HomeMy WebLinkAboutInspection Report 2000 Sept 15 - System #1_ SEf� t 9 2000
FIEALTN (�EP'f.
316 Route 28
West Yarmouth, Massachusetts
September 15, 2000
_ Prepared For:
Philips Van Heusen Company
-- c/o Southeast Commercial Real Estate
95 State Road
Bourne, Massachusetts 02532
I1 P Providing Innovative Solutions For...
Solid Waste Health & Safety
e
Hazardous Waste Environmental Monitoring
Materials Management Compliance Outsourcing
- Phone: (508) 790-8102
Fax: (508) 790-7119
P.O. Box 1988, Hyannis, MA 02601
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
One Winter Street, Boston MA. 02108 (617) 292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
PROPERTY ADDRESS: 316 Route 28, West Yarmouth NAME OF OWNER: Philips Van Heusen Corp.
DATE OF INSPECTION: September 12, 2000 ADDRESS OF OWNER: c/o S.E. Commercial R.E.
NAME OF INSPECTOR: (Please Print) Terry F. Bauer 95 State Road, Bourne, MA. 02532
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000)
COMPANY NAME: Green Seal Environmental, LLC
MAILING ADDRESS: Post Office Box 1988, Hyannis, MA. 02601
TELEPHONE NUMBER: (508) 79"102
CERTIFICATION STATEMENT
I 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 inspection. The inspection was performed based on my training and experience in the proper
function and maintenance of or-slte sewage disposal systems. The system:
X PASSES
_ CONDITIONALLY PASSES
_ NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
_ FAILS �J
INSPECTORS SIGNATURE: y. ,.,v.,_ DATE: September 15, 2000
The system Inspector shall submit a copy of t14inspection repot to the Approving Authority (Board of Health or DEP) within thirty (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 Department of Environmental Protection. The original
should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
NOTES AND COMMENTS:
The system was found to be in good working condition on the day of inspection. The system inspected is
one of two systems on site. The combined flow from the entire site building is approximately 860 gallons
per day [60 gallons per day per 1,000 square feet of retail space (50 X 17.251 (17,251 square feet)]. The
combined flow capacity of both systems is 932 gallons per day [system #1 (not inspected) = 264 gallons
capacity, system #2 (inspected system) = 668 gallons capacity). In the opinion of Green Seal
Environmental, Inc., the combined flow capacity provided is enough to handle the anticipated flow from the
building.
Please note that a separate inspection report was submitted to the Yarmouth Board of Health for the
inspection of System #1.
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 316 Route 28, West Yarmouth
Owner: Phillips Van Heusen Company
Date of Inspection: September 12, 2000
INSPECTION SUMMARY: Check A, 6, C, or D:
A. SYSTEM PASSES:
X I have no found any information which indicates that the system vidates any of the failure criteria as defined in 310 CMR
15.303. Arty failure criteria no evaluated are indicated below.
COMMENTS: System was found in good working condition on the day of inspection.
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.
Indicate yes, no, or no determined (Y, N, or ND). Describe basis of determination in all instances. if "not determined", explain why not)
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate
of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the
inspection; or the septic tank, whether or no metal, is cracked, structurally unsound, shows substantial infiltration or
exfiltration, or tank is failure is imminent. The system will pass inspection the endsGng septic tack is replaced with a
conforming septic tank as approved by the Board of Health.
_ Sewage backup or breakout or high 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).
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 remand
revised 9/2198
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 316 Route 28, West Yarmouth
Owner: Philips Van Heusen Company
Date of Inspection: September 12, 2000
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A
Conditions edist 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
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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 fed of surface water
Cesspool or privy is within 50 fed 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 AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and sal absorption system (SAS) and the SAS is within
100 fed of a surface water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone
1 of a public water supply well.
The system has a septic tank and sal absorption system and the SAS is within 50 fed
of a private water supply well.
The system has a septic tank and sal 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 colfform
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 and is equal to or less than 5 ppm.
Method used to determine distance (approximation net valid).
2) OTHER
revised 9/2/98 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 316 Route 28, West Yarmouth
Owner: Philips Van Heusen Company
Date of Inspection: September 12, 2000
D] SYSTEM FAILS: N/A
You must indicate either "Yes" or "No" to each of the following:
I have determined that one or more of the following failure conditions east as described in 310 CMR 15.303. The basis for this
detemtination is identified below. The Board of Health should be contacted to Determine what will be necessary to correct the
failure
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool
Discharge or poxling of effluent to the surface or 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 ovedoaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than %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 potion of a cesspool or privy is within 100 feel of surface water supply or tributary to a surface water supply.
Any potion 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 pmry is less than 100 feet but greater than 50 feel 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 col'rfom bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS: NIA
You 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 10,0D0 gpd or greeter (Large System) and the system is a significant threat to
public health and safely and the environment because one or more of the following conditions exist
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 mapped Zone II of a
public water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).
Please consult the local regional office of the Department for further information.
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 316 Route 28, West Yarmouth
Owner: Philips Van Heusen Company
Date of Inspection: September 12, 2000
Check ff the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes
X
X
X
X
X
X
X
X
X
X
X
No
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has not been
receiving normal flow rates during that period. Large volumes of water have not been introduced into the system
recently or as part of this inspection
As built plans have been obtained and examined. Note if they are not available with N/A
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non -sanitary or industrial waste flaw.
The site was inspected for signs of breakout.
All system components, including the Sal Absorption System, have been located on the site.
The septic tank 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 the site has been determined based on:
Existing information. For Example, Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]. The bottom of the SAS was determined In the field.
The facility owner (and occupants, if different from owner) were provided with information on the proper
maintenance of Sub Surface Disposed Systems.
revised 9/2/98 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 316 Route 28, West Yarmouth
Owner: Philips Van Heusen Comapny
Date of Inspection: September 12, 2000
FLOW CONDITIONS
RESIDENTIAL: NIA V
I
Design flow. g.p.d. /bedroom for SAS.
Number of bedrooms (design) Number of bedrooms (actual):
Total DESIGN flow
Number of current residents:
Garbage grinder (yes or no):
Laundry (separate system) (yes or no): If yes, separate inspection required
Laundry system inspected (yes or no):
Seasonal use (yes or no)
Water ureter readings, if available (last tiro (2) year usage (gpd):
Sump Pump (yes or no):
Last date of occupancy:
lei 8S1
Design flan. 932 gp
Basis of design flaw See
Grease trap present: (yes or m
Industrial Waste Holding Tank
Water meter readings,
on
section for details
present: (yes or no) No
to the Title 5 system: (yes or no) No
ft 1999 — 60K gallons, 2000 —40K galtorus (so far this year —1996 not wettable)
Last date of occupancy: Currently occupied.
OTHER: (Describe)
GENERAL INFORMATION
PUMPING RECORDS and source of information:
The systems were pumped In 1994 (1,500 gallons removed), one system
System pumped as part of inspection:(yes or no) No
If yes, volume pumped: gallons
Reason for pumping
TYPE OF SYSTEM
X Septic tank(distdbution boylsoll absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract.
Tight Tank Copy of DEP Approval
Other
In
APPROXIMATE AGE of all components, date installed (if known) and source of information:
at the site: (yes
revised 9/2/98 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 316 Route 28, West Yarmouth
Owner: Philips Van Heusen Company
Date of Inspection: September 12, 2000
BUILDING SEWER:
(Locate on site plan)
Depth below grade: Line exits under building slab.
Material of construction _ cast iron X 40 PVC _ other (explain)
Distance from private water supply well or suction line WA
Diameter 4"
Comments: (condition of joints, venting, evidence of leakage, etc.) Unable to observe sewer. Line exits under building slab.
SEPTIC TANK:
(Locate on site plan)
Depth below grade: 4"
Material of construction X concrete _ meta _ Fiberglass _ Polyethylene _ other (explain)
If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/NO)
Dimensions: 8.5' x 5' x 4'
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 27"
Scum thickness: 0"
Distance from top of scum to top of ou let tee or baffie: WA
Distance from bottom of scum to bottom of outlet tee or baffle: WA
How dimensions were determined Direct measurement
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
Inlet and outlet tees in good condition, liquid level at outlet Inver, no apparent leaks. Not recommended for Dumoine.
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:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 316 Route 28, West Yarmouth
Owner: Philips Van Heusen Company
Date of Inspection: September 12, 2000
TIGHT OR HOLDING TANK: WA (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other (explain)
Dimensions:
City: Gallons
Design flaw. gallons/day
Alarm present
_- Alarm lei: Alarm in waking order Yes; No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
_ DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc. J
"D" box In good condition. No signs of solids carryover. No apparent leaks. "D" box Is level and distributing fluid evenly.
PUMP CHAMBER: NIA
(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.)
revised 9/2/98 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 316 Route 28, West YArmouth
Owner: Philips Van Heusen Company
Date of Inspection: September 12, 2000
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by nori-intrusive methods)
If not located, explain:
Type:
Leaching pits, number.
'— Leaching chambers, number:
Leaching gables, number. 9 flow diffusers (w/2' of stone all around)
Leaching trenches, number, length:
Leaching fields, number, dimensions:
— Overflow cesspool, number,
Alternative system:
Name of Technology:
Conments:
(note condition of sal, signs of hydraulic failure, level of ponding, damp sal, condition of vegetation, etc.)
No signs of hydraulic failure. No ponding noted. SAS consists of 9 flow diffusers with 2 feet of stone all around.
CESSPOOLS: N/A
(locate 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 (cesspool must be pumped as part of inspection)
Comments::
(note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.)
PRIVY: NIA
(locate on site plan)
Materials of construction: Dimensions: _
Depth of solids:
Comments:
(note condition of sal, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
revised 912/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 316 Route 28, West Yarmouth
Owner: Philips van Heusen Company
Date of Inspection: September 12, 2000
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (locate where public water supply canes into house)
revised 9/2/98 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 316 Route 28, West Yarmouth
Owner: Philips Van Heusen Company
Date of Inspection: September 12, 2000
NRCS Report name
Soil Type
Typical depth to
USGS Date web site visited September 12, 2000
Observation Wells checked Mlw-29
Ground water depth: Shallow X Moderate Deep
SITE EXAM Slope: Flat (slight slope to west)
Surface water. Cranberry bog is approximately 170 feet west of SAS
Check Cellar. No cellar on site
Shailowwells: None nearby
Estimated Depth to Groundwater 8.0 feet Feet (estimated adjusted groundwater from the ground surface).
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site (Abutting property, observation hole, basemod sump, etc.)
X Determined from local conditions
Checked with local Board of Health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
X Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
The seasonal high groundwater elevation was determined using the USGS and Cape Cod Commission
method. Groundwater was measured to be 10 feet below the surface in a soil boring located approximately
15 feet away from the SAS. The surface elevation at the boring was assumed to be at the same
approximate elevation as the ground surface above the SAS. Please note that survey equipment was not
used to make this determination.
The SAS was partially excavated using a backhoe. The bottom of the SAS was measured to be 2'11" below
the surface (7'1" above encountered groundwater).
The site is located in Zone A of indicator well MIW-29. The August 2000 adjustment (the latest Cape Cod
Commission information) for that indicator well is 2.0 feet upward. This results in a seasonal high
groundwater elevation of 8.0 feet below the surface. When subtracted from the SAS bottom elevation the
separation was found to be approximately 51".
revised 9/2/98 11
Septic System Sketch
Soil Boring O
SAS
89, 4— 19 flow diffusers w/
2' stone all around)
96, "D" Box
100, 44_ Septic Tank
49'
Cross Section
aog Ground Surface
to cvanaeccY
.A'Jp•hl Septic Tank z1r.
edge °{ SpS ❑ SAS
"D" Box
U 5.t..
#316 PEAT
0
To Route 28
Adjusted groundwater
(2 feet higher, 8' below
he surface)
Location: Cranberry Factory Outlet Not To Scale
316 Route 28 Based on Visual Observations
b Rest Yarmouth, MA
ohD Date: September 11, 2000
0