HomeMy WebLinkAbout0054 WASHINGTON BURSLEY WAY - Health F54 Washington Bursley Way r
_ Centerville
A= 172 — 170 ` r
I
i
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TOWN OF BARNSTABLE
LOCATION 4,/J JUG/00 UrSk WAY SEWAGE# (}I —633
VILLAGE A�eNTE�_QI I E ASSESSOR'S MAP&PARCEL -7-®
INSTALLER'S NAME&PHONE NO. .446
SEPTIC TANK CAPACITY xt�rj�-* 16L,6 `I
LEACHING FACILITY:(type) -ROBS C & (size) 11.5r2���'3.
w 3 ev�p
NO.OF BEDROOMS t � /,
OWNER c r1114�/�
PERMIT DATE: A h// X 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
FURNISHED BY
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63 - - �e oVC'5IZ
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No. �I ,033 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppYication for � gpo5al 6y5tem Congtruction Vermtt
Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No. 55� 42 3,-ISLA
7PAVUrZZ�
H aPCk4L
Assessor's Map/Parcel \"IQ V�ASI{IAJ13 Y3t'�'f tea"
Installer's Name,Address,and Tel.No./aa/ Designer's Name,Address and Tel.No.
S7' �'�4�7r'`r�/nY, M F 6l Sa�ai tNc-
w.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ((4)
Other Type of Building R'E5 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 333 -U 0 gpd
Plan Date ` ;LG 1 Number of sheets eaZ Revision Date
Title
Size of Septic Tank ibw (-exvs,6 n ) Type of S.A.S. PA?-C 3104C CHj P*AO MS 00
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)?,GLACCME1,T\ (jF i{is.1(,-�I IJS(�U ItJls �J�S'RZ(13t7("tc�►J
�x
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 by this Board of Health.
Signed Date
Application Approved by lacZ_ Date
Application Disapproved by: Date
for the following reasons
Permit No.201 2- 0 33 Date Issued Z ZO 1 Z
No. 2 - 033 Fee •v
`"t Entered in computer:
THE COMMONWEALTH bF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
4' Zipprfcation for � gpogal *p.5tem Cow5truction Permit
Application for a Permit to Construct Repair O Upgrade O Abandon O ❑Complete System ❑Individual Components
Location Address or Lot No.5�4 t �"� j��q ; N 7v^'A\-f Owner's Name,Address,and Tel.No. 5a ZAZ-'T5 S(4
Assessor'sMap/parcel \-1 ' \ jo ( AsNtoJbtt>� {31t7s��`11v4c`-�
C kJrF.aV i L i i
Installer's Name,Address,and Tel.No./ov/ .oto�f�;� Designer's Name,Address and Tel.No. w
S? 11f17 M 4 Svas in+L
w. y�/•ryd�fy sob T73 ��.z a 00 e,u x. 56 3i011 a�a a
Type of Building:
Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder (N)
Other Type of Building RV5 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided �33 -1. gpd
Plan Date ) -La 1 0l Number of sheets Revision Date
Title
Size of Septic Tank low (P X ,� l Type of S.A.S. A` aC `7�)toi{C CF1 AMa 6-t,S I��
Description of Soil
1
Nature of Repairs or Alterations(Answer when applicable)00AX C i0 QJ 7 ( i [Wgr1Cs,t Ie15 lL ihll- 1�( 17Zt t1�!i(,aJ
�QX o
, t
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of ealth. `
Signed Date
.Application Approved'by Date
Application Disapproved by: Date
for the following reasons
Permit No. 20 1 Z - 033 Date Issued 2 ZO 1 Z
——————————————————————————————— -------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (e,� Upgraded ( )
Abandoned
��( )by
at S`f
' has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.a/Z- 033 dated 7 Zo/Z-
Installer �_/ ,ter.- Designer
#bedrooms Approved designflow 3s0, gpd
The issuance of this permit shall t be construed as a guarantee that the system will function des'h ned.
Date ` ��� Inspector
--------------------------------------------
No.2017-- 033 Fee 00' ep
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Digonl:*pgtem Cow5truction Permit
Permission is hereby granted to Construct ( ) Repair (e-< Upgrade ( ) Abandon ( )
System located at CjLA WCA<h\nCc\7A ?D SSRtj WO-VV
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of thispen
9t.
Date 20 1 ZD 12 Approved byv /
Town of Barnstable
Op1HE qn Regulatory Services
Thomas F. Geiler, Director
snxxsrasc€.
9�p1. Public Health Division
' Thomas McKean, Director
"— 200 Main Street,Hyannis,MA 02601
Office: 503-362-4644 Fax: 503-790-6304
Installer & Designer Certification Form
Date: Sewage Permit# d 0Q —D,3.3 Assessor's Map\Parcel
Designer: D61"u, Installer: A/3 �q-�7C y
Address: q Address: 3L
On Ck i 1,:). /` B 64Lo was issued a permit to install a
(da ) (Installer)
septic system at w�}('j� 70N gu, based on a design drawn by
(address) l
� � �./ dated Z✓ - Z
(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.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than I 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.
OF MgSs�
DAR
t M
(Ins 1 er's Signature) 1 140
SAN I TAR�I'�
(Designer's Signature) f ZD
(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.
Q:Health/Septic/Designer Certification Form 3-26-04:1doc
I
• --astable
p#
Town of B
Department of Regulatory Services
Public Health Division Date
1639. tee$ 200 Main Street,Hyannis MA 02601
~rfD r,AA'�� '•
Date Scheduled L t? Time Fee Pd.
i ( o
g wage Dzs�oaM oil Suitability Ases
Performed Witnessed By i
LOCATION & GENERAL INFORMATION
Location Address,j,t WASH t,,J67 --,J Owner's Name 5L f�C.�
�7_ P>>tir,Si K J 4� r t�
M f,. k/? Address
Assessor's Map/P4rcel: 2-/t 11-��� I Engineer's Nain M
/ :ten .
NEW CONSIRU '[ION REPAIR Telephone# �►Drc Sic-n� �tq�
Land Use //J Z��6i1'F�'� Slopes(To) �/ Surface Stones /✓l//L-r
Distances from: Open Water Body >Za)ft Possible Wdc Area ft Drinking Water Well ft
Drainage Way ft Property Linc Z 1 V ft Other ft
SKETCH:(Street name,dimcnsiods'of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
40
I
- i -
I
I
I
.•ram,
I
l P nt material(geglogic) Depth to Bedrockce
" � I •p
Depth to Groundwatdr. Standing Water in Hole: i Weeping from Pit FR.
c!:
Estimated Seasonal Thigh Groundwater id A
DtTERIVIINATION FOR SEASONAL HIGFI WATER TAME
Method Used: In.
Depth C beerved standing in obs.hole: _ in. Depth 10 spll Mottles:
i in. aroundwnter Adjustment ft
Depth toiweeping from side of obs.hole: _ A •{7etor•, _v-
AdJ,Orpundwflterlevel.,,,,e,
Index Well# Reading Date: Index Well levdl --
i
PERCOLATION TEST Dilte--�---� xlnsp"
Observation Time at 9" T
Hole#
y Time at G" �✓ .-..-------
Depth of Pere
v � Time(9"-0) —
Start Pre-soak Time.@
bz"
End Pre-soak
Rate MinJlnch
site Suitability Assessment Site Passed Site Failed: —
Additional Testing Needed(YIN)
Original: Public k;e'aith Division Observatiol Hole Data To Be ComQleted on Back—
***If percola ibn testis to be conducted within 100' of wetland,you must first notify the
rior to beginning.
Barnstable C4.4servation Division at least one (1) week p
DEEP OBSERVATION HOLE LOG Hole# /
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
tj
_� ►�o
DEEP OBSERVATION HOLE LOG Hole# 2—
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
/ Consistenc %Gravel)
00
DEEP OBSERVATION HOLE LOG Hole# N 14
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.). (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
DEEP.OBSERVATION HOLE L G Hole#
14k-
Depth from Soil Horizon Soil Texture Soil Color Soil Ether
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. ra 1
t
Flood Insurance Rate Map:
Above 500 year flood boundary No—
Yes
Within 500 year boundary No J Yes
Within 100 year flood boundary No- Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv'oµ�s material exist.in all areas observed throughout the
area proposed for the soil absorption system? �'J�
If not,what is the depth of naturally occurring pe vious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environm6tal Protection and that the above analysis was performed by me consistent with
the requir rain ,experti a and ex rience described in 3,10 CMR 15.017.
Signature Date 1 i v
Q:\SEPTICIPERCFORM.DOC
No.-• - ..... F�s......Q:..................
THE COMMONWEALTH OF MASSACHUSETTS
4�Y �✓�t BOARD OF HEALTH
TOWN OF BARNSTABLE
Signed Date
, pplirFa#ilan for Disposal lVark.6 Tonstrnrtuan ramit
Application is hereby made for a Permit to Construct ( ) or Repair (k-r an Individual Sewage Disposal
System at:
,5" Lr9aq t36
N Ybt� 0 '[�Z 1,=•�a CAN �lLi!!
C
• - - . ..-•............... -......�1 ..-• - 1• Y.....- .........................................
. Location--Address
or o.
�.. o�.�,``.. . .................•................. ..........-......................................................................................
Owner Address
a !� !� C�nfC. 6 ...........
Installer Addre
Q Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms___.....................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q Other fixtures . ...
WDesign Flow............................................gallons per person per day. Total daily flow..................................:.........gallons.
WSeptic 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--------•-------------------------------••-----------------•----------•-•-----•-•---......_.._---•--.........................................................O Description of Soil........................................................................................................................................................................
x
U --------------------------•--------------------•---------------•----------------------------------------•---------------------------•------•---------------------...._....-----------------•-•----------
-------------------- - ---------------------------------------------------------------------------
----�-- -- - ........-
U Na ure of Repairs or Alterat' ns—A wer when applicabl pp �: ._._.__.. . L-l� f.b� .__r________...
Wit..._ ....
� -
-S
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Enviro ental Code— undersigned further agrees not to place the
system in operation until a Certificate of Com Banc as been iss d y the board of health. Q
Signed ------ ---- ------ [3..--......------ ......�.-` -1.--` .j------.
Dace
Application Approved By .. ... ... .. .. .... .. .. -=-.... A �... . ----------------Da[e ---------------.
Application Disapproved for the following reasons- --- ------------- ------- --------------------------- -- --- -------------------------------------
................... .� .....--- ---- --....-------- -- --------.....................---- -- -----
/ Dare
Permit No. /. ........................ Issued .......... .[ , /...
ae
No.._ / � D.''
.:� F.R$.�� .................._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
4
a\0 ,,- c0 TOWN OF BARNSTABLE
Appliratilan for DispatiFal Works Tonstrnrtiun runfit
Application is hereby made for a Permit to Construct ( ) or Repair ( v)'an Individual Sewage Disposal
System at:
.....: -------------------------------------------
L_.ci,��l� ►`tJ6Y(at? i c� ,�LLVt LvR ��N �RVI�c_L-
Location-Address or Lot No.
...................... ... ................................... ..........--......................................................................................
Owner Address
................................................. �!a a� q t ��....... �� r�o u�-t�
� Installer Addres5�
UType of Building Size Lot.................... .....Sq. feet
Dwelling No. of Bedrooms.__ _--__Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons......._.................... Showers ( ) Cafeteria ( )
Pa
Other fixtures
W Design Flow.........4......I...........................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
1
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........................
0 a •-------•-------•-------------------------------••---•-•--••------------------....•-----...--.-•----.........................................................
Description of Soil........................................................................................................................................................................
x
U .........•----•----•---••-•---•-------••••-----••-•------------••--•---------••--•-------•-----•--•-----••--•-------------------•------•-------•--------•••-----------•---•......-----....._....._......
w
x ..........................-----•-----------------••----•-•-----------------. ----------------••------•--•- ------
U Na ure of Repairs or Alterations—Answer when applicable\,.- A _W_.. L+ - ...�....../Aw G�,..._..
....................................
i
Agreement: v
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complian e,has been issued by the board of health.
r 9 �Si Signed J
te
�Application Approved By --. / - . VV.......�. .1� ................ ----
Date
Application Disapproved for the following rearons:6--------------------------------------------------------------------------------------- -------------------------------------
....... ............. I -/ -------'------ -- n..- ------------..................� .... ....... Date
Permit No. l ` ............... Issued ............._..
. _ ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ter#ifira a of Guylinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( t/}
by-.. .' - ....----A.j.:c
Installer
at ...!��.`( ........ .......1�11 R.
.� N
has been installed in accordance with the provisions of TITLE 5 f TheM___
Eta- ironmental Code as described in
the application for Disposal Works Construction Permit No. ........ .....-fi1.".. dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BEE�NSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
(DATE............................................--- ---r: ° Inspector .........................L- - ......
THE COMMONWEALTH OF MASSACHUSETTS
l BOARD OF HEALTH
l TOWN OF BARNSTABLE
;Biopsaal nrko TIM&nr$iaaa anti#
Permission is hereby granted.....?!��`.. ��..._..� ................... -----------•------------------•----
to Construct ( ) or Repair ( p,)s an Individual Sewage Disposal System
at No.--- 'P)jc_4N-!W_ .T _ ?-.-.-- --.---WA`,t= C PT_4S
7 �reetl �
as shown on the a plicat on for Disposal Works Construction Per 't No.____!!_ 5a I'D!ated .`�'__ _r _. ._ _l.___1�....
DATE......../ -•-••................................... Board o `I-IeaA
1-- ;-•- ,-�•---
FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS
TOWN OF BARNSTABLE �
LOCATION Sy R u a sIe SEWAGE#
VILLAGE ASSESSOR'S MAP 6z LOT
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY 1006 Q R l LJ I o X
LEACHING FACILITY:(type) L P - (o tj a (size)
NO. OF BEDROOMS -3 ,PRIVATE WELL 06BLI TER
BUILDER OR OWNER c
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
� 2k S q
0 � ✓i
�a-9�
L 7��A4�
LOCATI �/� Wil C,E PERMIT UO.
VILLAGE - - - - - -
IW5ThLL ADDRESS
BUILDERS Q &MF- AD RE SS
D(aTE PERVA T ISSUED
0 ATE COMPLI &MCE ISSUED : — — —
.tea +4i
��
i
I �I
�� ��
/7 0
V. //
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---- -- ------ ----------
C � Appliration -for M,ipoottl Works Towitrixrtion Vrrniit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: ,.
ma y. �U cS-4,4- °L�7 - .
Locatio Address or Lot No.
/r/-.--... .........................•-........ .............�'. 11 �1 ......................
W r Addre
a -------'�� .----------; W. .'------- --------------- .........� , --
----------------------------------------
Installer Address
Type of Building Size Lo feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
A'' Other fixtures
W Design Flow............................................gallons per person per day. Total d ily flow_________.__.______.._______.__-------------gallons.
WSeptic Tank—Liquid capacity-_.__---____gallons Length______________ Width---(P....... Diameter-----...__..... Depth.__-_---_...--.
xDisposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area...-.---__-•-_-_---sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below,inle�j_..... _._...... Total leaching area------------------sq. tt.
z Other Distribution box ( ) Dosing tank ( ) Qb� IC16 - 7- ,,j'_. 74
aPercolation Test Results Performed by------ ------------------------------------------------------------------ Date--_-.----------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-..__-..--_-___.-.._...-
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------.--------
----------------------- -- - ------- - -- I ----- -------------------------------
O Description of Soil -. '': .i.a ..��--g'- ------------- ----
x ----2 J' - , --- --- 'oar
� L r
v 3 �?.n.__ .._ _
j
V Nature of Repairs or Alterations—Answer when applicable---------------------------------_--------------------------------- -------...------------------
--
---------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual ewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The enders lied further agrees not to place the system in
operation until a Certificate of Compliance has been i u� by the d of heal h
Sign =
D
a
Application Approved By------ ---- ----- -- ------- . te
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo------------ ........................................... Issued........................................................
Date
I V J ram'
? ___._.. V
// ti
02
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTHell-
Apphratiun -for ]igpniittl Works Tottfitrnrtinn Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at: -�—• _____
sr' ; jr1'fit/ �,SJ _ _ '�/// 5zc _ .. .
...................................... ......."---•--'---•-•---'•-•••--- -'•''•.. •---- ......
Location-Address or-.Lot No.
.. /'....a`c....-..
W , .�"%�=—,_-• .�� �Owner
a ,.._.. ---------- ---•-------- _
.....
Installer Address
U Type of Building Size Lot_."{ _.< =` S feet
Dwelling—No. of Bedrooms_....._...®+-r-------------------------Expansion Attic ( ) Garbage Grinder ( )
G1a.4 Other—Type of Building ____________________________ No. of persons..-__-_-.._--._-.---___-_--_ Showers ( ) — Cafeteria ( )
04 Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-----:,'7...... Diameter_----_-..-_--_ Depth----------_---
Disposal Trench—No- ____________________ Width-------------------- Total Length-------------------- Total leaching area..-..----_-_-__-----sq. ft.
Seepage Pit No---------------_---- Diameter-------------------- Depth below/inlet�j......_ ....___-__ Total_leachin area-..___.-.----____sq. ft.
z Other Distribution box ( ) Dosing tank ( ) 0'�/ /"G�`�" 7-/,� - �
aPercolation Test Results Performed bY----------- --•-------------•-'•-•--------------•---•"-------------•-'-" Date---------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit..-----------....... Depth to ground water..-.__-___. --..--.-.
Lr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-...-.-.--_..__--..-.._-
04 ------------•- ------------- ---•--- {
O Description of Soil G_Y� =. - _ (� :�t1 u
L �-'c ------•-----
.
------- ---------
� .
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 issued.by the board of health,,
Sign - ----------- •-•--•-------•-------•-------•---•------------ -l`
Date�
-------
Application A roved B
PP Y ... �-------- --- ---- ,, l� l.._ -...... ��'� - .�
ff Date
Application Disapproved for t12e�f ollowing reasons:..------------------------------------------------- -----
---•--------------------------------------------- ---------'-"-------•-'-"-----"--'------•"""•'--•-------- -----------------------•-------------------------------------------------------------
Date
PermitNo......................................................... Issued........................ ................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
........... ...d. ........OF.............. .... .....................................
�rrtifiratle of f lantplialta
THINKS rCER,P FY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by,. cC vv -
In 1!1 .�.1 -Z. _ _..
`= '` `f f!f f/ �111er -----------
at. _ . .........
.. ��C.�16� --�•.
has been installed in accordance wit 1T the provisions of Age XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.___._._..__.le............... dated__.._.7��f_.`.7�....__._....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL F NCTION SATISFACTORY.
DATE............ -----�-a----- ................... Inspector- -------- ................ ........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALT
0
7. Cf� ...........OF. ........ Q.�� .... .-.
No. ..... FEE__ . ..
Permission !',s h b Bi�vn�tt� iv' al �Sew �Cg-e-n Dni�t�jrs nrStyistne n rrmit
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or Repair to Const c nd �.
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Street '
as shown on the application for Disposal Works Constr ction Permit No_____________________ Dated______.{ `. -".._, __
-•----------------------•---------------••---------------------•---------------.-----_-------•----------
Board of Health
DATE-------------------------------------------------------------- ---------------- 0
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FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS \j
` PLOT PLAN SHOWING LOCATION OF BUILDING
)? 'A( T 7-/q >61 MASS.
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SCALE ,Sa DATE.
{ CHARLES N. SAVER 04C REG C E 8 L S 712 MAIN ST HYAN►VIS, MASS
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1 hereby certify that the building exists .• " '` "4,r
on the ground as shown on this plan and r ,
Poer.Rr
is in accordance with the zoning
requ ements of the Town of R.6 - Sfe
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Registered Land St,rveyor - I °
I CENTERVILLE
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BULKHEAD FOUNDATION 'n5PF70ts CD4570? CIO
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a LOCUS
EXIST. LEACH PIT 4� 54 WASHINGTON
G 1 .3 LOCUS MAP
NOTE 10 BURSLEY WAY
EXIST. I,000G
!�Q SEPTIC TANK LOCUS INFORMATION
' TITLE REF: 2411/336
� +G0.2 PARCEL ID: MAP 172 PAR. 170
�+ •0 PARCEL IS SUBJECT TO ESTUARIES RESTRICTION
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G0.G+
SEPTIC SYSTEM
REPAIR PLAN
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LOCATED AT:
+61 '2 54 WASHINGTON BURSLEY WAY
�P CENTERVILLE, MA
PREPARED FOR
HAROLD & JO ANN
s/ SLACK
+G I .4 JANUARY 22, 2012
OF MASs9�
D y�
` o. 1140
GENERAL NOTES: ` 'PEG/STE��
8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. S4,91TAR�a� I Z2 +Z
BOARD of HEALTH AND THE DESIGN ENGINEER. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE CONSTRUCTION.
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. {
— 310 CMR 15.405 (1) (B):
1) A 0.29 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
TO BE 3.29 FT (MAX) BELOW GRADE VS REQ'D 3 FT. 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 1 MEYER & SONS, INC.
(H20/VENT PROVIDED) AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY }
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING !
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE), P.O. B 0 X 981
DESIGN ENGINEER. 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW }
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FOR THE USE OF A GARBAGE GRINDER EAST SANDWICH M A. 02537
ENGINEER BEFORE CONSTRUCTION CONTINUES.
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING ,
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. ,
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE of 5 0 8)3 6 2-2 9 2 2
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. i
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 6 SCALE: 1 r, 30 ,1 SHEET 1 OF 2 1387
r
=
f
NOTE: TO!PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:57.71
FOR A DISTANCE OF 15' AROUND THE
=4 PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
i4 T.O.F. EL.=62.00 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER 1a-
OUTLET AND SET TO 6 OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. IN�GTH
LEO
•;-•lF.G. EL.=61.30t F.G. EL.=61.Ot F.G. EL:61.Of F.G. 'EL- 61.00(MAX.) OF SS
� 9.45-VENT AR Gn
-YER
L = 12't 9- MIN COVER/ + L = 15' 704
5'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) 1237" No. 1140
0 S=1X (MIN.) 36" MAX COVER 0 S=1% (MIN.) % (MIN.)
4"SCH40 PVC 4"SCH40 PVC 40 PVCC,� _mN
10• JB.AFFLE
s10.38E To SgNITAR0�'
INV.= 58.83 4a-uouroINV.=58.58 INVERTCOUPLER DETAIL��� M
NV.= 57.25
GAS 4 ROWS OF 4 UNITS ® 5'/UNIT t 3 COUPLERS ® 1.16'/UNIT = 23.48'/ROW
AM AM INV.=58.20 .=58.o SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING 1.000 GALLON SEPTIC TANK
EXISTING OUTLET RESTORE VEGETATIVE COVER
BACKFILL WITH CLEAN PERC SAND 60-
TO TOP OF CHAMBERS
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
PIPE INVERTS PRIOR TO CONSTRUCTION
2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=57.71
GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 57.25
INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 56.38 EXISTING SUITABLE
310 CMR 15.221(2) 2,gg' MATERIAL
3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 5' MIN. ABOVE BOTTOM OF
WITH 1500 GALLON SEPTIC TANK IF FAILED, T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.88' = 11.52
DAMAGED, NOT H2O LOADING, OR UNDERSIZED. (6.58' PROVIDED) USE 4 ROWS OF 4-ADS ARC 36HC
4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL.=49.80 _ (H20) UNITS - NO STONE W/ 3 COUPLERS
GAS BAFFLE AS REQUIRED IN EACH ROW
SEPTIC SYSTEM PROFILE •
TYPICAL SECTION
16
N.T.S. M.rs
"
SOIL LOG P#: 13530
DESIGN CRITERIA DATE: JANUARY 20, 2012
NUMBER OF BEDROOMS: 3 BR DWELLING
SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 SECTION INVERT
SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVID STANTON, BARNSTABLE BOH HEIGHT END CAP
DESIGN PERCOLATION RATE: <2 MIN/IN Elev. TP-1 Depth Fjov. TP-2 Depth ADS - ARC 36HC CHAMBER (H20 LOAD)
60.30 0" 60.30 0"
DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. 0/A/E O/A/E MODEL ARC 36HC
LOAMY SAND LOAMY SAND
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 10YR 4/1 ! 10YR 4/1 LENGTH 63"
58.97 16" I 58.97 16" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK B I 8 EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 100MY SSAAND LOAMY �D SIDE WALL HEIGHT 10.38E
57.47 34" 57.47 34" OVERALL HEIGHT 16"
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM)(H20 LOADING) C C
FINE - OVERALL WIDTH 34.5" 4640 TRUEMAN BL►iD
PRIMARY S.A.S. FINE -
MEDIUM SAND HILLIARD, OHIO 43026
.
USE 4 ROWS OF 4 - ADS ARCHC 3616 H2O UNITS-NO STONE EVUBS'
Vzj2.5Y 6/4 10 7 CF MEDIUM SANG CAPACITY (80.0 GAL) ADVANCED DFWWE SYSTEMS, INC.
AND EXTENDED 1.16' W/ COUPLERS IN BETWEEN EACH UNIT PERC O 55.97 2.5Y 6/4
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) 9 - PROPOSED SEPTIC SYSTEM/SITE PLAN
(CHAMBERS: 4/ROW)16 UNITS x 5.0 LF x 4.80 SF/LF = 384.00 SF 49.8
126E 49 80 126E
(COUPLER: 3/ROW) 12 UNITS x 1.16 LF x 4.80 SF/LF = 66.82 SF 54 WASHINGTON BURSLEY WAY, CENTERVILLE, MA
TOTAL AREA = 450.82 SF PERC RATE <7 MIN/IN. ("C2" HORIZON) ' Prepared for: Slack
DESIGN FLOW PROVIDED: 0.74GPD/SF(450.82SF) = 333.60 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN
MEYER&SONS,INC. Feller & Assoc. NTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX981 (508) 775-0735 DATE:
to conduct soil evaluations and that the above analysis has been performed by me consistent with the CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that i have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH,A4A 02537
508_V2-2922 01/22/12 D.M.M. 2 OF 2