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539 Septic Inspection 2003 BOARD OF HEALTH MEMBERS :HARD P.BRUNSWICK,M.D., MPH,Chair EMARIE KARPARIS,R.N.,MPH JAY FLEITMAN,M.D. ER]. McERLAIN,Health Agent CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH 210 MAIN STREET 01060 (413)587-1213 ), 2003 .ouis Tacy Vesthampton Rd. nce, MA 01062 RE: Sewage Disposal System Inspection 539 Westhampton Rd.,Florence Mr. Louis Tacy: dorthampton Board of Health is in receipt of a report on the Subsurface Sewage Disposal System Inspection icted by Raymond Mieczkowski at 539 Westhampton Rd., Florence on June 9, 2003. That inspection report ates 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 rity of Massachusetts General Laws,Chapter 2IA, Section 13,you(or the subsequent owners of the property)are tv ordered to repair the subsurface sewage disposal system at 539 Westhampton Rd.,within two(2)years of ate of the inspection, (by June 9, 2005). If further degradation of the sewage disposal system occurs (e.g. sewage ng to the surface of the ground),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 n installer, in accordance with the requirements of 310 CMR 15.000, and with plans prepared by a Registered Irian or Registered Professional Engineer and approved by the Northampton Board of Health. 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 ceipt of this notice. e feel free to contact the Board of Health office,at 587-1213, if you have any questions concerning this notice. <you for your anticipated cooperation in this matter. truly yours, J. McErlain h Agent ied Mail#7001 1940 0005 1331 7330 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT/T O! c, JUL 9 2003 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 539 WESTHAMPTON ROAD Owner's Name: LOUIS TACY Owner's Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Date of Inspection: JUNE 9,2003 Name of Inspector:(please print)RAYMOND MIECZKOWSKI Company Name: SYSTEMS Mailing Address. P.O.BOX 684 HADLEY,MA. 01035 Telephone Number: 413-374-0483 CERTIFICATION STATEMENT 1 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 fimction and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority XX F Inspector's Signe re: Ill.rer 4 / /t Date: 6/16/2003 The system inspector shall submit a .,y 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 10,000 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. Notes and Comments ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACY Date of Inspection: JUNE 9,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A 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: B. System 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If`not determined"please explain. N/A 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 exultation 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. ND explain: N/A 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 obstruction is removed distribution box is leveled or replaced ND explain: N/A 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACT Date of Inspection: JUNE 9,2003 C. 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 public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15303(1xb)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 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 conform 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACY Date of Inspection: JUNE 9.2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ XX Liquid depth in cesspool is less than 6"below invert or available volume is less than'/:day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ XX Any portion of a cesspool or privy is within a Zone 1 of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX My 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) YES (Yes/No)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 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) yes no XX the system is within 400 feet of a surface drinking water supply XX the system is within 200 feet of a tributary to a surface drinking water supply _ XX 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 D 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. 'age 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Dwner's Name: LOWS TACY Date of inspection: JUNE 9,2003 Check if the following have been done.You must indicate lyes or 'no as to each of the following: Yes No XX _ Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks XX Has the system received normal flows in the previous two week period XX Have large volumes of water been introduced to the system recently or as part of this inspection N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX Was the facility or dwelling inspected for signs of sewage back up XX Was the site inspected for signs of break out XX _ Were all system components,excluding the SAS,located on site XX _ 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 XX Was the facility owner(and occupants if different from owner)provided with information on the p opc maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no XX Existing information.For example,a plan at the Board of Health. — XX Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 MR 15.302(3)(6)] SEPTIC TANK OUTLET BAFFLES WAS BROKEN AND AT BOTTOM OF SEPTIC TANK/ Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACY Date of Inspection: JUNE 9,2003 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO[if yes separate inspection required] Laundry system inspected(yes or no):N/A Seasonal use:(yes or no):YES Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):NO J ast date of occupancy:DWELLING CURRENTLY OCCUPIED COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:OWNER Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped:_gallons–How was quantity pumped determined? Reason for pumping:N/A TYPE OF SYSTEM XX Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: SYSTEM INSTALLED IN THE LATE 1960'S PER OWNER Were sewage odors detected when arriving at the site(yes or no):NO 'age 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACY Date of Inspection: JUNE 9,2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition ofjoints,venting,evidence of leakage,etc.): SEPTIC TANK: XX(locate on site plan) Depth below grade: 17" Material of construction:XX concrete_metal fiberglass polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1200 GALLON TANK Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:N/A Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:N/A Distance from bottom of scum to bottom of outlet tee or baffle:N/A How were dimensions determined:ALL MEASUREMENTS WHERE FIELD MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK IS IN FAIR CONDITION OVERALL//SOME SIGNS OF HYDROGEN SULFIDE DETERIORATION//SOME SIGNS OF HYDRAULIC FAILURE//CONCRETE OUTLET BAFFLE BROKEN OFF AND HAS ALLOWED SOLIDS TO PASS TO LEACH TANK GREASE TRAP:N/A(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass polyethylene other (explain): Dimensions: 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: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACY Date of Inspection: JUNE 9,2003 TIGHT or HOLDING TANK:N/A (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (if present must be openedxlocate on site plan) Depth of liquid level above outlet invert: N/A 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.):NO DISTRIBUTION BOX ON THIS SYSTEM—PIPE GOES DIRECTLY FROM SEPTIC TANK TO LEACH TANK PUMP CHAMBER:N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACY Date of Inspection: JUNE 9,2003 SOIL ABSORPTION SYSTEM(SAS):XX (locate on site plan,excavation not required) If SAS not located explain why: Type XX leaching pits,number:I LEACH TANK 8.5'LX5'W leaching chambers,number: _leaching galleries,number: _leaching trenches,number,length: _leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): SIGNS OF HYDRAULIC FAILURE/NO SURFACE BREAKOUT YET/DUG DOWN TO TOP OF TANK AND FOUND WATER 10"BELOW TOP OF TANK IN STONE/NO SPONGY SOILS/NO ODORS/ CESSPOOLS: N/A(cesspool must be pumped as part of inspection)(loate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N/A (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cceuinued) Property Address: Owner's Name: Date of Inspection: 539 WESTHAMPTON ROAD NORTHAMPTON MA LOUIS TACY JUNE 9.2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feel.Locate where public water supply enters the building. 64-t ',A11wt Q• r, UM ti3 of Pu470 t5 6_ E = 45, &' 57, Z A -0= y.7' Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 539 WESTHAMPTON ROAD NORTHAMPTON,MA Owner's Name: LOUIS TACY Date of Inspection: JUNE 9,2003 SITE EXAM Slope 10% Surface water N/A Check cellar Y Shallow wells NONE Estimated depth to ground water 4+ feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: XX Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high round water elevation: SITE IS FAIRLY WELL SLOPED/SPOKE WITH OWNER AND APPROXIMATED ORIGINAL GRADE PRIOR TO POOL PLACEMENT/HE SAID THAT HE HAS NEVER HAD WATER IN HIS CELLAR BUT THAT WHERE WE WHERE WAS AN AREA OF HIGH GROUNDWATER FLOW ORIGINATING FROM ACROSS THE STREET/IT APPEARS TO BE WET AT THE BOTTOM OF THE SLOPE BEHIND HIS HOUSE/DUG DOWN WITH A POST HOLE DIGGER AND FOUND SOME APPARENT MOTTLING AT APPROXIMATELY 4'/