HomeMy WebLinkAbout0034 QUISSET ROAD - Health 34.Quisset L_ane
'�,A VI(�I S
�k= 250 128
r
a;
I
�I
I
F
TOWN OF BARNSTABLE f`
t l e _: ►20 SEWAGE #
L(JEATION
�: s� J
VI,,L,;AGE I� �nw✓S Celv'ief 7l ASSESSOR'S MAP & LOT / )_a
INSTALLER'S NAME&PHONE NO. 020'� a XR
1 SEPTIC TANK CAPACITY 1600 P-Las.rtc_
LEACHING FACILITY: (type) ��, ' � 1' i►�Fr�-' 4^t(size) • S k' t k I a 1
NO.OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: lagfo`q COMPLIANCE DATE: 1. _
Separation Distance Between the:
Maximum Adjusted,Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
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
. s
Furnished by
e
Z-'s T>
ul VI 5
i
i
i
I C C
El
Town of Barnstable P#_ 2 33 i-q
' Department of Regulatory Services
,,,ar,UMBLM i Public Health Division Date Jc -
'e"ss. `
D a�� 200 Main Street,Hyannis MA 02601
Date Scheduled p Time Fee Pd.
Soil Suitability Assessment for Se e Disposal
Performed B : S uf�/`'w,
Y / - Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address /,�U/ -�F D Owner's Name
Address .54 A4 Erg
Assessor's Map/Parcel: ZS-p 2 Q Engineer's Name �S�
NEW CONSTRUCTION REPAIR(/ - t Telephone# --5 2 �. 8
3G
Land Use LCLJ�/ �lCi/ Slopes(9b)_ �(�• Surface Stones /Iwe ( /
Distances from: Open Water Body ft 'Possible Wet Area 11eA—ft ,Drinking Water Well'
�� r
Drainage Way N1#4 A Property Line = ' ft Other ' ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
J �
�4r
�G
ti
Parent material(geologic) � �`�'"� Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater > �2/
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: ----1� In. Depth to soil mottles: -.._,In.
Depth to weeping from side of obs.hole: In. Groundwater Adjustment JUiLl ft.
Index Well# Reading Date:\_ Index Well level Adj.factor ,m�`AdJ.Groundwater Level,,
PERCOLATION TEST Date '7-� nme �2d1_19
Observation 9
Hole# / Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ / ' 03 Time(9"-6")
End Pre-soak v ` Z 4Gk4Q IA 1
Rate Min./Inch nil.
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTICVERCFORM.DOC
t
r I '
DEEP-OBSERVATION HOLE LOG Hole#.�_1(
Depth from Soil Horizon Soil Texture .Sdil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency,%Graven
lo
DEEP OBSERVATION HOLE LOG Hole# GS 7
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency.%Grave
ZV
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders.
Consistency.
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes
Within 500 year boundary No L/ Yes
Within 100 year flood boundary No k yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area Iproposed for the soil absorption system?
If not,what is the depth of naturally occurring per ious material?
Certification
I certify t o tha 1 (date)I have passed the soil evaluator examination approved by the
Department of nvironmental Protection and that the above analysis was performed by me consistent with .
the required tr ' ' g,a ertis enence described in 310 CMR 15.017.
Signature Date
Q.%SEPTl0PERCFORM.DOC
�� a0
No
( 1��`�� 3ZK V� Fee OO-
THE COMMONWEALTH OF MASSACHUSETTS. Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTA�3.LEa MASSACHUSETTS
ZippYication for Miopool *pgtem or,gtruct11Qn Permit
Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) 0 Complete System . El Individual Components
Location Address or Lot No.3 4 Q U c sJ•e(�- 20 i Owner's Name,Address and Tel.'No. (�q 775-3.3,?6
Assessor's Map/Parcel 4 f.Pq n m'i'S 3 4 du 14S e- &dJ (� ►J/1/l�1( �vl-�l
SO- I
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -3Co lg
1 t 1►'S 63 W1 F4 3 S 114 l /? `—o /.0" 12;9
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other T+pe of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow LA S { gallons per day.M daily flow 3Q gallons.
Plan Date FF2&I71 Number of sheets 0- Revision Date ' r /0/I/
Title
Size of Septic Tank IK00 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) UP in
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 b is Board o ealth .0 _
Signed Date
Application Approved by Date b 2
Application Disapproved the following reasons
Permit No. Zot 1 3 6.;' Date Issued /b1ZKlL01 1
0 U,
No. 0011
Fee «�
` —rt;HE COMMONWEALTH=OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION,!+TOWN OF BARNSTAB.,LY MASSACHUSETTS
s Zippficatiott for,0�' pooal *potem Con0truction Permit
Application for a Permit to Coonst ct( . )Repair( Agrade( )Abandon( ) ❑Complete System F Individual Components
# Location Address or Lot No. .,I 1 / v;SC �UQ Owner's Name,Address and Tel.No. n R t 1 Y� 775—33.7(p
Assessor's Map/Parcel R�q n v%�S
Installer's Name,Address,and Tel.No. S&or 3W- Gal 7 Designer's Name,Address and Tel.No.
12;1
!r r p i . k4 n-.°n d_ /1-M 1ri
Type of Building:
Dwelling No.of Bedrooms Lot Size\ sq.ft. Garbage Grinder( )
Other Type of Building d No. of Per ns Showers( ) Cafeteria
Other Fixtures ti
y' Design Flow LAS q _ gallons per da Cply flow 3 3 gallons.
Plan Date alo ra it t IA 0J Number of sheets Revision Date.. .C2/*14�
Title
Size of Septic Tank 1sfdCr3nty/` Type of S.A.S.
`Description'°of Soil, C:49,e
Nature of Repairs or Alterations(Answer when_applicable) �� , f,r ¢ P I v,
,r
4.
� J
Date.last inspected: .
r
�. Agreement:
The undersigned agrees to ensure the con`st ction 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 y;h46oard i;f ea H:•
Signed - Date
Application Approved by —Date 1/4 2_4'
Application Disapproved for a followin asons
Permit No. ant I — ate[ Date Issued 4pj4z6 —tad
a
THE COMMONWEALTH OFIMASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate�of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired( )Upgraded( )
Abandoned( )by ` A
has been constructed in accordance
with the provisions of Title 5 and the f r Disposal SystedConstruction-Permit o dated /o /�,TH
Installer PI C ; Designer
The issuance of this permi•sh 11 not be construed as a guarantee that th y ern n ion as designed.
Date a / Inspecto
No. / v^ , Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Wi5pozat *pgtem Contruction permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at 310 n
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 threee years of the date of this
permit-2
Date: ID Z(o IZO I 1 Approved by / �L
/_iL/
Town of Barnstable
Regulatory Services
�. Thomas F. Geiler,Director
NAM = Public Health Division
16 9. `� Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: — Sewage Permit#a01 I- 34oS Assessor's Map/Parcel 2d
Installer&Designer Certification Form
Designer: ��s SUS V�� tiC, Installer: [j 4&S
�1 ) n.,.
Address: T 4�.� �µ�; "' Address:
SEA NnWle.1-1 v1_ d (o'3
On R(p- 9,0 k 1 6,(--i S 616Zv S, C0r4�? was issued a permit to install a
(date) (installer)
septic system at QW135elt based on a design drawn by
(address)
0-rl-05-4 I p C , dated 10 (o -- a,o t ( .
(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. Stripout (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 R tions. Plan revision or
certified as-built by designer to follow. Stripout(if req ' map", cted and the soils
were found satisfactory. S�`c
DAVID yes
D. °=
FI.AHERTY, JR. in '
(Installer's Signature) No. 1211
r t 9F �10
SANI7AR\P�
(Designer's Signatur (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.
gAoffice forms\designercertificauon form.doc
DO•_: 1 s 17b s 145 10-24-2011 10:32
BARNSTABLE LAND COURT REGISTRY
DEED RESTRICTION
Whereas, Bradley J. Bailey, of 34 Quisset Road, Centerville, Massachusetts 02632, is the
being the owner of Lot 37, as shown on Land Court Plan No. 40592-C (Sheet 1), located at 34
Quisset Road, Centerville, Massachusetts (hereinafter, the "Lot"); and
Whereas, Bradley J. Bailey, as the owner of the Lot has agreed with the Town of
Barnstable Board of Health to a restriction as to the number of bedrooms which can be included
in any home built on the Lot as a pre-condition to obtaining a disposal works construction permit
in compliance with 310 CMR 15.000, State Environmental Code, Title V, Minimum
Requirements for the Subsurface Disposal of Sanitary Sewage; and
Whereas, the Town of Barnstable Board of Health, as a pre-condition to granting a
disposal works construction permit for a septic system in compliance with 310 CMR 15.200,
State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of
Sanitary Sewage, is requiring that the agreement for the restriction on the number of bedrooms in
any house constructed on the Lot be put on recorded with the Barnstable County Registry of
Deeds and/or the Barnstable Registry District of the Land Court, as applicable, by recording this
document.
Now, therefore, Bradley J. Bailey, does hereby place and impose the following restriction
upon the Lot in accordance with his agreement with the Town of Barnstable Board of Health,
which said restriction shall run with the land and be binding upon all successors in title:
The dwelling constructed upon the Lot shall contain no more than three (3) bedrooms
unless and until it is connected to the municipal sewer or the Board of Health of the Town of
Barnstable permits otherwise.
Property Address: 34 Quisset Road, Centerville, Massachusetts
For title, see Certificate of Title No. 114755.
Executed as a sealed instrument this2-Y day of October, 2011.
f �
ey J. Ba' e
COMMONWEALTH OF MASSACHUSETTS
Barnstable, ss:
On this 24th day of October, 2011 before me, the undersigned notary public, personally
appeared Bradley J. Bailey,personally known to me,to be the person whose name is signed on
the preceding or attached document, and acknowledged to me that he signed it voluntarily and
for its stated purpose,
Helen C. Grang
Notary Public
My commission expires: January 3, 2014
HELEN C.GRANGER
Notary Public
My Commission Expires January 3,20i4
Commonwealth of Massachusetts
6ARNSTASLE COUNTY .
REGISTRY OF DEEDS
ATR--U-�E COPY,ATTEST
JOHN F.MEADE,REGISTER
SARNSTASLE REGISTRY OF
DEEDS
TOWN OF BARNSTABLE
SEWAGE # ®� 7 S ®
ASSESSOR'S MAP & LOT '�`�
INSTALLER'S NAME&PHONE NO. ICJ 16 f4b:!r1`e d Cc 64- -A 64 6
SEPTIC TANK CAPACITY 150 o P �
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNERt5d-CI -41 ►� �`
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
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
�ucs��rr
i
(� 1
v - � 4 i 1 ,.
- IT '
No. Fee
\/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTSYe
Application for �Dtopaal �&potem Con0truction Vermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. % LL/ � Own is Name,Address,and Tel.
Assessor's Map/Parcel t�3 44�/�
Ins�taller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
GoA/5�
ti
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (/00
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets� / Revision Da
Title A"J;/ 4—s J
Size of Septic Tank Type of S.A.S.
s
Descri tion of Soil
/ rn
Nature of Repairs or Alterations(Answer when applicable) 49 k7lC_flZ�ij,
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 de and not to place the system in operation until a Certificate of
Compliance has been issued�yqhis Boar ealth.
Sign Date
Application Approved by Date
Application Disapproved by: Date
for the following reasons
...
Permit No. Date Issued
0 t . No. Fee D'
1 - Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS A Ye
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplicatton for Ote;pozal *- pgtem COon�-tructton 3permtt
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ❑.Complete System ❑Individual Components
i
f Location Address or Lot No.341( /f� f Owner's Name,Address;and Tel N
/�.4 , ,ft •�/L��/4��-.(�i9iefG ,�i�!
Assessor's Map/Parcel /� 'T�t//s$ef ��'t✓�%L I
Installer's Name,Address,and Tel.No. -,-b y' `13 Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (/00 j
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures.,
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Re/vision Date-
Title A4 OLIJ L 11-H .7
Size of Septic Tank 7 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) "k s/'
Rs
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
y accordance with the provisions of Title 5 of the Environmental C de and not to place the system in operation until a Certificate of
t Compliance has been issued -this Board ealth. -..
Signed_ ' J I-) Date j.
Application Approved by ��( Date IaAjo It
V
Application Disapproved by: ' " / '` Date
"forwthe following reasons .
Permit No. —' _ Date Issued
————————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS �I
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage
Disposal System Constructed ( )'"Repaired (/Upgraded ( )
Abandoned( )by ij
/�/SS a L-oy ' C�IJ-�✓ I� Ltd has been constr cted in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer /v 2-359,y 1 . Lso Designer
#bedrooms Approved design-flow gpd
The issuance of this permit shall/not be,
constr-edjas a guarantee that the system will function as desr ned.
Date /v`�'//�� J Inspector "� t
r
--------------------------------------------
No.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
=t5pont *p!gtem Cp4tructton permit
Permission is hereby granted to Construct ( ) ,Repair (tom ) Upgrade ( ) Abandon ( )
System located at � �`✓i Js� E .r...,V Z_,
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Constructibn must be completed within three years of the date of this p
Date �� t Approved by
f
r i
t� Cb
Tl-
O J
c
00
N �O
V
ro
.�39
z
f
Jt
s.....:..1'5.............
THE COMMONWEALTH OF MASSACHU5ETTS
BOAR® OF HEALTH
-74_2.44�•?................OF.......
/. �-n..3: ,�1.�......._..
App irFatiura for Uiupug ai Workii Tuaautrurtivat ramit
Application is hereby made for a Permit to Construct (Vol,or Repair ( ) an Individual Sewage Disposal
System at:
4® ..----- ..... r.. ' ?®c;c/_ C p��rr!!./lie._.�`. Q��......1!! r ._..._.
Location-Addre orL t No.
......... .....
�% Owner -LL �� �• Address
• c _T� �l.��! _...4,e.� Czd!! / 5,----•......................................
Installer Address
UType of Building Size Lot..... ...Sq. feet
Dwelling—No. of Bedrooms...................—J5_......................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers
a YP g ----•----------------------- P {--->--- Cafeteria.(.....).
Other fixtures ---------------------------
W Design Flow................... ................gallons per person per day. Total daily flow................ ...............gallons.
fYi Septic Tank—Liquid capacity./A _.�gallons Length__ i/i...._ Width................ Diameter---------------- Depth................
W Disposal Trench—'No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No........./......... Diameter.... Depth below inlet.... Total leaching area. �q. ft.
Z Other Distribution box (✓5 Dosing tank ( )
'—' Percolation Test Results Performed by-/3/-y .1 ��.�rJ lt1 v f� ate.... �, ----------------
Test Pit No. 1...�.Z.....minutes per inch Depth of Test Pit.......AL...... Depth to ground water...Ale.z,?,=---.
4, R1,71A0 Test Pit No. 2'...<2..._minutes per inch Depth of Test Pit.......1:?.------- Depth to ground water......./0t2JCnL_._.
a+ :• ----------------•---- r.............
i i .-/
O Description of Soil..............a 3�...l.��P.. � a! .� f3.- lL 'c rs -^ 'raw C
x
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 f-M,U4, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
ed.........::.......................•-•--------•------------•--•----....._•--- -----• .......... D e
ApplicationApproved .... . . .............................................................. ---- .__.._
Date
Application Disapprove r t following reasons: -------------••-----------••----------------------------------................................................
..................................................•---------...-----------•--•--------...--••--------....•------------•.....-----•-•-----------•--•--•------•-•----------•----•-•----•--•--•-•-------_..
Date.
PermitNo......................................................... Issued........................................................
Date
1 ' �
ti rr��
No.d..:�......` ! FEs..... ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
:.... ... :'..'.................OF.......1- - -7 -.................................f/-'-
......................................
Alip iratiun for %iVuottl Workii Tonotrurtiun rrrntit
Application is hereby made for a Permit to Construct (li) or Repair ( ) an Individual Sewage Disposal
System at:
'
T-
_-� ,:UJ 5. T rI cr>r l
........._: --.--.- ------------------------------------ ...................................................... ..... • .........----
Location-Address r 1 _or Lot No.{
l f i t ;er . l L_....� ..............._ �ji / �� .....f">�.. .. . �s .
/ Owner �, i � Address `
a _%3r� y i l/� l`.' 7 C.J. !�f`' _.':::...---._..l���` .............
' Installer Address
Q Q Type of Building y Size Lot----- '_�..3....Sq. feet
Dwelling—No. of Bedrooms.................J.......__....._.......Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g ---------------•------------ P ( ) — Cafeteria ( )
dOther fixtures ------------------------------------•-••----•• ------.-•--•-••---•-•-----•-•---------•-------••----•-----------••-----•• ...........
W Design Flow....................................._.._..gallons per person per day. Total daily flow..............._ __)......._........gallons.
WSeptic Tank—Liquid capacity�2'2.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 ft.
Z Other Distribution box (_/) Dosing tank ( ) /
'-' Percolation Test Results Performed by. ` � =�..�r-=��1....?:� �. 'a"-f:c.r� date..._. _ 1_:'"3................
Pli37 Test Pit No. 1...: _ .....minutes per inch Depth of Test Pit....... ........ Depth to ground water.._
Test Pit No. 2--- ....minutes per inch Depth of Test Pit.......Z.2=... Depth to ground
a .......•...................................................
......
.----------------------------------
---•--•-•-----------•-----------•--------------•---------
D Description of Soil............j`
x
- `` -5a,/ _ = Z-- - -= = - - -�-•'.-•o-•--v_..a...W ••---• --------------------•-----•-•----•--•--•-••------------------------------------••--•-•••-•-•----------------------------------••-•-----------•-••••--•-----•--••------------••......-•----.-•---
U Nature of Repairs or Alterations--Answer when applicable._..................:...........................................................................
-------••--------------------------•------------•-----------------------------------.............-------•-----••---••-------------•-••------••---•-••-•-•-•--............_..................._..•-•---••
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Ti L
p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
ned----.. ••-•----•------•-----------•---------------------------•--....-•---------• ......... '.._,r ...
�-` D,e'`sje
Application Approved II` '`" = r��? .--------------
Date
Application Disapprove 6r t following reasons: -'--------------------------•-----------•-•------------------------------•----
..................................................•----------.......---....-•--••-----.......-----------
g Date
Permit No......................................................... Issued-.....................................................
-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................:......................O F.....................................................................................
(grrtifiratr of fgontlifianrr
/51
T� �O CERTIFY, That the Individual Sewage Disposal System constructed 4,,ror Repaired ( )
by . .....................................
Installer
at-7. ... .... 4r,7,2),L&4i, .............................................................................................................
has been stalled in accordance with the provisions of TITLE j of The State Sanitary Code s d cribed in the
application for Disposal Works Construction Permit No. 0-_ij- ?/............ dated--_ ..................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WIL U CTION SATISFACTORY.
DATE......
../.3,: /. Inspector........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF..................................................................................... D
No... ..��..... FEE...- ..............
iopoot W."- anti#
Permission is hereby granted...... d' .. ....................
to Construct ( . a air ( an Ind iv' w ge Disposal System
---------- •... ..................
Street
as show on the appli tion for Disposal Works Construction Permit No..................... !' f---------------
-- -- .---'--------------------------------------------
B'ar�f Health
DATA-----�- --,r�----•• ---•------------------------------------------•--
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �. 3
LOCUS DATA - - - - - - - - - - - - / � LOT
. . .. - i P�
OWNER BRADLEY BAI
LEY OPO I 36 -aZ
QUISSET ROAD N
NANCY BAILEY
QUISSET ? LOCUS
PLAN REFERENCE LC 40592-C
y v
DEED REFERENCE CTF 114755
ZONING DISTRICT RD-1LR 52.21 7 1 28
_ 1
OVERLAY DIST. WP-ZONE II / \ \\ 1 i 4ro,2 I LOCUS MAP
CONCRETE BENCHMARK cO I NOT TO SCALE:
FLOOD ZONE 250001 - 5C BOUND 1
8-19-85, "C" FOUND �l I 1 j CORNER OF
CONCRETE
ASSESSORS MAP 250 LOT \ \\ ' BULKHEAD
PARCEL 128 I I \ ELEV 66.59
I #37 1 I SECOND FLOOR
LOT AREA 20,183f S.F. L
OPEN TO
\ 2� BELOW BED
SITE 8c SEWAGE %E \v\NG gE� >�a�RR MEDIA HALL #3
REPAIR PLAN / - I � �_ \-PREP 66 �� j\ ROOM DEN/
//34 I T \NO� 0\N\NG ^ �� ,66 STUDY BATH
QUISSET ROA D N I /
IN Lo
C E N TE R VI LLE °PRP , \�°�`�`� a
X �ZNOF/�y 2011-0121
�\A #� 6 CHESTNUT oay�`rA D VI ss�c ti
DATE. SEPTEMBER 29, 2011 0 65 TREE/10 DI m
REV: OCTOBER 6, 2011 r EGA .�\NO o�N #` PLANTER T
6 F R
b, 0 i Eli\S LLON 65 6 REMAIN 2
OWNER/APPLICANT: N �� 15°° �G LPN 56 G/STEREO
BRADLEY & NANCY P\�p,5 REMP\ vEN X 6 SgArITAR\
BAILEY
34 QUISSET ROAD � 2°•
CEN TER VI LLE, M A 02632 CONCRETE ( �,�� oBs. �`�HOF�s
BOUND FOUND .� g �• PORTS o�� s9�
SHEET 1 OF 2 CD ' rob- ! ' W/TIED EDWARD tiU
A.
S5Z•4j 10„E 16 ENDS STONE
PREPARED BY: 10g•2p, 652 �o �N0. 2 80
EAS SURVEY, INC.
141 R T. 6 A 0 �,� PUMP, SAND ,FILL AND 0 20 30 40 - b�
CRUSH EXISTING
P• 0• BOX 1 729 LEACHING PIT- AND
SANDWICH , MA 02563 LOT AABANDONEIN CCORDANCE WITH GRAPHIC SCALE:
PH. (508) 888-3619 #'38 TITLE 5 1 INCH = 20 FEET
i FAX (508) 888-2496
REMOVE CONCRETE PATIO SYSTEM D E S M
OVER SEPTIC TANK RAISE COVERS TO WITHIN 611 OF FINISH GRADE OBSERVATION
PORT TO GRADE ,
DESIGN FLOW
SILL = 66.25 FINISH GRADE TIE ENDS 3 BEDROOMS AT 110 GPB/D IM GPD
F.G. ELEV. 66.3 ELEV, 66.0 FINISH GRADE FINISH GRADE FINISH GRADE / & VENT
• �I �_l � - ELEV. 65.8 _ ELEV. 65.6 - ELEV. 65.4 ` REQUIRED SEPTIC TANK
1 *Zl AlIzv p -
A, 4.1' OF COVER ,3�0�_7__ m __ __660 GAL,
�•' " 12,®S- 013 TOP ELEV 81,4 SEPTIC TANK PROVIDED - _1,`2QSL_GAL,
_ 4" PVC SCH 40 6 ®S- 0,05
INV. 83.58 63.00 1 14"TE INV,® a Ila 3-MAX ji - SIZE OF LEACHING FACILITY REQUIRED
SCH 40 INV.-
EXISTING PIPE I I I I 62,80 /IN
DESIGN PERC RAT€ ®m _®_®MIN,/INCH
TO REMAIN GAS AF E OUTLET (21) 34" x 75" x 16" CHAMBERS LONG TERM APPL, RATE_QJ.4_GPD/3,F,-BOX ! HIGH CAPACITY INFILTRATORS
TEE INV,® INV,=60.98 ov SIZE OF LEACHING SYSTEM PROVIDED:
61,07 w61.24 43.75' a 60..06
• • 3 ROWS OF 7 0 6.25' EACH ,� b 330 _ 0.74 SF/GPD = _446 S.F. MIN. REQ.
(6Sri
EXISTING 1,500 PLASTIC GAL TANK TO REMAIN V 53.6 USING 21 CHAMBERS NTH NO STONE AROUND
OBSERVATION PORT HIGH CAPACITY H-20 INFILTRATORS
I CERTIFY THAT I AM CURRENTLY APPROVED BY / SCREW CAP �, 4.73 SF / LF X (6.25 x 21) = 620.8 S.F
THE DEPARTMENT OF ENVIRONMENTAL FINISHED GRADE 65.5
PROTECTION TO CONDUCT SOIL EVALUATIONS SAND FILL SAND FILL SAND FILL �4���ti OF Mti q 620.8 x 0.74 G/SF = 459 GPD
AND THAT THE RESULTS OF MY SOIL ELEV 61,7 °� D ►D
EVALUATION ARE ACCURATE AND IN INV-61,2 a o "` 4 9 GPD PROV > 330 GPD REQ, a 129 GPD RES,
r.d SITE �cSEWAGE ACCORDANCE WITH 90 M;�l ,100 THROUGH U F N 1 J N NO (GARBAGE DISPOSAL / GRINDER ALLOWED)
REPAIR
--:: - --- --- ------ ELEV 60.3 0
REPAIR PLAN EDWARD A. STO � 283 2,83 2,83'J G/STE'L
ERTIFIE SOIL EVALUATOR �'"' -1 SANITARY N
,34 E.--- 8.5'
GENERAL NOTES: SIDE VIEW
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO CONSTRUCTION NOTES:
QUISSET R0,40
DEP TITLE V AND THE TOWN OF BARNSTABLE RULES AND 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND
�) REGULATIONS FOR SUBSURFACE DISPOSAL OF SEWERAGE. ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING
2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE WORK ON THE SITE.
C E N TE R VI LL E ACCESSIBLE WITHIN 6" OF FINISH GRADE, WITH ANY REMAINING 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE
ACCESS PORTS BROUGHT TO WITHIN 12 OF FINISH GRADE. WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT
DATE: SEPTEMBER 29, 2011 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE DATUM: IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING
REV. OCTOBER 6, 2011 UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEY VERTICAL DATUM: MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND
MUST WITHSTAND H-20 LOADING. S.A.S. AREA IS PROHIBITED
OWNER/APPLICANT: 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION BARN. GIS MSL± D.T.H. #1 91 D.T.H. #2
B R A D L E Y 8c N A N C Y 5. OF ALL UTILITIES PRIOR TO ANY EXCAVATION. DATE: 9-7-11 DATE: 9-7-11
ANY MASONRY UNITS USED TO BRING COVERS TO GRADE BENCH MARK USED: GROUND ELEV. 65.6 GROUND ELEV. 65.7
OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. NO GROUNDWATER NO GROUNDWATER
BAILEY 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER CORNER OF BULKHEAD
FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. ELEVATION 66.59 INDICATES DEEP
34 Q U I S S E T ROAD 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF DTH #1 TEST HOLE A O E A O E
„ LOAMY SAND LOAMY SAND
CEN TER VI LLE, M A 02632 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6 ABOVE
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND GROUNDWATER ADJUSTMENT 10YR 4/3 10YR 4/3
LOCATED DIRECTLY UNDER,THE CLEAN OUT MANHOLES. 10YR 5/1' 14„ 10YR 5/1 8„
SHEET 2 OF 2 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN 1 DEPTH TO BOTTOM OF HOLE 12.0 INDICATES B B
2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT P-1 52" PERC TEST LOAMY SAND LOAMY SAND
ELEVATION OF THE OUTLET PIPE. VARIANCES REQUIRED 11 10YR 7 6 34„ 10YR 7/6 28„
PREPARED BY: 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9'INCHES 350 CMR: TO ALLOW THE LEACHING ELEV =62.8 C-1
10 BAFFLE,4 INCHES IN DIAMETER AND CONSTRUCTED OUTLET
SANITARY SHALL CONST OF 4" PVC CHAMBERS TO BE 4.1' BELOW NO MOTTLING SANDY LOAM
EQUIPPED
E A S SURVEY, I N C.
THE FINISHED GRADE IN LIEU B.O.H. NO WEEPING C 2.5Y 7/3 54"
11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND OF 3.0'. DON DESMARAIS MEDIUM
141 R T. 6 A SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE SOIL EVALUATOR 52" ELEV =61.2
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL ED. STONE COARSE SAND
P. O. B 0 X 1 729
-7 2 9 BE LEVEL SOIL EV. LIC. APRIL, 1995 2.5Y 7/6 MEDIUM
12. CHANGES OR REVISIONS-TO SEPTIC DESIGN REQUIRE NOTIFICATfON BACKHOE OPERATOR.
SANDWICH M A 02563 TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW ELLIS BROTHERS (BRUCE) COARSE SAND
AND APPROVAL. SOIL TYPE: 2- 2.G. AT
PH. (508) 888-3619
13. MAGNETIC TAPE OVER ALL COMPONENTS. PERC RATE: <2 MIN. PER INCH NO G. WATER 144' NO G. WATER 144"
FAX (508) 888-2496 LOADING RATE: Q.1
L GAL/SF/MIN ELEV =53.6 ELEV =53.7
SITE PLAN T YPI CQ L PROFIL E
SCALE — / " = r t . NOT TO SCA L E
18NSTD. LT. WGT C.I. MH COVER
N.
4"C I. P.'PE 4"8IT FIBER PIPE TIGHT JOINTS
=--- '� r-----t---- OUTLET LEVEL
F O
1N
,. FLOW LINE .__ FIRST
To ✓ T r
DWELLING I� AID" I4„ o O
C.1. TEE
' t r C.I. TEE
�! STANDARD PRECAST
,_ -y
CONCRETE 'GAL LON
SEPTIC rANK DISTRIBUTION BOX i
TO BE INS TA L L ED ON
LEVEL STABLE BASE. !
__-SEP TIC' TANK �
TO BE INS TA L.L EC ON i
S LEVEL , STABLE BASE P
t'cL
2" - //8" TO 1/2" WASHLG FEA5TCNt LEACHING PIT
i ALL AROUND FREE OF IRONS FItVES BA TO BE LEVEL
SF AND DUST IN PLACE
8•1?1'CA' S MORTAR COURES� \ 3' 4" TO I-1/2" WASHED CRUSHED
AS REOUIRED TO BRING `` STONE ALL AROUND FREE OF
COVER TO GRADE 24" C.I. MH COVER IRONS, FINES AND DUST IN PL ACE
AND FRAME `
5T R PV-E D�Li j Lvl..i. ; - r 71 hT T)0y,4 rr
`�-__._.-_
G. r,tr . E P T 1 Z cot!`�� t 4 L' •-1= -- --�~ -- ---- 1
_ ____ ____ ___ ;� ►lIt L ET B FLOW L INE . - --- h'/N PIT SEC T/V N
111r .
N
P,PE ' f 1. CONCRETE TO BE 4000 PSI 28 DAYS
f?` y �� 2. REINFORCED WITH 6" x 6" N0. 6 GA W W M
- ,y� I _ 6 111 3. 2' AND 4 SECTIONS ARE AVAILABLE FOR GREATER
DEPTH REQUIREMENTS.
F _ _ OPENING WITH 4-4/8" 4. NUMBER OF PITS REQUIRED
�a �. Q OUTER DIAMETER 8 - r �?Z•a S
I ! NOTE , EXCAVATE R Lr>wEFt A ,
/• r 1-3/4" INSIDE 91AMETE,R TO ELEVATION G
I
�f ' •• 3� REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH
�T I j PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN`
A�. � N
GRAVEL TO DESIGNED GRADE
/ Q,_O„
L EFFECTIVE DIAME F R !
' (NOT To EXCEED 3 IMES EF ECT/V£ DEPTH)
WAT£R TABLE
SOIL. A ND f=Eh C. OA 7A GENERAL NO TES
PERC. RATE < MIN. /IN. NO HEAVY EQUIPMENT TO RUN OVER SYSTEM
SEPTIC TANK DIS-RIBUTION BOX LEACHING PITS TO BE STANDARD
TEST BY: 1', M v F N Ic t`. O W NA, to J A W,uJ ;c. +. }� 4 s5 o� ,
PRECAST REINFORCED CONCRETE UNITS
WITNESSED BY -- �'' �� .� A e- a i ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
� , g" TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE ,
TEST PIT GR. EL.: z_ aL 404.0 DATE : �' ` ''� MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF
TEST PIT NO-1 P TEST PIT NO. 2 P 1O4c SANITARY SEWAGE EFFECTIVE I JULY 1977.
0 ' 1,- i ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE
Al -.
T=Y� -- ` -, ,� T,ve-/-5,u Mja i_" BOARD OF HEALTH.
a - AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE
�-�� G' v �- BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
A a-+ tU C.; to A. v% ;
PITCH ALL SEWER LINES 1/4" /FT. UNLESS INDICATED
?j E� p
OTHERWISE.
Z• - EL.Sz.o
DESIGN DATA
BEDROOMS DISPOSAL
EST. TOTAL DAILY EFF. !' GALS.
L EGEND _ SEPTIC TANK ` E'E GAL.
SIDEWALL AREA Z • 1� GAL /SO. FT
BOTTOM AREA I o GAL./SQ. FT Sr-r .49E DISPOSAL S KSTE
Dx00 EXISTING GRADE LEACHING REQUIRED + �"- � "- SQ FT c �j�/
ZONE \�^o>o FINISHED GRADE ACTUAL LEACHING AREA = -` `1 lSQ FT FOR
---- / /G) '
r c ' �, :J %i A T !x, c� - oo i INVERT ELEVATIONi�%C L i�G _ . .. —
DOMESTIC WATER SOURCE _. — _ __. �. y T f5-7 Li
PROPERTY LINE � /� rc_ G�r :r 2 ,� t�A tZ n.l ��7 A t
• SCALE: AS INDICATED DATE
I
Y WM. M WARWICK & ASSOCIATES
BOX 801 - NORTH FALMOUTH
'VA554G'HUSETTl C?556