470 Septic Inspection 1998 C
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
PART A - CERTIFICATION
470 Coles Meadow Rd.Northampton,MA
4/22/98
George Page
do Pat Goggins Real Estate, 226 King St., Northampton, MA 01096
Board of Health,Northampton
Property Address:
Date of Inspection:
Owner's Name:
Owner's Address:
Copy to:
Mailing Address:
Witness:
Name of Inspector:
Company Address:
tf
a27Re U
JO6THAMPTON Wow&HEALTHI
Bill Ducharme Number: SSDS-226
Thomas S. Leue, Homestead Inc.
1664 Cape St., Williamsburg, MA 01096 (413) 628-4533
CERTIFICATION STATFMFNT
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 the inspection. The inspection was performed based on my training and experience in the
proper function and maintenance of on-site sewage disposal systems. I do not represent or warrant the operation or proper function of
this system for any period of time. The system:
_IC_ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature:
vl Date. April 77 1998
The System Inspector shell submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. It 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 once of the
Deparbnent of Environmental Protector( The original should be sent to the system owner and copies 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 OAR
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 need to be replaced or repaired. The system,
upon 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; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or
extiltralion, or tank failure is imminent. The system will pass inspection if the 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 a broken,settled or uneven distribution box. The system will pass inspection it(with approval by
the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than tour times a year due to broken or obstructed pipe(s)or due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
Revised edition 04'2557
Page 1
Homestead Inc.
Property Address.
Owner's Name:
Date of Inspection:
PART A - CERTIFICATION (continued)
470 Coles Meadow Rd., Northampton,MA
George Page
4/22/98
The system required pumping more than four times a year due to broken or obstructed pipe(s)or due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION I S 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:
1) 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.
2) 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 PUBLIC HEALTH,SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and is within 100 feet to a surface water supply or a tributary
to a surface water supply.
The system has a septic tank and a SAS and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and a SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and a SAS 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 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 (approximation not valid). If the well has been analyzed to be acceptable, attach
copy of well water analysis for coliform,volatile organic compounds,ammonia nitrogen, and nitrate nitrogen.
3) OTHER
D] SYSTEM FAILS:
Must indicate either"Yes(Y)or"No"(N)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 CM 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
iL Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
7L_ Discharge or ponding of effluent to surface of the ground or surface waters due to an overloaded or clogged MS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
7(_ Liquid depth in cesspool less than 6"below invert,or available volume less than 1/2 day of calculated daily flow?(Part 7)
7L_ Required pumping 4 times or more in the last yearNOT due to clogged or obstructed pipe(s).Number of times pumped_
)L Any portion of the Soil Absorption System,cesspool or privy below high groundwater elevation.
- 7L_ Any portion of a cesspool or privy is within 100 feet of a surface water supply or a tributary to a surface water supply.
X_ Any portion of a cesspool or privy is within a Zone I of a public well.
}L_ Any portion of a cesspool or privy is within 50 feet of a private water supply.
X_ 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.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow is 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:
- 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(I W PA)or a mapped Zone I I of a
public water supply well)
The owner or operator of any such system shall bring the system and the 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.
Revised edition 04/25/97
Page 2
Homestead Inc.
Property Address:
Owner's Name:
Date of Inspection:
PART B - CHECKLIST
470 Coles Meadow Rd., Northampton,MA
George Page
4/22/98
CHECK IF THE FOLLOWING HAVE BEEN DONE:
L. 1 Pumping information was requested of the owner,occupant and/or Board of Health.
2. 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 pan of this
inspection.
tILL 3. As built plans have been obtained and examined. Note if they are not available with N/A.
4 The system does not receive non-sanitary or industrial waste flow.
L 5. The facility or dwelling was inspected for signs of sewage back-up.
6. The site was inspected for signs of breakout.
7 All system components,excluding the Soil Absorption System,have been located on site.
L . 8. The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected 1orcondition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
9. The size and location of the Soil Absorption System on site has been determined based on:
.V— a) Existing information on file with the Board of Health.
b) Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[15.302(3)(b)]
y_ 10 The facility owner(and occupants,if different from owner)were provided with information on proper maintenance of
Subsurface Sewage Disposal Systems(SSDS).
FLOW CONDITIONS
R ES IDENTIAL•
Design Flow:_ gallons/day/bedroom for SAS
Number of bedrooms
Number of current residents
Garbage grinder(V or N)
Laundry connected to system(V or N)
Season use(V or N)
Sump Pump into system(Y or N)
Water meter readings,if available: gallons per day
Date of last occupancy:
COMMERCIAL /INDUSTRIAI •
Type of Establishment' garaga
Design Flow:fig gallons/day [Design flow on plan, as built appears to be 79 .2
gallons/day)
1_ Grease trap present(Y or N)
N Industrial Waste Holding Tank present(Y or N)
N Non-sanitary waste discharge to the Title 5 system(Y or N)
Water meter readings,if available' n/a gallons per day
Date of last occupancy not an orcunied building
OTHERS (Describe)
Date of last occupancy:
Revised edition 04125197
Page 3
Homestead Inc.
Property Address:
Owner's Name:
Date of Inspection:
PART C • SYSTEM INFORMATION
470 Coles Meadow Rd., Northampton,MA
George Page
4/22/98
PUMPING RECORDS and source of information:
Not nrevi misty numned Pumpima not needed at this time
N System pumped as part of inspection(V or N) [subsequent day)
If yes,volume pumped: gallons
Reason for pumping:
Name of Septage Pumper:
TYPE OF SYSTEM:
X Septic tank/distribution box/soil adsorption system.
Single cesspool
Overflow cesspool
Privy
N Shared system(Y or N),if yes,attach previous inspection records,if any.
I/A Technology etc. Copy of up-to-date contract?
Other(explain)
APPROXIMATE AGE of all components. date installed (if known) and source of information:
at of ronsfrurtinn nermit 17/17/gi
Sewage odors detected when arriving at the site:(Y or N) N
BUILDING SEWER:
Y (located on site plan)
16" Average depth below grade
Material of construction: _past iron _2(_Sch.40 PVC _other(explain)
25' Distance from private water supply well or suction line
4" Diameter
Comments: (condition of joints, venting, evidence of leakage etc.)
SEPTIC TANK:
Y (located on site plan)
—12" Average depth below grade
Material of construction:fyyoncrete_metal_FRP_polyethylene_other(explain)
Dimensions: 10'-6" long bv60"deen bv60"wide (net measurements inside).
How dimensions were determined: Measured
(A) sludge depth
24„ (B) top of sludge layer to bottom of outlet tee or baffle
n/a (C) bottom of scum layer to bottom of outlet tee or baffle
_O _ (D) scum thickness
n/a_ (E) top of scum layer to top of outlet tee or baffle
Comments: (recommendation for pumping,conditions of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,
structural integrity, evidence of leakage, etc.)
Tees in nlare 1 500 nallon tank Ta,.k near emnty but confer olio in nlare and
pn leaks seen Very little use of huildina means no arrumulafpd water waste 3 e
pnlv a few low flow toilpt flashes no laundry use and no other si nnifi rant use
Revised edition 04/25/97
Page 4 Homestead Inc.
PART C - SYSTEM INFORMATION (continued)
Property Address: 470 Coles Meadow Rd., Northampton,MA
Owner's Name: George Page
Date of Inspection: 4/22/98
GREASE TRAP: N/A (Usually present in certain commercial systems)
Depth below grade:
Material of construction:_concrete_metal_FRP_polyethylene_other(explain)
Dimensions:
(A) scum thickness
(B) top of scum layer to top of outlet tee or baffle
(C) bottom of scum layer to bottom of outlet tee or baffle
(D) date of last pumping
Comments: (recommendation for pumping,conditions of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,
structural integrity, evidence of leakage, etc.)
TIGHT OR HOI DING TANK N/A (Special circumstances only)
Depth below grade:
Material of construction:_concrete_metal_FRP_polyethylene_other(explain)
Dimensions:
Capacity: gallons
Design flow' gallons/day
Alarm level: _Alarm in working order Yes' _No
Comments: (conditions of inlet tees,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site pan)("D-box")
Depth of liquid level above outlet invert: 0"
Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,
recommendations for repairs, etc.)
e
SOIL ABSORPTION SYSTEM (SASI:
Locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods. If not
determined to be present,explain'
Type:
a. leaching pits 8 number:
b. leaching chambers and number:
c. leaching galleries and number:
d. leaching trenches,number,length' 1 Moe 40'long
e. leaching fields,number,dimensions:
f. overflow cesspool,number:
g. Alternative system,name technology:
h. Comments: (note soil conditions,signs of hydraulic failure,level of ponding,condition of vegetation,
recommendations for maintenance or repairs, etc.)
Nn nrnhl ems seen hos recommend mnwina over leach Ina area fn avoid root
infiltration Pecinn calls for RS' of leach nine hat menvrred 40'
Revised edition 04/25/97
Page 5
Homestead Inc.
PART C - SYSTEM INFORMATION (continued)
Property Address: 470 Coles Meadow Rd., Northampton,MA
Owner's Name: George Page
Date of Inspection: 4/22/98
PUMP CHAMBER: N/A (part of pump-up systems only)
Pumps in working order:(V or N)
Alarms in working order:(V or N)
Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.)
S:FSSPOOI S; N/A (locate on site plan,if any)
Note: Cesspools must be pumped as part of the inspection.
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 inflow:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note soil conditions,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY. N/A (locate on site plan,if any)
Materials of construction:
Dimensions:
Depth of solids:
Comments: (note soil conditions,signs of hydraulic failure,level of pending,condition of vegetation,etc.)
DEPTH TO GROUNDWATER:
96" inches
Please indicate all the methods used to determine High Groundwater Elevation:
7(_ Obtained from Design Plan on record
Observation of Site(Abutting property,observation hole,basement sump,etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators,installers
Use USGS Date
Describe in your own words how you established the High Groundwater Elevation.;Mien be completed)
Oriainal Apan hole axravatinn shnwed arnundwarer at thin danth
COMMENTS:
RESOURCES:
Department of Environmental Protection, Western Regional Office, 436 Dwight St., Springfield, MA
01103, (413) 784-1100; Title 5 Hotline - (800) 266-1122
Revised edition 04/25197 Page 6 Homestead Inc.
Racc1rnapic. trcrs
Septic tank 0 box
I
102'
r_ , So,
59
2,
■ I 10(
Leach trench
rtl
■l
il WelI location
C✓
1
CaPF 1 North
1
As built Drawing of scale: t : 250 Owner: George Page HOMESTEAD INC.
Existing Septic System Note: 470 Coles Meadow Rd. 1664 Cape St.
Some Dimensions Approximated Northampton, MA 01060 Williamsburg, MA 01096
F41316711-4513