357 Title 5 Application/Permits 1985, Site Documents ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 SYSTEM
LEEDS, MA 01053 1-413-586-7200 INSPECTION
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference- landmarks or benchmarks
locate all wells within 100'
Taws- Liu-ter-
- ho (AJ e //S
s-o0 a / rcie
—e.tiF_ � Leac L C naaZ
J-i
/ earMSS cx
DEPTH TO GROUNDWATER
r '7 depth to groundwater
method of determination or approximation:
N0 ev.o'er.c ooh q a tne'✓n Jrr is /en.rL
ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053 1-413-586-7200
SOIL ABSORPTION SYSTEM (SAS) : V7
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
SEPTIC
SYSTEM
INSPECTION
If not determined to be present, explain:
Ltn_r r i1AllM1fr a xra.n.{ra/ ?Over red/rat
Type
leaching
leaching
leaching
leaching
leaching
overflow
pits and number
chambers and number
galleries and number
trenches, number, length
fields, number, dimensions
cesspool, number
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs etc. )
Grr e4._ 9..an- oJ,nM.or S�9C'� ., iY:f.� - A acruyLf ra d i'4&r ,i vcr rer/o t,6o .
CES (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 (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
Sfic' .
(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, recommendations for maintenance or repairs,etc. )
ENVIRONMENTAL FIELD SERVICES, IN
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
September 21 , 1995
Gary & Marsha Ciaschini
357 N. Farms Road
Florence, MA 01060
SEP 2 5 1995
NORTHAMPTON
re: Septic System Inspection at 357 N. Farms Road, Florence, MA
Dear Gary & Marsha:
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 and to Brad McGrath per his request.
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,
Michael J. .vigne
Environmental Engineer
Certified System Inspector
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 SYSTEM
LEEDS MA 01053 1-413-586-7200 INSPECTION
Address of property 3S7 F/cn- enee /7V9
Owner's name �or p%iar-sly
Date of Inspection
9 - rs- 9 s'
PART A
CHECKLIST
Check if the following have been done:
✓ Pumping information was requested of the owner, occupant, and Board of
Health.
✓ None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
AO/ 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 back-up.
✓ The site was inspected for signs of breakout.
✓ All system components, excluding the SAS, 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 SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
✓ The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053 1-413-586-7200
FLOW CONDITIONS
If residential
‘3 number of bedrooms
H. number of current residents
yg garbage grinder, yes or no
♦c laundry connected to system, yes or no
hn seasonal use, yes or no
If nonresidential, calculated flow:
water meter readings, if available:
S 1Arrf .F Last date of occupancy
GENERAL INFORMATION
SEPTIC
SYSTEM
INSPECTION
Pumping records and source of information:
eve. . +kJ-cc_ yen c Pw n -N-0-'r rti9CA4-.
✓ System pumped as part of
if yes, volume pumped
Reason for pumping:
T
inspection, yes or no
J000Sac.
tacifAG is a...,.�c >nspcoon•
Type of system
✓ Septic tank/distrlbut4en-box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes,• attach previous inspection
records, if any)
Other (explain)
Approximate age of all
information:
Lcox L
components. Date installed, if
Law-A
cr- )O YG0.c-S \ pto-
ran ye n rf
known. Source of
rJ�)All�l' 0..ge/`�.
hri Sewage odors detected when arriving at the site, yes or no
ENVIRONMENTAL HELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053 1-413-586-7200
SEPTIC TANK:
(locate on site plan)
SEPTIC
SYSTEM
INSPECTION
"
depth below grade:
ia
material of construction: Vconcrete _metal _FRP _other(explain)
dimensions: 1026 " 0.-) x (QN "C")) x <(7"12))
A-' ' sludge depth
31" distance from top of
H" scum thickness
R" distance from top of
Al" distance from bottom
sludge to bottom of outlet tee or baffle
scum to top of outlet tee or baffle
of scum to bottom of outlet tee or baffle
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, recommendations for repairs, etc. )
r rb
C')f)..cr,ojc c +nw% nprearr h he i .— 96nd rat
• • •ham.— ).b- / Trop
DISTRI BOX:_
(tea a on site plan)
depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc. )
PUMP C
(1
ER:
e on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs,etc. )
CHECK OR FILL IN WHERE APPLICABLE
A,)
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY of NORTHAMPTON
Application for Tispusttl 16 arks (tunstructiun tIrrniit
Application is hereby made for a Permit to Construct
System at:
or Repair ( Individual Sewage Disposal
or Lot
Address
Installer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers (. ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity gallons Length Width Diameter Depth
Disposal Trench--No. Width Total Length Total leaching area
Seepage Pit No Diameter Depth below inlet Total leaching area
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
sq. ft.
sq. ft.
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beeryjssued by he board of ealth.
Application Approved By
Application Disapproved for the following reasons'
Issued
� 5y/rat
v
Permit No - 0
Date
Date
N WHERE APP
CHECK OR FIL
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY ofNORTHAMPTON
Appliratiun fur 39i ipmial
Fax IC (
.
"mks Qlnnutrnrtinn hermit
Application is_h eby made fo.r�a Permit to Construct.( ) or Repair (41 n Individual Sewage Disposal
System at: ash' T U.nM.,
C
or Lot No.
Address
Installer Address
Type of Building . Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity gallons Length Width Diameter Depth
Disposal Trench -No Width Total Length Total leaching area sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Comp>7 has_b3issurd l the board of q a¢aen.
... .1.v/? ;Y t Lv
Application Approved By �.:y .tl
I-
Application Disapproved for the following reasons'
la - fl
Permit No
Date
Date
Date
b
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY or.N ORTHAM.PTQN
Trrtifiratr of (lumptittntr
THIS IS TO RT/�YT t,thel Inuiv ual Sewage Disposal System constructed ( ) or Repaired (J
_ ,t -taper
at 3S. 1 i'b/vA-d
has been installed in accordance with the provisions of TITLE of T1&State Sanitary CWs_der ribed in the
application for Disposal Works Construction Permit No /1I-fJ dated ry/fir—
THE ISSUANCE TI THIS ISFTCICATE SHALL NOT BE CONSTq�IED GUARANTEE THAT THE
SYSTEM WILL
//��FUNCTION SATISFACTORY. f��^(/nr�—'
DATE Tt�:.1..95 Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY orNORTHAMPTQN
nionna 093Ft Te sa n jaPrmit
Permission is hereby u
red
to Construct ( )35a,6pah (, „ypolvjdnd:Fe4vage Disposal System
at No //��'''((.•
FEE
as shown on the application for Disposal Works Construction Per D
LS
DATE
FORM 1255 A. M. SULKIN, INC., BOSTON
/Board of Health