892 Septic Inspection 2003 BOARD OF HEALTH
MEMBERS
0 P.BRUNSWICK,M.D.,MPH,Chair
iEMARIE KARPARIS,R.N.,MPH
JAY FLErTMAN,M.D.
ETER J.McERLAIN,R.S.,MPH
Health Agent
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
(413)587-1214 BOARD OF HEALTH
FAX(413)587-1221 210 MAIN STREET,Room 8
NORTHAMPTON,MA 01060-3167
October 29, 2003
Ns. Kathleen Troisi
24 Norfolk Ave.
Vorthampton, MA 01060
Re: Sewage Disposal System Inspection @ 892 Westhampton
Rd. Florence
Dear Ms. Troisi:
file Northampton Board of Health is in receipt of a report on a sewage disposal system inspection
:onducted at 892 Westhampton Rd., Florence by Nathan Torretti of Clean Septics, Inc., on October
21, 2003. That report indicates the following:
• It was impossible to determine if the sewage disposal system was functioning properly
because the dwelling had been vacant for over six(6) months.
3ased on Mr. Torretti's report your sewage disposal system has been classified as "passed -
ionditionally." In order for the sewage disposal system to be classified as "passed,"the following
nust occur:
• After the dwelling has be occupied for three months you, or the subsequent owner of the
property, must have the sewage disposal system re-inspected.
that inspection must be conducted by a licensed septic system inspector. If the sewage disposal
system is found to be functioning in accordance with the provisions of 310 CMR 15.000 the system will
re reclassified as "passed".
lease feel free to contact the Board of Health office, at 587-1213 if you have any questions concerning
his notice.
"hank you for your anticipated cooperation in this matter.
Eery truly yours, CIL
'eter J. McErlain, Agent
Jorthampton Board of Health
)ert. Mail #7001 1940 0005 1331 4629
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFAM , csd
DEPARTMENT OF ENVIRONMENTAL PROTEC CGS
SO,
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 892 WESTHAMPTON RD
NORTHAMPTON MA
Owner's Name: KATHLEEN TROISI_
Owner's Address: SAME
Date of Inspection: 10/21/03
(�q /WI? Foca,pc)
Name of Inspector: (please print) NATHAN TORRETTI
Company Name: CLEAN$EPTICS
Mailing Address._P.O.BOX 394
LUDLOW.MA
Telephone Number._583-2138
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below
is tare,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
1�Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
�yFails
Inspector's Signature: //,�/,an, �yrR ffistt Date:_10/21/2003
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 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
OFFICAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSEMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 892 WESTHAMPTON RD
NORTHAMPTON.MA
Owner: TROISI
Date of Inspection: 10/21/03
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:
B. System Conditionally Passes:
/ One or mom 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.
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.
ND explain:
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):
ND explain:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
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: HOUSE VACCANT SINCE 4/03;S.A.S.IS NOT RECEIVING NORMAL LIQUID FLOWS
S.A.S.NEED'S RE-INSPECTION 3 MONTHS AFTER OCCUPANCY
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_892 WESTHAMPTON RD
NORTHAMPTON, MA
Owner:_TROISI
Date of Inspection: 10/21/03
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
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 pars 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
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: 892 WESTHAMPTON RD
NORTHAMPTON, MA
Owner:_TROISI_
Date of Inspection:_10121103
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for an inspections:
Yes Igo
t/ Backup of sewage into facility or system component due to 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 disuibution 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 is less than h day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of
times lumped—
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 wa ter
supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
/ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
f/ 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 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]
(Y The system(AL al .1 have determined that one or more of the above failure criteria exist as described in 310
15.303,therefore the system fails.The system owner should contact the Board of Health to determine
what will be nececsary 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`ryes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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 11 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 huge 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.
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:_892 WESTHAMPTON RD
_NORTHAMPTON,MA
Owner: TROISI
Date of Inspection: 10/21/03
Check if the following have been done.You mast indicate"yes"or"no"as to each of the following:
Yesc 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?
1../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 9
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:
Yes no
Existing information.For example,a plan at the Board of Health
✓ _ Determined in Ole field(if any of the failure criteria related to Pmt C is at issue approximation of distance is
unacceptable)[310 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:_892 WESTHAMPTON RD
NORTHAMPTON, MA
Owner. TROISI
Date of Inspection: 10/21/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_3_ 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: 0
Does residence have a garbage grinder(yes or no): _YES
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): —
Seasonal use:(yes or no):_NO_
Water meter readings,if available(last 2 years usage(gpd)): TOWN WATER
Sump pump(yes or no):_NO
Last date of occupancy APRIL 2003
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):_bpd
Basis of design flow(seats/persons/sgf,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: SPRING OF 2002
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:_
/E OF SYSTEM
Septic tank,distsibntenrbnx,soil absorption system
_Single cesspool
Overflow cesspool
_Privy
_Shared system(yes or no)(if 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)
_Tight tank _Attach a copy of the DEP approval
/Other(describe): LEACH PIT
Approximate age of all components,date installed(if known)and source of information:
S.A.S. 27 YRS OLD HOME OWNER
Were sewage odors detected when arriving at the site(yes or no): N�
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_
Owner:_ TROISI
Date of Inspection:
892 WESTHAMPTON RD
NORTHAMPTON MA
10/21/03
BUILDING SEWER(locate on site plan)
Depth below grade: 1'5"
Materials of consnucuon: _ cast iron _XX_ 40 PVC other(explain):
Distance from private water supply well or suction line: N/A
Comments(on condition of joints,venting,evidence of leakage,etc.):
JOINTS.VENTS OK NO SIGNS OF LEAKAGE
SEPTC TANK: f (locate on site plan)
Depth below grade: 9"
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: 10'5" L.5'W,5'D
Sludge depth: NONE
Distance from top of sludge to bottom of outlet tee or baffle: _
Scum thickness: NONE
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: MEASURED
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,stmcnnal integrity,liquid levels as
related to outlet invert,evidence of leakage,Etc.):
PUMP SEPTIC TANK EVERY YEAR:STRUCTURAL INTEGRITY OK LIQUID LEVELS OK 740 LEAKS
GREASE TRAP: (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 owlet 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 owlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_892 WESTHAMPTON RD
NORTHAMPTON .MA
Owner. TROISI_
Date of Inspection:_10/21/03
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/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: NONE (if present must be opened)(locate on site plan)
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,
PUMP CHAMBER:_(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 I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_892 WESTHAMPTON RD
NORTHAMPTON MA
OWNER: TROISI
Date of Inspection: 10/21/03
SOIL ABSORPTION SYSTEM(SAS):_(locate on site plan,excavation not required)
If SAS not located explain why:
7 leaching pits,number. 1
_teaching 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.):
NO SIGNS OF HYDRAULIC FAILURE. SOIL AND VEGETATION OK
CESSPOOLS:_(cesspool must be pumped as part of inspectionxlocate 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[anding,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.):
OFFS INSPECTION AGE DISPOSAL SYSTEM INSPECTION O ASSESSMENTS
PART C
SYSTEM INFORMATION(coatiwed)
Property Address:.
Owner.
Date of inspection:
Srovkle iOFSEWAGE DISPOSAL system including ties to at least two permanent peace landmarks or a sketch of the sewage disposal
benchmarks.jooate all wells within 100 feet.Locate where public water suPPlY eat theboiidin&
Leach ()if
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Propertoy Address: _892 WESTHAMPTON RD_
NORTHAMPTON,MA
Owner: TROISI
Date of Inspection: 10/21/03
SITE EXAM
Slope
S ow wells
Estimated depth to ground water NONE*5'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:
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 ground water elevation.
CHECKED CELLAR