;
(note it level and distribution is equal, evidenee of solids carryover, evidence of leakage into or out al box.etc.)
,44h_ dy
PUMP CHAMBER:ill//N
(locate on site plan)
/.c. - acMP
/e..r_�C f. eta', it P°"`/
Pumps in working order:(Yes or Nol_
Alarms in working order(Yes or Nol_
Comments:
'note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98
Page 8 of II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icortirawd)
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade: " 18
Material of construction: cast iron_90 PVC_other(explain'
Distance from private water supply well or suction line AAA
Diameter q
Comments:(condition of joints,venting, evidence of Mkye,atc.)
P C, prnnlerrt ,uoi.ed
SEPTIC TANI:_L/
(locate on site plan)
Depth below grade: 4i rr /
Material of construction:.Concrete_metal_Fiberglass _Polyethylene otherlesplain)
If tank is metal,list age_ liege confirmed by Certificate of Compliance_(Yes/No)
Dimensions: iwo O G.eQ.Ulu
Sludge depth: Of"J
Distance from top of sludge to bottom of outlet tee or belle: l//4
Scum thickness: (
Distance from top of scum to top of outlet tee or belle: N//_
Distance from bottom of scum to bottom of outlet tee or baffle: N/A
How dimensions were determined: .f///l
Comments:
'recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structureHntegrity,
evidence of leakage,etc.( C cut/Pe-Fe ,ha_ 'e C ho.). r- lo) ou ile -1 £hate Irl /AS \per-ler/
Q eve - • •
GREASE TRAP: Afp
(locate on site plan)
Depth below grade:
Materiel of construction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tea or belle:_
Date of lest pumping:
Comments:
recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level In relation to outlet Invert,structural integrity,
evidence of leakage,etc.)
revised 9/2/98
Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(conlirusdl
Property Address:
Owner:
Data of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include lies to at least two permanent reference landmarks or benchmarks
locate ell wells within 100' (locate where public water supply comes into house)
Co I e_s hnea-ol0 W a.d`
3 Bt
m/9a-
ica99J-
—itio1r
aQ
revised 9/2/98
Page 10 of Ii
SUBSURFACE SEWAGE DISPOSAL SYSTEM PISPECT1ON FORM
PART C
SYSTEM ITFORMATION(continued)
Property Address:
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM(SASE s/
(locate on site plan,If possible:excavation not required,location may be approximated by non-intrusive methods)
If not located,explain: /
1/ 1C D- ROX (2.0■0C- Alt n'"7 ;.-&x71-
Type
leaching pits,number:_
leaching chambers,number:_
leaching galleries,number:
leaching trenches.number, length:s3 pi peL> or 7rCi CV)
leaching fields,number,dimensions:
overflow cesspool.number:_
Alternative system:
Name of Technology:
Comments:
/note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.)
n/p Pbhlei..r , ka'. .44 a— du, .— seer cS4n/rrr— A 1,5“. :4 .' 1 5-6 c+- -
CESSPOOLS:464
)locate on sits 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(cesspool must be pumped as pert of inspection)
Comments:
(note condition of soil,signs of hydraulic failure.level of p. ding.condition efwegatetion, etc.)
PRIVY:Ain
(locate on site plan)
Materials of constructon:
Depth of solids:_
Comments:
(nob condition of soil.signs of hydraulic failure, level of ponding,condition of vegetation.etc.)
Dimensions:
revised 9/2/98
Per 9 of II
Property Address:
Owner:
Dan of Inspection:
NRCS Report name
Soil Type
Typical depth to groundwater
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continuant
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to GroundweteiX Feet
Please Indicate all the methods used to determine High Groundwater Eleyation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,Installers
Used USGS Date
Describe how you established the High Groundwater Elevation. (Must be completed)
Icpo2Tcp) A,,OQ N , 0 Lwciu (.tw d a,Lca CA-dl0ctM{ - u14.S.
revised 9/2/98
Page II of II