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
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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
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-- SySley,ti 1,3 laykr - o-P- ox;i 5
ASSES - CONDITIONALLY PASSE FAILS FURTHER EVALUATION NEEDED
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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