679 Septic Inspection 2002 COMMONWEALTH OF MASSACHUSEI 1 S
EXECUTIVE OFFICE OF ENVIRONMENTAL AFF
DEPARTMENT OF ENVIRONMENTAL PROTECT]
TITLES
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS -
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
rty Address: 679 Westhampton Road, Northampton, MA
rs Name: Ed Kendall
rs Address: 679 Westhampton Rd. , Florence, MA 01062
d Inspection: 8/2/02
to: Board of Health, Northampton:
as: Owner Number: SSDS-700
of Inspector: Thomas S. Leue
zany Name: Homestead Inc.
g Address: 1664 Cape St. . Williamsburg. MA 01096
)hone Number: (413) 628-4533
tTIFICATION STATEMENT
ify that I have personally inspected the sewage disposal system at this address and that the information
ted below is true, accurate and complete as of the time of the inspection. The inspection was performed
I on my training and experience in the proper function and maintenance of on-site sewage disposal
ms. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (310 CMR 15.000).
peptic system condition must be evaluated and classified into one of the following four conditions:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
pystem condition: Passes
actor's Signature:
Date: August 2 , 2002
Iystem Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health
BP) within thirty(30)days of completing this inspection. If the system is a shared system or has a design
of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
nal office of the DEP. The original should be sent to the system owner and copies to the buyer, if
cable and the approving authority.
s and Comments
This report only describes conditions at the time of inspection and under the conditions of use at that
This inspection does not address how the system will perform in the future under the same or
rent conditions of use.
5 Inspection Form 6/15/2000
page 1 of 10
Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
rty Address: 679 Westhampton Road, Northampton. MA
r: Ed Kendall
of Inspection: 8/2/02
:Non Summary: Check A,B, C, D or E/ALWAYS complete all of Section D:
System Passes:
I have not found any information which indicates that any of the failure criteria as described in 310
CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
vents:
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. Answer yes,no, or not determined (Y,N, or ND) in the for the following
statements. If"not determined"please explain.
9 The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is
rrally unsound, exhibits substantial infiltration or exfiltration,or tank failure is imminent. The system will
aspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of
1. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of
liance indicating that the tank is less than 20 years old is available.
cplain:
Observation of sewage backup or break out or high static water level in the distribution box due
ken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass
:lion if(with approval by the Board of Health). _ broken pipe(s) are replaced
_ obstruction is removed
distribution box is levelled or replaced
plain.
IL The system required pumping more than four times a year due to broken or obstructed pipe(s).
ystem will pass inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
xplain
IL. Other: explain:_
urther 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
m is failing to protect the public health, safety or the environment:
ystem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that
ystem 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.
5Inspection Form 6/1512000
page 2 of 10
Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION (continued)
rty Address: 679 Westhampton Road. Northamoton, t9R
r: Ed Kendal]
pf Inspection: 8/2/02
System will fail unless Board of Health (and Public Water Supplier, if any)determines that the
r 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
e water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I 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
e water supply well** Method used to determine distance
s system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria
)latile organic compounds indicates that the well is free from pollution from that facility and the presence
monia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
ggered. A copy of the analysis must be attached to this form.
her:
System Failure Criteria applicable to all systems:
aost indicate either"Yes" or"No" as to each of the following for all inspections:
Y)or NO (N)
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
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" below invert or available volume less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
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 cesspool privy is within a Zone I of a public well.
Any portion of cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply 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.]
he system fails. I have determined that one or more of the above failure criteria exist as defined in 310
.5.303, therefore the system fails. The system owner should contact the Board of Health should be
cted to determine what will be necessary to correct the failure.
Inspection Form 6/15/2000
page 3 of 10
Homestead Inc.
CIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION (continued)
rty Address:
r:
if Inspection:
679 Westhampton Road, Northampton, MA
Ed Kendall
8/2/02
irge Systems:
considered a large system the system must serve a facility with a design flow of 10,000 to 15,000 gpd.
rost indicate either"Yes" or"Noll as to each of the following:
flowing criteria apply to large systems in addition to the criteria above:
Y)or NO (N)
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
:d Zone II of a public water supply well)
answered "yes"to any question in Section E the system is considered a significant threat, or answered
in Section D above the large system has failed. The owner or operator of any large system considered a
icant threat under Section E or failed under Section D shall upgrade the system in accordance with 310
15.304. The system owner should contact the appropriate regional office of the Department.
PART B: CHECKLIST
if the following have been doneYYou must indicate"ves" or"no" as to each of the following:
Y)or NO (N)
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 the inspection?
Were as built plans of the system obtained and examined? (If they are not available note as N/A)
Was the facility or dwelling was inspected for signs of sewage back up?
Was the site was 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 septic tank inspected for the condition
baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
ize and location of the Soil Absorption System(SAS) on the site has been determined based on:
a) Existing information. For example, a plan at the Board of Health.
b) Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
tce is unacceptable) [15.302(3)(b)].
The facility owner(and occupants,if different from owner) were provided with information on proper
enance of Subsurface Sewage Disposal Systems(SSDS).
Inspection Form 6/15/2000
page 4 of 10 Homestead Inc
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C: SYSTEM INFORMATION
rty Address:
r:
f Inspection:
679 Westhampton Road, Northampton, MA
F� eendall
8/2/02
FLOW CONDITIONS
)ENTIAL
:known DESIGN flow based on 310 CMR 15.203 (gallons/day)
Number of bedrooms(design)
3 Number of bedrooms (actual)
1 Number of current residents
N
Y
Y
Is there a garbage grinder ?(Y or N) _
Is there a Laundry Hookup?(Y or N)
Is the Laundry a separate system? (Y or N) (If yes,separate inspection required)_
N I Seasonal use (Y or N)
16 Water meter readings,if available (last two years usage) (gallons per day)
N Sump Pump (Y or N)_
tinuOUs Date of last occupancy _
MERCIAL/INDUSTRIAL
tf establishment:
1 flow (based on 310 CMR 15.203): gpd
of design flow (seats/persons/sqft,etc.):
trap present(yes or no):
rail waste holding tank present(yes or no):
meter readings,if available:
ate of occupancy/use:
It(describe):
GENERAL INFORMATION
ling Records
e of information: Pu ped summer, 2001 says Owner.
Was system pumped as part of the inspection(Y or N)
yes, volume pumped: gallons --How was quantity pumped determined?
:ason for pumping:
)mment:
's OF SYSTEM:
Septic tank, a cliiitaihstessis, soil adsorption system.
Single cesspool
Overflow cesspool
Privy
Shared system(Y or N) (if yes, attach previous inspection records, if any)
Innovative/Altemative technology. Attach 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):
Inspection Form 6/15/2000
page 5 of 10 Homestead Inc.
DFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
•ty Address:
f Inspection:
679 Westhampton Road. Northampton. KA
Ed Kendall
8/2/02
Were sewage odors detected when arriving at the site(Y or N):
OXIMATE AGE of all components, date installed(if known) and source of information:
im from 1955. says Owner
)ING SEWER: (located on site plan)
Average depth below grade 20' Distance from private water supply well or suction line
Material of construction: _cast iron X Sch.40 PVC _other(explain)_
ents: (condition of joints, venting, evidence of leakage,etc.) No oroblems seen.
[C TANK: I' (located on site plan)
Material of construction: X concrete _metal _FRP polyethylene_other(explain)
24 Depth below grade (inches)
48 Septic tank width (inches)
108 Septic tank length (inches)
42 Septic tank height (inches)
2 Calculated gross volume (gallons)
8 Air space in tank (inches)
760 Net Volume
18 Baffle depth
3 Sludge thickness
0 Scum thickness
(gallons)
(inches)
(inches) Represents average
(inches) Represents average
Top of sludge layer to bottom
21 of outlet tee or baffle (inches)
Bottom of scum layer to
10 bottom of outlet tee or baffle (inches)
Top of scum layer to top of
6 outlet tee or baffle (inches)
Lents: (recommendation for pumping,conditions of inlet and outlet tees or baffles, depth of liquid
level in relation to outlet invert, structural integrity, evidence of leakage, etc.)
Tank structurally OK. Baffles intact. Tee added to outlet recently.
1 in tank appropriate. Art Cement Products tank.
limensions were determined: Measured.
Inspection Form 6/15/2000
page 6 of 10 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
rty Address:
r:
if Inspection:
679 Westhampton Road, Northampton, MA
Ed Kendall
8/2/02
'CHAMBER: N/A (part of pump-up systems only)
in working order: (Y or N)
s in working order: (Y or N) _
tents: (note condition of pump chamber, condition of pumps and appurtenances, etc.)
IIBUTION BOX: MA (if present must be opened)(locate on site plan) ("D-box")
of liquid level above outlet invert:
tents: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into
of box, recommendations for repairs, etc.) No d-box in system.
ADSORPTION SYSTEM(SAS),y (locate on site plan, excavation not required)
{ not located explain why
ag pits& number: one Pit, site built of concrete block and oak cover
ag chambers and number:
rig galleries and number:
rig trenches,number, length:
rig fields, number, dimensions:
ow cesspool, number:
rtive/alternative system,Type/name of technology:
tents: (note soil conditions, signs of hydraulic failure,level of ponding, condition of
problems seen on surface. No evidence of breakout.
aced in last few years. Also a separate drywell for
ted, but not opened.
Inspection Form 6/15/2000
vegetation, etc.)
Oak top
laundry,
page 7 of 10 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(continued)
rty Address: 679 Westhampton Road, Northampton, MA
r: Ed Kendall
of Inspection: 8/2/02
T OR HOLDING TANK: tic. (tank must be pumped at time of inspection) (locate on site plan)
below grade:
al of construction: _concrete _metal FRP polyethylene_other(explain)
isions:
ity: gallons
r flow: gallons/day
level: _ Alarm in working order Yes No
if last pumping:
tents: (conditions of inlet tees, condition of alarm and float switches, etc.)
POOLS: N/A (cesspool must be pumped as part of inspection) (locate on site plan, if any)
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(cesspool must be pumped as part of inspection)
tents: (note soil conditions, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
Y: WA (locate on site plan, if any)
ials of construction.
rsions:
of solids:
rents: (note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
%SE TRAP: j (Usually present in certain commercial systems) (locate on site plan)
ial of construction:_concrete_metal _FRP polyethylene_other(explain)
below grade: inches
rsions: inches
thickness: inches
f scum layer to top of outlet tee or baffle: _ inches
n of scum layer to bottom of outlet tee or baffle inches
if last pumping_
cents: (recommendation for pumping, conditions of inlet and outlet tees or baffles,depth of liquid level in
ation to outlet invert, structural integrity,evidence of leakage, etc.)
Inspection Form 6/15/2000
page 8 of 10 Homestead Inc.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(continued)
rty Address: 679 Westhampton Road, Northampton, MA
;d Kendall
flnspection: 8/2/02
EXAM
e water
Cellar
w wells
led depth to ground water: >10 feet
indicate(check) all the methods used to determine high groundwater elevation:
Obtained from system design plan on record- If checked, date of design plan reviewed:
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
_ Check local excavators, installers-(attach documentation)
_ Accessed USGS database- explain:
lust describe how you established the high groundwater elevation.
Very sandy soi l. basement never floods.
ANTS•
Recommend pumping on a 3 to 5 year schedule. Also, a copy of the
attached plan posted in the basement/utility area would keep this
Lnformation accessible in futnreygars for maintenance
IURCES:
Department of Environmental Protection, Western Regional Office,436 Dwight St., Springfield,MA
01103, (413)784-1100;Title 5 Hotline- (800)266-1122
Inspection Form 6/15/2000
page 9 of 10
Homestead Inc.
Leaching pit North
imm
septic tan MN 9 a
IA' 1tti N
2A tiCt) 0
N
M
14O
l
N
' drywell or leach pit for laundry
v
N
Outline of House
Note: No drinking wate sources within 100' radius.
Hate: owner: - HOMESTEAD INC.
As-Built Drawing g/2/02 Ed Kendall
Existing Septic System 679 Westhampton Road Thomas S. Leue R.S.
Revision Date: Florence, MA 01062 ^-' 1664 cape St.
Scale: 1 : 20' Williamsburg,MA 01096
_. 141316284533
Except as Noted