41 Septic Inspection 1998 BOARD OF HEALTH
MEMBERS
OHN T.JOYCE,Chairman
ANNE SURES,M.D.
(MIA DOURMASHKIN,R.N.
:R J.McERLAIN,Health Agent
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET
01060
(413)586-6950Ext 213
3, 1998
Blaha
d Ferry Road
lampton,MA 01060
RE: Sewage Disposal System Inspection
41 Old Ferry Road,Northampton
Mr.Blaha:
to are aware the Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System
ction conducted by Michael McDowell at 41 Old Ferry Road,Northampton on June 29, 1998.That inspection
t indicates that your subsurface sewage disposal system fails to protect the public health and the environment as
ed in Section 15.303 of CMR 15.000,State Environmental Code,Title 5.
;fore,in accordance with the provisions of 310 CMR 15.000 of the State Environmental Code,Title 5,and under
city of Massachusetts General Laws, Chapter 2IA, Section 13,you(or the subsequent owners of the property)are
y ordered to repair the subsurface sewage disposal system at 41 Old Ferry Road,within two (2)years of the
pt of this notice.If further degradation of the sewage disposal system occurs(e.g. sewage flowing to the surface of
round),you may be required to complete the repairs sooner.
,ork to repair/upgrade the subsurface sewage disposal system must be performed by a licensed sewage disposal
m installer, in accordance with the requirements of 310 CMR 15.000, and with plans approved by the Northampton
i of Health.
e be advised that you are entitled to a hearing on this order to upgrade your subsurface sewage disposal system,
ded that you file a written petition requesting such a hearing in the Board of health office within seven(7) days of
cceipt of this notice.
,e feel free to contact the Board of Health office,at 587-1213,if you have any questions concerning this matter.
k you for your anticipated cooperation in this matter.
truly yours,
•J. McErlain
th Agent
fled Mail#P 573 708 190
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
IN ENOWf
NORTHAMPTON WARD OF HEALTH
PART A
CERTIFICATION
roperty Address: 41 Old Ferry Road, Northampton,
ddress of Owner: Of different)
late of Inspection: June 29 , 1998
MA
lame of Inspector: Michael McDowell
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CAM 15.000)
;ompany Name, Address &Telephone Number: The Builds a Cspector of America
2 Wilbraham, MA 01095
1-800-626-4408
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that
the inspection awas performed is true,
on my training and experience in of the time of the proper function and The
maintenance of on-site sewage disposal systems. The system:
Passes
_Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
X Fails
Date: 6/29/98
Inspector's Michael McDowell
MM/jk
The System Inspector shall submit a copy of this inspection 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
The original should be sent to the system owner and copies sent to the buyer, if applicable and
report to the appropriate regional office of the Department of Environmental Protection.
the approving authority.
Copy to: Board f of f H
City y oorthampton
City Hall
210 Main Street
Northampton, MA 01060
(Return Receipt Requested)
(Copy Provided for Buyer)
Original to: 41r Old l Ferry Road
Northampton, MA 01060
lre.imd 04/35911
INSPECTION SUMMARY:
;heck A, B, C, or D
SYSTEM PASSES: N/A
I failure e criter anas defined in information
10 CMRh15 303. Any failure criteria
nottevalu evaluated e e
indicated below.
omments:
) SYSTEM CONDITIONALLY PASSES: N/A
on_ One or more system components as described in the"Co
onndittona a l Pass" secti or need
to be replaced or repaired. The system, pass.
as approved by the Board of Health, P
ndicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all
nstances. If not determined", explain why not.
The septic tank is metal,a Certificate of Compliance (attached) in d c t ng that the tank
inspector installed within a copy twenty years prior to the date of the inspection; or the septic
was ,whethe or not twenty (is cracked,Y ,structurally unsound, shows substantial
tank, whether or not or is tank failure is a the
the texisting septi1c tank is replaced 1with'a conforming septic tank as approved o ie by the if
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 if (with approval of the Board of
Health):
broken pipe(s) are replaced
obstruction is removed
_ distribution box is levelled or replaced
_ The system required pumping more than four limes 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
(revised O4l2597)
2
FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A
_ 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
the public health and safety and the environment: he
The system has a septic tank and soil absorption butary to s system ( AS)eand and
ySAS is within
100 feet to a surface water supply or
_ The system has a septic tank and soil absorption system and the SAS is within a
Zone 1 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. lss than
The system has a 100 feet but 50 feet or o
more from apry ate water and
ter supply well,tunless al well water
sanalysis
free(from pollution from that facility and the presence of ammoniatnitrogen h and
nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance
(approximation not valid).
(3) Other
(,e„eed 04/25'97)
3
SYSTEM FAILS:
a must indicate either"Yes" or"No" as to each of the following:
I have determined that defined in 310 CMR 15.303 system
The basis tfor this determinat oo soiidentif ed failure
below. The as
Board of Health should be contacted to determine what will be necessary to correct
the failure.
as No
N Backup of sewage into facility or system component due to an overloaded or
clogged SAS or cesspool.
N Discharge or ponding of effluent the
or cesspool.
of the ground or surface waters
due to an overloaded or clogged SAS
y _ Static liquid level in the distribution box above outlet invert due to an overloaded
or dogged SAS or cesspool.
N/A_ Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow. ed or
N Required pumping more than 4 times in the last year NOT due to clogged
pipe(s). Number of times pump
N Any portion of the Soil Absorption System, cesspool or privy is below the high
ground water elevation.
N/A Any portion of a cesspool or privy is within 100 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 1 of a public well. well.
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply
N/A Any p a private a water suor pply privy is less no acceptable water qualtyranalysis.f ft
from a private wetea analyzed of well water analysis be acceptable, attach copy
for conform ma bacteria, volatile oorgani ompounds, ammonia nitrogen and nitrate
nitrogen.
N/A = non-applicable, no
(revised 0405107)
4
ARGE SYSTEM FAILS: N/A
i must indicate either"Yes" or"No" as to each of the following:
The following criteria apply to large systems in addition to the criteria 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 conditions exist:
s 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.
m
_ The system is located in a nitrogen sensitive area a (Intel m a
Wellhead Protection Area (IWPA) or a mapped
water supply well).
he owner or operator of any such system shall bring the system and facility into full
ompince with th ground watr treatment program ease consult the local regional c
office of the Department for further info mation5 00 and 6.00.
I,evised 04125197)
5
SUBSURFACE SEWAGE DISPORT BSYSTEM INSPECTION FORM
CHECKLIST
eck if the following have been done: You must indicate either"Yes' or"No" as to each of
following:
s 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.
N/A As built plans have been obtained and examined. Note if they are not available with
N/A.
Y
The facility or dwelling was inspected for signs of sewage backup.
y _The system does not receive non-sanitary or industrial waste flow.
Y _The site was inspected for signs of breakout.
Y _All system components, excluding the Soil Absorption System, have been located on
the site.
Y _The septic tank manholes were uncovered, opened, and the interior of the septic
tank was inspected for condition of baffles or tees, of scum.of construction,
depth
depth of liquid, depth of sludge, p
The size and location of the Soil Absorption System on the site has been determined
based on:
Y _
The facility owner nd occupants, if information on the proper maintenance eof Sub-Surface owner)sposalrSystem.
N Existing information. Ex. Plan at B.O.H.Determined in approximate ntof distance s
tance any unacceptable)criteria related to Part C is at issue,
5.302(3)(b
(revised 04125197)
6
SUBSURFACE SEWAGE DISPOSAL T YSTEM INSPECTION FORM
SYSTEM INFORMATION
FLOW CONDITIONS
SIDENTIAL:
sign flow: 330 g.p.d./bedroom for SAS Actual design flow not available .
mber of bedrooms: 3
mber ofurrentresidents: 4 its removal .
usage current
or no): y a Garbage grinder is non-functional . Recommend
undry connected to system (yes or no): _Les_
:asonal use (yes or no): N year usage (gpd): 17 , 500 cubic feet , as
ater waterreadings,r available (last two (2)y
imp year
(yes or no): Yes
ast date of occupancy: Currently occupied
GENERAL INFORMATION
PUMPING RECORDS and source ur &of inford ton: Health
Unknown, per
System pumped as part of inspection: (yes or no) N_
If yes, volume pumped:
Reason for pumping:
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy attach previous inspection records, if any)
Shared system (yes or no) (if yes,
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sestember 1979 •er Board of Health records .
SEWAGE ODORS detected when arriving at the site: (yes or no) No
(revised 04r2s97)
7
LDING SEWER:
:ate on site plan)
)th below grade: 26" other (explain)
:Sal of construction: X cast iron 40 PVC_
lance from p supply ply well or suction line 34' 6"
private water su
meter 4" evidence of leakage, etc.)
mments: (condition of joints, venting,
ildin: sewer exits rear foundation wall one foot in from le t rear
rner .
EPTIC TANK: X
)sate on site plan)
epth below grade: 20"
ex lain
laterial of construction: X concrete_metal Fiberglass Polyethylene_other P )
f tank is metal, list age
Is age confirmed by Certificate of Compliance (Yes/No)
Dimensions: 3 ' 6"L x 4' 6"W x 6' D a. .roximatel 1000 Gallons
Sludge depth: 4"
Distance from top of sludge to bottom of outlet tee or baffle: 2
Scum thickness: 2-4" LIZ
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee measure 1 baffle:
How dimensions were determined: ith
Comments: pumping, condition of inlet and outlet tees or baffles, depth of liquid level
(recommendation toutlet for invert,ert, structural integrity, evidence of leakage, etc.)
in relation to outlet invert, • ,
Fluid level was correct h t s '
rev ions back
(red. Recommend
tank & ba£fl- a e s. _.• of
bottom of covers mandatorrs indica
ion r
se tank. A grade .
(sets to within 6 inches of g
tic
insta
ing
(,et;,,e<nsnn
fl
iTRIBUTION BOX: X
;ate on site plan)
pth of liquid level above outlet invert: 2-1 .4"
ual, evidence of solids carryover, evidence of leakage into or
,mments: •
SAS .
itoiflevelanddFlbid level was not • due -
It ches ab.) Sussed backu ` . • „Kati O�
stain n• solid ca over .
,nches above outlet invers• evidence of minimal
Cnteriox of distributiThere xisas black
of om end r blaceme.
Recommend replacement of the distribution box & SA
(loIL ABSORPTION SYSTEM R
(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
leaching pits, number:
leaching chambers, number:
leaching galleries number: length
leaching trenches, number,
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system: condition of
Name of Technology --- level of ponding, r to
draulic failure, •
outlet •i•es at distribution the
Comments: (note condition of soil, signs of Y replacement of clay.
etc. Observed 3 recommend re SAS contain
vegetation, etc) distribution box
ol• s in area
findings utlon •ox S �
tnvS,d ps1DHn
9
ETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two (2) permanent references, landmarks or benchmarks.
Locate all wells within 100' (one hundred feet). (Locate where public water supply
comes into house.)
T TO SCALE A inlet cover
B outlet cover
C distribution box
(revised M130N1
I
y
XA=23' 6"
XB = 29 ' 7"
XC = 54 ' 4"
YA = 17 ' 6"
YB = 22' 1"
YC = 47 ' 5"
{pyn loafer
OLD FERRY ROAD
10
:PTH TO GROUND WATER
ipth to Groundwater 4 Feet
ease indicate all the methods used to determine High Groundwater Elevation:
_Obtained from Design Plans on record
X 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 crAgg be
completed)
Depth of groundwater was determined based on evidence of water
penetration & sump pump in basement .
NOTE: Grade falls off towards rear of property.
NOTE: As per owner a previous Title 5 Septic System Inspection
to
was performed in the Fall ofc 1995 . OwnerrwasaunableHealth
locate his copy of the inspection.
are no records of same.
Devised 041251971
11
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF. . {/ ,,,ay
Appliratlwn or 'Disposal Marks ( utintntnnwwn Permit
pplication is hereby made for a Permit to Construct ( ) or Repair (Van Individual Sewage Disposal
i at:
to. .411-16.
n .nemi y .�/
n
tmtet
. ......._.._....---....-'---........_ < No.No..
or Lot
Address
Addren
I Building Size Lot Sq. feet
welling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
ther—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Flow gallons per person per day. Total daily flow
Tank—Liquid-capacity gallons Length Width Diameter... Depth
al Trench—No Width Total Length Total leaching area sq. ft.
e Pit No Diameter.. Depth below inlet Total leaching area sq. ft.
) Dosing tank ( )
Performed by Date
minutes per inch Depth of Test Pit Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
gallons.
Distribution box
Mon Test Results
est Pit No. 1
est Pit No. 2
ption of Soil
........... .
of Repairs or trations—�iswer when applicab -- . �;, �-y77 �^�"="'�' ..
t..ft._Q.Q.._Qa,�( .G+.eXe, -z7,s.J:.,.aira fi!<°� ^dK 'r�
rent:
he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
'visions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
ion until a Certificate of Compliance has been ' sued by the board of health.
Si
mtion Approved By
ration Disapproved for the following r
Permit No....{T.,,�t..l
Date
Issued-