27 Septic Inspection 2012 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
27 WEST FARMS ROAD
Property Address
27 WEST FARMS ROAD CONDO ASSOC. ( UNIT 27A SELLER - PATRICK SULLIVAN )
ner Owner's Name
oration Is
re NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
ry
r e page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
aslant: A. General Information
en filling out
ns on the
muter,use 1 Inspector.
l the tab key
love your PHILIP J. PASIECNIK
:or-do not Name of Inspector
the return
GREG'S WASTE WATER REMOVAL
Company Name
239 GREENFIELD ROAD
Company Address
SOUTH DEERFIELD MA.
City/Town State
413-665-3989 SI1526
Telephone Number License Number
01373
Zip Code
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes
❑ Needs Further Evaluation by the Local Approving Authority
❑ Fails
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
na.11/10 idle S Official Impaction Form.Subsurface Senege Disposal System.Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
27 WEST FARMS ROAD
Property Address
27 WEST FARMS ROAD CONDO ASSOC. (UNIT 27A SELLER -PATRICK SULLIVAN 1
'r Owners Name
'ed for.aeon is NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
page. City/Town State Zip Code Date of Inspection
ns.nfm
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced O Y E I N E ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
❑ Y ❑ N ❑ ND(Explain below):
❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
Title s Official Inspection Form Subsurface Sewage Disposal Syslem•Page 3 o1 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
27 WEST FARMS ROAD
Property Address
27 WEST FARMS ROAD CONDO ASSOC. ( UNIT 27A SELLER -PATRICK SULLIVAN )
r Owners Name
iation is
o NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
pagee.. CRylrown
edg State Zip Code Date of Inspection
ns.11110
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis- [This
system passes if the well water analysis,performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
• El
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either yes or no to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
Title 5 Official Inspection Form Subsurface Sewage Disposal System.Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 WEST FARMS ROAD
Property Address
27 WEST FARMS ROAD CONDO ASSOC. ( UNIT 27A SELLER -PATRICK SULLIVAN )
r Owners Name
cation is
p for NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
. City/Town State Zip Code Date of Inspection
page
D. System Information
Description:
4 Condo Units with 5 Bedrooms Total
4
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?lif yes separate inspection required) ❑ Yes ® No
Laundry system inspected? ❑ Yes Z No
Seasonal use? ❑ Yes ® No
123 gpd Unit
Water meter readings, if available(last 2 years usage(gpd)): 27A
Detail:
Last 2 years usage= 12,000 cu.ft. x 7.5 gp cu ft=90,000 gallons/730 days= 123.29 gpd
Readings obtained for unit selling only.
Sump pump? ❑ Yes Z No
Units Currently
Last date of occupancy: Occupied
Commercial/Industrial Flow Conditions:
N/A
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
27 WEST FARMS ROAD
Property Address
27 WEST FARMS ROAD CONDO ASSOC. (UNIT 27A SELLER - PATRICK SULLIVAN 1
r Owners Name
ed fo r is NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
page.fo
page. Cdy/rown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
9 Years Old / 04/30/03 / As Built Date
Were sewage odors detected when arriving at the site?
Building Sewer(locate on site plan):
Depth below grade:
Material of construction:
[' cast iron
®40 PVC ❑ other(explain):
Distance from private water supply well or suction line:
2.5
feet
❑ Yes ID No
PVC Entering Septic Tank
Town Water
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Building sewer appeared to be in good condition. Venting was visible on
the roofs of condo units. No leakage was visible at this time.
Septic Tank(locate on site plan).
Depth below grade:
Material of construction:
® concrete
❑ metal ❑ fiberglass
2
feet
❑ polyethylene LI other(explain)
If tank is metal, list age:
N/A
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
12' Lx 6'W x6' D
Dimensions:
Sludge depth:
is•11/10
11"
Title 5 Official Inspection Form Subsurface Sewage Disposal System•Pages of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
27 WEST FARMS ROAD
Properly Address
27 WEST FARMS ROAD CONDO ASSOC. ( UNIT 27A SELLER - PATRICK SULLIVAN )
Owners Name
cation is NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
p for page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
N/A
Depth below grade.
Material of construction:
❑ concrete ❑ metal
❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Tales Official L¢q]im Form:subsurface Sewage Disposal system.Page 11 N n
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 WEST FARMS ROAD
Property Address
27 WEST FARMS ROAD CONDO ASSOC. (UNIT VA SELLER -PATRICK SULLIVAN )
r Owner's Name
ed or15 NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
ation page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
leaching fields number, dimensions.
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
1 -50' L x 24'W
with 4 laterals
No evidence of soil clogging, hydraulic failure or ponding. Soil over
leaching field wasn't damp or spongy under foot. Vegetation was mowed grass which appeared to be
uniform in growth.Venting pipe for leachfield was in place.
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
N/A
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
❑ yes ❑ No
The 5 Official lnspedwn Form:Subsurface S ewage Disposal System•Page 13 at 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 WEST FARMS ROAD
Property Address
27 WEST FARMS ROAD CONDO ASSOC. ( UNIT 27A SELLER -PATRICK SULLIVAN)
Owner's Name
ration 1s NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
page.for
page. City/TOwn
State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
Z drawing attached separately
See As 7 0 /F 4ftAPd
;.11/10 Title 5 Offoal Inspection Form:Subsurface Sewage Dlaposall System•Page 15 of 17
ation is
ad for
page.
s•11110
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
27 WEST FARMS ROAD
Properly Address
27 WEST FARMS ROAD CONDO ASSOC. ( UNIT 27A SELLER -PATRICK SULLIVAN )
Owner's Name
NORTHAMPTON MA. 01062 NOVEMBER 2, 2012
City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
tills 5 Vidal in ion Form Subsurface Sewage Oi9posal System•P 0117
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I NOTES:
J1
f I ILL - 1-�"- 1 ] S - s Mffi amYmWRaeWar 1.ASLMNLT SITE PLAN BASED ON
t '! S .olcmwlenmvauenrano AVSIECJR]N-UJR97.
__ _ -
1 a
�, } ^ LFACM EL0 AMMAN::PML m T r.n SIAM S.NOT DRAPING,LOANING d SEEDING •
;am V y"' '"'- I CLE.ameia ALOESS •�•°' INCLEw YEOPEL mEnun SIAM NOT COMPLETE AT now or INSPECTION
ITae.cE SITE PLAN ANA••••..14`
AS•BWLTNNVERr ELEVATHONS: SCALE: V ."10' - - ----- ---
soave TLEIRENe =+E MST FLEW AS-BUILT SITE PLAN(70211-2) - 4130/03
SEWERATOARAGE: 10.3.23 O¢s-, PERO TEST Ne.t _ __. ,.. ___ —____ __
SEWERATWALL: 101.34 - - AnOPERTY UNE(APPR x.LOCATICN)
SEPTIC TANK NLET: 100.7E IR WELL WEST FARMS PLACE, NORTHAMPTON, MA
SEPTIC TANK OUTLET: 100.3 - + EMOTING CONTpO1AEL.TO SITE&N1
Nseor MEG 100.38 —•-" DWILAWGCamO D FOR DAVID MCCUTCHEON
�mfEDWMnxns INFORM( t T
DBDroNRErs: 100.70 -- ' - 'OJRE1EEWNMtkM3PROX.uCAn _._—__.—.—_—_._ ..__.__ - _
DRSTRUI.1WESO: on -_ - BUREDELE:--- -Wk-MP---- -CM1TIOW) NEWMAN ENVIRONMENTAL 1 ( HCK RO ENGNN IF 01008
OFSTRIS.LWESQ: on --- _- FENCE WE NIE INYAOM.ICCATaOnI------------------ ---- - - pa, SOY 006. 21 MIAMI ROAD 0ORT4i7NLT0 N. N4 01008
...r--�-. FENCE
1E1. 1.IJ ONO 5703
L ' i
NORTH '"'AV'/
�' x
Porch
� gyp/'i
Note: No known drinking water sources within 100 foot radius. ,\ ! 4\i/ .
y
'2 1' Nim \ a
l \
Septic tank c�N I \� p
0
\
N
/
Distribution box //
/
c
Leachfield, approximate layout vent
c
0
c
0
a
-0
m
0
E
0
0
0
m
0
COMMENTS:
Recommend pumping on a 2 to 3 year schedule. Also. a COPY of this plan posted in the
basement/utility area would keep this information accessible in future years for maintenance.
Date: Owner: /�ytx OF lu8'Ts HOMESTEAD INC. ,
As-Built Drawing /e+ y-
Jo
Existing Septic System 11 /23/05 Paul Entis lre Tit
MultS IL e., Thomas S. Leue R.S.
Revision Date: 27 West Farms Road 1°„ , 7 , I t664 cape St.
Scale: 1 : 20' Florence, MA 01062 / of �� W�7iiamsburg,MA 01096
Except as Noted 04' 'eeo s$'� [413]628-4533 Al