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Home My WebLink AboutSystem B Inspection Report 2004 Apr 20 . > � COMMONWEALTH OF MASSACHUSETTS EXECUITVE OFFICE OF ENVIRONMENTAL AFFAIRS , , DEPARTMENT OF ENVIRONMENTAL PROTECTION G3C� Gr- i` _ �'t'' -. '�� h"�Y ? �� 2COa HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ��a�G� �N Tourn� M� � Property Address: �a6 I � �� S ya,�ro� M�-- �26�f sys'r�/vt �� B�� i �oo�ns�s, 6 --�-- I/ Owner's Name: R��G•� S�.(�P� ��Ql�✓ ! �2✓1� Owner's Address: Date of[nspection: C�l��/�B(F� G��p/a.vQ� Name of Inspector. (please print) Joseph M.Martins Compaoy Name: Accu Sepcheck Mailing Address: 17 Northside Dr., S Dennis,MA 02660 Telephone Number: SOS-38S5891 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 fundion and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursusnt to Section 15340 of Title 5(310 CMR 15.000). The system: �Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authairy Fails Inspector's Signatu : l � Date: 7 �'� �y The system inspector shall submit a copy of this inspec[ion repoR to the Appcoving 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]0,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The ariginal should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. �J� �C �G/'1� �� C'Ol/�i� ��lS'P�� Notes and Comm�ts: �j/ �/n 6�� O F �/��h/ �12u/ C'p V E� �z� �o��n�e G�/ /��l�r� /'��1�� Qvvt�l�/l/1� . ***"This report only describes cooditions at the time ot inspection and under the conditions of use at that time.This inspecHon dces not address how the system will perform in the future under the same or different conditions of use. • Page 2 of I 1 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 TOVVNE MOTEL � SYST"�� Owner: RSP Incl., Sleepy Hollow Trust Date of lnspection: 4/10-4/20/04 Inspection$ummary: Check A,B,C,D or E/ALWAYS complete all oTSection D A. System Passes: I have not found any information which indicates that any of the failwe aiteria described in 310 CMR 15303 or in 310 CMR 15304 exist.My failure aiteria not evaluated aze indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section nced to be r ced or repaired.The system,upon completi�of the replacement or repa"v,as approved by the B Health,will pass. Answer yes,no or not determined(Y,N,ND)in the_for the foll � g statements. If"not detamic�ed"please explain. The septic tank is metal and over 20 y *or the septic tank(whether metal a not)is structurally unso�md,exhibits substantial infilhation Itrarion or tank failure is imminent. System will pass inspection if the existing tank is replaced with a com g septic tank as approved by the Board of Health. •A metal septic tank will pass ' ion if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is than 20 years old is available. ND explain: bservation of sewage backup or break out�high static water level in the distribution box due to broken or obshvcted pipe(s)or due to a broken,settled or imeven disffibution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)aze replaced obstruction is removed distribution box is leveled or replaced ND expiain: 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): _Ixoken pipels)are replaced obstruction is removed ND explain: , Page 3 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFqCE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1261 Route 28, S.Yarmouth, MA Owuer: BEACH `N TOWNE MOTEL� $�T"Q�� Date of Inspection: RSP Incl., Sleepy Hollow Trust C. Further Evaluation is Required by the Board of Health:4/10-4/20/04 Conditions exist wh�ch�eyuve��eVa�� by the Board of Health in order to determine�pt}�e system is failing to protect public health,safety or the environment. 1. System will py�unless Board of Health determines' corraly dao�e wrth 310 CMR 15.303 I b that the system is not functioniog in a manner which ' O( ) protect public health,safety and the enviroumeot: _ Casspool or privy is within of a swface water _ Cesspool or priry is ' S0 feet of a borderin v g egetated wetland or a salt marsh 2. System�yip fail unless the Board of Health(and Public Water Supplier ' y determines that the system is functioning in a manoer that protects the public Lealth,s and enviroomenh Tf1e�Ys�e+n has a septic tarilc and soil absorption em (SAS)and the SAS is within 100 feet of a s��e water supply or tributary to a s�uface supply. — Tt'e SYs�em hss a septic ta�lc S and the SAS is within a Zone 1 of a public water supply. — �e��h�e �k and SAS and the SAS is within 50 feet of a private water supply we��, — �e as a septic tank and SAS arid the SAS is less than 100 feet but SO feet or more from a private water supply we11** Meth��to determine distance ""Ihis system p�if the well water analysis,performed at a DEP certiSed laboratory> for coliform bacteria and volatile organi��po�ds indicates that the N,ell is free from pollution from that facility and the presence of amroonia nitrogen and nitrate nitrog�(S eyual to or less tha� 5 pPm,provided t}iat no other failw�e criteria are trigg¢��.A�py of the analysis must be attached to this form. 3. Ot6er: • Page 4 of I t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 1261 Route 28 S. Yarmouth, MA Property Addresr. BEACH `N TOWNE MOTEL �$y,S7��8�� Owner: RSP Incl., Sleepy Hollow Trust Date of Inspection: 4/10-4/20/04 D. System Failure Criteria applicable to all systems: You must indicate`�es"or`ho"to each of the following for all inspections: Yes No _ _�Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ ,/Uischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ciogged SAS or cesspool �Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or ✓cesspool L�quid depth in cesspool is less than 6"below imert or available volume is less than %x day flow _ .�Requ'ved pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).N�nnber �f times pumped_. Any portion of the SAS,cesspool or privy is below high ground water elevation. _ _/Any portion of cesspool or privy is within 100 fcet of a swface water supply or tributary to a surface water supply. �Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ��Any porti�of a cesspool or priry is withici 50 feet of a private water supply well. ,/ My portion of a cesspool or privy is less than ]00 fcet but greata ihan 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 coliforro bacteria and volstile organic compounds iodicstes that t6e well is tree from pollution from that facility and the presence of ammonia nitrogen and nitrate oitrogen is equal to or less than 5 ppm,provided that no other failure criteria are tri�ered.A copy of the anslysis must be attac6ed to this form.� �(YesJNo)The system fails. I have determmed that one or more of the above failure caiteria e�cist as described in 310 CMR 15.303,thaefore the system fails.The system owner should contad the Board of Health to determine what will be necessary to correct the tail�e. E. Lsrge 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 eithes"yes"or"no"to each of the following: (The following crita�ia apply to large systems in addition to the criteria above) yes no _ _ the system is within 400 feet of a surface drinkin er supply _ _ the system is within 200 feet of a tribu to a swfice drinking water supply the system is located in a ni en sensitive area(Intaim Wellhead Protection Area—1 WPA)or a mapped Zone 11 of a public wat upply well If you have answered" to any question in Section E the system is considered a significant threat,or answered `�es" in Section D above the large system has fiiled.The owner or operator of any large system considered a significant t}veat imda Section E or failed imder Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional 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 Property Address: 1261 Route 28, S.Yartnouth, MA BEACH `N TOWNE MOTEL� Sy.ST"Q�� Owner: RSP Incl., Sleepy Hollow Trust Date ot Inspectioo: 4/10-4/20/04 Check if the following have bcen done You must indicate`�es"or"no"as to each of the following: Yes No t/_ 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 nornial flows in the previous two week period? _ ✓Have large volumes of water been intrnduced to the sysrem recenUy or as part of this inspec[ion? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) �_ Was the facility or dwelling ins�ected for signs of sewage back up? .� Was the site inspected for signs of break out? — — /✓)C/v � i/ _ Were all system components,e g the SAS,located on site? � Were the seplic tanlc manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tces,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? v Was the facility owner(and occupants if different from owner)provided with infom�ation on the proper maintenance of subsurface sewage disposal sys[ems? The size and location of the Soil Absorption System(SAS)on[he site has been determined based on: Yes no ✓ Existing information.For example,a plan at the Board of Health. � Detertnined in the field(if any of the failwe criteria related to Part C is at issue approximati�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 fSyS7"L3�� Owner: RSP Incl., Sleepy Hollow Trust Datc ot Inspection: 4/10-4/20l04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):� Number of bedrooms(actual): _ ZZv 3 q 2 A-r�i� DESIGN flow based on 310 CMR 15.�2j13 (for examplc: I 10 gpd x#of bedrooms): Number of current residents:_fZ`'� Dces residence have a gafiage grinder(yes or no): � Is laundry on a sepatate sewage system(yes or no):�/ if yes separate inspection required] Laundry system inspected(yes or no):�//' o'Z QO 3 ; S/7 DOfI - 35ono�/�qpt� = �9.2�U Seasonal use: (ves or no):��?S a DOo'! ' S 6f�000 -.3s-000(�yo� -S�?9°oa Water meter readings,if available(last Z years usage(gpd)). SumP P�P(Yes or no):�a /�V� ��0 � �3ils�sy f7�i� Last date of occupancy: � COMMERCIAL/INDUSTRIAL Type of establishment: M07��- Design flow(based on 310 CMR 15.203): A-(SE�/�i Qpd Basis of design flow(seatsJpersons/sqft,etcJ: Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste dischazged to the Title 5 system(yes or no):_ W ater meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records / a oo a` ' �j�� /�,.. Sourceofinformation: �C/m�P�i a00d � /9q� /9!6 t� yN�� Was system pumped as part of the inspection(yes or no):�1/d If yes,volume pumped: Qallwis—How was quantity pumped determined? Reason for pumping: TY�E OF SYSTEM /�Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool _��Y Shared system(yes or no)(if yes,attach previous inspection records,if any) InnovativelAlternative technology. Attach a copy of the curr�t 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 compona�ts,date ins�1led(if Irnown Land source of information: 9'�1�ra'r.S � c-rra/l.vd 99�if �.Q d� � Were sewage odors detected when arriving at the site(yes or no):�U ' 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: 1261 Route 28, S. Yarmouth, MA BEACH `N TOWNE MOTEL �� owner: �SY� B Date of lnspection: RSP Incl., Sleepy Hollow Trus[ 4/10-4/20/04 BUILDING SEWER(locate on site plan) Depth below grade: ''� c� � Materials ofconstruc[ion: cast'von 40 PVC other(explain): Distance from private water supply well or suction line: >�O� Comments(on condition of joints,venting,evid ce of leakage,et .): �c�_ `_�/)d �r/� N�P �4 s ,P SEPTIC TANK:�(locate on site plan) �,�t CQ UQ/S T� �� 6 r/ Depth below grade: �n' Material of construction:�concrete_metal_fiberglass_�olyethylene _other(explain) If tank is metal list age:_ ls age con6rmed by a Certificate of Compliance(yes or no):_(attach a copy of �rt�fi�te� ��io �'X� '�ii�S'7" � . .p. /od��-fn� Dimensions: Sludge depth _ !� a 9// Distance from top of sludge to bottom of outlet tee or bat�le: Scum thiclmess: o��r g�� Distance from top of scum to top of outlet tee or baffle: �� Distance from bottom of scum to bottom of outl tee r ftle:�� /U d � v�� ' How were dim�sions det�nined: G� S � 9 Comments(on pumping recommen 'ons,inlet and outlet tee or baflle ondition,structural integity, liquid levels as related to outlet invert,evidence of leakage, etcJ: .e V � � �? i�,�Qf- 2� No -e✓� ��c2 O,� /-Pal��- GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construc[ion:_concrete_metal_fiberglass�olyethylene_other (explain): Dimensions: Scum thiclrness: Distance from top of scum to top of outlet tee or baf�le: Distance from bottom of scum to bottom of out or baftle: Date of last pumping: Comments(on pumping recom ions, inlet and outlet tee or bafile condition,structural integrity, liquid Ievels as related to outlet inve �dence of leakage,etc.): • Page 8 0(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� Sy�� B�� Date of Inspection: RSP Incl., Sleepy Hollow Trust 4/10-4/20/04 TIGHT or HOLDING TAIYK:_(tank must be pumped at time of' tion)(locate on site plan) Depth below grade:_ Mataial of wnstruction:_concrete_metal glass_polyethylene_other(explain): Dimensions: Capacity: Rallo Design Flow: �s��y Alarm present(yes or no): Alarm level: in working order(yes or no):_ Date of last pumping: Comments(condition of alarm and float switches;etc.): DISTRIBUTION BOX: `�(�Y pTesent must be opened)(locate on site plan) Depth of liquid level above outlet invert:� /f�V P� 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.):_ � � p t PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): Alazms in working order(yes or no • Comments(note conditian of p chamber,condition of pumps and appurtenances,etc.): • Page 9 0(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.Yattnouth, MA D te of Inspection: BEACH `N TOWNE MOTEL 1 SyST��B�� RSP Incl., Sleepy Hollow Trust SOIL ABSORPTION SYSTEM (SAS):_(locate on site plaA��:f�34(AAoot required) /�//�p _ 5!/a p/� Op l, If SAS not located explain why: TyPe 1 � l� G !�')p�''S 1,." � ��/ `� jl' !1 leaching pits,number. _leaching chambers,number:_ �r�j,�P,g�1.� �� — g.Z/ leaching galleries,number: leaching tr�ches,number, length: _leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note wndition of soil,signs of hydraulic failure,level of ponding,damp soil,wndition of vegetatio etc.): .S J�- - i ✓� � �/1� � (� l l�il�� ,t 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: Dim�sions of cesspooL• Mat�ials of canstruction: Indication of groundwater inflow(yes or❑ . Comments(nMe condition of soil,si of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_(locate on site plan) Materials of construction: Dimensions: Depth of solids: Commenu(note condition of soil,signs of hydraulic failwe of ponding,condition of vegetation,etc.): +� l'%-- _ idt'x� _ \ �6� � . . , — 7a — +► I�i� .r' _ _ 6 � .r . ; �. .' � � 3 � ' � = , �- a�s.._ 7 !Z�.7� �. ' =� .�N ,•� , � ` � � , � . J � `� ` ty,.�� ! 1 _ - _ -3� ' '�e` � _ � �� + � ` 1 q '- '�. . _��' ; �� ' ,' � ___ !-� � J J �. . � � D? --;�LT��7;� IpLX7 l � �_fw�R 5 ,- ., � � ,: _, s�r5,-�x �� ' I �,a�'� /zo� � � r. __ ro• i ; '� � � % I � __Y�.. ( r 'r ,� ; ' _�'{ �� ; \�i�=. ;� j ' \,' /e'y ;' '; '�:. .�_ 7 � - �i- 1 � / SY$T� ,. f . i �c°h '�- ;. .- � � � � ,`_ , �. , ' - - -r � � _ _ . �+j j ' � ' C �.. �''` . zp' � G � . � � . �� '� '� � � ,s j r'j 'r>� � �' � � 1 0� . '�' _ _� � `# 2e'� , � , �4".=-� � � � 3�� ; .1 � � �a�"'� ,� - � c" , : � �' � �rc-fG� , _ u. ..°��L � l'j ` � O . � .. / . .'x. . . -, I 1 V� ! ^ � �.=�._' f y �F'K�`�C�y�: r r: m t�_` '� � :.', .s J 5�s,, _ �s, f�,1 c� ` � I .e• , � -,` � � � �� `__;:.. � `� . s � ' `i� �; -k- -_;, - - �iR -. �- �erm� - �'v �:'- ' '� � Lo �,� . _ - ., � . �• .�, i'•_ • �:. ��eY6 . ''—:• �` . ` �'- - ,, i � • Page 10 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM 1NSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1261 Route 28, S. Yarmouth, MA Owner: BEACH `N TOWNE MOTEL �SySr��B�� Date of Inspection: RSP Incl., $leepy Hollow Trust 4/]0-4/20/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Rovide a sketch of tfie sewage disposal sys[em including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public wata supply entas the building. 2c� 6 S A., , . � j� O � �t p 3 L _ � �(.S�II�� A� = ��s � � � = �� -Z = zy. �3 Z=z`f � �I'j =Z3 S c�3 = 25 /�'�( � Z�s a �=3 l� * F11dW1./ S� ir�I� clusC�� Do�� N(1,� j7 Cd��o�Q�/ � ) . ; Page I I of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 1261 Route 28, S. Yarntouth, MA Date of Inspection: BEACH `N TOWNE MOTEL� SyS7��[3�� RSP Incl., Sleepy Hollow Trust SITE EXAM 4/]0-4/20/04 Slope Surface water Check cellar Shallow wells , Estimated depth to ground water � 1 3 . Z Please indicate(check)all methods used to determine the high ground water elevati�: �Obtained from system design plans on record-If checked,date of design plan reviewed: 9 �Z Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Boazd of Health-explain: Checked with local excavators,installas-(attach documentation) _�Accessed USGS database-explain: �Ki�+pTE�Q 8�4y You must describe how you established the high ground water elevation: I , �� S I �- �/ j�S'� -f}z�L� � 1 � n0 �►�u�� -- � � �3� z , �-- tTra�e- � �� ,�dl� : � Z � 3. G4'�GlS7�l�'UT,' � R Z M��U Zq 13 z . 7 � � '�� -; ! 3. z - �'! Z -�- Z. 7 � 2_ 3