246 Inspection Form 2002 Timothy E. Maginnis RS
Registered Sanitarian
70 Montague Road
Westhampton, MA 01027
Barbara Demerski
Associate Broker
Goggins Real Estate
226 King Street
Northampton, Ma. 01060
Re: Northampton - # 244 & # 246 Haydenville Road
Title— 5 inspections
May 8, 2001
Dear Barbara:
Enclosed please find two copies (each) of Title-5 inspections that I conducted on
May 7, 2002 at# 244 & # 246 Haydenville Road in Northampton.
Please be aware that the entire sewage disposal system at # 244 has failed and must
be replaced in accordance with the State Sanitary Code Title-5. The soil
absorbtion system (SAS) at# 246 is in good repair and does not need to be
disturbed. However, the septic tank at # 246 is in poor condition and should be
either repaired or replaced. I recommend a new tank.
I have spoken with Mr. Peter McErlain of the Northampton Board of Health and he
has agreed to allow.a 2000 gallon septic tank to serve both units witt each unit
having their own SAS.
As we discussed on May 7, 2002, I will design and submit, upon confirmation, a
new sewage disposal system plan to the Northampton Board of Health showing a
shared 2000 gallon septic tank for # 246 & # 244. In addition, a new SAS at# 244
will be designed to function in combination with the SAS at # 246.
2
Please confirm the above and I will begin the new design immediately.
If I can be of any further service or you have any questions, please contact me.
Very truly yours;
Timothy5 gm is R.S.
/cc Northampton Board of Health
BOARD OF HEALTH
MEMBERS
CYNTHIA DOURMASHKIN,RN.,thair
ROSEMARIE KARPARIS,RN.,MPH
RICHARD P.BRUNSWICK,M.D.,MPH
PETER].McERU1IN RS MPH
Health Agent
(413)587—1214
FAX(413)587-1221
May 14,2002
Mr.John Mckenna
70 a Montague rd.
Wendell,MA 01379
Dear Mr.McKenna:
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET,Room 8
NORTHAMPTON,MA 01060-3167
Re:Septic Inspection at 246 Haydenville Rd.,Leeds
The Board of Health is in receipt of a report on a sewage disposal system inspection conducted at 246 Havdenville Rd..
Leeds on May 8,2002 by Timothy Maginnis.In his report Mr.Maginnis has classified your septic system as a
"Conditional Pass"due to the following:
• The septic tank is deteriorated and must be replaced.
In order for your sewage disposal system to be classified as"Passed,"you must do the following:
• Replace the deteriorated septic tank with a new 1500 gallon two compartment tank.
All of the work described above must be done by a licensed septic system installer in accordance with the requirements of
310 CMR 15.000 and a Septic System Repair Permit must be obtained from the Board of Health office prior to beginning
the work.
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 2IA,Section 13,you(or the subsequent owners of the property)are hereby ordered
to repair the subsurface sewage disposal system at 246 Haydenville Rd.,within two years of the date of the original
inspection,(by May 8,2004).If further degradation of the sewage disposal system occurs,(e.g.sewage flowing to the
surface of the ground),the repairs will be required sooner.
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 me at the Board of Health office,at 587-1213 if you have any questions concerning this notice.
Thank you for your anticipated cooperation in this matter.
Very trill y Ypgr
/711 Peter J. McErlain,Agent
Northampton Board of Health
Cert.Mail g 7001 2510 0004 8173 5198
cc: Barbara Demerski, Goggins Realty, 266 King Street, Northampton
BOARD OF HEALTH
MEMBERS
CYNTHIA DOURMASHKIN,R.N.,
ROSEMARIE KARPARIS,R.N.MPH
RICHARD P.BRUNSWICK,M.D.,MPH
PETER I.McERIAIN,Health Agent
CITY OF
NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET
01060
(413)587-1213
May 14,2002
Mr.John McKenna
70 a Montague Rd.
Wendell,MA 01379
Re: Septic Inspection at 244 Haydenville Rd.,Leeds
Dear Mr. McKenna:
The Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System Inspection
conducted by Timothy Maginnis at 244 Haydenville Rd. Leeds on May 8,2002. That inspection report indicates that the
subsurface sewage disposal system at that address 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 21 A, Section 13,you(or the subsequent owners of the property)are
hereby ordered to repair the subsurface sewage disposal system at 244 Haydenville Rd.,within two(2)years of the date
of the inspection,(by May 8,2004).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 the 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 prepared by a Registered
Sanitarian or Registered Professional Engineer and 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 587-1213,if you have any questions concerning this notice.
Thank you for your anticipated cooperation in this matter.
Very truly yours,
Peter J. McErlain
Health Agent
Certified Mail#7001 2510 0004 8173 5198
"
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PR
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 244 HAYDENVILLE ROAD—ONE HALF OF TWO BEDROOM DUPLEX
NORTHAMPTON,MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL MA.
Date of Inspection: APRIL 7,2002
Name of Inspector: (please print)TIMOTHY E.MAGINNIS R.S.
Company Name:
Mailing Address: 70 MONTAGUE ROAD -WESTHAMPTON,MA. 01027
Telephone Number: (413)527-5291
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 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 am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Inspector's Signatu
onally Passes
rther Evaluation by the Local Approving Authority
,j Date: MAY S, 2002
The system inspector shall s
DEP)within 30 days of comp
gpd or greater,the inspector and the
DEP.The original should be sent to the
authority.
Notes and Comments This system was installed in 1975. All components are original and in failure.
ection report to the Approving Authority(Board of Health or
n.If the system is a shared system or has a design flow of 10,000
owner shall submit the report to the appropriate regional office of the
system owner and copies sent to the buyer,if applicable,and the approving
****This report only describes conditions at the time of inspection and under
the conditions of use at that time. This inspection does not address how the
system will perform in the future under the same or different conditions of
use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 244 HAYDENVILLE ROAD
NORTHAMPTON,MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL MA
Date of Inspection:APRIL 7,2002
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_N/A I have not found any information which indicates that any of the failure criteria described in 310 CMR
15303 or in 310 CMR 15304 exist. Any failure criteria not evaluated are indicated below.
Comments: THIS SYSTEM WAS INSTALLED IN 1975. THIS IS ORIGINAL DATE OF
CONSTRUCTION ALL COMPONENTS ARE IN FAILURE
B. System Conditionally Passes:
N/A_ 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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If not determined"please
explain.
_X_The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain: THIS SITE REQUIRES A NEW SEPTIC TANK AND SAS. BOTH ARE FAILING.
N_ Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain: NO DISTRIBUTION BOX
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 pipe(s)are replaced
obstruction is removed
ND explain:
T:ao
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2
Page 3 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 244 HAYDENVILLE ROAD
NORTHAMPTON,MA. 01060
Owner's Name: JOHN MCKENNA
Owner's Address: WENDELL,MA.
Date of Inspection: APRIL 7,2002
C. Further Evaluation is Required by the Board of Health: NO
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(6)that the
system is not functioning in a manner which will protect public health,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 any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**.Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory,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,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
6/1G nnnn
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner's Name:
Owner's Address:
244 HAYDENVILLE ROAD
NORTHAMPTON,MA. 01060
JOHN McKENNA
WENDELL,MA.
Date of Inspection: APRIL 7,2002
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
N/A Liquid depth in cesspool is less than 6"below invert or available volume is less than'A day flow
_ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. )This system passes if the well water analysis,
performed at a DEP certified laboratory,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 provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.)
YES (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems: N/A
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes 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
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department
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4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 244 HAYDENVILLE ROAD
NORTHAMPTON,MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL,MA
Date of Inspection: APRIL 7,2002
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out? -NO BREAK-OUT OBSERVED
X _ Were all system components,excluding the SAS, located on site?
X Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X Existing information. For example,a plan at the Board of Health.
X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(6)] THE EXISTING SAS WAS UNCOVERED. SEWAGE BACK-UP
WAS OBSERVED. THE LEACHING PIT WAS FULL OF EFFLUENT AND/OR GROUNDWATER .
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5
Page 6 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 244 HAYDENVILLE ROAD
NORTHAMPTON,MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL MA
Date of Inspection: APRIL 7,2002
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):UNKNOWN_ Number of bedrooms(actual):_2_
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): UNKNOWN
Number of current residents: VACANT AT TIME OF INSPECTION
Does residence have a garbage grinder(yes or no):_YES_
Is laundry on a separate sewage system(yes or no):_NO_ [if yes separate inspection required]
Laundry system inspected(yes or no): YES
Seasonal use: (yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)): 55,390 CU.FT.
Sump pump(yes or no): YES—CELLAR SHOWS SIGNS OF WATER DAMAGE
Last date of occupancy:CURRENTLY UNOCCUPIED
COMMERCIAL/INDUSTRIAL: N/A
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: HOME OWNER/REALESTATE AGENT
Was system pumped as part of the inspection(yes or no):NO
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
_X_Septic tank,distribution box,soil absorption system— ONE PIT WITH 4' STONE AROUND.
_Single cesspool
_Overflow cesspool
Privy
NO Shared system(yes or no)(if yes,attach previous inspection records, if any)
Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information: THIS SYSTEM WAS
INSTALLED IN 1975.APPROXIMATELY 27 YEARS OLD. ALL COMPONENTS ARE ORIGINAL AND IN
FAILURE.
Were sewage odors detected when arriving at the site(yes or no): NO
Tao[T.,,...e,.:.». v ..., cn[noon
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 244 HAYDENVILLE ROAD
NORTHAMPTON MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL.MA
Date of Inspection: APRIL 7,2002
BUILDING SEWER(locate on site plan)
Depth below grade: 12"
Materials of construction:X cast iron X 40 PVC_other(explain):
Distance from private water supply well or suction line: N/A—CITY WATER
Comments(on condition of joints,venting,evidence of leakage,etc.):NO EVIDENCE OF LEAKAGE JOINTS
ARE SECURE AND NOT LEAKING
SEPTIC TANK: X (locate on site plan)
Depth below grade: 14"
Material of construction: X concrete metal fiberglass polyethylene
other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 8.5'x 5.5' 4.0'D
Sludge depth: NONE
Distance from top of sludge to bottom of outlet tee or baffle:N/A
Scum thickness: NONE
Distance from top of scum to top of outlet tee or baffle: N/A
Distance from bottom of scum to bottom of outlet tee or baffle:N/A
How were dimensions determined: OBSERVED AND MEASURED
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):THIS TANK IS IN FAILURE. AT THE TIME OF THIS
INSPECTION THE WATER LEVEL AT THE OUTLET WAS 10"BELOW THE INVERT. THIS INDICATES
THAT THE TANK IS LEAKING AND SHOULD BE REPLACED. IT ALSO,MIGHT BE IN
GROUNDWATER.
GREASE TRAP: (locate on site plan) N/A
Depth below grade:
Material of construction: concrete metal_fiberglass polyethylene_other
(explain):
Dimensions:
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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
lraie en cnnnn
7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 244 HAYDENYILLE ROAD
NORTHAMPTON,MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL MA
Date of Inspection: APRIL 7,2002
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) N/A
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level. Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: NONE_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.): NO"D"BOX FOR THIS SYSTEM.
PUMP CHAMBER: N/A (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 244 HAYDENVILLE ROAD
NORTHAMPTON,MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL MA
Date of Inspection: APRIL 7,2002
SOIL ABSORPTION SYSTEM(SAS):_YES (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits,number:ONE LEACHING PIT AT THIS SITE. IT WAS FULL OF EFFLUENT.
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): THIS LEACHING PIT WAS FULL AT TIME OF THE INSPECTION. THE EFFLUENT LEVEL WAS 9"
BELOW THE INLET INVERT. THIS INDICATES A FAILED SAS DUE TO CLOGGED STONE AND
SURROUNDING SOIL OF THE LEACHING PIT. ALSO,THIS PIT MAY BE M GROUNDWATER.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) N/A
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(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)N/A
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
C/14 tintin
9
Page 1 0 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner's Name:
Owner's Address:
244 HAYDENVILLE ROAD
NORTHAMPTON MA. 01060
JOHN McKENNA
WENDELL,MA.
Date of Inspection: APRIL 7,2002
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building.
TitIc G Inenc.Hn..C
SEE ATTACHED PLAN
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10
% AS-BUILT DIMENSIONS
x \ x \ STOCKADE FENCE
I % 'A' to 'C' = 29'
x 'A' ■ ICRT1ERLY COPIER OF HOUSE
lE5! PR DATA \x "6' to 'C' = 21.5' 'B' • mummy CORNER or HOUSE
X \x _._.rtil
A Imo 3 / 2 a• R" / W \x
WW FLING SEPTIC TANK \
Ow ImS/SL 3 a•- 35. X TEST PIT % \ %mti R\ %\
X /�_7 x
C IqR 5 / 2 ,����{cP1h�,��, L'W^N
STANDING WATER: NONE W XISTING 1350 GALLON lPTIC TANK
EsllM: Xa' I 'al , # 246
RING: fi I EXISTING 111111111111111111
[
X CONCRETE GALLERIES 'B' % A'
I • 246 2 BEDROOM :F0�0/ NOTE
3/4' - 1 1/2 STONE UNR '/
x x
�,_�qry$
I FAILING LEACHING PR 244 248 1. EXISTING SEPTIC TANK AND
"W 244 I LEACHING PIT FOR # 244 ARE
IN FAILURE AND MUST BE
x x REPLACED.
I0
0 X
IPLAN VIEW _
x
X SCALE; L' = 30' TITLE-5 INSPECTION
x x OWNER: JOHN McKENNA
N - X - x X- X-x x -X
SITE: 244 HAYDENJILLE ROAD
BY: TIMOTHY E. MAGINNIS R.S.
DATE: AP' DOI
Vii Alkyd.
(iiiR
14t
HAYDENVILLE ROAD — NORTHAMPTON, MA.
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 244 HAYDENVILLE ROAD
NORTHAMPTON MA. 01060
Owner's Name: JOHN McKENNA
Owner's Address: WENDELL MA
Date of Inspection: APRIL 7,2002
SITE EXAM
Slope: <3
Surface water: NONE
Check cellar:EVIDENCE OF SURFACE WATER INFILTRATION DURING PERIODS OF HEAVY RAIN AND
MELTING SNOW WALLS OF CELLAR SHOWED SIGNS OF PAST WATER PROBLEMS WHICH
CONTINUE TO THIS DATE.
Shallow wells: NONE
Estimated depth to ground water 4.0'feet
Please indicate(check)all methods used to determine the high ground water elevation:
X Obtained from system design plans on record-If checked,date of design plan reviewed:
X Observed site(abutting property/observation hole within 150 feet of SAS)
X Checked with local Board of Health-explain:DISCUSSED SITE WITH HEALTH AGENT
Checked with local excavators,installers-(attach documentation)
X Accessed USGS database-explain: REVIES OF HAMPSHIRE COUNTY SOIL SURVEY BY USCS.
You must describe how you established the high ground water elevation: SEE ABOVE AT SITE EXAM. THE
GROUNDWATER WAS DETERMINED BY INSTALLING A DEEP HOLE IN THE VACINITY OF
LEACHING AREA, ALSO,I REVIEWED THE HAMPSHIRE COUNTY SOIL SURVEY BY THE UNITED
STATES SOIL CONSERVATION SERVICE.
****This report only describes conditions at the time of inspection and under
the conditions of use at that time. This inspection does not address how the
system will perform in the future under the same or different conditions of
use.
T;oo c..,..,,ancnnnn
n
tr[i trrx .�ovia6ft-- I a76 l r to 2,/ al
r � r -. I 3/3 1
1
PERCOLATION TEST(S)
I Time: I I Time: I I
Observation Hole #1 Observation Hole #2
Depth of Perc 3 5 y Depth of Perc y
'Start Pre-soak ./,1 A / Li Start Pre-soak /I i /
End Pre-soak y 3 / End Pre-soak // , j
Time at 12' a / Time at 12'
/� ' 11 . 33
Time at 9' Time at 9' �
Time at 6' Time at 6'
Time(9'-6') Time(9'-6') 7i'
Rate Min./Inch Rate Min./Inch / /f,
*minimum of 1 percolation test must be performed in both the primary area AND reserve area.
Performed by . Performed by 4 p'U I C^t!
Witnessed by I Witnessed by
Comments:
•
A.
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7
On-Site Review
Deep Hole#:
DEEP
MINIMUM OF TWO
LocationAddress or Lot#
,;-y L.
Owner
Time
�Q`M btrf.
, .Qiiy.Hiiifx-.
Address
Weather
Soil Tenure
(USDA)
Date
31 , 55
s-130,
-e -
Engineering Firm
T
Engineer or Sanitarian
.2r:
--- - -
Idgntity on Site Plan
- - -- -
Land Use
-
Slope%
Surface Stones I - -
Vegetation
I
Landform
-
Position on Landscape
Distances from:
Open Water Body
feet
Drinking Water Well
feet
feet
, Property Line
Other
feet
feel
Possible Wet Area
feet
Drainage Way
Deep Hole#:
DEEP
MINIMUM OF TWO
OBSERVATION
HOLES REQUIRED
HOLE LOG*
AT EVERY PROPOSED
DISPOSAL AREA
Depth from
Surface(Inches)
Soil
Horizon
Soil Tenure
(USDA)
Soil Color
(Monsen)
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency-%Grovel)
,y, 1
5
,D z
II .
f -
j1—
r
is 3/Y
0
Parent Material(geologic) I
Depth to Bedrock
Depth to groundwater. Standing Water in the Hole
I Weeping from Pd Face I
Estimated Seasonal High Ground Water '
. U
Deep Hole#: ;-
Depth from
Surface(Inches)
DEEP OBSERVATION HOLE LOG*
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Soil Horizon
-Soil Texture
(USDA)
Soil Color
(Munsell)
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency,%Gravel)
J .
6
C
Pa(entl t J1N(geptogio)`I
Dep313:3 ro
d St44.
xESUmsted Seasonal tjigh
ag��.at€�tt
`.:p§milo fladropt ,
IWeepinglfpm PdF,aig,,1
1