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Home My WebLink AboutSystem H Inspection Report 2004 Apr 10-20 s- � COMMONWFALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS , DEPARTMENT OF ENVIRONMENTAL PROTECTION U3 � �55 'J �% � �° n�,,^,� ;� 9 20�4 HEALTH DEPT. T'ITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION �;�, �N �r•v/�2 /1�Io1�/ �J yn / / Property Address: �Z� � ��.Z�; S yll�(�(// "L/ ��/ (/�!O(�y � �� /lbams �/O r l��o Owoer�sName: �� eP�y � ��W /�US� Owner's Address: ��// �r Date of Inspection: �/�b/a��✓ � �/yd lz od y 7 Name of Inspector: (please print) Joseph M.Martins Company Name: Acca Sepcheck Mailing Address: 17 Northside Dr., S Deonis,MA 02660 Telephoce Number: 508-385-5891 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infoimazion reported below is true,accurate and complete as of the time of the inspectioa The inspection was performed based on my training and expai�ce in the proper fimction and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursaant to Sectioo 15.340 of TiUe 5(310 CMR 15.000} The system: � passes Conditionally Passes = Needs F� uation by the I,ocal Approving Au ority F " Inspector's Signatu : Date• � Z � L Ud y 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 inspectioa If the system is a shared system or has a design flow of 1 Q000 gpd or greater,the inspector and the system owner shall submit the repoR to the appropriate regianal office of the DEP."[l�e aiginal should be sent to the system owner and copies sent to the buyer,if applicable,and the approving � authority. C� � J �/��G�q „ [` �✓T!`e��✓Q/L �G�CJ�Q 1' Notes and Comments: -�—� � �� /�� O � C2 , �2 �'O/�inn�2,� /C.�'�//Gir �Gii✓i��vM��/� epnTl q v...� J •***This report only descri s conditioos at the time of inspection and under the cooditions of use at that time.This inspection dces not address how the system will perform io the future under the same or different conditions of use. Page 2 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1261 Route 28, S.Yarmouth, MA BEACH `N TOWNE MOTEL � SrS�N�{�� Owoer: RSP Inc., Sleepy Hollow Trust Date of lospection: 4/]0-4/20/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy�tem Passes: �� I have not found any information which indicates that any of the failure criteria described in 310 CMR 15303 or in 310 CMR 15304 exist.My failure criteria not evaluated aze indicated below. Comments: B. System Conditionally Passes: � One or more system componenu as described in the"Conditi�al Pass"section need to be replaced or repa'ved.The system, upon completion of the replacement or repa'v,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the_for the f ng statem�ts. If"not determined"please e�cplain. The septic tank is metal and ov�20 y "or the septic tank(whetha metal or not)is strucdually unsound,e�chibits substantial infiltration Itration or tank faili¢e is imminent. System will pass inspection if the eacisting tank is replaced with a cam ' g septic tank as approved by the Board of Health. •A metal septic tank will pass' ion if it is structurally sound,no[leaking and if a Certificate of Compliance indicating that the tank is I than 20 years old is available. ND explain: O ation of sewage backup or break out a high static water level in the dislribution box due to broken or obstructed pipe(s)or due to a broken,settled or imeven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced obstruction is ranoved distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstruded 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: - Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1261 Route 28, S.Yarmouth, MA D te of Ins BEACH `N TOWNE MOTEL�Sy.ST�' {�� pection: RSP Inc., Sleepy Hollow Trust C. Further Evaluatioo is Required by t6e Board of Health: 4/10-4/20/04 is failing o protect publi health,safetY�the envi onme��.the Board of Health in order to determine if the system 1. System will pyys�o��goy�of Health determioes in acco oce itb 310 CMR 15.303 1 b that the syshm is not functiooing io a manner which wili prot ublic health,safety and the en ir oment: _ Cesspool or priry�s within 50 feet of a s _ Cesspool or i e Water pr vy is within 50 feet of rdering vegetated wetland or a salt mazsh 1 2. System will fai less the Board of Health(and Public Water Supplieq if any)determines that tbe system is functio ng in a manner that protects the public health,safety and environment: 7he system has a septic tanlc and soil absorpti�� SAS)and the SAS is within 100 feet of a surfece water supply or tributary to a swface water supply. _ 11ie system has a�ptic tank and SAS and the SAS is within a Zone 1 of a public wat � , — T�e�em has a PP Y septic tanlc a�d SAS and the SAS is within 50 feet of vate water supply we�1, — T�e��n has a septic tanlc a�d SAS and the SAS is less th private water suPP�Y well**.M�� 0 feet bat 50 fe�or more from a used to determine di *'lhis system p��if�e well water analysis> rmed a�a DEP bacteria and volatile orga�� N&ed laboratory, for coliform pO��"d' �s tl�at the well is free from pollution from that facility and �e P��nce of ammonia nitrogen and n' te nitrogen is equal to or less than 5 PPm,provided ihat no other fail�ve caitaia aze triggered.A cop the analysis must be attached to this form. 3• Other: Page 4 ot I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 1261 Route 28, S.Yarmouth, MA Property Address: BEACH `N TOWNE MOTEL�S)6T�� Owner: RSP[nc., Sleepy Hollow Trust Date of Inspection: 4/10-4/20/04 D. System Failure Criteria applicabk to all systems: You must indicate"yes"or`t�d'to each of the following for ail inspections: Yes No _ �/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 distribution box above outlet invert due to an overloaded or dogged SAS or cesspool `�Liquid depth in cesspool is less thah 6"below invert or available volume is less than '/,day flow �Requ'ved pumping more than 4 times in the last year NOT due to clogged or obstruded pipe(s).Number — — of times pumped_. � Any porti� of the SAS,cesspool or privy is below high ground water elevation. � _ �My portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a sisface � water supply. My portiai of a cesspool or privy is within a Zone 1 of a public well. � My portion of a cesspool or privy is within 50 fcet of a private water supply well. _ �Any portion of a cesspool or privy is less than ]00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system pssses if the well water analysis, performed at s DEP certified laboratory,for coliform bacteria and wlstile organic compounds indicates thst t6e well is free from pollution from that tacility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or leas t6ao 5 ppm,provided t6at o0 other fsilure criteria , /� are triggered.A copy ot t6e analysis must be attac6ed to this torm.� N (Yes/No)The system tails.I have determmed that one or more of the above failure aitaia e�cist as described in 310 CMR 15.303,therefore the system fiils."Ihe system owner should contact the Board of Health to determine what will be necessary to correct the&il�se. E. Large Sysrems: To be considered a large system the system must serve a faciGty wit6 a design flow of 10,000 gpd to 15,000 SPd• You must indicate eitha`�es"or"no"to each of the following: ('Ihe following critaia apply to lazge syst�ns in addition to the critaia abov yes no _ _ the sys[em is within 400 feet of a surface drinldn er supply _ _ the system is within 200 feet of a tribu o a sw�face drinking wata supply _ the system is located in a nitr s�sitive area(Intaim Wellhead Protxtion Area—IWPA)or a mapped Zone[I of a public wata ply well If you have answered" ' o any question in Section E the system is considaed a significant threat,o�answered `yes"in Section D above the large system has failed.The owner or operator of any lazge system considered a significant Uveat�mda Section E or failed�mda Section D shall upgade the system in accordance with 310 CMR 15304.'Ihe system owner should contad the appropriate regimial office of the Departrnent. Page 5 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 1261 Route 28,S.Yarmouth, ly�/L BEACH `N TOWNE MOTEL �T N W �� Owner: RSP Inc., Sleepy Hollow Trust� Date of Inspectioo: 4/]0-4/20/04 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes iNo � Pumping infortnation was provided by the owner,occupant,or Board of Health _ V Were any of the system componems pumped out in the previous two weeks? _ �Has the system received norn�al flows in tLe previous two week period 7 r/ Have large volumes of water been introduced ro the system recenUy or as pari of Utis inspection? i V — Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ _ Was the fxility or dwelling inspected for signs of sewage back up? � Was the site inspected for signs of break out? �� Were all system componems,excluding the SAS,located on site? � Were the septic tank manlioles uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of consUuctioq dimensions,depth of liquid,depth of sludge and depth of scum? � Was the facility owner(and occupants if different from owner)provided with infom�ation on the proper maintenance of subsurface sewage disposal systems? The size aod location of t6e Soil Absorption System(SAS)on the site has been detertnined based on: Yes no � Existing informatian.For example,a plan at the Board of Health. � Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is�macceptable) [310 CMR 15302(3)(b)] Page 6 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1261 Route 28, S.Yarmouth,MA BEACH `N TOWNE MOTEL �SyST��/-� �� Oa�ner. RSP Inc., Sleepy Hollow Trust Date of Inspection• 4/10-4/20/04 FLOW CONDITIONS RESIDENTIAI, Number of bedrooms(design):_ Number of bedrooms(aaual):� 33� 3�f'Z y��T(� DESIGN flow based on 310 CMR 15.203(for eacample: 110 gpd x#of bedrooms): Number of current residents: � �''� N� Dces residence have a gafiage gnnder(yes or no):_ Is laundry on a sepazate sewage system(yes or no):A7/�}''S yes separate inspectionrequired] q�v L,aundry sys[em inspected(yes or no):��' 2vo.3 : SI�A�l7 —3S�d�pL = �z Seasonal use: (yes or no): N d �t)d 2 : S�jAGYI —.35��e L = �s!OOi� Water meter readings,if available(last 2 years usage(gpd)): SumP P�P Cves or no):�10 �L .— �3�S"'/� (`��I.S Last date of occupancy:�o'f � � COMMERCIAIJINDUSTRIAL Type of establishment: /�'1 G�!/` � Design flow(based on 310 CMR 15.203):��!J Q Rpd 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 dischazged to the TiHe 5 system (yes or no):_ Water meta readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 7-6 2 Z--�d° �k q � �q9 � Was sys[em pumped as par[of the inspection(yes or no):_ !7 If yes,volume pumped: p.allons—How was quantity pumped detamined? Reason for pmnping: TYP�FSYSTEM �Septic tanlc,distribution box,soil absorption system Single cesspool Overflow cesspool —�'ry _Shared system(yes or no)(if yes,attach previous inspedion records,if any) Innovative/Altemative technology.Attach a copy of the cwr�t operation and maintenance contract(to be obtained from systan owner) _Tight tank _Attach a copy of the DEP approval _Ofher(describe): �ppr��f all cqmponents,date installed(i Imo )and source of information: �jG-�r-_-� ) Were sewage odors detected when arriving at the site(yes or no):�� Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 126] Route 28, S. Yartnouth, MA N Owner: BEACH `N TOWNE MOTEL �SySTf{ �� Date of Inspection: RSP Inc., Sleepy Hollow Trust 4/]0-4/20/04 BUILDING SEWER(locate on site plan) Depth below grade: �- �3 r Materials of constructio�cast'von 40 PVC other(explain): Distance from private water supply well or suction Iine: Commenu(on condition of'oints,venting,evidence of leakage,etc. : � -��Aao��.� O!��- N o .S i 6�J o l P R SEPTIC TANK:_(locate on site plan) Depth below grade: �� w�`� � �G ��'(h � 41 � I r�`L' Material of construction:�/concrete_metal_fiberglass�olyethylene V � other(explain) ]f tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certi5cate) [f��p X��6� ��a �►„ Dim�sions: ! Sludge depth-�� *�n 11 Distance from top of slu e to bottom of outlet tee or baflle: J'�^- Scum thiclmess: " � 11 Distance from top of scum to top of outlet tee or baf�le: �� Distance from bottom of scum to bottom of outl tee or�aftle: / How were dimensions detamined: � fu�U ��_�sc uOGE T�/��E Comments(on p�nnping recommendat—i�,inlet and outlet tee or baftle cond�uon,structural mtegrity, liquid levels as relffi to outlet invert, d ce of l�a e,etc. : iYD �Pea�n1/%PnC�A�idy� ti� U/�P�� q t"�i�l 7�i� E. � � d e� L /Au,l vf �i e� /✓� VPk..-j- • NO 2V�G�P/K'P D7� �9�� GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thiclmess: Distance from top of scum to top of outlet tee or baffle• Distance from bottom of scum to bottom of outl or baflle: Date of last pumping: Comments(on pumping recommen ons,inlet and outlet tee or baflle condition, structural integriry, liquid Ievels as related to outlet invert,evid of leakage,e[c.): Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 1 Property Address: 1261 Route 28, S. Yarmouth,MA BEACH `N TOWNE MOTEL S ST��N�� D te of InspeMion: RSP Inc., Sleepy Hollow Trust � y 4/10-4/20/04 TIGHT or HOLDING TAIVK:_(tank must be pumped at time of inspection)(locate on site plan) Depth below gade:_ Material of construction: concaete metal lass_�folyethylene_other(explain): Dimwsions: Capacity: Ka s Design Flow: allonslday Alacm present(yes or no � Alarm level: larm in working order(yes or no):_ Date of last p mg: Comm conditian of alarro and float switches,etc.): DISTRIBI7'f10N BOX:_(if present must be opened)(locate on site plan) H ^Z-� Depth of liquid level above outlet invert:�T ��1 vL1�T Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of bo ,etc.):/ �� L � ��/e� �✓ �� O� � � O �' AI✓✓�✓ �C� A..P . PUMP CHAMBER_(locate on site plan) pumps in working order(yes or no):_ Alarms in working order(yes or�o):_ Comments(note condition of pump diaznber,condition of pumps and appwtenan c.): Page 9 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1261 Route 28, S. Yarmouth, MA �� ►i Owner: BEACH `N TOWNE MOTEL /S`�� Date of lnspection: RSP Inc., Sleepy Hollow Trust SOIL ABSORPTION SYSTEM (SAS): _(locate oo site p1an4�rQ�A�ot required) [��p i�� Z�� If SAS not located explain why: Type �/ y/ /' ,J .,��,u� / � _leaching pits,number:1 /� �/i (p CT►�d(�� /� /T �Jd �!//�l —� 7•(o leaching chambers,number:_ �jt/Z� 57--��1� / leaching galleries,munber: leaching trenches,number,I�gth: _leaching fields,number,dim�sions: overflow cesspool,number: innovative/alternative system Type/name oftechnology: Comments(note condition of soil,signs of hydraulic fail�e,level of ponding,damp soil,condition of vegetation, ��.r. P, f is I�R y s7�i✓ /�� - ��"" �✓P �,r- s T—dl� � r is c /oa�iqn/a r' l1cv. 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 scmn layer: Dimensions of cesspool: Mataials of construction: Indication of groundwater inflow or no):_ Comments(note condition �I,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVP:_(locate on site plan) Materials of construction: Dimaisions Depth of solids: Comments(note condition of soil,signs of aulic failure,level of ponding condition of vegetation,etc.): 4 �� ' � . �X �/- __ o t,x 4 _ ` �� . - - -- ;�. — — � �'; :, ' � . y � � '; ', ' � 3 �, • { . Dk` �- . ; !ZF.7� -i� �.. _� ` `�� ,� 4 z�,�:�.�� ` :` I c, +�, ` , , _ - _ G �,� � e�- 3O� `io` , �A � r`` - ��;~ I ` ' . . � �' ' � . � ,. . _ =r \� ) t� i a" ��Cy� II'UT( -''� ` !p J �1`; . ':�N - �1+ <�Tics GX� I 1_�w�R i' .. � l . ., SYS�� , � J '' ' ! � �,A�'� �zo'; �� - _tO ' r, �r 4 ^ � .� �� `_Y ' � \�i�` �,'( ' , , 5� ' \.� io�y __ :' 't� �-' ir / 7 �• .�i• � 2 . Il '�C� 54� , - , i � � . + � � - 1 �'�Y.:� �� .. � _ � f - _ . . C � — ` f c �' �e'�.... �� La�: � . . p 1• � � �� ' �- 'CS � �` S �'+�� _ ,�i\�y �� -'� � . I �- � ' I' � �S {� �ZO� � f2`�L, � �� J` ; '-1 7 / 's- - -- ��1 ' � �'� • r��Q �;r' �Yt-T�� I ''-' ,',� LdL Gi` o I _��`- ' ' � 't'' ! r :�x�yr� ` ( �� r �' � '�-' D "�° . � � � V fw � •.. 1 l�4`�iz` i�� `�� (� l 1� ' �s � `j• � `, � � T - � � r� �/ ; ��,�• `-(%� ` � �.'•�. S � � :�-_ . � , -k. ��' `, 1'rrmc I -- ,' ' zo' ' � �;._--- '� , �•• .. �:,_ � . �= !�o Y 6 . `'�;. �v^' ` �� '�� / j . Page 10 oT I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMEIVTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1261 Route 28, S. Yarmouth, MA �� Owoer. BEACH `N TOWNE MOTEL�S�}} Date of Inspection: RSP Inc., Sleepy Hollow Trust 4/]0-4/20/04 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 fcet.Locate where public water supply enters the building. �� - �il � D 7T• • - a �D►s�C�S : , z � �/ � l`fl BI =31 � o �z = /9S� 6Z= 3z 3 �1'3 .: Z/J �33 ,Z8' /�'Y��.3�� 3� =-Z�7.� �o��' Is S�iia�(� �P��o a�dd✓ ,�Ke%�. �IZ _ � ' � - Page 1 I of i I � � OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) � Property Address: 1261 Route 28, S.Yarmouth, MA Owner: BEACH `N TOWNE MOTEL �S�T��h �� Date of Inspection: RSP Inc., Sleepy Hollow Trust SITE EXAM 4/]0-4l20/04 Slope Surface water Check cellar Shallow wells � Estimated depth to gowd water � � �, Z" Please indicate(check)all methods used to determine the high gaund wata elevatim�: m R �t— _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 Healih-explain: Checked with local excavators, installas-(attach documentation� �Accessed USGS databas�explain: �/A��' �'i'L You must describe how you established the high ground water elevation: � . �D � s �G-�l / .�.�sr �l-e.�� Q/3/9Z /�o y2d�� — ,3. Z , , z ��a�� 130�-�► _ �7- � 3. �dJ�.s�m�e�� /v1/�.t� Z � 3 ` 2..7 � F�9� � � � /�a� : � 3 . 2 — 7, � f- Z- 7 � Z- �