12 Septic Inspection 1997 William Weld
Governor
Argeo Paul Cellucci
Lt.Governor
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of Environmental Protection
One Winter Street, Boston, MA 02108 617-292-5500
Subsurface Sewage
Tardy Coxe
Secretary
David B. Struhs
c*HA'3�PT0ti 60AaD OF HEA 9i"..
DisposalSyste nspection Form
PART A
CERTIFICATION
Address of Property: Street: 12 Cahillane Terrace
Owner's Name:
Prepared For:
(if different)
Date of Inspection :
Name of Inspector:
I am a DEP approved
Company Name:
Town: Florence
Robert Frappier
First National Net-Donna Hall
25,000 Pitkin Drive, 2a Floor
Spring, TX 77386
11/5/97
Darren Michaelis
inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Mount Hope Engineering
163 G.A.R Highway Swansea, MA 02777
Phone (508) 677-3936-Far(508) 677-2756
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information
reported is true,accurate and complete as of the time of inspection. The inspection was performed based on my
experience in the proper function and maintenance of on-site sewage disposal systems.
The system:
Passes
Conditionally passes
Needs further evaluation by the local approving authority
Fails
Inspector's Signature
Dale II
The system inspector shall mit a copy of this inspection report to the approving authority thin 30 days of
completing this inspection. If the system is a shared system or has a design flow of 10,000 gallons per day or
greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving
authority.
INSPECTION COMMENTS:
• Title 5 Inspections are based on what is witnessed on the day of the inspection.No guarantee or warranty for
future performance of the sewage system is expressed or implied. If a guarantee of future performance is
expected,this report should not be accepted.
• Liquid in the Septic Tank was 2"above the outlet invert. The house has been empty for 2 years,therefore,this
system does not appear to be functioning properly and may not function properly under daily flow.
INSPECTION SUMMARY:
Check A,B,C or D.
A) SYSTEM PASSES:
❑I have not found any information which indicates that the system violates any of the failure criteria as defined
in 310 CMR 15.303. Any failure criteria not evaluated are indicated below:
B) SYSTEM CONDITIONALLY PASSES:
❑ One or more system components as described in the"Conditional Pass" section needs to be replaced or
repaired. The system upon completion of the replacement or repair,as approved by the Board Of Health passes
inspection
Indicate yes,no or not determined(Y,N or ND).Describe basis of determination in all instances.If"not
determined"explain why not.
❑ The septic tank is metal,unless the owner or operator has provided the system inspector with copy of a
certificate of compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date
of inspection;or the septic tank,whether or not metal, is cracked,structurally unsound,shows 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 broken, settled or uneven distribution box.The system will pass inspection if(with
approval of the Board of Health):Describe Observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the Board of Health):
broken pipes are replaced
obstruction is removed
C) 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 failing to protect the public health,safety and the environment.
I) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
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 wetlands or a salt marsh
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,
IF APPROPIATE)DETERMINES THE SYSTEM IS FUNCTIONING IN A MANNER THAT
PROTECTS THE PUBLIC HEALTH AND SAFETY OF THE ENVIRONMENT:
T he system has a septic tank and soil 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 then 100 feet but 50 feet or
more a private water supply well.
The system has a septic tank and soil absorption system and is less then 100 feet but 50 feet or
more a private water supply well,unless a water analysis for coliform 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 PPM.Method used
to determine distance: (approximate not valid)
3) OTHER
D) SYSTEM FAILS:
Yes I have determined that the system violates one or more of the following failure criteria as defined in 310
CMR 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.
YES NO
® ❑Backup of sewage in to facility or system component due to an overload or clogged SAS or
cesspool.
❑ Z Discharge or pending of effluent to the surface of the ground or surface waters due to an
overload or clogged SAS or cesspool.
❑ VA Static level or pending of effluent to the surface of the ground or surface waters due to an
overloaded or clogged SAS or cesspool.
❑ Z'Liquid depth level in the cesspool is less than 6"below invert or available volume is less than
Y day Row.
❑ ]Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes.
Number of times pumped_
❑ 0Any portion of the soil adsorption system, cesspool or privy is below the high groundwater
ovation.
p Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply.
❑ ZAny portion of a cesspool or privy is within a zone 1 of a public well.
❑ ®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 then 100 feet but 50 feet or more a private water
supply well with no acceptable water quality analysis. If the well has been analyzed to be
acceptable,attach copy of a well water analysis for coliform bacteria,volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of systems is 10,000 gallons per day or greater(large systems)and the system is a
significant threat to health and safety and the environment because one or more of the following
conditions are met:
YES NO
❑ ❑The system is within 400 feet of a drinking water supply.
❑ ❑The system is within 200 feet of a tributary to a surface water supply.
❑ ❑ The system is in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a
mapped Zone II of a public water supply well)
The owner or operated of any such system shall be bring the system and facility into full compliance with the
groundwater treatment requirements of 314 CMR 5.00 and 6.00. Please consult the local regional offices of the
Department for further information.
PART B
CHECKLIST
Check if the follmting have been done:
YES NO
® ['Pumping information was requested of the owner,occupant,and Board of Health.
❑ None of the system components have been pumped 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.
®
DAs-built plans have been obtained and examined ®N/A.
• ❑The facility or dwelling was inspected for signs of sewage back-up.
®
One system does not receive non-sanitary or industrial waste flow.
® ❑The site was inspected for signs of breakout.
❑ ®All system components,excluding the SAS,have been located on the site.
® ['The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for
condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of
scorn.
• ❑The size and location of the SAS on the site has been determined based on:
❑ ®Existing information.Existing plan at BOH
• ❑Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of
distance is unacceptable
® ❑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 SSDS.
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
RESIDENTIAL:
Design flow 330 gpd
number of bedrooms 3 3 rooms may be considered bedrooms by Title 5
description of a bedroom.
number of current residents
garbage grinder,yes or no YES Z NO
laundry connected to system ®YES❑NO
seasonal use,yes or no DYES®NO
If non-residential,calculated flow:
Water meter readings,if available(last 2
year usage(gpd)
Sump Pump(yes or no) No
Last Date of occupancy 2 years ago
COMMERCIALJI NDUSTRIAL
Type of establishment
Design flow
Grease trap present
Industrial waste holding tank
Non-sanitary waste discharge to the Title V System:
Water meter readings,if available:
Last date of occupancy
EYES❑ NO
DYES ❑NO
DYES❑NO
GENERAL INFORMATION
PUMPING RECORDS and source of information:
No records were available.
System pumped as part of inspection❑yes® no Volume Pumped= Gallons
Reason for pumping:
TYPE OF SYSTEM
❑ Septic tank/distribution box/soil absorption system
❑ Single cesspool
❑ overflow cesspool
❑ privy
❑ shared system
❑ OTHER(explain)
❑ I/A technology etc.Copy of up to date contract
APPROXIMATE AGE of all components,date installed(if known)and source of information:
System was installed when house was built and has not been upgraded per Title 5.
Sewage odors detected when arriving at the site: OYES®NO
BUILDING SEWER:
(locate on site plan)
Depth below grade:
Material of Construction: cast iron 40 PVC other(explain)
Distant from private water supply well or suction line
Diameter:
Comments: (Condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK
(locate on site plan)
Depth below grade: 30"
Material of construction: � Concrete❑Metal❑Fiberglass❑Polyethylene❑other(explain)
If tank is metal,list age: Is age confirmed by Certificate of Compliance
(YES/NO)
Dimensions: see site plan for size and location
Tank Capacity 1,000
Sludge depth 2'
Distance from top of sludge to bottom of outlet tee or No tee or
baffle baffle
Scum thickness None
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee NA
or baffle
How dimensions were determined: Measured
in Field
Comments:
(recommendations for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to
outlet invert,structural integrity,evidence of leakage,etc.
Septic Tank does not meet current Title 5 requirements. No tees or baffles are present on the inlet or outlet pipes.
Depth of sludge indicates that system has not been pumped for some time. There was evidence of solids and liquid
level being over the outlet invert. The liquid level is presently 2"above the outlet invert. This may be due to a
clogged leaching trench.
GREASE TRAP
(locate on site plan)
Depth below grade:
Material of construction:
Dimensions:
Concrete❑Metal❑FRP
Scum thickness
Distance from top of scum to top of outlet tee or baffle=
Distance from bottom of scum to bottom of outlet tee or baffle=
Date of last pumping:
Comments:
(recommendations for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to
outlet invert,structural integrity,evidence of leakage,etc.
TIGHT OR HOLDING TANK
(locate on site plan)
Depth below grade:
Material of construction: ❑Concrete❑Metal❑Fiberglass❑Polyethylene❑ other(explain)
Dimensions:
Capacity:
Design flow:
Alarm level:
Date of previous pumping:
Comments:
(recommendations for inlet tee,condition of alarm and float switches,etc.
DISTRIBUTION BOX
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal,solids carryover,evidence of leakage into or out of box,etc.
PUMP CHAMBER
(locate on site plan)
Pumps are in working order OYES❑NO
Alarms are in working order OYES❑NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
SOIL ABSORPTION SYSTEM (SAS)
(locate on site plan)
If not determined,why:
Type No Size
❑ leaching pits- number
❑ leaching chambers and number
❑ leaching galleries and number
❑ leaching trenches,number,length ? Size and location could not be determined
without more intrusive methods.
❑ leaching fields,number,dimensions
❑ Overflow cesspool, number
❑ Alternative System:
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Leaching trench may not be functioning properly due to the level of the liquid over the outlet invert of the septic
tank.
CESSPOOLS:
(locate on site plan)
number and configuration
depth-top of liquid to inlet invert
depth of sludge layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwater
inflow
(cesspool must be pumped ss part ofmgiootim)
Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
PRIVY
(locate on site plan)
Material of construction:
Dimensions:
Depth of solids:
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
DEPTH TO GROUNDWATER
depth to groundwater(feet) >12'
Please indicate all methods used to determine high groundwater elevation:
❑ Obtained from Design Plans on record
® Observation of site(Abutting property,observation hole,basement sump etc.
®Determined it from local conditions
® Check with Board of Health
❑ Check FEMA Maps
❑ Check Pumping records
❑ Check local excavators, installers
❑ Use USGS Data
ounT Hope
"ENGINEERING
163 GA R.Highway,2s Floor
Swansea.MA 02777
PROJECT: \Z Lai-1u Al—C7 \EDQAea=
DESIGNED BY:
CHECKED BY:
SCALE:
DATE:
DATE:
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BOARD OF HEALTH
JOHN T.JOYCE Chairman
ANNE BORES,M.D.
CYNTHIA DOURMASHKIN,R.N.
PETER J.McERLA1N,Health Agent
November 12, 1997
First National Net
c/o Mount Hope Engineering
163 G.A.R. Highway
Swansea, MA 02777
Ann Darren Michaelis:
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
Re: Septic Inspection, 12 Cahillane Ten.,
Northampton, MA
The Board of Health is in receipt of airport on a sewage disposal system inspection
conducted at 12 Cahillane Terrace By Darren Michaelis on November 7, 1997. That
report indicates that the septic system at 12 Cahillane Terrace fails to protect the public
health and the environment as defined in Sec.15.303 of CMR 15.000, State
Environmental Code, Title 5.
210 MAIN STREET
01060
(413)58669SO Est 213
Because the dwelling, owned by the party which you represent, is located on a street
where the city's sewer system is now available you must, in accordance with the
requirements of Mass. General Laws Ch. 83 Sec. I I, connect your dwelling to the sewer
line.
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, and Chapter 83, Section 11, the present(or the subsequent
owners of the property) are hereby ordered to connect the dwelling at 12 Cahillane Terr.
to the city sewer system within two years of the date of the original inspection, (by
11/7/99). If further degradation of the sewage disposal system occurs, (e.g. sewage
flowing to the surface of the ground), the connection will be required sooner.
In order to tie into the city sewer you must obtain a sewer connection permit from the
Northampton Dept. Public Works. Any questions concerning sewer connection should be
directed to Asst. City Engineer George Andrikidis at 413-587-1574
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 586 - 6950, ext. 213, if you
have any questions concerning this matter.
Thank you for your anticipated cooperation in this matter.
Ve truly yours,
•
eter J. McErlain, Agent
Northampton Board of Health
cc: Asst. City Engineer George Andrikidis, DPW
Cert Mail # P 082 853 196