380 Septic Inspection 1997 BOARD OF HEALTH
JOHN T.JOYCE,Chairman
ANNE BORES.M.D.
CYNTHIA DOURMASHKIN,R.N.
PETER J.McERLAIN,Health Agent
September 29, 1997
Beatrice Dickinson
380 Chesterfield Rd.
Florence, MA 01062
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
RE: Sewage Disposal System Inspection
At 380 Chesterfield Rd., Florence
210 MAIN STREET
01060
(413)586-6950 Ext.213
Dear Ms. Dickinson:
The Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal
System Inspection conducted by Tim Maginnis at property owned by you at 380 Chesterfield
Rd. Florence on Sept. 22,1997. That inspection report indicates that your subsurface sewage
disposal system fails to protect the public health and the environment as defined in Sec.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, Tine 5, and under authority of Mass 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 380 Chesterfield Rd., Florence within two (21 years of the date of the
original inspection, (by September 22,1999). 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. (Note: The Board of
Health is aware that a percolation test has been schedule for your property for 10/2/97).
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 587-1213, if you have any questions
concerning this matter.
Thank you for your anticipated cooperation in this matter.
Very truly yours,
eter J. McEdain
Health Agent
Certified mail: #P 573 708 976
WILLIAM F WELD
Governor
ARGEO PAUL CELLUCCI
Ls.Gmcmor
IP
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS SEP 29 PY-.
DEPARTMENT OF ENVIRONMENTAL PROTECTION
WINTER STREET. BOSTON. MA 0210a 617-192.5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 3 SHE„Rc(6'0 �O■ � Address of Owner:
S3 R CC Li 1C-e1NI5U/.l
Date of Inspection: 9-Z1_C? \ (If different) SAME r'
Name of Inspector:I lvs..s5� �/ E, MAGI FJF.) S
I am a DEP approved syst4m inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name:
Mailing Address: 96 MOsiTheGvE RD (JES r{A✓jOF.I,, M A
Telephone Number: Cl.1-13, Sot C)- 5a 9I
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system. -
T
0.0
Secretar
DA\1D B STRUM
Commission.
Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: 1 . c a fA,u,-- Date: SE L 2-4” 19 sr)
!
The System Inspector shah submit crpy of ' •-coon report to the Approving Authority within thirty(30) days of completing this
inspection. If the system is a shared system or has a design flow of 10.000 gpd 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 owne
and copies sent to the buyer, if applicable, and the approving authority.
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.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the 'Conditional Pass" section need to be replaced or repaired. The system, upo
completion of the replacement or repair, as approved by the Board of Health, will pass.
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 a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; o
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltrauon, or tan(
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.
(raa..a 0e/15HI)
Page 1 of 10
DEP on the Ww1d WEe Web nbp/Mww magnet state ma uLOep
CS Punted on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: CHEP&'RI�ltZO /2prAO —AjCP-D-/rjrbi 7 /nil
Owner: BCA11RICE LJtCC,/„SUAI l�/`�
Dale of Inspection:
'YZZ -7y
BJ SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipets)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
_ broken pipets) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
ry
Conditions exist which require funher evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
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 wetland or a salt marsh.
SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, If APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
OTHER
The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for conform 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 (approximation not valid).
(revised 04/25/97)
Pp. 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: SEC) C 4 ES-caeif D RC AO - NCf Wvn51 k3 MA
Owner: S R,E OiCC iJISOf4
Date of Inspection:
9- z2 -cto
DI SYSTEM FAILS:
You must indicate ec-er "Yes" or No as to each of the following.
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 -
„_, No �PAChi.L1 (II \
�° _/ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool I'S .ry LL/
V Discharge or pondmg of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
icesspooli .
NC B StEcgwd level in the distribution box above outlet inven due to an overloaded or clogged SAS or cesspool.
_ IP_ Limon depth in cesspool is less than 6" below invert or available volume is less than lit day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets).
Number of times pumped
• _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
tl Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
NIA Any portion of a cesspool or privy is within a Zone I of a public well.
NI Any portion of a cesspool or privy is within 50 feet of a private water supply well.
- > 16 Any pomon of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well w
f I acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis r•
cobform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
You must indicate either 'Wes" or "No' as to each of the following.
The following criteria apply to large systems in addition to the criteria above.
AThe system serves a facility with a design flow of 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.
Yes l No
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)
The wner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(reflood 04/25/971
Pig. 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 380 Cf1ECTZCl j oeD - Ax., - iWAER ✓Alit
Owner: fact tatCC PICKtr sc 4
Date of Inspection:
923- 4 r)
Check if the following have been done: You must indicate either'Yes" or'No'as to each of the following:
Ye/ No
Pumping Information was provided by th
upant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving norma:. .#.
flow rates during that period large volumes of water have not been introduced into the system recenth
as part of this Inspection.
_�/ As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up. _
✓ The system does not receive non-sanitary or industrial waste flow.
_✓ _ The site was inspected for signs of breakout. N D BR. ' c c V f
✓ _ All system components, excluding the Soil Absorption System, have been located on the site.
s✓ _ 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 scum.
/ The size and location of the Soil Absorption System on the site has been determined based on.
✓ _ The facility owner land occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
JExisting information. Ex. Plan at B.O.H.
• _ Determined in the field (if any of the failure criteria related to Pan C Is at issue, approximation of distance is
unacceptable) [15.3021311d)
(e.vis.d 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
c��`�,�,r( � SYSTEM INFORMATION
Property Address: 380 C H E—S T U S L a J RUAD - ottivip pA pTh sj� AAA
Owner: B eAmICE Dtc cIN50hl
Dale of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow: NOB bedroom for S.A.S.
Number of bedrooms: )(-
Number of current residents- e1�-
Garbage grinder (yes or nor T 5
X- Laundry connected to system (yes or noW T1i`eR C- L6 A LA.,,v�r2� CCuMNEL`l(pN) %3L r3-%gAnc G� /NS
Seasonal use (yes or no). NO fti.i S MG"L Hoc/Cat?) l -sll� 1)2 Se pe alt d15p GS�L
Water meter readings, d available (last two (2) year usage (gpo): t4//1--Sump Pump (yes or no):Ma O 5U M
c) pi, sAspo Bs-7 71c- . ai RE TWO c(.aat2. a(2 rlNS r�
IiA SG'am C - StE ..rut� c..-. Pg, l0
last date of occupancy. &j R-R-ETs I OC.c p e 0
COMMERCIAUI N D USTRIAL:
Type of establishmene.
Design flow: vallons/day
Grease trap present (yes or no)
Industrial Waste Holding Tank presen
Non-sanitary waste discharged to the
Wafer meter readings, if available.
N/A
(yes or no)_
isle 5 system: (yes or no)_
Last date of occupancy.
OTHER: (Describe)
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information
Olr NE2
System pumped as part of inspection. (yes or no)/-5
If yes, volume pumped. I CO 0 gallons
Reason for pumping. Rt?TC ESTA TRr1MrER
T2A,c, 5tp; tc p . 1?,ti6 5Ekv/C
&' )tLIAMS/3Uf2C , /11A
TYPE F SYSTEM
Septic tank lab:b,d,.... L.,.Jsoil absorption system - SA5 = Le AC. d A:( p.--1
_ Single cesspool
_ Overflow cesspool
_
Privy
_Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known)and source of information: 5L-tPrC I FIA.( 5)1E4,2- S
5,46 = .f 96 vE),R5
Sewage odors detected when arriving at the site (yes or no)NU
evi..a 04/25/97) Page 5 of 10
Property Address:
Owner: l7jC-
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
go C 46514( ',alp Pe D —NoRTh vipTD J, f11f9- .
r'�
iR)c& D,CKiN5an1
at-act-9r)
11
Depth below grade.- l'23/41"
Material of construction: _cast iron _40 PVC/other (explain) r I r I
aRA.U6E 8ER6
Distance from private water supply well or suction line * SO
Diameter
Comments. (condition of Joints, venting, evidence of leakage, etc.)
PIPE FRo,v) s&7!/c 7AA/K T LE1CC)-) )u6 OCT 15 130Okc7J dry Twa
Pt A(ES. IT HAS DgI tOF'Ifl oVF2l1l& j7E/9123
SEPTIC TANK: s/
(locate on site plant
tl
Depth below grade 30 j
Material of construction: jconcrete _metal _Fiberglass _Polyethylene _other(explainl
If tank is metal, list age Is age confirmed by Certificate of Compliance _(YestNO)
Dimensions: /6 e, L x 5 4i x 5 0
Sludge depth: j 3 '
Distance from top of sludge to bottom of outlet tee or baffle: 4D —
f,
Scum thickness: a-3 1
Distance from top of scum to top of outlet tee or baffle. OF
r
Distance from bottom of scum to bottom of outlet tee or baffle:?II
How dimensions were determined: WIEA5URE10
Comments
(recommendation 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.) THIS 1500 6 AtLcn&d S EVra_ T AC t..FlS /N)SIA{ La) w /990
/SX KARC'S EkCAV47i01J n-I Nnni_ct/. CT H IA) Scum° ccA/071 c/o
GREASE TRAP:_ N/A
(locate on site plan)
Depth below grade_
Material of construction: .
concrete _metal _Fiberglass Polyethylene otherleaplain)
Dimensions:
Scum thickness.
Distance from top of scum t top of outlet tee or baffle:_
Distance from bottom of scu to bottom of outlet tee or baffle:_
Date of last pumping:
Comments:
(recommendation for pump i , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakag etc.!
tr.vi..d 04/25/97) P.qe 4 at 10
Property Address:
Owner:
Dale of Inspection
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
3@o c H&C kr/a0 8090 - nicer»-/44 p tau, m79
Q-z2-90 R
/3r5RK£ DKCltisJA 1i
TIGHT OR HOLDING TANK:
(locate on site plan)
Tank must be pumped prior to, or at time, of inspection)
Depth below grade._
Material of construction: _con
rete _metal _Fiberglass _Polyethylene _otherlexplain)
Dimensions:
Capacity gallons
ay
working order_Yes;
No
etc.)
Design Bow: gallon
Alarm level: Alarm i
Date of previous pumping.
Comments
(condition of inlet tee, condition
f alarm and float switches,
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above owl
Comments:
(note if level and distribution is
Invert.
NO D Bo)
qual, evidence of solids carryover, evidence of leakage into or out of box, etc)
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order: (Yes or N )_
Alarms in working order(Yes or N
Comments:
(note condition of pump chamber, ondilion of pumps and appurtenances etc.)
(r.vind 04/15/97) eps 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 3 s D kc iD - NGIMHriAI ;A,
Owner: /3C rrl2 tiL Di c .A.. SGA.5
Date of Inspects n:
7-a: 117
SOIL ABSORPTION SYSTEM (SAS)_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain: M/r
Type
r.
leaching pits, number V
01.10- 3oyttgR oco
umber:
leas mg ga ers, _
leac ing gal l ern ies, tuber.
leac ing tre ches, n mber,length.
leac
eveing fiel s, num.-r, dimensions.
low ce pool, n tuber:
Alte
alive S
Na
stem.
e of Te
hnology:
p S- SL2.0 U ■Kt.IOwtd (± 5 Dtzc-)
Pry
AAC1/4_7 (3E IN GRpvn Dlt i 2
Comments.
(note condition of soil, signs of hydraulic failure, level of ponding,,condition of vegetation, etc.)
TftrtL IS fv'D CC tic rl-(Oi2P,JL(C !-AILVRE . This (hT f1AS ± or Ltq p
LvP C C •JRff !AA
a )r T t tw&
J . C
pe ADruA
CESSPOOLS:
(locate on site plan)
p
N�A
f-1A5 5e.e ixA7b O
Number and configuration:
Depth-top of liquid to inlet inv re.
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool.
Materials of construction
Indication of groundwater:
inflow (cesspool must pumped as pan of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate on site plan)
N4
Materials of construction:
Depth of solids:
Comments:
(note condition of soil, signs of
draulic failure, level of ponding, condition of vegetation, etc.)
Dimensions:
(revised 09/25/91)
Page 8 of 10
n
0
0
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 3&3 CHESFERFIELO ROAD - NO MY\p Imo, $4 el
Owner: /v&yripiGE O /GK/N$QN
Date of Inspection:
4- 2z-99
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
ExisTm6, WELL
0
0
ie .. max.\ST IM& 4 GeOROOMJ
NeusE (zA2ACsE
•
RoKEU pipe
1E'
y
•
•
EX)5T1rJ
co Cc RLLoN
5epTtC TANK
5 AN D
E k15T1N[� LEl9LH1NICt P17-
(revised 09/15/91)
•
ce
Q
us '
s C Hes7 F, ELD QoCC
Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 380 C HEsTLVI ROnP
Owner: 3 R1cE DfcKltvsaiy
Date of Inspection:
Depth to Groundwater _Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
/
V Observation of Si
_ Determine it from local conditions
Check with loot Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
bservation hole, basement sump etc.)
Moll Llhl(r o) 559 ON
AD,yicECI GPopOZT7
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
i cee� AR-C w Z Sifts i d'& Th& (SASes/ &.A CH Apj)b
c.i. i t I6.4ORAS tc J ,
T 6E, C rs•,s tb fly
S pa c e
n-tt D■Cci-h\:z-6 Pol,C S GC. G �j'.A. J 'ft40a t•-d
�3AS�n o,(.y s u0 3E o MINAO A- O lc A Se4tefTE
1D ESposac ✓ a5. \ Fx.LSls (T S+1a LJ� (3o CoivwccT2 1a
/
IZtc fewa6E OIS905/1- L. SySTcW1 /4-I r7) 2 or 10•-) S-TALC1 Iian
(revised 04/25/97)
Pp. 10 of 10