64 Septic Inspection Form 2000 ENVIRONMENTAL HELD SERVICES,
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
June 22, 2000
Shawn & Wendy Terwilliger
64 Dunphy Drive
Northampton, MA 01060
IN
LP. JUL 2 5 2oa
NORTHAMPTON BOARD OF r
re: Septic System Inspection at 64 Dunphy Drive, Northampton
Dear Scott:
Enclosed please find a copy of our report for the referenced inspection. We
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 our inspection in accordance with 310 CMR 15.300,
we 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,
MichaeiJ.
System Inspector
SUBSUIVACE SEWAGE DISPOSA1.SYSTEM INSPEC ZION MOM
PAItI A
CEBiIrICATION(continued/
Properly Arkk•ss'
Ow
Dela of Inspection
PIMPLE" liN SUMMARY: Clerk A. II, C. or II
A SYSTEM PASSES:
I/ I have not found any Information whi
criteria not evacuated are Indicated help
COWMEN IS,
B. SYSIFM CONDITIONAL I Y PASSES:
of the torture condlliorn described In 310 CMB 16.303 exist. Any failure
One or system components on dean lh ed in Ihe 'C ondi donnl Pass" section need to be replaced or repaired. The system, upon
completion of the replacement or repair. In,PPravnrl by Me Board at neamr, will peas.
Iutlic ore yes. no, or not deter IY, N. or NDI- Descrihe besis of determination In all In/dances. II not determined", explain why not.
The septic tank Is metal. rmless the owner or operator hes provided the system Inspector with a copy of a Cattirleate of
- Cornnlience Imtaclietll indicating thnl the mnk was Inetelled within twenty 1201 Years prior to the date of the Inepeclion; or
Be septic Iank, whether or not metal. Is cracked,structurally unsound, shows subset fillet infiltration or uflllretion, or tank
failure is imminent. The system will pass inspection If the existing septic tank Is replaced with a complying aaptic tank as
rnnrn
oppr oved by the Board of Health_
Sewer's hookup or breakout or high ensue water lave?observed b, the distribution box is due to broken or obstructed plpepl
Of tl■e to a broken. settled or nneverr Alebilnnlmn box. The system will pass Inspection If(with approval of Ilia Board of
lipniOd
broken pipers) no render od
obstruction is removorl
distribution hos I. levnllnd Pr toploced
The sysmm required pumping mom than four tiros a year due to broken or obstructed pipell). The system oBlTp
insportion if with epprnval of the Board of Ilenhbh --
er-
_ __ Frmkan pipelel era,plane)
obel me lino is renmved
1eviFnd 9/2/99
Irnpe t of 11
ARCED PAUL CELLUCCI
Governor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER 0Ti!EE;P, BOSTON MA 92108 MP) 2926500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CFHI1FICATION
TRUDY CORE
Secretary
DAVID B. STRUN0
Cormnieeloner
property Address: 6U D LVnQ hj Dr LVC None of Owner udy -re rLJI 1( e
Adding of Owner:6 V O Ct/n rh 0Ft,ut
ome of inspection: 6/15/CO AJO r rip m 0 loco
Nana ol Inspector:/Please Print) :I'Y) L Q t)3 q Ri r?
I an•DEP approved system Inspleddnr moment to Section 15.340 0l Mile 6(310 CMR 15.0001
Company Henn: CLS)SZ_o Vine Dia/ ULU iiSP ru'o)
Magog Addeo: _PO (40 Y,5-1S' Lee.rl C) 103-3
Telephone Number: 6:15 rcc_I2 .(Y)
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 es of the time of Inspection. The Inspection was performed based ore my training end experience In the proper(unction and
maintenance of on-site sewage disposal systems. The system:
.A.e,PRNHIS
_
Conditionsily Passes
Ne
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector s Signature:
Date: `f/O/)oj)
The System Inspector shall subs a copy of this inspection report to the Approving Authority'Board ol Health or DEPIwfh'n thirty 1301 days of
completing this inspection. If the system is a shared system or has delign flow of 10,000 gpd or greater,the inspector end the system owner
shall submit the report to the appropriate regional office of the Deportment of'Envbanmemd Protection. The original should be sent teSlw
system owner end copies sent to the buyer, if applicable, and the approving authority. . . •
NOTES AND COMMENTS
revised 9/2/98
nl u
�e5nn,ad tryd.d n.n..
sonslnlrACF SFwArl IIISN)5A1 SYSTEM INSPECTION FOAM
PANT A
CEO I Ir ICA I IIIN Icmtlilmrd)
Property A,Weser
Ow
Dale of bni'.ctimc
IT SYSTEM rAlls:
You 1111/S1 rndlcele either 'Yen' or No la and,of the following'.
I Irnvr datennlned Ibn1 one of Um followirm Inilrnn conditions eeisl ee descrtlntl in 310 CMS 15.303. The bosln for this
determinntion in Idnnlifind below. The Rorer"of Health s ionld he contacted to determine what will be necessary in cnrres! the failure.
Yoe No
rim:1cup of eawnge Into 4noilitwor .TSS rn r nq`nnnrit don En nu over inminrl m rI q Puri SAS or c .spool
Oisclnrge nr pointing of effluent to the sop lnen of the ground or mot nee wntere chin Inn?)ovednntlnrl or clogged SAS or
nrismpool.
Stria.liquid ^unlit Pin rlialrihullmr box nhnvo nnllnt irlvarl dun In nil nvnrlentlnrl m riiimind SAS or cfpapord.
Liquid depth nrcranium'In Inds llrmr r•" below invert or avniinbin volume in Inns then Ir7 (lay flow.
Required pumping mina then 4 limes in the Ins" year NOT due to clogged or ohntine;led pipets).
Numhr, or tins pumped
Any portion of Ilrn Snit Absorption Systnin. " ^I'nol or privy Is below the high gnnmdwnler elevation.
Any portion nl n cnsspanl m privy is within Inn lent of n sorince water elgply or ulbiitarY to a nuance wetar!apply.
Any portion of n c ssponl or privy is within n ]Ann I of a IliOslio well.
Any portion of n c snpnnl or privy is WWII., bn Inn" of a p•ivoip wettr snprdy wall.
Any portion nl n scum'nr privy is Inns gwr IM, tem but runnier firm 601nnt Iron n
•� aepinh r le w quality n,nlyfin. II fin woil ins been finely/ad to b ee ceptable. Mine
nlnarrn Irnmario volntiln oreinr m n mpmealln. anrrnonin nitrogen nrrd nitrate nmm�nrr.
E. LAPPS SYSTEM.All Si
Tim min) Irnllnnta rllhnr •Yon' or -No anti.of Ili'' Inllnwbrp
The following mired),Amply In Irafin sy•lrms in nddirinn rm Ihn oilrrin(boor.
Ater supply wag with no
well wn er ennlysls for
The system servrs n fnrility wiIM1 n design now nl I0.000 purl or glnaler Il.Argo Syslend not lisp nyslnnl is a s'rgnincar,l throe"to public
health and misty end Iho nnvirorrnmul bnrnnan Ann nr nn.re of the lallawing cnndldmrs
Yes No
Ihn v i rn rs
nrr 400 Intl nl n sartnar Min lrinnl wrier Willi
Ihn rya torn in within 200 Inn! of n Tributary In n nut leoedda4inq-wailer n
thin Ny.lnrr,Is "mated m n nll,nnnn anndnvn mon Orderin, wnlp,end Prolmnlou,Aron
wnter only wnlll
PA l ore mopped Zone II of a public
Om owner or alraralm of nny such syslnm ll,nll ITT San the nyslnrr, In SP pin with 310 CMR 15 104171 Pierre cumuli the Intel regional
olncn of the nnpmhnnni Int bndhat Inlnrgsmlm,.
revir—nr1 9/2/9R
rner 4 et I
SUBSURTACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
rAOt A
CERTIFICATION Iconlirewdl
Roperly Address:
Owner:
Date el Inspection:
FURTHER EVALUAIION IS REOUInED BY IIIE. BRAID OF ITEAL Tlh
Conditions exist which termite further eveluellon by the Board of Health in order to determine it the system Is failing to protect the
public heellh. en loly and the environment.
11 SYSTEM WILT.PASS UNLESS BOAOU OF IIEALIII OEIFIIMINF.S W ACCORDANCE WWII 310 chin 16.303 IIIIb)THAT THE SYSTEM
15 NOT FUNCTIONING IN A MANNER WLIICII.WIIL PIIOIECr 111E PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT_
_ Cesspool or privy is within 50 lest of nurince wester
Cesspool or privy is within 50 feet of n bordering vegetated wetland or a snit nsereh.
2) SYSTEM WILL FAIL UNLESS 1HE BOARD Or HEALTH JANE PUBLIC WATER SUPPLIER.IF ANTI DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PURL IC HEALTH AND SAFETY AND THE ENVIRONMENT:
_
the system hos a settee took and sell nbeogrtinn system(SAS)and the SAS k Milan 100 Ise(of n surface water supply or
tributary to sutlers wilier supply.
_ The system has n septic tank end soli nbsorppan system end the SAS Is wldrin a Zone 1 of a public water supply well.
The syslenr has a septic lank and soil nbeorption system and the SAS is within 50 Intl of a private water supply well.
The ayslem hes a sepiiv lank and soil absorption syHem and the SAS Is less Than 100 lent but 50 feel or more from e
privets water supply well.unless a well weber winlyele for coin orm beclerle and volatile organic compounds indicates ihel the
wog Is Tree Itorn pollution from tint Iarigly and Ube presence of ammonia nitrogen and nitrebe nitrogen Is erusl TO or less
than 5 pprn. Method used to dal Waive distntirn • lapproalmntian not velid •
31 OTHER
revised 9/2/98
Page 3 nr 11
Properly Address:
Owner:
Date of nspeetion:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSI EM INFORMATION
Fl OW CONDITIONS
RESIDETI1I4;
Design now!J. p-hd./bedroom.
Number of bed,cor n'design): <, Number of bedrooms lectuall: j-l/
Tote, DESIGN flow /g 'I
Number of current residents L_
Garbage grinder(yes or no))yy
Laundry 1 epera l esystem} es ro)k)C If yes, CCpantie Inspection,e ulr ed
laundry system iuepecfed ye nol
Seasonal ice l yes or nod:
Water instor readings.II available (last two yeer'c u,age gpd L la
sump rump 1yes or nor: /.)l)
c
Les' dole of ccupancWLLrr c C101-
COMMERCIAL/NOUSIRML:
Type of eeleblishmenu
Design flow'. gpd I Based on 15.203)
Beers of design flow
Grease trap proem: lye! no)..
Industrial Waste Ilniding 1 nnlr present:ryes or no)_
Non s aril ary waste disci,erged to the Title 6 system) (yes or nal
Water meler readings, If available:
Losi dote of occupancy'.
0111E11'(De.vdbol
Lost dole of occupancy'.
GENERAL INFORMATION
PUMPING RECORDS end source of Information:
LAO `�LII _ VEDA) .rrrj -11°111 UI 'CA r! LTV pzai >_i,th 4Lp
System pumped es owl of Inspectiod: Ives or ml_L O
If yes. volume pumped: gallons
Renton for pumping: pc In�iCLLc bi [cu fc C P 1 �:p I C e l,len It '(CC
TYPEJIr SYSTEM TT
✓ Septic tank Idle nibotion box/colt obeom lion eyelen'
_ Single cesspool
Overflow cesspool
Privy
Shored syslenr ryes or no) 111 yes. Minch previous Inspection record,,If any)
I/A Technology em. Acted),copy of up to date operation and maintenance contract
noel lank r !ropy of Der Approval
DOD)
APPROXIMATE AGE of all components.date Installed NI;mown)end•ot,ree WJMenn Bra. 3-- tz 1 O W As.t I) /(.00
Sewage odors detected when err Iving ci the site'ryes or nor JJU
)retried 9/2/98
rest a el I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner:
Date of Inspection:
Check If the following have been done: You must indicate either "Yee" or No as to each of the following:
Ye> No
✓� _ Pumping Information was provided by the owner, occupant. or Board of Health.
None of the system compoeurY.Yw ban pumpeddonatleast1Wa weeks and-We'system haskeeeicdniMesesmal AoW
raise during tint period. Large Volumes of water have not been Introduced Into the system recently orb pert of this
Inspection. '.
}Jill _ As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was Inspected for signs of sewage beck-up.
L/ The system does not receive non-sanitary or industrial waste flow.
✓ The site was Inspected for signs of breakout.
r./t All system components, excluding the Soil Absorption System.have been rotated on the sitar : 1 n
1
_ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition el belles
or tees. material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The she and location of the Soil Absorption System on the site has been determined based on,
Existing Information. For exempla, Plan at B.O.H.
Determined In the field ill any of the failure criteria related to part C is at Issue,approximetlen of distance Is unacceptable)
/ 115.3021311bIl
s/ The facility owner land.occupsntsrif dilleree!Iran.owoed.wesaprax ded.wliJi WormaBOnan.tWympermbsWepoael
Subsurlace Disposal Systems.
revised 9/2/98
Page 5 of II
NrvpSO°.l 8o/`L/6 L.aaiAa2C
•
•
•
•• —___1'ale huauuualnids yu pdmnJ Id Iollllw a upu •la dluml to •Io1110uua 0104"
WSJ ion
"ION Al SS• I w1l0 611111u1.. ail 5u1mIV
• —IoN i.• osA" ;wpm OlilMwna ail udwnd
valid SIP 110 ,1100411
•��(11:113V W V 11B
•Wll•
z-rrrzsn—Trr-awa� jbn b--S C o 71111 i e /T110
-. . . —T"" aW IA04 l• mu so 0011 800•9 1•11 I J0111•• ^“A/4U •011411 lu •eusPiAU 1pl Lai I uOugO •lp pus 14^01 II 003 11
;a1116W1110n
r� �gmn4l luyiu• . uyu I0np1 PIm41 to yPlan
/ Om1• ,1I• 4• 411,3011
."%Iltl NOIII IIIIl11,S1(1
•
'01u 'puyallmli Ipoll 1.""""1"to uollII IUa IJSI 161(11 1" u..11lluoa"
"I"'"I"""9
weu4d , uul 01, slain
..N "A •••11)1" Wpylum .q 44411• amnl wmnV
uwau wIS
"e11/ 1".0n 1n.up utlPUn
e•
wllutl _. :AIPSdup
lulujdxollallu "" p•lu1AyJUA14J uulbw41J mum uIUJUUUJ wllanuvuuu "u p051uW
:01m10 muluq yldSO
OIIId ,111,1 1,u •144011
(uUlloudnq 'lll null l'I II 'ail wlm pwlumd 1,q 1511111 pa I l 11�(/ NN V I.IINI(I mil 11O 111011
w!yud5•y 11,polo
"on/ea
• .11,11•1•1•AIwJOJd
Ip,1lu!IOOa1 NW I V W LIIJNI MIA I SAS
3 lava
W VOJ NOI I 33JSNI Wi1SAS IVSOJSIN iDVMAS d3 VJIIOSSOS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION leontlruedl
Property Address:
owner:
Date at Inspection:
BUILDING SEWER:
(Locale on site plan)
Depth below grade:tyj� �
Materiel of construction:_cast Iron 4;PVC_other lenpl slid
Distance from private water supply well or suction line 01 '9
Diameter N Pr
Cornments:'condition of johns, venting, evidence of leekspe.etc.)
nVo pro Ala mS 1v0-1-e
SEPTIC TANID_r-/
'locate on elle plan)
Depth below grade: Olt
Materiel of construction:✓oncrete metal_Margin* Polyethylene other'eaplabd
It tank la ptetal, list age_ ledge confirmed by Certificate of Compliance_IY esfNol
Dimensions:050 Ad IL% '&
Sludge depth:G lr
Distance from top$1 sludge to bottom of outlet tee or beme''a)p
Scum thickness:3-f/'
Distance from top of scum to top of outlet tee or baffle:4 "
Distance from bottom of scorn to bottom of outlet tee or baffle: 16 u
How dlmenelons were determined: C inn Di C (i
Comments: .,,.
(recommendation fat pumping,Condition of Inlet and outlet tees or baffles, depth of liquid level In relation to outlet Invert,Oruetut
evidence of leakage,etc.) O plpt rrl.9S' t _a C CIS.-1.. I&iVV1 (7.Ygvl.01_1,
toothy,
GREASE TRAP:/411
'locale an Bile plan)
Depth below grade)
Materiel of construction) concrete metal_Fiberglass __Polyethylene otherlecp)dnl
Dimensions:
Scum thickness:"
Dlstenc•from top el scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of lest pumping:
Cormmmrts:
(recommendation for pumping.common 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
Peer'or I I
SUASUOPACE SEWAGE DISPOSAL SYSTEM INSPECTION rOOM
PAIR C
SYSTEM INrOAMAT1oN Icm'Hnuedl
Property Address:
Owner:
Date of lnspatHOn:
SKETCH or SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply cornea into house)
i,sa 'Ark
'}C
revised 9/2/98
bi`K
3)"fl
Pepe m nl II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Pent C
SYSTEM INFORMATION(conroaedl
Properly AMkess:
Owner:
Date of Impaction:
SOIL ABSORPTION SYSTEM ISAS)tV
Resale on mite plan.II possible:ex cevalion not re/Mrad.Incnlion may he Refrradnnoted by noninlnralve methods/
If not located explain:
IJ I .CA. ll f't0% o 011
Type
lenchlnp pits. number:
Pinching chnnrbers, n mbar:
leeching grille/lam.number:
cooling benches,111,11111/0t. length:
leeching Kelm, mm11bnr. dimensions: 2--(j 'X _2 ) {d h Tern%i 0 I 1 art bed
ovetflow cesspool,number:_
Alternative system:
None o11 ecbnology:
Comments.
(note cnnditlen of soil.signs of hydrae olic failure, level of ponditig, dart/1p soil. condllion nl vepelalmi, etc.)
/F/it 4 J.GMfs Mf c.cLr
CESSPOOLS:IJI_P
(locale bn site plan)
Number and configuration:
Depth-top of Iimild to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimenslobn of cesspool:
Materials of construction:
Indic atloll of groundwater:
Inflow lens spool must he pumped as pal of Inspection)
Conlnea.l n'.
Incite condition of eon, Agile of hydratillc failure, level of pending.condition ebvegelegon, etc./
PRNY:UL-N"
(locate on site plan)
Materjel,of eonnhucton: Dimensions:
Depth of solids:
Cote condllion of soil. signs of hydraulic tellnre,level of ponding, condition of vegetation:etc./
revised 9/2/9B
Per 9 of
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION IeogBroedl
Property AMY•u:
Owner:
Date of Inspection(
NRCS Report name
Soil Type
Typical depth to groundwater
OSGS Ont•webelt•visited
Observation Wells checked
Woundwster deptin Shallow_ _ Moderate Deep
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 2/C Feet
Please Indicate all the methods used to determine High Groundwater Elevation:
12 Obteined born Design Plans on record
t/Ohserv•d Site(Abutting property, observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping record,
Checked local ex cavetens,Installers
Used DSOS Data
Describe how you estebli shed the Ill ph Groundwater Elevation, (Must be completed)
c I t t ik,St / f Cl nr.1 e C 1'i n )7e0
ieT bttiLt -/fl Aww 7-- ,, %)o „lords)
revised 9/2/98
u II ofII
CERTIFICATE OF COMPLIANCE
This i to certify that the on-site sewage disposal system installed or repaired(
on lv/2G/�i7 at o 1 2)v u v> 2)ie) Ve-; Ne e-7,/Am/-D7o,t/
by Df94t— Fre7ie-- c (1.0,1_,/,5 7: has been
constructed in accordance with the provisions of Title 5, the o
Board of Health Regulations, and the Disposal Works Construction Permit Not-97
a
a at
rn
THE COMMONWEALTH OF MASSACHUSETTS
C?r/nom /'Y°fYii1AMP77N MASSACHUSETTS
Certificate of ump(ialtre
THIS IS 10 CERTIFY. that the On-site Sewage Disposal System installed ( )or repaired/replaced( 4 on
4:-_y'6/7 be LE:NSap W• 3dCK for S'.44/ r," f1/292`"N
at G<F C0NG1+y /-'/?//f NG.<'e7.7em,onjq/ has been constructed in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 23-07 dated
-9T Use of this system is conditioned an compliance with the provisions set forth below_
The issuance of this certificate shall not be construed as a guarantee that the system will function "deigned. This
Certificate expires on j. /
DATE 37NP Zi f7 Inspector /%�9//J /l'%/
SIGNATURES"
Des
James A. Gracia, PE
James A. Gracia, PE
99 Glendale Sires,
Easdtampee,; Af.4 01027
FROro5LD NEW
LEACH 1=IFl_D -
(SEE DETAIL)
125/15
IBM :
Vol' or 5FFFIG 1 ANK
17 LV • 100.00
EXISTING FAILED
- LEAGI I FIELD
ISEE NOYF5)
101 -
U
EXISTING
1250 GAIL -ON
SE_FT IF TANK
ISEE: NOTES)
• - 100
- 101
J
DUNPHY DRIVE
PLAN VIEW
SCALE. 1° • 20