HomeMy WebLinkAbout0025 ENSIGN ROAD - Health 25 ENSIGN ROAD, CENTERVILLE
A= 147 066
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UPC 12534 '
No.2_ 1_R , s
HASTINGS,MN
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No. Fee Coo
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppliLatlon for -Misposal *pstrm Cone.t urtlon.Vermit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No ��5� o `�"� �� Owner's Nampiki SONe, ddre s,and Te No.
Assessor's Map/Parcel QQ O-r W oc�s.
Q6M
er's Name,Address,and Tel. & esigner's ame,Ad ss,�rrd Tel.No.
®
R. C ��� i1�s �1➢�r
_S
Type of Building:
Dwelling No.of Bedrooms Lot Size J.S .3 5� sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.requ' ed) gpd Design flow provided gpd
Plan Date c;Q aC) Number of sheets 3 Revision Date �—
Title @,�
Size of Septic Tank /0� Type of S.A.S� a C CQ,6�UN t T%-S
Description of Soil Q J A IB HP rVZO S C --R0-r-y_U AJ
Nature of Repairs or Alterations¢Answer when applicable) !:L5I fQ N\ !'cv) pllofij
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 an of to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. C
Signed Date b aoco -0
Application Approved by / Date P
Application Disapproved by Date
for the following reasons
Permit No. s Date Issued
« '" � e'� ��+- , to•Y
NiI-IN
. Fee too
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplication for Vsposal 6pstetn Construction 3permit
Application for a Permit to Construct( ) Repair(-J) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot n No. �S t N s rV�`C �� Ower's Name, ddress,and Tel.No. G 'a Cl" 3
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ,,
lt1�s c .0 4 CI 1'Fr7 `{ i#JI) MC, 13,a 1
Type of Building:
Dwelling No.of Bedrooms Lot Size .n sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
lr
Other Fixtures
Design Flow(min.required) ) gpd Design flow provided gpd
by Plan Date Number of sheets Revision Date
Title i
Size of Septic Tank 1�000 Type of S.A.SO)w - Q 11ot-i C &V Yam' c--S
Description of Soil (") Q Honlowc.
Nature of Repairs or Alterations((Answer when applicable) �JrJ_t f Q I) h-fin., \silk') r,n I 10,4
t h A Wl t-.S
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 of to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signedj Date it a1�OZ
Application Approved by E yft ?Date '.�
, -
Application Disapproved by Date
for the following reasons
Permit No. Lj 't.� d""' Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by R0, p,r"'j" )r C6, 'TN
at "i QCj has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.p U;y`1 5 Z-'dated r c)
Installer s ("T OV'Z CCU .�a" ,J Designer -<,<, IVIS, - 0 a ta A.,1I�7�
#bedrooms r Approved design flow ,J gpd e'
M
The issuance of this per shall not be construed as a guarantee that the system Al function as esign�e/d.
Date t t) ,, Inspectors
--------------------------- - - ---------- - -
- No. 90)-U — ( ?, �-' _ Fee AT)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal *pstrm Construction Permit
Permission is hereby granted to Construct( ) Repair /} Upgrade( ) Abandon( )
System located atti
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit.
Date f S Approved by
r
Town of Barnstable
Inspectional services
• �- Public Health Division r
s�nrrsrnats. � _
KASS � Thomas McKean,Director
1639.
D ems' 200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
c.,
Installer&Designer Certification Form
Date: eJ`14120 Sewage Permit# Assessor's MapWarcel ±q1�bl
Designer:. ��MM MCR WN 'P f- Installer: PZBW OUrZ-
Address: Address:
DEN V I S 5 MA oU 41 NpI-u 6GH .IYA 0L6 45
On 0 J 0S- PC)_)9-V-f was issued a permit to install a
(date) (installer)
septic system at EINS 9 6tw� rLQ based on a design drawn by
address
TH.o/nA y MG(.1✓Luy -ll ,PE' dated LI
(designer)
/I 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. Strip out (if required) was inspected and the soils
were.found satisfactory.
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
of the septic system) but in accordance with State&Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed ink ; rd, with the to rms of
the 4approval letters(if applicable)
�� `i110�J1A5J. y�
o McLELLAN N
///V :� t;IVlp
v 0. 6471�
nstaller's ignature)
)signer's i afore (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
WoAdeptsWEALTMEWER conneOSEPTIMesigner Certification Form Rev 8-14-13.DOC
TOWN OF BARNSTABLE
LOCATION 0%!S "n'N 51Cj tJ Pd SEWAGE# g2a o- 3
VILLAGE Cet,119-4111 ASSESSOR'S MAP&PARCEL �n
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY [QC®
LEACHING FACILITY.(typex Ct� - &A e (size) a 5
NO.OF BEDROOMS-3
OWNER PLI. c C,�n .D
PERMIT DATE: COMPLIAN DATE: 5 ;d "J :
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) AJ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
i to
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BORTOLOTTI CONSTRUCTION,INC. c' Y
765 WAKEBY ROAD,MARSTONS MILLS,MA 02648
508-771-9399 508428-8926 FAX: 508-428-9399 a ,'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address /���3/ %) i -C.•'. /z%��l
Date of Inspection: 12 Inspector's Name: f ` �,/
Owner's Name and Address: %N',� t/. �' i
CERTIFICATION STATEMENT:
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete as of the time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal systems. The System:
1/ Passes
Conditionally Passes
Needs Further];valuation B the.Local Aproving Authority
Fails
Inspector's Signature: Dater
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional
office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable and the approving authority.
INSPECTION JMMARY•
A)SYS M PASSES:
I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair,passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If
not determined",explain why not.
The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or
exfiltration, or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
-1-
.A
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The System required pumping more than four times a year,due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of The Board of Health):
Broken pipe(s)are replaced
Obstruction is removed
C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by The Board of Health in order to determine if
stem is failing to protect the public health, safety and the environment.
the g P
system
1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 Feet of a surface water
Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION
-
ING ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 Feet to a surface
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a lone I of a public
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well, unless a well water analysis for colifonn
bacteria and volatile organic compounds indicates that the well is free from pollution from
the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm.
D)SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined
in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health
should be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent 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 clog-
ged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2
day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed
pipe(s). Number of times pumped
-2-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 Feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant
threat to public health and safety and the environment because one or more of the following
conditions exist:
The system is within 400 Feet of 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 Il of a public water supply well.
The owner or operator of any such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
✓Pumping information was requested of the owner,occupant,and Board of Health.
None of the system components have been pumped for alleast two weeks and the system has
been receiving normal flow rates during that period. Large volumes of water have not been
introduced into the system recently or as part of this inspection.
✓As-built plans have been obtained and examined. Note if they are not available with N/A.
The facility r ty o dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
✓The site was inspected for signs of breakout.
All system components,excluding the Soil Absorption System, have been located on site.
The septic tank manholes were uncovered,opened,and the interior of the septic tank was in-
spected for condition of baffles or tees,material of construction,dimensions,depth of liquid,
/depth of sludge,depth of scum.
I✓ The size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
-3-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
[--The facility owner(and occupants, if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
RFv%MFNTLAL*
Design Flow: allons Number of Bedrooms:__: Number of Current Reside ts: 11 4� 9�
Garbage Grinder: A In Laundry Connected To System: Seasonal Use:
Water Meter Readings,if availab�e:
Last Date of Occupancy: 1S P ✓v t Aj
COMMERCIALIINDUSTRTALv �
Type of Establishment:
Design Flow: aallons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System Pumped as part of inspection:_ If yes,vo ume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM:
�eptic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records, if any)
Other(explain):
AP ROXIMATE AGE of all components,date installed(if known)and source of information:
Sewage odors det6cted when arriving at the si e: )
-4-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK:
Depth below grade: Material of Construction:11---concrete metal FRP Other
(explain)
Dimisions:Q�S Sludge Depth: Scum Thickness: /L" d)e-
Distance from top of sludge to bottom of outlet tee or baffle: 3
Distance from bottom of scum to bottom of outlet tee or baffle: e'
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation outlet invert,structural integrity,evidence of 194kage,etc.) s><s CL 16W cy;
GREASE TRAP:
Depth Below Grade: Material of Construction: concrete metal FRP Other
)(explain — — — —
Dimensions: Scum Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation to outlet invert,structural integrity,evidence of leakage,etc.)
TIGHT OR HOLDING TANK A
Depth Below Grade: Material of Construction:_concrete metal—FRP Other(explain)
Dimensions: Capacity: gallons Design Flow: gallonstday
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches etc.)
DISTRIBUTION BOX:
Depth of liquid level above outlet invert:(can
Comments: (note level and distribution is equal,evidence of solids carryover,evidence of leakage into
or out of box,etc.k ks
PUMP CHAMBER:
Pump is in working order:
Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.)
-5-
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
(Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive
methods) If not determined to be present,explain:
Type:
Leaching pits,number: Leaching chambers, number: Leaching gaileries,number:
Leaching trenches,number,length:
Leaching fields,number,dimensions:
Overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic f ilure leyKI of ponding,condition of veaetation,
etp S Cam:,:/� % ,/� , _C' •� 'G % ..i,�'- ,��' c C?»
IL
CESSPOOLS:�U
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(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:,A6_
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
-6 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
SKETCH.OF SEWAGE DISPOSAL SYSTEM:
Include des to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
,,�yCrr 1 1
c7 t,1I
�l
DEPTH TO GROUNDWATER: '
Depth to groundwater: Feet ,
Met]iod of Determinationl o r.A proxima •on
ar �� .• S. r a
-7-
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TOWN OF BARNSTABLE `d
LOCATION < n<SI�Cn k0aC) SEWAGE #
VILLAGE an A--)>.,.Il '- ASSESSOR'S MAP & LOT 01Y
-VOI&Y-76iPS NAME&PHONE N0. )z� �()af
SEPTIC TANK CAPACITY )6(26 0a l 11&aLL
LEACHING FACILITY: (type)?/r 7t C J (size)
NO.OF BEDROOMS
BUILDER ZOWNE� - _12d VZ-
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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r THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.........
............... 9 .........�:
T.
, .-... -�',.
pphr�a#iun fur DiaposFal urki C�nnitrnrtion ranfit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: _
Locatio5-A,ddress or Lot No.
Owner .................................
---------•••-----•.-••-- Address
nst.11er Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms........ ...............Expansion Attic Garbage Grinder
pa Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .
Design Flow................... .. gallons per person per day. Total daily flow..........._ ...........
WSeptic Tank—Liquid capacityllo-Ogallons 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 b C I.!/I is------j !tt Date............
N ..minutes per inch Depth of Test Pit...... .i De pt�h/tto ground water.
6v Test Pit � o. 1_s.rr�. p p p gr � .... /
(i Test Pit No. 2_.�f?�.minutes per inch Depth of Test Pit.--.. ............... Depth to ground water----�®�.c.q_s r/t
�Z ......I-------•-•-•I......••.. ••. ...--- .....,
Description of Soil 0. r
U --------------------•----------•---------- ......---•-........---•--•--•------------------•-------•------
W •------•--•----------------•---------------------•--------------------••-•-------------•------•---••-----------•----•----•----------•----••----------•----------•-••••-------••-------------------------
UNature of Repairs or Alterations—Answer when applicable ..................................................................: ...e. .....................
-----------------------------------------------------------•---••-•-••-••-•••.-•---•----------------------------------------------------•---•---.•-------•---------......------------------•............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of 1 lth.
Signed................. ........................ ---_
* D e
Application Approved BY..........
:` �_..... ...... .
Date
Application Disapproved for the following reasons:................................................................................................................
---------------------•------..........---...•-------•----•---•--•---..........----------•-......---------..................................-.............-..............................................
Date
PermitNo......................................................... Issued_.......................................................
Date
No.B�.... ? L " F:ms..........a_............_.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratiun for Diopuottl 10orkii Tonotrnrtion ramit
Application is hereby made for a Permit to Construct (.�. 'or Repair ( ) an Individual Sewage Disposal
System at: //'
.---- •-_..._. .. ....
Location-laddress Lot of
----
Owner e Addrye s
aa............ .
Installer Address
d Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms........... ........,__._______.._._Expansion Attic Garbage Grinder*--14.)
Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria
a' Other fixtures
s.m- ,.
W Design Flow............................................gallons per person per day. Total daily flow-_.........
._____...___._ .............gallons.
WSeptic Tank—Liquid'capacity/3OUQgallons 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 tam ( _
`" Percolation Test Results Performed by...__.__ c.' (t. 1.6 o :.__:_ ' t`` ✓ �,�
........ Date-------•--•----- -----------
Test,`�a Pit No. 1 4y.1 5--minutes per inch Depth of Test Pit_____ . ___.__ Depth to ground water......A 0--Q!
Test Pit No. 2. - ..minutes per inch Depth of Test Pit----I.....�.. Depth to ground water.-
....... ....................'
' 1.... ----_...-- v .. ....
Descri Description of Soil $ ......._.._
P ----.---------------•- - '
IT
U ---------------------
W --•---•-•--•---------•-----------•---•-------•------------------•---•-----•------••--••••-•--•-•......---------------•----------...--------••--•--•-------------••------•----•-•---•----•------......---
UNature of Repairs or Alterations—Answer when applicable................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
f'1 I f71�:r^
the provisions of T :I5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed..................
..1. `' "- - - r- `°'c' !..._._..
-aDV te
Application Approved By------.. .................. �, l:P .. ,
Date
Application Disapproved for the following reasons:-•-•---•-------------------------•------•-•-----....----------------------------•-----------•---••--------••--••
---------------------------------------------•--•--.....----......----•----------------------•-----------...--------------------------------------------•---------•--------------....---...----•--•.-----
Date
PermitNo--------------------------------------------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............h.�-'..� .............
�nr$ifiratr of (font lionrr
THIS IS TO CE IFY, That the Individual Sewa e Disposal System constructed (-'')'`or Repaired ( )
by ,:: ✓ . -- v/� ----•---- -----•-------------------•----•---•...._.........-••-••------•-•--
L U 1 1 � !�/S r 61, 9 t. -�� -t
at..... ................................••--------------- ------......------•--.I......esr ........------------....-----------------•-------------•-------------._......--•------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......Oe'n._��._,?.L........... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. (�
DATE...................................... _'1q.-b.�- Inspector........ I" -" -------------•-•----....-----•---•------......_......
i
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH
.............OF...
No.S i4 ... FEE-3 ......
Disposal Work.5 Toaw, lion ramit
Permission s reby granted-----------•. -1/ ....... -•---
to Construct -" for Reba}'r �, ) an Indiv}dual Swage `ispos�l ,S stemOf
atNo.......................................... ._ ` .!--------.....�...''....ff.�....'�� �.. � .f.l
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated.
----- .........__.__............_..............
.. .... :_
DATE ._.._.. -1.! P�................................... oard ea?
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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LEGEND
EXISTING SPOT ELEVATION Ox0. ,, o� .�,' i x °yc " CERTIFIED PLOT PLAN
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EXISTING CONTOUR ---- 0 — E r, t' c; ,�_n�► i
FINISHED SPOT ELEVATION ® ; A.
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FINISHED CONTOUR - 0 IN
APPROVED& BOARD OF HEALT TAF.3
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DATE AGENT ;�x 4 t� g;j ';{SCALE+' / -� o. DATE /n�7.3�g'/
EL.DREDGE ENGINEERING G1G! INC:
CLIENTkp-.CERTIFY THAT THE PROPOSED
REGISTERE EGISTERE J09 NC. '/D 3 �, SulLDING'$NOWN ON THIS PLAN
CIVIL LAND '�"'�" """"' CONfORM3 .;.T0 THE ONING LAWS
ENGINEERS SURVEYOR k , DR.RSYs
4 OF {3prQ.lsrAP , MA
712 MAIN $T, z. CN BY! / >>10:2-7•81
HYANNISI MASS: SHEET...OF,. ,.�. DATE E0. ^LAND SURVEYOR
NOTE /F E/TNER TWe SEPT/C TAN/C DR -
�� ?D FT. 'MIN. G:EAGfll.,vG P%T Ave MORE TNA/V /2 SELOW
.GRAOEF A 24"O/A W ET.ER CONCRETL=. COliER`
SNALL eE ®RDuGNT TO GRAGE.�AN EXTRA
9"FRVC P/PE
CONCRCTE h+E,4VY CAST/RON CoP/ER .Sf/:4LL L3E USFp
M/N. P/TCN IFYN L7R/VEWAY;
Z, O COYERS
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BACXF'/L[
-- - - - • • � � . z LAYER
of 'CAST '. o o a,-
/RON P/PE i o
b M/N.P/TGN U O�. GAL. ° ' f •, • • • • • • v o WASHED 57?7NE
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PdFit yr , SEPT/C TANK • . d
BOX o • � 8 • >P • • • � • •
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...� _•� �' ° ��• DEPTi/ • • • • � o 0 1rV.4SHE0 STO/YE
• r' a D ' PRECAST SEEPAGE
74
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JI�UMBER QF LEACX/NZ P/TS_j_' ELEY. 'ELY .DATE'OF SO/L. TES r
ShhL�.L�ACH/NG.PER P/T Jig �T 'Xp , � � RESULTS JV/TN�SSED BY'
/6ioP
* et�TTOMLL�r'IGN/NG,PER.P%T 3� $Q. �7- 2� t`i '` f9EltCOLAT/ON AA re
TOTAL LM1CN/NG ARE
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RESERVE LEACNlN6 AREA ' SQ. -,Fr .
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F� EevGe�r, �ini�ec�eE
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JOB No. 1 U SHEET
KEY:
N EXISTING CONTOUR: ---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION
PROPOSED CONTOUR: ------------- 2"
SPOT ELEVATION: 25.5 2"PE -1 1/2" O FILTER FABRIC
FLOW ESTIMATE: FIRST FLOOR COVERS WITHIN 6" 3/4"-1 1/2"DOUBLE
PROPOSED SPOT ELEVATION: 25.5 3 BEDROOMS AT 110 GAL/DAY= 330 GAL/DAY 102.38 OF FINISHED GRADE WASHED STONE
TEST HOLE: TOP OF FINISHEp GRAD
*0 Q� UTILITY POLE: -O- FOUNDATION l INSPECTION PORT
p cn SEPTIC TANK:
��p-{ O 5�G FENCE LINE: ' , E E-LEA'.=96 0
v�m �� HYDRANT: 330 GAL/DAY x 2 DAYS= 660 GAL T
�a -
VS RETAINING WALL: 0 3 MAX.
COVER
USE 1000 GALLON SEPTIC TANK (EXISTING) 98.45 1/4"per ft (1 MIN)
ELEV,
W m 97.4
m 25.0' LEACHING AREA: (EXISTING ELEV.
USE 2-500 GALLON CHAMBERS 8.5'x 4.8'x 2'EFF.DEPTH WITH 97.65 E ELEV.
( ) ELEV. ELEV. ° 93.17
LOT 17 ION(15,035ASF ELEV. 6"OF STONE D-BUNDEROR 4' 4'
( ) 4'OF STONE ALL AROUND (25'x 12.8'x 2'DEEP)
H � ELEV.
ASSESSORS MAP:147 PARCEL:66 CD 1000 GAL MECHANICALLY COMPACTED)
N SEPTIC TANK 25'x 12.8'
PLAN BOOK:293, PAGE:28 SIDE AREA: (25'+ 12.8')x 2 x 2=151 SF (0.74)=112 GAL/DAY
95 17 2-500 GALLON CHAMBERS WITH
BOTTOM AREA: 25'x 12.8'=320 SF (0.74)=237 GAL/DAY TEE SIZES: (TO BE CONFIRMED) ( 'x STONE ALL AROUND
LEACH AREA DETAIL INLET:6"UP, 13"DOWN ELEV. (25'x 12.8'x 2'EFF.DEPTH)
CAPACITY=349 GAL/DAY OUTLET:6"UP, 14"DOWN GAS BAFFLE
AT OUTLET TEE
N / 99
99 TEST HOLE LOGS TH-1 100.0 PREVIOUSTH 101.0
/ ENGINEER:THOMAS McLELLAN,P.E. O/A HORIZON ELEV. LOAM& V.
LOAMY SAND TOPSOIL
/ WITNESS:DONALD DESMARIS,R.S. 9° 10YR 4/1 gg g
/ \ DATE: 4-23-20 B HORIZON 24" 0
/ \ PERCOLATION RATE: <2 MIN/IN LOAMY SAND
36" 10YR 5/8 97.0
C HORIZON MEDIUM SAND
\ PREVIOUS TEST HOLE/ 2 5Y IU4 SAND PERC N \ ENGINEER:ELDREDGE ENG.
WITNESS:JOE GIFFORD
dO \ \ DATE: 9-1-81 132"1 1 89.0 144"1 89.0
PERCOLATION RATE: <2 MIN/IN NO GROUND WATER ENCOUNTERED (>20'DEEP)
�Q P 99 / th-1 F�e��
0' 0•'' 99 3 `��w, NOTES:
�G a� ' Ste,•' `:�� o°
w` P� 100 �f 1.VERTICAL DATUM: ASSUMED
'✓ .�°�o ��o� 2.MUNICAPAL WATER IS AVAILABLE.
QaJg.0e - f , ! aP��P 2 `` 88 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM.
o� 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS.
101 ,' �� 5.PIPE PITCH= 1/4" PER FOOT(UNLESS NOTED OTHERWISE).
6.FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL.
7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL.
/ C�RgG�c 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL
/ CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS.
9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION.
W .�/ ,�' 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED T WITHOUT VARIANCE.
11.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA.
n s7 12"oak f, f
12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND
Q a atjO l P',£' �cG. IS SUBJECT TO CHANGE UNTIL SUCH TIME. THIS PLAN HAS BEEN PREPARED FOR THE SOLE
PURPOSE OF CONSTRUCTION OF A NEW SEPTIC SYSTEM AND DOES NOT NECESSARILY
Q QQ � REPRESENT A FULL DETAILED PROPERTY SURVEY.
/ , 5 98 13.EXISTING LEACH PIT IS TO BE PUMPED AND FILLED WITH SAND OR REMOVED.
3e STtN \ S 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW.
fnd,N,4f yg
BED
101 (C) v' ROOM BATH
i BED
\ 9�a ROOM
SITE PLAN
BED
99 'o / �' BATH
ROOM
�/ "' ✓/ �-BENCHMARK AT _ LOCATION:
li LEFT CORNER
S'^ / 100 OF EVAT ONAD101.41 2nd FLOOR OFss9c 25 ENSIGN RD., CENTERVILLE,MA
; �� THOMAS J. yG PREPARED FOR:
°'o �o LIVING Deck McLELLAN ALLISON MCNAUGHTON
GARAGE
f ROOM BREAK-
� CIVIL
NOOK No.36471
PORCH D 9FQ � �Q DATE:4-23-20 SCALE: 1"=20'
BREEZE IS7EP�
99 WAY ONAL
' ROOM
98 BASS RIVER ENGINEERING
� � BATH KIT CHEN
\ \\ bh 1st FLOOR THOMAS J. McLE LAN, P.E. P.O. BOX 1163, EAST 508-364 90DENNIS,MA 02641
M20-20 98 EXISTING FLOOR PLAN