41 Septic Inspection 2000 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FARM
PART A l
CERTIFICATION
u �
operty Address: 41 Old Ferry Road Northampton
ime of Owner: Kurt Blaha
OCT 27 2000
Nor. '.I AMPTON BOARD OF HEALTH
dress of Owner: Of different) 225 Main Street , Easthampton, MA 01027
to of Inspection:
October 17 , 2000
me of Inspector: Michael McDowell
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
mpany Name, Address & Telephone Number: The Building Inspector of America
2 Brookside Circle
Wilbraham, MA 01095
1-800-626-4408
2TIFICATION STATEMENT
rtify that I have personally inspected the sewage disposal system at this address and that
information reported below is true, accurate and complete as of the time of inspection. The
section was performed based on my training and experience in the proper function and
ntenance of on-site sewage disposal systems. The system:
X Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
lector's Signature: /12G//It.Cx Jr)(1 4/',(I'Pf Date: October 17 , 2000
Michael McDowell MM/
System Inspector shall submit a copy of this inspection report to the Approving Authority
ird of Health or DEP) within thirty (30) days of completing this inspection. If the system is a
ed system or has a design flow of 10,000 gpd or greater, the inspector and the system
ar shall submit the report to the appropriate regional office of the Department of
ronmental Protection: The original should be sent to the system owner and copies sent to
iuyer, if applicable and the approving authority.
s and Comments: See * comment below.
nal To: Kurt Blaha (copy provided for buyer)
225 Main Street
Easthampton, MA 01027
' to: Board of Health (Certified Mail 7099 3400 0007 8316 9499)
City of Northampton
City Hall - 210 Main St .
3/02/98 Northampton, MA 01060
med a Title 5 Septic System Inspection on this same property on 6-29-98 & the system
There have been no repairs to system. Number of occupants have been reduced & water
measures were performed on abutting property altering groundwater.
5PECTION SUMMARY: Check A, B, C, or D
SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions
described in 310 CMR 15.303 exist. Any failure criteria not evaluated are
indicated below.
nments:
ting Tri-County Fairgrounds have implemented water control measures lowering
ndwater table. Soils adjacent to left rear of this property were dry and firm
ime of inspection. This was not the case during the previous inspection.
iYSTEM 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.
cafe yes, no, or not determined (Y, N, or ND). Describe basis of determination in all
ances. 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 ex-filtration, or tank failure is imminent. The system will pass inspection if
the existing septic tank is replaced with a complying 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 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 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
09/02/98/
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 in accordance with 310 CMR
15.303 (1)(b) 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 any)
determines that the system is functioning in a manner that protects
the public health and safety and the 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 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.
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 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).
Other
se
09102/98)
3
SYSTEM FAILS:
1 must indicate either"Yes" or"No" to each of the following:
I have determined that one or more of the following failure conditions exists as described
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.
N/A
/A
No
X Backup of sewage into facility or system component due to an 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.
X Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6 inches below invert or available volume is
less than 1/2 day flow.
X Required pumping more than 4 times in the last year NOT due to dogged or
obstructed pipe(s). Number of times pumped_.
X
Any portion of the Soil Absorption System, cesspool or privy is below the high
groundwater elevation.
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.
N/A_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
N/A 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. If
the well has been analyzed to be acceptable, attach copy of well water analysis
for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate
nitrogen.
= non-applicable
d o9mzsal
4
ARGE SYSTEM FAILS: N/A
must indicate either"Yes" or"No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
No
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:
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).
owner or operator of any such system shall upgrade the system in accordance with 310
2 15.304(2). Please consult the local regional office of the Department for further
oration.
109/92198)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
ck if the following have been done. You must indicate either"Yes" or"No" as to each of
following:
No
Pumping information was provided by the owner, occupant, or Board of Health.
X 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.
/A 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 backup.
The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on
the site.
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:
Existing information. For example, Plan at B.O.H.
Determined in the field Of any of the failure criteria related to Part C is at issue,
approximation of distance is unacceptable) [15.302(3)(b)].
The facility owner (and occupants, if different from owner) were provided with
information on the proper maintenance of Subsurface Disposal Systems.
09102198)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
DENTIAL:
In flow: 110 g.p.d./bedroom
Der of bedrooms (design): 3
DESIGN flow: 330
per of current residents: 0
age grinder(yes or no): yes
dry (separate system) (yes or no): no ; If yes, separate
dry system inspected (yes or no): ?T!T-
onal use (yes or no): no
r meter readings, if available (last two years' usage (gpd):
le water department .
FLOW CONDITIONS
Number of bedrooms (actual): 3
Actual design flow records not available
Garbage griner is non-functional . Recommend
its removal .
inspection required.
4600 cubic feet , as per
Pump (yes or no): Yes
date of occupancy: Approximately 9-20-00
GENERAL INFORMATION
PING RECORDS and source of information:
s not been pumped in years as per owner .
ystem pumped as part of inspection (yes or no): no
yes, volume pumped: gallons
season for pumping:
F. OF SYSTEM
_ Septic tank/distribution bo dsoil absorption system
_ Single cesspool
_ Overflow cesspool
_ Privy
_ Shared system (yes or no) Of yes, attach previous inspection records, if any)
_ I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank_Copy of DEP Approval
ROXIMATE AGE of all components, date installed (if known) and source of information:
.ro n:
I . • • •
• •
age odors detected when arriving at the site (yes or no): no
09/02/981
7
DING SEWER:
de on site plan)
1 below grade: 26"
rial of construction: x cast iron 40 PVC other(explain)
nce from private water supply well or suction line 34 ' -6"
eter 4"
vents: (condition of joints, venting, evidence of leakage, etc.)
Lding sewer exits rear foundation wall one foot in from the
t rear corner .
DC TANK: X
to on site plan)
h below grade: 20"
rial of construction: x concrete_metal_Fiberglass_Polyethylene_other ((explain)
k is metal, list age _ Is age confirmed by Certificate of Compliance (Yes/No)
nsions: 8 ' -6" L x 4 ' -6" W x 6 ' D, approximately 1000 gallons
3e depth: 3"
,nce from top of sludge to bottom of outlet tee or baffle: 27"
i thickness: 2"
ince from top of scum to top of outlet tee or baffle: 11"
ince from bottom of scum to bottom of outlet tee or baffle: 17"
dimensions were determined: with a tape measure and a pole
ments:
immendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level
ation to outlet invert, structural integrity, evidence of leakage, etc.)
id level was correct , that is , equal with outlet invert .
tic tank and baffles appear to be sound. There is evidence of
ck staining on bottom of covers . This is an indication of
vious back ups into the septic tank. A mandatory pumping is not
uired . Recommend pumping every three years . Recommend installing
ers on all covers to within 6 inches of grade.
09102/98
RIBUTION BOX: X
e on site plan)
i of liquid level above outlet invert
nents:
if level and distribution is equal, evidence of solids carryover, evidence of leakage into or
f box, etc.)
-d level was correct , that is, equal with outlet inverts .
!rior of the distribution box is stained black which is an
_cation of previous back ups . There is no evidence of solid
:yover . Distribution box appears sound.
ABSORPTION SYSTEM (SAS): x
:e on site plan, if possible; excavation not required, location may be approximated by
ntrusive methods)
located, explain:
leaching pits, number
leaching chambers, number:
leaching galleries number:
leaching trenches, number, length:
leaching fields, number, dimensions: onw, approximately 15 ' x70 '
overflow cesspool, number:
Alternative system:
Name of Technology:
Tents:
condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
tation, etc.)
rved three outlet pipes at the distribution box. There was no
ence of hydrualic failure . The septic system has not been receiving
al daily flows .
. Bottom of SAS to groundwater is less than one (1 ) foot .
09102190)
ICH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house.)
TO SCALE
= Inlet Cover
= Outlet Cover
= Distribution Box
'D91@198�
XA = 23 ' 6"
XB = 29 ' 7"
XC = 54 '4"
& ikiloy
sewer
YA = 17 ' 6"
YB + 22 ' 1"
YC = 47 ' 5"
towq i ter
41 Old Ferry Road, Northampton, MA
10
> Report name
Soil Type
Typical depth to groundwater
Date website visited:
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
EXAM Slope
Surface water
Check Cellar
Shallow wells
ated Depth to Groundwater 4 Feet 6 inches
e indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Date
ribe how you established the High Groundwater Elevation. (Must be completed)
pth of groundwater was determined based on evidence of
ter penetration and sump pump in basement and retention
nd on the abutting property to the left .
11