397 Title 5 Inspections 2007, 2003, Repair Plan 2003, Upgrade Approval 2003 FORM 1A - APPLICATION FOR DSCP
No. 3%—.d 3 Fee 3o
COMMOMWEALT47-COT MA3591 1111SE ''T'S
Board of Health, Northampton, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Repair
( X ) Complete System ( ) Individual Components
Location 397 North Farms Road
Owner's Name Richard Picard 913-- )4,56C5
Map/Parcel
Address 397 North Farms Rd.
liot#
Florence, MA 01062
Installer's name 1/2X if-T. GU 4D e-
Telephone # 586-5271
Address 41,3_ Ni of rvn S /D
Designer's Name Thomas Leue, Homestead Inc.
NU ri-li 4 m h•r1
Address 1664 Cape St., Williamsburg MA
Telephone# a2V- 3 yl a--
Telephone 413 628-4533
Building Type: Dwelling.
Bedrooms: 3
Other- Type of Building
No. of persons
Other Fixtures
Design Flow (min. required):
Calculated design flow:
Design flow provided:
Lot Size (sq ft.) 113 .400
Garbage grinder (no)
Showers ( ), Cafeteria ( )
330 gpd
330 gpd
362 gpd
Description of Soil(s) fine sandy loam to loamy sand
Soil Evaluator Form No. 257
Name of Soil Evaluator Thomas Leue
Date of Soil Evaluation 6/12/03
DESCRIPTION OF REPAIRS OR ALTERATIONS new septic tank and leach trenches.
The undersigned agrees to Install the above described Individual Sewage Disposal System in accordance wfth
the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance
has been Issued by the Board of Health.
Signed
Inspections
Date
6-z. o 3
DEP APPROVED FORM 5/96
.74--- G� (1/4 3 FORM2A - DSCP
No. P-->--05 ( Fee 30
COSO4.o144 cgt(oT atmssaICTPUSzgt s
Board of Health, Northampton, MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to. Repair an individual sewage disposal system at
397 North Farms Road, Northampton as described in the application for Disposal System Construction
Permit No. a%--03 dated & `a 3 -v 3
Provided: Construction shall be completed within three years the date of this permit. All I cal conditions must be met.
Date - 4" 77j Board of Health
DEP APPROVED FORM 5/98
■
No.
FORM 3A - CERTIFICATE OF COMPLIANCE
COM14OM'W2 JLr7COF M4LSSWOUSTItt
Board of Health, Northampton, MA
CERTIFICATE OF COMPLIANCE
Description of Work: ( X ) Complete System ( ) Individual Components
The undersigned hereby certify that the Sewage Disposal System Repair
by: Bob Wade Excavating
at: 397 North Farms Road. North. ipton
Homestead Inc. Project#: 257
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved
design plans/as built plans relating to application No.
dated 6/18/03 . Approved Design Flow 362 (gpd).
Installer %I l' / Date: /0 - 7- b 3
s
/1t N « -03
Date:
Designer:
Inspector:
Date: octnher 4. 2003,
The issuance of this permit shall not be construed as a guarantee that the system will function
as designed.
cc: Richard Picard, 397 North Farms Rd., Florence, MA 01062
DEP APPROVED FORM 596
— PL-- --100 — 99
Notes: —_—___ . ,
1 . Septic tank is equipped with an outlet filter.
This is a maintenance item. Filter must be curtain drai 98
cleaned whenever septic tank is pumped, or =__== __Th.
every 5 years, whichever is sooner. Failure to — —____–___—__– North
maintain filter may lead to system failure. _—I
2. Recommend pumping septic tank on a 3 to
5 year schedule, depending on house 97
occupancy. 111 maple tree 96
3. A copy of this document attached in the
basement/utility area will keep this
information available in future years for 0 : eakout barrier membrane
maintenance. X81/2'
Partial outline 1 'of the house. 1
TBM: top of bulkhead foundation _ I' '
Elev.: 100.00' • '
3.9 II
A/C unit �� ‘'sr, '
New PVC sewer pipe 1' ,
raised approx. 38" 16' !�
1 - sue- e 14
341/2'
New, 1500 gal Title 5 septic
tank with outlet filter.
t Date: Owner: 1
As-Built Drawing HOMESTEAD INC.
Existing Septic System 6/18/03 Richard Picard Thomas S. Leue R.S.
Revision Date: 397 North Farms Rd. 1664 Cape St.
Scale: 1 : 20' Florence, MA 01062 Williamsburg,MA 01096
Except as Noted 10/4/03 L 0 j [413]628-4533
1
FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL
PAGE 1 of 5
cog,t3■ to1■ wEALT'4 of MASSAC`I- UsfT'T's
Board of Health, Northampton, MA
Application for Local Upgrade Approval
Title 5, 310 CMR 15.000
DEP Approved form required by 310 CMR 15.401(1)
To •• b u't e to oc• • . .r.vin. s uthori Board of Healt r For the upgrade of a failed or
nonconforming system with a design flow of<10,000 gpd,where full compliance, as defined in
310 CMR 15.404(1), is not feasible.
To be submitted to DEP: For the upgrade of a failed or nonconforming system with a design
flow of 10,000 up to 15,000 gpd and/or of a state or federal facility,where full compliance, as
defined in 310 CMR 15.404(1), is not feasible.
NOTE: Local upgrade approval shall not be granted for an upgrade that includes the addition
of new design flow to a cesspool or privy or the addition of new design flow above the existing
approved capacity of a system constructed in accordance with either the 1978 Code or 310
CMR 15.000.
1) Facility/system owner
Name: Richard Picard
Address: 397 North Farms Rd.
Florence MA 01067
Phone # 586-5271
Address of facility: 397 North Farms Road, Northampton
2) Applicant(if different from above)
Name:
Address:
3) Type of facility
X Residential _ Commercial
_ School _ Institutional
_ Other(specify)
4) Type of existing system
— privy _ cesspool
X conventional system
_ Other (specify)
Type of soil absorption system(trenches, chambers, pits, etc.)
leach field
DEP APPROVED FORM 12/07/95
FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL
PAGE 2 of 5
5) Design flow based on 310 CMR 15.203
a) Design for of existing system 495 gpd
Approved? yes
Approval Date 6/27/81
If not,why?
b) Design flow of proposed upgraded system Sgpd
c) Design flow of facility 330 gpd
6) Proposed upgrade of existing system is
Voluntary
Required by order,letter, etc. (attach copy)
X Required following inspection required by 310 CMR 15.301
date inspection was submitted to the approving authority:
b) Describe the proposed upgrade to the system:
New septic tank and leach trenches.
c) Which of the following are applicable to the proposed upgrade?
_ Reduction of setback(s) (list setbacks to be reduced with proposed setback distances)
Percolation rate of 30-60 minutes per inch(state actual perc rate)
_ Up to 25% reduction in subsurface disposal design requirements (state required &
proposed size)
Relocation of water supply well (identify well, describe relocation)
X Reduction of required separation between bottom of SAS &high groundwater
(specify proposed reduction&perc rate)
3' separation at 3.3 min per inch
_ Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the
Code)
System upgrades that cannot be performed in accordance with 310 CMR 15.404&15.405, or
in full compliance with the requirements of 310 CMR,require a variance pursuant to 310
CMR 15.410-15.417.
DEP APPROVED FORM 120795
FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL
PAGE 3 of 5
7) If the proposed upgrade involves a reduction in the required separation between the
bottom of the soil absorption system and the high groundwater elevation, an Approved
Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR
15.404 (1)(i)(1).The evaluator must be a member or agent of the local approving authority.
Distance from soil absorption system to high groundwater: 3 feet
As determined by:
Evaluator's Name: Peter McErlain
Evaluator's Signature:
Date of Evaluation: 6/12/03
8) Notice to Abutters
No application for upgrade approval in which the setback from property lines or a private
water supply well is reduced shall be complete until the applicant has notified all abutters
whose property or well is affected by certified mail at least ten days before the Board of
Health meeting at which the upgrade approval will be on the agenda.Such notice shall
include the date, time and place where the upgrade approval will be discussed.
If the Department is the approving authority, then such notices to abutters must be
completed prior to the date of submission of the application to the Department.
The notices to abutters shall include a copy of the completed application form and shall
reference the standards set forth in 310 CMR 15.402 through 15.405.
List of Affected Abutters:
Abutter Name: _
Address:
Date Notified:
Abutter Name:
Address:
Date Notified:
Abutter Name:
Address:
Date Notified:
Abutter Name:
Address:
Date Notified:
DEP APPROVED FORM 7207/95
FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL
PAGE 4 of 5
9. Explain why full compliance, as described in 310 CMIZ 15.404(1), is not feasible (each
section must be completed):
a) an upgraded system in full compliance with 310 CMR 15.000 is not feasible.
In order to control cost and to minimize surface disurption,
request reduction to groundwater of 3'
b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible:
Not needed, conventional system feasible.
c) a shared system is not feasible:
Not required, lot will support system.
d) connection to a sewer is not feasible:
No Dublic sewer in area.
10) An application for a disposal system construction permit, including all required
attachments (e.g. plans and specifications, site evaluation forms), must accompany this
application. Is the DSCP application attached? X yes _ no
11) Certification
"I, the facility owner, certify under penalty of law that this document and all
attachments, to the best of my knowledge and belief, are true, accurate, and complete. I
am aware that there may be significant consequences for submitting false information,
including,but not limited to, penalties or fine and/or imprisonment for knowing
violations."
Facility Owner's signature Date
Richard Picard
Print Name
Thomas S. Leue
Homestead Inc. 6/18/03
Name of Preparer Date
1664 Cape Street. Williamsburg', MA 01096 (4131 628-4533
Telephone # &address of preparer
NOTE:Title 5,310 CMR 15.403(4), requires the system owner or operator to submit to the
Department a copy of the local upgrade approval upon issuance by the Board of Health
and prior to commencement of construction.
DEP APPROVED FORM 120795
FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL
PAGE 5 of 5
coMMo'F%v ALtli OP TVISSI{c7-LUsEgts
Northampton, Massachusetts
LOCAL UPGRADE APPROVAL ISSUED PURSUANT TO 310 CMR 15.404 & 15.405
Facility.system owner: Name: Richard Picard, 397 North Farms Rd. Florence, MA
01062
Address of Facility: 397 North Farms Road
Type of facility: Residential
design flow per 310 CMR 15.203 3 62 qpm
System designer: Name: Thomas Leue Address Homestead Inc. . 1669 Cabe St •
Williamsburg, MA 01096 Phone No. 413. 628-9533
Local Upgrade AR rD oval granted for:
reduction in setback(s) (specify)
per rate of 30-60 min./inch (specify rate)
reduction in SAS of uD to 25%
(specify%reduction&size of SAS)
x reduction in separation between SAS & high arntlndwater
(specify reduction&oerc rate) 3' separation at 3.3 min per inch
relocation of a well (explain)
t ist local variances granted (no DFP anoroval required oer 310 CMR 15 412(41)
I ist variances granted requiring DEP approval
Board of Health Approval of proposed upgrade
1Q14r SIlk&IL ded
Signature
Name&Title
joid
I?&IB
THE SYSTEM OWNER OR OPERATOR SHALL PROVIDE A COPY OF THIS LOCAL UPGRADE APPROVAL
TO THE REGIONAL OFFICE OF THE DEPARTMENT OF ENVIRONMENTAL PROTECTION DIVISION OF
WATER POLLUTION CONTROL UPON ISSUANCE BY THE LOCAL APPROVING AUTHORITY&BEFORE
COMMENCEMENT OF CONSTRUCTION.
Mail to: DEP, Western Regional Office, 426 Dwight St., 5th Floor, Springfield, MA 01102
DEP APPROVED FORM 120795
Plan to Repair
SEPTIC SYSTEM
for
Richard Picard
Located at
397 North Farms Road
in Northampton, Massachusetts
Plan Number 257
Thomas S. Leue, R.S.
Homestead Inc.
1664 Cape Street
Williamsburg, MA 01096
413 628-4533
fax: 413 628-3973
Design Date: 6/18/03 Plan ap d
of th 1ort :. of Health
subject to the following conditions:
Design Engineer must inspect
and verify in writing that
the sewage disposal system
was installed in accordance
with these approved plans.
Contents
Site Plan:
Site Suitability Form 11.1:
On-Site Review Form 11.2:
Groundwater Form 11.3:
Perc Test Form 12:
Deed Restriction for garbage Grinder
Specifications:
Design Calculations: System
Plan Drawing:
1 page
1 page
2 pages
1 page
1 page
1 page
3 pages
1 page
1 page
Separate To be signed by owner(sj
Application for Construction Permit: 3 pages
Local Upgrade Approval form: 5 pages
Work Site Location
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1999 L Lorme Street Atlas USA 6.0 t6 for Macintosht , - ):Rrtg 1 ' t i.
a°
LI TT
Mag 14.00
Mon Jun 16 11312 2003
Scale 1.31250(at center)
2000 Feet
1000 Meters
(
Local Road
Major Connector
Primary State Route
— - Trail
Interstate/Limited Access
US Highway
13 Exit
No. PT-20-257
Commonwealth of Massachusetts
Northampton, Massachusetts
FORM11 -SOIL EVALUATOR FORM
Soil Suitability Assessment for On-site Disposal
Performed By: Thomas S. Leue Date: 6/12/03
Witnessed By:
peter McErlain. Town of Northampton
Location Address or Lot No.
397 North Farms Road Northampton
New or Repair Construction: Repair
Owner's Name. Address & Tef.N
Richard Picard
397 North Farms Rd. ,
Florence, MA 01062
586-5271
Office Review ppII
Published Soil Survey Available: No I: Yes K]I
Year Published: 1980 Publication Scale: 15840 Soil Map Unit: _a
Drainage Class: Well drained.
Soil Limitations: moderate effluent limitations, slope.
Soil Type: CmB, Charlton fine sandy loam
Superficial Geologic Report Available: No ® Yes ❑
Year Published Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year flood boundary No Yes
Within 100 year flood boundary No Yes
Wetland Area
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Condition ( GS): Month
Range: Above Normal U Normal igi Below Normal ❑
Other References Reviewed:
DEP APPROVED FORM - 12/07/95
Location Address or Lot No.:
Number:
FORM 11-SOIL EVALUATOR FORM
Page 2 of 3
397 North Farms Road, Northampton
57
On-site Review
Deep Hole #:
Date:
Land Use:
Vegetation:
Slope (%):
Distance in feet from:
Open
Possible
Drinking
1
Soil Evaluation
IMAM
>150
Number:
Time
Surface
Drainageway:
Property
PT-20- 257
6/12/03
Weather:
Stones:
Landform:
Line:
Other:
clear
lawn
no
grass
drumlin
2%
>150
Water Body:
Wet Area:
Water Well:
>150
30
>150
Depth from
Surface
(inches)
Soil
Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
(inches)
Other
(Structures,Stones, Boulders,
Consistency,%Gravel)
0 - 26
26 - 30
30 - 76
76 - 108
A
B
Cl
fine sandy
loam
sandy loam
loamy sand
10YR 2/1
10YR 4/3
10YR 3/4
Mottles
7.5YR 4/6
7 .5YR 5/1
no
48
roots
10% gravel, friable
same
>5%
*MINIMUM
Comments:
Parent Material (geologic):
Depth to Bedrock:
Depth to Groundwater:
Standing Water in
Weeping from Pit
Estimated Seasonal
OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
the Hole.
Face:
High Groundwater:
alluvial
108 inches
Depth: 88 inches
Depth: 68 inches
48 inches
Depth of Excavation:
YES
YES
DEP APPROVED FORM-12/07/95
FORM 11-SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. 397 North Farms Road, Northampton
Homestead Inc. No. 2n
Determination for Seasonal High Water Table
Method Used
❑ Depth observed standing in observation hole inches
❑ Depth weeping from side of observation hole inches
® Depth to soil mottles 48 inches
❑ Ground water adjustment_ feet
Index Well Number_ Reading Date _ Index well level
Adjustment Factor _ Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally orn'rring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? Yes
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on June, 1995 I have passed the examination approved by
the Department of Environmental Protection and that the above analysis was performed by
me consistent with the required training, expertise and experience described in 310
CMR15.017.
Signature:
Date: 6/14/03
DEP APPROVED FORM - 12/07/95
FORM 12-PERCOLATION TEST
Location Address or Lot No. 397 North Farms Road
Homestead Inc. #: Z
COMMONWEALTH OF MASSACHUSETTS
Northampton, Massachusetts
Percolation Test*
Date:
6/12/03
Time:
9:14 AM
Observation Hole#
1
2
3
4
Depth of Perc:
44
(inches)
Start Pre-soak:
9:14 AM
End Pre-soak:
9:29 AM
Time at 12":
9:29 AM
Time at 9":
9:35 AM
Time at 6":
9:45 AM
Time (9" - 6"):
0:10
Rate - Min./Inch:
0:03:20
* Minimum of 1 percolation test must be performed In both the primary area AND
reserve area.
Site Passes /Site Fails: Passes
Performed By: Thomas S. Lena, Homestead Inc.
Witnessed By: peter McErlain. Northampton
Comments:
DAP APPROVED FORM - 12/07/95
RESTRICTION
I, Richard Picard Owner of the real estate and designated as 397 North Farms Road in
Northampton, Hampshire County, Massachusetts by virtue of a deed dated
from and recorded with the
Hampshire County Registry of Deeds in Book Page
hereby impose the following permanent restriction upon said premises, into perpetuity:
Due to the design of the septic system, a garbage disposal system shall never be
installed and connected to the sewer on this property.
This restriction is applied to the subject premises in compliance with the Waiver of Garbage
Disposal/Sewer Capacity Requirement issued by the City of Northampton Board of
Health dated
WITNESS my hand and seal this day of
COMMONWEALTH OF MASSACHUSETTS
HAMPSHIRE, S.S. DATE:
The above named Richard Picard personally appeared before me and acknowledged the
foregoing to be his free act and deed.
Notary of the Public
CONSTRUCTION SPECIFICATIONS
Title 5 Septic System Plan for
397 North Farms Road Northampton
1. General
a. No work on this system construction shall take place until a permit for the approved system plan has
been received from the local Board of Health. A copy of the Disposal Works Construction Permit should be
on site for inspection during the time of construction. Additional specifications may be included elsewhere
in this design.
b. Loading requirements are specified for the septic tank on the system calculations page. Loading
requirements for any other component are on the drawing. Normal loading systems are designated H-10. If
H-20 rating is specified on the drawing and/or on the page for system calculations,the tank or leaching
facility shall be custom built to meet the increased loading requirements using additional rebar,greater wall
thickness and/or other approved methods. Follow the manufacturer's rating system and installation
procedures.
2. Septic Tank Note: Not all repair plans require new septic tanks. Refer to the drawing to determine if a
tank is required.
a. The septic tank selected by the contractor shall conform with 310 CMR 15.223. The septic tank shall be
a minimum effective liquid capacity of 1,500 gallons below the outlet invert,rectangular,and with a
minimum length to width ration of 1.5:1. Compartmentalized tanks are not to be used.
b. Septic tank shall be installed on a minimum of 6"of crushed stone,leveled to grade and thoroughly
compacted. Septic tanks shall have a minimum cover of nine inches. No structures shall be located directly
upon or above the septic tank access locations which interfere with performance,access, inspection,
pumping, or repair.
c. All three access covers to the septic tank shall have risers at least 20"diameter, if round,tightly fitted to
the tank to resist water infiltration,and terminated with a tight fitting cover no more than 6"below ground
surface. If,with the agreement of the Owner,one or more of the risers are terninated flush with ground,
these shall be secured against unauthorized entry with stainless steel hardware.
d. Inlet and outlet tees shall be of Schedule 40 PVC and shall extend a minimum of six inches above the flow
line of the septic tank and be on the center line of the septic tank located directly under the clean-out
manhole. All fittings to be glued and secured against any movement due to horizontal or vertical impacts.
Cross-sectional flow baffles shall not be used as substitutes for inlet or outlet tees. The minimum separation
between inlet and outlet tees shall be no less than the liquid depth of the septic tank and shall be the longest
direction(which shall not include the diagonal distance)across the tank in plan view. Inlet and outlet tees to
rectangular tanks shall be set in the end walls or into a side wall within 12 inches of the end wall.The inlet
pipe elevation shall be no less than two inches nor more than three inches above the invert elevation of the
outlet pipe.
e. There shall be an air space of at least three inches between the tops of the tees and the inside of the tank
cover. Inlet tees may be modified or a 6"riser on inlet cover may achieve this spacing. The tops of the tees
shall be left open to provide ventilation or separate ventilation shall be provided. The outlet tee and
compartment connection shall be equipped with a gas baffle. The inlet tee shall extend a minimum of ten
inches below the flow line. The outlet shall be provided with a tee extending below the flow line 14 to 18
inches. The effluent tee shall be fitted with a removable plastic outlet filter,as manufactured by Polylok Inc.,
Homestead Inc.
Page 1 6/18/03
■
CONSTRUCTION SPECIFICATIONS
model PL-120,Zebco, or approved equal. Provide manufacturer's maintenance data to homeowner and
engineer.
f Septic tank should be inspected by the Owner or his representative for solids accumulation annually.
When the sum of the sludge and scum layer approach 1/3 the net working volume of the tank(net of 16"
total thickness), as measured at the center of the tank,the tank is due for pumping. Septic tanks shall be
inspected and maintained in accordance with 310 CMR 15.300 and applicable local requirements.
pump System Note: Not all repair plans require a pump and controls. Refer to the drawing to
determine if this system is required.
a. Pump chamber to be 1000 gallon concrete pump chamber, unless otherwise specified elsewhere. Include
one manhole access 24"diameter that terminates at or above ground surface with a steel manhole cover that
can be secured.
b. Pump to be used is specified in the pump calculation worksheet.
c. Alarm system to be installed inside of dwelling unit in an accessible location. Alarm unit to have an
audible and visible indicator of water level above the pump on level. Include a shut off or silence mode. Use
CSI Controls model S230 NEMA 4X Simplex or approved equal.
d. Pump circuit and control circuit to be on separate and dedicated circuit breakers installed by a licensed
electrician.
Distribution Box Note: Not all repair plans require new distribution boxes. Refer to the drawing to
determine if a d-box is required.
a. The distribution box selected by the contractor shall conform with 310 CMR 15.232. Material of
construction shall be concrete or plastic lined concrete.
b. The distribution box shall be placed on thoroughly tamped and compacted sand or pension a minimum
of 6"thickness,and shall be leveled utilizing a water flow test. Speed levelers shall not be used on a new
installation to obtain level and equal distribution flow,but should be installed after leveling is completed in
case uneven settling occurs in the future.
c. For inlet pipe slopes of 8%or greater,or where there is a pumped flow,the distribution box shall have
an internal cast baffle or solvent welded pipe tee to reduce the velocity of the influent flow. An internal pipe
"Y"is not acceptable.
d. For systems with different sections of the leaching facility at different elevations, the first 2 feet of pipe
out of the distribution box to be set dead level.
5. Pi in
a Piping to the septic tank(the building sewer) shall be Schedule 40 or better.
b. All piping from the septic tank to the end of the system shall be 4"diameter, SDR-35 or better, except
as noted on the drawings.
c. Pressure piping to be 1.5"diameter, Schedule 40 poly pipe or 2"diameter PVC Schedule 40 pipe, as
called for in the page titled Volume, Alarm and Flotation Calculations.
6. Leaching Facilities
a General: All leaching facilities to be of the size and location shown on the drawings All aggregate used
in leaching facilities to be of double washed stone. Pipes in leaching facility shall be pitched downward 0.5%
Homestead Inc. Page 2 6/18/03
CONSTRUCTION SPECIFICATIONS
from inlet end. End caps required on all distribution lines. Additional requirements based on type of leaching
facility shown on drawing.
b. Leach fields: 6"double washed stone 3/4"screen size laid essentially level, upon which 4"distribution
piping is to be laid. Area between pipes to be filled with additional 3/4"stone. Cover top of field with 2"
double washed peastone. Total thickness of leachfield is to be 1 foot.
c. Leaching galleries: made with internal piping,either cast in place or of PVC plastic. Gallery dimensions
to be 4' x 8' and approximately 19"tall. Galleries to have inspection covers with handles. All galleries to be
placed on a stable base of a minimum of 6"double washed stone of 3/4"size Galleries to be surrounded on
all sides with 4 feet of 3/4"to 1-1/2"double washed stone. Top 2"of stone to be peastone sized to reduce
soil intrusion. Horizontal gaps between adjacent galleries to be sealed with butyl tape along top edge.
d. Leach trenches: construction similar to the materials specified for leach fields, except total height to be
approximately two feet. For Infiltratorr"' systems, see detailed construction procedures on the drawing.
e. Breakout barrier, if shown on plan,to be minimum 40 mil thick continuous sheet. Install barrier
vertically from bottom of excavation to height of top of leaching system. Seams of membrane material to be
overlapped a minimum of 12 inches and glued with sealant as recommended by manufacturer. Material to be
hypolon, low density polyethylene, buna-N rubber,EPDM,or approved equal. Backfill in lifts of no more
than 6"to assure minimal deformation of membrane. If material is wider than the vertical distance to be
covered as shown on the drawing, fold excess material over at the bottom of the trench.
7. Inspection
a. The contractor shall notify the System Designer a minimum of 48 hours in advance of the anticipated
completion time for a final inspection. The system shall be essentially complete at the time of the final
inspection,including all components in place,risers and covers installed,electrical components functional,
etc. No installed system component shall be buried greater than I"depth at the time of final inspection. The
System designer shall verify the system was installed as designed and authorize the final grading.
b. If the System Designer finds the system is not ready for inspection after being called,or if serious
deficiencies are discovered,the System Designer must be notified to return to the job site when it is
complete. There will be a charge to the installer of$50 for each return trip, payable directly to the System
Designer at the time of the reinspection.
8. Final Grading
a. At conclusion of work, loam and seed all disturbed areas to perennial grass mixture.Added loam may be
required for adequate grass growth. Mulch slopes with hay,burlap or netting to minimize erosion.
b. Surface over leaching facility shall be pitched so as to shed rainwater.
c. Systems built late in the year,where the grass cover does not have a chance to establish itself,requires
the contractor is to return after spring thaw and resurface final grades and add grass seed cover as required to
equalize and stabilize all disturbed areas.
s
Homestead Inc. Page 3
6/18/03
397 North Farms Road, Northampton
DESIGN CALCULATIONS
Infiltrator® System
(Note: equivalent sized
Structure: Single family home
Design Flow:
Total Design Flow:
Garbage Grinder: Not Allowed
Credit for Compost Toilet: 0%
Total Design Flow:
plastic structures are deemed equivalent of this brand name)
3 bedrooms
110 gallons per bedroom per day
330 gallons per day
1.0 factor
0 gallons per day
330 gallons per day
Percolation Rate: measured
Percolation Rate: design rate
Loading rate: Class I Soil
Area required for infiltration:
3.3 min. per inch
5 min. per inch
0.74 gallons/sq.ft./day
446 sq. ft.
Trench Configuration
# Infiltrator® Model
1 High Capacity
2 Standard
3 Equalizer® 24
4 Infiltrator® 3050
Loading Length Width Invert Height
sq.ft./In.ft. Inches Inches Inches Inches
7.79 75 34 10 16
6.53 75 34 6.5 12
3.75 101 15 9 11
8.2 95.5 50 24 30
For this project, model chosen:
Effective leaching area of Infiltrators:
Width of 3/4" gravel on sides and ends:
Effective leaching area of gravel
Total effective leaching area:
Number of Infiltrators® required:
Total Leaching area:
Length of trench(es):
Number of trenches:
Total Design Capacity:
Separation between trenches:
Loading:
2
40.8 sq. ft. per chamber
O ft.
0.0 sq. ft. per chamber
40.8 sq. ft. per chamber
10.93 say: 1 2 chambers
489.8 sq. ft.
H-10
75.0 feet total
2 each @
362 gallons per day
37.5 feet each
System Designer
Homestead Inc.
6/18/03
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION° 4 2003
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
397 North Farms Road, Northampton MA
Richard Picard
397 N. Farms Rd
5/30/03
Board of
Owner.
Thomas S. Leue
Homestead Inc.
1664 Cape St. , Williamsburg, MA 01096
(413) 628-4533
Property Address.
Owner's Name:
Owner's Address:
Date of Inspection:
Copy to:
Witness:
Name of Inspector
Company Name:
Mailing Address:
Telephone Number.
Florence, MA 01062
Health, Northampton
Number: 55135-788
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:
Date: May 30 . 2003
The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health
of DEP) within thirty(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.
Title 5 Inspection Fotm 6/15/2000
page 1 of 9 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 397 North Farms Road, Northampton, MA
Owner: Richard Picard
Date of Inspection: 5/30/03
Inspection Summary: Check A, B, C, D or E/ALWAYS complete all of Section D:
A. System Passes:
N 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.
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 exfiltration,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: _
CI 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.
Title 5 Inspection Fonn 6/15/20(0
page 2 of 9 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION (continued)
Property Address: 397 North Farms Road, Northampton. MA
Owner: Richard Picard
Date of Inspection: 5/30/03
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 all 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 Any 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.
Title 5 Inspection Form 6/15/2000
page 3 of 9 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION (continued)
Property Address: 397 North Farms Road, Northampton, MA
Owner: Richard Picard
Date of Inspection: 5/30/03
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 H 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.
PART B• CHECKLIST
Check if the following have been done. You must indicate "ves" or"no" as to each of the following;
YES (Y)or NO(N)
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?
• 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?
N/A Were as built plans of the system obtained and examined? (If they are not available note as N/A)
Y Was the facility or dwelling was inspected for signs of sewage back up?
• Was the site was inspected for signs of break out?
Y Were all system components,excluding the SAS,located on site?
• 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 depth of scum?
The size and location of the Soil Absorption System(SAS) on the site has been determined based on:
• 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)].
• The facility owner(and occupants, if different from owner) were provided with information on
proper maintenance of Subsurface Sewage Disposal Systems (SSDS).
RESOURCES:
Department of Environmental Protection,Western Regional Office,436 Dwight St., Springfield, MA
01103, (413)784-1100; Title 5 Hotline-(800)266-1122
Title 5 Inspection Form 6/15/2000
page 4 of 9 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C: SYSTEM INFORMATION
Property Address: 397 North Farms Road, Northampton, MA
Owner: Richard Picard
Date of Inspection: 5/30/03
RESIDENTIAL
495
3
3
2
Y
Y
N
N
138
N
FLOW CONDITIONS
DESIGN flow based on 310 CMR 15.203 (gallons/day)
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)_
Seasonal use (Y or N)
Water meter readings,if available(last two years usage) (gallons per day)
Sump Pump(Y or N)_
continuous Date of last occupancy_
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): gpd
Basis of design flow (seats/persons/sqft, etc.):
Grease trap present(yes or no):
Industrail waste holding tank present(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: _ _ pumped about 1 month ago, says Owner
Was system pumped as part of the inspection(Y or N)
If yes, volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
Comment:
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):
N Were sewage odors detected when arriving at the site(Y or N)
Title 5 Inspection Form 6/15/2000
page 5 of 9 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
Property Address: 397 North Farms Road, Northampton, MA
Owner: Richard Picard
Date of Inspection: 5/30/03
APPROXIMATE AGE
Septic plan: 6/27/81
Source of Information
All components, date installed, and source of information
design date
BUILDING SEWER (located on site plan)
36 Depth below grade (inches) Estimated Average
32 Distance in feet from private water supply well or suction line
PVC Materials of Construction
Comments:
SEPTIC TANK (located on site plan)
Concrete Materials of Construction
24 Depth below grade (inches)
O Riser depth (inches)
59 Septic tank width (inches)
118 Septic tank length (inches)
59 Septic tank height (inches)
1,783 Calculated gross volume (gallons calculated
9 Air space in tank (inches)
1,500 Net Volume (gallons calculated
22 Baffle depth (inches)
2 Sludge thickness (inches) Average
o Scum thickness (inches) Average
35 Top of sludge layer to __ (inches) calculated
13 Bottom of scum to outlet. (inches) calculated
7 Top of scum to top outlet (inches) calculated
Comments:
Recommendations:
PUMP CHAMBER
N Pump part of septic system: (Y or N)
Pumps in working order: (Y or N)
Alarms in working order: (Y or N)
Comments:
Title 5 Inspection Form 6/15/2000
page 6 of 9 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
Property Address: 397 North Farms Road, Northampton. MA
Owner: Richard Picard
Date of Inspection: 5/30/93
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
Comments: box submerged and pressurized. Black sulfides around lid.
SOIL ADSORPTION SYSTEM (SAS): Technology Used (located on site plan by estimate):
leaching pits &number:
leaching chambers and number:
leaching galleries and number:
leaching trenches, number, length:
Y leaching fields, number, dimensions: 20' x 30•
overflow cesspool,number:
innovative/alternative system,Type:
Comments: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
No sign of breakout.
If 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 (inches) From plan
Tank length (inches) From Plan
Tank height (inches) from plan
Calculated gross volume (gallons calculated
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.)
PRIVY (locate on site plan,if any)
N Privy part of system: (Y or N
Materials of construction:
Dimensions:
Depth of solids:
Comments: (soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, et(
Tale 5 Inspection Form 6/15/2000
page 7 of 9 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspection:
397 North Farms Road. Northampton. MA
Richard Picard
5/30/03
CESSPOOLS
N
Comments:
(cesspool must be pumped as part of inspection)
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)
(note soil conditions, signs of hydraulic failure,level of ponding, condition of vegetation,
GREASE TRAP (Usually present in certain commercial systems)
N Grease Trap part of system: (Y or N)
Materials of construction:
Depth below grade (inches)
Dimensions:
Depth of solids layer
Depth of scum layer
Top of scum to top outlet
Date of last pumping
Bottom of scum to outlet.
Scum thickness (inches)
(recommendation and conditions)
Comments:
Measured
Calculated Innheq
Ca].cu]ated I/chev
Average
SITE EXAM (Source of Information)
Slope
Surface water
Check Cellar
Shallow wells
96 Estimated depth to ground water (inches)
Please indicate(check) all the methods used to determine high groundwater elevation:
Y Obtained from system design plan on record
6/27/81 Date of design plan reviewed
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Dated perc test data, may be higher during new perc testing.
Information:
Title 5 Inspection Fonn 6/15/2000
page 8 of 9 Homestead Inc.
North
/
NI
20'
Partial t le
outline
of the 1
house —____
\n s� --leachfield, approximate layout
0
M
\ ,
I
septic tank distribution box
Note: No known drinking water sources within 100' radius.
As-Built Drawing Date: Owner: HOMESTEAD INC. ,
Existing Septic System 5/30/03 Richard Picard 7tpYhff I Thomas S. Leu2 R.S.
—
397 North Farms Rd.
Scale: 1 : 20' Revision Date: Florence, MA 01062 / rz 1664 cape s[.
T/ Williamsburg,MA 01096
Except as Noted 1\� t{� 1413]6284533
II 39 / 7%1 f--
��i< .. .i1 e- / / � / 0
5
PERCOLATION TEST(S)
I Time: I I Time: I
Observation Hole #1 Observation Hole #2
Depth of Perc ,1 Depth of Perc
Start Pre-soak Start Pre-soak
End Pre-soak End Pre-soak
Time at 12" Time at 12"
Time at 9" /7 - Time at 9"
Time at 6" Time at 6"
Time(9"-6") Time(9"-6")
Rate Min./Inch - Rate Min/Inch
I 'minimum of I percolation test must be performed in both the primary area AND reserve area.
SITE`:"" s.#T$JSE' 4 11TEP':.: SITE
PASSED_ _°1.F Ee I
Si ," SSED- _ .FAILED
Performed by I Performed by
Witnessed by ) Witnessed by
Comments:
-
-
locaeotl cc:.
18tesa or`aaiR2
'Aga
NORTHAMPTON BOARD of HEALTH— Title 5— Site Review
35 N F� 2
G//1 / 9 I WMS, i1 )
N
(Open Water Bodya: .:
Ppa4ible Wet4rea p4
feet
feet
feet
feet
feet
feet
ep Hole#:
DEEP OBSERVATION HOLE LOG*
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depth from
face(Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency,To Gravel)
- ?
'>0 . �
-
�-
t1
I
tot Material(geologic) I 'DepthloBedrock'1
th to groundwater. Standing Water in,paaja,
(,Weeping from PE Face.I
Estimated Seasonal High Ground Water tI "e'
Hole#:
epth from
ace(Inches)
DEEP OBSERVATION HOLE LOG*
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOS
AREA
Soil Horizon
Soil Texture
(USDA)
Sal Color
(Munsell)
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency,%Gravel)
hgog!wrlArater~ tarrinp:Watele
'^timated Seasonal High GroundWa,
•
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification
1. Property Information
Property Address: 397 North Farms Road, Northampton, MA
Owner's Name:
Owner's Address:
Date of Inspection:
Copy to:
Witness:
John Murphy
15 Woodhill Rd. Westport, CT 06880
4/11/07
Board of Health, Northampton
Ami Sharff , Goggins Realty
Number: SSDS-1166
2. Inspector:
Name of Inspector: Thomas S. Leue
Company Name: Homestead Inc.
Mailing Address: 1664 Cape St. Williamsburg, MA 01096
Telephone Number: (4131 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: Passes
Inspector's Signature:
Date: 4/11/07
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@aJC5141-35 00,3
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: 397 North Farms Road, Northampton, MA
Owner' Name: John Murphy
Date of Inspection: 9/11/07
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 as described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
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 V, 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 exfiltration, 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 397 North Farms Road. Northampton. MA
Owner' Name: John Murphy
Date of Inspection: 4/11/07
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 all inspections:
YES (Y)or NO (N)
N 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.
N 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 Any 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]
N 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.
COMMENT:
t5insp.doc• 11/2004 Homestead Inc.
Title 5 Official Inspection Form: Subsurface Disposal System
•page3 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (Cont.)
Property Address: 397 North Farms Road, Northampton, MA
Owner' Name: John Murphy
Date of Inspection: 4/11/07
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 (Y) or NO IN) as to each of the followings
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 Of any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable) [15.302(3)(b)].
Y The facility owner(and occupants, if different from owner)were provided with information on proper
maintenance of Subsurface Sewage Disposal Systems(SSDS).
t5insp.don• 11/2004
Homestead Inc. Title 5 Official Inspection Form'. Subsurface Disposal System
• page 4 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
197 North Farms Road, Northampton, MA
John Murphy
4/11/07
FLOW CONDITIONS
RESIDENTIAL
3.62 DESIGN flow based on 310 CMR 15.203 (gallons/day)
3 _ Number of bedrooms(design)_
3 Number of bedrooms (actual)__
1 Number of current residents
N Is there a garbage grinder? (Y or N)
Y Is there a Laundry Hookup? (Y or N)
N Is the Laundry a separate system? (Y or N) (If yes separate inspection required)_
N Seasonal use (Y or N)
N/A Water meter readings, if available (last two years usage) (gallons per day),
N _ Sump Pump(Y or N)__
continuous Date of last occupancy_
COMMERCIAL/INDUSTRIAL
Type of establishment: _
Design flow(based on 310 CMR 15.203): — gpd
Basis of design flow(seats/persons/sqft, 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: Not pumped since installation, says Owner
Y Was system pumped as part of the inspection (Y or N)
If yes, volume pumped. _1500 gallons
How was quantity pumped determined? based on nominal tank volume
Reason for pumping. maintenance •
Comment: Pump on 3 to 4 year interval.
TYPE OF SYSTEM:
X Septic tank, distribution box, soil adsorption system. __
Single cesspool _
Overflow cesspool
Privy =
N Shared system (V or N) Of 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):
15insp.doc• 11/2004
Homestead Inc. Title 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: 397 North Farms Road, Northampton MA
Owner' Name: John Murphy
Date of Inspection: 4/11/07
APPROXIMATE AGE All components, date installed, and source of info.
Septic plan: Design date of 6/18/03
Source of Info. BoH
N Were sewage odors detected when arriving at the site (V or N)
BUILDING SEWER (located on site plan)
16 Depth below grade (inches) Estimated Average
>100 Distance in feet from private water supply well or suction line
ABS plastic Materials of Construction
Comments: No problems seen.
SEPTIC TANK (located on site plan)
Concrete Materials of Construction
12 Depth below grade (inches)
O Riser depth (inches)
58 Septic tank width
124 Septic tank length
59 tank height
1,842 Calculated gross volume
8 _ _ Air space in tank
1,500 _ Net Volume
▪ 24 _ Baffle depth
2 Sludge thickness
O Scum thickness
33 Top Sludge Bottom Baffle
16 Bottom Scum : Bottom Baffle
6 Top Scum Top Baffle
Comments:
(inches) Interior dimensions
(inches) Interior dimensions
(inches) Interior dimensions
(gallons) Calculated
(inches)
(gallons) Calculated
(inches)
(inches) Average
(inches) Average
(inches) Calculated
(inches) Calculated
(inches) Calculated
No operational or structural problems seen. Outlet filter
removed and cleaned. Outlet cover to tank broken and replaced.
Pump on 3 to 4 year interval. ;,)p ,� A..'v,..,� -r,,.�� i �i7 Se AV-
r
fiDc� may c 1a;Lit {_:.z«' .dcr,tr Sc�
SL_°v<c b1 c(o-•,cai.
c
t5insp.doc• 1112004
dr Cc�'Z.�rt PS1 442 .
Homestead Inc. Title 5 Official Inspection Form:Subsurface Disposal System
•page 6 of 10
Property Address:
Owner' Name:
Date of Inspection:
PUMP CHAMBER
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
397 North Farms Road, Northampton, MA
John Murphy
4/11/07
N Pump part of septic system: (Y or N)
Pumps in working order (Y or N)
Alarms in working order: (Y or N)
Comments:
'DISTRIBUTION BOX (located on site plan)("D-box')
Y D-box part of septic system: (Y or N)
0 Depth of liquid level above outlet invert Ind
Comments: Box appears level and flow distributed equally.
SOIL ADSORPTION SYSTEM (SAS): Technology Used (located on site plan by estimate):
leaching pits& number:
leaching chambers and number:
leaching galleries and number:
Y leaching trenches, number, length: 2 at 37 .5 ft. long each
leaching fields, number, dimensions:
overflow cesspool, number:
innovative/alternative 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.
If 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 Official Inspection Form: Subsurface Disposal System
•page 7 of 10
Property Address:
Owner' Name:
Date of Inspection:
PRIVY
N
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
397 North Farms Road, Northampton, MA
John Murphy
4/11/07
Comments:
CESSPOOLS
N
Comments:
GREASE TRAP
N
Comments:
t5insp.doc• 11/2004
(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.)
(cesspool must be pumped as part of inspection)
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)
(note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(Usually present in certain commercial systems)
Grease Trap part of system: (Y or N)
Materials of construction:
Depth below grade (inches)
Dimensions:
Depth of solids layer
Depth of scum layer
Top of scum to top outlet
Date of last pumping
Bottom of scum to outlet.
Scum thickness (inches)
(recommendation and conditions)
Measured
Calculated Inches
Calculated Inches
A■eraoe
Homestead Inc Title 5 Official Inspection Form: Subsurface Disposal System
•page8 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
397 North Farms Road, Northampton, MA
John Murphy
4/11/07
SITE EXAM (Source of Information)
Slope 6/14/03 Official Perc Date
Y _ _ Surface water 6/18/03 Official Plan Date
Y Check Cellar Other Official Source
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: System area built-up to be out of groundwater.
RESOURCES: Department of Environmental Protection, Western Regional Office,
436 Dwight St, Springfield, MA 01103, (413)784-1100;Title 5 Hotline- (800) 266-1122
t5insp.doc• 11/2004
Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal System
• page 9 of 10
PL
Notes:
1 . Septic tank is equipped with an outlet filter.
This is a maintenance item. Filter must be curtain drain
cleaned whenever septic tank is pumped, or
every 5 years, whichever is sooner. Failure to North
maintain filter may lead to system failure.
2. Recommend pumping septic tank on a 3 to 0
5 year schedule, depending on house
occupancy. maple tree
3. A copy of this document attached in the
basement/utility area will keep this A
information available in future years for 0 Breakout barrier membrane
maintenance.
EH- X81/2'
Partial t the outline ill
of the house.
TBM: top of bulkhead foundation i _
Elev.: 100.00' 1 N
�' 3y ro
N_1 Jj
A/C unit y. ., y,
r`
New PVC sewer pipe
raised approx.
38" li 16'
bin
u ,
434 1/2'
I
I
1 500 gal Title 5 septic tank
with outlet filter.
PL
As-Built Drawing Date: Owner: HOMESTEAD INC.
Existing Septic System 4/1 1 /07 John Murphy Thomas S. Leue R.S.
Revision Date: 397 North Farms Rd. 1664 Cape sc.
Scale: ] : 20' Florence, MA 01062 Williamsburg, MA 01096
Except as Noted 14131 628-4533