Loading...
HomeMy WebLinkAbout0077 CHERRYWOOD LANE - Health "77 Cherrywood Lane 041-012-015 Marstons Mills \ �,�Oq7TOWN OF BAR STABLE t�.19 LOCATION �'/N�y� �O0 `"60e SEWAGE # �7 VILLAGE 4IL;-ASSESSOR'S rAP r OT O/ .Old-0 -" �yg-ayov INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY J�Z7U ;BLEACHING FACILITY:(type) 1j)/ S (size) %000 NO. OF BEDROOMS PRIVATE WELL OR rUBLIC WATER BUILDER OR OWNER AN DATE PERMIT ISSUED: A?/ DATE COMPLIANCE ISSUED: Z2 �� VARIANCE GRANTED: Yes No �a � �� � 3 a ��y r- - 01 Fimic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............v�`wrl...... ......OF....... Appliration for Uhimal Works Tomitrnrtiun Prrutit Application is hereby made for a Permit to Construct Q(,) or Repair ( ) an Individual Sewage Disposal j System at: �lti¢rn l.0 l.0 to t 1. Pi V) '( LOT Z_ ............... i s.*¢e??........' '.... ------... .-------------- --........--- --------•-----•--.....-----•-------------•----------........•..•..........-------- _ Location-Address or Lot Ijo. H� !lJ1 ....�,---_.X!ac:......................................... .7a---Hdm_ .......I/Rim U041j?-.?in? ............... Address �} Owy r .......... Installer Address d Type of Building Size Lot___ .....Sq. feet U Dwelling—No. of Bedrooms-----f'o..............................Expansion Attic (Al ) Garbage Grinder 4) '4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria P4 Other fixtures ---------•--•-------------------------------•- W Design Flow....................................Z5__gallons per person per day. Total daily flow........................... .....gallons. WSeptic Tank—Liquid capacitv_1_�gallons Length.l q!-C%4.. Width.,!6'`.._ Diameter._.__ _____ Depth47 !.1�.'-... x Disposal Trench—No..................... Width.................... Total Length..........._........ Total leaching area....................sq. ft. Seepage Pit No.....7t­o....... Diameter....__ Depth below inlet.....6---._...._._ Total leaching area...5......sq. ft. Z Other Distribution box (X) Dosing tank ( ) '-' Percolation Test Results Performed by..!54-Lpk c,_%..A_.t0i:l-s-s .....?_G._............... Test Pit No. 1____lk ro....minutes per inch Depth of Test Pit___/ 6.`...... Depth to ground water. LLt Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground 0 u P'+ ------------------------------------------------•----------------------...........---------•-------.....------• ...... �. .... . O Description of Soil_...®-l''.510 65 1I..( TOPsa d...)ke4 he"1 cxx►iry rlJ------------ -------- (xj ••... It ��`�s ��__ vs+ f7Ss!�_.dl4l tu!`1_`�AarsSe _. cc. C -•-'-------. ....... LLYN �e- i ,�W, -----------•------------------- i�_ISre��__F1 ..S +s ........-•--•-•---•••-------------.....---'---•••------•----•-'.......------•---- ..........aL3tftNb tY t w } V Nature of Repairs or Alterations—Answer when applicable..................:...................................... -4— 14u!4a*(.; 4 Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance en isFkc-d-t-y-,the board of health. Signed ..... . -- . . --- y.. Application Approved B} ....... ....... Date Application Disapproved for the following reasons: ......................... ................................................................. .......... .................. ................................... ... .... ...•.-- -------------....----. .--------............--------...-------------------------------------- . ............. ..................... Date PermitNo. ... .......................................... .. Issued ---- -------- --- ------------------•-. ---.--.... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............4.w...42...............OF.......�1'�a ras. .................................................... Appliration for Uinlinnttl Works Tnnitrnrtlun Prrutit Application is hereby made for a Permit to Construct 1C) or Repair ( ) an Individual Sewage Disposal System at t 1I rnT t,=j...�;ti'1�....... GO f d....P!!..cc's.I� .G®T.Z/.............................................................................. Location-Address or Lot I�jo. T.klk'A---- ------•------•-•--------------•---------- 7 __.Hdai.4.,7 .,.1.....'!? .........Azmeumlaar: ......---.... Owner Address W Installer Address Type of Building Size Lot...(a4q_$II1.....Sq. feet U Dwelling—No. of Bedrooms.....5"©u r...........................Expansion Attic (A.J) Garbage Grinder W6) �_l Other—T e of Building ............................ Showers a yP g ---------------•-----------_ No. of persons ( ) — Cafeteria ( ) W Other fixtures -------------------------------• - W Design Flow....................................S.S-_gallons per person per day. Total daily flow............._........._.__4.4-?.....gallon. WSeptic Tank—Liquid capacity.15.Qtf�-.gallons Length._lo.'6"_. Width_S_!:(o"... Diameter__-_-- Depth:9.��b""... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... Diameter......1.R.......... Depth below inlet................... Total leaching area...5::.......sq. ft. Z Other Distribution box (Y,) Dosing tank ( ) Percolation Test Results Performed by.. hcn._ i...I,Ji.1.Sa......P-1.,................ Date_I_l._t7�ctxr►Last-._l�t�t/ Test Pit No. 1.... sro....minutes per inch Depth of Test Pit._IA4........ Depth to ground water_______________________. rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -•-•-----------------------------------------------------•••. --•---------..............•---..............--••--------. •= *.... A?".. tI --- -----�: O Description of Soil.... -18----5�b off_'-_(To ga,.1_..hssl__-hE� ___re-MiL cd- ----------------------------- ►�i .....-•----------------•----•..... ��-iS9��_.,f7fKYs�'a. sad._!1M1lr iut!!.'.�x? :__vim !1.5�.-----------•..................------.. r ��.c W -•-•------------------------•---�`i- ..'a �o 1=1�...c'�--a-Kar'- ....---•---•---•--•---------------------......-----•............---•-•.------ ._.__AtLYI�J U Nature of Repairs or Alterations—Answer when applicable________________________________________________________. .... .._.�a(' !...... No.30216 !�. Agreement: � l/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste in ; quEh the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not ce the system in operation until a Certificate of Compliance has been issued by the board of health. Signed s ........................................ /%/ r .............................�............................. Date N ? /`" Application Approved By ............... .... ' r:�.�: / �1- -h�................ ..Y:_t:'.' --i'-----J--t---(�-�`1.�.,:.... �„�:- -...-.. - Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- .. . . ... .. . ... .. ................................................................................ .... ... .. ........................................... ........................ ------------.....---------------- Dare PermitNo- -------------------------------------------------------------------- Issued ............ .................................................... Date THE COMMONWEALTH OF MASSACHUSETTS r BOARD,-Or H 1 ---------------) [ZI-V---- OF -.... Cher liftca#e of QTentyliance THIS IS TO CE F t te Individ al Sewage Dispos 1 to constructed ( ) or Repairedby - �� (-. ...... � r ...................... ..... ....... ----------------.. Ir?stau -- .. ---c ... 1D....... .--...... ... has been installed in accordance with the provisions of TITLE 5 The S onmental Code as described in the application for Disposal Works Construction Permit No. .............I------- .......- dated ................................................ THE ISSUANCE F THIS ERTIFICATE SHALL NOT BE ONSTRUED A UARANTEE THAT THE SYSTEM WILL FUNCTION SAT SFA Y. DATE -- -----�-------- --�----------------------------- Inspector THE COMMONWEALTH OF MASSACHUSETTS !rJ BOARD F 1LEA7 TH No.......L. ........! Y• FEE...1-�------------- Nioposal //orks �nn$rnrffutt antic Permission is hereby granted -- •-.1-L C -------•--.---------------------•-----.•.........----:-•---------....'----------......................... to Construct ( � or epair (,,) n_ Indiui�3 al Sewage Dispos System --• -�" at No 'f . ..J �KPLOt ! •i _l_)%-!-..... 7...~ _ Street' as shown on the application for Disposal Works Construction P t f � • - Board of althr' DATE...................! ` 1 ........................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t William E. Robinson MAR 10 2004 Septic Service TOVtiN OF EA-�NSTABLE HEALTH DEPT. THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 77 CheM wood Lane MAPMarston Mills Owners Name: Avelino and Maria Lopes PARCEL ir--, I t ®� Owner's Address: 21 Whitmar Road __ Marstons Mills,MA 02648 ICY 2 Date of Inspection: February 27,2004 "`' Name of Inspector: (Please Print) David D. Coughanowr,R.S. Company Name: William Robinson Septic Service Mailing Address: P.O.Box 1089 Centerville,MA 02632 Telephone Number: (508)775-8776 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 function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature Date: U Vr—� L t 2W4- 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 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 sent to the system owner and copies sent to the buyer,if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note==> Although this system would not fail with regard to the Commonwealth ofMassachusetts failure criteria, it does not meet the requirements of the Town of Barnstable and therefore is deemed to fail. Specifically, "Septic systems consisting of one cesspool shall be upgraded to conform to 310(1M 15.00 of the State Environmental code."A copy of this regulation follows page 11 of this report. ****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 1 i Page 2 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 CheMr 3yood Lane Marston Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: Yes I have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no,or not determined(Y,N,or ND). in the_for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not),is structurally unsound,exhibits substantial infiltration or exfiltration, or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level 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 Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced. ND explain 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 ND explain 2 Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 Cherrywood Lane Marston Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 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 public health,safety and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,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 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 surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 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 from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of armuonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3)OTHER 3 Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 CheMovood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 D) System Failure Criteria applicable to all systems: You must indicate either"yes" or"no"to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described 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. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X 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.(This system passes if the well water analysis, performed by a DEP certified laboratory, 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form) No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist a described in 310 CMR 15.303,therefore, the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E)Large 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 either"yes" or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 II of a public water supply well. If you have answered "yes"to any question in Section E the system is considered a significant threat,or answered "yes" in section D above the large system has failed.The owner or operator of any large system considered a significant threat under section E or failed under section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 I OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 CheMr )vood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No Y _ Pumping information was provided by the owner,occupant or Board of Health. N Were any of the system components pumped out in the last two weeks? N Has the system received normal flows in the previous two week period? N Have large volumes of water been introduced to the system recently or as part of this inspection? Y _ Were as built plans of the system obtained and examined?(If they were not available as N/A) N Was the facility or dwelling inspected for signs of sewage back-up? Y _ Was the site inspected for signs of breakout? Y _ Were all system components,excluding the SAS.located on site? Y _ Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum.? Y _ Was the facility owner(and occupants, if different from owner)provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal stems le p P p systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y _ Existing information. For example,Plan at the Board of Health. N Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 77 Cherrywood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd. Number of current residents 0 Does the residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection required) Laundry system inspected (yes or no): n/a Seasonal use(yes or no): no Water meter readings,if available(last two year's usage(gpd): 205 gpd Sump Pump(yes or no): no Last date of occupancy:Fall, 2003 COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd 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 discharged to the Title 5 system: (yes or no) Water meter readings,if available: Last date of occupancy/use:_ OTHER: (Describe): GENERAL INFORMATION PUMPING RECORDS Source of information: System not pumped in recent past(Owner) Was system pumped as part of the inspection: (yes or no) No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM: X 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/Alternate 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: Age: 12+years Certificate of Compliance issued 1/22/92(BOH permit#91-557) Were sewage odors detected when arriving at the site: (yes or no) no 6 Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Cherrywood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 BUILDING SEWER_(Locate on site plan) Depth below grade: 1.5 ft Material of construction:—cast iron _40 PVC other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting,evidence of leakage,etc.) Sewers are vented through roof. SEPTIC TANK:Yes (locate on site plan) Depth below grade: 8 inches Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: 10.5 ft x 5.5 ft x 5.5 ft(1500 gallon) Sludge depth: 10 in Distance from top of sludge to bottom of outlet tee or baffle: 24 in Scum thickness: 6 in Distance from top of scum to top of outlet tee or baffle: 7 in Distance from bottom of scum to bottom of outlet tee or baffle: 11 in How dimensions were determined: Probe to top of tank Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Septic tank was pumped at time of inspection Maintenance pumping is recommended eveg 2 years Liquid level was at outlet invert.Tank and tees appear structurally sound and functioning as intended No evidence of leakage in or out GREASE TRAP: none (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene 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:_ Date of last pumping: Conunents: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I I OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Che=ood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 TIGHT OR HOLDING TANK: none (Tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_metal _fiberglass_polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: _gallons/day Alarm present(yes or no):_ Alarm level:_ Alarm in working order(yes or no):_ Date of last pumping: Comments:(condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: Yes(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: at outlet inverts Comments:(note if box is level and distribution to outlets is equal,an evidence of solids carryover,an evidence f q Y �' y ceo leakage into or out of box, etc.) D-box appears structurally sound with no evidence of leakage in or out Effluent level at outlet inverts Few solids in sump. PUMP CHAMBER: none (locate on site plan) Pumps in working order: (yes or no) Alarms in working order:(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Cherrywood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required) If SAS not located,explain why: Type: X leaching pits,number 2 _leaching chambers,number _leaching galleries,number _leaching trenches,number,length _leaching fields,number,dimensions _overflow cesspool,number —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) Soils above leaching pits appeared unsaturated.No evidence of surface ponding breakout,lush vegetation or other evidence of hydraulic failure was observed. CESSPOOLS: none (cesspool must be pumped at time of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: none (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Cherrywood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 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'(Locate where public water supply enters the building) LEACH LEACH LOCATIONS OO PIT 2 PIT O D-BOX O A B 1 24 f t 34 Ft 2 39 ft 45 ft SEPTIC 3 36 f t 62 f t TANK o 4 54 f t 31 Ft A B EXISTING DWELLING # 77 W Z J W I W F- 3 CHERRYWOOD LANE NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Cherrywood Lane Marstons Mills Owner: Avelino&Maria Lopes Date of Inspection: February 27,2004 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater: 35+ feet Please indicate(check)all methods used to determine 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 150 feet of SAS) Checked with local Board of health-explain: Checked local excavators,installers-attach documentation) X Accessed USGS database You must describe how you established the high ground water elevation. Barnstable GIS department records indicate that property is over 35 feet above groundwater table f 11 , ,. � . .. , I CA 20 MINIMUM'OR AS HJDI TED ON PLAN > ` NOTES, 1 o MIN. W• 1. ALL WORKMANSHIP AND MATERIALS SHALL. CONFORM TO_D.E. .E. Q n.1 S mac. - C3 A �. T�4 4 MASONRY EXTENSION tD 12 TITLE 5 THE :TOWN OF RULES AND , BELOW GRADE ,'S eACKFIu WITH �7 E 'SUBSURFACE° D OSAL OF 'SEWAGE- TOP of FouNDAnoN ;-, REGULATIONS FOR TH DISPOSAL IN. 7 a i 8 M 7 ` � CLEAN AN .�' o r 0:1 MASONRY EXTENSIONT 2 s `AND EREQUIREMENTSOF PLAN. ._, THE TH(S AN OW GRADE BEL z _ 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO _ WITHIN 12 OF FINISHED H E GRADE. .•.,, 4 SCH. 40 PVC PIPE MIN. PITCH / 8 PER FT. T 3. ALL MASONRY UNITS USED TO `BRING COVERS TO .GRADE ' a � A PLACE.I 2 LAYER of SHALL BE MORTARED IN PLA , 4 B TOE ROAD PER FT FL Ow LINE STUB 1 8 1 2 r �. A SYSTEM AL CA .. 10 TEE I ! ALL :COMPONENTS OF THE SANITARY SHALL BE CAPABLE WasH sTON t ED E i TR NE DRIVE /O G t7 EELI F T LNGLOADING: ' E ARE UNDER OR 5 Z , � 0 WITHSTANDING H 10 UNLESS THEY ,. 'r MIN. < a 2 0 GA LLON ..ALL WITHIN 10 T. OF DRIVES OR N AREAS. H 20 LOADING td4 T F D VE PARKING EA 2 .,YIN. A LEVEL: LEACH < J 0 4 0 r PIT ,. V 0 DRIVES OR r� _SHALL BE USED UNDER OR WITHIN 10 FT. F ES S, at, r Y N O MIN. b � J 4 1 1/2- LIQUID Gr PARKING. o F WASHED STONE -� LEVEL DISTRIBUTIO N 44, b I `TO COMPLIANCE H DEED aox - 5> NO_DETERMINATION HAS BEEN ,MADE AS CO PL E WITH OR ZONINGREGULATIONS. :'OWNER APPLICANT SHALL c , RESTRICTIONSZO / , P AUTHORITY. OBTAIN SUCH DETERMINATION FROM THE APPRQ RIATE AUTH I / P LOCATION MAP' GALLON SEPTIC TANK' z 6. HORIZONTAL AND VERTICAL CONTROL SEE LEVY ELDREDGE T L VE L , , 1 i 0 4 .1. ASSESSORS MAP I PARCEL IZ z o WAGNERW NOTEBOOK s I , , & GNER FIELD �___,_,,. f I I w U IN SEPTIC ANK 'DEPTH of OUTLET'TEE BELOWFLOW LINE QUID DEPTH i 0 8 TTOM OF TEST HOLE 4.FEET 14 INCHES OR USGS PROBABLEHIGH`WATER LEVEL 3 5"FEET _' 19 iNCIiES 6 4 FEET 2 INCHES a T INTERPRETATION: CURRENT ZONING � DESIGN CALCULATIONS 'SEWAGE DISPOSAL SYSTEM PROFILE ' r E GEDS AL MPR IE _< A � 0 -MIN FRONT SETBACK FEET NUMBER OF BEDROOMS T NO 70 SCAL E P :UNIT ` MIN. SIDE, SETBACK' FEET GARBAGE DISPOSAL L ins - «. D E R W Lei w h�"t' -� ►k>�t-� 1 ?c 3 S _ C 1 gol sF' 3b � �' 4.4' g:�S U qt G r 5�f �' TOTAL ESTIMATED FLOW C it MIN REAR SETBACK FEETGAL./BR./DAYc} »c� X _.�,BR. �� GAL. `DAY _ I TANK CAPACITY GAL. REQUIRED SEPTIC TA L .. TANK _1..� .GAL. . ACTUAL "SIZE OF SEPTIC ` PERCOLATION SOIL TEST.:.:. P- 7841 LEACHING AREA REQUIREMENTS ., o Sl EWALL AREA GPD. S.F. BOTTOM AREA GPb: S.F. �9_ 1 r DATE OF SOIL TEST o SIQEWALL 2?f / 2 & SF x 2>s GPD SF — 4 7 GAL DAY 3 r v ...t1 2 T Y - EST B a _ 7GAL/DAY BOTTOM � F F T M 7T 2 5 _x GPD S r a w d „I ,t� r9 i �z ritt�3a�r_- _ .BY , {r WITNESSED I :a o f•ur,ca x . PERCOLATION RATE MIN.` INCH. 5 f 3 SF ,GAL/DAY� � 4 I�+lo® f t , 's.. CALCULATION. TEST PIT 1 TEST PIT 2 BREAKOUT c ELEV. �� o ELEV. f o.ao 0 00 : I oi�o APN W 'S N wt C .> r tot r� CD, i fi. �Rf s tJ >�s R tP P _ LEGEND. s l-in a r c/ 1 I EXISTING POT ELEVATION 00 0 E I S s X , S E TING CONTOUR Ob a _ FINAL SPOT ELEVATION 00.0 t w L CONTOUR t, FINAL CON R TP i ".I T T LOCATION .;T S PIT A - , SOIL E T , � TTOM OF HO_ BOTTOM OE TEST HOLE BO TEST LE v O_ �3 w v R W OR WATER ELEV. OR WATER ELEV.. TOWN WATE ;. TP L SEPTIC TAN K T w DISTRIBUTION :`:BOX t G- IT -... PRIMARY LEACHING P -' WATER LEVEL AD'JUSTMEN _. / 1 l „ tz. W. R N T _ RESERVE ' LEACHI GPI I r . x ,y V WATER LEVEL TEST; DATE TE E iV i xbS¢ xx R A x � , 'INDEX WELL s � I 2 iZONE w W WATER LEVEL RANGE� // / INI AL ISSUE 41 l INITIAL s W r. DEPTH 'TO WATER LEVEL FOR INDEX WELL �- NO. DATE ::DESCRIPTION 8Y : FOR MONTH OF: o R TH o L. Y ..� - T"1 I 8 S r � »>`3 �a: C. Dom.,. N ar Z E G �. rq WATER V ADJUSTMENT A ER LEVEL a�'h I # t TO HIGH WATER DEPTH. ; �I a � W :> > t:n ft. L9 > s , It s.. : N H E STEP APPROVED. BOARD L ALLYPd i 3 N . VVILS® 1 i _ E z .Wi . � �QB o. � � �- :SCALE N W 3 a SITE PIAN ,._.� DATE AGENT ; DG & WAGNER ASSOCIATES INC. LEVY, ELDRE E z y / r . : 0 PERMIT BNGII�S LA1�SCIPB A1tCf�TB(,TS PLAN�(BRS 1lND SURVIfiII RS r 9 WEST 'MAIN` STREET 88 WE CENTERVILLE MA 02632 I SUP -Y>O NEWENGLRNtl REPROGF?APHC38 SU Pt C i I I