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HomeMy WebLinkAbout0088 FRANKLIN AVENUE - Health . 88 Franklin Ave 292-2/8 - — Hyannis it ° � ° o TOWN OF BARNSTABLE LOCATION SEWAGE'# `a Z VILLAGE J ASSESSOR'S MAP& A PARCEL � ?)R f. INSTALLER'S NAME&PHONE NO. 9 T+ SEPTIC TANK CAPACITY /0 y U LEACHING FACILITY:(type) .Z f-5-A �U✓ (size / 35-. j NO. OF BEDROOMS 3 �. OWNER /T y [.' -7' A el PERMIT DATE: .� G/-� 1' COMPLIANCE DATE: A. 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 leacpeility) feet. Edge of Wetland and Leaching Faciany wetlands exist within 300 feet of leaching faci feet FURNISHED BY v • Q 1� L . o j� p � No. e�-0� l 0�3 Fee .O�• / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Mi5pooal &pgtem Cott,5tructfon i3ermit Application for a Permit to Construct( . )Repair(NO)Upgrade( )Abandon( ) El Complete System O Individual Components AVM t No wner's Name,A reps and Tel.No.(\ 'a'tp-poet q j6,,^ s ' LVc1 ewe s /� S►\�,�¢ Installer's Name Address,and Tel.No.JD'8'7 7 p�7 Designer's Name,Address and Tel.No.$08 —73(oLl— (� F— K-OL.>irvsv" Ted �O U)( I0e91 C&- vi l'l.p— y3 i ri ch c, � ta►c.�^ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(Ng Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ��ll Design Flow V gallons per day. Calculated daily flow 33 0 ' gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature I Rep •rs or Alterations(Answer when applicable) `5m���- Ct_ new 1 1�C'- 5 � 1. R IGS c4. LLD--` ,I�, 4 �TC 3 iev. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by ' B and of Health. Signed 17 Date Application Approved by L Date O Application Disapproved for the folio ' g reasons Permit No. o20tJ 1 —bog Date Issued :�A�� • Y y= a i Y "1' '1�4 /A:3�'.a�T.�yvSshr'�Cr'kM"yiV*:.���YF.!'►�-iv�l+`SM�`�F-,e..�L';X e1 ):Vs�r+!'�iJ`y'�IV�`�';,;:4r:�jp+f:t�^ .r�,fr-.' — 0, ; / No. �. tTf� / 3 Fee e THE COMMONWEALTH,OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN'66F BARNSTABLE, MASSACHUSETTS 0(ppYtcatton for Mtgooal *pgtem Con.5tructton Fermat Application for a Permit to Construct( . )Repair( 16 Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Addressor Lot No. Owner's Name,Address and Tel.No. � �t k-k '(��Oke ��t s . Luc:,ewe bey;ro / �xi S,tea, As essor's ap/Pazcel v�4 a a7 g Q���.� ►"`��►'�U� �'ti�� . Installer's Name,Address,and Tel.No. 5,0 Designer's Name,Address and Tel.No. 50� _3(oLJ— O$ y In M F_ C 0— T�c1 Fb � ►og� C��v, Ile �Tri Type of Building: r Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures P; :Design Flow 330 gallons per day. Calculated daily flow 25 2 7 L� -gallons. Plan Date Number of sheets Revision Date r Title Size of Septic Tank Type of S.A.S. Description of Soil ' 1 a , Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ? The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal-system in accordance with the provisions of Title 5 of the Environmental Code and not'to place the system in operation until'a Ceitifi- cate of Compliance has been issued by this o d of Health. Signed r\ Date Application Approved by vi f U L Date -c, -r Application Disapproved for the followi reasons r- Permit No. Date Issued Q? —e/— 4! THE COMMONWEALTH OF MASSACHUSETTS i b2i KD BARNSTABLE, MASSACHUSETTS . Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(It paired ( pgraded( ) Abandoned( )by A�sl� (2,1_6 r�sN,- h C_ at r=rnt has been constructed in accordance with the provisions of 'tle 5 and the for Disposal System Constru tion Permit No.62 nr)9—0�3dated 2 —c(— U Cl . —�, Installer in'`n i�Cg crn Designer The issuance of this pe t sh 11 not be construed as a guarantee that the-systemwllkfunction a d signed. Date � ) Inspector- No. �� 1 /1_1f�D / Fee ! THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ;6t2;pogal *pztem CowAruction Permit Permission is hereby granted to Construct( )Repair( 1b Upgrade( )Abandon( ) System located at i and as described in-the above Application for Disposal System Consf action Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condirons. Provided: Construction must be completed within three years of the date of this permit. Dater _ — 0 Approved by Town of Barnstable Regulatory Services Thomas F. Geiler,Director MASS. g Public Health Division i63 9. `o ► ' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: b COUG 0W W R, Installer: ���✓`" `�� �/ �v. v a Address: 4-3 C i t Address: 0)5,63 On 00 was issued a permit to install a (date). (installer) septic system at t'R�NkLI N ��E based on a design drawn by (address) p(�UID C01)GN WoWrLASdated b 31 Zdb9 (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component l of the septic system) but in accordance with State & Local Reguldtions. Plan revision or certified as-built by designer to follow. ESN OF MqS F.Q' S9 �o DAVID cyGN o D• - COUGHANOWR N s (Installer's Signature) No. 1093 $1G/STS?' S4NI TARS PN z fps (Designer's Signature) (Affix Designer's Stamp Here) r PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE V OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. { THANK YOU. Q:Health/Septic/Desiper Certification Form Town of Barnstable P# gyp' Department of Regulatory Services Public Health Division a"n"er''e`B' ' OIl Date i6J9 200 Main Street Hyannis MA 02601 Date Scheduled /L Time Fee Pd. / Soil Suitability Assessment for Sewage Disposal 0 Performed By: UI/il l� CYIO ij ytJW✓ 117E i0y fi/V Witnessed By: J LO cAITION& GibINFORMAT OE r Location Address ' � 1t h n,-e� q��( + Owner's Name t 7�/ (1�►I VVV /�J Address 7-Mok-1i tl Aue 14Y-Itflvi Assessor's Map/Parcel: 9 '�� �X Engineer's Name 'J �I� �j of NEW CONSTRUCTION / REPAIR ✓ Telephone# S�� 3 Land Use, - Slopes(%) Surface Stones Distances from: 'Open Water Body r.�{ ft Possible Wet Area A60 ft Drinking Water Well K/ ft Drainage Way SD t ft Property Line �_ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) j I❑ GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL. BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. rRz ( Z INDICATED GW 26.00 I ® ® ~ INDEX WELL AIW-230 1 I` READING DATE DEC. 2006 i (� READING 24.1 e ADJUSTMENT 4.8 I ADJUSTED GW 30.8 P l I � Parent material(geologic) ro �G(el a L ®l t�Jfjs� Depth to Bedrock V�6ne— Depth to Groundwater. Standing Water in Hole: © Weeping from Pit Face �e- Estimated Seasonal High Groundwater See— gboye DETEATION FOR SEASONAL HIGH WATER TABLE Method Used: 4010- a One_ + Depth Observed standing in obs.hole: in. Depth to soil mottles: Deotb to weeping from side of obs.hole: fr. Growadwatar Ad;astthe fr. Index Well# Reading Date: Index Well level Adj.factor Adj,droutidwater level , PERCOLATION TEST Date-1121e yj Thne L P M Observation Hole# / Time at 9" Depth of Pere �4+h Time at 6" Start Pre-soak Time @ to,. 03 Time(9"•6") End Pre-soak Rate Minrinch 2 rn e, Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(Y/N) Original:'Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the t .Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC S � SOIL TEST-_�LOG -. -� DATE OF TEST: FEBRUARY 2. 2009 APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 WITNESSED BY: ' DONNA MIORANDI. HEALTH DEPT. PERC NUMBER: 12466 I NO ED NDWATER TEST PIT I PAARENOTUMATERIAL: PROGLACA L OUTWASH PERC AT 64 in — 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER f 47.00 (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 0-8 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE 1 44.00 B-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 36-13B C MEDIUM SAND 10 YR 6/4 NONE LOOSE I 35.50 NO TEST PIT 2 PARENOTU MATERIAL: PROGLACALD OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING ? 46.90 0-6 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE 43.90 6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 36-138 35.40 C MEDIUM SAND 10 YR 6/4 1 NONE ILOOSE g _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from ..Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consi n I t 1 T Flood Insurance Rate,Map: Above 500 year flood boundary No— Yes Within 500 year boundary No-� Yes Within 100 year flood boundary Nov Yes Depth of Naturally Occurring;Pervious Material Does at least four feet of naturally occurring perviou.s material exist in all areas observed throughout the r area proposed for the soil absorption system? YB S If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent w' the required training,expertise and experience described in 3 10 CMR 15.017. ��pytH OF Mass9 Signature L� Z. LSD k¢6I Date �e� 2� 2dd� . DAVID �yG� U D. COUGHANOWR " `r0l/LENS— VAI.UP�O Q �SEPi7C�P13RCFORM.DOC '� E Q: F Commonwealth of Massachusetts Title 5 Official Inspection Form T. 41 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is Hyannis MA 02601 1/20/2009 required for y every 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 A. General Information forms on the computer,use 1. Inspector: only the tab key to move your David D. Coughanowr, IRS cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 1328 Telephone Number License Number i B. Certification 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 16.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails; M j N ❑ Needs Further Evaluation by the Local Approving Authority 1/20/2009 a Inspector's Signature Date -17 tr; The system inspector shall submit a copy of this inspection report to the Appro ing Authimrity Mbard of Health or DEP)within 30 days of completing this inspection. If the system is a share"yst� or has a design flow of 10,000 gpd or greater, the inspector and the system own r shall &omit the report to the appropriate regional office of the DEP. The original should be se 'to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. 2,10 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero & Jose Ricardo Coelho DaSilva Owner Owner's Name information is Hyannis MA 02601 1/20/2009 required for H_Y ' every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: 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. Check the,box for"y-Bs", "no" or"not determined" (Y, N, ND) 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. i *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): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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): 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 or the 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 l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 88 Franklin Avenue Property Address Luciene Ribiero &Jose .Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 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 at a DEP certified laboratory, for 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any 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 well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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 2000gpd- 10,000gpd. ® ❑ 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. 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. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ® 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? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a-no plan t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 335 gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r . Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for y H annis MA 02601 1/20/2009 ' every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): ' General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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): I l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 11+ years. Certificate of Compliance for system upgrade was issued on 2/18/97 (Disposal construction permit#97-59). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 feeett Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound, No evidence of leakage or backup into dwelling was observed. Septic Tank(locate on site plan): Depth below grade: 0.5 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 Dimensions: 8.5 ft x 5 ft x 6 ft(1000 gallon) Sludge depth: n.d. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) ' Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle n.d. • Scum thickness n.d. Distance from top of scum to top of outlet tee or baffle n.d. Distance from bottom of scum to bottom of outlet tee or baffle n.d. How were dimensions determined? n.d. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level at outlet invert. Septic tank is to be pumped at time of system repair and inspected for structural integrity and condition of tees. Grease Trap (locate on site plan): Depth below grade: feet 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 , l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 . I Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(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 per day 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is Hyannis MA 02601 1/20/2009 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 1 inch over outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Effluent level is above outlet invert due to clogged or overloaded soil absorption system. See page, 13. i 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.): I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): An observation hole was dug into leaching gallery stone. Soil staining was observed. Effluent was observed welling up into hole 4 inches above stone layer. Cesspools (cesspool must be pumped as part 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 ElYes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site 1plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface iewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero &Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 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 aea y - t5iris•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero & Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. Citylrown State Zip Code Date of Inspection r D. System Information (cont.) Site Exam: ❑ Check Slope , ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet I Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ 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: Town of Sarnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 20 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Franklin Avenue Property Address Luciene Ribiero & Jose Ricardo Coelho DaSilva Owner Owner's Name information is required for Hyannis MA 02601 1/20/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f 1 t t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 J TOWN OF BARNSTABLE T.r ate. Q +E+2 LOCATION d� ��. (�,u2 t SEWAGE # VILLAGE ASSESSOR'S MAP & LOT , INSTALLER'S N &PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER T � PERMIT DATE: '�. IL Q 7 COMPLIANCE DATE: Separation Distance Between the:u 'a Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet 4Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished,byr �;���f ,. r ' �'' �� k � � v ,� '� c .�\ -\ �r �� ®. Y �+ ` d: ' � �3* �� � � y No. 27 P- Fee �y / THE CO-MMO WEALTH OF MASSACHUSETTS Entered in computer: y Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for � gpogttY *pgtem Congtruction Permit Application for a Permit to Construct( )Repair V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel _ �o w``� aG9a Installer's e,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ` Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow '1 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank rST• l0 D Vz. Type of S.A.S. LTvcAT02_( Description of Soil rt Nature of Repairs or Alterations(Answer when applicable) ST KJ-C T ►�/ �. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E vironmental Code 4nd not to place the system in operation until a Certifi- cate of Compliance has been is oaz of Signed Date ��y Application Approved by _ Date Application Disapproved for the following reasons Permit No. — Date Issued a .+,.N- `.`-rrt{vy� .,f 'ar.� �+i' "�``�'_. ..ti..,+..n,.+�..: .r•. -+�,3M�.:4'�F`y,.s'. rV'� �'...+.9"y.�{.r�«J•;Ms .. .. . �.- 'M� .(+�Yy4-I1'^'YMy^"I1'.n 'Y.3`Y' L .Y. .,Y • a -7 2 No. , 7-s2 ,� sv � e�d+'"' Fee / THE.GRJYIbA1 ONWEALTH OF MASSACHUSETTS Entered in computer: .Yesv s — PUBLIC HEALTH DIVISION —TOWN;OF BARNSTABLE., MASSACHUSETTS qL 01ppYication for Mtgogar bpgtem (fongtruction Permit Application for a Permit to Construct( )Repair'V-.)*'Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. per-- Owner's Name,Address and Tel.No. Assessor's Map/Parcel .Crla_ a� W `k,( W" t Installer's ame,Address,lland Tel.No. Designer's Name,Address and Tel.No. �Cc— aDry`5 Type of Building: Dwelling No.of Bedrooms vZ' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 7:?,' gallons. Plan Date Number of sheets f Revision Date .� Title kx I Size of Septic Tank — :T lC ,[> AL, rType of ,� � 4y 'r^{t.yvr��'�•-"! ""` .•- � �cam" Description of Soil IE� 0 4 IL == ,-'•` V r' y Nature of Repairs or Alterations(Answer when applicable) Sn-R —6 t, 7— lw r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E vironmentaI Code d not to place the system in operation until a Certifi- cate of Compliance has been issued oar of �. Signe Date ��S Application Approved by Date a �•� "�, Application Disapproved for the following reasons h� r Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO C , thh t the a Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by �o di�Y d 6,X5 at 7 F 51, IAy w N-° S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1?2--5Y dated Installer Designer The issuance of this permit shall not be cogstr ed as a guarantee that the systew will function as designed. Date 2L Inspector ——————Q—————————————————————————————— —— No. �S/ Fee J THE COMMONWEALTH OF MASSACHUSETTS f, PUBLIQJHEALTH DIVISION - BARNSTABLE., MASSACHUSETTS r Xigpogal 40p2tem C ngtruction' Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abari`don( ) System located at ���_✓A n ��r &L S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this pmmit. Date: Approved by Q ^TOWN OF BARNSTABLE �- LOCATION (? �'�yti w �-a Ce-�"L SEWAGE # .VELLAGE -�a =mil ASSESSOR'S MAP & LOT � INSTALLER'S N &PHONE NO. SEPTIC TANK CAPACITY j n�n0 2-d LEACHING FACU-r Y: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: T 7 COMPLIANCE DATE: :.Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by C ek I q NOTICE:This Form is to be Used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, ►G o.��� �c , hereby certify that the application for disposal works construction permit signed by me dated —'7 , concerning the property located at rk-, Au r-- meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed i • There are no variances requested or needed. SIGNED : DATE: �r��? LICENSED SEPTIC YSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j xert .--. t s,. ._; \ I " 1 F` � _ � Q .. �� t No...1.7/......... Flux............................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �. Z VVliratinn for lkiip sal Iforka Tuntrurtian Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: !-,v..\:........... v................................•---„ L ton.Address or Lot No. .......o s ue. .�........�...... N ........................ ....... -: 1... ......1-1:�. �x is.... Owner Ad ress ... ........ ..... ................................. ............ .... Installer Address U Type of Building Size Lot....l614!!!'....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`-4 Other—Type of Building .. No. of persons............................ Showers g ..............•--..-.--... P ( ) — Cafeteria ( ) dOther fixtures ----•-------------------------•-•---------....--------..........------....------------------------•---�-----•--•---• ••---- WDesign Flow........%1C)...........................gallons per person per day. Total daily flow---------.7..2A.Q-.......................gallons. 04 Septic Tank—Liquid capacityl0.-00gallons Length................ Width..............-- Diameter..... --.--. Depth................ Disposal Trench—No. .............�.�.,.,.�. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit DiairSeter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution boxy( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..........--.--..... Depth to ground water------------------------ IX4 Test Pit No. 2.............:..minutes per inch Depth of Test Pit.................... Depth to ground water.---.----............... -------------------- --------- O Description of Soil...-----•--------•---•••...... ..�3�W_ . .. // �—._......... x •...........................................•---•------..........•-•...-,....-•----.. U •-•-•-•-•-••-•-•-•........-•-----------•-----•••--••.................••-•-..........................................----•.......--•.....--------•........---------------•••.......-••------•••-••-.-•--• W U Nature of Repairs or Alterations=Answer when applicable.--..-.......................................................................................... ............... ........................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i s ed by the board of h . Signed........... ---•• .. ...✓.-.:' .... ..... �-/(�„7-'�� i /� Date Application Approved By----.....6` `Q......- Date Application Disapproved for the following reaso s:................ ........••-•-••.•--•-•---•-•---•---•..........................................................•---.••---•---•-•------............---:................-----.........-------•--•-••---•................... / Date Permit No. { '................................. Issued =/ --------- -•--•• Date No..... .......... Ficit............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH ........7 ;. ........................ OF__,............ ....................i................;................................ �7 e4 le /_1 Appliration for Bisposalej 1/1 Application is hereby made.for a Permit to Construct or,!Repair Repair an Individual Sewage Disposal System at: V-k V, - ...V.... —S�� ....................................................... ................................................................. ..... ................. ... .. ..... Location-Address .................. ............................. .or Lot No. ................................................................................................. ......... Owner Address -1 ............... .................................................................................................. Installer Address U Type of Building Size Lot... ....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder %-I P-4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria a4 OthSr fixtures ..................................................................................................... Fl Design ow......��:Lo W D . .............................gallons per person per day. Total daily flow.._....:'...:.- .-_.---..._---- ..............gallons. W- Septic Tank—Liquid capacity��J�*r�(Lgallons Length................ Width................ Diameter...—......... Depth...._......._... Disposal Trench No............ Width..-................. Total Length.................... Total leaching area....................sq. f t. Seepage Pit Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.......................................................................... Date-----. ---.-----•- ------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--__-___-__-____-_____-. Test Pit No.-2................minutes per inch Depth of Test Pit.....__....._.__.... Depth to ground water......................_. ........... ................ ........*............*.......­------------- ....... ..................."........*............ 0 Description of Soil............................... '�4 ;? --------------------------------------------------------------------------------------- U ........................t................................................................................................................................................................................ ......................................................................................................................................................................................................... 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—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is!we by the board of health. a Signed............ - ------ ...................................... .......... ..................... Date .......... Application Approved 'By.......... . ..... ....... .................. .............. - = Application Disapproved for the following reasons................ . ........ .................................................................................... ......................................................................................................................................................................................................... Date Ae Permit No..----- Issued...................t'......e7.......................... D-t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ...............OF........... ................................... (Irratirate of Toutpliattre THIS~IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.......... ...............................e ....... .. ............................................................................................................................... at.................................. 4,... ............. ... .............................................................................................. has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._.,;,.'1/.......................... dated...._ ---------------- 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION. SATISFACTORY. DATE........... ............... Inspector.....� ........:;,� .................................7...........:'7------- ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF 'HEALTH 27/ _V......A, ,..........................................OF......Q�7.... No......................... FEE........................ lgispviial Works Tanstrurtion lirrafit Permission is hereby granted............................................................................................................................................... -7rn to Construct 4 or Repair an -jividAle-SewakeDispbsal System atNo.... ..................................................................................................................................................:.................................... St t'as shown on the application for 6isp`o_S`a1 Works Construction ........ Dated.._.................._........._.......... ................................ ........................ ............. Board of Health DATE..J/tyr ...................................................... A....r FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS CONTOURS , ROUTE 28 160.00 f t FALMOUTH ROAD EXISTING - - - - - - - 50 I ---� MINIMAL GRADING PROPOSED LOT 103 N I� AREA = 16800 s f+ I " I � I � " Locus �r F HYANNIS. MA GARBAGE GRINDER 47 I � I IS NOT ALLOWED I EXISTING / \ PAVED L�O oS M A P WITH THIS DESIGN. INFILTRAT(�f? I SCALE SYSTEM�r /� W/�Y RDA I / \ d 0_0 I _� _ LEGEND � � — — 48 LIN m I I GAS I EXISTING TP-2 TP 1 C� / ( 4� 1000 GALLON WATER LINE 1 cA E Z SEPTIC TANK NOTE 24 Ft x 125 Ft x 2 FL R E W \ I I LEACHING GALLERY j EXISTING LEACH G E i I EXISTING INFILTRATOR STSYEM TO O � \ O Z + j PIT/CESSPOOL • BE ABANDONED IN PLACE OR REMOVED. �}p{> '�, '� Z N 1 I J 1 i 16-M � m 1� I TEST PIT D-BOX O I Q J s o O II '' '' II '' 1 C)l0 m DECIDUOUS CONIFEROUS �. W W I \ X u Im I TREE TREETREE 34 Ft II ,' '' O J 1 O 1 12-M �12-P I W W I ILl BENCH MARK I \ \ 4 m I -NUMBER REFERS TO DIAMETER IN 4 A INCHES. LETTER DENOTES TYPE. TOP OF CONCRETE BULKHEAD CORNER I �1 \ 48 O-OAK M-MAPLE P-PINE C-CEDAR � L _ ELEVATION = 49.23 a 160.00 Ft." BARNSTABLE GIS DATUM '747 �SHOFMgSsq �NOF DADVID cyG� �o� DAVID q�y� � � s D. COUGHANOWR " COUGHANOWR � PLAN �No. 10930 ` SCALE: 1 1n = 20 `c01STef' so '�ENs�° pQ Sq R`PN /( F A V t' EL_O W P R O E I L_E EXPRESSEDALL PIPELATIONS INV DECIMAL FEET NOT FEET AND SPECIFIED ARET INCHES.ELEVATIONS f t SL 20 0 20 40 TOP OF FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE to 10 20 F-ebrv9ry 3, Z06)9 ONE INSPECTION RISER FOR LEACHING GALLERY TO , SEWAGE DISPOSAL SYSTEM PLAN EL = 50.00+— WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT. a7.00 �r®� Te -TO SERVE EXISTING DWELLING ALL PIPE TO BE EST_ LUCIENE S. RIBEIRO AND D-BOX MAX SCHEDULE 40 PV;� JOSE RICARDO COELHO DA SILVA 3" DROP AND TO PITCH AT OWNERS OF RECORD FLOW LINE 1/8 In/ft MIN. Q� 11 TE 44.50 10.. 14 ..ir �� 1995 - BB FRANKLIN AVENUE 48" GA PRECAST ®�I'A�� HYANNIS. MA BAFFLE DRYWELL PROPERTY ADDRESS BOTTOM OF \46.001+— 6 in Y LEACHING y LEACHING ASSESSORS MAP 292 PARCEL 278 EXISTING STONE43.86 J GALLERY 43 TRIANGLE CIRCLE EXISTING EXISTING BASE GALLERY 4d 44.05 SANDWICH MA 02563 PLAN BOOK 260 PAGE 79 1000 GALLON 43.75 (END VIEW) 41.75 5.00 Ft + 506 364-0694 DATE: FEBRUARY 3. 2009 EXISTING JOB B E T E-31 D m PAGE l OF 2 1 VERSION: SEPTIC TANK SEE DETAIL ON REVERSE THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED EXISTING 18 Ft. o) 5 FL 12.5 f t SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM b) 12 ft DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING ADJUSTED SEASONAL 30.8 PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER HIGH GROUNDWATER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOIL TEST LOG DESIGN CALCULATIONS DATE OF TEST: FEBRUARY 2. 2009 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC NUMBER: 12466 CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) TEST PIT 1 NO GROUNDWATER ENCOUNTERED DISTRIBUTION BOX: USE 3 OUTLET D-BOX. PARENT MATERIAL: PROGLACIAL OUTWASH SOIL ABSORBTION SYSTEM: A 24 Ft x 12.5 Ft x 2 Ft LEACHING GALLERY CAN LEACH PERC AT 64 in - 2 MIN/INCH IN C SOILS Abot = ( 24 x 12.5 ) = 300 sF ELEVATION A s d w = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sF DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Atot = 446 sF 47.00 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Vt 0.74 x 446 = 330.04 GPD 0-8 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE USE A 24 Ft x 12.5 Ft x 2 Ft GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 44.00 B-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 36-138 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 35.50 LEACHING GALLERY TEST PIT 2 NO PAARENOTUNDWATER MAATER AL EPROGLACRED USE SHOREY PRECAST OUTWASH LEACHING DRYWELL (H-10 00 GALLON NOT TO LOADING) SCALE 1000 GALLON SEPTIC TAW 2 MIN/INCH IN C SOILS DIMENSIONS AND DETAIL NOT TO ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER AVI CONSTRUCTION DETAIL USE EXISTRvG H-10 LT SCALE(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DRYWELL UNITTSTON SEPTIC TANK IS TO BE PUMPED DRY 46.90 AT TIME OF INSTALLATION AND IS TO 0-6 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE 24.0 Ft BE EXAMINED FOR STRUCTURAL n INTEGRITY. INSTALL NEW PVC OUTLET 43.90 6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE a) TEE EQUIPPED WITH A GAS BAFFLE. 35.40 36-138 C MEDIUM SAND 10 YR 6/4 NONE LOOSE n 4- m 1 In in IE�:ll O m N TAPER N m lz r � 3.5 Ft 8.5 Ft B. Ft 5 t t cm I GROUNDWATER ADJUSTMENT 24.0 Ft EXISTING GROUNDWATER LEVEL ([1 :777: '• a +* BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. �0 ' '�(���'- ` 500 GALLON DRYWELL r t INDICATED GW 26.00 DIMENSIONS AND DETAIL INDEX WELL A1W-230 In Q ZONE D USE H-10 UNIT READING DATE DEC. 2008 INSTALL ONE INSPECTION RISER TO WITHIN THREE COVER OUTLET -� s, ; READING 24.1 INCHES OF FINAL GRADE ADJUSTMENT 4.8 AND INDICATE LOCATION ADJUSTED GW 30.8 ON AS-BUILT PLAN —� All3 DROP FLOW LINE IN FROM 10 in - 14 TO BUILDING In D-BOX Q � 33 LIQUID 48 DNOTES GAS O E Im LEVEL 1 BAFFLE ooa00000000 ��OQ 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. o0000000aoo pQ ,� 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 1021n �0 CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES CROSS SECTION VIEW SEWAGE DISPOSAL SYSTEM PLAN BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING INFILTRATOR STSYEM TO BE ABANDONED IN PLACE OR REMOVED. 2 in PEASTONE 2 to PEASTONE -TO SERVE EXISTING DWELLING 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. 28 s.4,n ro 0 2E4FFE"crlvEa 4,n ro 26 LLJCIENE S. RIBEIRO AND Z) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES In -112'^�"�' �TM h1/2 GRAVEL '^ DOSE RICARDO COELHO DA SILVA AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. B) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 46 1n 58 1n 46 In 88 FRANKLIN AVENUE HYANNIS• MA , PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. ECO-TECH ENVIRONMENTAL ' 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL INSTALLER MAY SUBSTITUTE 150 i n AN APPROVED GEOTEXTILE STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-31a0 FEBRUARY 3. 2009 1 212