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'/