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15 Septic Inspection 2013 ?\ Commonwealth of Massachusetts Owner information is required for every page Important when filling out Corms on the computer,use only the tab key to move your cursor-do not use the return key thins•11110 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefoundsecomcastnet). Owners Name Northampton MA City/Town State 01060 06.19.2013 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: Alan E Weiss, M S, Hydrogeologist, RS#933 Name of Inspector Cold Spring Environmental Consultants Inc. _... Company Name 350 Old Enfield Road Company Address Belchertown CmRown 413.3215957 Telephone Number MA State #738 License Number 01007 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 06.19.2013 Inspectors 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. nee 5 Official Inspecton Form Subsurface Sewage disposal System.Paget of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefounds(dcomcast net) Owner Owners Name meQ rredll for Is Northampton MA 01060 06192013 every page. City/Town State Lp Code Date of Inspection bins.nno 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 15303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Property has two chambered 1500 Gallon Septic tank, and three chamber 300 gallon leaching tanks set as a galley, system was functional(13+/ yrs old),good levels and no high staining observed. B) System Conditionally Passes: El 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): Tie 5 olfimi Inspection Foam:Subsurface Sewage Disposal Sys em.Pale]or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefoundsacomcast net) Owner Owners Name information Northampton MA 01060 06 19.2013 everyeyed for r P every page City/Town Slate GP Coda Date of Inspection 61w.11110 B. Certification (cons.) 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 ❑ N ❑ 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 ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ Y ❑ N ❑ NO(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 Tore 50ffcal Nspecoon Form.SubsuRece Sewage DYpOSar System•Page 3 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefounds@comcast.net) ..... Owner Owners Name information is required for Northampton MA 01060 06.19.2013 every page. City/Town State Lip Code Date of Inspection Inns•nn0 B. Certification (cont.) 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 ❑ Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 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 2 day flow Title 5 Official Inspection Form:Subsurface Sewage Dlspocd System•Page a or 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 15 Fair Street Property Address_. _. _.. James Steven Founds (stevefoundst comcast.net) Owners Name Northampton MA 01060 06.19.2013 Crtyffown State Lip Code Date of Inspection B. Certification (coot.) 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. ❑ Z 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. ❑ %. 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.] ❑ F1 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. 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—I W PA)or a mapped Zone I I 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. t5ms.11/10 Tiles°Maar Inspection Form SINSURare Sewage Drspm'ai Syslem•Page 5 0117 l‘ Commonwealth of Massachusetts Owner information is required for every page Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds(stevefoundsecomcast net) Owner's Name Northampton MA 01060 City/Town State Zip Code 06.19.2013 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 Z ❑ 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? Z ❑ 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) Z ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? Z ❑ 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)] 0 D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2 tsms 11110 rde 5 Official Inspecton Form.Suomrace Sewage Disposal System Page 6 0ry Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefounds©comcast.net) Owner Owner's Name inforation required fors Northampton MA 01060 06 19 2013 every page. City/Town State Lip Code Date of Inspection tsms lino D. System Information Description: 1500 gallon septic lank, D Box and three 300 gallon leaching tanks. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? . ❑ Yes ® No Seasonal use? ® Yes ❑ No n/a Water meter readings, if available(last 2 years usage(gpd)): Detail Laundry connected Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): 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: Gallons per day(gpd) 0 Date Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Tie 5 omaai msoecton Fom[suomilace sewage Disposal system'Page 7 of 17 Owner information is required for every page ibins•11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Properly Address _.. _. _. .. James Steven Founds (stevefoundsacomcast.net) Owners Name Northampton _.. MA 01060 06192013 CM/rown State zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other(describe below): current 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: 2010 8 2003 1500 gallons Estimated inspection of tank Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ No ❑ Shared system (yes or no) (if 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): ime 5°Masi Inspection Form Suoiuheee Sewage alsposai System•Page a of Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds(stevefounds @comcast.net) Owner Owner's Name _..._... information required fors Northampton MA 01060 06.19.2013 every page. City/Town Stale Lip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed Of known)and source of information: 13+(- 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: 2. feel feet Comments(on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: Material of construction: ® concrete ❑ Yes ® No 2(mid riser at 6") feet ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain) Good condition tees in place If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No w x 10.5'1 x 4.2'd. Dimensions: Sludge depth: inns n fro Tie 5 ofoal Inspect on Form Subsurface Sewage Duyosai system'Page 9 am Owner • information is required for every P899 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefounds@comcast.net) Owners Name Northampton MA 01060 06.19.2013 City/Town State lip 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? 32" 3" 9.. Meas.than pumped Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Good condition. No high staining. Grease Trap(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal feet ❑fiberglass ❑ polyethylene ❑ other(explain): 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: Date t51m-11110 Title 5 Ofiaal Inspeamn rmm Subsurface Sewage olswsel System'Page 10 of IT Owner Information is required for every page tNns•11110 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street _.. _....... Property Address _. James Steven Founds(stevefounds@comcastnet) Owner's Name Northampton MA 01060 0619 2013 City/Town State Lip 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: --------- Alarm in working order. Z. Yes ❑ No Date of last pumping: Dale Comments(condition of alarm and float switches,etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Toe 5 Omoai Inspection Form Sasolace Sewage Disposal System•Page 11 of IT Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefounds@comcast.net) Owner Owner's Name infomiation is required fo r Northampton MA 01060 06.19.2013 every page City/Town Stale Zrp Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 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: t5ins•11/10 ➢ee 5 O final Inspection Form Su5sm1Me sewage DiSDMat SV9em•Page 120117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds(stevefounds@comcast.net) Owner Owner's Name information is Northampton MA 01060 06.19.2013 every for P every Oega Clty/rown State Lip Code Date of Inspection D. System Information (cant.) Type: ❑ leaching pits ❑ leaching chambers ❑ leaching galleries ❑ leaching trenches ❑ leaching fields ❑ overflow cesspool ❑ innovative/alternative system number: number: number: number, length: number, dimensions number: 3-300 gal. Type/name of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): No standing liquid, stone dry. 20' ht. Cesspools (cesspool must be pumped as part of inspection)(locate on site 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 Sins•11/10 Tie 5 Olfical Inspection Fe ❑ Yes ❑ No ge Disposal Syslem Page 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 15 Fair Street Property Address James Steven Founds (stevefoundsacomcast.net) Owners Name Northampton CM/Town MA 01060 State Zip Code 06.19.2013 Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.)'. No staining or signs of improper conditions Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5lns.rom Toe 5 Othaannspect n Farm Subsur ate Sewage Disposal System.Page 14 of Owner information is required for every page Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Fair Street Property Address James Steven Founds (stevefounds@comcast net) _.. Ownei s Name Northampton MA 01060 06.19.2013 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 0 drawing attached separately 15 ns•nrlo Talle 5 oToai inspection Form subsurface Sewage asposN System•mile 15 01 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 15 Fair Street Properly Address James Steven Founds (stevefounds@comcast net) Owners Name Northampton MA 01060 06.192013 City/Town State Lip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water • Check cellar ❑ Shallow wells Estimated depth to high ground water: 4-5+ 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: 2000, 2003 8 2010 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Work in area ❑ Checked with local excavators, installers-(attach documentation) • Accessed USGS database -explain: You must describe how you established the high ground water elevation: Records and review of area Before filing this Inspection Report, please see Report Completeness Checklist on next page. tarns.1110 nee 5 OfAtler iwpecon Form subsume Sewage msWem System.Page 1s of IT Owner information is required for every page Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Fair Street Property Address _... _. . James Steven Founds(stevefounds@comcast,net) Owner's Name Northampton City/Town MA 01060 06192013 State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15 ns•f1110 Title 5 Official Inspecton Form Suosunace Sewage Disposal System•Page IT or 17 vizttoorr It SUBSI RFACE SEWAGE DISPOSAL SYSTEM INSPECTION EORiM PART C SYSTEM INFORMATION otoutinurdi Properry Address Ove _. Date aF of Impeder A 01060 s Ap, f k l tt L n.� JU icrert >4„ gco cr .. lc S Tank Inlet Tee 15 Fair St 6.19.2013 2,4 S Tank OUtlet Tee 15 Fair St 6.19.2013 L tank 15 Fair St 6.192013