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64 Septic Inspection Form 1997 May 29, 1997 Mr. John Hazen 64 Dunphy Drive Northampton, MA 01060 RE: Sewage Disposal System Inspection At 64 Dunphy Drive, Northampton Dear Mr. Hazen: The Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System Inspection conducted by Pamela Bissell at your property, 64 Dunphy Dr. Northampton. on May 23, 1997. That inspection report indicates that your subsurface sewage disposal system fails to protect the public health and the environment as defined in Sec.15.303 of CMR 15.000, State Environmental Code, Title 5. Therefore, in accordance with the provisions of 310 CMR 15.000 of the State Environmental Code, Title 5, and under authority of Mass General Laws, Chapter 21A, Section 13, you(or the subsequent owner of the property)are hereby ordered to repair the subsurface sewage disposal system at 64 Dunphy Dr., Northampton,within two(2) years of the date of the original inspection, (by May 23,1999). If further degradation of the sewage disposal system occurs(e.g. sewage flowing to the surface of the ground), you may be required to complete the repairs sooner. All work to repair/upgrade your subsurface sewage disposal system must be performed by a licensed sewage disposal system installer in accordance with the requirements of 310 CMR 15.000, and with plans approved by the Northampton Board of Health. Please be advised that you are entitled to a hearing on this order to upgrade your subsurface sewage disposal system, provided that you file a written petition requesting such a hearing in the Board of Health office within seven (7)days of the receipt of this notice. Please feel free to contact the Board of Health office, at 586-6950, Ext. 213, if you have any questions concerning this matter. Thank you for your anticipated cooperation in this matter. Very truly yours, Peter J. McErlain Health Agent Certified mail: # P 573 708 95Q BOARD OF HEALTH JOHN T.JOYCE,Chairman ANNE BORES.M.D. CYNTHIA DOURMASHKIN,R.N. PETER J.MCERLAIN,Health Agent May 29, 1997 Mr. John Hazen 64 Dunphy Drive Northampton, MA 01060 Dear Mr. Hazen: CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH RE: Sewage Disposal System Inspection At 64 Dunphy Drive, Northampton 210 MAIN STREET 01060 (413)586-6950 Ext 213 The Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System Inspection conducted by Pamela Bissell at your property, 64 Dunphy Dr Northampton on May 23. 1997. That inspection report indicates that your subsurface sewage disposal system fails to protect the public health and the environment as defined in Sec.15.303 of CMR 15.000, State Environmental Code, Title 5. Therefore, in accordance with the provisions of 310 CMR 15.000 of the State Environmental Code, Title 5, and under authority of Mass General Laws, Chapter 21A, Section 13, you(or the subsequent owner of the property)are hereby ordered to repair the subsurface sewage disposal system at 64 Dunphy Dr., Northampton,within two(2) years of the date of the original inspection, (by May 23,1999). If further degradation of the sewage disposal system occurs (e.g. sewage flowing to the surface of the ground), you may be required to complete the repairs sooner. All work to repair/upgrade your subsurface sewage disposal system must be performed by a licensed sewage disposal system installer in accordance with the requirements of 310 CMR 15.000, and with plans approved by the Northampton Board of Health. Please be advised that you are entitled to a hearing on this order to upgrade your subsurface sewage disposal system provided that you file a written petition requesting such a hearing in the Board of Health office within seven (7)days of the receipt of this notice. Please feel free to contact the Board of Health office, at 586-6950, Ext. 213, if you have any questions concerning this matter. Thank you for your anticipated cooperation in this matter. Very Jlyyours t Peter J. McErlain Health Agent Certified mail: # P 573 708 956 Willem F.Weld Owno- Commonwealth of Massochusetts Executive Office of Environmental Affairs Department of Environmental Protection Trudy DYa LL seemmy M Nmo,ul Dlusel DkNd B.Strube cammmi-w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Pester"Addsese: (oN 2511/21.f Al P4, 11 01140.,,yw,o TPT_. Addis of Owner Dam.1laaps•O•m S�(/ay lq7 Of different) Name of Iwpseter. Fanvf& grzl i'auLt . Campany Names Address and Telephone Number Affordable Home b, Septic Inspection Inc. 342 West Rd. Westfield Ma. 01085 . CERTIFICATION STATEMENT 413-568-4289 I certify that 1 ham personally wpeetad the sewap d sponi 9rtem at this address and that the information reported below Y tut,animate and templets as of the time of inspection. The inspection was performed based on my training and experience in the proper function and aWeteum of eadte sewage disposal syweme. Ttw system: Passes — Conditionally Puma Node Further Evaluation By the Local Approving Authority Fails InsPeoters Blgnaturs �Onna�.A whit., Date: S/au /9 7 TM System Inspeter shall submit•copy of this inspection neon to the Approving Authority within thirty(301 days of eomplMiag this inspection. If1be system is•shared Fyrtam or his•design flow of 10,000 gpd or gnamr,the inspector and the system owner ilia submit the report to the appropriate regime]ease of the Depntmant of Environmental Pnspsction. T .MOW should he seat to the system owner and espies sent to tie buyer.if applicable and the approving authority. INSPECTION SUMMARY: k J-jd /'^- '`L.,w-Qt.�, �,/�'�'9`,,,�, {�} r., m a{ n.(rdr,�. �)�2.44.4 a.Gvve .�.{1e c - %h.0 K stL) 0 9 u.t i-Elite_ Check A,B,C. AI Wit=PASSIM I lam ant head may information which Indicates t t the system violates any of the failure sirenr as defused in 910 ChM 76103. An Ware utark not a.ahuted en iadkatad B] SYSTEM cONDmONAW.Y PASSIM: One u men system components need to be/.placed or repaired. The metros,upon oaapletian of the nptecemeat or repair,panes tndlseta yes,no.m not determined K,N,or ND), basis of deermimtlon k W instances. If^not determiner.explain why am) — Threeptio tank b metal,auk structurally unwind,chow mbstantkl infiltration or sdlltmtlon or tank failure is bamlasnt. Tba gram will inspection if the existing septic tank is upland with a podorvung septic tank u sppnnd by the Board of Health. (revised 11/03/95) I One Winter Sliest • Boston,Massachusetts 02100 • FAX(617)696-1040 • Telephone(617)292.6600 t�. P,.,wentwnwnw SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION on tlnued) Pnpty (/ � r_ d &Lt /17/k- Orr Dab of IapeaUm cr 7 B)SYSTEM COND117ONALLY PASSES(continued) Seep backup or breakout or high reek water Mn! or due tea broken,settled or uneven Retribution beef The System will pan inspection if(wjtb approval of the Bake of Health): M the Retribution box is due to broken or obteutt d pipets) broken pleb)an carrion Is dlnnbutlon Dm b M IMd or npbced / TM rein required pumping an than tow llmae•fear duo to broken or obeMnmed piprW. The eyatem will pass Wpactlon if Idtb approval of the Baud of Heath): broken pipNS)rpo rap)acd ebmnetlen b iamavd _ Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions mkt which nquin further evaluation by the Board of Health fr.order to rennin*If tke system is failing to proud'the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUB C HEALTH AND SAFETY AND THE ENVIRONMENT. Cereal or privy Is within 50 fret of• Cesepool or privy is within 50 feet of• E SYSTEM WILL FAIL UNLESS THE BO MOWN=THAT THE SYSTEM IS SAFETY AND THE ENVIRONMENT. 5) OTHER an water ring vegetated wetland or•salt mash. OF HEALTH (AND PUBLIC WATER SUPPLIER IF APPROPRIATE) CTIONINO IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND Tha system ban.septic tank and{oU abortion System arid is within 100 fret to•surface water supply or tributary to a wfaee water Ripply. The glum bas a septic tank an soil absorption aynem and is within a Lone I of a public water supply wail. The ear has•septic tank soil absorption glum and is within 60 feet of a private water Supply wall. Tins ear has aseptic tank sad soil abeerptlan glum and Is less than 100 feet but 60 bat or re bum•private water amply walk vela.•well water analysis for a1Bnm bacteria and volatile organic oampoads indicator that the wall is free Ur psis from that facility and the presence of ammanb nitrogen ad nitrate nitrogen b equal to or Si dun 6 yr: (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Iwntloued) Property Addreaa io l4 'punt led- N^ ; t cn 'IL/ref Po>L-. Owner. Date of o: gig / D1 SYSTEM FAXLa ✓ nave datermiead that the taco violater one or an of the fotbwh.f.Sre were as darted in 910 CldR 16303. The how for thY detamin Ucc fa ideotiSed blow. The Scud of Health should to centered to determine what will to nie Bury to cornet the fides. J Lehup of ravens Into facility or nem oompweet due to.a overloaded or wgpd SAS or orpool. Dechare or pondinp of affluent to the nonce of On pound or matte.waters due to an merloadd or eland SAS or —pool. Static liquid howl 1n thi dotribution box above omht invert due to an unloaded or One SAS or ceapocl. Liquid depth in ounce is lee than 6'below invert or available volume iS le than 12 day Cow. Inquired pumping mon than 4 time te the last year NQ/due to cloned or obetriRed pipe(.). Number of timan pumped Any portion of the Soil Absorption System,cenpool or prig is below the high groundwater• vetion. - My portion of•onnpocl or pry is within 100 het of•wine water supply or tributary to•mire*water soppy. Any portion of•raspooi or privy is within a Zone I of a public well. Any portion of.cesspool or privy is within 50 feet of•privae weer ripply well ▪ My portion of•onspool or pity to lee than 100 feet but seater than 60 feet from•private water supply well with no aeogthfa water quart.Sy.is U the well bar been uulytd to be acceptable,attach copy of tell water anemia for ceiform bacteria,volatile!,orunic compounds,amawnla nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The Mowing mttnii apply to large ma in addition to the ewe above.. ▪ TW seem sense•Stanley with design Oow of 10000 Span or peat*.(tarp Syeteml and the system is•aiget6aant threat to public health and soft red the t because one or men of the knowing content eWt the miens is within fast of a surface drinking water mapply the system is within 400 feet of a tributary to•rumen drinking water supply the tent L lea in•nitrogen unitive err(Interim Wallhed Protection Ana(IWPA)or•masse Zone II of•public weer supply well Tb.ownn or opener of W such aymam shall bring the mum and faanit into Atli compliance with the poundwter treatment proper ngalwaaat of 314 ClOt 6.00 sad 6.00. Phase consult the kcal regional office of the Deportment for Bother Inhnrmatlon.. revised 71/09/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Piepr Y Atrst 6/l Utne L , Y 1 din owes. I Data of yam S eq b Check if Os following Lonn been done: . PymP{ng information wen ngareN of the one omupaat,and Soud of Health. 2No6e of the swim coenponsnU have been pumped tor et hart two wake sad the votes has bean waving novena!flow rates Irving that period. Isrge Wawa of wow hays not ban ttrwdtroed tin the myna newly or u past of this Wpation. /As built plans bays been obulasd sad aaabad. Nob H they Sr.not salable with NIA Tae teary or twang was Wonted for steno of awn baton // The rata door am receive aoaeaa&ury or IndnRral wets Cow l/The site wet inspected for ripen of breakout. _✓/All mym ae component standing anding the Soil Absorption System,have ban butts on the ate. _/The septic tank manholes were uncovered,opened, and the inurla of the with tank was inspected for condition of taffies or ter,interim!of construction.dimensions,depth of liquid,depth of sludge,depth of aunt. /The sW and location of the lot!Absorption Syass on the site has been daennued bawd on eattag intonation or appaedmated by notuiatrudn mwthoda. fad Iity owner Gad ooaopaats, if different from owner)ten provided with information on the proper maintensaa of Sub. Sundae Disposal Syria. {revised i1/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Dw.! u' aa /a 7 FLOW CONDITIONS D Mabr dMdroamo Neekr Mart nrldret. O.lWp plotter(pee m ao)- lo6s mewed to mama or ao):�¢ Mrwelw Om or*DP Wrr nee nap,If anLahk: Lae late of mower '_!it.6 r wL NS — COTIOlC1Al./INDUSTRIAL: Y Typo drls3Whr-U Data Gm---116316mMAY One ire preset: (Ye or Do) TaMU W Waite Neleat Tank p at:(ye Or no)_ Nta..SWT ware dimkupd the ml.6 roam:(yet or not_ Water Ste nether, if• It lam doe of Omapaacy: OTBS7h(Describe) Lam dote It temperer GENERAL INFORMATION PUMPING RECORDS..cep ..t. of .. orwaU n: _d .. fli • • r.. . Syeels;nand a part of iorp.ctinn: (pr or aor I , d Ups,.alumm pumped: rano= bee for p.lspiee TYPS ep&Y _ ✓SepS do t nkMlN6utbn b&.S1 akerpebn ernm wee foorof OvorSow sompool Priv Shand motels(pas or ao) (If)r,attach;maims Iup• ioa nmre V an) Otter(green) APPIIOEIMATE AGE of all aomponm4,date Installed(O keno)and source of faformation: /d3/73 '01..in 0]r 5/n'aX yC(a.n4 Snrap odors d.(eted when arriving at the rite. (yet or not%1 frwtaad 11/03/95) 6 Oontem o..at d... DWK • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 5 a3/9'7 SE TO TANILL Onto so NM SW Depth Monte d sstr a D —metal_TAP_,4MrtorNalol IfaterW efaoesntotles:_ Dlrr.otesr Madge depth: e, Dias.fa tap of Wedge to bottom of weeks tee or bats: f0 " 4a thiboa /4 " ,,,,pp DlwAesSa bop of awes to top of*Mkt me or baffle. eantiet Dims*As bottom of mum to bottom of outlet war talc, N" OaMoa: OoaendotMe for rasping, witless dLWP,etc) of inlet and outlet to or d m notion to outlet rt,oMUtsual tw•grim S Lid/ r GREASE TRAP_ Omote on alto pigs/ Dgthlake pa_ PRP_wMaM rtpinl Material daeeatawHen: - metal Dlotimekow Dienes Sera top dm to Dim s from bottom of Commeiata ttuoamesdpMp Far ..... . .. ,seGUon of inlet and outlet to or baron,depth of liquid level in relation to outlet frown etnetuN Mtoprty, Gelder af.Wp,a. of outlet toe or lame_ to bottom of outlet a a bnme:_ Invitee 11/0/95p S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ((( ^ SYSTEM INFORMATION leantWood) Peep.e.y aee.e (e if Owner nt Dda of Qahr7 TIGHT OR BOLDING TANK; Gras.ae she NW Depth keOedr- INeaia d caaeee<ioe: mend FRP_etWriaplein) DiaWeer Coped D Ddb Aeon day ANam Neel: Ceaa.nte: beeditiw Menet ,condition of Nan end Beat mritcbm,tic.) DISTRIBUTION BOX:_ Grote a ax.pled Depth of Neel are outlet weer: Oaaesnta: Mete YMd.ed te�Nan N.yy�,.vW.aq d solid,earno+.e�evidence of Nalup law or out of Ate.etc.) I/...L i( . p e / 3 fa maa V�� uv P� L o-� a o� ( o-4ti/ut /L-aJr a /Y cT °nY „At 3 " PUMP GRAl®tvt•, Oft,a elm Pled Pee le mates adr.W no), Gamest.: Wet mew of pomp condition of pumps and apported^ae etc 1 trevle.d 11/03/93) want pn M+> ('o"WSWinJs nopipaao tweed ins'o e9 ailnsiplgle Sap'gasp woa):wnwna0 eI6np visa • :aawanmia Ja TWrlt • lsgd q dd semi) 1'»a'sgiwata+W weeps=tsyp od/o ewe '+mem+ftae+pd4JO—ten so woos)wn)Wan* (ddlindfl Jo wad it padwM law Fawn)*mpg :+waa+pmndl Jo®pw-MR :aoli.Ci p TIMM( :endow Je ne, uatm asap epic '+a i_J.oft : ••m ie1N w ramp deiiidaa :aspnNpm pug ■4ax mid ass to west '(Hood° �(.p�:I�' Y� awn , _rnay.�1->u syarn-a "'�7''rour41 g. ^en.'0mWtdan 10 uepRvw'166iaaa Jo I+ 1 'Wang 3IrSCPS9l�+°dla'pw Jo uWerP o Id*( senewo —uayrmia Zaadana aaawn :nolnamip'loco".'vt u 1o/Cn1 g.,,a 9 F ',rte._ ? :gitaq'+pwna'aagma;Jun a+( —:+ajmas Wm..WWII' —:anew Ise+ana4a pagan( —ants=Wei/WPM sett :sends Wald M se Tenn ,WA R owns=aum+fahaoa y pwawlsidda q ins 3M pw)vbn lot;sapsaoa:gVwed p"Rd wl+ao pomp run musts NOtavowwYtoo Lb era Lasso —v.a.tdv-teuljpcn '!. vO -12*-nc, h �6t+adeaa (panspsos)NOttYM IOANI W2L616 o Lava WHOA NO1.L3Yd6N1 N9t616'iy6Od61a 110Y6L161OYd11J1611116 • 6(; WN/LO/I% Y6166+) • d -'d •r1IBi _ EF G —Y° ♦ ' t. e, '6e!16arlddd6K aMMa1v POP MPY P6 . M ia16.pmloe w odic ivIRLYAON.TOIO OL SLIM • I 1 i ' 1 IA i I 1 Yoh t ` W \. 91 1 • �� ,�S181� FM 4S-rtn IbYa�1 V) l 3s/1o� (T 'DJ 4) • • .001 Mils a16A Its 61666! 9mryweq+e n(auap661 waaapa,u6anvuad ass 11/661 M e6 MMp appal wawa inane soma JO IOinn • • 688/Fz-ells, Yelp ri(pevullavo) NOILYYUUANI W816AB 0 MEW WIOA NOLLiGJSNI NAME 7V604191(11101611.116 seminar's ? - FORM 1]-PERCOLATOR xt .✓ t �7:. tCMao'-Aebmrw ter No y7b .. ffi "dk.Hb e EA LT}7bF"tilA SS"q'C l i�1 S E T T S . . . ®11111.11111 lime et ®® •Ye :nLi'uiieon'h+te..tM Vaf«meab both wMmw....MID Ste Passed 0 so taw LI - • Harmed Witnessed gt- Comments: re .r..e.erm,.e.,e alfd!= : Deep Hole b: DEEP OBSERVATION HOLE LOG' MDIWUY OF IWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth ham Robot(Inches) Sol Rod= SW Tebw...,. saGgpr. 0-14304 Sol - hfoting Ouw (*Wm.Saws.Booklets.Cas'sbnsy.%Gravel) .- .,h .I...♦.I. ... LccaDOn Addressor Lot R j I �_„ iu - Deep Hole Number rate Sif / i A Time ` Aar i ' 'i_____ ' Location(identify on site plan) Land Use Slope %) 16 Surface Stones I �Lw-.--- h� _ I ( _'�v.1 Vegetation Landon ~' positon on landscape(sketch on the back Distances from: Open Water Body 224 CT feet Orin kug Water Wel �fx� feet Property Line Se feet Possible Wet Area prat 0-0 feet Drainage Way /to feet Other feet Deep Hole b: DEEP OBSERVATION HOLE LOG' MDIWUY OF IWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth ham Robot(Inches) Sol Rod= SW Tebw...,. saGgpr. 0-14304 Sol - hfoting Ouw (*Wm.Saws.Booklets.Cas'sbnsy.%Gravel) .- .,h .I...♦.I. ... DEEP OBSERVATION HOLE LOG' Deep Hole O: *IR7WDU OF TWO HOLES REWIRED AT EVERY PROPOSED DISPOSAL AREA • Depth from &oboe(wits) SIR Halms Sal Texture VEDA) Sat Caor (Unveil Sol Wang Other (Soon,Sahel Smilers.Consistency.%Gravel) n —(o (s_ coi S[% %a 4 c , Ca- 5C p\SJ 5 14 . y0 ," 94 01 b/f I o '' S/}-, y6( 6) r Parts wWl(geobsa I • . .... I Depth mBedeck I iota-'~- r Depth b toe: StilettoWater h We lob /i✓?Mi"-- I Weeping torn Pi Face I Aoraer”—^r gro Estrobd Seasonal flab Ghwd West '','a .... 4 L 4) — Deep Hole b: DEEP OBSERVATION HOLE LOG' MDIWUY OF IWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth ham Robot(Inches) Sol Rod= SW Tebw...,. saGgpr. 0-14304 Sol - hfoting Ouw (*Wm.Saws.Booklets.Cas'sbnsy.%Gravel) .- .,h .I...♦.I. ...