HomeMy WebLinkAbout0139 FOX HILL ROAD - Health 139 Fox Hill Road
Centerville CIA
A= 190-142 'mWendafte,3C
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42101/3 ORA 10%@ P4
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No. t Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes .
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2ptJYILatIDn for M18t1 � p 0 al strm eunstrurttun Permit
Application for a Permit to Construct( ) Repair(kilUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. t__S OY-id Owner's Name,Address,and Tel.No.
C,er�i Cr l r(tom A 6f oZt' d 9,141 B ro M k
Assessor's Map/Parcel / D—/ya
Instal is Na e,Address,and Tel.No. �-��_ ya g Designer's Name,Address,and Tel.No. sag-
r�,cc�-car.�lC�sb� era �A t`tc•TeL2 .3a-a9ao2
8't�o+� Si ��Y�,�,�L�� 'P.o.3oac. 81 �.-5 �o•.-:ca- -
Type of Building: /p
Dwelling No.of Bedrooms Lot Size Z sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided y�. �/� gpd
Plan Date _X 1-d.d,[ a6, A D// Number of sheets Revision Date
Title
Size of Septic Tank /5-040 GA . Type of S.A.S. &¢06o/ .)r>wc/1 C3�
Description of Soil 45?C-0�iW
Nature of Repairs or Alterations(Answer when applicable) f c mo f T Zl ex f-s/If C,CV,060
,4t`f�Tc`7A�/h' Nei✓ D!s%. 6oX - 3SooG4t. Dr,., �ol�/�.1 f J7Tinc
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 Certificate of
Compliance has been issued b this Board of Health.
Si d Date
Application Approved by Date /
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
--------------------------- --------------------------------------------------------------------------------------------------------
No.� / y•@, u .,�.<;� i Fee
THE COMMONWEALTH OF MASSAHUSETTS Entered in computer:
PUBLIC HEALTH,D.IVISION - TOWN OF BARNSTABLE,aMASSACHUSETTS ' Yes
ZlppliratIott or isposal *pstetn ConBtrUrtton Permit
Application for a Permit to Construct( ) Repair({<Upgrdde( ) Abandon( ) ❑Complete System ❑Individual Components s
Location Address or Lot No. 3�j Foy- �{+ i I f2 d• Owner's Name,Address,and Tel:No.'
C�51C (•v ((C tidv�cTl i�b�tjTt' �c..T�l"P;t,hi
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. v�_ `1,�18 Designer's Name,Address,and Tel.No. '06
�3cv�ce j-tc ec.l l',,j c.r �tit rr,N
P.
i Type of Building: f
Dwelling No.of Bedrooms 'y Lot Size J 41 sq.ft. Garbage Grinder(/(/)d
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) yo gpd Design flow provided `/$�9. C/` gpd
Plan Date 3 ►-1 L a , -;k O// Number of sheets jZ Revision Date
i
Title
Size of Septic Tank /`.� U(J 6,9/ �` Type of S.A.S: 5-006HI (30
Description of Soil
Nature of Repairs/or Alterations(Answer when applicable) !vn1/1 f l�/=X t Sii, C,cc�S�,/%UG S ' /1'Ti9/1/5lafi�iBC
Srf7c 7�J//h" Atr,- G�;%, 1/ 3 G L,C Z,, /I• I�� f] �/ `G�/��1 t ST�i'1C
0 =
0>
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 Certificate of
i
Compliance has been issued by-this Board of Health.
Date :Tv�� S,aO /
Application Approved by / � Date J
Application Disapproved by v U Date
for the following reasons
Permit No. Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifirate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(l< Upgraded( )
Abandoned O by S Ny P2 J%,t C Cv r\3 t�c v
at t 39 E'v x J� CC, ��c has been con cted'n cod nce `�j
with the provisions of Title 5 and the for Disposal System Construction Permit No. ated r
Installer 3s�C C C,Lc'_' Designer, a 1 C N ` E/-i t t� 1
#bedrooms 1-� Approved design flow gpd
1
The issuance of thi pe t shall not be construed as a guarantee that the system willrin) s designed.
Date Inspector
' I
No. AIE�--- _- �---- > -:,- - �_�•- _— - � ---_-- _ Fee II� �COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction permit
Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( )1 I
System located at 13 9 E_u'l W l`'R,31 L V,/,)k'7 L . A
C 7 r 1 V L t /UT/ �(,A,
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
iTitle 5 and the following local provisions or special conditions.
f Provided:Construction must bejornp ted within three years of the date of this permit.
Date Approved by t
TOWN OF 4ARNSTABLE
LOCATION I3 /Z X ,�/ SEWAGE#
VILLAGE �h/�/%j iP��l�l� ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.�.1 `���(,s�C s'os-yam-,5-5'a9
SEPTIC TANK CAPACITY /$'00 C-vgl C,1-1-/D)
LEACHING FACILITY:(type) 5�G'w• CWi A14C Pi C3 11 (size) /3 �x 3 3 6 `�
�O
NO.OF BEDROOMS /
OWNER
PERMIT DATE: 7' COMPLIANCE DATE: 7J
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
y
l�Lf3' 3
0
a ,
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Public Health Division
Thoinas McKean,Director
- 200 Blain Street,Hyannis,iINIA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date:'_-r'''04 Sewage Permit# 900ti- Q 13 Assessor's MaplParcel I
Designer: Ac'c'c�c l 1 c-,c2 Installer: wec �cLc��I S t
Address: lam` 0 130 Q$1 Address: C d al ,
lcn•�U h
On Zr6ln s,aott :Er. t c_ h0-r.0-1st was issued a permit to install a
(date) (installer)
septic system at l Yt ('o X.N:(( 1 Cd. (I( based on a design drawn by
(address)
v/Alrc (� c� dated , ntc a'.6; L b
des' er)
I cert&;t'hat the septic system referenced above was installed substantially according to
the desiem which may include minor approved changes'such as lateral relocation of the
distribution box and;or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 107 lateral relocation of the SAS or any vertical relocation of any component.
of the septic system)but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow.
(Ins er DA R N s Signature) ,
M FR in
o. 1140
- - �esisner's.Siaturel
r� E
PLEASE RETU&N .TO BARt STABLE PUBLIC HEALTH D1V15 CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS-FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BAMSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26 kdoc
I
Town of Bdi instable P#
of�
Department of Regulatory Services
wealth D'' ion Date
. aTisrAVEX, • Public
, ¢ ems$ 200 Main Street:Hyannis MA 02601
Date Scheduled - / Time
Fee Pd. 0 V
oil Suitahifity Assessment fop Se a Disposal
Performed By: I �'9 Witnessed By:
k
LOCATION & GENERAL INFORMATION
Location Address ( Owner's Name kao�18
Address
4 .
Assessor's Map/P4rcel: ! Engineer's Name"�
NEW CONSiRUt,ON REPAIR Telephone# ���y :)�'% 2,'1 7-��i
Land Use l 0 e N '`i't Slopes Surface Stones
Distances from: ripen Water Body ft Possible Wee Are? �ft Drinking Water Well ft
Drainage Way ft Property Line _l ft Other fr
o 5$8g
N33-14'20"yy
SKETCH:($ 0 88.71 55g 2�3
-Z
O rA PATIO I W
N __
---- GAS �
to
TO
14
• � h 1 i i////i iii/// ENT. , ./
z,
o I �
a5.09
549'34'40 E
t I
f
�,Q C7, G5L�
Depth to Bedrock
Parent material(geologic) � C I P
Depth to Groundwater. Standing Water in Hole:' ri 11A Weeping from Plt FACE
Estimated Seasonal Righ Groundwater )A i
D An oTION FOR SEASONAL HIGH WATER TALE
Method Used: I ln,
Depth ab-serve standing!in hole: in. Depth td still MOttlCSC it
Depth toiweeping from side of obs.hole: in. Groundwater Adjustment
I Adj.f':letor.� �- Adj.flrplindWtltC1 LE441,,,s
Index Well# T Reading Date Index Well 1ev61._;a e....
PERCOLATION TEST . Date
Observation Time at 9" 1 ......_..
Hole# I �i '` 3 0
t- y Time at 6" ....� --
c Depth of Pere
t t o 3 I Time(91+-61+) �o —
Start Pre-soak Time.@TIT
i
End Pre-soak
I
Rate MinJlnch
Site Suitability Assessment: Site Additional Testing Needed(YIN)
Passed � Site Failed: '
, 1 .
Observation Hole Data To Be Completed on Back
Original:.Public r'e;;1th Division —
***If percolafiibn testis to be cone*scted within 1.00' of wetland,.-You must first notify the
Barnstable Nriservation Division at least one (1) wedk prior to beginning.
I
DEEP OBSERVATION HOLE LOG Hole# I
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
LAM V �Ar► d IN,a-+ 'li
Cam-M A4 i Dv to
'! S�► c ,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel)
PA-
(01
,
13 2'I Z 7/
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
EP OBSERVATION HOLE LOG Hole#
Depth from Soi on Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders.
Consisten Gravel)
Flood Insurance Rate Map: /
Above 500 year flood bounds No_ Yes
Y boundary
Within 500 year boundary No_ Yes i
Within 100 year flood boundary No_ Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring per 177f
aterial exist.in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on l (date)I have passed the soil evaluator examination approved by the
l Protection and that the above analysis was performed by me consistent with
Department of Environ enta
the required ftning.
eexxperti and experience described in 3:10 CMR 15.017.
Signature
1/ �--' Date
Q:\SEPTICVERCFORM.DOC
CENTERVILLE
TB M
CB CONC. BOUND
ELEV =44 16 (GIS±) s�
o� LOCU S
1!45 -- __ q.5 � 139 FOX HILL RD. 9
vent
0 '/ 46 - °' ___-- 46 71
c, �, 1 RpV
12"OAK TH-1 ° 41 ' � PROP. 1 50OG
6 OAK — 51EPT1 C TANK M
- -----� _ -48
47 --
12'OAK/� O Zc� TH- — — 49 v LOCUS MAP
✓'� ° 10 � PARCEL ID: J
, 10°HOLLY/ 50 190/141 LOCUS INFORMATION
IPLAN REF: LCP 33466—B
1 2"OA,K — TITLE REF: CTF# 126449
12"0 EX15t. Ce55 0015 PARCEL ID: MAP 190 PAR. 142
�/ _ tItTERZ p NOT IN ZONE II
(see note 10) FLOOD ZONE: "C"
COMMUNITY PANEL: 250001-0015—C DATED:08/19/85
CB
CB `�1 �`" ---- SEPTIC SYSTEM
REPAIR PLAN
3,g F LOCATED AT:
PARCEL ID: __ - -- -'-1�,TBM s8
139 FOX HILL ROAD
190/142 __ _= CONC. PATIO. 8s CEN TER VI LLE, MA.
00 AREA=14,922t S.F. _- _ - EL V.'=54.00 ISf) PREPARED FOR
#139 -__ �� EVERETT L. ABBOTT �c
- -- TOF=53.90 ,��'ol i RUTH BRONK
JUNE 26, 2011
OH W
ME R
/ S '9s,� No. 1140
19.
�s c
DARREN M. MEYER, R.S.
P.O. BOX 981
EAST SANDWICH, MA. 02537
R=25.00 } (508)362-2922
L=41.�5
SHEET 1 OF 2 J#1341
ELEV. TOP
FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS
(Existing) FINISHED GRADE (46.0--50.0)
= 53.90 �F.G.EL: 52.5 F.G.EL: 52.5 F.G. EL: 49.0 VENT
MAINTAIN 2% MIN SLOPE OVER LEACHING AREA
.i Z.
2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2"
• STONE OR FILTER FABRIC DOUBLE WASHED STONE
6„
4" SCH 40 PVC
.41 10"I 14' 6 131214 S= 1% MIN. 160®®®®®®®®®®
!' TEE'S ARE TO BE
INV.45.70 0RV ®®®®®®E 004' scH 40 PVC 2 E F. DEPTH FEE ®®®®®®®®®®
.....a::: INV.49.75
i NV.45.5 4' 3 X 8.5' 4'
PROPOSED DB-3
EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 33.5'
EL.50.48 •40 • ~ . • H-20 DISTRIBUTION BOX
INV, ELEV.= 43.85
INV. 50.0 PROPOSED 1,500 GALLON SEPTIC TANK
Of Mq
GAS BAFFLE TO BE INSTALLED ON BREAKOUT
OUTLET TEE AS MANUFACTURED BY o ADA M o ELEV.= 44.35
TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 44.35 :. ;. .: .
No. 1140 INV. ELEV.= 43.85 •®® o ®®
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ®®®®®®® .
PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®®
®®®®®®® •.
2) TANK AND D-BOX SHALL BE SET LEVEL AND TRUE ` NITA%\ BOTTOM EL.= 41 .85 ®®®®®®®
TO GRADE ON A MECHANICALLY COMPACTED SIX )
INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' S FT. 4'
310 CMR 15.221(2) `C EFFECTIVE WIDTH = 13'
3) INSTALL INLET & OUTLET TEES AS REQUIRED SEPARATION 6.05 FT.
SEPTIC SYSTEM PROFILE
4) ALL COVERS TO BE BROUGHT WITHIN 3" OF FINISHED GRADE. SOIL ABSORPTION SYSTEM SECTION
BOTTOM OF TESTHOLE EL: 35.8 _ ( �
5) PLACE SANITARY TEE IN D-BOX. (500 GALLON LEACH CHAMBER (H-20) LOADING)
GENERAL. NOTES: SOIL LOGS P#:13313 DESIGN CRITERIA
NUMBER OF BEDROOMS: EXISTING 4 BEDROOMM
i• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL. SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF)
BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE:. JUNE 17, 2011
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DESIGN PERCOLATION RATE: <2 MIN/IN
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: DAILY FLOW: 110 G.P.D. X 4 BR DESIGN FLOW: 440 G.P.D.
- 310 CMR 15.405 (1) (B): WITNESS: DONALD DESMARAIS, B.O.H.
1) A 2.65 Fr. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE GARBAGE GRINDER: NO (not designed for garbage grinder)
5.65 Fr (MAX) BELOW GRADE VS REQ'D 3 FT. (H2O/VENT PROVIDED) SEPTIC TANK: 440 gpd x 200% = 880 gpd USE PROP. 1,500 GALLON SEPTIC TANK
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP-1 Depth Elev. TP-2 Depth
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER. .46.80 A 0" 47.20 0" LEACHING AREA REQUIRED: (440) = 594.59 S.F.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND A LOAMY SAND .74
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 46.13 1OYR 4 2 8" 46.62 1OYR 4/2 7"
ENGINEER BEFORE CONSTRUCTION CONTINUES. B B USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS (H20 LOAD)
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND LOAMY SAND
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 1CYR 6/6 1OYR 6/6 W1 4 STONE ON SIDES AND ENDS: 33.5 L x 13 W x 2 D
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 43.88 C 1 35" 43.95 39" BOTTOM AREA: 33.5 x 13 = 435.5 SF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. FINE - C 1 FINE -
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PERC • EL. 43.80 MEDIUM SAND MEDIUM SAND SIDE AREA: (33.5 + 13) X 2 X 2 = 186 SF
ti 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 41.38 2.5Y 6/4 z.SY s 4 TOTAL SQUARE FEET PROVIDED = 621.5 vs. 594.59 REQ'D
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE C2 65" 41.45 C2 69" DESIGN FLOW PROVIDED: 0.74(621.5 S.F.) = 459.91 G.P.D. vs. 440 G.P.D. req'd
THE LOCATION OF ALL
UTI
NG
10. EXISTING CESSPOOLS TONBERPUMPED. CRUSHED AND PRIOR
FILLED TO EPER ITITLE 5. M2015UY 7/3 MEDIUM2 7/3 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 35.80 132" 36.20 132" 139 FOX HILL ROAD, CENTERVILLE, MA
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. (-Cl- HORIZON) Prepared for: Abbott Bronk
13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN
14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING. ` DARRENM.MEYER,R.S. AlaoDo ell Stirve N.T.S. DMM
15. ALL PIPING TO BE 4" SCH 40 O 1/8"/FT (UNLESS SPECIFIED) ' 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX Y
t\ to conduct soil evaluations and that the above analysis has been performed by me consistent with the (508) 419-1086 DATE
` requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil EvaL Exam in October, 1999. E4STSANDW/CH,MA02537 CHECKED SHEET NO.
1 $08-362-2922 06/26/11 DMM 2 of 2