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HomeMy WebLinkAbout0145 EISENHOWER DRIVE - Health 145 Eisenhower Drive, Cotuit Sewage er, No. Location: �... � � C� �-s x• �/ h o cJ ERA � Village: 0,0ur f• Installer's Mayne & Address: rl J s I Q�r Iy k Builder's Name & Address: E Date Permit Issued Date Compliance Issued 6 i P-t •.a 9AL r 7 Commonwec tth of Massachusetts �s Executive Office of Environmental Affcirs Department of log �'� `�`�` had Environmental Protection oFAsr 199, WBBam P.Weld Tndr 0lorwner AMeo Pwl Ceduocl LLGom= p SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION ProPm' Addre : 145 Eisenhower Dr. Cotuit Address of Owner. same Date of Inspection: (If different) Name of Inspector. Frederick Kiely Company Name,Address and Telephone Number. Environmental Reclamation;Inc. 446 Waquoit Hwy Waquoit MA 02536 (508) 457-5020 CERTIFICATION STATEMENT 1 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 on-site sewage disposal systems. The system: )W:K Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: April 17,1997 The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: .ram One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Y (revised 11/03/95) 1 One WIntii Street • Boston, Masseahus•nts 02108 • FAX(617)556.1049 • Telephone(617)292-Ww w Pnnteu on R=Kled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) .a t Property Address: 145 Eisenhower Dr. Cotuit MarCantonnio Date of Inspection: �� '� .. r \'- B)SYSTEKCONDITIONALLY'PASSES (continued) � i*b c p 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 levelled 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 removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. 3) OTHER (revlsed.11/03/95) 2 / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ( PART A CERTIFICATION (continued) Prolmly Address: 145 Eisenhower Dr. Cotuit Owner: Marcantonio Date of Inspection: D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion 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 privy is less than 100 feet but greater than 50 feet 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 coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. �• ;revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST Property Address: 145 Eisenhower Dr. Cotuit Owner. Marcantonio Date of.Inspection: 4/10/97 Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has 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. X.As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. 2L The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. 2L All system components, excluding the Soil Absorption System, have been located on the site. X__The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles oti. tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. l (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ( PART C SYSTEM INFORMATION Property Address: 2M Eisenhower Dr. Cotuit Owner. Marcantonio Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design flow:3,30_gallons Number of bedrooms:_ Number of current residents:) Garbage grinder(yes or no):n� Laundry connected to system (yei or no):Y Seasonal use(yes or no):m Water meter readings, if availabia: mi nj- hi 1 1 i nq 1 aaf- t-hr-cca �7aara Last date of occupancy COMMERCIAUINDUSTRIAL• N/A Type of establishment: _• _gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank, prosent: (yes or no)_ Non-sanitary waste discharged to the Title S system: (yes or no)_ Water meter readings, if available: 'ast date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or not N If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM XXX Septic tankidistribution boxisoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or rno) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all composts, date installed (if known) and source of information: 13 Years Old/new Construction 1984 Sewage odors detected when arwiving at the site: (yes or no)f (revised 11/03/9S1 S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 145 Eisenhower Dr. Cotuit Owner Marcantonio Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grader inches Material of construction: ,concrete_metal _FRP _other(explain) Dimensions: 10.6 x n.8 Sludge depth: h inches Distance from top of sludge to bottom of outlet tee or baffle:--30—inches Scum thickness: 4 inches Distance from top of scum to top of outlet tee or baffle: 12 inches Distance from bottom of scum to bottom of outlet tee or baffle: 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 s ) the system shows no structural problems or evidence of leakage GREASE TRAP:_N/A (locate on site plan) Depth below grade: Material of construction: ,_concrete _metal _FRP—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: 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 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 145 Eisenhower Dr. Cbtuit Owner. Marcantonio Date of Inspection: TIGHT OR HOLDING TANK:—N/A (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity gallons Design flow: gallons/day Alarm level: 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.) �+wrwi1i'�' ■Llt'�n hr�v i ¢ CCt 1?x7Pl anrj has nr) sign.-, Cif solids narroLoyer PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 145 Eisenhower Dr. Cotnit Owner. Marcantonio Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 2 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) nn Ri gn. of pnncii ng nr break out CESSPOOLS: J (A il (locate on site plan) Number and configuration: „ Depth4op 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:__N/A (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) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) proo"Addrew 145 Eisenhower Dr. Cott Owner. Marcantonio Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent eferei ces landmarks or benchmarks locate all wells within 100, �t -AL- L DEPTH TO GROUNDWATER Depth to groundm feet tttetl!tod of dm..inabon or approximation: Tha grnnnriwat-mr a==rnxi mat-i nn i s hasxl on t-he surface water el evert•i nn of Rawl P nn Pd,flan foot =Qd j--ha rtT_Glovatir takenn f v-r-,m tho TTcr:g min `• (raised 11/03/95) 9 Sewage ermit No. Location: C' c A/ h o/JJ E e �' Village: Installer's Name & Address: J — ; f /y Builder's Name & Address: . Date Permit Issued —40•Sr/ Date Compliance.Issued J_11-$Y 867 3 _t ,Lid w = V THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Frederick Kiely Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. December 12 ,1995 Acting Director of the j0,ion of Water Pollution Control 0 3 9, Fxs .!e......1. ..........._ THE COMMONWEALTH OF IASSACHUSETTS BOARD OF HEALTH 0 1 --..._'..v .---..._.OF.... R.t�:�� t�" --.... 31f(I ll 5 jq Alijifiratinn for Uhivviitt1 arks rlaniarurtinn rrmit J� Application is hereby made for a Permit to Construct ( or Repair. ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. . . ............. ._ .........- W _� �........ Ownez •-.-. ------.Address .......... ••1 ? C............................................................. ......................... --•-------•-............•.................. Installer Address Type of B Size Lot I.y�O.�--------Sq. feet V Dw No. of Bedrooms.._.... �1.._...Expansion Attic ( Garbage Grinder W6 •-+ - - - pa,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures Design Flow.............:.,..1:. . . .................gallons per person erPdaH. Total daily flow-. ..�5.[.1.�..=....�7 -- -- -------- - y W P q `Y g gt .Q Jr 8Depth.. W Septic Tank—Li ui It .....gallons Len h.. _......�. Width_____ _ ____ Diameter__._.__...______ .._........__. x Disposal Trench—No. .......... ....... Widths_ ... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___ - .. iameter...._1............. Depth below inlet.__!.5._.-•_- Total leaching area_. D....sq. ft. Z Other Distribution box ( Dosing tank ( ) ~' Percolation Test Results Performed by..... ............... Date..... Q_ �� ....... W Test Pit No. 1 A�! ._..minutes per inch Depth of Test Pit-----jV........ Depth to ground water..l?a'f�_4 ._.. 44 Test Pit No. 2-/—.Z--_niinutes per inch Depth of Test Pit......L;? 1...... Depth to ground water.. a ---------------------------------------------------------------•---------................---•-....--••-••....---•------•---------.........---...............-E- Vl �o Description of Soil.............. 1.......Z. --------------•---------------------...-------------------------••-•----------- W --------------------------------------------------------------------------------------•---------------------------------------------------------------------.......................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..... . ------•---...••....-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'i U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ram---- ••-------------•----..--.....----.....--------•---••-------••--•--- ............ e Application ApprovedVore .......... .. --------••--•--------------------•--.......:-......-----•------ Date Application Disapprov llowing reasons: -----------•------------------------------------------•-----------------------------------•---......-••-••-- -----••--------------•-------•--------------•---------------•-------------••-•-----------••----------------------------•-----------------------------...----•---------- ............................... Date PermitNo......................................................... Issued-....................................................... Date _.rr' • Fiz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ T4 u� ►Jj ...----... ..............................OF..............`_ ...... .j Appliration for Dispntia1 Work twtrurtiott Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_................................................................................ ....._.......•-----------------•--•-----------•---•--.............----------------............--•- Locati n-Address —or Lot No. A.t2 .► � ' :..- C-4-1-1Teets)i o,� i v �,Lr�e� � A vet -?.�................................. ner Address ••••••..................•....... Installer Address I Z Type of B > Size Lot.?-) feet 3 Dw —No. of Bedrooms------- __-•--_-._._ .___.Expansion Attic ( Garbage Grinder (00 p-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixture W Design Flow................ _ gallons per person per day. Total ailX flow-_�._x,JI U .__4_ ......gallons., P4 Septic Tank—Liqui// igallons Length__ U_. '. Width__...._- ---. Diameter--. -------- Depth--`�------- Disposal Trench— . ._ . .....___. Width_y_-_o............. Total Length.................... Total leaching area-_-_------_•-._____-sq. ft. Seepage Pit No..._ _ — meter-------------------- Depth below inlet.................... Total leaching area..�2 ....sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by __:__.�-�_L �U.f_. _ .y________________ Date.....I.G}/Z.. 0 3_............ 04 Test Pit No. 1 4"2 minutes per inch Depth of Test Pit._.....z.�..___... Depth to ground water.Q!71' .1=.. (z, Test Pit No. 2_G'.�`r _minutes per inch Depth of Test Pit...... ...... Depth to ground water... }` a •--••-••----•••--------------••••-•-•-•---•-•••••---•••---•--••-•••••-•-----------------•-----...•--......................................................... D Description of Soil............. .. ... .I_____..T I �_ 5U� 5 G/L - ----- ------------------------------------------•--------------------------------------------- x Z' l Z ' W -------------------------------------------------------------------------------------------------- -------------------------------------------•----------------------------------------....._..._..... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ..----------•------------------------------------------------••-•••---•-•••--•••-••-•••......._•---.._.....•-•••••-••----••-....---•--••....-••--••----•------•---•-• .................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t'1... the provisions of T T t:�"� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certincate of Compliance has been issued by the board of health. -• ed... ....n - - . to ed Application Approved ` � Date Application Disappro f e following reasons-------------------------•------------------------•----------------•-------------•---------•---•••------•-•-•---. ...........................................•----------------•----•---------------------------------•----...------------......---•--............-•-•..................... ........................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................I.......................OF........................................I........,............................... %rrtifiratr of Tompliana % S'TZ7� R IFY That the Individual Sewage Disposal System constructed�or Repaired ( ) by.. .... = ::.;_-_-----------•---•-•-•--•----•---•----••-------------•----••--- •-------------- ' '� � Install at has been i aped in accordance with the provisions of " 7' S f The State SanitaryCo . as escribed in the application for rAANCE' posal works Construction Permit Nor _.*� 2 ":......._..._ dated.`_l:4 __Y%...................... THE I CF THIS CERTIFICATE SHALL NOT BE C®N U AS A GUARANTEE THAT THE S'YSTEA+1 � SATISFACTORY. DATE........... ............................................. Inspector... _..------------------•--------••---•----------------------•-••----•------_---•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... No......................... FECZ,................. R,5vo �t � i n r Eltt ,�.-� lr Permission is her g (ed� = ............................ to Construct ir-- an I 1d 1 S e Disposal System atNo. •-•-•••-----• '2 --- -•----• ------ .... Street as shown on the application for Disposal Works Construction Permit •.............. Dated.......................................... .............. ...... .............................................................................. Board of Health DATE..................•---._...------------••---•--•----------•-•••...........-•--- FORM 1255 HOBBS & WARREN. INC.. 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