Loading...
39 Septic Inspection 2014 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L.Halbert:Bacon Wilson,P.C. Owner Owners Name required for every Northampton page. CirylTown B. Certification (cant.) MA 01006 9/4/2014 State Zip Code Date of Inspection Inspection Summary.Check A,B,C,D or E/always complete all of Section D A) System Passes' ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System consists of one 1,500 gallon septic tank,one distribution box and two 1,000 gallon leaching galleries installed in 1988. Water levels were appropriate with no high staining noted. Distribution box was cracked and corroded(replaced on September 6d1,2014). Health Agent,Ed Smith Approved Distnbution Box Replacement at time of Title 5 Inspection. 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. Check the box for"yes','no'or"not determined'(Y.N. ND)for the following statements. If"not determined'please explain. 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. ❑ Y C N C ND(Explain below)'. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L.Halbert: Bacon Wilson,P.C. Owner Demers Name information is Northampton MA 01006 9/4/2014 required every r e.e P page. ctyROwn state Zip case Date at Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important wnen A General Information filling out forms on the computer, use only the tab 1. Inspector: key to move yaw us` -do not Alan Weiss w the Name or Inspector key Cold Spring Environmental Consultants, Inc. Company Name 350 Old Enfield Road Company Address Belchetown MA 01007 cayRaam State Zip Code 413-323-5957 Telephone Number Registered Sanitarian#933 License Number B. Certification 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'. ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority F_ in pe mrf Signature 9/6/2014 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 14000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ****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. C\ Commonwealth of Massachusetts 7- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street _ Property Address Attorney Lisa L.Halbert'.Bacon Wilson,P.C. Owner Owners Name required for is Northampton MA 01006 9/4/2014 page 0rorevery City/Town State Zip Code Date of Inspection Page Y B. Certification (cont.) 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 fecal coliform bacteria indicates absent 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 O) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No O ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool O ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool E ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 7 ® Liquid depth in cesspool is less than S"below invert or available volume is less than'A day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L.Halbert:Bacon Wilson,P.C. Owner Owners Name information is Northam ton required for every P MA 01006 9/4/2014 Page. OtyROwn State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont p ❑ 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 ❑ Y ❑ N ❑ ND(Explain below). ❑ obstruction is removed ❑ Y E N E ND(Explain below): Z distribution box is leveled or replaced ® Y ❑ N ❑ ND(Explain below): Distribution box was replaced on September 6m,2014. ❑ 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 ❑ V ❑ N ❑ ND(Explain below). ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below). C) Further Evaluation is 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 public health,safety or 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 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 rme 5 orhas n.v<mo.ro,m.&o wer<s..ay.o.w.m Sy.am•Page 3 ar tr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L. Halbert:Bacon Wilson,P.C. owner owners Name mmrmation is Northamp ton MA 01006 9/4/2014 required for Beery p age e City/Town Stale Zip code Date m Inspection page C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site? 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? 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 Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C at issue approximation of distance is unacceptable)[310 CMR 15302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design). =-- --- Number of bedrooms(actual). 3 DESIGN flow based on 310 CMR 15.203(for example. 110 gpd x#of bedrooms): 330 GPD dmvf mrem cage 6 my Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address AttorneyLLisa L.Halbert Bacon Wilson.P.C. Owner owners Name information is Northampton page required for every o Nirtoan . MA 01006 9/4/2014 State lip code Date of Inspection B. Certification (cons.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ Z Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z 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 fecal colifonn bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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; To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes'or no to each of the following, in addition to the questions in Section D. 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 0 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L.Halbert:Bacon Wilson,P.C. Owner Owners Name requi red friz Northampton MA 01006 9/4/2014 regwee f«a.ery page. Orly/Town State zip cede Date of Inspection D. System Information (cons.) Septic Tank(cant.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments(on pumping recommendations.inlet and outlet tee or baffle condition,structural integrity. liquid levels as related to outlet invert,evidence of leakage,etc.): Concrete inlet and outlet baffles in good condition. Tank was structurally sound with no evidence of exfiltration or infiltration. Liquid levels were at the outlet invert. Tank should be pumped every two years. Measured Grease Trap(locate on site plan). Depth below grade'. Material of construction: ❑concrete ❑metal feet ❑fiberglass ❑polyethylene ❑other(explain): Dimensions 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'. Date Owner is required for eery page Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L.Halbert:Bacon Wilson,P.C. Owners Name Northampton MA 01006 9/4/2014 city/rows State Zip Code Date of Inspection D. System Information (coat.) Approximate age of all components,date installed Of known)and source of information: 27 Years Were sewage odors detected when arriving at the site? Building Sewer(locate on site plan)'. Depth below grade: Material of construction: ❑cast iron ®40 PVC ❑other(explain). Distance from private water supply well or suction line ❑ Yes ® No 4 feet >10' feet Comments(on condition ofjoints,venting,evidence of leakage, etc.)' Building sewer and joints were in good condition with no evidence of leakage. Septic Tank(locate on site plan)'. Depth below grade Material of construction: 31 Inches feet ®concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) Septic tank(1500 gallon tank)with concrete baffles. Septic tank and baffles were intact and in good condition. Levels were appropriate and no exfiltration or infiltration were noted. If tank is metal,list age. years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) 10'x5'x 4.5' Dimensions: Sludge depth. ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Properly Address Attorney Lisa L.Halbert'. Bacon Wilson,P.C. Owner Owners Name required ation is for every Northampton MA 01006 9/4/2014 Page. Cltyfown State Zip Code Date of Inspedlon D. System Information (cant.) Last date of occupancy/use: Other(describe below). Date General Information Pumping Records; Source of information: Was system pumped as part of the inspection? If yes,volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: Unknown 1.500 gallons Measured Inspection ® Yes ❑ No • Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)Of yes,attach previous inspection records,if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. • Other(describe). Septic tank with a distribution box and two 1,000 gallon leaching tanks. Tme 5 oma Inspecton Fwm.sm..ma S..<v asw.e System•c.g.a or IT Commonwealth of Massachusetts y Title 5 Official Inspection Form Owner information is required for every page. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L.Halbert:Bacon Wilson,P.C. Owners Name Northampton MA 01006 9/4/2014 City/Town State Lp coca Date of Inspection D. System Information Description: One 1,500 gallon septic tank with a distribution box and two 1,000 gallon leaching galleries... Number of current residents. Does residence have a garbage grinder? Is laundry on a separate sewage system?(Include laundry system inspection information in this report_) Laundry system inspected? Seasonal use? Water meter readings if available(last 2 years usage(gpd)): Detail: Town Water 0 ❑ Yes ® No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No NA Sump pump? ® Yes ❑ No Last date of occupancy. DApatel,2014 e Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203). Gallons per day(gpd) Basis of design flow(seals/persons/sp.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Properly Address Attorney Lisa L.Halbert: Bacon Wilson,P C. Owner Owners Name information is Northampton MA 01006 9/4/2014 r nmred for every P page. Qryrtom State ➢p Code Date of nspegion D. System Information (cant.) Distribution Box(if present must be opened)(locate on site plan): At the invert. 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.): Distribution was not level with unequal distribution the outlets. Distnbution box was cracked with some leakage observed. Distribution box was replaced(with flow levellers)on September 6'",2014. Minimal solids carryover. New distribution box was inspected and found to be level,with equal flow to outlets and no evidence of leakage or solids carryover. Pump Chamber(locate on site plan)- Pumps in working order'. Alarms in working order ❑ yes ❑ No' ❑ Yes ❑ No' Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.). If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why Located on site plan. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Properly Address Attorney Lisa L.Halbert:Bacon Wilson.P C. owner Owners Name information is Northampton MA 01006 9/4/2014 regmred t«every P page. City/Town State zip code Date or Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in wonting order ❑ Yes ❑ NO Date of last pumping: Date Comments(condition of alarm and float switches,etc.)'. Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑ No of Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Properly Address Attorney Lisa L.Halbert Bacon Wilson.P.C. Owner owners Name infomilation required for every Northampton MA 01006 9/4/2014 page City/Town State Zip Code Dale of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc) Privy(locate on site plan): Materials of construction Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure.level of ponding,condition of vegetation. etc.) S-% Commonwealth of Massachusetts Title 5 Official Inspection Form Owner information is required tar every page. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Properly Address Attorney Lisa L.Halbert: Bacon Wilson,P.C. amers Name Northampton Cigrtown MA 01006 9/42014 State Zip code Date of Inspection D. System Information (con[.) Type' ❑ leaching pits number. ❑ 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.): Soils were dry at the time of inspection. No signs of hydraulic failure. No liquid was present in one leaching gallery and 18"of liquid was noted in the second. Vegetation was not impacted,and no high staining was noted inside the leaching galleries. Top of leaching galleries was 25 inches below grade, and the bottoms were 6 feet below grade. 2-1,000 Gallon Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): 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 ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Properly Address Attorney Lisa L.Halbert: Bacon Wilson,P.C. Owner Owners Name information quiris Northampton MA 01006 9/4/2014 Page tor every Cnyrtava,P vase. State Zip code Date of Inspection D. System Information (cont.) Site Exam'. • Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >8 Feet feet Please indicate all methods used to determine the high ground water elevation. • Obtained from system design plans on record If checked,date of design plan reviewed. 1987 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) • Checked with local Board of Health-explain. Records. Original design notes no oxides to a depth of 8.5 feet. ❑ Checked with local excavators,ins tallers-(attach documentation) ❑ Accessed USGS database-explain. You must describe how you established the high ground water elevation: From BOH records(original system design from 1987). Before filing this Inspection Report,please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Aggress Attorney Lisa L.Halbert Bacon Wilson,P.C. Owner Owner's Name information o is Northampton MA 01006 9/4/2014 page- a fog every Cityfto n State Zip Code Date of Inspenim page. D. System Information (cant.) Sketch Of Sewage Disposal System.Provide a view 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.Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately //1� J/1� �`j T A\& 51 3 S EP r -r-A-k/c SYSre rt ( IWL I Nix. .V3 ) (4 0.•-.-t_ / q lit 1-7-10 reL V)01 /001V ' r -1 U^� V a ire t � 0_ r 1. e? VAlt awl " 1�•9 I ✓4. et V o- L. n 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Fair Street Property Address Attorney Lisa L.Halbert. Bacon Wilson,P.C. Darter owner's Name information q reVery Northampton MA 01006 9/4/2014 page City/Town State Zip Code Date of InspMlon E. Report Completeness Checklist E Inspection Summary'.A,B,C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r--- LI a/h 1 1 y ,,,7C it 1 j 1 .b V Lc ?JI � , • KARL'S EXCAVATING INC. Fzurtling-Compress-Rents/•Grml Septic Tani Installation.pumping•gullda2Mg 327 River Drive HADLEY, MASSACHUSETTS 01035 Phone 544539G 3/7 1500 gallon tank 3/7 20' sched 40 3/7 2- 1000 gal dry wells 3/7 40' sdr 35 3/7 distribution box 3/7 70 yds 3/7 truck stone 3/7 10 tons 3/8" stone 3/7 tax 3/7 backhoe 3/7 pump cess pool 3/7 laborers 3/7 dump truck- haul off site AttUNr DUE KARL'S EXCAVATING INC. '"qE %MI; Ni Sir 4/11/88 2425 BALANCE FORWARO 500. 100 700 160 25 7D0 243 115 40 540 80 160 135. 00 00 00 00 00 00 00 00 00 00 00 00 Ogaribctotew KARL'S EXCAVATING INC. S tank Outlet baffle 39 Fair St Northampton, MA 09,04,2014 S tank Inlet baffle 39 Fair St Northampton, MA 09.04 2014 Leaching pit(north) 141 Fair St Ext. Northampton, MA 09.04.2014 / t CY q.- v x .'� --#-• Ip - Ypn Na m o°' ° g mot ' s ' $ d x, aG X r7.7 • 5 New Distribution Box Installed 2 39 Fair St Northampton, MA 09.06 2014 New Distribution Box Installed 39 Fair St Northampton, MA 09.06.2014