903 Septic Inspection 2000 BOARD OF HEALTH
MEMBERS
CYNTHIA DOURMASHKIN,R.N.,
ANNE BURES,M.D.
ROSEMARIE KARPARIS,R.N.MPH
PETER J.McERLAIN,Health Agent
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET
01080
(413)587-1213
December 5, 2000
Mr. John Geryk
903 Florence Rd.
Florence, MA 01062
RE: Sewage Disposal System Inspection
903 Florence Rd Rd Florence
Dear Mr. Geryk:
The Northampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System Inspection
conducted by Pamela Bissell at 903 Florence Rd.,Florence on November 16, 2000. That inspection report indicates that
your subsurface sewage disposal system 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 2IA, Section 13,you(or the subsequent owners of the property)are
hereby ordered to repair the subsurface sewage disposal system at 903 Florence Rd. within two(2)years of the date of
the inspection,(by November 16,2002). 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#7099 3400 0003 5607 4458
•
ANGEO PAL:.(ELLLICCI
Governor
Property Addresu:
On.of Inspector n
Nam.of Inspector:(Rees.Pratt O.1heX.A r
Ire D LP sypeowed syatrn inspector pursuant to Section 15.340 of Tree 5 1310 CMR 15,0001
Company None: ..Affordable Home and Septic Inspections Inc.
M&r.g A6e4 51 Laurel St.
Telephone Num pO Holyoke,Ma.01040 413-532-8600
CERTIFICATION 5 rATENfENT
I certify the: I h personally inspected the swag•dispose'system at this .duress and that the infotmetion r ported below is true, .cco a e
and complete a: 0 the time of inspection. Tne inspection was performed based on my training and esperienc. In the proper function and
maintenance of on site sewage disposal systems. The system.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFT
DEPARTMENT OF ENVIRONMENTAL PROTEC
ONE WINTER STREET, BOSTON MA 02108 (614)2925500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
nna s,s/r` $ 11 d. CERTIFICATION
ft(fs More, „ J' A Nn of O.rrw
gf 4/0-c Address of Owner:
B 5 2000
RS'
.." '.AMPTON BOARD OF ft EAU,
TRUDY CCU
Se:retary
DAVID B STRUN5
Cm=_s goner
Passes
Conditionally Passes
/teas Further Evaluation By the Local Approving Authority
lads gJn
Inspector's Signet,re:
OWE 1(114(do
ne System Inzpe nor shall submil a copy of this inspection report to the Approving Au:horay leoard of Heals or DEplwimin th ny 130' days Pr
complying this it ::Ion. It the system Is a share:system or has a des.gn flow of 10.000 gpd or greats.t. inspector and the system owner
shah submit the n urn to the appropriate regional office of the Department of Environmental Protection. The • gmal should be sent to the
system owner and copies sent to the buyer,if applicable, and the approving authority
NOTES AND CC'. .ENTS
sac is e I ,tw it.<
prised P/2/9 8
Peer I of I
C: r:,:s^...afloat'repo
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
(-/ CERTIFICATION(eondrardl
Property Adxb� Q g�a `J rah LW R8 iCd,t(<t.,..�Y.,,r�.
Owner; X�jL
Owe of hspectS: fl/
lie
INSPECTION SUMMARY: Check A, B, C, O47
SYSTEM PASSES:
I hey m found any information which indicates that any of the failure conditions described in 310 CMR 15,303 e
via not evaluated are indicated below.
COMM TS•
t. Any failure
B. SYSTEM CONDITIONALLY PASSES: -
One or more system components as described in the "Conditional Pass'section need to be replace
completion of the replacement or repair.as approved by the Board of Health, will pass.
Indicate yes,no.or not determined(Y,N. or ND). Describe basis of determination in all instances. If "not de
The septic tank is metal, unless the owner or operator has provided the system inspector
Compliance(attached] indicating that the tank was installed within twenty 120)years ono
the septic tank, whether or not meter,is cracked.structurally unsound, shows substantial
failure is jmns rent The system will pass inspection if the existing septic tank is replaced
epprr eed by the Board of Health.
or repaired. The system, upon
ermined-, explain why not.
ith a copy of a Certificate of
to the date of the inspection, or
infiltration Or exfi0ration, or tank
ith a complying septic tank as
Sewage backup or breakout or high static water level observed in the distribution box is d e to broken or obstructed pipets)
or due to a broken, settled or uneven distribution box. The system will pass inspection if with approval of the Board of
Health).
broken pipelsl 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 pip I
inspection if(with approval of the Board of Heelthl:
broken pipelsl are replaced
obstruction is removed
revised 9/2/98
Page 2 of I I
The system will pass
Property AddyeN;
0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION Iconliruad)
9113 JJ /eltn(.OS 04 .
on.nl wpecu tl'Ib/OD
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
a)iietznyA4nk,
Conditions exist which require further evaluation by the Board of Health in order to determine if th
public health, safety and the environment.
11 SYSTEM WILL PASS UNLES RD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CM
IS NOT FUNCTIONING MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY
Cess41 or privy is within 50 feet of surface water
Cesspool or privy is within 501eet of• bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE EN
_ The system has a septi tank and soil absorption system (SAS)and the 545 is within 10
tributary to a s - e water supply.
_ The sys as a septic tank and soil absorption system and the SAS is within a Zone I
_ ystem has a septic tank and soil absorption system and the SAS is within 50 feet o
he system has a septic tank and soil absorption system and the SAS is less than 100 I
private water supply well, unless a well water analysis for conform bacteria and volatile
well is free from pollution born that facility end the presence of ammonia nitrogen and n
than 5 ppm. Method used to determine distance lapprosimabon not valid).
31 OTHER
system is failing to protect the
15.303(11(b)THAT THE SYSTEM
NO THE ENVIRONMENT:
ETERMINES THAT THE SYSTEM IS
IRONMENT:
feet of a surface water supply or
1 a public water supply well.
a private water supply well.
t but 50 feet or more from a
genic compounds indicates that the
rate nitrogen is equal to or less
revised 9/2/98
Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(COrrdraeadl
Property Addgf{as: k /
Dote el Inspection. rl 16 Aro
D. SYSTEM FAILS•
Yqy must indicate either 'Yee or No to each of the following:
I have determined that one or more of the following failure conditions exist es described in 310 CM 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will necessary to correct the failure.
Owner:
No
J
Backup of sewage into facility or system component due to an overloaded or cloggedS 5 or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an verloeded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogge
SAS or cesspool.
Liquid depth in cesspool is less than 6' below Invert or available volume is Ins than 112 d y flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pi• Is).
Number of times pumped_
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwet r elevation.
Any portion of a 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 I of a public well.
JAny portion of a cesspool or privy is within 50 feet of a private water supply well.
JAny portion of a cesspool or privy is less.then 100 feet but greater than 50 feet from a pri ate water supply well with no
acceptable water quality analysis. It the well has been analyzed to be acceptable, attach •opy of well water analysis for
cobfdrm bacteria, volatile organic compounds. ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow of 10.000 gpd or greater(Large System) end the sy tern is a significant threat to public
health and safety and the ronment because one or more of the following conditions exist:
Yes No
'the system is within 400 feet of•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 tlntarim Wellhead Protection Area-IWPA or a mapped Zone ll of a public
water supply we'll
The owner or operator of any such system shell upgrade the system in¢cordance with 310 CMR 15.304121. Please consult the local regional
office of the Department for further infognation.
revised 9/2/98
Page 4 of 11
Property Addrfas: r 0.3ds
Owner: , j
Dote of Inspection:p II/i4 1m
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:You must indicate either 'Yes" or 'No- as to each of the following
J
J
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the sys em has beenaceiving normal flow
rates during that period. Large voiumo of water have not been introduced into the sy tern recently or as part of this
Inspection.
As built plans have been obtained and examined. Note if they are not available with NI
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
Tht site was inspected for signs of breakout.
All system components. excluding the Soil Absorption System, have been located on th site.
The septic tank manholes were uncovered, opened. and the interior of the septic tank w s inspected for condition of baffles
or tees.material of construction, dimensions, depth of liquid, depth of sludge, depth of cum.
The site and location of the Soil Absorption System on the site has been determined bas ed on:
Existing information. For example. Plan at B.O.H.
Determined in the field(if any of the failure criteria related to Part C is at issue, apprcxi ation of distance is unacceptable)
(1 5.302(31(b)I
The facility owner and occupants,if differerd from owner) were provided with informati n on the proper maintenance at
Subsurface Disposal Systems.
revised 9/2/99
Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM YISPECf1ON FORM
PARTgC
}Q9 11—k�-t-erkpKt,v�—�
Property A YSlan. QC a`3 ` �uT e.aca-
Owner: on
One m ktapecti i(I I g/o-g
FLOW CONDmONS
RESIDENTIAL:
Design flow: Lnnl g.p,d./bedtoom.
Number of bedrooms Idgsignl: 3 Number of bedrooms(actual):
Total DESIGN flow 4-IF '
Number of currant residents:
Garbage grinder(yes or no):
Laundry(separate system) I s or nol"-d • II yes,separate inspection required
Laundry system inspected/yes or nol
Seasonal use (yes or no): /, '
Water meter readings,if lable(lest two year's usage Igpol: ( Ouivk VJ
Sump Pump)yes or no):
Last date of occupancy: till
Type of establishment:
Design Row:
Basis of design flow
Grease trap present: (yes qr 1
Industrial Waste Holding ink present: (yes or reel_
Non-sanitary waste Charged to the Title 5 system:(yes or nol_
Water meter rem gs.if available:
Last date of pccupancy:__
qpd I Based on 15.203)
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and swe f information:
ry �K
If yes, pumped
lum ep m pen of impaction: (yes or nol�U
If yes, volume pumped'. gallons
Reason for pumping:
TYPE QF SYSTEM
1 Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system )yes or not Of yes.attach previous inspection records,if any)
IIA Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,dm installed Il known)and source of information: /975
Sewage odors detected when arriving at the site: (yes or no) A
revised 9/2/96
Page 6 of II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
,( SY STE M )� ImNasedl
/ )l
Property Adbe a•i , /
Owner:
One of bsspectia / 1L(d0
BUILDING SEWER:
(Locate on site plan)
Depth below grade: "3_
Material of construction:_cast iron ✓ 40 PVC_other laaplain)
Distance from,private water supply well or suction line 1-20 1-20 Diameter
Comments: (condition of joints, venting,evidence of leakage,etc.)
SEPTIC TANK:jh*L
Vacate on site plan)
Depth grade:
Material at construction:ti�en:
s'conuete_meter_Fiberglass _Polyethylene_otherlexPbiM
If tank is metal.list age age confirmed by Certificate of Compliance_IYes:Nol
Dimensions: /6 if
Sludge depth: 0r' a,
Distance from top of sludge to bottom of outlet tee or battle.
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottont of outlet tee r bent:
How dimensions were determined:ye/urya I p.p R•
SO
Comments': I
Ire mmendation for pumping, co ditio gf inlet s •utl t tees or bames,depth of liquid el in rel;tjo. I?outlet i yen, st uc(oral integr
evidence of L Gage. et .1 ! ' , •..r V 0'
GREASE TRAP:_
(locate on site plan)
Depth below ade:
Material of construction: concrete_metal_Fiberglass _Polyethylene_otherfesplain)
Dimensions:
Scum thickn
DDistance tance from to scam to top of outlet tee or beMc_
Distance tro onom of scum to bottom of outlet tee or baffle:_
Date of eSE pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to
evidence of leakage etc.)
inlet invert. structural integrity.
revised 9/2/y8
Page 1 of t I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
smut INFORMATION(conSrued
1aMrry AP.Ars:j. /E a 4th AnHte— /R Il 11-6144 M1 YM
Thome: AI_-l.
e BO
)tl of impacti JIRO/
FIGHT OR HOLDING TANK:_(Tank must be pumped prior to. or at time of. inspection)
locate on site plan/
Depth below grade:_
Material of construction: concrete_metal_fiberglass Polyethylene_otherleaplainl
Dimensions:
Capacity' gallon
No_
etc.)
Design flow: ons
Alarm present
Alarm level:l: AIArm in working order:Yes
Date ofryevious pumping:.
Comments:
!condition of inlet tee, condition of alarm and float switches,
ox Mel
. ..t°,4
an
.
DISTRIBUTION BOX:! eks-
(locate on site planl
Depth of liquid level above outlet invert ALL,46
Comments:
I note if le el and di nbuugq s equal. • • en • of soligs
den a of lea' into op out of
carryover.j go
f
t. ,(,e. , il wR1r
��l�.�L
PUMP CHAMBER:_
tlocnn on site plan) J
Pumps in working oj4ef. )Yes or Nol_
Alarms in wo jirrg caper Ives or Nal_
omma N
Comments!'
InanKCndiron of pump chamber.condition of pumps
and appurtenances, etc.)
revised 9/2/98 Page of II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
,�--// rlSYUThI DIFORMATIO Icmmued)
Properly Aaaq4���aaa pyO c-3 44",ea _ ic-t v ri only
�y
Owner: tOt 11/II//SO n
Date Wpeo'd 1
SOIL ABSORPTION SYSTEM ISAS1: leA1-ey.L�-
(locate on site plan. it possible:excavation not required,location may be approximated by non-intrusive metho
If not located.explain:
s)
revised 9/2/98
Page 9 of I I
Type:
leaching pits. number:
leaching chambers.number:_ n
leeching galleries,number:
�_rt¢iy
4� 1�-�
leaching trenches.number. length: �Ap UP.+ -eJOes
' O. LS
I
leaching fields,number, dimensions: he- t.a- p.(du""-'
/
overflow cesspool,number:
Alternative system:
Name of Technology:
Comments:
Inure concision n cif soil. signs of hydra 1-failure levet of pis ding d mp soil t•nditi•n of vegetatin e`r
��..��.tePaa.!!
. .
1
frI71.It%SF'a-"�l+•e •.' a 'EacnelliarAll ►inl.
CESSPOOLS:
orate on site plan)
Number and configuration:
Depth-top of liquid to inl)!t invert:
Depth of solids layer: /.--
Depth of scum layer:
Dimensions ceSsPii
Materiels o f c onsird ti t iom
Indication of g/oundw air:
be as of inspection)
inflow!cesspool must pumped part
Comments:
(note condition of soil, signs olnythaulic failure,levet of ponding, condition of vegetation, etc.)
/
PRIVY:-
Ilocay6n site plan)
Dimensions'.
M ateria!s of construction:
Depth of solids_
Comments:
(note condition of soil,signs of hydraulic failure,levet of pointing. condition of vegetation, etc.)
revised 9/2/98
Page 9 of I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART C
....pp � ((��
SYSTEM p(INFORMATION lca,taWl
t1 3 '`7/nz✓ea. / D GL-aZTP-e- "
Owner: Adh Q
Owner: : l
Date al NS ,1�tc afl
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate al%wells within 100' (Locate where public water supply comes into house)
revised 9/2/9?
Per 1 0 of I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Arida ,76,3 �7l>,t,r-e-r_. YCdq(� /LV4 loiL
Owner: µµ
Dote of Irspect:Mot /I/,LIM
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date websit.visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM
Surce WAIN
€aback Cellar
She ow wells
Estimated Depth to Groundwater .D— Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Detign Plans on record
Observed Site !Abutting property.observation hole. basement sump etc.)
JDetermined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, lnnaners
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
V 4,U a.eea. G co
revised 9/2/ 8 Prat 11 of 11