HomeMy WebLinkAbout0019 SHEAFFER ROAD - Health 19 Sheaffer Road
Centerville
A = 172 077
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' 1122 No. [ Fee
THE COMMONWEALTH OF MASSACHU.SETT3. Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE''MASSACHUSETTS
ZIppYication for Migpool *pgtem-CoR5trud on Permit
Application for a Permit to Constrict( Repair( )Upgrade(1,)Abandon( ) 0 Complete System O Individual Components
Location Address or Lot No./ -�t Owner's Name,Address and Tel.No. y/�j�
Assessor's Map/Parcel cs.�-f'ft t
Installer's Name,Address, d Tel.No. Designer's Name, dr ss and Tel.No.
Go✓ FctnH �•�o• G� - r'ul lf�
pe of Building:
Dwelling No.of Bedrooms Lot Size /5�2 516 sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 3 n gallons per day. Calculated daily flow `��• gallons.
Plan Date 6— 31-a5' Number f sheets —Re vi ion Date
Title se71'_—_ 115 cl . GC�11ec 14
Size of Septic Tank _/!WQ C Type of
Description of Soil Nature of epairs 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 Certifi-
cate-of Compliance has been issued by this Board of ealtlu
Signed > Date O S
,P ftlication Approved by Date
Application Disapproved for the following reas
Permit No. '� Date Issued
{ f2� Lw� Fee
ti THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpprication for -Miqu ar *patent Construction Permit
Application for a Permit to Construct ) epair( j Upgrade( NyAbandon( ) El Complete System ❑Individual Components
Location Address or Lot No. 4j��1�-C�- �eQ, Owner's Name,Address and Tel.No. .
Cev�-ter yr ( r'� Gam'"31
Assessor's Map/Parcel —,9 4asr�"��Y" X4• C f
C.t^Yl�I�
Installer's Name,Address,and f el.No. Designer's Name,Address and Tel.No.
/v3 $ram F��� 2�P•iVo. Ge�f�r'v! (!'e
. ar uv or /Lfl� .��— 3�S Uf: -• 7 S'— °��✓� P
TY4 of Building-
Dwelling No.of Bedrooms_ Lot Size / Z S5q.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 cn gallons per day. Calculated daily flow 3 55. -Z gallons.
Plan Date 3/—G C, Number of sheets Revision Date
Title 5r 7� -S�wc�esre raGdu � �f�//� //tea•' �c� � �Cc1 �
Size of Septic Tank Type of S.A.S. e,U" 4 �<
Description of,Soil
Nature of Repairs or Alterations(Answer when applicable)_1 Pt t)-ht..it 4.
Date last inspected:
Agreement:
s,
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 this Board of Health. -
Signed ,. Lam• k Date D r t
Application Approved by A , Date q112
Application Disapproved for the following reasona� ` v vi j
Permit No. �''' Date Issued L7
THE COMMONWEALTH OF MASSACHUSETTS
f
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( )
Abandoned( )by
at .a (171 Y ' has been,,constructed 'n accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Yiated .
Installer n T Designer o
The issuance of this permit shal not be construed as a guarantee that the system 11 c 'on
No. Fee
as designed.
Date (P 1� "1 Inspector f
• —————�———---------------=------- ----
W.� THE COMMONWEALTH OF MASSACHUSETTS
,�/01PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
Mtg;po5ar *pgtem Construction Permit
Permission is herebyrante to Construct( )Repaird( (, bpgrade( )g P Abandonn
System located at k
r 1
04
and as described in the above Application for Disposal System Construction Permit. The applicant rec.Qgnizes hi ltylto.�)comply with Title 5 and the following local provisions or special conditions. j!
Provided: Construction ust, be completed within three years of the date of thi p fmi I
Dater 4) Approved by / t
r
9/16/03
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
hereby certify that the engineered plan signed by me
concerning the property located at
j �'��STc72 e/i C G c
meets all of the
following criteria:
• This failed system is connected to a residential dwelling only. There.are no commercial or
business uses associated with the.dwelling.
• The soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes
per inch. The applicant may use historical data to conclude this fact or may conduct deep
test holes and percolation tests.at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the.
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) '`
B) G.W. Elevation AZ%1tJsrus r high G.W. _
qc
DIFFERENCE BETWEEN �d[ NIEL E. tiGN�
FRA tAN
o '
CIVIL
32686C
SIGN1 D : ``� DATE: r C
�SS�ONAi- �av
NOTICE
Based upon the above information;a repair permit will be issued for bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASeptic\percexcmp.doc
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E5;123�200K 10:53 5087750751 4ELLEP. ASS: ='ASE. 0i
Town of Barnstable
. Regulatory Services
3 Thomas F.Geller,Director
'oil a�i ]Public Health Division
nomas]McKean,Director
200 Main Street.H ya2a*MA 02601
Offca: 308-9624644 Fax: 308-7Y"304
Inatnikr&Deai Ca:rtilieatlos Form
Date: C� -2�•-v s
Designer: uQaet..4f Z ger-g Installer: C .U-
Address: Address:
e-e-CV
On. re"7-a5 issued a permit to install a
(date) (installer)
seep tic system at./f based on at design d*awn by
(address)
��� dated
design—'' t)
I C&rfury that the septic systta referencoed above was installed substana ally according to
the desirA wWch may include minor approved clwLnges such as lateral relocation of the
distribution box and/or septic tank.
I certify fti #w septic system referenced above was installed with or P , major changes (i.e.
greater than I0 lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State&Local Plans revision or
certified as-built by designer to follow. OF
1W BAtAN44..tl �
d o symucr aAl.
er's 5ignatw a � NO,�
AL
esigner's Signature) (Affix bcsigr:cr's Stamp Herej
IQ W1I, O B I.,E PUB C ETVISION. y CATL
COMPIL Issill
B 1 T CA R ARE RECEIVED BY )< ST PU IDI)aSION.
Q tiMalt/SepwMesiper CeMfiabon Foma
I 'd 9i09-z9E-805 3d ueweJg -3 tatueO a c:11 so oa unc
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No.... 1..: FRs..... .�.
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Appliration for 3lispos al Works (foustrnlrtiun Prruti#
Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal
System at:
�.........�/fA i4 .. 7�,�: � I� [.��--------------------------------------------------------•--•---------------...........------
Location•Address _ or Lot No.
.......... .._...�7i' ................................ ..
60� G/ Adds
F� ------------ ------ -------------------------------------------•---- ................................ ...... .-z-��----------------------..........---------
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
p`-4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ...--••---_...• •............. •
W Design Flow.............6_5............_......._..gallons per person per day. Total daily flow.......:7,-3.0_..•.•..................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.............-...... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......9�.......... Diameter....f G'.._..__. Depth below inlet._....;._.......... Total leaching area._�._._�........sq-4t,.6"A
Z 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.........................
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ................................-••••--••-•••••••-•----••-•••-•--•-•-•..._......---•----•-..................................................................
ODescription of Soil................................................................................................................................---.....................................
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 T I T U 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 oj health.
Signed... 7,",...........................
ae
Application Approved By-••-••••__� --------------------------------------- ------ -'r9..........
Date
Application Disapproved for the following reasons-------------------------------------------------------------------------------.................................
---------------------•--------•-•-----------•-••--••••--••••---•--••••_....••-••-........_•--•---•-_... -•-•_.._....-••••••-••••••••••.._..•---•-••••-••••----•-------......•••--------••••--••••••••--
Date
Q
Permit No.......U.4°- ----•-------------------- Issued_...-----------
Date
w J=+
FE$.....r4U............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
��.w.�.........-- OF................
Apli iration for DiipuoFal Works Tonstrurtivat Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
q ..........[.....� ('tie ........ .�, ....GC'. (//1.G E... ...........
Location-Address
or Lo 0
...SHEFF'+ rZ
caner Addr ss
a �.�c-C-•-..._cc), t AcTv, S................ ....._ P1 v,, 60k1 0 � °v. P
.......
Installer Address
Type of Building Size Lot--__••••••---___-._•--•-•___Sq. feet
Dwelling No. of Bedrooms.............-3...._............•._.._...Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ....................................
...... 1.. --•------•---•-•-•------•------------- --•----•----- •--------•--------------•••-•--••---•-----
W
Design Flow.............5.5..............._.._,..gallons per person per day. Total daily flow......... 6.......................gallons.
WSeptic Tank—Liquid capacity.......,....gallons Length................ Width---------------- Diameter---------------- Depth................
Disposal Trench—No. .................... Width.................... Total 4ength.................... Total leaching area--------------------sq. ft.
Seepage Pit No........Z.......... Diameter....-Ija _..... Depth below inlet......co._........ Total leaching area.--�-V.......sT._f'i'_ ?P
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
OP4 •---•--•--------------------- -•------------------•••••----------••---T•-••••---•-......--•--.•---•--•......---•--•-••-•-------•-•--•••....---.........---•--
Description of Soil....................................-................................................................................................-............
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 TITIa,, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been
n/ issued by the board of health.
Signed...l �M- � �Uf
` c
> _ Date
Application Approved By------•-� ----•------------•----------------•--- ------- `=.....
Date
Application Disapproved for the following reasons:.............................................-••---•--••-----•-------•-••-•----•••-----•-•----••-•.............
--•-•-•--•-••-•••--•----•--------•----•-...•-•••-•--•••••-----••----•--•-...........••-----•-••-•--•.....-----••-••-••-•---...---••-•-------•----••••----••••--------••••••----•-----------••--••-•-•---
Date
�r,
Permit No........ = Issued.......................................................
.._._....--•------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............../../9✓ . OF........ ... "A.4........................................
�2........... ..:..._.
Trr#ifiratp of ToutpliFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by (..`�. ._.- r�, ..:�7.tr............•---------------------------------------------------------------------------------------------------------
Installer
at
has been install�incco,dance with the provisions of n'-.m 1 a, j of The State Sanitary Code as described in the
application for Disposal works Construction Permit No......... r_.:..:�?5._ .._ dated_.-______--____-_._.________________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
-SYSTEM WILL FUNCTION SATISFACTORY.
DATE---•---•--.....-•----•---...G.-n. .".. ,d,?.. .....•............... Inspector................ .................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� Pr` ..:........OF...................: .............................................................
•� FEE........................
Disposal Varkii C�unBtrurtion amit
Permissionis hereby granted................ P"... Owr........----•------------------------------------------------------------•-------------..........---....
to Construct ( ) or Repai ( ->k an Individualewage Disposal System /
.........................r ` . .
Street <,
as shown-on the application for Disposal Works Construction Permit No.... 1- _�� Dated..........................................
...................•-----.. .
•. -------------- ...........................................
-•
DATE....................................................................
Board of Health
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �:
N
TOWN OF BARNSTABLE
LQjj�ATION i SEWAGE #
VILLAGE 66X; V d L t, ASSESSOR'S MAP Cz LOT
INSTALLER'S NAME & PHONE NO.6 lLC C0014AC-7 lV
SEPTIC TANK CAPACITY 630 6T° IC20 G' G
LEACHING FACILITY:(type) L-CZ ACP PE"r (size) &0 0
NO. OF BEDROOMS Z PRIVATE WELL OR PUBLIC WATER pc>,3CfC
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No D�
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Z
PT C 1�
PIT
/5 7s,
i30X �'�
TOWN OF BARNSTABLE
L(jCATIOI`'t ``� ��' ��• SEWAGE #
VI LLAGE deo erVI ASSESSOR'S MAP&LOT
IX5TALLER'S NAME&PHONE NO.I"`-(!•I UC�//L""�,, 44M
SEPTIC TANK CAPACITY 16'00 C SDK/
LEACHING FACILITY: (type) Q9dd ek$ (size) 00 X Z4
NO.OF BEDROOMS
BUILDER OR OWNER 6i4` �e-11& We-ller
PERMITDATE: G ? - O�E COMPLIANCE DATE: —1'7— b�
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 �.Il Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist ,�y Feet
within 300 feet of leaching facility)Furnished by M. 4, • A4 C-_rA71 G1 M
`'y .4 --rlav
s Co?`s/,3 Pve7s
i
E�Ci�ST"
DGUELL o
1. DECA.T10 % LC-�- q Sf ',VAGE PERMIT NO.
VI tEA6 L
I H STAA. L £ R'S H A. mA ADDRESS
e
9 U I L D E R 0R OWNER /
. 0 A 3 E PERMIT ISSUED
0AX.,E:. C 0 M P L I A N C E IS SUED
�- _
��..`�•
o ��
`� lea® ���.,
9 .; , � �� �
N N TE5T HOLE LOG
Q
PIPE TO BE LAID LEVEL
w / FOR FIRST 2' OUT Or T O 4" DIA. 5CH 40 PVC PIPE —� DISTRIBUTION 130X DATE: MAY 12, 2005
O EL. 74
/�� <<� .0 CULTEC FILTER CLOTH OVER TOP OF FIELD
4" OH5ERVATION PORT TEST BY: WELLER � ASSOCIATES
I PERC RATE: < 2 MIN./IN.
� � Z
I O" 18" �� 15 CULTEC FIELD DRAIN PANE TOP EL. 70.5 73.0 o"
,� \-70-75 L5 BOTTOM EL. G9.750 �t 7I .5Oro. a A LOAMY SAND
INSTALL GAS BAFFIF
IN OUTLET TEE 70 00 I 0YR3/1
w 0 71 .00 1-70.50 70.33 72.4 7"
Q J 8 = LOAMY SAND
'rb, xp.•16.-a.i,i,, S,''m':r -.nil rnea
PROPOSED 1500 GAL.
I OYR5/G
SEPTIC TANK INS ALL 51 rIC TANK<- 70.7 28"
LOCATION MAP DIST. fl+!X ON C"STONE BASE
DB— 1 I — C I = COARSE SAND
t GRAVEL
DISTRIBUTION BOX G7 5 2.5YG/G GG
5EPTIC SYSTEM PROEILE C2 = MEDIUM SAND
2.5Y7/3
G3.0 1 20"
7Z NO WATER ENCOUNTERED
DE51GN DATA
DAILY FLOW: 3 BEDROOMS x I 10 GPD = 330 GPD
SEPTIC TANK: 330 GPD x 200% = GGO GPD 11
USE: 1 500 GAL. PLASTIC SEPTIC TANK
DISTRIBUTION BOX:
USE: DB- 1 ! — ( 1 1 ) OUTLET BOX
o•
0
�nli AR ,C�1? T!n�! �Y�7Fnr;
USF: ( 1 5) CULTEC FIELD DRAIN PANELS LAID OUT IN
�s 20' x 24' FIELD
PROPOSED 20'x 24' CAPACITY:
LEACH FIELD -- (U5E
(1 5)CULTEC C-4 � ��,� BOTTOM AREA: 20' x 24' x 0.74 = 355.2 GPD
FIELD DRAIN PANELS ��
PROPOSED 1'
/ D15TKIBUTION EXISTING GENERAL NOTES
BOX - DB-I I SEPTIC SYSTEM --
O/ TO BE PUMPED DRY t
IV/ CRUSHED IN PLACE -�Z 1 . CONTRACTOR TO BE RE5PON51BLE FOR THE LOCATION
't OF ALL UTILITIES, ABOVE � UNDERGROUND, PRIOR TO
72 ANY EXCAVATION OR CONSTRUCTION.
0
2. SEPTIC SYSTEM IS TO BE INSTALLED IN COMPLIANCE
® �< �� WITH 3 10 CMK 1 5.00: TITLE V.
3. THIS PLAN IS NOT TO BE U5ED FOR PROPERTY LINE
PROPOSED 1500 ;AL. � \�, \; DETERMINATION.
PLASTIC SEPTIC TANK \� ,l� �` ,'
4. ALL D15TURBED AREAS ARE TO BE LOAMED t- SEEDED.
P 5. CONTRACTOR TO PROVIDE 48 HOUR NOTICE FOR ANY
REQUIRED INSPECTIONS.
G. THI5 SYSTEM IS NOT DESIGNED FOR THE USE OF A
pp ,
�O GARBAGE DISPOSAL.
o ,
0
'c 51TE --- SEWAGE PLAN
LOCATION: # 19 SHEAFFER RD., CENTERVILLE, MA
\ CLIENT: 5TELLA WELLER � KAREN PROCACCINI
SCALE: DATE: DRAWN BY:
VZt1DF"qS6
9c 20' 05-3 1 -2005 TMW
DANIEL E. y�N
BRCIVIL AMAN u SA. JOB NUMBER: REVISION: SHEET NUMBER:
SS\O�P
/ Z' �SS'ONAL ECG q�� SUM��Q WELLER * A550C I ATE5
c 1 G45 FALMOUTH RD. --- SUITE 4C
P.O. BOX 4 17 CENTERVILLE, MA 02G32
TEL. ; (508) 775-0735 FAX: (508) 775-0754