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731 Septic Inspection 2006 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification 1. Property Information Property Address: 731 Florence Road, Northampton, MA Owners Name: Kiritkamur Patel Owners Address: 731 Florence Rd. , Florence, MA 01062 Date of Inspection: 10/3/06 Copy to: Board of Health. Northampton Real Estate Connection Witness: Nancy Nickerson Number: SSDS-1136 2. Inspector: Name of Inspector Thomas S. Leue Company Name: Homestead Inc, Mailing Address: 1664 Cape St. , Williamsburg, MA 01096 Telephone Number. J4131 628-4533 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 septic system condition must be evaluated and classified into one of the following four conditions: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails The system condition: Fails Inspector's Signature: s Date: 10/3/06 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 to the buyer, if applicable and the approving authority. Notes and Comments: ""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. 5@©45l41$O W`3 t5insp.doc• 11/2004 Homestead Inc. Title 5 Official Inspection Form:Subsurface Disposal System •page 1 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (Cont) Property Address: 731 Florence Road. Northampton. MA Owner Name: Niritkamur P fll Date of Inspection: 10/3/00 Inspection Summary: Check A, B, C, D or E/ofways complete all of Section 0: A. System Passes: I have not found any information which indicates that any of the failure criteria as described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: a11_ components backed up. B. System Conditionally Passes: N 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. Answer yes, no, or not determined (Y, N, or ND) in the_for the following statements. If"not determined" please explain. (1) N 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 exfltration, 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. `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. ND explain: (2) N 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 by the Board of Health). _ broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced ND explain: (3) N The system required pumping more than four 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 ND explain: (4) N Other: explain: C. Further Evaluation is Required by the Board of Health: N 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 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. t5insp.doc•11/2004 Homestead Inc. Title 5 Official Inspection Form:Subsurface Disposal System •page 2 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (Cont) Property Address: 731 Florence Road, Northampton. MA Owner' Name: Riritkamur Patel Date of Inspection: 10/3/06 2) System will fail unless 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 I 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 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. 3) Other: D. System Failure Criteria applicable to all systems: You must indicate either"Yes" or"No°as to each of the following for alt inspections: YES(Y)or NO(N) Y Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. N Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Y Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. N Liquid depth in cesspool is less than 6" below invert or available volume less than 1/2 day flow. N Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped N Any portion of the SAS, cesspool or privy is below high ground water elevation. N My portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N Any portion of cesspool privy is within a Zone I of a public well. N Any portion of cesspool or privy is within 50 feet of a private water supply well. N Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply 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.] Y The System Fails: I have determined that one or more of the above failure criteria exist as defined in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health should be contacted to determine what will be necessary to correct the failure. COMMFNT: t5insp.doc•11/2004 Homestead Inc Ttle 5 Official Inspection Form:Subsurface Disposal System •page 3 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Sewage Disposal System Form A. Certification (Cont) Property Address: Owner' Name: Date of Inspection: 731 F1 orPnr:e Road. Northampton. MA Kiritkamur Patel 10/3/06 E] Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 to 15,000 gpd. You must indicate either"Yes° or"No°as to each of the following: The following criteria apply to large systems in addition to the criteria above. YES(Y)or NO(N) N the system is within 400 feet of a surface drinking water supply N the system is within 200 feet of a tributary to a surface drinking water supply N 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 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. B: Checklist Check if the following have been done. You must indicate YES Ill or NO IN)as to each of the following: Y Pumping information was provided by the owner, occupant or Board of Health._ N Were any of the system components pumped out in the previous two weeks? _ Y Has the system received normal flows in the previous two week period? N Have large volumes of water been introduced to the system recently or as part of the inspection? Y Were"as-built"plans of the system obtained and examined? (If not available note as N/A) _ Y Was the facility or dwelling was inspected for signs of sewage back up? _ Y Was the site was inspected for signs of break out? = Y Were all system components, excluding the SAS, located on site? _ Y Were the septic tank manholes uncovered, opened, and the interior of the septic tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and scum? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Y a) Existing information. For example, a plan at the Board of Health. N b) Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[15.302(3)(b)1. Y The facility owner(and occupants, if different from owner)were provided with information on proper maintenance of Subsurface Sewage Disposal Systems(SSDS). t5insp.doc•11/2004 Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal System •page 4 of 10 )nwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Property Address: 731 Florence Road, North•. pton, MA Owner' Name: Riritkamur Patel Date of Inspection: 10/3/06 RESIDENTIAL 330+ 3 3 3 N Y N N N/A N continuous FLOW CONDITIONS DESIGN flow based on 310 CMR 15.203(gallons/day) oriai.nn]. nlans not found Number of bedrooms(design) Number of bedrooms(actual)_ Number of current residents_ Is there a garbage grinder? (Y or N) Is there a Laundry Hookup?(Y or N) Is the Laundry a separate system?(Y or N) (If yes, separate inspection required)a Seasonal use(V or N) Water meter readings, if available(last two years usage)(gallons per day) Sump Pump(Y or N)9 Date of last occupancy COMMERCIAL/INDUSTRIAL Type of establishment: _ Design flow(based on 310 CMR 15.203). gpd Basis of design flow(seats/persons/sgft, etc.): _ Grease trap present(Y or N): _ Industrail waste holding tank present(Y or N): _ Water meter readings, if available:_ Last date of occupancy/use: _ OTHER (describe): GENERAL INFORMATION Pumping Records: Source of information: Pumped summer 2005, says Owner N Was system pumped as part of the inspection(Y or N) H yes, volume pumped:_ gallons How was quantity pumped determined? Reason for pumping: _ Comment: Pump on Z to 3 year interval. To be pumped during repair. TYPE OF SYSTEM: X Septic tank, distribution box, soil adsorption system. _ Single cesspool _ Overflow cesspool Privy N Shared system (Y or N)(if yes, attach previous inspection records if any) _ Innovative/Alternative technology. Attach 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) t5insp.doc•11/2009 Homestead Inc. Tale 5 Official Inspection Form:Subsurface Disposal System •page 5 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Property Address: 731 Florence Road Northampton. MA Owner Name: Kiritkamur Patel Date of Inspection: 10/3/06 APPROXIMATE AGE All components, date installed, and source of info. Septic plan: Design date unknown, estimated as 1960 ' s. Source of Info: Evaluation of technology used. N Were sewage odors detected when arriving at the site(Y or N) BUILDING SEWER (located on site plan) 16 Depth below grade (inches) Fstimated Average 15 Distance in feet from private water supply well or suction line cast iron Materials of Construction Comments: Below floor slab, not visable. SEPTIC TANK (located on site plan) Concrete Materials of Construction 18 Depth below grade (inches) 0 Riser depth (inches) 56 Septic tank width (inches) Interior dimensions 84 Septic tank length (inches) interior dimensions 59 Septic tank height (inches) Interior dimensions 1,205 Calculated gross volume (gallons) Calculated 2 Air space in tank (inches) 1,100 Net Volume (gallons) Calculated 20 Baffle depth (inches) 2 Sludge thickness (inches) Averaoe 1 Scum thickness (inches) Averace 37 Top Sludge : Bottom Baffle (inches) Calculated 17 Bottom Scum : Bottom Baffle (inches) Calculated —0 Top Scum : Top Baffle (inches) Calculated Comments: Tank backed up. Sludge slugs near outlet. Tank structurally OK. Baffles about 1/2 eroded, but functional. Recommendations: Pump on 3 to 4 year interval. Tank is old, but appears as functional. t5insp.doc• 11/2004 Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal System •page 6 of 10 Property Address: Owner' Name: Date of Inspection: Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 731 Florence Road, Northampton. MA Kiritkamur Patel 10/3/06 PUMP CHAMBER N Pump part of septic system: (Y or N) Pumps in working order (Y or N) .,,a,,„, „, W.,, I„y v,ao,. ‘, .,, ,., Comments: DISTRIBUTION BOX (located on site plan) ("D-box") Y D-box part of septic system: (Y or N) >8 Depth of liquid level above outlet invert Inches Comments: Box pressurized with sewage >200% of volume. Box not opened due to sewage. SOIL ADSORPTION SYSTEM (SAS): Technology Used (located on site plan by estimate): Y leaching pits& number: two concrete pits leaching chambers and number: leaching galleries and number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number. innovative/attemative system, Type: Comments: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Shallow system in built—up area. No surface problems seen. Recorded as 5 ' x 7 ' x 6 ' each H SAS not located explain why: TIGHT OR HOLDING TANK (tank must be pumped at time of inspection) N Tight tank part of system: (Y or N) Depth below grade (inches) Measured Tank width Tank length (inches) Tank height Calculated gross volume (gallons; Materials of construction Design flow: gallons/day Pumps in working order (Y or N) Alarms in working order: (Y or N) Date of last pumping Comments: (conditions of inlet tees, condition of alarm and float switches, etc.) t5insp.doc•11/2004 Homestead Inc. Title 5 Offidal Inspection Form: Subsurface Disposal System •page?of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Property Address: 731 Florence Road, Northampton, MA Owner Name: $1 ritkamur Pate] Date of Inspection: 10/3/06 PRIVY N Comments: (locate on site plan, if any) Privy part of system: (Y or N) Materials of construction: Dimensions: Depth of solids: (soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS (cesspool must be pumped as part of inspection) N Cesspool part of system: (Y or N) 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 part of inspection) Comments: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc GREASE TRAP (Usually present in certain commercial systems) N Grease Trap part of system: (Y or N) Materials of construction: Depth below grade (inches) Measured Dimensions: Depth of solids layer Depth of scum layer Top of scum to top outlet Calculated Inches Date of last pumping Bottom of scum to outlet. Calculated Inches Scum thickness (inches) Average Comments: (recommendation and conditions) t5insp.doc• 1112004 Homestead Inc. Title 5 Official Inspection Form:Subsurface Disposal System •page 8 of10 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Property Address: 731 Florence Road, Northampton, MA Owner Name: j(l ri.tkamur Patel Date of Inspection: 10/3/06 SITE EXAM (Source of Information) Y Slope Official Perc Date Y Surface water Official Plan Date Y Check Cellar Other Official Source N Shallow wells Other Source 60 Estimated depth to ground water (inches) Please indicate(check)all the methods used to determine high groundwater elevation: Y Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Information: Based on typical for neighborhood. To be determined during pert test for repair. RESOURCES: Department of Environmental Protection, Western Regional Office, 436 Dwight St., Springfield, MA 01103, (413) 784-1100 Title 5 Hotline- (80) 266-1122 t5insp.doc•11/2004 Homestead Inc. Tille 5 Official Inspection Form:Subsurface Disposal System •page 9 of 10 - , .-4 4— NORTH Outline of House \7 `� lt Septic Tank — . _._ c\I a. Town water in. Distribution Box Leaching Pits, approximate locations Note: No known drinking water sources within 100 foot radius. e Date: Owner: HOMESTEAD INC. , As-Built Drawing '�\ \ Existing Septic System 10/3/06 Kiritkamur Patel , Thomas S. Leue R.S. Revision Date: 731 Florence Road - 1664 Cape St. Scale: 1 : 20' Florence, MA 01062 / / Williamsburg,MA 01096 Except as Noted �xfi� • 1413]628-4533 ,