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Home My WebLink About0091 ELDRIDGE AVENUE - Health 91 .EI ridge Avenue Hyannis A = 292 282 `t Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r r *w 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Nam information is required for every y H annis Ma 02601 9-15-2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, Daniel Hawkins use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 411 . Company Address Sandwich Ma 02563 City/Town State Zip Code m (508)477-0653 S114324 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ■❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation bj the Local Approving Authority 4. ❑ Fails Dan Hawkins Digitally elgned by Dan Hawkins 'Date:2020.09.1707:28:33-04'00' 9-15-2020 Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Please note: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. t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 ' I Commonwealth of Massachusetts Title 5 Official Inspection Form 1~ rr i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments %41 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System.Passes: ❑■ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) 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,w.11 pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," I explain. please e p 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. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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 or the environment. a. 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: t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts -- Title 5 Official Inspection Form j- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owners Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 seritic 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 determire distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•'age 4 of 18 Commonwealth of Massachusetts �y Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is required for every Hyannis Ma 02601 9-15-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ [D Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ . O Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow ❑ a Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ El tributary portion of 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 1 of a public water supply well. ❑ E 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ E] The system fails. I have determined that one or more of the above failure criteria exist as 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. 5) 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 118 Commonwealth of Massachusetts Title 5 Official Inspection Form -i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave 1' Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? ❑ 0 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? O ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? Ex-1 ❑ Was the site inspected for signs of break out? p 9 El ❑ Were all system components,excluding the SAS, located on site? ❑ ❑ Were the septic tank 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? ❑ El Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: El ❑ Existing information. For example,a plan at the Board of Health. ❑ O 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(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•?age 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 2 Number of bedrooms(design): Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220/GPD Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes Q No Does residence have a water treatment unit? ❑ Yes Q No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes Q No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2019- 120,000gallons 2018- 124,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: 9-2-2020Date t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts T , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- date of last pump is unknown Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: New leaching added to existing tank in 2003 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): ' 2' Depth below grade: feet Material of construction: ❑cast iron X 40 PVC ❑other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage,etc.): t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11111 Subsurface Sewage Disposal System Form Not for Voluntary Assessments - 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons 311 Sludge depth: 3311 Distance from top of sludge to bottom of outlet tee or baffle 811 Scum thickness 411 Distance from top of scum to top of outlet tee or baffle 10" Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•?age 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form l P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y St page. City/Town ate Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: NAfeet .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: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments % 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present -rust be opened)(locate on site plan): 0" Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or cut of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 TIda 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection 'Form 4Pi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. CitylTown Satet Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): NA ' * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate 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: 5 infiltrators(37.25'M') 0 leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t51nsp.doc•rev.7/26/2018 • Me 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form P i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): The SAS was in working order at the time of inspection. Leaching was dry with a stain line 1/2 up from bottom. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): NA 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 ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ft �� 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is required for every -Hyannis annis Ma 02601 9-15-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): S P t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 l Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Cade Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately Q F BA.RNSTAB'LE ,�. ...,- ASS � �E sow s MAP Lt2 f STALIZR°S r4. F r pF{ONE NCB. SEYM TANK CAPACTTY r LEAMUNc FAMTTx° (W—) NO, OF a7.ltczMs Is BUILDER OR OWNER PEPcasrUTDA.TE: compLlwrl IDATE; C of separation Distance Betare=the MaxiTnutn Adjusted Gmun wAter Table t0 the BotaM Of Leachittg Facility private Water Supply Well and L r wbing,Facility (If ADY wells exist on site.at withinZotl feet of leachixtg facility) Fee Feige of Wetland aatd.Uaching Facility(if any wetlands exist e ew•ittt n 3o()feet of tcactaing fee titY) Furnishc4 by. cs �' A t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•?age 16 of 18 Commonwealth of Massachusetts �m-- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is Hyannis Ma 02601 9-15-2020 required for every y page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water Check cellar ❑■ Shallow wells Estimated depth to high ground water: No GW @ 132"feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record ,. If checked,date of design plan reviewed: 10-10-2003Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form iSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Eldridge Ave Property Address Jenaina Nogueira Owner Owner's Name information is H annis Ma 02601 9-15-2020 required for every y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: 0■ A. Inspector Information: Complete all fields in this section. B. Certification: Signed&Dated and 1, 2, 3,or 4 checked ❑� C. Inspection Summary: 1, 2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ❑■ D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•'age 18 of 18 BARNSTABLE _ LOCATION a= I V e SEWAGE # �: J VILLA �-�"- c S ASS SOR'S MAP & LOT INSTALLER'S NA41E&PHONE NO- _ A A v SEPTIC TANK CAPACITY �,t- -- LEACHING FACILITY: (type) (size) c��I�t X10 NO. OF BEDROOMS . BUILDER OR OWNER PERMITDATE: Ifs .3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 300 feet of leaching facility) Feet Furnished by f\D may - • f r, TOWN OF BARNSTABLE ,LOCATION / ; �°�, , � �c� SEWAGE # VILLAGE /'✓ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. s. SEPTIC TANK CAPACITY la 6--1 V LEACHING FACILITY:(type) ;2= F (size) 4 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER cam, DATE PERMIT ISSUED: �/ —/.� 0 �— DATE COMPLIANCE ISSUED: L/ -- r VARIANCE GRANTED: Yes No �Y -__. � ,_;� � 6' �� -� �: � i :.�. � � ,3 e / � �� __..___� ,j �5 �•_ .. '� No. f :1. ... Fu$....$1 ,00...... . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uhipniial Workii Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ... .91 Eldridge•.Rd.Hyannis............................. Bill Lebo Location-Address or Lot No. ......................—.......................................................................... .........•-----.....------••-•-•-----•--•--•-•---•----•--•---•-•-•--•••-----•...---•••---...--•--- Owner Address a W.. ---Bnbinss�n.fiegtic._Berni e......................... ]�A0.._.1089..C�ntery .11e_MA..02632_.............----•--- 14 Installer Address Q Type of Building Size Lot............................Sq. feet U g— .Expansion Attic ( ) Garbage Grinder ( )Dwelling No. of Bedrooms______ ___________________________________ aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) G4 g ............................................ Other fixtures ----------------g---------•-P--•-P--•-------P--------y---•-•-------•---- y-----------••--------------------------•-•......._..�...---- ..............gallons per person per day. Total daily flow__.____......_.........•._............._..._gallons. W Design Flow................... .. . �' W Septic Tank—Liquid'capacity............gallons Length---------------- Width................ Diameter----------:_.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter...._--------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GX, Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water-________-_.___.-__.___. 04 --------•----------------------------------------------------------••-----------____......_........_......................................................... 0 Description of Soil........ and and gravel.......................... . ----•----------------------------------------------- W V .------------------------------------•-----------------------•-----------•----------------------------•---------------------•------------•---------------••-------------...---------------•-••...._-•---- W ----- ----- - U Nature of Re airs or Alterations—Answer when applicable....Installation of 1 D-box and --- ----- - --- -- an 1 stone .packed leachpit.--•.......-•---•----•---------••-------------•-•----------------------------------------------------•--•--. Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System 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 CompliaZ has bee issued t oLrd of health. Signed ..... .. ..........5z.......... --------------.-------- - ..-7-----1.../......�..c� Dare Application Approved By ------------------ .--� t '-�----------------------------- ---------------------- ---�:~..`�.--.-�...) Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ .-..------------------------------------- ........................................... ...........................-----.:... Date PermitNo. ..-....f.6-.1................. ......... Issued ----------------------..................................Da-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applira#ion for DiipngFal Works Tnntrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair, (g) an Individual Sewage Disposal System at: ......9i...Elckdcra_Rd,Ryaxlns....................................... -----... Bill Gebo Location-Address or Lot No. ......................_.......................................................................... ..........------.......----.....------............................................................ Owner Address .CQ'} -. ? r r?............ ....2_10109._Conte—ndlIe--MA._Q?632 Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms......2...................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a Other—Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth_............. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY ----------------------------------•-•---------•- Date a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-••------•--••-...-•-......-•-•-•--•••--------•---•••-••---------•••--------•............................................................................... ODescription of Soil........ and_ ..qmyai............................................................................................................................ U .........••-••••-••--•------•••--••--••••-----•--••••••-----------------------••••••-----------•-•••-----•---•--•---•-•••-•......-----•-•---- w x ------------------------------------------------------------------------•------•••--••-•--------••------•-------•--•-•--------------•----••-•-----•--••-••------•••---•--•---••-....................... U Nature of Repairs or Alterations—Answer when applicable._._Installation of 1 D-box and ----------------------------------------------------••. and.1 stone-toacbed leachAit..... -----------------------------.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System 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 has bee issued � 'oa d of health. Signed -- --- I... • - ..-- -+� I— Date ApplicationApproved BY ................ --- --------------------------...------------------------------------ ---- -..-..--Dare... Application Disapproved for the following reasons- ---------- --------------------------------------------=--- ---- ----------------------------------------------------------- f -------------------------------- �'r•�---- � Date PermitNo. ..... ------------------------------- Issued .......................----- -----------...-------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trlr#ifirate of Q-11omplianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by .. - �r,,: ' ? i?_-on---Septic..A e.---v.i e-------------------------------------------------------------------------------------------------------- Installer 91 Eldridge Rd Hyannis at ...................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....�{ ----... -�1.............. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 7SATtIySFACTORY. DATE ----- ..................................... ---------------------- ------- Inspector --------....-�....................'.1....,................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE...$30.00...... Disposal Workii T-1nnitr ion anti# Permission is hereby granted......161—F.a-.Ro i_'Tisoa..SimtJn..S�2 i ae to Construct ( ) or Repair (X) an Individual Sewage Disposal System at No.......g1...Eldridge-Rd til�a nis --------------------------------------------------------------------------------------------- , Street q as shown on the application for Disposal Works Construction Permit No;lDated.......................................... ......................... -. -- .......................................................... —DATE. Board of Health �3 �--- FORM 3850a HOBBS h WARREN,INC.,PUBLISHERS FEE 15® COMMONWEALTH OF MASSAC14USETIS Board of Health, ^_I t��0�`C1i2 ' MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) - ❑Complete System individual Components Location Owner's NamexwWom Map/Parcel#^ Oe Address Lot# Telephone# Installer's Name Designer's Name Address Ctex C Address 'Bcx rn MA Telephone# "' ` Telephone# ap StA8 Type of Building 4 `5\�e�C)'t\(�\ Lot Size ��.0 5` sq.ft. Dwelling-No.of Bedrooms .ran &Lvli� Garbage grinder 041A Other-Type of Building N Dr & No.of persons C_Showers ( &!Cafeteria (V� Other Fixtures _A =nnC!& t.Nrjnn, \r1 L-wcdM Design Flow (min.required) ) gpd Calculated design flow 35D Design flow provided L2AM$ZZ gpd Plan: Date -� b� 0�_ Number of sheets Revision Date Title � M0 2Rk ��C 'SUEMfYM UCXNM& a1 - Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator G2cm9n Zhg�Date of Evaluation 1 0 110'03 DESCRIPTION OF REPAIRS OR ALTERATIONS �� r.•nr�a�tllRtA t=A1�1�9t=1=R IIA�I�T Sr6t=i:tr {ie�UTALLATION AND CERTIFY IN W—I`i -°"`RDANCE TO PLAM The undersigned agrees tall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further to no to place em in operation until a Certificate of Com fiance has been issued by the Board of Health. Si- Date I Inspections '�r..raslti,✓•r•...�..,f7iY1,1.-..-.�, ^..1 T/f�'�/✓S�.w..fV`X.Y�...f�.:tjr*f�w.yw,�v.P'*.iVrji',,,,,.vY:;'{�.+ {Jti-y..rK.+^ h'd4"F!.°`.ln•''R I-S`•y++-'�'a.�ry,�_Y "".� '^^'�-�'.�^�-h�r--.� .. f.. f No.e FEE 0 At ��1 a COMMONWEALT14 ®F MASSACHUS ETTS10 Board of Health, d Y' -,,*0,`!_)\4P MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repai ( Upgrade( ) Abandon( ) - ❑Complete System ,Individual Components Location 1 C� �` ` Ct cz) Owner's Name Map/Parcel# na a 1 Address f^ ��1 �, �"' Lot# 4 r Telephone# 1 Installer's Name Soo j\ Designer's Name C 'Address -�C Z� C' AC �� Address �• ��!`npU NX Telephone# � .ram ) � ` Telephone# �y 8 Type of Building \�2�j� e(�t (►\ Lot Size I D}0 5` sq.ft. 1 c / Dwelling-No.of Bedrooms 'Ti .111 C�C t c�G C�Qy'sac) Garbage grinder NIA Other-Type of Building �!pC1Q- No.of persons C _Showers ( H!Cafeteria (V' Other Fixtures Design Flow (min.required) 32)b gpd Calculated design flow, 33o 0 Design flow provided 3,12)b gpd Plan: Date l7 ! 0�_ Number of sheets ` Revision Date Title c s,-\RIY,, Qc,5r ,AP1� Description of Soil(s) \j N -� Soil-Evaluator Form No. Name of Soil Evaluator S\la Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS4�, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 anil further a tes to no to place tem in operation until a Certificate of Compliance has been issued by the Board of Health. Si� A n _ Date � =��`17 = Inspections �'� FEE COMMONWEALTH��]�-1 LTH OF MASSACHU ETA x Board of Health, vl ._ .. MA. CERTIFICATE OF COMPLIANCE Description of Work: l Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; C*** ruated"( ),Repaired ( ),Upgraded ),Abandoned ( ) at 91 LAX- rlao l�c� 4-h-0 rwtt5 has been installed in accordance with the pro isions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.2003'50S , dated 10 fSIt3 Approved Design Flow (gpd) a Installer cta_E,%9 Q.) / Designer:-�SVy-_•i CnejvcAn"c!.?n-•) . r,5 Inspector: Jt! Date: /0/1-1-1163 The issuance of this permit shall not be construed as a guarantee that/t/he system will function as designed. .. . . - . - ........ i i -..1'... . -.f... No. '550,j FEE GJ Board of Health,- ti3'v1 A\,\ - , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(a. upgrade( ) Abandon( ) an individual sewage disposal system at ��" ..1 'oi= ` as described in the application for Disposal System Construction Permit No. W3-505•,dated Provided: Construction shall be completed within three years of the - t �thi-7l. •'t. local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date d / Board of Health Sep— 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 P . UL I �Sris;ot i !.XOTICE: This Form Is To Be Used For the Repair Of Faileld Septic Systems Only. PERCOLATION TEST AKD SOIL EVALUATION EXENIPTIO!N FORM cot CrA 04i ` j _, hereby certify that the engineered pian signet b� me i Uatec l��lO�a3 , concerning the property located at j I q l F;tCk.id 3C &&tR meets all of the tc11ow;ng �:ritena: i • This failed system is connected to a residential dwelling only. There are no .orrvrierzIa.! or business uses associated with the dwelling, j I • 'F�e soil is ciass:t:ed as CLASS 1 and the percolation rave is less than or equal to -ri.nutes per inch. •i'he applicant may use historical data to conclude this f3C: or "nay 'Dr.d UC tests at the site without a health agent present • There :s no tncr.-a.e to Flow and/or change in use proposed • I here are rto variances requested or needed. I • The bottom of the proposed [caching facility will not be located less than founeen I,j fee; aonve the maximum adjusted groundwater table elevation. (Adjust the j nunc!.vater table using the Frimptor method when applicablel t Please complete the following: i I 'fop of G",rouno Surface Elevation (using GIS informauon) 6; t, w' E I.e v3(:on �,d;ustment for high G.W. 14C= .--_a� ."t0 I '�'FhT.RENCF 8ETWEEI,,( and B Q . O1 S,G VE D rn%�� F--2—QbA(' DATE: I --------------- -- -- :NOTICE ' 3asec jpoa the above irforrinvion, a reoair permit will be issued for -)zdroorns T.a.�.irnu r No addi(ional bedrooms are authorized to t`ce future without en;tneerec i:ert.: syste^t plans. 96 -- -- rain!r,Au Puccxmp i I r � Permit Number: Datei : Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: Vekt*Aso A\,KnyW �CJ1(1\S Lot No. �3y Owner: ( L-%i%Xlart�, G2\en Address: Contractor: Sk'Ahl.�j4��n�C\Address: 5S4 Notes: 'D2S\C,n i i STEP i Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date /Q ho A ik o?S mont /day l STEP 2 Using Water-Level Range Zone j and Index Well Map locate site and determine: OAppropriate index well.................................................... at 0 OWater level range zone i STEP 3 Using monthly report "Current Water Resources Conditions" I determine current depth to ,-, �1 water level for index well J_lO 6 pc�} month/year i STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment .......................................................... 4•�- i i STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) •' i ag i 1; i I I i Figure 13.--Reproducible computation form, I i I 15 I i i i CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O.Box 627,East Falmouth,MA 02536 October 17, 2003 RE: Certification of Title V Septic System Installation: Residential Property 91 Eldridge Avenue,Hyannis, MA Dear Sir or Madam: On October 15, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 91 Eldridge Avenue, Hyannis, MA, based on a design drawn by Shay Environmental Services on October 10, 2003. I CeT tify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions,please do not hesitate to call the undersigned at(508)-548-0796. Sincerely, CARMENE. SHAY ENVIRONMENTAL SERVICES,INC. ��SN OF iygssq . CARMEN cycN o E• HAY 6mmen E.'55ay,R.S., C.S. No. 1181 President `��s T E P- S4N1TWN VUPM r O F BARNSTABLE _ LOCATION SEWAGE # � VILLAGE c.S f ASS SOR'S MAP & LOT Lg2'S,?2- INSTALLER'S N &PHONE NO. !,ri.i4we._ � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �tl�— (size) zoo lot Kle NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: ICE COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 300 feet of leaching facility) Feet i Furnished by / l � � qd .: ............................. . .......... SUBJECT OF BOARD OF HEALTH it 0 1 - I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above . construction. ................. Nome ` �z '` �� ' ` �� —T—~---- THE COMMONWEALTH OFMASSACHUSETTS ' BOARD4 � ' ...'s�� Application is hereby made for a Permit to Construct --�or Repair an 4ndividual Sewd"ge Disposal System Loca Address No. wner Type of Building 6Z___ Size Lot.... q. feet � Dwelling � Other—Type of Building ............................ No. of persons............................ Sbovvcru ( ) -- Cafeteria ( ) � � Other n . �--Other Distribution uvuu `uuZ feroolu6uoTest Results Pc�000edby----------.--- _..��------------' Dut�.�_'�-�'.�-----. -------`� u Test Pit No. 1--_----'minutes per�c6 Depth of IotIit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth toground water........................ � 0 Description of Soil........../................... . ...................................... -- ------------------------------------........ .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the -State Sanitary Code— le undersign urther agrees not to place the system in operation until a Certificate of Compliance has be i su y the rd ealth. 'te Sanitary Code— le Ince ha ned ----.---' �� '� �7g . ....9 Date /\ool�ut�� Bv-- Abe '��%�|' -��--- / ' Da" Application Disapproved for the following reasons:................................................................................................................ _/Ijate� r................. No..... ..........o._.... Fnn..... THE COMMONWEALTH OF MASSACHUSETTS BOARD/ F H - ------......................OF...... ............ ------------------------------------ .: . Appliration for Bifipoi;ai Works Tonotrurtion runtit Application is hereby made for a Permit to Construct ( or Repair ( ) an-Individual Se ` e Disposal System YM Loca on}.Address / " r Lot o. ......................... - / —N ......................................... �-- wner ( l A� a ' ------------------- ............................ -_-_ ................ :. .... ........ ._ Installer Address f Q Type of Building Size Lot...... -aA.S.. Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............!................ Showers ( ) — Cafeteria ( ) Otherfixtures ..................................... ;.2_ ---------------------------•--- W Design Flow.........�.1`.. .........................gallons per person per day. Total daily flow---_................ ........................gallons. Septic Tank—Liquid ca -gMons Length.__ -- Width________________ Diameter....._................ Depth................ Disposal Trench—No. .................... Width....................pi tal h.................... Total leaching area..............---.sq. ft. 3 Seepage Pit No...... ._'_. ... et __ ._ e ��.. .� ^; Total leaching area... ..........sq. ft. Z Other Distribution bbx ) Dosing tank ( l� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fsI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............_........... 9 ------------------------•••-----•_--•--•-••_----_-_--____-_........_-_--•-•--••- c Description of Soil............. .... -- -- ---•----......�...-"---------------••-•--. , ---•------------------•••_•-----•-__-••-_•__--•-_-__•---•--•----------•------•-•.--• _..._-_-----------•---•--------••----•-_•----------•-•_---.---••••_••-•_-_-•---_•_•______-_......---------. 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 Article XI of the State Sanitary Code— he undersign cl further agrees not to place the system in operation until a Certificate of Compliance has bN sual y theabar 'of health. �� r d° jf Date . Application Approved By...... �: �... ...... Date Application Disapproved for the following reaso s: i t Date PermitNo......................................................... Issued.--.� . _. . .................... Date E COMMONWEALTH OF MASSACHUSETTS BOARD OF 1-IE e 'ti!! ................OF.....::..:: ....:..:::... ..._..............................;.... 10-Ier#ifirate of Toutpliam , i' THIS IS TO CE -T-rPY, Thar the Indivi. 1 Sewa D�isposa�l S stem constructed or Repaired bye ............................................................... In ler has been installed in accordance with the provisions of Article XI of The State Sanitary Code as escrib d in the application for Disposal Works Construction Permit No--------------- _y40......... dated__!r_----G L "i ' ....... THE ISSUANCE OF THIS CERTIFICATE SHAI•L NOT BE COIISTR ® Al GgUARANTEE THAT THE SYSTEM WILL FUIICT O SATI, ACTORY. DATE......................... .... ....... ..... --f-.................... Inspector.................----.... ....... •..........................•. /JE COMMONWEALTH OF MASSACHUSETTS BOAR......... ...........................OF .................................. / .✓"� No... FEE....:................... � �t•, Permission as reby granted. -••-----`�'-. --• -----•- --•--- ...........:.•----................----••---......-•------•••---- to Construct ( r Repair ( ) I vidu Sewag�Disposal'Systerry at No.. ={ l � ''......:'-----------•-----.-----. Street 1 as shown on the application for Disposal Works Construction No._ Dated—. (¢. ... .._.f...�..x........ �..,. =r d DATE................................................................................ Boar f eaIth H FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - - Location: .Lot-434 Megan Road___S�w pnr.�-qy0 _ Villages -Hyannis, M ss. - - Installer: Frank J. Linhares P-:fi o - Box -661 Y:attapoisett a -Mass.. Builder: William E. Dacey, Jr. - 112_ West Main- St: Hyannis-, - Mass-. Date Permit Issued:+ loli �' / -- --- - Date Compliance- .-Issued: --- "a I J�l SECTION A -A *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (O Least 24 inches tall) J ALL OUTLET PIPES FROM THE 10' min. from Schedule 40 PVC w/Charcool odor Filter PROFILE VIEW OF ADDITION TO LEACHING SYSTEM, DIs7RIBUT1aN Box SHALL BE 12 coNCRETE COVER n Existing Foundation I house to septic tank SET LEVEL FOR AT LEAST 2 FT. Septic tank covers moat be TOP OF FOUNDATION = ELEV. 100.00 (Assumed) 3" of 1/8" - 1/2" Washed Peastone _ within 6 in. of finished grodc 3/4 to 1 1/2 Washed Crushed Stone r -` 3 - 6'OUTLET -Grade over Septic Tank -- 96,50 Grade over D-Boz - 99.00 ovd SAS -99.00. . ` c\. KNOCKOUTS ` 5.5• �. 12' R1lET OUTLET I � t_I,xr. S - 0.02 3 HOLE H-10 4 Top Load - Ehv. =94.83 'l\ e" d+t*qz ' DIST. BOX 3' Maximum cover Top of SAS- Elev. -94.33 'r 2 0 10' EXISTING S-0.01 or Greater EXIST, PIPE U7 N 1,000 GAL S- 0.01' per foot tS.5' 4" - SCH. 40 Te 1.75' ttj N O 20' 10" Effective Depth ,a FRON EXIST. FOUNDATION rn SEPTIC TANK oto 5.Unfts 2 6.25' = 30' PLAN SECTION CROSS-SECTION - Mary Atrco Ln rn H-10 PVC TEE o 20 cT' ` REQUIRED r er t CONCRETE FULL FaVNDA > _ n TO REDUCE .f rn °M° �0.83' (10 inches) 3 31�L�5 3/ aI o U. WATER VELOCITY rn D BOX S 3 HOLE H-10 DISTRIBUTION BOX f SYSTEM PROFILE QC, " a 3 e L � � u o y � � Effective length NOT TO SCALE �'ooen Not to Scale _ c ° a 4' 4. 1I c w i SOIL ABSORPTION SYSTEM (SAS) ��'�� ' �-.�:;ro...,.,�,,. o-.• � �~- INFILTATROR HIGH CAPACITY (H-10 LOADING)/ GEORGE ❑'BRIEN GENERAL NOTES 6 In.of 3/4'-1 1/2" o compacted atone EFCective Width _ OR EQUIVALENT Not to Scale NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE and p w o ( ) 1. Contractor is responsible for Di notification m NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" EFFECTIVE HEIGHT IS 10" and protection of all undergroundnd Utilities and pipes. Bottom of Test Hole 1 Elev.=88.00 ---.------------------ -------- 2. The septictank and distribution box shall be set level on 6 of 3/4"-1 1/2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. - i 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance TEST with Title V of the Massachusetts state code, the approved plan PERCOLATION and Local Regulations. 6. If, during installation the contractor encounters any Date of Percolation Test: OCTOBER 10, 2003 soil conditions or site conditions that are different Test Performed By. CARMEN E. SHAY, R.S., C.S.E. � from those shown on the soil log or in our design Results Witnessed By. WAIVER (per BARNSTABLE B.O.H,) 1 installation must halt & immediate notification be sign SHAY ENVIRONMENTAL SERVICES, INC. 9g,\ I made to Carmen E. Shay Environmental Services, Inc. Percolation Rate: Less Than 2 MPI i T T jE i 7. No vehicle or heavy machinery shall drive over the IN septic system unless noted as H-20 septic components. \1 ��' 11 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Test Hole1l WAY \\ NO. 1 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Ii 11 FOOT RIGHT OF 10. All solid piping, tees & fittings shall be 4" diameter DEPTH SOILS ELEV. (4O '--~-----_C-- _ �� Schedule 40 NSF PVC pipes with water. tight joints. 0 99.00 �� - - 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loamy `� _ Properties Within 150 Feet. Sand 10 YR 3/2 P 9s.ao \�, C OQ' - THE PROPERTY LINES ARE APPROXIMATE AND 0•-7" A I 9 COMPILED FROM THE SURVEY PLAN Sandy ------ I LC 27099-8 SHEET 4 Loom �+ I I ENTITLED " SUBDIVISION PLAN OF LAND IN HYANNIS, MA 10 YR 5/6 g2d 07 00- DATED JULY 30, 1972 7-- 60• Be sa.00i /' ' i' 1 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN Medium i Cp LOT #34 1 i �� IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Sand i CID 1 1 I ,' THE SEPTIC SYSTEM INSTALLATION. 2.5 Y 7/4 I ^ 10,051 Square Feet 6D 132 C 88.001 1 ^ / b I EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE. NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE - PROJECT ;BENCH MARK _ _ - -------- --- - I POSED - -. - FROM THE�XISILNG_L_EAC-H E'lI_TO_BE��- I ' TOP OF FOUNDATION _ OF AS PER BOARD OF HEALTH SPECIFICATIONS; ELEV. 100.00 (Assumed) 11 Q o r i LOT #35 NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY L Perc 1 HOUSE #91 ASSESSORS MAP 292, PARCEL 282 R III Depth to Perc: 60" to 78" I EXISTING LEGEND 1 Perc Rate= Less Than 2 MPI I I � l � I No Observed ESHWT 2 BEDROOM No Groundwater Observed 0132" 1 HOUSE I I 1 LOT #32 11 i i DENOTES PROPOSED -- , 104X 1 I �-F_- SPOT GRADE li Pnno I � DENOTES EXISTING Septic Tank I X 104.46 EXIST. 1000 gal. �� L----' � SPOT GRADE O , O Failed I - 23' i Leach Pit TEST HOLE #1 `V PL PROPERTY LINE ELEv.=/199.00 -- 96P PROPOSED CONTOUR D-B4 / i ----- .,' o - - - - - -97 EXISTING CONTOUR t -t. <: ® DEEP TEST HOLE & TYPICAL 1000 GALLON SEPTIC TANK �' y: ;f.,' 0 PERCOLATION TEST LOCATION NOT TO SCALE i -37.25 I _ .- 6 FOOT STOCKADE FENCE 2-16' DIAM. ACCESS MANHOLES nr �� 90.03 -- ; . - .;. ._.. •t_-B� 4,. PVC 1% I S 84d 57 /2� i / vent Pipe P LOT P LAN INSTALL TUF-T1TE GAS BAFFLES OR EQUALS ro �� INLET OUT SYSTEM UPGRADE �.: THE ACCESS COVERS FOR THE SEPTIC TANK, LOT #33 OF PROPOSED SEPTIC . PREPARED FOR DISTRIBUTION BOX AND LEACHING COMPONENT SET DEEPER THAN 6 INCHES BELOW FINISHED 1 -- - - GRADE SHALL BE RAISED TO WTHIN 6" OF V Y I L L I A M G E B O STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. JA,I PLAN VIEW AT 3-24' REMOVABLE COVERS #91 ELDRIDGE AVENUE J HYANNIS , MA 4 .:. 3' min. cleoronce, WLE-T 8' min.r j 2• min. Inlet to «,fief _. J}- D e s i g n C a l c u l a t ions Q�MA e- OUTLET -}{- - ��. ssq PREPARED BY: x.._.- 10'�min.-t ' -quid IevelT U t ! s' -T � - �-- ' s• -7. Number of Bedrooms: ,� Equivalent to �0 Gal./Day (330 Gal./Day Min. per Title V) � �J' ,/ V �« g o CARMEN G� CAR1V1 E1 Y 1� Sff 1 r Garbage Grinder: No Ea I 4'-0" nin Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) o E. _` _ om sae. LiqLAd depth 12 Septic Tank - 3 x 330 Gal./Day = 660 USE 1,500 GAL. Septic Tank, 0 20 40 50 " SHAY °' ENVIRONMENTAL SERVICES, INC. I SOIL ABSORPTION AREA. Using percolation rate o m n. ch O. Oi N ng per la to f <2 i /in N 11$1 i Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. 273.8 gallons 'PF �4 P.O. BOX 627 8 0'`- to---- Sidewaii Area: 0.74 gal./sq. ft. x 78 sq. ft. = 58 gallons GISTS EAST FALMOUTH, MA 02.536 Providing: = 331.80 gallons AN SITAR\ CROSS SECTION END-SECTION TEL/FAX : 508-548-0796 Use: (5) INFILTRATOR HIGH CAPACITY H-10 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE' l =20' - SCALE:. 1 "=20' DRAWN BY: CES DATE: OCT. 10, 2003 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE I ON THE ENDS. NO STONE UNDER. PROJECT#SD486 FILENAME: SD486PP.DWG SHEET 1 OF 1