HomeMy WebLinkAbout0092 ZENO CROCKER ROAD - Health (3) 92 ZENO CROCKER
CENTERVILLE
A= 170 - 135
S M E A D
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE FORESTRY MIN.RECYCLED AMLINITIATIVE CONTENT10%
Cer6Led Fber Sourcing POSLCONSLIMER
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SFWI o
MADE IN USA
^•ET ORGANU D AT SMEAR COY
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No. /I�
, Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
�
PUBLIC HEALTH DIVISION - TOWN.OF BARNSTABLE, MASSACHUSETTS
ftpliLation for Misposal *pStem Construction Permit
Application for a Permit to Construct( ) Repair(,<Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. 9a zeoo f77 Pd Owner's Name,Address,and Tel.No./07-
Assessor's Map/Parcel 170 >3 6¢n d fie �C )0ea- )e 'd'f�WM90 o?89S 5W,Qr.'jk cagy
U
�tstaller's Name,Address,and el.No. 508. r)f) Q�9 Designer' N e Address,and Tel.No. Ao -3&P • yJ f/
f�zr6 o Cv6�S�vuc lt� �,,e / 9�n���i°
s oi?&
Type of Building: f
Dwelling No.of Bedrooms .3 Lot Size Si sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided 3 7 gpd
Plan Date Qj&U 10 dal Number of sheets Revision Date
Title i '
Size of Septic Tank eA141'h4 /6MQie Type of S.A.S. �V IMP VW11Z114 AVLA
Description of Soil �nit9J
Nature of Repairs or Alterations(Answer when applicable) 0,41601 L
�i
Date last in cted:
Agreement:
The undersigned agrees to ensure the construction and maintenance of t ore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental and not to ce the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No. Fee
THE COMMONWEALTH, M OF ASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - �QWN,�OF BARNSTABLE, MASSACHUSETTS Y�
21pprication for Mcspo�al°6pstem Construction Permit
Application for a Permit to Construct Repair ✓'U rade Abandon `0
PP ( ) p ( ) pg ( ) ( ) Complete System ®Individual Components
Location Address or Lot No. 9.2 Zef)o CAS -t k) Owner's Name,Address,and Tel.No.
{ err.aP �5"en�e � rS 5W P_64 ,",U),j
Assessor's Map/Parcel i'�//3� Can' rvj_�le 4)r�.�',�•,•,A lL. , F �v qV
Installer's Name,Address,and Tel.No. _-vs- Designer's Narrie.Address,and Tel.No. .�Olf'36.?� • 1/,S it
;-Ior O'U»Str-u4-1,cy,�rr+G Gr, JC'r� ►i'il�gi 17 t'F�fe 1 s�L y a",Axz 2��4
�iST: sae�AI AP& V1 bi;&V15 ,„orP/W, t� ,f"4-. &1
_.
Type of Building: t a
? f
Dwelling No.of Bedrooms J Lot Size / , �/`�� - sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ,3(J gpd Design flow provided 30 gpd
Plan Date A A1114 10, "� Number of sheets 1 Revision Date
Title j 41 "i-,�;4; Ann tsi 9,3 ,/_y"/1,r,-d fer RJ
Size of Septic Tankni.Sc /lXa^scc/r Type of S.A.S. .9 t}/ . �"r+x � ? ��r.�r lYrraa � E`1•t
Description of Soil ee )
Nature of Repairs or Alterations
rAlterations(Answer when applicable)f 2r"
'04"rt:4A ! Mf a C5 �fL �i oaf , , /k /f,�j � y /�✓
46 [
-/� f�. •J� /✓1 /ri L n^ /i f1 A �t � f ��s�/a� l`tJ
44
Date last inspected:
Agreement: r
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. /;), A-
.........
Signed ,„. ��e ',,`sDate Application Approved by \ aJ Date / }
Application Disapproved by Date
for the following reasons
Permit No. Date Issued .
-------- ------ -- -------- - - - - -- --- ---- - - - ---- -- -- - -----_------•-
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(J�) Upgraded( )
( ) y�' r sy! ice? / --
Abandoned b ar a� w.. f,r�`S is r•',r,�,.�.r.,n.-x ..�.�►�
at ._ tom,CV 1 c,�, /� has been constructed in accordance f t
with the provisions of Title 5 and the for Disposal System Construction Permit No: }} j- 3 dated
Installer r`'h,f trJ1_ftA_ l�reC�r�/����. Z..>"s�-_ Designer
#bedrooms _ d gpd
Approved design flow 3
The issuance of this permit shall not be construed as a guarantee that the system will funcct_ionn^asdesigned:"`-�" �
Date Z. ( Inspector
----- ---------------- ----- -------- --
' ( — �f _ - - Fee
eG' a _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair F.F ) gr de( ) Abandon
,_ ( )
System located at an (, ,f^�" cke y^ �. ( k i'3 IP�`11 T Ilto
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 this permit.
Date Approved by
SEP-09-2021 23:15 From: To:15087906304 Pa9e:1,'1
Town of Barnstable
F "E Inspectional Services
Public Health Division
i .nnrrne Thomas McKean,Director
A0;9•
a ° 2U0 Main Street,Hyannis,MA 02601
Fax: 508-790-6304
Office: 508-862-4644
Installer&Designer Certification Form
Date: 2 Sewage Permit#d0aI — 31(o Assessor's MaplParcel 670 t35
Designer: DOWKCRP��GINlI�,, 6NC_ Installer:
Address: -� fr�lUf�(nR Address. qT (�1W
• •�� 11�i M[ �'. M�
41ate;
& was issued a permit to install a
rOn 6fin
septic system at Q19 745M' Gft9('Kt?Z B based on a design drawn by
(address)
VPc,L, dated
l0 24?
Agri r
L.
I certify that the septic system referenced above was installed substantially according to
ttie design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
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
cortif ed as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that t , system referenced above was constructed inpli_ ce with the to rms of
the IAA r 1 letters(if applicable) �,,���1101:fif a.
c DANIELA. cs`�
U' OJALA
CIVIL Ca
(Installer's Signature) N0.as502
T � o tea;
qeF`cI S'i ER
Affix Designer Stain Here
(�gneesgnature ( g p
PLEASE RETURN TO gARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPL A CE WILL NOT BE ISSUED UNTIL BOTH THIS FORMA D AS-
BUIL CARD ARE RECEIVED BY THE BARNST BLE PUBLIC HEALTH DIVISION.
THANK YOU.
iMod(dutaNFIBALTMEWER connecQSEPTPrIesigner CcdlOeetion Forth Rov&14-13.DOC
0 ..'a:•. ..�rC. .....�
No...... � Fps
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.......... .K-. - '' v -
ApptirFation for Uhipaii al Workii Tomitrnrtinn Prrutit
Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal
System at:
.......... ... .. .......................
.. • .............
Location-Address
�or Lot No
----r-
.......................................
Address
/C ✓ . y1� �.f �1 / �wZ �A �TZ Installer Address
UType of Building Size Lot_ L,,/.A.1_1---------Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria )
Q' Other fixtu s .----•--•--••......-•.............
w Design Flow...............6. .......................gallons per person per day. Total daily flow._........:...5?.................gallons.
WSeptic Tank—Liquid capacity(ao4L.gallons Length.TP!... Width................ Diameter................ Depth-...............
x Disposal Trench—No..................... Width.................... Total Length....................... area sq.----------- Diameter....... ------ inlet..... Total leaching area_�'9....sq. ft.
Z Other Distribution box (✓) Dosingtank ( )
''' Percolation Test Results Performed b �IA� � .......................... Date
y 14 / ' .
Test Pit No. 1......-�...minutes per inch Depth of Testti-t....�. ......... Depth to ground water------ .-__---__.
fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............
..............................................................------......----------•--•-------..........------------------------------._.......-•-.........
0 Description of Soil........O z -ram ,!�.v_ 5_Q1 L_ --z 'S h'I iJ D ` •- p v--L .
x
-------------------------------------------------------------------------------------------------------- --" �'�- M �_-..... ?-----------....---------------
w
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The under agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the rovisions of i 5 of the State Sanitary C e— The u ersigned further agrees not to place the s stem in
peration u ertificate of Compliance has b n ' d t b - 'of health.
Signed..• ....... . .. .. . ..........................................
ApplicationApproved By•......---•- .-•-••. -•...................... ..... • ------------------------- --•-•-••�- • _
Date
Application Disapproved for the f o lowing reasons: ------.--
......................................-.................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
r
Ww"
THE COMMONWEALTH OF MASi ACHUSETTS
BOARD OF HEALTH
.....o F.. ... .. ...t ` .` . . ':�� ...........................
Trtifiratr of Timptianrr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( L:Repaired ( )
by........... — -1 ------.� _ _f� ._. _1�'.r.� f- �'�--- --- -------
nsta
I
6 > j . ..
at--••--...... ...Q. t. --•---...� `7="_ram. � l '<�-t.��Il '
has been installed in accordance with the provisions of Ti T LE' j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated----------......................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUIED AS A GVARANTEE THAT THE
SYSTEM WILL FUJ CT ON SATISFACTORY.
DATE ........ Inspector -------------------•----
THE COMMONWEALTH OF MASSAC SETTS
i
BOAI�t OF HEA!,,T�kl
No.e; ........... FEE.........................
Movaasa1 Wore Tangtrnrtion ramit
Permission is reby granted----- " .ice:. ; -= 1 j" ......................................
to Construct (I-�or Repair ( ) an Individual Sewap Disposal Sys em
at No.......�. -j--------.---6 - ,,4 `=---�e- !_*i / �_ • P.�,r Y� ¢lj�' 't�� ' `� � � ''
Street ��.�
as shown on the application for Disposal Works Construction Permit No ...._.PoarM
D�te ..-. ...0 ..... ..
f •..............•----•---•-----•. .•.--- . ... . . ---...DATE.--------•-----1�._.-do.......rN...................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
VAL
I
No........................ Fxa..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
---- -------1EJ------.
ApplirFatiou for Disposal Works Tonstrnrtion rumit
Application is hereby made for a Permit to Construct (V ) or Repair ( ) an Individual Sewage Disposal
System at:
Location•Address or Lot No.
....--------•-------••-•••_..... ...... ........ ... •. -- ....... ................
caner W.. R Address
a C.:. �'! :?J✓� !! ........... ....... ----------------
Installer Address
d Type of Building �. Size ........Sq. feet
Dwelling—No. of Bedrooms.._....f.................................Expansion Attic ( ) Garbage Grinder ( i
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria ((''
t� Other fixtu s -----•--•-------------------•--- .
W Design Flow..............'?_ ......................gallons per person per day. Total daily flow........... �1.L�.................gallons.
WSeptic Tank—Liquid capacity!A'.v _.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. '`7....sq. ft.
Z Other Distribution box (✓) Dosing tank ( )
Percolation Test Results Performed by-tad_-- -CL« __ _._ `Z.!�E..�.................... Date._.._i.U._�.�r�J..`� _..
Test Pit No. 1....G'�___minutes per inch Depth of Test Pit....1.;�:-......... Depth to ground water--------"...........
Lt, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •---••----------------------•-----------•-------•-------....---....--•-•••-••--•-----------------------...........----------••.......--•---............-•---
O Description of Soil........=� z ��_ s s .? 4.1_-l•_.: : ...........:� -�-------�'--�=--r..-v-��--.................
-----------------------------------------------------------------------•-••---------------------•-••---------------------•-•------------------------•-----------•--------------------------•---...-•----
U Nature of Repairs or Alterations—Answer when applicable._..............................................................................................
------•---------•-------------------------------------•-----------•---- .......................................................-......................................................................
Agreement:
The under F, 'agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the rovisions of 1 ! 5 of the.State Sanitary Cade— The u ersigned further agrees not to place the system in
operation ertificate of Compliance has b nod b}�,t e b of health.
�f
/ /r r ... . o .mot.----"'"��•^'•- �/ j
Signed �..�_.. fit'_.._..- - •--3:.._.:G�------------------------------•---•--- ----� •----ate,- -•-s�r�-
iApplication Approved BY . ........................... ........�- -------
Date
Application Disapproved for the f o lowing reasons: -------•------
---•-••-----••••-•------•.......................................................................................---•--•-------•------ --------•------------------------•••---------------•-••--------
Date
PermitNo--------------------------------------------------------- Issued........................................................
Date
TOWN OF BARNSTABLE
LOCATI ? SEWAGE # �
tiILLAGE f0le,110s-I% ASSESSOR'S MAP & LOT G
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) �' C�_J (size) k/Q
NO. OF BEDROOMS �, PRIVATE WELL R PUBLI�WAf-E—�R---3
BUILDER OklWN
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
�yi ���� �
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Py � s
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' SITE PLAN SHEET l OF 2
SCALE: l = Zo'
Wl 9AM
g �q� R.
GALA L Pik
........._.
(41
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-57
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L�Li�'��aisscJ �
RE6/STEREO L ANO SURVEYOR FOR-L� ' L ' =1.-L,
lrc7-r l03e;l 07 G - GI4C-g-f Z L2
ZONE G �' m A,s
PLAN REF. DATE 1-2 4 o!f
BENCH MARK DATUM ��h �M b WM. M. WARWICK 8 ASSOC., INC.
DOMESTIC WATER SOURCE-fin w '� �` 80X 80/ - NOR TH FA L MOUTH
FLOOD.ZONE. 17 MASS. 02556 - (6/7) 563 -2638
LEACHING DASIN SECTION NOT TO SCALE sheet
24"C.I.MH COVER
EARTH F/LL BRICK AND MORTAR COURSES AS REOD• TO BRING
COVER TO GRADE
4 -� B'FLOW LINE
INLET _� _ _— __: s �" 2'�- I/8"TO% WASHED PEA STONE FREE OF/R0NS,
PIPE T FINES AND DUST IN PLACE
OPENING WITH 4%g" 114�" TO I/2 WASHED CRUSHED STONE FREE OF
�� : ; ��• ' OUTER DIAMETER IRONS, FINES AND DUST /N PLACE
AND l3/4",INS/DE
DIAMETER 1. CONCRETE TO BE 4000 PSI 28 DAYS
2. REINFORCED WITH 6%6" NO. 6 GA. W.W.M.
y 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR
\" GREATER DEPTH REQUIREMENTS
40•- I--- �► — 6'0' 1 �j --� 4. NUMBER OF PITS REQUIRED aOt
MIN. I 12 EFFECTIVE DIAMETER NOTE: EXCAVATE TO ELEVATION41. � OR
(NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL
WArER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE
EXCAVATED MATERIAL WITH CLEAN
TYPICAL PROF/LE GRAVEL TO DESIGNED GRADE.
/8"STD. LT. WGT. al.MH COVER
4"C./.PIPE 4"'B/T FIBER PIPE
TIGHT JOINT OUTLET LEVEL
i DWELLING _ FLOW_L/N£ _ TO FIRST JOINT
/0 /4 9 b 00 110 00 11
C.I. TEE gQj,3 I 1 10 1 0 0 1 1
' III 000 00 1 1 I I_
'STD. PRECAST CONC. D/ST. BOX TO BE I f 0 0 0 O 0 1 1 I I .
UdGAL.SEPTIC TANK. INSTALLED ON LEVEL, �� I I 1 100 00 0 1 I I
STABLE BASE 1 1 1 000 00 0,1 I
.. 111100 0011 � 1
\SEPTIC TANK TO BE 1 11 0 0 0 00 1 1 I ;
INSTALLED ON LEVEL I I 1 100,00 1 1 ' '
STABLE BASE. ; 1 114 00 00 Q 1 I
LEACHING BASIN i 11 1 O I 0 0 0
L
BASE TO BE LEVEL I 11 S 0 00 1 1
SOIL AND PERC. DATA
PERC. RATE � `'_-7 MIN. /IN.
011 TEST PIT NO. P TEST PIT NO. 2
.TEST BY : •ice izy�� 1-�-�I�� Z' �'"t' h�t�5d 1�,.
�0r-j 6. 1 p�IZ r> 5" S�rJC7 �r-Au�L
WITNESSED. BY� .
TEST PIT GR. EL.
DATE: l o z -2
tVa (a{�•�17.�JA•T� grl•� .
DESIGN DATA GENERAL NOTES
BEDROOMS 3 NO HEAVY EQUIPMENT TO RUN OVER SYSTEM.
DISPOSAL N SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD
EST. TOTAL DAILY EFFLt3�GPD• PRECAST REINFORCED CONCRETE UNITS.
SEPTIC TANK. GAL, ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE,
SIDEWALL AREA 2'�'GAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF
BOTTOM AREA � 'a' GAL./SQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY I , 1977.
LEACHING REQUIRED Zdo SQ,FT,. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
ACTUAL LEACHING AREA OF HEALTH.
Z Q:FT ..AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE
BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
PITCH ALL SEWER LINES I/411 / FT. UNLESS. INDICATED OTHERWISE,
s"°� SEWAGE DISPOSA L SYS TEM
MARTIN G
E. r, FOR' L 1'%t'� iL 5 o L t✓v V J Z
MORAN v"►, VOT (c 3 �jYGt�Jp Gjzo��C E -p 123417�Q �
`i �o,��crs•r��` `��" G�r.�"r�i1Z-y� I�l�.� M h� h5
�Sorrnt
a SCALE AS INDICATED DATE l 1 -2
WM. M. WARWICK 8 ASSOC., INC.
80X 801 - -NORTH FAL MOUTH
` MASS. 02556 - (617) 565 -2638
PROFESSIONAL ENGINEER
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cgertifi ate of Cgomplianre
THIS IS TO CERTIFY, That-tbe Individual Sewage Disposal System constructed ( ) or Repaired (� )
----by ------------------ ------
--------------------------
at _...........................---------------------._._------._.Sc�----------- --- i.Jp-------------�'L_c1 G`-F�---....��-----�------- ----.� .---------
has been installed in accordance with the provisions of TITLE S f The State Environmental Code as described in
the application for Disposal Works Construction Permit Now . .... - ._ datedr'�.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
f
DATE---------- /.........'w. -f_....!r" .------- ----- ............ . Inspect r ._. ............ - -------.......... ....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No...e...............•-- FEE
Permission is hereby granted....................... G-t'...................... '-`-.'�
-------------------------------------------------
to Construct ( ) or Repair ,an Individual Sewage Disposal System �.
r
at No.- -� f 1... . ' �..._....�`�
Street .
as shown on the application for Disposal Works Construction Permit N� _.... Dated. �f�-_"". / " ��
Board of Health !
DATE------' .... Board
-..........------------...
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS
-�Q
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Ditivotial lVurkr ( outitrurtinrt Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (�4 an Individual Sewage Disposal
System at
f_.-Jo C
.------..� -......--•. .........-•........--•••-�.. ���-�... C .._.. f.,tE.... ...
Location-Address r Lot No.
a
�,/�— vner �"�C//✓/ CJ 1-U 1> Address
.....installer
� A dress
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.___-------.�-----------------------Expansion Attic ( ) Garbage Grinder AJO
aOther—Type of Building ---------------------------- No. of persons.-..-________-____--_-.---.. Showers ( ) — Cafeteria ( )
dOther fixtures --------------- -------------------------------------------------
W Design Flow................... _.__........gallons per person per day. Total daily flow.............. .0.................
Septic Tank—Liquid capacity/ q---gallons Length________________ Width---------------- Diameter......---------- Depth................
W Disposal Trench—No. .................... Width-------------------- Total Length----.-___--r....... Total leaching area....................sq. ft.
3 Seepage Pit No------------- ..... Diameter._.._._ 0.._.... Depth below inlet..._............ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by--------- --------------------------------............................... Date........................................
a
Test Pit No. I--_.___.-_--__-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-.----_.----____.---_--.
9 ----•.......................•----•-•--••--•---•------•---------•-•-----••-•-----•••••----•----•.....................-•---•------•................•••--.-•---
0 Description of Soil........................................................................................................................................................................
x
W
x ...................
U Nature of Repairs or Alterations Answer when applicable.---.-._. .Q__.._.�..._._._.__lot�0.. ._.. ........_.
.......... V... -•' .....�7Z�.J�'........�........... £........���6_T�� ...............
Agreement:
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 Compliance ha een is u ?b,,yhe board of health.
Signed - - ............ .-- . 1����9..y......
Application Approved BY -'=o..- = .. : � ....... '... ` ° -G(1 Date
Application Disapproved for the following reafons- ------------------------------------------------ ----------------- ............... . ........... ..........
Permit No. .1..... .. .,'` .. Issued ..........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Alipfiratiott for Bi-wipwial Workn Tonofrnr#inn rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal
System at:
.........5F.- - �.�Jo /Lej c�_
.............�--------------------.......------_....' _ 1 C- ..W. � r✓Lv t. ��
Location-Address or Lot No.
-f�4 /LAG�.l 14XCGA'� /�b . L '.�.
----------------- --•-------------------------------•----.-•--- -------------------------------------------•--•-------••--•--•-----•----•-•--•-•--••••-••.........
Owner Address
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� Installer Address
UType of Building Size Lot............................Sq. feet
t-, Dwelling— No. of Bedrooms.............---_--....._.-._-_-..-.--..Expansion Attic ( ) Garbage Grinder (-r' N4
aOther—Type of Building ---------------------------- No. of persons.-.--_.----_--_---_--_.---- Showers ( ) — Cafeteria ( )
Other fixtures ---------------------------------------
Design Flow................... ............gallons per person per day. Total daily flow..............
v~'3 ......_.-_.......gallons.
WSeptic Tank—Liquid capacity/uov---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..----------------....---------------...
a
Test Pit No. I................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.............--.........
9 ------------------------•-----------...............---•--•-•-•-..........-------•-------------------.........................................----------------
O Description of Soil-------------------------------------------------------------•-------------------------.------......-•---------------------------------------•-•--------.......--------
W
U
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x ---------------------- ------------------------------------- -------------------------------- -------------------------------------------------•-------•---------- --------- -------.
U Nature of Repairs or Alterations—Answer when applicable....-.-.1.--"D ------ .....-_...../C�o. �,6- ...P. /I
.. S:U„..�---------�-............ .....1. `� .5."i�/�1�. �.�.- ✓
Agreement:
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 Compliance has,been is u/ed by the board of health.
Signed (... `✓a-. .... GfGI.....� ...
Day.
Application Approved B .._...
1 Dare
Application Disapproved for the following reasons- -------------------------------------------------------------------
.................... ...................................`....................................................................................... .. ................--------------- ........................................
Permit No. .7.... L .-✓...,4..... � .. Issued ----------- '.'�`..-;W� 7. � .....
Date
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0CATION qQ SEWAGE PERMIT NO.
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VILLAGE
I`NSTA LLER'S NAME i ADDRESS
ILAW
S U I L D E R OR OWNER
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DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED /4L
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6/15/2021 ShowAsbuilt(1700x2800)
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SEWAGE
VILLAGE 211E ASSESSOR'S
MAP&LOT/L/,-/e,C
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY ldDO Q//l `d/7
LEACHING FACILITY:(type) ">1 C�J (size)
NO.OF BEDROOMS PRIVATE WELL CR PUBLIC WA ER
BUILDER OtL/21PC/
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED; ^' l
VARIANCE GRANTED: Yes No
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MINI�
https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=170135&sq=1 1/1
SYSTEM PROFILE MARKED WITHCMAGNETICTTAPSHALLE OR BE NOTES
(NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING °�� r �\ o TOP FOUND. EL. 54.5' FILTER FABRIC OVER STONE p
3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. v r
EKE MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 52.5' C� a
PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST
RISERS (TYP.) MIN. 2" WALL THICKNESS PRECAST RISERS UNITS TO BE AASHO H-M �° o
52.5' 41OSCH40 PVC MORTAR ALL
PIPES LEVEL 1ST 2' COMPONENTS INVERT IN 48.67'
.: �4 (nP) 4, 5. PIPE JOINTS TO BE MADE WATERTIGHT.
i` ENDS SIDES 5' e�
6 C
10" EXISTING 14" J--o-o
IN ACCORDANCE_ NSTRUCT ON DET LS TO B �
0 I AI E � �e�TEE SEPTIC TANK** TEE ° �®® �O�® ®®®® ®®® WITH 310 CMR 15.000TITLE 5.) `51.17t'* o 0 o 0 o 6., MIN. SUMP
00o0o0o0o0oo °+0000°0°0,°,00 12" MIN. INT. DIM. �o° �®®®®®�®�® ®®®®®®®®®®® °0000000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 5e Locus
GAS BAFFLE NOT TO BE USED FOR LOT LINE STAKING OR ANY49.29' 49.12' 46.67' c°°°° °°°
OTHER PURPOSE. �� n
}
H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. r
3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED
6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' 9. COMPONENTS NOT TO BE BACKFILLED OR
COMPACTION. (15.221 [2])
CONCEALED WITHOUT INSPECTION BY BOARD OF
4 % SLOPE 4.5 HEALTH AND PERMISSION OBTAINED FROM BOARD o�{e 28
( ) ( % SLOPE) OF HEALTH.
R
FOUNDATION EXIST. SEPTIC TANK 47' D' BOX 12' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
FACILITY CALLING 33) AND
VERIFYING ITHE LOCATION OF ALL GSAFE 2UNDERGROUND & LOCUS MAP
41.3' BOTTOM TH-1 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
*THE INSTALLER SHALL VERIFY THE **INSTALLER SHALL CONFIRM MINIMUM • NO GROUNDWATER FOUND WORK. SCALE 1"=2000'f
LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK SIZE AT 1000 GALLONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 170 PARCEL 135
BUILDING SEWER OUTLETS AND AND ITS SUITABILITY FOR RE-USE. BE REMOVED BENEATH AND 5' AROUND THE
ELEVATIONS PRIOR TO INSTALLING ANY REPLACE WITH 1500 GALLON SEPTIC PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X
PORTION OF SEPTIC SYSTEM TANK APPROPRIATE TO SITE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS
CONDITIONS IF NOT SUITABLE AND REMOVED OR PUMPED AND FILLED WITH CLEAN SHOWN ON COMMUNITY PANEL #25001CO561J
LE
(, D SAND. DATED 7/16/2014
99— EXISTING CONTOUR SITE IS LOCATED IN A STATE ZONE II
X 99.1 EXIST. SPOT ELEV. SITE 1S LOCATED IN THE GROUNDWATER
—[99]— PROPOSED CONTOUR
PROTECTION OVERLAY DISTRICT
198.4] PROPOSED SPOT EL. � _ /
SITE IS LOCATED IN THE SALTWATER
TH1
ESTUARY OVERLAY DISTRICT
BENCHMARK:
TEST "0LE BOUND DISC SYSTEM DESIGN:
SLOPE OF GROUND =52.8' NAVD88 54
UTILITY POLE
GARBAGE DISPOSER IS NOT ALLOWED
FIRE HYDRANT
Yo 196.1-0 c ,� �� EXISTING 3, BEDROOM DWELLING
y N87"44'
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING O \ DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD
S3--� USE A 330 GPD DESIGN FLOW
1 � 53
TEST HOLE LOGS f G LOT 638 SEPTIC TANK: 330 GPD (2) = 660
J - �G G G _ / / 16,411t S.F. **RE—USE EXISTING 1000 GAL. SEPTIC TANK
ENGINEER: CRAIG J. FERRARI, SE #13871 Z G. w� LEACHING:
WITNESS: DAVE STANTON p w/ SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD
J ( w o
DATE: 8/9/21 ` , EXISTING ( 1 D N BOTTOM 25 x 12.83 (.74) = 237 GPD
PERC. RATE _ < 2 MIN/INCH s D DOW�LLIN54.5' �� I N of TOTAL: 472 S.F. 349 GPD
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CLASS I SOILS P# 21 —208 n00 47 8' TH2 Z USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
1 ELEV. z ELEV. 0 \0 , WITH 4 STONE ALL AROUND
p" 52.3' 0„ 52.5, <r , // DEC ��----- -----� LP)
A Q600 p o N
LS LS GRAVEL 53 TH1
go, 1 OYR 3/2 6" 1 OYR 3/2 , DRIVE k, 1 '' 22.0' APPROVED DATE BOARD OF HEALTH MA
e SHED B 0
LS LS TITLE 5 SITE PLAN
„ 10YR 6/8 10YR 6/8
No '09'49"E c OF
36 49.3 30" 50.0' S2 8.78 .�� ,� ,
OF :s� �NOFMA �/��l 92 ZENO CROCKER RD.
DANIELA cy� �0`1� DANIEL yes , CENTERVILLE MA
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OjALA
C C CIVIL cm OJALA
PERC �No.46502 No.409£30 PREPARED FOR
Fsc ` '. d OFE S
f� �� �s BORTOLOTTI CONSTRUCTION
MS MS
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DA."� =L + DATE: AUGUST 10, 2021
2.5Y 7/4 2.5Y 7/4 'zv o
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�f ROW# cope eagiaeering Inc.
132" 41.3' 120" 42.5' �
0 civil engineers
NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' � 1 P 0o land surveyors
939 Main Street ( Rte 6A)
LICE #2 1 -246 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
21-246 BORTOLOTTI-KEN NEY.DWG
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