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380 Septic Inspection 1997 (2) COMMONWEALTH OF MASSACHUSETTS rn ENVIRONMENTAL AFFAIRS SEP - FU EXECUTIVE OFFICE OF E\'V]RO q S°' Z9 DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. 51A 02109 6r' 2'r_ 5500 WILLIAM F OSLO GOKmpr TRLBil SI AROEO PALL CELLUCCI Lt.Gosemor DAC!OB S' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Comm: PART A CERTIFICATION Property Address: 386 CHESS IE1,1� 12GAfi BRtCC 17K.0 Date of Inspection: 9-22-4•' Address of Owner: IT.I$Ui Name of Inspector:I tu.∎GtLyy Er AAAG NJN\5 (11 different) SAME " I am a DEP approved system inspector pursuant to Section 15.340 of Title 51}10 CMR 15000) Company Name: Mailing Address: MO CI we- R0 E t r A p . M A telephone Number: 1 ' er CERTIFICATION STATEMENT I certify that I have personally mspeced the sewage disposal system at this address and that the information reported below is true. acme and complete as of the time of Inspemon. The inspection was performed based on my training and experience In the proper function ar maintenance of omsne sewage disposal systems. The system. . Passes _ Condluonally Passes Needs Further Evaluation By the Fails Inspector's Signature: 1 c L 'L 0. Date: SEAL Z4 I9447 The System Inspector shall submit copy of ;Is i. . c ion report to the Approving Authority within thirty 001 days of completing this inspealon 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 subs the report to the appropriate regmnal office of the Department of Envnonmental Protection. The original should be sent to the system aw and copes sent to the buyer. it applicable. and the approving authority INSPECTION SUMMARY: Check A, B, C, or D. al Approving Authority A] SYSTEM PA$$E5: ave not found any information which indicates that the system violates any of the failure cote ha as deimed in 310 CMR 15 7C Any failure aiteria 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, up completion of the replacement cr repair, as approved by the Board of Health, will pass- Indicate yes. no, or not determined 111, N. or NO Describe basis of determination in all instances. If not determined', explain why not. The septic tank is met, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance latched; Indicating that the tank was installed within twenty 120)years prior to the dale of the Inspection, the septic tank, whether or not metal. Is cracked, struaurally unsound, shows substantial infiltratmn w exhltratron. of tar failure rs immmem. The system will pass Inspeamn sf the existing seplrc tank d replaced with a conforming septic tank as approved by the Board of Health. traaaaa 04/25/$7) Pae• 1 of 12 DEP an;he wc10 Woe We nit rwww tonne state ma iYeep Vile M RecycJ4 Paper BOARD OF HEALTH S T JOYCE.Chairman iE BORES.M.D. ITHIA DOURMASHKIN.R N ER 1.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 1413)566440 Est 2t3 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, Title 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(2) 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. NI 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 573 708 975 * SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: sec c 2cAC - NC Sit Fcvvg5 C MA Owner: Gas 7p tccs DIGr so,.( Date of Inspection: DI SYSTEM FAILS: You must indicate a< er 'Yes' or"No' as to each of the foflcwing ✓ t have determined that the system violates one or more of the following failure criteria as defined in 310 Cm; 13 303 The bas for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cat the failure Yea No (each,_< V Backup of sewage mm facility or system component due to an overloaded or clogged S.AS cr cesspool 15 cc/LC — 1. Discharge or pond mg of effluent to the surface of the ground or suAace waters due man everloacca or clogged SAS o ����/ esspool. N MO bciY or _ A c�igwd level .n the dnoibuuon bo. above outlet Invert due to an overoaded o doggee SAS a cesspool — uif% ..q depth in cesspool is less man B-oelomv invert or availab m th le +o�ue is ess an I:2 pas flo++ ✓ Required pumping more than 4 times in the fast year NOT due to clogged or ooetructed pipets} Number of times pumped _. Any portion of the Sou Absorppon System, cesspool or privy is below the h,gh groundwater elevation. �{ Any portion of a Cesspool or pr se is within 103 feet of a surface water supply or tributary to a Surface water Supply N/A Any portion of a cesspool or privy is within a Zone I of a public well — N Any portion of a cesspool or privy is within 50 feet of a private water supply welt. — I t Any potion of a cesspool or privy is'ess than 100 feet but greater than 50 feet iron a private water supply well *lig 1 acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis coliforrn bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El URGE SYSTEM FAILS: You must Ind.Gate ether 'Yes' or No as to each of the following. The following cater a apply to large systems in addition to the critena above The 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 conddlons exist 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- IWPAI or a mapped Zone II of a public water supply well) The\bwner or operaror of any such system shall bring the system and facility into full compliance with the groundwater treatment progom requirements of 314 CMR 500 and 6.00 Please consult the local regional office of the Department for further intormatron. Qwuea ca/IDa'; ascot 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) opens Address: S80 Cha I?fE2.o /?or1D -NckrTh,ij C A/ ,n, wner: 13c:R 7RICE L-lCL A Sciki ate of Inspection: rn 7"CL "77 SYSTEM CONDITIONALLY PASSES (continued, N Sewage backup or breakout or high static water levet observed in the distribution box is due to broken or obstructed pipets/ or due to a broken, senled or uneven distribution box. The system will pass inspection if(with approval al 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 d(with approval of the Board of Health): _ broken pipet)are replaced obstruction is removed II FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: !Z r Conditions exist which require tuner 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 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 suppy 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 feel but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile orpnic 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). revt• a 0e/as/ell tan 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propeny Address: 38o C rl SvERS at Pc1t ) - N 0ich-t?A A\p-ra,J Owner: f3EW`tR10E DLCKIf 5Ok) / n1R Date of Inspection: 9-zz - (2 RESIDENTIAL: Design flow. h�G,4Q.rbedmom for S.A.S. Number of bedrooms. if- Number of current residents 4- j_ Garbage grinder Oyes or no 0,5 Laundry connected to system ryes or na:ilye -7rraR.E S A LA.),1/4,0 rv. CCo AINEC.j)pN 131.! rr l f,lL c:L Seasonal use(yes or nal NO C 0.-A 5 MST H 0 , �'( —Itavo..) Ibe S pe,.a e d 5 5: Water melee readings, if asadable fast two 12: year usage igpd;: N ti Sump ( es or n NC 5UMn_7VM 3 B.,i ThLfZe Pi RE rdASEWLCk1 5t •acic A. P . to last dare of occupancy, Ct la—ter I-y oc cc p e ROW CONDITIONS p Pump y o) Nfi COMMERCIAL/INDUSTRIAL: Type of establishment Design flow. Rallonslday Grease trap present (yes or not Industrial Waste Holding Tank prese ryes or not Non-sanitary waste discharged to the tIe 5 system Oyes or not Water meter readings, if available fast date of occupancy. OTHER: tOescnbel Two t(.0eR 0,2q,w5 iA Last date of occupancy.__ GENERAL INFORMATION PUMPING RECORDS and source of information OW Pi az System pumped as pan of inspection. Tres or not .S If yes, volume pumped /CO 0 gallons Reason for pumping Rt.R(. E5TA -nznkafEi1/4. TYPE OF SYSTEM I� Septic tank/OKirhnmaeaewEsoil absorption system - 5A5 : Single cesspool Overflow cesspod Privy Shared system (yes or no) (d yes. attach previous inspection records VA Technology etc.Copy of up to date contract? Other 7.72A,(, 5cplc PL .AA?,A 6 luicLlAMSl3 4r /11/4 Leaf P-f any) 12v APPROXIMATE AGE of all components, dare installed (if known)and source of information: S&P-7C T C1 A.0 SAS = lEsAV.+ Sewage odors detected when arriving at the site. (yes or not NO (comma 04/25/17) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST petty Address: 38c Ctie 4{ia 88D - �N��N/ MPt ner: fl'er9ORICE DICRINSG>`4 e of Inspection: 13-23-4 eck if the following have ben done: You must indicate either'Yes'or"No-as to each of the following. No Pumping information was provded by di !AA upant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been race wing norma.,��((��4 fow rates during that period. large volumes of water have not been -nsroduced into the system tecentlCSl" ' as part of this inspection. As built plans have been obti ned and examined. Note they are not available with N/A. The facility or dweibng was inspected for signs of sewage bad-up. _✓ The system does not receive non-sanitary or inclusirwl waste flow. The site was inspected for signs of breakout. Af BRr7■KCLI All system components, excluding the Sol Absorption System, have been located on the site. _✓ The septic tank manholes were uncovered, opened, and the interior the septic tudtan k was cu inspectm for Condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of ` The size and location of the Soil Absorption System on the site has been determined based on' _/ The facility owner land occupants, d different from owned were provided with information on the proper maintenance of / Sub-Surface Disposal System / _ Existing information. Ex. Plan at 6 O.H. Determined ,n the field IT any of the failure criteria related to Part C is at Issue, apprommauon of&stance is — unacceptable) 11i.3021DibQ trsvisaa 0e/1S/971 Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address. 3eC C H&S/E) F)CUO /R640 ' NCk"}r l44.Sp ILA,', /N fl Owner: fJ-ZZ-9� Dale of Inspection: Ser I%2f CL dJCCIAS:i P; u TIGHT OR HOLDING TANK (locate on site plant Tank must be pumped prior to. or at lime, of lnspedionl Depth below grade metal _Fiberglass_Polyethylene_mherlexpiam) of construomn: _cono.ete Dimensions: Capa[ay. gallons ay working order Yes( No Design flow: gallons/ Alarm level Alarm I Date of pre(lots pumping Comments (condition of inlet lee,condition oof alarm and float switches, etc.■ 3 DISTRIBUTION BOX:_ (locate on sae plan) Depth of liquid level above outl}. ,nyer? Comments. (note if level and distribution rvQ tl� Bax real,evidence of solids c ryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order (Yes or N I Alarms In working order(Yes or N4 Comments: Inoe condition of pump chamber, condition of pumps and apponenances etc.) (revised 04/I5/77) Ie4e 7 of 10 deny Address net: e of Inspection: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM SYSTEM INFORMATION (continued) BO GI1ES7t2FIEL✓) Q6)9D -NOR177 ,4,11) LDAI/ TRICE ©1GK/MSOU ILDING SEWER. rate on site plan) 'L pth below grade-} o2 T • serial of construction: _cast iron 40 PVC/other 'explain) ' 'dance horn Q ate water supply well or suction line*ira_ meter mments 'condition of Joints, venting. evidence of leakage. etc )NG �s,--r IS ����� prp>= FRa Ai sm/c TAANK T E CH KC3' P1 A(.6-4.• IT HAS DA./d 1'O&W 1 nVCR it-/F yF 9 PTIC TANK:V care on site plan) ii !ph below grade /0 i aerial of construction: j 'concrete _metal _Fiberglass _Polyethylene_other explain) tank is metal, list age Is age confirmed by Ceniflote of Compliance fifes/No) imensions: /Gyp L x 5 w x 5 D udge depth._ listance from top of sludge to bottom of outlet tee or baffle:¥$$ ,f - cum thickness a e� 'r 'stance from top of scum to top of outlet tee or baffle Nuance from bottom of scum to bottom of outlet tee or baffle 3! tow dimensions were detetmmed: N'1619514ZSt9 :omments to recommendation for pumping, condition of Inlet and outlet tees or baffles, depth of liquid level in. S relation t o u t l e t AL Left)strunural/`19ST niegrity, evidence of leakage, WI) TN IS )506 6 iAL(.,N 5t (. !iy KARL'S EkCrAV97[0) r-U H.^nLGy, Ssl� Is ru 5aufd? coi,07,ou •V-) w6 GREASE TRAP:_ N (locate on site plan) Depth below grade._ Material of construction: concrete _meal _Fiberglass _Polyethylene _ahertexplain) 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: depth of liquid keel in relation m outlet even, stmnural (recommendation for pump condition of inlet and outlet tees or baffles, R integrity. evidence of lea (mane 2et/23ff7) Page a of SO SLBSLRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3803 C•sy E57 C 1 E.O R0140 — NORTherWIPIZ A/ M Owner: /1j R,Cc d% ICCWS4 I !9 Date of Inspection: t — zz- 99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at leas; two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) E X15TIn1(� L.5/EL.. Q I) EX)37,n/4 T 06 Cc Rct„&N SepT,c TANK SAND Exr37rN x PtT- leavaaua 04/35/971 t us ' C 7F' ELD ,Qcto Paa. 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued& ty Address: 3Sc C ,,F' -- D k6;1 et - Arc,- I�i�l�•,,1. f�'c ter— <. tit. a .A >Lti- d Inspecti n: , 1/ tSSORPTION SYSTEM{SAS):_ - an site plan, d possible: excavation not required, but may he approximated by non-; determined to be present, explain. N/4 usive mehodsl 1A leaching pas leac ^g gal Inc g gall leac ing tier Over rag fit! e Alte number. ✓ OtJt.I' 30 yew R. OLO sben, umber:= nes, n mber :hes. n mber,length s, nu r,dimensions ere pool, n mber. alive s stem. Na a of T hnology. 5 2.0 'AL KµowN (± S Dc& ) PIT y Bc ls'J GRavk DU.ATER moms. h1aS ± �ror Lle�•'P cq.-E IS sod, signs ofCC rcl� fsi-/t�i2P�l�dn¢AILVR-.�-rv��IS mph . rFR6 IS fv D - • G •l� M • •G• s. • IS • R• Lv � Ou/). TN'E Stwtl2 • aoCf�. 6 ct.�7 /o ES Al p7 AA. 3� ce�e+ivy ripe (2AO)arAA "i0 P, _fif15 5cTpc Th- SPOOLS: _ ate on sae plan) nber and configuration- ,h-tep of liquid to inlet inv it ath of solids layer: ath of scum layer nensions of cesspool. feria of conspuction. lotion of groundwater. inflow (cesspool must . pumped as pan of impearon; N/A immentS se condition of sod, signs of hydraulic failure, level of pandits& condition of vegetation, etc.) tIVY:_ Cate on site plan} Werals of construction. Kqh of so4ids. eminents: tote condition of soil. signs of [rev/god 04 MO') ydraulic failure, level of pending,condition of vegetation.etc.) /ago i of 10 Dimensions. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ',p.�� SYSTEM INFORMATION (continued} r1y Address: 38O C HSS j 2>ZF,t� ROA et: 3r7RICE 0/G /n,saty of Inspection: h to Groundwater _Fret se indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of S Determine it from local conditions Check with local Board of health Check FEN&& Staps Check pumping records Check local excavators. Installers observati ole, basement sump etc.} Mca!7L/r,16- cb 59 ON RDjiCgC P041) -7-7 Use USGS Data — scribe in your Own words how you established the high Groundwater Elevation. (MUSE be completed} T LE pit 1 ST' S ©r✓ Tr& (3ASeit - w aL(. C," 1—hCh CA.dse) r� S"2 cox C CLpTeR E: DISC rn4<C Pc IAA s cC fib 1 " o QoZ 'ORM, v5 1Na-Th\-2 fASt$,ti c,,,C Sh-.NLV:: 36 Ott -�tNt�D A- ° lc A s th t, . T +sposa c_ sae. € LLSIs f i SrtO„ LJ 13;‘, CoA A cCM) -C2) -11rc Seu-a't6c 0 t fi s,tt SySTcW\ AT 71 t al:- f7-- sTo\ ,C AM/n page 10 Cl 10 (reviled 04/25/07I