HomeMy WebLinkAbout0029 ZENO CROCKER ROAD - Health (2) 29 ZENO CROCKER RD., CENTERVILLE
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UPC 12534
No.2 153LQR
HASTINGS.MN
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
J: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
1Zipplication for Mfg ogal otem Cougtruction Permit
Application for a Permit to Construct( )Repair(�)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Ow is Name, dress Tel.No. 4 2 0—5 2 8 8
29 Zenm.f Crocker Rd.. , Centerville Caren A encfal
Assessor'sMap/Parcel 1A 02632 29 Zeno Crocker Rd., Centerville
I�St ller' ame�q ddress and Tel.No. Designer's Name,Address and Tel.No.
VUIII. `R. AlTltISOTi, Sr . Septic Servile
P.O . Box 1089
, Centerville ,
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 Sand.
Nature of Repairs or Alterations(Answer when applicable) Install a new D-box and.
folAr high capacity stone-packed. H-20 leach chambers according
to plans .
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 BgArd o Health.
Signed p—c A o Date //—C,?0._ff
Application Approved by _ Date
Application Disapproved fo the following reason
e t No. Date Issued
3
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS Yes
0(pprication for Mt-4pomf *pitem Construction Permit
Application for a Permit to Construct( )Repair(�)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Ow iws Name, dress Tel.No. 42 O-5 2 8 8
29 ZenmmCrocker Rd.. , Centerville renenc al e
Assessor'sMap/Parcel MA o2632 29
a. Zeno Crocker Rd.,- Centerville
Lalam dress,and TeL No. Designer's Name,Address and Tel.No.
e 'o�inson, Sr. Septic Servie
BVx - 089
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/ayA AIc fated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand
Nature of Repairs or Alterations(Answer when applicable) Install a new D-box and
four high c acity storepac ecT;H=2�"`l-e�agh chambers according
.t {
to plans.
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 h -beeissed ythsB� -o Heath CSigned {q
Date r'
Application Approved by 4A �CPr �/ Date
P
Application Disapproved for the following reason 1
v ' !
Permit No. Date Issued
— ————— —— ——— ——————
i THE�,C0MM0NWEA LT_H OF MASSACHUSETTS f
--�� �PARIVSfABLE MASSACHUSETTS
Karen We'ndal
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(X )Repaired( )Upgraded( )
Abandoned( )by Wm. E . Robinson Septic Service , PO Box 1089,Centerville , MMA
at 29 Zeno Crocker Rd. , Centerville, MA be constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No ated
Installer Designer.
The issuance of this ermit sh 11 not be construed as a guarantee that the sgstem-w 1 cti as designed.
Date . -2 r lnspector-4�
————--F_71-/—7�5———————————————————————————————
No. Feed
\
THE COMMONWEALTH OF MASSAChUSETTS 4
PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS ' I
Karen Wendal
Miopogaf *pgtem Congtruction Permit
Permission is hereby.•anted to Construct( )Re air )Upgrade( )Abandon
Systemlocatedat 9 Zeno Crocker Rd.. , Centerville , MA
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/he duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction mus be c mpl ted within three years of the date of this t. o
Date: Approved by /
r
d
a -J
NOTICE: This Form Is To Be Used For The Repair Of wiled
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
I, William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated 12 36 9 concerning the
property located at 29 Zeno Crocker Road, Centerville, MA meets all of the
following criteria:
* There are no wetlands within 100 feet of the proposed leaching facility.
* There are no private wells within 150 feet of the proposed septic system.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
* If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the
proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following: �
A)Top of Ground Elevation(according to the Engineering Division G.I.S. map)
B)Observed Groundwater Table Evaluation(according to Health Division well map) !1
SIGNED: DATE
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60
(Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
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LOCATION SEWAGE PERMIT NO
VILLAGE
tL� A
INSTALLER'S NAME i ADDRESS
ti
S U I L D E R OR OWNER
DATE PERMIT ISSUED
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D A T E COMPLIANCE ISSUED
F
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TOWN OF BARNS .ABLE
°LOCATIO ZEIVO "SEWAGE #
VILLAGE 4a A" ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO. Il[l i i h- 5
% S� "� ? '
SEPTIC TANK CAPACITY C1 �
LEACHING FACILITY: (type) f C, '° (size)
NO.OF BEDROOMS 3
BUILDER OR OWNER �� '/��A'�j'y PERMIT DATE:, COMPLIANCE DATE: 102—
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facilit Feet
Private Water Supply Well and Leaching Facility (If any wells exis
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exis
within 300 feet of leaching facility) Feet
Furnished by
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No... :p .--....Fss....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.....----.....OF........ �. - ...��_ L ...
Appliratiuu for Disposal Works Cnuuutrurtiou Pumit
Application is hereby made for a Permit to Construct (4 or Repair ( ) an Individual Sewage Disposal
System at:
--�T . .................................................. .........
L ,e— 0, t Location-Address or Lot N_.
----1--X--j-------.�j._...•..=`�....L�.,�_�7..-----�-�.i�.--.�-�..-t�...------..la.. .�aUN1.�........hr�� -•--•---.........
W . L .....6.ZA.�T)........_` ........ ...... 1_.t✓.• j• dress
Installer Address j
Type of Building � Size Lot----l5�_�J.�..Sq. feet
,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (O
Pk 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 Tank—Liquid capacity.I �ogallons Length..�5 12. Width................ Diameter................ Depth................
x Disposal Trench—No.................. . ` g q
Seepage Pit No-----------I-.-.Diameter......F—....... Depth below inlet_...�.V_...... Total leachingarea.-.__. 5.'bs . ft.
Width_.._ _ ._ Total Length.................... Total leaching area....................s ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test ResultsZ Performed by.werJ_!_i- -. ._ S OG_____________________ Date___.....J d/Z>.�.
Test Pit No. 1................minutes per inch Depth of Te Pit.....I`2�........ Depth to ground water_-__—.............
�Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ------------•-- -------•------•--- ---•------•---•-----••--•---------•-•-• --------- ------------ ...............................
0 Description of Soil----------- �� T' �7 1�1`�.`7l[ ----� t�1 a� - .t1 ----------------•-----
x
W
T.,
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 iITL U 5 of the State Sanitary Code— The un rsigned further agrees not to pla/tn �s"
em in
operation until a C to of Compliance has been b t bo of health.
��
..
Application proved BY--...------�T--- ---••...............•--•--------•--`fit --•----�`----/ -�
ned
Date
Application Disapproved for the following reasons---------------•----------------------------------.......-----------------------------•-----------•-•---•-••--•
------•------------•-----------------------------------------------------------
-------------..._..
_ Date
Permit No....... �. __Z -fl..--•----------•-----------. Issued_---------•=�--•--� ��_......•-----......
D
� A_
No....... � �" Fxs. � .......
1_+HE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ......
Appliration for'Disposal Works Taustrortion rnmit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
...4- :�___�_�.D..=z:.E:tom_--: 2 .1�-�.2: .............................( L:. ?: � `? 1 �......................
Location- Address or Lot No.
:. P� -� _ U. 1 ��� ....4 !- t . _t.,.......---! - ......................
-- -_ i -
p /Owner ,�...•.- ..,, �"�r Address
•44:.....� I....... .....�f _- -----------------------
Installer Address
UType of Building Size Lot-----I----.-4--..Sq. feet
Dwelling—No. of Bedrooms.......................................-----Expansion Attic ( ) Garbage Grinder
Pk Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures .............................. ..
W Design Flow................5.............._.___..gallons per person per day. Total daily flow-----------1 .1_ ._.._._............gallons.
WSeptic Tank—Liquid capacity__'� ggallons Length.-.--;;, . Width................ Diameter------------.--- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------------------- Diameter......1 ....... Depth below inlet....... ..... Total leaching area. q. ft.
Z Other Distribution box Dosing tank ( )
Percolation Test Results Performed �..................... Date.........
,-a Test Pit.No. 1----L___2':-.minutes per inch Depth of Test Pit-----J'�r........ Depth to ground water_.-___---------------
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----------------------------•-•-• ---••-......-•--••......-- ••••-•--•--.._......---- .••••-•-••----•-••-•••••---.._.........---•_-----
D Description of Soil------------ '7�' .��� j4?. .�1�?j -- :_..._.._..
U ••...-••---•--•-•-••--••••-•-••---•----••---•-•••--••----•--••----••--••--._.42.' �.... 1 r�l '! -=------.... t C?...................-•--..........
W
UNature 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 TITLE 5 of the State Sanitary Code— The un ersigned further agrees not to place the system in
operation until a Certificate of Compliance has been}' sued b th o of health.
r ~� ;iened-----�g� ----------------------------------------- . .., .....
ote
Application roved BY........... ............................. -ti._._.._... ""` --------
i r
f Date
Application Disapproved for the following reasons----------------------------L1-•-•••----•---•••-••...--------•••••••••--•••-----•••--••-•----•--------......-----
....................•----......_.....----••-•-------------------------•---....•-•----•---••-•••-------•-
Date
Permit No......................................................... Issued---- ...._..
Date
THE COMMONWEALTH OF MASSACHUSETTS +°
BOARD OF HEALTH
., ................OF.... - ?"��yf ...........................
Turrtifiratr of Toutpliaaire
THIS IS 0 CERT FY, That the Individual Sewage Disposal System constructed (, edr Repaired ( :)
by. � )z--- -;r� �/`«% �r.�y-.. Jc .........................
...... ---_--
` Installed
! ,r ll
has been installed in accordance with the provisions of mI I .,; 5 of The State Sanimry Code as described in the
application for Disposal Works Construction Permit No----------------------------------------- dated------------------------------ ___..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUSE® A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......5.. ...................................... Inspector............ -----
THE COMMONWEALTH OF MASS,,�qHUSETTS
BOARDj OF HEALTH
OF... r :...: / . fr ......
Disposal Wor Tonstr ion Y,-
r Uti#
Permission is hereby granted ' ' t r ..........................................................
to Construct Re air ( ) an Individual rage Disposal System
Street �r��n
as shown on the application for Disposal Works Construction P it No......:............. Dated. V.!!"......_._.....__.........._...
' DATE................�'.� S r
Board of Health
FORM 1255 HOSES & WARREN. INC.. PUBLISHERS
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f. /T� PLAN' SHEEr l OF"2
SCALE:
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777
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REC/STERED LANQ St/RFOR
�EYOR
ZONE .., .�, G trNT" -y'[�.L MAC •
PLAN REF ,-.-�-- PATE
BENCH MARK,QATUM ' �' ��' �- �, , WM• M. WARWICK 9 ASSOC. INC.
QOMESTIC WATER SORCE„ � .� .,. i l90X B0/ !NOR TN FALMOUTH
FL000 ZONE O �:: ;. " MASS. 02536 - (6/7) 563-263B
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77777 x # �
LcA(iHIN6 8ASIN SECT101V NOT TO SCALE Shecsl L2 �� 2
24 C.1.NH COVER
EARTH FILL
�+ BR/CI( AND MORTAR COURSES A5 AEO'D. TO BRING
� S-4". •_.�•,.: COVER TO GRADE
� 4 B FLOW L/NE `
IN
.i_ _ __:;1�•:� ?'= "TO "WASHED PEA SrONE FREE Of/BONS,
PIPE ',• FINES AND OUST /N PLACE
�1 �� ' • ' OPENING W/TH 4 8" �4 r0 /%p"WASHED CRUSHED STONE FREE OF
OUTER DIAMETER IRONS, FINES AND DUST /N PLACE
AND 1414 INSIDE
D/AA/Er£R. I• CONCRETE TO BE 4000 PS1 28 DAYS
2. REINFORCED WITH " N0. 6 GA. W.W.M.
3. 2'AND 4' SECTJONS ARE AVAILABLE FOR.
1 GREATER D1:;PTI4. REQUIREMENTS
M0 -61
011 ly, 3 --� 4. NUMBER DF.PITS REQUIRED Z/Q-&-.
EFFECTIVE D/AMErER NOTE: EXCAVATE .TO ELEVATION
(Nor ro EXCEED S TIMES EFFEcrIVE oEPrH/ LOWER AS ftEOUIRED TO REM VE ALL
-wArER MOLE-
LOAM LOAM ANO CLAY BENEATH PIT. REPLACE
EXCAVATED MATERIAL WITH CLEAN
TYPICAL PROF/LE GRAVEL TO-,DESIGNED GRADE"
...
lB STD L r. WGT. C./.MH,COVER
4"8IT.FIBER PIPE
4"CLPIPE F/GHr JOINT OUTLET LEVEL
DWELL/NG FLOW LINE TO f/BST JOINT S, _
/ /4" 01
1 (D p 1
TEE. i,2 I I 0 I o i 1
�,,y ' ' loco 00 11 I I
TO ST CO
PRECANC O
' 11 �O 00 1 1 I 1
TAL/ST. BOX r0 BE 0 0 0 0 0 1 I I
GAL:SEPTIC TAN /NS�LEO ON LEVECi S� I I
STABLE BASE I if 000 00 6,11
r ,
. .. 1. - 111100 0011 � , .
T/C'TANK {TO B£ I ilea 0 00 0 1
/HST LL LEVFG, I It 10 00 1 1 i
STABLE BASE. I I 1 0 0 0 00 0 1
ilea 0 I G 0 1 1 , I �1,8V LEACH/NG BASIN , i( / 0 0 0
BASE TO BE L EVEL , to! O O 1 1
SOIL ANO PERC. DATA .
PERC• RATE,: .4 Z-: MIN: /IN."
F ; „ TEST PIT NO. -r 10777' O�" tEST PIT NO. 2
0.
TEST BY; v4z�o H .i..p,�_ 41t� V ala.
WITNESSED. BY IZor1
TEST PIT GR, EL. M E-p;
DATE: �o
5 rt D
I let,
DESIGN DAT,4 GENERAL NOTES
BEDROOMS ,NO HEAVY EQUIPMENT TO RUN OVER SYSTEM.
DISPOSAL i%-1 o SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD
EST. TOTAL DAILY EFFL-��PD, PRECAST-REINFORCED CONCRETE UNITS.
' SEPTIC TANK (0�0 GAL,' ALL .SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE,
SIDEWALL AREAIAL./SQ FT. : ` ' MINIMUM REQUIREMENT$ FOR THE SUBSURFACE DISPOSAL OF
BOTTOM AREA GAL./6Q,FT SANITARY SEWAGE. EFFECTIVE ON JULY 1 , 1977.
LEACHING REQUIRED i212SQ.FT.. ANY ,.CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
ACTUAL LEACHING;AREA OF HEALTH.
COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE
ACTvta.�. G`�`pITY BOARD 'OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
. PITCH;ALL SEWER LINES I/4 / FT UNLESS INDICATED OTHERWISE,
SN OF jyq�9
S,EWAW DISPOSAL SyS TEM
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3 MORA
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.p� f23417�Q L.o C' (0 1 `b Z--Lr•1n, G czy _ p
QNALEN - y
SCALE'.AS INO/CATEO,' DATE-- 'S I' 1
WX 'M. WARWICK 8 ASSOC., /NC, .
8OX 80/ - NORTH FAL hf01ITN
' MASS.`02556 - /6/T! 563-26j8
' PROFESS/ONAJ ENG/NEEoP
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