Commonwealth of Massachusetts DCR Dam Safety Inspection Checklist

Updated 10 15 12
Instructions
This spreadsheet contains macros to facilitate correct data entry. You must enable macros in Excel for
the spreadsheet to function properly. If you did not enable macros when opening this spreadsheet, do so
now by selecting Tools - Macro - Security, Medium, then close and restart Excel. Click on Enable Macros
when opening the checklist.
All of the worksheets (tabs) are protected to restrict data entry to the proper cells. If you need to make
modifications, select Tools - Protection - Unprotect Sheet; a password is not required.
Enter data on Sheets 1, 2 and 3 first in that order. In general, data are entered only once, on the first
sheet on which they appear. Repeated data entries on subsequent sheets are generated automatically.
In cases where two data items are linked (e.g., Condition Code and Condition Description), only one data
item can be entered, the other is generated automatically. The entire Summary Detail sheet (to be
inserted at the front of the Phase I report) is generated automatically. Most of the Dam Data Summary
Sheet (Summary Data Table in Section 1 of the report) is generated automatically. The remaining sheets
can be completed in any order.
Be careful to only check one box when using the checkboxes.
Contact Tom Famulari at the Office of Dam Safety if you have any questions about using this checklist.
Tom can be reached at 617-626-1367, tom.famulari@state.ma.us

Dam Evaluation Summary Detail Sheet

1. NID ID:
0
2. Dam Name:
0
3. Dam Location:
, MA
7. Inspector:
0
8. Consultant:
0
9. Hazard Code:
0
10. Insp. Frequency: #N/A
12. Spillway Capacity (% SDF)
E1. Design Methodology:
E2. Level of Maintenance:
E3. Emergency Action Plan:
E4. Embankment Seepage:
E5. Embankment Condition:
E6. Concrete Condition:

4. Inspection Date:
5. Last Insp. Date:
6. Next Inspection:

December 30, 1899

December 30, 1899
December 30, 1904

9a. Is Hazard Code Change Requested?:

0
11. Overall Physical Condition of Dam:
#N/A
#N/A
0
E7. Low-Level Discharge Capacity:
0
E8. Low-Level Outlet Physical Condition:
0
E9. Spillway Design Flood Capacity:
0
E10. Overall Physical Condition of the Dam:
0
E11. Estimated Repair Cost:
0

0
0
0
0
$0

Evaluation Description
E1: DESIGN METHODOLOGY
1. Unknown Design no design records available
2. No design or post-design analyses
3. No analyses, but dam features appear suitable
4. Design or post design analysis show dam meets most criteria
5. State of the art design design records available & dam meets all criteria
E2: LEVEL OF MAINTENANCE
1. Dam in disrepair, no evidence of maintenance, no O&M manual
2. Dam in poor level of upkeep, very little maintenance, no O&M manual
3. Dam in fair level of upkeep, some maintenance and standard procedures
4. Adequate level of maintenance and standard procedures
5. Dam well maintained, detailed maintenance plan that is executed
E3: EMERGENCY ACTION PLAN
1. No plan or idea of what to do in the event of an emergency
2. Some idea but no written plan
3. No formal plan but well thought out
4. Available written plan that needs updating
5. Detailed, updated written plan available and filed with MADCR, annual training
E4: SEEPAGE (Embankments, Foundations, & Abutments)
1. Severe piping and/or seepage with no monitoring
2. Evidence of monitored piping and seepage
3. No piping but uncontrolled seepage
Minor seepage or high volumes of seepage with filtered collection
5. No seepage or minor seepage with filtered collection
E5: EMBANKMENT CONDITION (See Note 1)
1. Severe erosion and/or large trees
2. Significant erosion or significant woody vegetation
3. Brush and exposed embankment soils, or moderate erosion
4. Unmaintained grass, rodent activity and maintainable erosion
5. Well maintained healthy uniform grass cover
E6: CONCRETE CONDITION (See Note 2)
1. Major cracks, misalignment, discontinuities causing leaks,
seepage or stability concerns
2. Cracks with misalignment inclusive of transverse cracks with no
misalignment but with potential for significant structural degradation
3. Significant longitudinal cracking and minor transverse cracking
4. Spalling and minor surface cracking
5. No apparent deficiencies

E7: LOW-LEVEL OUTLET DISCHARGE CAPACITY

1. No low level outlet, no provisions (e.g. pumps, siphons) for emptying pond
2. No operable outlet, plans for emptying pond, but no equipment
3. Outlet with insufficient drawdown capacity, pumping equipment available
4. Operable gate with sufficient drawdown capacity
5. Operable gate with capacity greater than necessary
E8: LOW-LEVEL OUTLET PHYSICAL CONDITION
1. Outlet inoperative needs replacement, non-existent or inaccessible
2. Outlet inoperative needs repair
3. Outlet operable but needs repair
4. Outlet operable but needs maintenance
5. Outlet and operator operable and well maintained
E9: SPILLWAY DESIGN FLOOD CAPACITY
1. 0 - 50% of the SDF or unknown
2. 50-90% of the SDF
3. 90 - 100% of the SDF
4. >100% of the SDF with actions required by caretaker (e.g. open outlet)
5. >100% of the SDF with no actions required by caretaker
E10: OVERALL PHYSICAL CONDITION OF DAM
1. UNSAFE Major structural, operational, and maintenance deficiencies
exist under normal operating conditions
2. POOR - Significant structural, operation and maintenance deficiencies
are clearly recognized under normal loading conditions
3. FAIR - Significant operational and maintenance deficiencies, no structural
deficiencies. Potential deficiencies exist under unusual loading conditions
that may realistically occur. Can be used when uncertainties exist as to
critical parameters
4. SATISFACTORY - Minor operational and maintenance deficiencies.
Infrequent hydrologic events would probably result In deficiencies.
5. GOOD - No existing or potential deficiencies recognized. Safe performance
is expected under all loading including SDF
E11: ESTIMATED REPAIR COST
Estimation of the total cost to address all identified structural, operational,
maintenance deficiencies. Cost shall be developed utilizing standard
estimating guides and procedures

Changes/Deviations to Database Information since Last Inspection

1.1 Summary Data Table

Required Phase I Report Data
National ID #
Dam Name
Dam Name (Alternate)
River Name
Impoundment Name
Hazard Class
Size Class
Dam Type
Dam Purpose
Structural Height of Dam (feet)
Hydraulic Height of Dam (feet)
Drainage Area (sq. mi.)
Reservoir Surface Area (acres)
Normal Impoundment Volume (acre-feet)
Max Impoundment Volume ((top of dam) acre-feet)
SDF Impoundment Volume* (acre-feet)
Spillway Type
Spillway Length (feet)
Freeboard at Normal Pool (feet)
Principal Spillway Capacity* (cfs)
Auxiliary Spillway Capacity* (cfs)
Low-Level Outlet Capacity* (cfs)
Spillway Design Flood* (flow rate - cfs)
Winter Drawdown (feet below normal pool)
Drawdown Impoundment Vol. (acre-feet)
Latitude
Longitude
City/Town
County Name
Public Road on Crest
Public Bridge over Spillway
EAP Date (if applicable)
Owner Name
Owner Address
Owner Town
Owner Phone
Owner Emergency Phone
Owner Type
Caretaker Name
Caretaker Address
Caretaker Town
Caretaker Phone
Caretaker Emergency Phone
Date of Field Inspection
Consultant Firm Name
Inspecting Engineer
Engineer Phone Number

Data Provided by the Inspecting Engineer

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0

0
0
0
#N/A

0
0
0
0
0
0
0
0
0
0
0
0
12/30/1899
12/30/1899
0

*In the event a hydraulic and hydrologic analysis has not been completed for the dam, indicate "No H&H" in this table, recommendation
section shall include specific recommendation to hire a qualified dam engineering consultant to conduct analysis to determine spillway
adequacy in conformance with 302 CMR 10.00.

Dam Name and Town

Date of Inspection: Date

DAM DEFICIENCIES
Dam Name
NID ID #

0
0

Copy and paste to this spreadsheet the dam deficiencies enumerated in Section 3
of the Phase I Dam Safety Inspection Report. Put each deficiency in a separate
cell. This sheet does not need to be printed out. It is for the internal use of DCR.
This Excel spreadsheet must be submitted on a CD with the PDF of the report.
Deficiency No.

Description

8
9
10
11
12

DAM SAFETY INSPECTION CHECKLIST

NAME OF DAM:
REGISTERED:

STATE ID #:

YES

NID ID #:

NO

STATE SIZE CLASSIFICATION:

STATE HAZARD CLASSIFICATION:

CHANGE IN HAZARD CLASSIFICATION REQUESTED?:
DAM LOCATION INFORMATION

CITY/TOWN:

COUNTY: #N/A

DAM LOCATION:
(street address if known)

ALTERNATE DAM NAME:

USGS QUAD.:

LAT.:

DRAINAGE BASIN:

RIVER:

LONG.:

IMPOUNDMENT NAME(S):
GENERAL DAM INFORMATION
TYPE OF DAM:

OVERALL LENGTH (FT):

PURPOSE OF DAM:

NORMAL POOL STORAGE (ACRE-FT):

YEAR BUILT:

MAXIMUM POOL STORAGE (ACRE-FT):

STRUCTURAL HEIGHT (FT):

EL. NORMAL POOL (FT):

HYDRAULIC HEIGHT (FT):

EL. MAXIMUM POOL (FT):

FOR INTERNAL MADCR USE ONLY

FOLLOW-UP INSPECTION REQUIRED:

Dam Safety Inspection Checklist v.3.1

YES

NO

CONDITIONAL LETTER:

YES

NO

Page 1

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

INSPECTION SUMMARY
DATE OF INSPECTION:

DATE OF PREVIOUS INSPECTION:

TEMPERATURE/WEATHER:

ARMY CORPS PHASE I:

CONSULTANT:

PREVIOUS DCR PHASE I:

YE
S
YE
S

N
O
N
O

If YES, date
If YES, date

BENCHMARK/DATUM:
OVERALL PHYSICAL
CONDITION OF DAM:

#N/A

SPILLWAY CAPACITY:

#N/A

DATE OF LAST REHABILITATION:

EL. POOL DURING INSP.:

EL. TAILWATER DURING INSP.:

PERSONS PRESENT AT INSPECTION

NAME

TITLE/POSITION

REPRESENTING

EVALUATION INFORMATION
Click on box to select E-code

E1)
E2)
E3)
E4)
E5)
E6)
E7)

TYPE OF DESIGN
LEVEL OF MAINTENANCE
EMERGENCY ACTION PLAN
EMBANKMENT SEEPAGE
EMBANKMENT CONDITION
CONCRETE CONDITION
LOW-LEVEL OUTLET CAPACITY

NAME OF INSPECTING ENGINEER:

Dam Safety Inspection Checklist v.3.1

Click on box to select E-code

E8)
E9)
E10)
E11)

LOW-LEVEL OUTLET CONDITION

SPILLWAY DESIGN FLOOD CAPACITY
OVERALL PHYSICAL CONDITION
ESTIMATED REPAIR COST
ROADWAY OVER CREST
NO
BRIDGE NEAR DAM
NO

SIGNATURE:

Page 2

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

OWNER: ORGANIZATION
NAME/TITLE
STREET
TOWN, STATE, ZIP
PHONE
EMERGENCY PH. #
FAX
EMAIL
OWNER TYPE

STATE ID #:

NID ID #:

CARETAKER:

ORGANIZATION
NAME/TITLE
STREET
TOWN, STATE, ZIP
PHONE
EMERGENCY PH. #
FAX
EMAIL

PRIMARY SPILLWAY TYPE

SPILLWAY LENGTH (FT)

SPILLWAY CAPACITY (CFS)

AUXILIARY SPILLWAY TYPE

AUX. SPILLWAY CAPACITY (CFS)

NUMBER OF OUTLETS

OUTLET(S) CAPACITY (CFS)

TYPE OF OUTLETS

TOTAL DISCHARGE CAPACITY (CFS)

DRAINAGE AREA (SQ MI)

SPILLWAY DESIGN FLOOD (PERIOD/CFS)

HAS DAM BEEN BREACHED OR OVERTOPPED

YES

NO IF YES, PROVIDE DATE(S)

FISH LADDER (LIST TYPE IF PRESENT)

DOES CREST SUPPORT PUBLIC ROAD?

YES

NO

IF YES, ROAD NAME:

PUBLIC BRIDGE WITHIN 50' OF DAM?

YES

NO

IF YES, ROAD/BRIDGE NAME:

MHD BRIDGE NO. (IF APPLICABLE)

Dam Safety Inspection Checklist v.3.1

Page 3

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

CREST

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

EMBANKMENT (CREST)

1. SURFACE TYPE
2. SURFACE CRACKING
3. SINKHOLES, ANIMAL BURROWS
4. VERTICAL ALIGNMENT (DEPRESSIONS)
5. HORIZONTAL ALIGNMENT
6. RUTS AND/OR PUDDLES
7. VEGETATION (PRESENCE/CONDITION)
8. ABUTMENT CONTACT

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 4

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

D/S
SLOPE

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

EMBANKMENT (D/S SLOPE)

1. WET AREAS (NO FLOW)

2. SEEPAGE
3. SLIDE, SLOUGH, SCARP
4. EMB.-ABUTMENT CONTACT
5. SINKHOLE/ANIMAL BURROWS
6. EROSION
7. UNUSUAL MOVEMENT
8. VEGETATION (PRESENCE/CONDITION)

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 5

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

U/S
SLOPE

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

EMBANKMENT (U/S SLOPE)

1. SLIDE, SLOUGH, SCARP

2. SLOPE PROTECTION TYPE AND COND.
3. SINKHOLE/ANIMAL BURROWS
4. EMB.-ABUTMENT CONTACT
5. EROSION
6. UNUSUAL MOVEMENT
7. VEGETATION (PRESENCE/CONDITION)

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 6

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

INSTR.

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

INSTRUMENTATION

1. PIEZOMETERS
2. OBSERVATION WELLS
3. STAFF GAGE AND RECORDER
4. WEIRS
5. INCLINOMETERS
6. SURVEY MONUMENTS
7. DRAINS
8. FREQUENCY OF READINGS
9. LOCATION OF READINGS

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 7

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

D/S WALLS

1. WALL TYPE
2. WALL ALIGNMENT
3. WALL CONDITION
4. HEIGHT: TOP OF WALL TO MUDLINE
5. SEEPAGE OR LEAKAGE
6. ABUTMENT CONTACT
7. EROSION/SINKHOLES BEHIND WALL
8. ANIMAL BURROWS
9. UNUSUAL MOVEMENT
10. WET AREAS AT TOE OF WALL

OBSERVATIONS

min:

max:

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

DOWNSTREAM MASONRY WALLS

avg:

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 8

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

U/S WALLS

1. WALL TYPE
2. WALL ALIGNMENT
3. WALL CONDITION
4. HEIGHT: TOP OF WALL TO MUDLINE
5. ABUTMENT CONTACT
6. EROSION/SINKHOLES BEHIND WALL
7. ANIMAL BURROWS
8. UNUSUAL MOVEMENT

OBSERVATIONS

min:

max:

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

UPSTREAM MASONRY WALLS

avg:

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 9

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

D/S
AREA

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

DOWNSTREAM AREA

1. ABUTMENT LEAKAGE
2. FOUNDATION SEEPAGE
3. SLIDE, SLOUGH, SCARP
4. WEIRS
5. DRAINAGE SYSTEM
6. INSTRUMENTATION
7. VEGETATION
8. ACCESSIBILITY

9. DOWNSTREAM HAZARD DESCRIPTION

10. DATE OF LAST EAP UPDATE

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 10

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

MISCELLANEOUS
AREA
INSPECTED

CONDITION

OBSERVATIONS

1. RESERVOIR DEPTH (AVG)

2. RESERVOIR SHORELINE
3. RESERVOIR SLOPES
MISC.

4. ACCESS ROADS
5. SECURITY DEVICES
6. VANDALISM OR TRESPASS
7. AVAILABILITY OF PLANS
8. AVAILABILITY OF DESIGN CALCS
9. AVAILABILITY OF EAP/LAST UPDATE
10. AVAILABILITY OF O&M MANUAL
11. CARETAKER/OWNER AVAILABLE
12. CONFINED SPACE ENTRY REQUIRED

YES
YES
YES
YES
YES
YES
YES

NO
NO
NO
NO
NO
NO
NO

WHAT:
DATE:
DATE:
DATE:
DATE:
DATE:
PURPOSE:

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 11

MISCELLANEOUS
OBSERVATIONS

Dam Safety Inspection Checklist v.3.1

Page 11

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

SPILLWAY

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

PRIMARY SPILLWAY

SPILLWAY TYPE
WEIR TYPE
SPILLWAY CONDITION
TRAINING WALLS
SPILLWAY CONTROLS AND CONDITION
UNUSUAL MOVEMENT
APPROACH AREA
DISCHARGE AREA
DEBRIS
WATER LEVEL AT TIME OF INSPECTION

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 12

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

SPILLWAY

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

AUXILIARY SPILLWAY

SPILLWAY TYPE
WEIR TYPE
SPILLWAY CONDITION
TRAINING WALLS
SPILLWAY CONTROLS AND CONDITION
UNUSUAL MOVEMENT
APPROACH AREA
DISCHARGE AREA
DEBRIS
WATER LEVEL AT TIME OF INSPECTION

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 13

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

OUTLET
WORKS

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

OUTLET WORKS

TYPE
INTAKE STRUCTURE
TRASHRACK
PRIMARY CLOSURE
SECONDARY CLOSURE
CONDUIT
OUTLET STRUCTURE/HEADWALL
EROSION ALONG TOE OF DAM
SEEPAGE/LEAKAGE
DEBRIS/BLOCKAGE
UNUSUAL MOVEMENT
DOWNSTREAM AREA
MISCELLANEOUS

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 14

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

GENERAL

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

CONCRETE/MASONRY DAMS

TYPE
AVAILABILITY OF PLANS
AVAILABILITY OF DESIGN CALCS
PIEZOMETERS
OBSERVATION WELLS
INCLINOMETERS
SEEPAGE GALLERY
UNUSUAL MOVEMENT

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 15

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

CREST

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

CONCRETE/MASONRY DAMS (CREST)

TYPE
SURFACE CONDITIONS
CONDITIONS OF JOINTS
UNUSUAL MOVEMENT
HORIZONTAL ALIGNMENT
VERTICAL ALIGNMENT

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 16

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

D/S
FACE

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

CONCRETE/MASONRY DAMS (DOWNSTREAM FACE)

TYPE
SURFACE CONDITIONS
CONDITIONS OF JOINTS
UNUSUAL MOVEMENT
ABUTMENT CONTACT
LEAKAGE

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 17

NAME OF DAM: 0
INSPECTION DATE:

December 30, 1899

STATE ID #:

NID ID #:

U/S
FACE

OBSERVATIONS

REPAIR

CONDITION

MONITOR

AREA
INSPECTED

NO
ACTION

CONCRETE/MASONRY DAMS (UPSTREAM FACE)

TYPE
SURFACE CONDITIONS
CONDITIONS OF JOINTS
UNUSUAL MOVEMENT
ABUTMENT CONTACTS

ADDITIONAL COMMENTS:

Dam Safety Inspection Checklist v.3.1

Page 18