1195 Septic Inspection 1997 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
'roperty Address: 1195 Westhampton Road,Westhampton,MA Address of Owner Bank Boston Mortgage Corp
)ate of Inspection:8-19-97 (If Different)P.O.Box 44090 Jacksonville,Florida
game of Inspector,Karl M,Kuehner 32231-4090
I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000)
2ompany Name: Southampton Sanitary Enaincerina
Tailing Address: 168 County Road_SOUthanIPOn.MA 01073
fekphoue Number,(413)532-3876
:ERTIFICATION STATEMENT:
certify that I have personally inspected the sewage disposal system at this address and that the information win • below is true,
cremate and complete as the time of the inspection. The inspection was performed based on my training and experience in the proper
motion and maintenance of on site sewage disposal systems. The system:
Passes
Conditionally Passes
X Needs Further Evaluation By the Local Approving Authority
_ Fails
nspectors Signature:
Date: 8-19-97
fhe system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing
his 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
ubmit the report to the appropriate regional office of the Department of Environmental Protection.
be original should be sent to the system owner and copies to the buyer,if applicable,and the Approving Authority.
NSPECTION SUMMARY: Check A,B,C,or D:
1] SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR
15.303. Any failure criteria not evaluated me indicated below.
I] SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system
pon completion of the replacement or repair,as approved by the Board of Health,will pass.
odicate yes,no,or not determined(Y,N,or ND).Describe basis for determination in all instances.If "not determined",explain why
iot
The septic tank is metal,unless owner or operator has provided the system Spector with a copy of a certificate of
comp lance(attached)Skating that the tank was installed within twenty(20)years prior to the date of inspection;
or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or
exfltration,or tank failure is eminent. The system will pass inspection if the existing septic tank is replaced with a
conforming septic tank as approved by the Board of Health.
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
erty Address: 1195 Westhampton Road,Northampton,MA
en Bank Boston Jacksonville Florida
of Inspection:8-19-97
FSTEM CONDITIONALLY PASSES(continued)
_ Sewage backup or breakout or static water level observed in the distribution box is due to broken or obstructed
pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of
the Board of Health): Describe observations:
_ broken pipe(s)are replaced
_
obstruction is removed
_ distribution box is leveled or replaced
The system required pumping more than four 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
■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 system is failing to
protect the public health,safety and the environment.
SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT
FUNCTIONING IN A MANNER WHICH WILL PROTECT THE 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.
SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER IF
APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT
THE PUBLIC HEALTH AND SAFETY AND THE 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 a soil absorption system and the SAS is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water
supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliformof ammonia v nitrog®and nitrate compounds volatile organic
indicates that thewell is free from pollution from that facility and the presence nd not valid).
nitrogen is equal to or less than 5 ppm.Method used to determine distance. (Approximation
OTHER:
71 wage sanding in the cellar around drain nines from teakint,nines
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
arty Address:1195 Westhampton Road,Northampton,MA.
er:Bank Boston Jacksonville Florida
of Inspection:8-19-97
YSTEM FAILS:
must indicate either"Yes"or"No"as to each of the following:
I have determined that the system violates one of more of the following failure criteria as defined in 310 CMR 15.303 The
basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary
to correct the failure.
No
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 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 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 pumped_
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater 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.
Any portion of a 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 well with
no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water
analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
LARGE SYSTEM FAILS:
u must indicate either"Yes"or"No"as 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)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist.
The system is within 400 feet of a surface drinking water supply.
The system is within 200 feet of a tributary to a surface water supply.
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)
he owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment
vgam requirements of 314 CMR 5.00 and 6.00.Please consult the local regional office of the Department for further information.
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
petty Address: 1195 Westhampton Road,Northampton,MA
ten Bank Boston Jacksonville Florida
e of Inspection:8-19-97
ck if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
No
Pumping information was requested of the owner,occupant,and the Board of Health.
,2„ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period.Large volumes of water have not been introduced into the system recently or as pail of
the inspection.
yL_ As built plans have been obtained and examined. Note if they ere not available with N/A.
The facility or dwelling was inspected for signs of sewage backup.
The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout
All system components,excluding the Soil Absorption System,have been located on the site.
The septic manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of
baffles or tees material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on site has been determined based on:
x The facility owner(and occupants,if different from owner)were provided with information on the proper
maintenance of Sub-Surface Disposal System.
existing information, Ex.Plan at BOB.
x Determined in the field(if any of the failure criteria related to Part C is at issue,apprnx®ation of distance is
unacceptable)[15.302(3)(b)].
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
fly Addreas:.1195 Westhampton Road,Northampton,MA
�r.Bank Boston Jacksonville Florida
of Inspection:8-19-97
FLOW CONDITIONS
MENTIAle
9 flow: 110 G.p.d./bedroom for S.A.S.
rer of bedrooms:_
bet of current residents:5
age Grinder:(yes or no):JQ_
dry connected to system(yes or no): _
oral use(yes or no):�
r Meter readings,if available(last two(2)year usage(gpd) not available
p pump(yes or no): No
Date of occupancy: 8-19-97
4MERCIAIJINDUSTRIAL
of establishment:
gm flow: gallons May
se trap present:(yes or no)_
shial Waste Holding Tank present dyes or no)_
Sanitary Waste Discharge to the Title 5 System:(yes or no)_
er meter readings,if available:
date of occupancy:_
HER:(Describe)
t date of occupancy:_
GENERAL INFORMATION
MPING RECORDS and source of information
none available
System pumped as part of the inspection:(yes or no)ves
If yes,volume pumped: 1 0 Gallons
Reason for pumping: To allow for inspection of septic tank
'PE OF SYSTEM
_ 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)
Other(explain)
I/A Technology etc.Copy of up to date contract?
(her
PPROXIMATE AGE of all system components,Date installedTif known)and solace of information:
Unknown
ewage odors detected when arriving at the site:(yes or no)- Nom_
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
rty Address:.1195 Westhampton Road,Northampton,MA
r:Bank Boston Jacksonville Florida
of Inspection:8-19-97
DING SEWER:
to on site plan)
below grade: Other(explain)
ial of construction: cast iron 40 PVC_
ace from private water supply well or suction line:
eter:_
nents:(condition of joints,Venting,evidence of leakage,etc.)
ITC TANK:z
ate on site plan)
b below grade:=
aial of construction:x
Concrete_Metal_Fiberglass_Polyethylene_Other(explain)
rk is metal,list age_
Is age confirmed by Certificate of Compliance_(Yes/No)
ensions: 5'X 10'X 5' 1000 gallon
.go depth: 9"
slice from top of sludge to bottom of outlet tee or baffle: 18"
n thickness: 5"
anee from top of scum to top of outlet tee or baffle: 4"
net from bottom of scum to bottom of outlet tee or baffle: 19"
r dimensions were determined: Measured during vmuine
mats: depth of liquid level in relation to outlet invert,structural
ommendation for pumping,condition of inlet and outlet tees or baffles,dep 9
grity,evidence of leakage etc)_ Full transverse baffles in tank should be replaced with tee's
LEASE TRAP:
ate on site plan)
pth below grade:_ Polyethylene lane _Olher(explam)
aerial of construction: Concrete_Metal_Fiberglass_ Y Y
mansions:
mn thickness:_
stance from top of scum to top of outlet tee or baffle:_
stance from bottom of scum to bottom of outlet tee or baffle:_
de of last pumping:
imments:
xommendations for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural
tegnty,evidence of leakage,etc.)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
fly address:1195 Westhampton Road,Northampton,MA
r-Bank Boston Jacksonville Florida
of inspection:8-19-97
IT OR HOLDING TANK: (Tank must be pumped prior to,or at time,of inspection)
to on site plan)
m below grade:_
ial of construction:_Concrete_Metal_Fiberglass_Polyethylene _Other(ewlam)
nsimis:
city: Gallons
pi flow: Gallons/day
n level: Mann in wincing order_Yes:_No:
of previous pumping
menu:
lition of inlet tee,condition of alarm and float switches,etc.)
TRIBUTION BOX: x
;ate on site plan)
nth of liquid level above outlet invert:_
oments:(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc)
g_O__Wely soil conditions distribution box could not be located without heavy eouipment Attempting to locate in my opinion
/kido mor harm than rood to the system
MP CHAMBER:_
:cafe on site plan)
nips in working order:(Yes or No)_
arms in working order(Yes or No)_
=tents:
ate condition of pump chamber,condition of pumps,and appurtenances,etc)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
erty Address: 1195 Westhampton Road,Northampton,MA
err Bank Boston,Jacksonville Florida
of Inspection:8-19-97
ABSORPTION SYSTEM(SAS):,L_
ne on site plan,if possible.excavation not required,but may be approximated by non-intrusive methods)
t determined to be present,explain: Could not be located without heaw equipment. Attempt to locate system would in my
ado more harm than good to the system
Leaching pits,number:
Leaching chambers,number:
Leaching galleries,number:_
Leaching trenches,number ,length:_
Leaching fields,number,dimensions:
Overflow cesspool,number:_
Alternative system:
Name of Technology:
level of condition of vegitation,etc) There as stud
sments:(note condition of soil,signs of hydraulic failure, ponding,
cation of failure
SSPOOLS:_
cate on site plan)
caber and configuration:
pth-top of liquid to inlet raven:
pth of solids layer:
pth of scum layer:
nensions of cesspool:
iterials of construction:
lication of groundwater:
Inflow(cesspool must be pumped as part of inspection
amments:(note condition of soil,signs of hydraulic failure,level of pondmg,condition of vegitation,etc)
&IVY:_
ovate on site plan)
Dimensions:
Materials of construction:
epth of solids:_
omments:(note condition of soil,signs of hydraulic failure,level of pending,condition of vegitation etc)
8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
:ray Address: 1195 Westhampton Road,Northampton,MA
r,Bank Boston,Jacksonville Florida
of Inspection:8-19-97
['CH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references,landmarks,or benchmarks.
Locate all wells within 1001.(Locate where public water supply comes into the house)
attachment:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
rty Address: 1195 Westhampton Road,Northampton,MA
r•.Bank Boston,Jacksonville Florida
of Inspection:8-19-97
to groundwater: >8 feet
indicate all methods used to determine High Groundwater Elevation:
btained from Design Plans on record
bservation of Site(Abutting property,observation hole,Basement sump,etc.)
ktermine it from local conditions
:heck with local Board of Health
heck FEMA Maps
;heck Pumping records
;heck local excavators,installers
Jse USGS Data
,tribe in your own words how you established the High Groundwater Elevation.(Must be completed)
n information available from perc data on nearby property,Knowledge of the area
10
-Stathanya teary e'..g:..oe.,u-.g. Corr-
SSC •S'''----as a ociatara
ENVIRONMENTAL SERVICES
168 County Road Southampton,MA 01073-9547
Phone(413)532-3876 FAX(413)534-2427
Title S Inspection
An inspection of the septic system located at 1195 Westhampton Road,Northampton,was performed on
August 19, 1997 The septic tank was pumped and attempts were made to locate the distribution box and soil
absorption system. The system was in normal service at the time of the inspection.There was no indication
of backup or high water level in the septic tank.The property owner had no information as to t area did of
the system,and the tenant indicated that they had no problems_A visual inspection system
reveal any problems. Due to the rocky conditions in the area attempts to locate the distribution box and soil
absorption system failed.It is my opinion that heavy equipment would be required to locate the components
of the system,and the damage done might out way the mformation received.
There was no indication of system backup,however,paddled septage in the cellar and leaking sewage from
drain lines may indicate a partial sewer line blockage,or badly deteriorated piping.
It is my opinion that further evaluation is necessary by the local Board of Health.
Problem Areas:
No Maintenance schedule
Transverse baffles in septic tank
Puddled sewage in the cellar
Recommendations:
A regular Maintenance schedule should be established in
accordance with Title 5 recommendations.
Inlet and outlet baffles should be replaced with Tee"s
Necessary repairs should be made to eliminate the sewage
problem in the cellar
For further information please refer to the attached inspection two .
Inspector: Karl M.Kuebner President
11
NOLd WUFUISiM
z
0
WATEcjir
LINE
1000 GALLON
SEPTIC
TA N I<
ASSUME D
D 30% LOCATION
SOUTHAMPTON SANITARY
ENGINEERING
INSPECTOR Karl M. Kuehner
NO SCALE
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