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779 Title 5 Application 2018 Mar. i. 2(i5 9 1 .d.7 ii: filY P. - CITY of NORTHAMPTON • 'l�) PUBLIC HEALTH DEPARTMENT ��i tµ+ Public Health Director-Merrldith O'Leary Municipal building-212 Main Street.-Northampton. MA 01060 Phone(413)587-1215-Fax(413)587-1221 hru;Pin vw.northammmnwa-eav1245/Health Application for Witnessing Official Tide 5 Inspections Fee:$150.00(2 hour field);575/hour thereafter Data: -2 !28"115 Site Address: ��/7�-7q \es+`h`gwp'Or�. RSI. Parcel M. 4a- 030- 00 Property Owner: K.CM Y\ L Gn1 }'.1Atd ,i1n 11N Property Ownern Address: 171 LIC5}'Zp�.1�'I•Un K - /Ufa,(4\° eren f 44 Telephone mak\3 - ^,17- (a99 g Cell: Title 5 Inspector -�_('('.� 1 ` l !� �y ' Name of Inspector \C'i`51 `, F-- �7AfheI�� V; License#: \4 V D 9 Company Name .�DD..,�, I '^ /r' Halling Address P.O. t5eY. r'nf. C9 --- City/State/Zip Code o tlS 1 /•rA C`16-v3 Telephone: Office: _ Cell: 1413- 46L H37a Please answer the following: Yes /' l8o 15 Inspector hal most recent plans for system to be inspected JJhpt: availido , Pero WAcr Yes/ 4�a. T5 Inspector3 pump-out records Yes,e T5 Inspectorial location of private water supply wells(within 150 feet of system location? Reason for Inspection: pr°Ceti SO\ ,„.g Date requested forinapection: 3)Cil g _ 'Time: --.._..__/Q/)'�.� Return Application Ten Days Prior to Requested Inspection Date to: / Northampton Board of Health 212 Main Street Northampton. MA 01060 MAKE CHECKS PAYABLE TO THE CITY OF NORTHAMPTON Application Fee is Non•Refundable &; I �'{ c._.rVle 6 l ) 0io 5 ) +e w�� C�AACt,h ` . Cl.O tt/,. CITY of NORTHAMPTON �' , �' PUBLIC HEALTII DEPARTMENT ""sptii.tik or Public Health Director—Merridith O'Leary `'��-`=_" Municipal Building- 1 - 212 Main Street(Northatnpton,MA 01060 y4, <J 3/,S Phone(413)587-1215—Fax(413)587.1221 hup;/hvww,nofhampionma.gov/245/11eohh J,, 50-2-9--- CERTIFYING oCERTIFYING TITLE V INSPECTION ?lic /a ST Date of Inspection: Time . / o ' Pro '�'--- p rty Owner: A � r Location of Title V Inspection: de - Title S Inspector: - e - - a, , License#: /fQgy Phone#: /3- 1/ COMPONENTS IDENTIFIED: 4,44 : 577)4 rbm el: S in el / 't/9G5. BUILDING SEWER: CA" SEPTIC TANK: 7\ /U .) Te,//0 A/ "-' nce7- ,, t f Yes l . NoLiquid level'.below the outlet/invert<. YesNo y/ Evidence of YesNo /" Sludge depth and.thiclmess.(Within 12 inches of outlet tee-pumping recommended) D-BOX: // Yes_._ No / Static water level is at or higher thaninvert of outlet pipe YesNo ) Broken box, obstructed pipe,or box is uneven or settled Yes `\\\No D-box is level and flow is equal (Qcly 1et//e 1 I Yes_____ Ido �( Evidence of solids carryover J — SAA _ - ' Tat i . ningr s/ Yet 'v/ No Leaching system located Yes* No Portion of the SAS exposed to determine condition Yes . No '/ Evidence of breakout,ponding,or sewage backup Yes__ No _$ Leaching pit/Cesspool PUMP CHAMBER:_k7,/4----- --- �— - Yes t'No_Alarms and pumps functioning correctly Yes d)/4 Does system include a siphon CESSPOOL/PRIVY: NODE cISS1OL TQ i3�PUM� PARTO iN PF.CTI N ficeci 10 C r' . �6-f�U7� ) nen, l k b. GREASE TRAP/TIGHT,TANK: , NOTEE::/T/AANNK MUST BE PUMPED AS PART OF INSPECTION - GROUNDWATER DETERMINATION: Methods 'f estimating 11GH g oundwa .r elevation: 4.I✓ i 4_ • t. .. Wc• nillillegn 71 NoLocation of bottom of leaching facility compared to the HIGH groundwateratelevation comple a .__?4bD 1/10/1/1 S ON rJ i— S45 ttfOw. &31-1 O cor -- SySley,ti 1,3 laykr - o-P- ox;i 5 ASSES - CONDITIONALLY PASSE FAILS FURTHER EVALUATION NEEDED JL 3 ie-/,...,)ter8 �oC: e Sfign.,'rre0 coa '.ealtlhAgent Cv 51, 6iAre 374M /NSX/%J /O0,/ // it e , -/ °'u/ CITY of NORTHAMPTON tired ) _ PUBLIC HEALTH DEPARTMENT 4:, m ,Y BOARD OF HEALTH MEMBERS:Donna Salloom, Chair-Joanne Levin,MD-Suzanne Smith, MD v.viaginucr .4+ STAFF:Merridith O'Leary, RS Director—Daniel Knuth,Inspector Edmund Smith, Inspector—Jennifer Brown, RN.Nurse March 12,2018 Kevin and Carol Kittredge 779 Westhampton Road Florence, MA 01062 RE: Sewage Disposal System Inspection 779 Westhampton Road Dear Homeowner: The Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System Inspection conducted by Jeffery L. Gamelli,Jr.,at your property, 779 Westhampton Road,on March 5, 2018.That inspection report indicates that your subsurface sewage disposal system fails to protect the public health and the environment as defined in Section 15.303 of CMR 15.000,State Environmental Code,Title 5. Therefore,in accordance with the provisions of 310 CMR 15.000 of the State Environmental Code,Title 5, and under authority of Massachusetts General Laws,Chapter 21A,Section 13,you (or the subsequent owner of the property)are hereby ordered to repair the subsurface sewage disposal system at 779 Westhampton Road,within two years of the date of the original inspection,(March 5,2020). If further degradation of the sewage disposal system occurs(e.g.sewage flowing to the surface of the ground),you may be required to complete the repairs sooner. All work to repair/upgrade your subsurface sewage disposal system must be performed by a licensed sewage disposal system installer,in accordance with the requirements of 310 CMR 15.000,and with plans approved by the Northampton Board of Health. Please be advised that you are entitled to a hearing on this order to upgrade your subsurface sewage disposal system,provided that you file a written petition requesting such a hearing in the Board of health office within seven(7) days of the receipt of this notice. Please feel free to contact the Board of Health office,at 587-1214 if you have any questions concerning this matter. Thank you for your anticipated cooperation in this matter. Sincerely, 6!� �' !r Danie '' .stuk Health Inspector 212 Main Street,Northampton,MA 01060 Ph(413)587-1214 Fax(413)587-1221