625 Septic Inspection 1999 ENVIRONMENTAL HELD SERVICES, INC.
P.O. BOX 518
LEEDS, MA 01053
1-413-586-7200
August 6, 1999
Richard Adams
625 Westhampton Road
Northampton, MA 01060
re: Septic System Inspection at 625 Westhampton Road
Dear Richard:
N6 2 7 1999
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.
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,
Micha- . La gne
Envir.nmental Engineer
Certified System Inspector
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(conliuedl
Property Adders:
Owner:
Dn.of Inspection:
INSPECTION SUMMARY: Check A, B, C, or O:
A.1/SYSTEM PASSES:
Y I have not found any information which indicates that any of the failure conditions described In 310 CMR 16.303 exist. Any Is
criteria not evaluated are Indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described In the "Conditional Pan" section need to be replaced or repaired. The system.t
completion of the replacement or repel,, as approved by the Board of Health, will pass.
Indicate yes, no. or not determined IV, N. or ND). Describe basis of determination in all instances. II not determined', explain why not.
The septic tank Is metel,unless the owner or operator hes provided the system Inspector with a copy of•Certificate
Compliance(attached)indicating that the tank was installed within twenty(201 years prior to the date of the Inspectic
the septic tank, whether or not metal, Is cracked,structurally unsound, shows substantial Infiltration or exfiltration, or
failure is imminent. The system will pees Inspection if the existing septic tank is replaced with a complying septic ten
approved by the Board of Health.
Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed p
or due to a broken, settled or uneven distribution box. The system will pass inspection Il Iwith approval of the Board I
Health)
broken pipets) are replaced
obstruction is removed
distribution box is levelled or replaced
The system requited pumping-more than loin-times a ynrdue to broken or obstmcted pipets/. The spatern will pwn
inspection 11 with approval of the Board of Health):
broken pipets)are replaced
obstruction Is removed
revised 9/2/98
Page 2 of I I
ARGEO PAUL CELLUCCI
Governor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 1619)2926500
SUBSURFACE SEWAGE DISPOSAL ASYSTEM INSPECTION FORM
CERTIFICATION
We �ihory) lac Rd Nan.of Owner FCIChard (dcamS
Property Address:4,9S C P Adbea.of Owner: 6 as Wt at-hQ» to N Rd
Nnri�ham{r}�10 NorHTamP%OO t Sn Si oitx0
Date of Inspection: 7-d 1 -4`j
Name of Inspector:I ease Print)
I ern a DEP approved system Inspector clean)to Section C15.340 of Title 5 1310 CMR 15.0001
Company Name: E %r^QS]—let e A1-1-al Ftei d _ I040I WO
Mirq Address: 1;35' Co s_. • A% 1yi1Ct m r M MR
Telephone
Number: . _ - s •
TRUDY CORE
Secretary
DAVID B.STRUMS
Commissioner
CEATIFICATON STATEMENT
I acertify
d complete as of the stime lol inspection.1eThe inspection awasyperformedlbased on my training and experience note proper function and
accurst.
Maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the local Approving Authority
Fails
Inspector's Signature:
The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty 1301 days of
completing this'shall submit the report tito the appropriate regional office of the rD has a epartment oPEnv*ondsadSI pmt otlogreeter,
n etThe original should be cent WPM owner
system owner end copies sent to the buyer.II applicable, and the approving authority.
Date:
8/09
NOTES AND COMMENTS
revised 9/2/9B
Page I or It
0 r".led on Recycled r.en
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOIIM
PART A
CERTIFICATION(continued)
Property Address:
Owner:
Date of Inspection:
D. SYSTEM FAILS:
You must indicate either "Yes' or No to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for
determination is Identified below. The Board of Health should be contacted to determine whet will he necessary to corrects
Yes No
- Backup of sewage Into fecilltyreryyatem component dune en overloaded or-cragged SAS orceesfsoot. - -y--a..
- Discharge or pending of effluent to the surface of the ground or surface waters due to overloaded or clogged cesspool.
^ en ov ogBatl SO
- Static liquid level in the distribution hot above outlet invert due to an overloaded or clogged SAS or cesspool.
- Liquid depth In cesspool is less than r below invert or available volume Is less than 1/2 day flow.
Required pumping'gore than 4 times in the last year NOT due to clogged or obstructed pipets).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feel of a surface water supply or tributary to a surface water supply
Any portion of a cesspool or privy is within a Zone I of a public well.
- Any portion of a cesspool or privy Is within 50 Feet of a private wale; supply well.
Any portion of a cesspool or privy is less-than 100 feet but greater than 60 feet from a private water supply well w0
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis
-conform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
the system serves a facility with a design flow of 10,000 gpd on greater(Large System) and the system Is a significant threat
health and safety and the environment because one or more of the following conditions exist:
Yes No
- the system is within 400 feet of a surface drinking water supply
- the system.le-within 200 feetole-td uIarv.toe eurfaoaJ
wrki.y.wa«waAy
the system Is located In nitrogen sensitive area(Interim Wellhead Protection Area-IWPAI or a mapped Zone II of s p
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304121. Please consult the local cal
office of the Department for further Information.
revised 9/2/96
•
rage 4 or II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner:
Date of Impaction:
FURTHER EVALUATION IS REQUIRED BY HE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine U the system Is felling to protect the
public health,safety and the environment.BOARD OF 1) SYSTEM UNLESS II ROI 1111b1 THAT E SYSTEM NOT FNCtONING M A MANNER WHC WILL PROTECT HIE PUBLIC HEALTH AND SAFETY MID THE a�ONMEN
_ Cesspool or privy is within 50 feet of surface water
Cesspool or privy Is within 50 feet of s bordering vegetated wetland or a salt marsh.
SYSTEM WILL F AIL UNLESS HE BOARD OF HEALTH AND PUBLIC WATER SUPPLIER,IF ANY(D
FUNCTIONING IN A MANNER THAT PROTECTS HE PUBLIC HEALTH AND SAFETY AND THE EN
The system has a septic tank and soil absorption system(SAS)end the SAS Is within 10
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I
_ The system has a septic tank and soil absorption system and the SAS Is within SO feet
_ The system has a septic tank and soil absorption system and the SAS Is less then 100 f
private water supply well,unless a well water analysis for calif arm bacteria and volatile
well Is free from pollution from that facility and the presence of ammonia
nitrogen
not and
than 5 ppm. Method used to determine distance • (approximation
ETERMINES THAT HE SYSTEM IS
VMONMENT:
0 feet of a surface water supply or
of a public water supply well
of a private water supply wall.
set but 50 feet or more from a
organic compounds Indieatee that the
nitrate nitrogen is equal to at less
3) OTHER
revised 9/2/98
Page 3 nr II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner:
Date of Inspection:
RESIDENTIAL: FLOW C(INUIIIUNS
Design pow: slit g.P.d.:bedroopgi.
Number of bedrooms(design):Opj Number of bedrooms laetuall:3
Total DESIGN Dow
Number of current residents;u2
Garbage winder)yes or nol:. �r
Laundry i eparete system) I4µ rol:yQ; If yes, separate Inspection re u red
Laundry system inspected Wes orr no) g
Seasonal use Ives or noril(i
Water meter readings,If available(last two year's usage Will:: 0 4
Swop Pump(Yes or not:/J0
Last date of occupancy:CFTC}I't.
COMMERCIAL/INDUSTRIAL:
Type of establishment:_
Design flow: grid I Based on 1 5.2031
Basis of design flow_
Grease trap present:)
Yes or not - - -_- -
Industrial Waste Holding Tank present:(yes or not
Non-sanitary waste discharged to the Title 6 system: Wes or no)
Water meter readings, If available:
Last date of occupancy.
OTHER:(Describe)
Last date of occupancy.
PUMPING RECORDS and source of Information:
System e - •'
pumped as p i speculum: (yes or
If yes, woos pumped:
Reason for pumping:_
TYPEs1F SYSTEM
/� Septic tankPbMbrrliarr-be,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (If yes, attach previous inspection records,it any)
VA Technology eta. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
gallons
GENERAL INFORMATION
Other
APPROXIMATE AGE of all components, date installed fit knownbend source of6lammtion: {Y.Lt .Jell / p1 t V•p r H
. ,'l CLvt C. wLtol/k� okl
Sewage odors detected when errlving at the site:(yes or nog&X) € Sl'T
Mate
revised 9/2/98
Page a nl I I
SUBSURFACE SEWAGE DISPOSAL BALSYSTEM INSPECTION FORM
CHECKLIST
Roperty Addeo:
Owner:
Date of Inspection:
Check II the following have been done:You must indicate either "Yes" or No as to each of the following:
Y7 No
Pumping information was provided by the owner,occupant,of Board of Health.
— — smiths NaMm hoLeaamceirrrg
new now
None of the
g that period. ts,ge baaties of water have betbvew• yor•
rates during that period Large volumes of water Meve not been Introduced into the system recently a pert of this
inspection.
As built plans have been obtained and examined. Note it they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non sanitery or Industrial waste Row.
✓ _ The site was inspected for signs of breakout.
✓ _ All system components, excluding the Soil Absorption System.have been located on the elte.
✓ — or tees,Ins material of constr uction,ction, dimensions,depth of Interior of the
depth of sludge,septic
depth oscum.
lspected for°onditlan of haloes The
The site and location of the Soil Absorption System on-the site has been determined based on:'
Id" Existing information. For example. Plan at B.O.H.
/ _ Determined in the field lit any of the failure criteria related to Part C is at issue,approximation of distance Is unacceptable)
�c Ii S.30213)lb/I
1
�_ _ The facility owner and occupants.if dill mug hom.owpaN.wuaArmddad with lalotwb
Dann EhaYraparmalnuna°°a°
Subsurface Disposal Systems.
revised 9/2/98
Page a of 11
Repent'Address:
Owner:
One of Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
11G11r OR HOLDING TANK:Al//I(Tank must be
(locate an site pienr pumped prior to, or at time ol. Inspenimrl
Depth below grade:
Materiel of constrectio r concrete metal__Fiberglass Polyethylene_atherlexplelnr
Dim
Capacity: gallons
Design flow: gallons/day
Alarm pies em__
Alarm level Alarm in working order: Yes No
Date of previous pumping: - - -
Comments:
(condilion of inlet tee, condition of alarm end float switchee,etc.)
DISTRIBUTION BOR:M/P
(locate on site plan,
Depth of liquid level above outlet invert_
Comrnants:
(note if level end distribution is equal. evident.*of solids carryover, evidence of leakage Into or out of box. etel
PUMP CHAMBER: %4
(locale on site plan)
Pumps in working order:(Yes or Nol
Alarms in working order ryes or No
Comments:
(note condition of pump clmmber,condition of pumps and appurtenances, elc.)
revised 9/2/98
Puy a or II
SUBSURFACE SEWAGE DIS PANT SYSTEM INSPECTION FORM
SYSTEM INFORMATION(continued)
Propwty Address:
Owner:
Date of Inspection:
BUILDING SEWFA:
(Locate on site plant
Depth below grsde6C b- SID33
Material of construction: ✓cast Iron_90 PVC other)explain)
Distance ham privets water supply well or suction line
Diameter yl
Comments:(condition of joints,venting. evidence
e,-etc.l
SEPTIC TANK: ✓
(locale on site plan)
I UIl
Depth ter below gmde:T�
Materiel of construction: ✓O^c'et° motel Fiberglass Polyethylene mn°rleevlelnl
If tank fs metal.tin age Is age confirmed by Certificate of Compliance (YeslNol
Dimensions. 100
Sludge tiepin:_ _
.
Distance from top of sludge to bottom of outlet tee or bailie:
thickness_� to top of outlet tee or baffle:
Distance from top o
Distance from bottom of scum to bottom of outlet lee or baffle: N
How dimensions were determined: e, " -e=Ce
p �� g' y,
Comments: condition of inlet and outlet tees,nbaffle a.depth of liquid ffo oowsFlnte h
evidnce of leakage,etc.)etc.)puttying, c {{..�� _ s R.
evidence of leakage,elc.l n - ' wn -
GREASE Tsite
gnome on site plan)
Depth below grade:_ _
Material of conshuction:_concrete metal_Fiberglass _Polyethylene otherlexpiain
Dimensions
Scum thickness:__
Distance hom top of scum to top of outlet tee or bathe:
h
Distance from bottom of scum to bottom of outlet tee or bathe:�
Dale of lest pumping:
Comments: liquid level in relation to outlet Invert,structural Integrity,
(recommendation evidence of leakage, elc.)p1ng,condition of{Met end outlet tees or beiges,depth o111W
revised 9/2/98
rage l of II
Property Address:
Own..:
Del.el Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION[continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include lies to el level two permanent reference landmarks or bencbn,ntke
locale all wells within 100"(Locale where public writer supply comes c ibis bowel
revised 9/2/98
/Ode 9^?
21acL P,Z
611* FJ Ca
Lies l pia �rJ
Pepe 10 of II
SUBSURFACE SEWAGE DISPOAS i CSYSTEM INSPECTION FORM
SYSTEM INFORMATION Icmrgnrmll
PmpeetY Address:
Owner:
lime of hnpecgnc
SOIL ABSOBPIION SYSTEM ISASI: I t d by min Intrusive methods)
(locale on site plan, If possible:excavation not Imp mired,location may he epirox nn e
If not located.explain:
Type'.
leeching pile,number:I. j000
1
leaching chambers,nurrmen_
leeching galleries,number:_
leeching trenches,number,length:
leeching fields.number,dlmenelons:
overflow cesspool,number_
Alternative system:
Nance of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level all ponding. damp soil.lndition of vegetation, etc.)
(AA s *r
• 4es s
,CESSPOOLS:
Ildcate on she plan)
Number end configuration,
_. ---
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer.
Dlmen lobe of cesspool:
Materiels of construction-
Indication of groundwater: pecgonl
inflow(cesspool must be pumped pert of
Comments:
)note condition of Boil, signs of hydraulic failure.level of pending, condition elvegetation.etc.I
PRIVY:Si%i
locate on site plan)
Meterjels of construction:
Depth of solids:__
Comments: hydraulic failure,level of pending.condition of vegetation. etc.)
Mote condition of soli,signs of by
revised 9/2/98
Pew 9 or II
Dimension'
Property Address:
Owner:
Dote of Yspa-Eon:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART
SYSTEM INFORMATION Icontitued)
NRCS Report name_,__ -- _ - - _
Soil type_
Typical depth to groundwatei ---
USGS Date webai(e visited
Observation Wells checked Modarme —Deep_
Groundwater depth: Shallow_. _
SITE EXAM Slope
Surlece water
Check Cellar
Shallow wells
Estimated Depth to Groundwater-WO Feet
Please Indicate all the methods used to determine Iligh Groundwater Elevation:
Obtained hom Design Plane on record
y Observed Site!Abutting property. observation hole, basement sump eta)
✓ Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
_ Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. Must be�completed)
� srunS
SYos' is' ot-- L.;Ili tp Cl) cbknte� YacIa 7
LAS' 2rn \I Ltd,- wz�lz� >, > /0I
or-
revised 9/2/98
rare a of D