1317 Septic Inspection 2006 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
:edification
roperty Information
lerty Address:
er's Name:
er's Address:
of Inspection:
‚to:
ess:
ispector
e of Inspector:
pally Name:
ing Address:
phone Number:
1317 Westhampton Road. Northampton, MA
i p Armstrong
Murphy Realtors 44 Conz St. , Northampton, MA 01060
12/22/06
Board of Health, Northampton; Tom Masters
Number:aaaS=1._6a-
Thomas S. Leue
Homestead Inc.
1664 Cape St. . Williamsburg. MA 01096
1413) 628-4533
tification Statement:
rtify that I have personally inspected the sewage disposal system at this address and that the information reported
Nv is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
:ling and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP
'roved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The septic system condition
A be evaluated and classified into one of the following four conditions:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
)system condition: Passes
>pectors Signature:
Date: 12/2 2/0 6
a System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
.P)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
I or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
P. The original should be sent to the system owner and copies to the buyer, if applicable and the approving
thority.
ites and Comments:
"'This report only describes conditions at the time of inspection and under the conditions of use at that
ne.This inspection does not address how the system will perform in the future under the same or different
mditions of use.
5!4138000"3
iinsp.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
ertification (Cont.)
erty Address: 1317 Westhampton Road Northampton, MA
er' Name: Kip Armstrong
of Inspection: 12/22/06
ection Summary: Check A, B,C, D or E 1 plways complete all of Section D:
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.
'manta:
System Conditionally Passes:
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.
N The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
fund, exhibits substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if
existing septic tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic
will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank
ss than 20 years old is available.
explain:
N Observation of sewage backup or break out or high static water level in the distribution box due to
<en or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if
h approval by the Board of Health). broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
explain:
N The system required pumping more than four times a year due to broken or obstructed pipe(s). The
;tem will pass inspection if(with appro br h okenpipe(sr are replaced
obstruction is removed
I explain:
N
Other: explain:
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
ling to protect the public health, safety or the environment:
System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
'stem 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.
insp.doc• 11/2004
Homestead Inc.
Title 5 Official Inspection Form: Subsurface Disposal System
m
of
•o
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
edification (Cont.)
arty Address:
al.' Name:
of Inspection:
System will fail unless Board of Health(and Public Water Supplier, if any)determines that the system
nctioning 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
r 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
supply well" Method used to determine distance s
its system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and
tile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia
gen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy
e analysis must be attached to this form.
1317 Westhampton Road, Northampton, MA
Kipp Armstrong
12/22/06
Other:
System Failure Criteria applicable to all systems:
must indicate either"Yes" or"No" as to each of the following for a inspections:
l(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
pt t fl hl nitrogen nitrogen ea than 5
ppm, provided hatnooer failure tera are triggered. A copy of the analys sust be attached to this
The System Fails: I have determined that one or more of the above failure criteria exist as defined in 310
1 15.303, therefore the system fails. The system owner should contact the Board of Health should be contacted to
ermine what will be necessary to correct the failure.
)MMENT:
isp.doc•11/2004
Homestead Inc.
Title 5 Official Inspection Form. Subsurface Disposal
3 System
page of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
edification (Cont.)
erty Address: 1317 Westhampton Road, Northampton, MA
er' Name: Kipp Armstrong
of Inspection: 12/22/06
.arge Systems:
considered a large system the system must serve a facility with a design flow of 10,000 to 15,000 gpd.
met indicate either"Yes" or"No" as to each of the following:
'ollowing criteria apply to large systems in addition to the criteria above:
(Y)or NO(N)
ii 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
V the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a
ped Zone II of a public water supply well)
J answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in
ion D above the large system has failed. The owner or operator of any large system considered a significant
3t under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The
am owner should contact the appropriate regional office of the Department.
;hecklist
;k if the followinc hav€been done. YQU must indicate YES (Yl or NO(N)as to each of the following:
Pumping information was provided by the owner, occupant or Board of Health.=
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?
Have large volumes of water been introduced to the system recently or as part of the inspection? =
Were"as-built" plans of the system obtained and examined? (If not available note as N/A)
Was the facility or dwelling was inspected for signs of sewage back up? =
Was the site was inspected for signs of break out?
Were all system components, excluding the SAS, located on site? s
Were the septic tank manholes uncovered, opened, and the interior of the septic tank inspected for the
dition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and scum?
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.
b) Determined in the field Of any of the failure criteria related to Part C is at issue approximation of
ance is unacceptable)115.302(3)(b)].
The facility owner(and occupants, if different from owner)were provided with information on proper
ntenance of Subsurface Sewage Disposal Systems (SSDS).
sp.doc• 11/2004
Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal
4yst stem
•
Commonwealth of Massachusetts
Title 5 Official Inspection Form
arty Address:
Dr' Name:
of Inspection:
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
7 W-sth
on Ro•d N•rtham
Kipp Armstrong
12/22/06
FLOW CONDITIONS
DENTIAL
330 I DESIGN flow based on 310 CMR 15.203(gallons/day)
Number of bedrooms (design)—
3 _ Number of bedrooms (actual)_
0 Number of current residents__
N Is there a garbage grinder? (Y or N)
Y Is there a Laundry Hookup? (Y or N)
N 1 Is the Laundry a separate system?(Y or N) (If yes, separate inspection required)
N 1 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)_
occupied Date of last occupancy
4 months
IMERCIALIINDUSTRIAL
of establishment: _
gn flow(based on 310 CMR 15.203): = gpd
s of design flow(seats/persons/sgft, etc.): =
Ise trap present(Y or N): =
strail waste holding tank present(Y or N): =
ar meter readings, if available: =
date of occupancy/use:_
IER (describe):=
GENERAL INFORMATION
iping Records: Source of information: Pumped 10/29/04 says earlier report
N 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: Pump on 3 to 4 year interval.
E OF SYSTEM:
Septic tank, distribution box, soil adsorption system.
Single cesspool =
Overflow cesspool =
Privy =
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): =
sp.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
erty Address:
r' Name:
of Inspection:
PROXIMATE AGE
1317 Westhampton Road, Northampton, MA
Kipp Armstrong
12/22/06
All components, date installed, and source of info.
ptic plan: 1985 system
uce of Info: earlier Title 5 report
N Were sewage odors detected when arriving at the site(Y or N)
ILDING SEWER (located on site plan)
16 Depth below grade (inches) Fstimated Average
22 Distance in feet from private water supply well or suction line
3BS plastic Materials of Construction
mments: No problems seen.
PTIC TANK (located on site plan)
Concrete Materials of Construction
7 Depth below grade (inches)
0 _ Riser depth (inches)
58 Septic tank width (inches) interior dimensions
122 Septic tank length (inches) Interior dimension4
60 Septic tank height (inches) Interior dimensions
1,843 Calculated gross volume (gallons) Calculated
11 Air space in tank (inches)
1,500 Net Volume (gallons) Calculated
26 Baffle depth (inches)
4 Sludge thickness (inches) 8yeage
1 Scum thickness (inches) Aygr ge
30 Top Sludge : Bottom Baffle (inches) Calculated
14 Bottom Scum : Bottom Baffle (inches) ,alculated
9 Top Scum • Top Baffle (inches) Calculated
rmments:
operational or structural problems seen.
,commendations:
amp on 3 to 4 year interval.
;p.doc• 11/2004
Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal System
•page 6 of 10
erty Address:
:r' Name:
of Inspection:
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
1317 Westhampton Road. Northampton, MA
Kipp Armstrong
12/22/0EE
MP CHAMBER
N Pump part of septic system: (Y or N)
Pumps in working order: (Y or N)
Alarms in working order: (Y or N)
mments:
)TRIBUTION 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 Inches
mments: D—box new. Box is level and flow distributed equally.
al_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: estimated as 20 ' x 30 '
overflow cesspool, number:
innovative/alternative system, Type:
imments: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
tallow system in built—up area. No surface problems seen.
SAS not located
)lain why:
3HT 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
)mments: (conditions of inlet tees, condition of alarm and float switches, etc.)
,p.doc• 11/2004 Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal
7 of System
10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
arty Address: 1317 Westhampton Road, Northampton, MA
ar Name: Kipp Armstrong
of Inspection: 12/22/06
IVY (locate on site plan, if any)
Privy part of system: (Y or N)
Materials of construction:
Dimensions:
Depth of solids:
mments: (soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
SSPOOLS (cesspool must be pumped as part of inspection)
N 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 infow(cesspool must be pumped as part of inspection)
mments: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
LEASE TRAP (Usually present in certain commercial systems)
N Grease Trap part of system: (Y or N)
Materials of construction:
Depth below grade (inches) Measured
Dimensions:
Depth of solids layer
Depth of scum layer
Top of scum to top outlet Calculated Inches
Date of last pumping
Bottom of scum to outlet. Calculated Inches
Scum thickness (inches) Averace
imments: (recommendation and conditions)
p.doc• 11/2004 Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal System
•page 8 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Ierty Address: 1317 Westhampton Road Northampton, MA
er' Name: Kipp Armstrong
of Inspection: 12/2 2/0 6
ITE EXAM (Source of Information)
Y Slope _ Official Perc Date
Surface water Official Plan Date
Y Check Cellar Other Official Source
N Shallow wells Other Source
>48 Estimated depth to ground water (inches)
lease 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:
formation: System area built—up to be out of groundwater.
Dry sandy soil on dry ridge.
ESOURCES: Department of Environmental Protection, Western Regional Office,
36 Dwight St., Springfield, MA 01103, (413) 784-1100;Title 5 Hotline- (800)266-1122
p.doc• 11/2004
Homestead Inc. Title 5 Official Inspection Form: Subsurface Disposal System
•page 9 of 10
COMMENTS: - "►
Recommend a ping on a 3 to 5
year schedule. Also, a copy of
this plan posted in the AC Well
basement/utility area would keep
this information accessible in
future years for maintenance.
/
NORTH
I.
A
Septic Tank 1-------
tiai
w
1
4. ri/ r Partial Outline of House
Distribution Box �2
2
4, 34•
Leachfield, approximate layout --- - -1 - is-
As-Built Drawing Date: (Owner: I I HOMESTEAD INC. 1
Exisfine Sent c System 12/22/06 Kipp Armstrong Thomas S. Leue R.S. I