HomeMy WebLinkAboutSystem 4 COMMONWEALTH OF MASSACHUSETTS
__1 * ` 11� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
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,�1=tt DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: Riviera Beach Resort SYSTEM 4
327 South Shore Drive
South Yarmouth,MA
Owner's Name: Riviera Beach Limited Partnership
Owner's Address: 20 North Main Street
South Yarmouth,MA 02664-3150
Date of Inspection: October 6,2005
Name of Inspector: (please print) Richard Judd,R.S.
Company Name: Richard Judd,R.S.
Mailing Address: 775 Freeman's Way
Brewster,MA 02631
Telephone Number: 508-896-9316
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 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:
1C
RICHARD tip,. Passes
(1 X Conditionally Passes
JUDD,J.R. k71 Needs Further Evaluation by the Local Approving Authority
-
,n No. 1125 Fails
Inspector's Signature: fr bad ,�.5 ' Date: October 6,2005
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: CONDITIONALLY PASSES
The existing distribution box requires being leveled.
OTHER:Recommend resealing the pitted(intact)interior of distribution box
Recommend the septic tank have a sanitary exit tee be installed(310 CMR 15.227(6)).
****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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
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:
X 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.
NO 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:
YES 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):
NO broken pipe(s)are replaced
NO obstruction is removed
YES distribution box is leveled or replaced
ND explain:
NO 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:
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Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
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 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.
3. Other:
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Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 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.]
NO (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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
_ X 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.
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Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS,located on site?
X 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?
X 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
X _ Existing information.For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable)[310 CMR 15.302(3)(b)]
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Page 6 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 8_ Number of bedrooms(actual): 8
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880.
Number of current residents:N/A. Complex is open and operating.
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):
Seasonal use:(yes or no):YES
Water meter readings,if available(last 2 years usage(gpd)): entire complex:05= 15,394 04=20,909(gpd/avg).
Note:water consumption includes irrigation and pool(s)uses. Water consumption/154 day season
Sump pump(yes or no):YES
Last date of occupancy: 10/11/05 complex closes.
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,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:Per Board of Health: Systems are pumped yearly each fall:records attached.
Was system pumped as part of the inspection(yes or no):NO:Maintenance pumping to be conducted this fall.
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X 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/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):
Approximate age of all components,date installed(if known)and source of information:
Per Yarmouth Health Department:Approval review(DEP)dated 4/8/74(No COC on file)
Were sewage odors detected when arriving at the site(yes or no):NO
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Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
BUILDING SEWER(locate on site plan)
Depth below grade: 37"
Materials of construction: 4" cast iron 40 PVC other(explain):
Distance from private water supply well or suction line:N/A. >10'to town water supply line.
Comments(on condition of joints,venting,evidence of leakage,etc.):
No evidence of leakage was observed within the cellar or crawl spaces at the time of the inspection.
SEPTIC TANK: 1250-Gallon(H-20)(locate on site plan)
Depth below grade: Inlet and outlet covers are steel and at grade. Top of tank:27"
Material of construction: X 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: 8'long by 5'wide by 4.67'flow line.
Sludge depth:2"
Distance from top of sludge to bottom of outlet tee: 52"
Scum thickness: 10"
Distance from top of scum to top of outlet tee:4"
Distance from bottom of scum to bottom of outlet tee or baffle:6"below exit tee.
How were dimensions determined: sludge judge,measure stick,tape and Shorey precast concrete catalog.
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
The exit tee is broken off below the flow line. Recommend the tank be fitted with a exit tee. The exit line contains
carryover. Recommend exit line to be cleaned as part of the yearly pump-out and maintenance. There were no
observed signs of backup or leakage within or above the tank at the time of the inspection.
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 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.):
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• Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
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: X (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0"
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.):
The box contains one inlet line and three outlet lines. The liquid level was observed at the lowest exit line pipe(east
and northeast lines)inverts. The distribution box requires levelers be installed and the box be water balanced for
exit flow. The interior of the box is pitted but intact. Recommend resealing the interior of the box.There were no
observed signs of backup,breakout or hydraulic failure within the distribution box at the time of the field inspection.
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.):
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Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
X_leaching fields,number,dimensions:(1)45'long by 18'wide by 0.5'deep(vented).
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.):
The distribution box was water tested to establish SAS distribution flow. The SAS contains three lines of lateral
piping. All three lines were receiving flow per water test. There were no observed signs of backup,breakout or
hydraulic failure within the d-box, SAS laterals or above the SAS at the time of the inspection.
CESSPOOLS: (cesspool must be pumped as part of inspection)(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(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,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.):
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Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
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 feet.Locate where public water supply enters the building.
MASTER LOCATION PLAN ATTACHED WITH PACKET
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 327 South Shore Drive
South Yarmouth,MA
Owner: Riviera Beach Limited Partnership
Date of Inspection: October 6,2005
SITE EXAM
Slope 3%
Surface water >100'
Check cellar sump pump located in office cellar
Shallow wells
Estimated depth to ground water 3.39'feet below floor of SAS.
Please indicate(check)all methods used to determine the high ground water elevation:
X Obtained from system design plans on record-If checked,date of design plan reviewed:6/1/84
X 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)
X Accessed USGS database-explain:Elevation 2.5 (mean sea level datum)per approved design plan.
You must describe how you established the high ground water elevation:
NOTE: elevation run and high ground water elevations are based on the 6/1/84 approved design plans adjusted
ground water elevations. The SAS floors were converted to MSL elevations.
The estimated depth to high ground water is based on a level elevation run from the 6/1/84 approved septic system
design plan. The approved high ground water elevation=Elevation 02.5 (mean sea level datum). This water
elevation was approved by use of the observed ground water(test pits 4/22/82 and 6/15/82),the Cape Cod
Commission Technical Bulletin(92-001)Estimation of High Ground-Water Levels for Construction And Land Use
Planning and the locus location proximity to tidal waters.
Floor of installed SAS: EL.05.89
Adjusted High Ground water elevation: EL.02.50
Separation Distance: : 03.39'
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