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Home My WebLink About0175 EISENHOWER DRIVE - Health l 175 Eisenhower Drive � eotuit P A' = 039 126 I TOWN OF BARNSTABLE LOCATION ��S I Se("1 U20 eL . Dom.- SEWAGE # _ VILLAGE V` A ASSESSOR'S MAP & LOT 03 ` (0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �LT (size) 1OOD --�— NO.OF BEDROOMS ,BUILDER O� —PL►c C co PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 306 feet of leaching facility) Feet Furnished by } a 9'� t /�' #°__ .' � ��d .cue.....�..w��•�•^^,�.....,,.r,� +..•+.�+'.'�'�""rr'.'w ��Y� :� �T. w �� ' "t � �. • � � � � � ' a , [ �.� i � �� /.,ss . �9- 1A6 ► dlu5x4l75— PERMIT a LOCATION SEWAGE E MIT O. _. VILLAGE . i r I ; INSTALLER'S NAME ADDRESS Q e U I L D E R OR OWNER w DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED co vH p-) ' 07 � �-- � � O �� . ", �� i� .��.. COMMONWEALTH OF ACHUSETTS. MASS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION RE-CEIVE L. F EB 15. 2005N OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address. 1775Eisenhower Drive ARCEI cotuit Owner's Name: Nick Piccolo LOT Owner's Address: --------- Date of Inspection: a� f Name of inspector:(please print) Wi 1 1 i am E_ Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 _Centerville, MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT. I certify that 1 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 Sect':onally 15340 of Title 5(310 CMR 15.000). The system: Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: C3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heanhvr 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 seat to the system owner and copies sent to the buyer,if applicable,and the approxing authority. Notes and Comments f ****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 I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 175 Eisenhower Drive o ui Owner. Nick Piccolo Date of Inspection; ma Inspection Sum ary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syste asses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 3I0 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. Syste Conditionally Passes: One or ore system components as described in the"Conditional Pass"section need to be replaced or repaired.The s tem,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no o not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits s bstantial infiltration or exftltration or tank failure is imminent.System will pass inspection if the existing tank is rep] ced with a complying septic tank as approved by the Board of Health. •A metal septic will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the ta A is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or _ obstructed pipes) r due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board f Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The sy tern required pumping more than 4 tunes a year due to broken or obstrmled pipe(s).The system will pass inspecti if(with approval of the Board of Health): broken pipe(s)are replaced obsmxtion is 1cm0YOd ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 175 Eisenhower Drive _ Cotuit Owner: Nick Piccolo Date of Inspection: . �— — C. Furt er Evaluation is Required by the Board of Health: Con itions exist which require further evaluation by the Board of Health in order to determine if the system is failing to rotect public health,safety or the environment. 1. Syste will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the syste is not functioning in a manner which will protect public health,safety and the-environment: _ C spool or privy is within 50 feet of a surface water _ Cc spool or privy is within 50 feet of a bordering vegetated wetland or,a salt marsh 2. Syste 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 su ace water supply or tributary to a surface water supply. The system has a septic.tank and SAS and the SAS is within a Zone I 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 front a priv to water supply well•• Method used to determine distance "Th s system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacte 'a and volatile organic compounds indicates that the well is free from pollution from that facility and - the pr sence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failur criteria are triggered.A copy of the analysis must be attached to this form. 3. Othe v i 3 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 175 Eisenhower Drive Cotuit Owner: Nick Piccolo Date of Inspection: r D. y em Failure Criteria applicable to all systems: You mu t indicate`yes"or"no"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 ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or logged SAS or cesspool _ tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or c sspool Li uid depth in cesspool is less than 6"below invert or.available volume is less than'/2 day flow Re uired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of imes pumped An portion of the SAS,cesspool or privy is below high ground water elevation. An portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface wa r supply. An portion of a cesspool or privy is within a Zone I of a public well. An portion of a cesspool or privy is within 50 feet of a private water supply well. An portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private%atrr sup ly well with no acceptable water quality analysis.]This system passes if the well water analysis, pe formed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds in icales that the Hell is free.from pollution from (fiat facility and the presence of ammonia lnilogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria ar triggered.A copy of the analysis must be attached to this form.] )d. o)The system fails. 1 have determined that one or more of the above failure criteria exist as scribed in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of alth to determine what will be necessary to correct the failure. E. tems:Torcd a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 g Yate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes n the system is within 400 feet of a surface drinking water supply _ e system is within 200 feet of a tributary to a surface drinking water supply the ystem is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zon 11 of a public water supply well If you have ans Bred"yes"to any question in Section E the system is considered a significant threat,or answered ..yes"in Section above the large system has failed.The arwner or operator of arty large system considered a s significant threat nder Section E or failed tinder Section D shall upgrade the sy stem tem in accordance with 310 CMR 15.304.The syste owner should contact the appropriate regional office of the Department. 4 r Page 5 of l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:175 Eisenhower Drive Cotuit Owner: Nick Piccolo Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _ plumping information was provided by the owner,occupant,or Board of Health _ __L/ mere any of the system components pumped out in the previous two weeks? — Has the system received normal flows in the previous two week period? :� Have large volumes of water been introduced to the system recently or as part of this inspection?:. Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? �/— Were all system components,excluding the SAS,located on site? F Were the septic cant;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? _ Was the facility owner(and occupants if different from owner)provided with information on the proper mamtenance 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 r/Existing information.For example,a plan at the Board of Health. ir— Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)13 10 CMR 15.302(3)(b)) 5 Page 6 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 175 Eisenhower Drive Cotuit - Owner: Nick Piccolo Date of Inspection:/,; � FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. '�' Number of bedrooms(actual): c DESIGN flow based on 310 CMA 15.203(for example: 110 gpd x#ofbedrooms): Number of current residents: Does residence have a garbs gander(yes or no): Is laundry on a separate sewage system(yes or no) 1 [if yes separate inspection required] Laundry system inspected(yes o no)./,L13 Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 4 - 1 91 0 0 0 Sump pump(yes or no):,4:�O 2003 — 53, 000 Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 C 15.203): gpd Basis of design flow(seats/p sons/sgft,etc.): Grease trap present(yes or o):_ Industrial waste holdin nk present(yes or no):_ Non-sanitary waste d' barged to the Title 5 system(yes or no):_ Water meter read' s,if available: Last date of oc ancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information,: fl/ Was system pumped p f the inspection(yes or no): !J If yes,volume pumped:_gallons•-How was quantity pumped determined? Reason for pumping: _ TYP F SYSTEM _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: Were sewage odors detected when arriving at the site(yes or no): 6 •1'agc 7 of I I OFFICIAL INSPECTION FORA'I—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0101 PART C SYSTEM INFORII'IATION(continued) Property Address: 175 Eisenhower Drive Cot11 Owner: Nick Piceo o Date of Inspection:_ BUILDING SEVER(loc on site plan) Depth below grade: Materials of construct' n:_cast iron _40 PVC_other(explain): Distance from priv water supply well or suction.lute: Comments(on c dition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: Kocatc on site plan) ) Depth below grade:_ L , Material of eonstruciio _ uncrcic metal fiberglass�,olycUrylcne _oUxr(explain) —' _fiberglass If tank is metal list age. Is age confinned•by a Cenif►cate of Complia»ce(yes or no):ccrtif►catc) _(attach a copy of d )J Dimensions: I ct, Sludge depth: 4. Distance from top of sludge to button►of outlet Ice or battle: _ Scum tl►ickncss:=s' Distance from top of scull'to lop of outlet Ice or baffle: r Distance Gom bottom of scup►to bottom of outlet tee or baflle:0 I low were dimensions determined: Cummcnts(on pumping recommendations,inlet and outlet Ice or battle condition,structwal integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): b e GREASE TRAP/iping: ate o to plan) - Dcptl►below Material of cconcrete metal fiberglass_polyethylene�otl►er (explain): — _ Dimensions: Scum INckn Distance [ roll, to top of outlet tee or baffle: Distance oHorncum to bottom of outlet Ice or baffle: Date of last p Conunents(on pumping recommendations, inlet and outlet tee or battle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,ctc.): 7 'agc 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress:175 Eisenhower Drive Cotui Owner: Nick Piccolo Date or Inspectlon: TIGHT or HOLDING T K. (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of eonstructio :—concrete_metal_fiberglass_polyethylene other(explaut): Din cnsionr Capacity: —gallons Design Flow: gallons/day Alarm present(y s or no): Alarm level: Alarm in working ordcr(ycs or no): Date of last p ping: Comments(e ndition of alarm and float switches,etc.): DISTRIBUTION BOX: rf prescnl must be opened)(locate on site plan) Depth of liquid level above outlet invert: - Conunenls(note if box is level and distribution to outlets equal,any evidence of solids carry-over,any evidence of - leakage into or out of box,etc.): _ PUMP CIIANIBEIi (locate on site plan) Pumps in workin or (yes or no): Alarms in wor ng order(yes or no): — Comments(n Ie condition of pump chamber,condition of pumps and appurtenances,e(c.): r Page 9 of I I OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 175 Eisenhower Drive o ui Owner: Nick Piccolo Date of Inspection:I—Z,'?`o 5� SOIL ABSORPTION SYSTEM(SAS): (►ovate 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: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of pond' 6 ng,damp soil,condition of vegetation, r. i etc.): ��0 1 t� a CESSPOO/oundwater (cessp I must be pumped as part of inspect ion)(locate on site plan) Number anurati n: Depth—topd inlet invert: Depth of so . Depth of scr: Dimensionspool: Materials oction: Indication odwater inflow(yes or no): Commentsndition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): _ PRIVY: (locat n site plan) Materials of con ction: Dimensions: Depth of sops: s: Comm en (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 175 Eisenhower Drive o ui Owner: Nick Picco1g Date of Inspection: S 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. d a Y � - -3b � 3 ,9 10 r Page.11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 175 Eisenhower Drive Cotuit Owner. Nick Piccolo Date.of Inspection: — 6 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within ISO feet of SAS) Checked with local Board of Health-explain: ticked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: ll f { M c - - - - - - - - - - - - - - - - - - - - - - - - - - - _ - - - - - - - - - - 0[ 00 �. I 1 Walk-in 1 closet i Bedroom0 i i 1 i 1 1 o I - 1 Smoke Smoke I o 1 Detector Detector o o o C I Smoke � g - - -- - - - - - Detector - - - cc r (D 0s w I I v ti 1 Smoke Detector i Bedroom Bedroom o N,o CO ._ CCULO G �Uf. ; -0 N cv- O G - - - — — — — — — — — — — — - - — -- — — — -- — — — — — — — — — — — — — — — - - � s� �ar CLw ti U� f i E r CO o c ExistingSecond Floor Plan LO N i 16'-0" I L 20'-0" C�1 c N i Extended k Area a Dec I c Q Co Existing Deck { o � iy New Walkout I New APatio — — — — — — — — — — Bay ' Door& side tights I ;� I O O ` ' — — — —1 - I Rebcte d V Q i BATH I O N 1 O OBEDROOM � � 0 en cKith _ — o Dining - - - - - - - - — c 06 LU O 12'-7 1/2" Smoke room 1 _Smoke 1 C14 Detector Detector 0 I ""°'�" Z Laundry N 4'-10" - - - - - - - - - - - Bath "ao 0 N d' I '-9318' — - - - - - - - Den k N - - - - - - - - - - - - - - - � o Living room 00Li 'm cased - - - o Q vi CD 'c opening ''� 26'-0" Addition c 4 a u7 _ Co j 'a N OO O L6 Co ExistingHouse & Addition First Floor Plan o a Extended Deck Area = an 36--0,, Existing House N 16'-0" 611 7'-611 71-611 611 CI 6"concrete sona-tube piers set to 48"below gradeCO (tYP) �_-- Q� � Outline of Deck Addition a M 2-2x8 PT girt 0 2x8 PT Joists (�i6"O.C. CO j widr SR PT 8"poured concrete Op �— decking foundation wall with V x r" 2'poured concrete botirw CO - 0 S I r — - - - - - - - - - - - - - -� I- o L ! - - - - — — - - - - - --- - - - - - - I !� 0 0 w 0 1 I ( I Heat Detector 1 winoow Relocated —� — t�_ 211-4H � Z I I / 31l2"x 16"OCt WO M l o wed Tdoi I I N I I _ Existing Garage I � 1 1 I I I i t I o Smoke ! �, i I a�Detector j - — — — — — — L -I — — — — — — -I- i rn -� - - - - - - - -, - - - - - - - -- � -F I 26'-0' Addition > *0 CO, I Existing Unfinished Basement i o. Ca h I L - - - - - - - - - - - - - - - - - - - - - - - - -- I E .,� rn� - - - - - - - - - - - - — — — — — — — — - - a� o 36'-0" 9 5 Addition foundation & Gara a Pian _ N 5 ?5evt ower D�. C. t MCI-