1443 Septic Inspection 1996 William F. Weld
Governor
Trudy Con
Secrelw, ECEA
David B. Struhs
Commissioner
Co[nmonwealth Of MassachUSefts
Executive Office of Environmental Affairs
Department of
Environmental Protection
Western Regional Office
@ 11 C�!-,
AM I �cg
NORTHAMPTON BOARD OF HE,
ENVIRONMENTAL FIELD SERVICES, INC.
O.O. BOX 518 LEEDS, MA 01053
1-413-586-7200
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
// CERTIFICATION /�
:party Address: /p/3 4%sihaM� gj�Address Owner:
I/d4 eN'`? -
to of Inspection: 7 zS/$c- a/84i fit
se of Inspector:Address £tP( ha �u2e !f ZW/.-tkenten--7)164 SS
See 4AC .•-e--_ 0j060
ITIFICATICJI STATEMENT -5196— 0334;
:ertify that I have personally inspected the sewage disposal system at this address and that the information reported below
true, accurate and complete as of the time of inspection. The inspection was performed based on w training and
oerience in the proper function and maintenance of on-site sewage disposal systems. The system:
X Passes
Conditionally Passes
Needs Further _al :tion By the Local Approving Authority
Fail
:pectorss Signature:
Date:
7446
. System Inspector shall srT it a copy of this inspection report to the Approving Authority within thirty (30) days of
rpleting this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector
I the system owner shall submit the report to the appropriate regional office of the Department of Environmental
tection.
t original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
;PECTIOII SUMMARY:
Check&B, C, or D:
SYSTEM PASSES:
x
I have not found any information which indicates that the system violates any of the failure crteria as
defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. .
SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the
replacement or repair, passes inspection.
licate yes, no, or not determined (Y, N, or MD). Describe basis of determination in all instances. If "not determined",
!lain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or
tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a
conforming septic tank as 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 pipe(s) or due to a broken, settled or uneven distribution box. The system will pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
'evised 8/15/95)
1
436 Dwight Street • Springfield, Massachusetts 01103 • FAX
• Telephone
ENVIRONMENTAL FIELD SERVICES, INC.
P.O. BOX 518 LEEDS, MA 01053
1-413-586-7200
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
PMT A
area�
CERTIFICATION (continued)
: /3/493 J .sdah 1 - ,44,- ahrt n
74-5-19to
fMTEM CONDITIONALLY PASSES (continued)
The system required punning
system will- pass Inspection
P os
/(l
broken is removed
SEPTIC
SYSTEM
INSPECTION
.41, : Ann" /"0/A cable
more than four times a year due to broken or obstructed pipe(s). The
if.(with approval of the Board of Health):
-broken i (B) are replaced -
FARTHER EVALUATION 15 REWIRED 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 the public health, safety and the environment.
1) SYSTEM WILL PASS WINLESS ROAM OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT
THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
•
Ad
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.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AID PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM
IS FUNCTIONING IN A WANNER THAT PROTECT THE PUBLIC WEALTH AND SAFETY AID THE ENVIRONMENT:
The system has a septic tank and soli absorption system and is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply
well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply
well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for col iform 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 ppn
SYSTEM FAILS:
1 have determined that the system violates one or more of the following failure criteria as defined in 310
CNR 15.303. The basis for this determination is identified below. The Board of Health should be contacted
to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the yround or surface waters due to an overloaded or
clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pulped
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 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.
revised 8/15/95)
2
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. 80X 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOSAL STSJF3f INSPECTION FBAI
PART A
t RTIFICATION continued)
r Addreeess: �////-tisetia/p.tie
of IrspeCtt m: gr/YfL` ed a irk
7/25!94
STEP FAILS (continued):
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. If the well has been analyzed to be acceptable,
attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and
nitrate nitrogen.
.41.4 Nor 4,4e/ead/P
WAGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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)
owner or operator of any such system shall bring the system and facility into full compliance with the groundwater
tment program requirements of 314 CPR 5.00 and 6.00. Please consult the local regional office of the Department for
her information.
PART B
CHECKLIST
k if the following have been done:
/id Pumping information was requested of the owner, occupant, and Board of Health.
✓None of the system components have been pooped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as
part of this inspection.
[ re�//rC?
01141 As built plans have been obtained and examined. Note if they are not available with N/A.. / 4"4/
The facility or dwelling was inspected for signs of sewage back-up.
✓ The system does not receive non-sanitary or industrial waste flow
L''.-The site was inspected for signs of,breakout.
/HL/w�)taf
✓
All system components, exmleding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for
conditim of baffles or tees,,material of construction, dimensions, depth of liquid, depth of sludge, depth of
scull. (4 n pa..rped
✓The size and location of the Soil Absorption System on the site has been determined based on existing
/information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were provided with information on the proper
maintenance of Sub-Surface Disposal System.
As J} ,nspe
P.rf
evised 8/15/95)
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 INSPECTION
1-413-586-7200
SUBSURFACE SEWGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
rtY Addr : /0.3 /rzp5M [ Ed /U ✓ihFOd /
of Ins b . 1 t ert1 e /O-% nprhCd b l° =If1//r�J 1
7/z-5/9G
ENTIAL:
n flow: a 2C' gallons
r of bedrooms: 2.1 /
r of current residents:
ge grinder (yes or no): NU
Try connected to system (yes or no): ye-5
net use (yes or no): ✓2S
meter readings, if dveilable: C-
CONDITIONS
date of occupancy: Cue-ten/9 to o
iRCIAL/INDUSTRIAL:
of establishment:
pi flow: gallons/day
le trap present: (yes or no)
;trial Waste Bolding Tank present: (yes or no)
;anitary waste discharged to the Title 5 system: (yes or no)
r meter readings, if available:
date of occupancy:
R: (Describe)
date of occupancy:
'INC RECORDS and source of infor
GENERAL INFORMATION
motion:
Pahrici
System pumped as pert of inspection: (yes or no)/V1(1
If yes, volume pupped: gallons
Reason for pumping:
OF SYSTEM
Septic tank/distribution box/soil absorption system
_ Single cesspool
Overflow cesspool
Privy
_ Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other (explain)
RO)(INATE AGE of all components, date installed (if known) and source of information:
2oyts±
age odors detected when arriving at the site: (yes or no) AID
'evised 8/15/95)
4
ENVIRONMENTAL HELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 INSPECTION
1413-586-7200
SUBSURFACE SAVAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMAL ION (continued)
rty Address:/ �/3%4sh4t '—
of Inspect'an 44400 if
ts/9d
C TASK: /00
ite on site plln)
i below grade: X jet of construction: /t concrete _metal _FRP _other(explain)
s�
2d % ' r 4-
1 1
AdA
-c67- 40,/,60,140
'signs:
)e depth: v
ince from top of qudge to bottom of outlet tee or baffle: 2 0
thickness:
ante from top of scup to top of outlet tee or baffle:
ince from bottom of stun to bottom of outlet tee or baffle: /9 v
ents:
cemendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet
rt, structural integrity, evidence of leakage, etc.)
Cif)) n am.
USE TRAP:L✓
:ate on site an)
:h below grade:
:vial of construction: date _metal FRP _other(explain)
srts i ons:
n thickness:
Lance from top of scup to top of outlet tee or baffle:
Lance from bottom of stun to bottom of outlet tee or baffle:
rents:
commendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid Level in relation to outlet
ert, structural integrity, evidence of Leakage, etc.)
A-
revised 8/15/95)
5
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 INSPECTION
1-413-586-7200
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR
PMT C
//4 ‘ SYSTEM tN/FOR�MTITION (contiianued))
ty Address: //�Iy.�3IA 37gBAr/i7 gcr i✓'i CkJ 4— "it
f Inspec ogn 7,te✓✓ie v ,U` A/oT /// /ca /P
7-26—96
OR HOLDING TANK:
e on site plan)
below grade:„_
el of construction: concrete metal _FRP __other(explein) '
:ions:
ity: gallons
I flow: gallons/day
level:
Its:
ition of inlet tee, condition of alarm and float switches, etc.)
MOTION BOX: /07 kt—
rte on site plan)
1 of liquid Level above outlet invert:
mts: etc.)
if level and distribution is equal, evidence of olids carryover, evidence of leakage into or out of box,
CHAMBER: L a
ate on site plan)
s in working order:(yes or no)__
ants:
e condition of poop chamber, condition of pops and appurtenances, etc.)
evised 8/15/95)
6
ENVIRONMENTAL HELD SERVICES, INC. SEPTIC
P.O. 80X 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SOILAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
-
SYSTEM INFORMATION (( tined)
y Address: /9H 4/eS/J .e ` � (✓
- n
`/n `L
U% /f�•cad/e
Inspection: Aida 7//40`r
SORPTION SYSTEM (SAS): , by non-intrusive methods)
on site plan, if possm approximated excavation not required, but may be / /
79y�l° . SGra,"P Chdmd-Gtr
determined to be present, explain:
leaching pits, number: /
leaching chambers, number:
Leaching galleries, number:
leaching trenches, n mber,length:
leaching fields, number, dimensions:
overflow cesspool, number:__
of ponding, condition of vegetation etc,)
Convents: (note condition of soil, signs of hydraulic failure,
/N C44&
RLS:
:e on site plan)
and configuration:
.top of liquid to inlet invert: �
of solids layer:
of sous layer:
signs of cesspool:
atio of construction:
ation of groundwater:esspo
inflow (cesspool oust be pnpcd as p rt of inspection)
nts: (note condition of soil, signs of hydraulic failure, level of pending, condition of vegetation, etc.)
it
rte site plan)
ale s of construction:
is ifn s: .✓L �/
0 solids: F
ents:: (note condition of soil, store of hydraulic failure, (eve( of m g condition of vegetation, etc.)
of
evised 8/15/95)
1
ENVIRONMENTAL FIELD SERVICES, INC. SEPTIC
P.O. BOX 518 LEEDS, MA 01053 SYSTEM
1-413-586-7200 INSPECTION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
ty Redress: n/-/2 RC( //r %a 71/4
f Inspection: NA9 Mart;ke
7-2r- 96
I OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
Locate all wells within 100'
/D o0
I
w
d;am e-{et,
hp Ge,04)
rode e S'
H well 2heel room
1-4 .1I k lead,l'
Sp
IN TO (ROMDOATER
th to groundwater: p feet
:hod of determination or approximation:
u-it-° 66
/ odhec4-
{C wG S
-leveret/ /
handed Yee/1
fu KB;w
yavose
ed
revised 8/15/95)
B
072 30 99 1 072°44 0.08" 072°,43'30.08 072 43 0 08 072° 30 08 072°42',0.08' 072°41'
I
= I t r, '' ' '. I, - I. I P,
1 . roaNgY Ira I i ' p H .._e s
r ^'Ii`,.epaet rQ .. ^Y °• .yWest PatAl� a y �*OOh ,
r 9
(/2 i Bon GMVO Rta '
gr
.r F
o r p I I
;XI ! '� � � jar:. �Gr�.al➢ae �_ ._ _
1 1 Mt , 1
'e
m , g ' pcsiNa"r'nn ,
•
` 1.
N d
e ,➢o
*cry t b ••• •• ar
a 4' 7 CitRIS?1NE YOUNG / LAURIE MEADE 1 '
aot
i t' cane,el .. -•
• ' Cle r Fa la t n1N.•=r"—h-
a.4x5 •fwvd s
a pn�
-- i
6 1, 06„r ••N< J.r C
Lti
' •L I °iF 'u ,f
I : IF'
f -
craw.
r�r �°°s 1
i _ — 1 940 ,F E A .
M '
9E '• ` _
FN
O :_ `rJ- \i4g
3
072.44 3009" 1 072°41 tl.te" 072°43'36.08" ' -0726 4'6'0 Os"i " ' 072.42' r.08" 072°42"C11.08' 0724 4
<Default>-0 Markers,Length=0 feet NORTHAMPTON,MA-1 Markers,Length=0 feat
Name:EASTHAMPTON Location: 042° 17'30.0" N 072°43'08.2" W
Date:8/16/98 Caption:CHRISTINE YOUNG
Scale: 1 inch equals 2000 feet — ,
LAURIE MEADE
Copyright(C)1997,Maptech,Inc ivcc+'unuo+nni nnnn