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HomeMy WebLinkAbout0166 SHEAFFER ROAD - Health 166 Sheaffer Road Centerville P A = 171 056 i r r� a a E"efte 1 1521/3 ORA 100/0 P2 TOWN OF BARNSTABL)r a':`.C�;.'1lnh' . SEWAGE # a ASSESSORS MAP & LO E'4S d'ALL.ER'S NAME&PHONE N0. 'irJ C G► Ail , + SEMC TANK CAPACITY o1p J LEACHING FACILITY: (type) , V Xy w eL f,s _ (size) NO.OF BEDRC)OMS_ BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: r 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 Furmished by l!a(� Shec Pr ��� • i i� } No. Fee ` ©� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Mopont *pgtem Con!5truction Permit Application for a Permit to Construct( . )Repair()�)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location_Address or Lot No. J_ _.01 /„ Owner' m ae,Add ss and Tel.,No. Assessor's Map/Parcel Installer's ss,and Te,}.Nff%MIC am o.� �"7C._77rv`' Design n�er®'sName, �d Tel.No.e pp, (o(0 �o.�7k C%\ Type of Building: Dwelling No.of Bedrooms 3 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)_C)41' lew vi V1 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 Certifi- cate of Compliance has be d by=tWs Bogrd of Health. gned Date 1 Application Approve Date [ w Application Disapproved for the following reasons Permit No. Date Issued 5 ., .. �' r. • . `1 ... ..�. "'.� .� M"'V.r v r... "°f•'p.. ,r- +'�. a -..P I v,t�r+; �^•r'.' .. �:. . , _. �.., • ' T# No. :. Fee ' HE COMMONWEALTH.OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pplication for ;Dizpaaf *pztem Construction 3permit Application for a Permit to Construct(. )Repair O Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Lo a o Ad ss or of No. , Owner' N e; dd ss Tel.N, o. taJ l , 5 3 a I I {Q�'{ Assessors Map/Parcel n\ fl I,`A Installer's Name,Address,and Tel. V 77 Designer's am a and Tel.No.` ` ,x Vic» �° �- L e p j6p;x,riic$ki Type of Buildings Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage.Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. .�. .r Plan Date Number of sheets Revision Date Title . , Size of Septic Tank Type of S.A.S. Description of Soil r Nature of Repairs or _teratio s(Ans er when applicable) 004 kX1+n1� evakV®n � ,6- Date last inspected: Agreement: The undersigned agrees to ensure the construction andmaintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b - ssn- ed 4'-wio of e t 1 J ened Date 1 1 /05 >� Application Approved y Date ' _ 0 .S Application Disapproved for the following reasons i Permit No. �0 Date Issued _ . _ ,.. THE COMMONWEALTH OF MASSACHUSETTS ,. BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sew ge Disposal System Constructed( )Repaired ( �{)Upgraded( ) Abandoned( )by .�.Y� � �1 G,.i' o r at 1(04 6hR9 has been constru ted 'n accordance with the provi �of Titl d the f.r D,ispos System Construction Permit No. oo�''vo�J dated 1 3�b Installer o6wf Y&DI �.Xf�i Designer (YIUV r The issuance of th4s e� 1 shall not be construed as a guarantee that the system id function as esigned. Date 1 I 1 Inspector v1./ Fee E THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpozal *p$tem Congtruction 3permit Permission is hereb granted o Co truct( ) epair LJ,p �grade )A'bt ndon( ) System located at ��0 1 "V 3 1 ' 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:Con truct'on must be completed within three years of the dal os r it. 30`s Date:_ Approved by 7 Town of Barnstable ' Regulatory Services Thomas F.Geiler,Director SAIiNUMBLE. Q Public Health Division -Op i6$.9. �0 rED Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 114-10< Designer: �� f�✓� �'� '�- Installer: r- Address: y-U Address: bso X. to P •���llr�W ZG� CAW - p253� On 9-1/n_F� _ c �, n( was issued a permit to install a (date) (installer) septic system at (p5 6- rA yv'k based on a design drawn by (address) dated 10-41 (designer) 1.4-certify that the tic toreferenced fy h septic system 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 of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. D R I M..- staller's Signature) YE No. 1140 // \ /STEa� (/ SgNITAR�P� (Designer's Signature) r"' (Affix Designer tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL, BOTH THIS FORM AND AS- BUILTCARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH'DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form O TOWN OF BARNSTABLE LOCATION.Z 1/ e 1��e g io SEWAGE # .0 VILLAGE C' eg V.111 e ASSESSOR'S MAP & LOT -/V-6�z INSTALLER'S.NAME&PHONE NO._ I?zi + S SEPTIC TANK CAPACITY LEACHING FACILITY: (type) „�_®�Y W eZls (size) .r� 13' NO. OF BEDROOMS_ BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Fumished by ` i% � � r e Commonwealth of Massachusetts Executive Office of Environmental Affairs,! .� A Department of Environmental Protection William F.Weld �® Governor ., Trudy Coxe 1 r Secretary.EOEA 9 U� David B.Struhsorr l �/jf Commissioner v< SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: /�6 J�/T���j��2 ¢� ���'� Address of Owner: C AX L Date of Inspection: �8-�,h �yj�¢, (If different) j"�C�S E�¢- Name of Inspector: •/�a� �E,b�v Company Name, Address andSTelepNone Numt1r. CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: I/Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signafure: I Date: "" The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 SUMMARY: Check A, B, C, or D: A] SYSTEM ASSES: 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: tOne or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, 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 septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5..500 40 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address 4W 5C k V- f� CeA-�1 Owner: 1405�'� Date of Inspection y(T, u 10 B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup 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): broken pipe(s) are 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 the system is failing to protect the public health, safety and the environment. 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 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The 5wsiem has a septic tank ana soil absorplion system and is within iw fCci iu a suliacc Yra,,E supp:) Or tributary to a surface water supply. _ The system ha! a septic tank and soil absorption system and is within a Zone 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 systen-, 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that 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 effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Ad ress: 4l�u� sc,f(,ipev--,1�Q G,ettiX-i Owner: -e y Date of Inspection- DI SYSTEM FAILS (continued): 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 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 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 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. `t 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. Ej LARGE SYSTEM FAILS: �r The following criteria apply to large systems in addition to the criteria above: / The design flow of 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 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! 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. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: h ec.ff-, ce� Owner: tN)be"( Date of Inspection: Check if the following have been done: 2Pumping information was requested of the owner, occupant, and Board of Health. Zone of the system components have been pumped for at least 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. rie facility or dwelling was inspected for signs of sewage back-up. _S/he 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 the site. ✓The septic tank manholes were uncovered, opened, and the interior of the septic tank`was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. �he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. 2:4.1_: 1�1--c facili,� occupants, if different from owner) were provided with information on the proper maintenance of Sub --c faci:i') Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: i L� 54����`p Owner: kk 0. �'f Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: U Gallons Number of bedrooms: Number of current residents: Garbage grinder (yes or no): Laundry connected to system (yes or no): Seasonal use (yes or no):,K ( Water meter readings, if available: Last date of occupancy: 5ef r r NM1Q, COMMERCIAUINDUSTRIAL• Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ 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 pan of inspection: (yes or no)_ If yes, volume pLimped: gallons 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) Other(explain) APPRO MATE AGE of all components, date installed (if known) and source of information: / �5 Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) $ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /- (` SYSTEM INFORMATION (continued) Property Address: l�¢(Q I h,ellole v, Kam. Owner: \kp b eon Date of Inspection: 3'1 A:z`(k7 SEPTIC TANK: (locate on site plan) dl Depth below grade � Material of construction: ��oncrete _,metal _FRP —other(explain) Dimensions: Sludge depth: a11` Distance from top ofIsludge to bottom of outlet tee or baffler* Scum thickness: Distance from top of scum to top of outlet tee or baffle. y�/ Distance from bottom of scum to bottom 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.) CA60:o i'zn JV 1 LA 'A+V-, GREASE TRAP:Lq (locate on site plan) 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: Distance from bottom ry trim t- hninm of otjOet tee o' bathe- 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.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C i SYSTEM INFORMATION (continued) Property Address: 1[a( Owner: \No�__ev,_ 1� Date of Inspection: TIGHT OR HOLDING TANK:±I (locate on site plan) Depth below grade: Material of construction: _concrete_metal FRP_other(explain) Dimensions: Capacity:-gal Ions Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:L4 (locate on site plan) ,p Depth of liquid level above outlet invert: Ax Corments: mote ii lever and distributi�,r, > eywa, e\.dence of solid. ca;r�&,er, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 d•'f'tf P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: SG� CLAN-'i Owner: 4 c—,ecZ Date of Inspectigo: '0 .G9� SOIL ABSORPTION SYSTEM (SAS):e (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 galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, conditio�of vegetation,etc.) G� --�� CESSPOOLS: (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 grounds+ate7: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: 4 (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C cc SYSTEM INFORMATION (continued) Property Ad Owner: C40Li,e� cc7 G`r\,'e;���' 1�• e�-f?Uu� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' d 0 DEPTH TO GROUNDWATER Depth to groundwater: L feet NO f'`'OTV-R- method of determination or approximation: Sc � 36-T OWS O (revised 8/15/95) 9 057931 Zoe cvyTce CUSTOMER ORDER NO. DATE NAME — I ADDRESS ---------------- CITY,.,I'A1 L,z I P ro CAShi COD. CHARGE ON ACCT. MDSE PAID OUT RE�_DhS71,1_ON__--- )RICE O T i fK r3� ' I � I I' , _ -;- RECEIVED BY KEEP THIS SLIP FOR REFERENCE 1 ; -L 0`C A T�16N 1 S� AGE PERMIT N0. , VILLAGE C6( INSTA LLER'S NAME i ADDRESS 3 U I L D E R 0 , OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �. � .. 7�9 I i � � �_� 1 `� ^ _ � �- �. ` , . �;. � , � . No...79-.............'• Fiz$....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...:.............T.own.--.........0F................. .......................................... ApplirFation for Uispllg ai Workii Tnntrurtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal',' System at: ;166 ,Schaffer Rd.:.r...Centerville 02632 I-.... ............... �. :.. .-_:.__ ..-• -••-•-••...............•-- Location-Address or Lot No. Robert Higg.ins 166 Schaffer Rd;_,_Centerville 02632 -------- Owner_.. --•----------- ---- --- •------- - Owner Address aA & B Cesspool_ Service 128 Bishops Terrace_-Hyannis--02601____-•__-_•_-•- � Installer Address d Type of Building Size Lot____ __-._ _.-___-_-Sq. feet V Dwelling—No. of Bedrooms.___-__._-__3.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.........3................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----------------------------------------------•-••••- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 W Septic Tank—Liquid capacity....._------gallons Length---------------- Width................ Diameter.______.._______ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............._....... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 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........................ x ••••- ------------------------------------------------------------------=-------------------------------------------------------•-••--•••-•---------••-•- Descriptionof Soil Sand....................................................--................................................................................. x w U Nature of Repairs or Alterations—Answer when applicable________.installation}--of--a__1-,-QOQ.-g;�],�S2i7_____________ gra-cast.__leac_h--git---4stnn.e.Pad)-(omarf1cmz ---------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu-ed by the board of health. Signed ............ .S`..:. a c�ra---�- .. -.........9/2 /79----•- ate Application Approved BY L�. `� . ... Application Disapproved for the following reasons_______________________________ ______________________________________ -----•-•••••-•-- Date•••-••-...--•- ............................................-............................................................---------------------------------------------------------------------- ----.-.---•••------- Date Permit No.........79- 19 ............................................ Issued-----...•-- ---g12• --•17----•-----•------•--•--------- Date 79- �iot� f No-..............._....ft. Fizs THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH X To1M.............OF................. �.�le Appl r4 tnn for DhipaoFal Works Tonotratrttnn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: V. 166 Schaffer Rc3. ; Cerlte�t-vie 02632 ................_........ - .. t. ..... ......-------••--•...._....._.....----....._ .._.........-----.._......._....... Locarion Address or Lot No. Robert Higgins .... - 1.66 Schaffer•Rd.,L.C®nterv�lle,®2632- -----•.... - ...................... Owner Address a A & P Cesspool_Sery 1 8_.Bishops Tetrac a Hyaruzls.026©1--------------- � Installer Address Type of Building ` ' Size Lot............................Sq. feet Dwelling—No. of Bedrooms 3 ......... Attic ( ) Garbage Grinder ( ) aOther—Type of'_Building _.. No. of persons.........3................ Showers ( ) — Cafeteria ( ) dOther fixtures --------.--•- •---••....-•••--•-•-•-•••-•-------•--•••-•---------••-••-•------------------------ ..... W Design Flow................. ._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid.`capacity , _gallons Length................ Width................ Diameter................ Depth___.............. xDisposal Trench No, ... _.._...Width____________________ Total Length.._______._.________ Total leaching area________________....sq. ff < Seepage Pit No....................... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by........-................................................................. Date........................................ y Test Pit No L.".. mmutes per inch Depth of Test Pit____________________ Depth to ground water..... ; (s, Test Pit.No. 2 's minutes per inch Depth of Test Pit____________________ Depth to ground water_...___..__ ' 3 O Description of Soil --- Sand p ......................................................... x W Z. x .................................................. -- --------•-`•••-•-•....------••-•----•-•-..... ------------------------------•-•--------•-•----- U Nature of Repairs or Alterations Answer when applicable................................................... g llon. Y installationof .1•z0©Q••_ vr�= t le;<sch_. t , ox��._:gaoke )(+axex _.................. --------------------------•--•---•••. --•----- •--•-.... --------- . Agreement: wV. The undersigned .agrees;.,to install the aforedescrib d Individual Sewage Disposal System in accordance with ,s the provisions of TITLE • p .�i� 5�f the State Sanitary Code—The undersigned further agrees not to lace the system in � operation until,a,Certificate o£, CpmghaiEe has been issued by the board of her h. t` ,, f ' L Signede_a�� -r • •--- _ 1217 .._.. ----- Application Approved,.BY --.•--• ---- ..... . .f�'�.. .....---••----- -"........................................ k .. ...... Date f �.is f lowing reasons: ------------------------------------------------------•------•--•-•-••----•- -- x Application Disapproved for+tthe of ... ________________.._....._....__...._____...._...._ ..........._..____.... ... e ...... Date Permit No...... ..:...... .. ......• Issued 9/2 �79 ; -----.---• '-n�c..--•--------------- . THE' COMMONWEALTH OF MASSACHUSETTS BOARD.�,OF:' HEALTH f ... . T.OW??.........oF....:� Barnstable '........................ Trrftftrati.of Toutpliai trr ,y T 1 TO C TIPY That I div'dual �w i e Disp al S tem onstr ed ( ) or Repaired. (X ) A 8c� G�®sspo �e v ce 1� 3 is ps er ac®, s, l A t3 ©1 K` by -______-_•••--•-------••••-------•----- •-- 166 Schaffer Fcd. , Centerville, 0263 "'Robert Higgins at.---•-•...............•. . --••----•---------. ----------•- ••-•-•-- -••------------..----••----- has been installed in accordance with the provisions of TIZ,1\ �D!,T�e..State Sanitary Cokigibed in theapplication for Disposal Works Construction Permit No.......__�___.__ ____________........ dated_-..._ __7_./__ �..(_._.._._____.______._.._._ THE ISSUANCE':OF'THIS' CERTIFICATE SHALL NOT BE CONSTRUED AS;i4 GUARANTEE THAT THE SYSTEM WILL FUNCTION;. SATISFACTORY. r - �- �: DATE f ... . Inspector.... . .......... f r. THE COMMONWEALTH OF MASSACHUSETTS v; BOARD OF HEALTH 79_ of Aarnstable5 DO ................... No...................... FEE............ ti,�sql nrkii Tomitrnr�ion rrntt# A & B Cesspool. Service, 128 Bishops Terrace Hyannis "t Permission is hereby granted ................ !.....Y-nnis 02d01 X -------•••••-•-•- to Constrt�c�t6(Si�harfe a } (, ) 'an Indio' al Se , isposal stem d �D S CentervAl'�e, M2 Robert Higgins atNo. ..:.. ' ......... ................................... � s as shown on the application for Dis osal Works Construction r it tN 9� 9��n,��79 Dated •-----:9--•.................. _ .......................... r Board of Health DATE------ -------- ... ... •-----------•----•--•-----.:..... FORM 1255 HOBBS & WARREN;" INC "PUBLISHERS i,•r' SEW _'E PERMIT 1.10. Got ._-bU_I.L-DE.R 5._IJ_�.►.�1_E__ _._ADQRE.SS__� --- .�oe e e t'' �6 Ar Gt �t • ,t :.,ti.. L It • , J i THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ... Appliratiun -fur 4%ip sal Works Tomitrurtion Perutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ........... = ----- .....---ZW ....................... cation�ddres ------2 ----- ------ -------•--••• --- - s.............................................. Owner Address a ----•---��/------ - --... ---•-•-----------------••---------------- -------._•------•---•---••--•---•---•-••------------•------_--_------•----•----------------•--•--- nstaller Address Type of Building Size Lot____________________________Sq. feet U U Dwelling�No. of Bedrooms.---____-__-.•_--------_-•.-__-_----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria dOther fixtures ----------------•----•---•-----•---------'--------------------------------------;---------.----..-------i----------••-----------------•--•------.---- W Design Flow........... __________..................gallons per person per day. Total daily flow_-__-______ -;I- _ WSeptic Tcnik1—quid capacity/_la4�Tallons Length___________-_- Width................ Diameter__----..--_-___ Depth.._--____.----- x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------Z-----___-__ Diameter.. _w_®__.__ Depth belo in Total leachiu rea__.._..__________sq. ft. z Other Distribution box ( ) Dosing tank ( ) moo -� �` aPercolation Test Results Performed by------ -------------------•--•------•----•-------•-----•---•----•-..._.. Date------------------------------------._.. Test Pit No. 1.....-----------minutes per inch Depth of "Pest Pit.................... Depth to ground water.-----._---_--.-.--.--- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to gro d water..._...-______-.-___---- O ('� ------------ Description �" 1 -- --• •----- " ,of Soil----•----L -•--•------ _ _ _ ........ ............Lt- ......... ___ ------ x7-------- -e �- _ W - �S' 7 ---- . ---- ---- �---_-•---------------- G -------------------------------------------------------------------------- ........................................ ------------------------------------------------------------------------------- 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 ued b} the board of health. Si d.-- •---- -- -----/------------- /' � _._.. D e Application Approved By-------- -------•------- ................•. • --1.1 Date Application Disapproved for the following reasons----------------------------- ---------....----------------•---•---------------.........------••--••-- ---------•-•••-••--•-------------•----------•----•--••---------••---...---------•-•---••------••-•-----------------••--•-•------•-•-----•------•--•-•--- ----------------------------------------------- Date Permit No......................................................... Issued----prf:7--------- I.................... Date �y No. ...&........ ... ... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratilau -fur Biupuiittt Works Tonfitrurtinu Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �� f ,r --- ------------------------- -� 62�,�d 6� �'. tion- ddre-s or rot W Owner Address ......................................... -----••.^_•...-•....._.__---•------._......Address Q Type of Building Size Lot----------------------------Sq. feet Dwellingtm!!!�No. of Bedrooms.__----------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building --------------------------•- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------- W Design Flow----------- ?_____________________gallons per person per day. Total daily flow........... -_-_-_---.--._--gallons. WSeptic Tunk`=­'Liquid capacity_ ._:..--gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No--------------------- Width-------------------- Total Length__...__-_- Total leaching area--__._._.-_--.-___--sq. ft. Seepage Pit No....../............ Diameter.. ..--.?----- Depth below i et-_�..._...r_._... Total leachin?•area-------_----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) J� " r •-' Percolation Test Results, Performed by----- -----------------------------------------------•------------->-•-•• Date-------------------------------------.. a Test Pit No. 1................minutes per inch Depth of Test Pit-..__-_-__-._--_-_ Depth to ground water..----.------_._.--.---- Gr, Test Pit No. 2................minutes;per inch Depth of Test Pit.................... Depth to ground water--.-_-____...._------- 1 F -�--� j ......r•----------•-—--•--•------------- Descnptlon of Soil f-------------- i y� `y� W ---2-t-.......7 •-----4- � ............ti� f ��-�c.�Q ,�s�.�rA_•= ------.7..Q'_f_�_:.�.._= ._lrl.G.�:--chi_ x -•-----•-------------------•---------------•-----------•---------•-•----------------------•----•-----------•------------••------•------•---- ---------•----..... ---------- .......................... 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 sued by the board of health. Si ed---- Application Approved B p� `— _-1 ____- --- Date Application Disapproved for the following reasons:-----•---------------- Da.t e-------------- ---........-•--•-•-•--•-------------•-----••-•------•----------...-----------•--------............................................................... -------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c...........................OF .... .............................................................. (TIrrtifiratr of Clutphaurr T 'PAS S TO TIFY, That the Individual Sewage Disposal System constructed Kor Repaired ( ) r � by ;' _. ::. ...................... j-----------------------------------------------------------------------•--------------- ----------------- ---- Inst e - - = -------------------------•-•--•---------------_._-•----•------- has been installed in accordance with the p .visions of A >icle XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..`:-�__�_r __/�--------------- dated-_:_'... _ .__.._.? _ 7 THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE----•-------------•--•-•-------•---•---•-----------•----••-•--•----••......--.. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� �...... '.' :..........OF �,.......-f�- -►............................................... No.._.... . f� FEE.f.... .......... urk 411mitrurtion Vrrutit Permtssio ereby granted_... aQi�siosal­ -------------------------------------•----------- =to Conruct. or Repair ( ) an Individual ew'ge stem ----•- •--••- - Street as shown on the application for Disposal Works ConstrucNZ4 ermit `'o---- ---------- Dated --.'_.)-/- . . 'S --------•------------------ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r . A s M" 'a5 `� —O, T tt�y��y5' �rk i i'` \ ,l y 5,�� Mlai�rif+ f'S�'�( H S7•,� � r ' x y /SOD Zi.O[T i 'LO.Up 5 i a a:,g qt / 11 t OF q4 h �• - - - i t i� l i 7 '.t � 41 r� q a� { �n r. x .,\ � k ^� ..-•_�., { <._. _ ,.� .2 , t S4•�$ ix � '� tt !�/� � < Sal I .� ST _� ,lP'I�-{ Ct HW j T x t'rk zl.i t I tr � ti �jr_ � �'.•� , t r • .fi 1r ,�3 is 1 ` 5 R ,�.�.fei1C'B.C3l�'G�Q,e7-�.c'y 7'.^✓.4•T' Ti°.�8� �dI�N O.c' s��r✓I1/JO�'..'fT.t70iCI7ti�`T • ' r = . atS7 �cTi�rtec - -�y�/,!��ra►a� f!/�%! o� `1 97, .rA.f�o ,. �•`>° - i�+/ _+' ._ I ,:-, 5 � 47 C'Cix/TL: a ` " '' C�i�i�er-G'o©s?�•�rs�Y Co�s�J�'vt f..Divs3' r }'.. .>:.. `-,, r f.O/v`::cr�ot�✓ O.�" .So.sv'r%.�.5o.oi-•rY Grct..i�r^HCT�+sv'rs,i�✓G OF MqS ° r rEDWIN A. x {M�; S., a ! s•• YOUNG H �'—�f�.5 t .p 9096 S�kyl��'`�ay� ,��Su itr t' _ i �'IY R? t• �.1^ :, 1 _ � - e :.t, _. .I/ 1 F p •,� ��r zo.-16 1� ffiMM 0-1 PI 43 V � O `', r N M 4 , i .�'.�.4are'�.CiY G's.�ri.�'y� Ti�.+r- 7r,�s's. ��114�V oc• l...orivca�3'T.Cd�!y.C�' r b j {f'•S'TieCciG.tt/Y�Q=� r.^�%�It�i7� �.I�L1r�fi]I.�j,/.� �.l��.s� �� ; .,, ' .y,.,�eN...41�rt�''^.:t'.f,'Y �!✓ s.�Gy«iAL �:e�rri� .G./cam /' _/G, J E r.:.:G'Gv✓.,C®.�'itir�5 Tu 4.7Fr6�r �:.4a^.�in/!� /_?Y�--. -wn ' Ci�oi�ee-G►o©„s?�,.t/'.�Yr Co/f/.i��tTi4i►�T.�' ,�tst9Ks75a�7sz� < v ,.��•- .�-�o,e^ �jt1 OF�yq EDWIN A.:", YOUNG l 9096 ND SUR`1� 10'.O' NgJDgV SO1FDLLE '3 112" OfY .H.Ol.1; DIMENSIONS R/O DESCR�fIONm COGf MP1JFKii LOMMEN(5 I 31 I/2"Xfi7 I/2" 32X48 DgA.E 294 GN 284p 1 I 63"X411/2' 631/TX46 MLLIED UOf —w 2640 MILLION I ttaMEN I I 72X823/6' 72 3/aXC2 7/8 EXf.51.®FX-CLASS PS 6L N .°CiN I I 72X823/B" 723/4Xf127/8 EX 5XM-QA55 P56F AWEMN I IW4 PFOP05EP EXTEPIR PECK � N j ' uu o 0 .. I CV JO� 'VEI.LLY FS S06 '06 R EXI5TIN6 EX150%PATH j "ff PEI7f;00M # I EXISTING KITCHEN a }' iR ®. MOF05E PINING POOM 5068 0 M VN11ED CEL 153"OFF%MtCC2 u 2666 13/41,X19"ll4 FOR _.__:_.MEfOL 511D __ -519J[1IR/L R®G2 CAM 22W - FFAMIµ2 f0 . . - 2663 .. 7 �atwlJG(21p; . � 6YhV�EY B 17ATE OF t'POp05Ef7 FINAL 155UE EXI5TIN6 EXI5TIN6 PANTt;Y PEIp00M# Z PEn1;00M # 5 EXISTING LIVING.t;00M - 5115/05 244 2W (5)2X10'5 cOVEM0 FOR FZ0FMAM b SCALE UNLESS PORQ1 NOTEr7 . j 3'dl1/2°. ,g•{ 4•-0. OTHEPIWI f- 2'51/4" .4 6-03l4" fi IST FLOOR PLAN Ao G 4Erot A\ �g y 1 Y � ` $Y ASSESSORS MAP : 17 ( TEST HOLE LOGS NOTES: � � iE►wQ"Paa, TgvF PARCEL: V�� i) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH 7� H 4 w HIS PLAN 1995 M A H TITLE V �nr c SOIL EVALUATOR : � • M �W VS. CSE ASS C USETTS T L & TOWN OF U FLOOD ZONE: � ON 4�Zit�o L� BOARD OF HEALTH REGULATIONS. 3• no�o�Ro crp �a ` w� WITNESS : �UT- H 't�K.��O `' ,o , REFERENCE: �� IO�{32 DATE: EM(3�`R- 11 L M r� 0 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, H / PERCOLAT i ON RATE. L th(,1� I 1 LS SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO (� Oq 7 THIS LE �� � � 4- t+ w / r a fi C,L k5S 1, :>G Z u� LT19 9- 0,?� g P���y INSTALLATION. �+ as 1 cL TJ O TH- i E =lp2,�-a TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION c ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE �j s �A � U L.PCIJ(� C3y �OS�-� 0�0 r�! FAN �•LS_ �'O,o`M DETERMINATION. fl toY{�3/z. -- s " � U 'p1'j ' 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS - �7 0 --- - - - - 13 ( Ion Kl-/, SPECIFIED OTHERWISE) LOCATION MAP(O T S.� 3� P`j�•'tO � 1 ` 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A mexx VM E ' ` GARBAGE DISPOSAL. Sp�1,� 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON 2-sy�Of A BASE OF 6"OF CRUSHED STONE. 1rJ LG iiCH F IT To F5E-_ uMPF-V,, 6v-L6141�0 No APLA 0 KNQV J_PP4V�I�WeLLh VQ/0,050, of PROF. LE�t1#q_ - I SEPT I` C SYSTEM DES I GN q' _1N� ►0`�__ �1�► of PRo . (.� �+-r SHEAFER ROAD - � 0 A-P"W5 h-VM__TI TI-E V 0►e- --15w,J OF- "5"_-R5tP'9,t,E EDGE OF PAVEI�7JT FLOW ESTIMATE f BENCH MARK 13D•-- l-�fl�-Tdt �_jv�__ _tQ_N_5 _� v�le.�. j 8 100.00 {t. 3 BEDROOMS AT 0 GAL/DAY/BEDROOM - 33U GAL/DAY o - - TOP OF DRAIN GRATE 4u �r2- N�T1L� (z.E�VI►�� �� �� • ���-i ELEVATION = 60.96 -- USGS DATUM ASSUMED SEPTIC TANK GAL/DAY S - 0 �! rn Lx 2 DAY (a�0GAL j >. O USE1 2 GALLON SEPTIC TANK,C1,15T_W�- �6PL4C,i✓ 1,5006xu,o� o — SOIL ABSORPTION SYSTEM: V NDF-Q!I LEO . BGDiTOMREA:AREA::a �I 31 �x � 7� _ �g m 2-5x 3 x 0,7N 2g0,so o NaN2O d01 L 35 P , G PD � I 9Nr-773M0 a SEPTIC SYSTEM SECTION c w00808 � t JN11 SIX 1 - - —_ -- - -- _ _ EL-, 1p2.S- 62.c se4loi CoVPlS fv n h O - w/l� (p'o �nis1, MLA , JEG 0' If7TIsl�ll �1 2 - g �blc (,U4shes�G� &f�t� �qJGD110 GAL , -Box SEPTIC TANK 11tV4rx�Ss� ScI �f0 Db_3 /�, i Doable WA-5 1-9 S'faN Jr 92- o� 13 W - ?� S /, 4$ TN- ' - H OF>was D °sue SITE AND SEWAGE PLAN ER 100.00 {t No. 1110 LOCATION : /� Sr A-F ►2 ��-� lST . �ANITAt'. PREPARED 0 c � A l REP RED FOR :. (,(�lL�/q-,v/ /�1 C.�vc.�� 0 o DARREN M. MEYER, R.S. SCALE : 0 P.U. BOX 981 DATE: 1 /3 EAST SANDWICH, MA 02537 J u z W DATE HEALTH AGENT Z (508) 362-2922