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HomeMy WebLinkAbout0414 PHINNEY'S LANE - Health (2) 414 PHINNEYS LANE, CENTERVILLE A=230-125.001 Al l uu UPC 17534 No.2-15 COR KASTINOS.UN _ TOWN�F BARNSTABLE / L YZ1,'-TION �l ��� S /,�� SEWAGE # �'7-W Z VILLAGE �,G/� i/(//'�liC ASSESSOR'S MAP & LOT INS ALLER'S NAME&PHONE NO. SEPTIC TANK CAPACInnT f LEACHING FACILITY: (type) v�f& (size) 16 r*T ?6 "e NO. OF BEDROOMS .� BUILDER OR OWNE �/ PERMTTDATE: q—M 47 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 _ «-� �'" _ ,� �-' .. \� � �i... -,� �• Z • � r < � pr I -,�a g � 3 � ,, � a � �- �� �� � .� i -� � � �`� �� -�.�' 4, No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for &5paaY *pgtem Cow6truction Permit Application for a Permit to Construct( )Repair/Upgrade(ice)Abandon( ) ❑Complete System MIndividual Components Location Address or Lot No. IM/ ° Owner's Name,Address and Tel.No. Assessor's Map/Parcel Gee 4znr l//;Ile- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. leerta plov-1 45 r"07_ 7 7 9° P Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(4to Other Type of Building 96� � - No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ilep gallons per day. Calculated daily flow 33 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ifX;,52 *9 Type of S.A.S. le U"Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) � ql�t° /V zt ,:51 'r 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 t 's and Health. Signed Date Application Approved by Date Application Disapproved for the ollow g reasons Permit No. 2 Date Issued TOWN�F BARNSTABLE LOCAnON �� s „�� SEWAGE # r 9Z VILLAGE. � Y�w/ l ASSESSOR'S MAP& LOT G'�='�.c?�/ INSTALLER'S NAME&PHONE N0. � ��/i C4�15�` 77/ j SEPTIC TANK CAPACITY Mao O-1 LEACHING FACILITY: (type) 4 Z" &h (size) r1( NO.OF BE BUILDER OR OWNS �/ PERMITDATE: -le 47 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 wi shin 300 feet of leaching facility) Feet Furnished by 43 Ql 2 a'5 .3a -a3 3 30` �� r No. t FeeG THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Mizpaaf *pztem Construction Permit Application for a Permit to Construct )Repair U rade ✓ Abandon ❑Complete System L�Individual Components PP� ( ) P � Pg ( ) ( ) P Y P Location Address or Lot No. //J/1 Q v Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. /v Designer's Name,Address and Tel.No. 7 7l g399 Type of Building: 7 Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder 't Other Type of Building x25,1 effCe No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 30 gallons. Plan Date Number of sheets Revision Date f Title Size of Septic Tank M�01 4X/1 !,V9 Type of S.A.S. e� Description of Soil ! Nature of Repairs or Alterations(Answer when applicable) 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 t is B and ealth. � Signed Date / Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------- THE COMMONWEALTH OF MASSACHUSETTS -"�ZSr BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-s'te Sewage Disposal System Constructed( )Repaired ( ) Upgraded Abandoned( )by/ r�Dfl5 at �r/���� S �• ����`�'�v� C has been constructed in accordance ,with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer . The issuance of this permit shah no071T ed as a guarantee that the syst,t w -'n do was sig . Date Inspector --------------------------------------- Fee y_ THE COMMONWEALTH OF MASSACHUSETTS�/ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Misspozal *pgtem Construction Permit I Permission is hereby granted °7Gonstruct( )/Reps}( )Upgrade(�✓)Abandon( ) System located at y�y �/inn e t/5 1�• „ N and as described in the above Application for Disposal System Construction Permit.The applicant recognize's his/her duty to comply withiTitle 5 and the following local provisions or special conditions. , l Provided:Construction must be completed within three years of the date of this permit. D 92 Approved by j T l �y LA pµ�ijIJ � Q NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH ND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (`WITHOUT DESIGNED PLAINS) ierebv cenir:that the apniication `or aisposai works 1.o^structicn permit signed pv me gated ��q�f joncer�sn� he property located at l41lme y wee_ _i -_ -- �cacyvinQ ci;teria: ,er> =0 '.V?:! .C$ car-; ., e ^ _ _ C _ _o prl ale .Y - :1..� � _V .ilk .,.1 'L.t _1.1 _ ...•��_�'_ .-- --- - _ _ "_�._ 5,IGNED LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also if the !icensed installer posesses a certified plot plan. this plan should be submitted]. �� " 1c 3 Y7.9 !` ..�.•t s,v -'tea-K3�'+'j a: „�+ -.�- #' }:- Wit'. 4 n. r `f' c H 1 ...- .,,• ,,,: u � '-5':•.S.z -k .s.^S- i•v -•e.=... ._ :_ ...� ,.L ..:• 1tS'�� r'f.: w4 q:health fol17 zq b to��1� ''v iS y^L��ti"y'S ' ....... - S''i•J ... f� ,. i PN� UTILITY DATJM ASSUMED FROM BARNSTABLE GIS '��� t POLE ZONED: RD-1 S �� FRONT: 30' 0 \. SIDE AND REAR: 10' FLOOOZONE: C i11 \ NO ADDITIONAL BEDROOMS PROPOSED 9 STONE DRIVE ' t i � •\ 1 i ID F� �� q3 PROP. WATERLINE \ W EXISTIN TITLE 5 SEPTIC SYST M INSTALL SEPTEMBER 1997. OCATION 2$ AS PER S-BUILT CARD ERMIT 10' 97-492 26•� TIE PROPOSE 1 BARN BATH I TO i `PROP. EXISTING TITLE 5 1 ADD'N 1 SEPTIC SYSTEM AT MINIMUM 1.5% SLOPE EXISTING BARN TF 49.66' Co do. O O .O O. LOTS 1 47,800t SF 'yy0 ENCH-MA RK. HYDRANT TAG BOLT #16 It A n c TOWN/OF BARNSTABLE Q LOCATION �7 nlfe VS ! SEWAGE M VILLAGE r,ei1 YZ°l1,111 e� ASSESSOR'S MAP & LOTZ,3�9-12Y'::10/ INSTALLER'S NAME & PHONE NO. ���� � Cy�-��'• 77/-9399 SEPTIC TANK CAPACITY 000 I . LEACHING FACILITY: (type) (sizc) NO. OF BEDROOMS a BUILDER OWNER 5�L�Q` 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 Pumd l,,id by _ ✓AS'SESSA--S MAP NO.30g-P6 PARCEL L0~ CATION SEWA-G-E"_PERMIT NO. y VILLAGE tv T�(Z v l\) 15 INSTA LLER'S NAME a ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED C:�7—y_ - DATE COMPLIANCE ISSUED �° �"� �� cam'.c nc� �'ca•<^rrr,.:��..r,r� `1 � �� f ©ate ��P'i'tC 3� cs 4-0 0 0 t� cbQ St sT pje— Ind 1� I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratiun for Disposal Works Tonstrnrtiun Permit Application is hereby made for a Permit to ..Construct ( ) or Repair ( an Individual Sewage Disposal System at Location ... -Address ------------•----- ••---•-- --•---- T Installer Address Type of Building Z Size Lot................. ........... feet r., Dwelling—No. of Bedrooms............--............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................. No. of persons............................ Showers 04 Other fixturesCafeteria ( ) w Design Flow........... .:.....................gallons per person per day. Total daily flow--_...... Z_..........._......gallons. W Septic Tank—Liquid capacity .gallons Length....:__._ Width..... ......... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......V............. Diameter.....V). ...... Depth below inlet.....&........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by...............................-------------------------•--- ......... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................ fsr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------- ----------- ........................................................0 Description of Soil.................••--••---------------------------------•-•---....-----•------------------ W U ......................••----••----•--•---•---••.....-------•-••.....-•--- •-•---•-•••-....••-•--•--••---••-----•••••---••••--•--•••---••-----•--•----•••-•...---------•••-••-•-•-------••-•----••--•--•• t -----....... U Nature of Repairs or Alterations—Answer when applicable._-..-_�_OV -2-__......��' _ _:_�_ -�. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITU 5 of the State Sanitary Code—The undersigrwd further a r not to place the system in operation until a Certificate of Complia �issie bo of 7 Slgned - ---- ------------------- • ---•-•-• . .. .. ..... Date Application Approved y....._. � __ ... Application Disapproved for the follo`wing reasons:.........................................."— Date ... ..----...--•--•----•-•-----.....-•---------------------------------------<---------........-----=--.....-------••--••........... q Date Permit No... ...... -` ......... Issued_ ._... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •. Appliratio A fur Disposal Works Construction remit Application is hereby made for a Permit to Construct ( ) or Repair (L4-a"n Individual Sewage Disposal System at .........4y...-••-- 1.1.t��.! ..... ..:........ . .. . .....Location-Ad ress /� or Lot No. a .......�-CII V2.01 .V� .''��!�c1,.(-. !_�.......•..................• . . !r'�f? .�A.l�d��:.�......� I r Owner t.. ......... Y .. ....... _-•_• ......................... Installer Address Type of Building r Size Lot............................Sq. feet DwellingNo. of Bedrooms_._..._..�.........................Expansion Attic h g ( ) a Other—Type Type of Building ............................ No. of pe s ns-_.._..._...__..... ( )Showers (Cra)ba Cafeter a ( ) d Design y - g P P P Y y '- W Desl Flow..........the fixtures '-.--------'._gallons per person per day. Total daily flow..._...•_ _ ..................gallons. WSeptic Tank—Liquld capacityil-T3O.gallons Length......... Width.._.._--. Diameter................ Depth................ j x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....%............... Diameter.....p.. Depth below inlet..... ....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f�! Test Pit No. 2.......:........minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ..........-.................................................................................................................................................. 0 Description of Soil-----------------------------------------•-------------....----------••-------------....--------------....--------------------------- ...----------•.....----.----- x _ U ........................ ................................................................................................................................................................................. . ------ -••-- ---•- fi U Nature of Repairs or Alterations—Answer when applicable------J-—UZ?......�50 _ 77 w'K________________•__.___. lid=n ? -" s ? ............ --------{ `-?5: 1 ......................................... Agreement: The undersigned agrees-'to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LE 5 of;the State Sanitary Code— The undersignp-d further agrees not to place the system in operation until a Certificate of `h Compliancesas-been issued+y t e boapQ of health. ..- l _,:�•r--r' - t,--------•='"2'----a-•- •---- ---�-=--�rt-`-�-�•;•-------- p,..r,e_ Date 4 Application Approved rye _`.. _= !"�e- �'l !..j ................... .........�! � f Date Application Disapproved for the following reasons--------------------------------•-------------------------------•-----------.........----•--•---••-----••------- ...................................•-•--...........----•------•.......--------•----------•---------...._......-------------•----•••-------------••••-------•------------------------------------••-•-•--- Date Permit No Issued ..........- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v��...OF....... l am,. g ..................................... Trrtifiratr of f ompliam THIS IS TQ GETIFY�; hat the Ind,*vidual Sewage Disposal System constructed ( ) or Repaired by--•----••---•---------------t••------............. ........ ......: Instal er at............................4-�-�_•------.--- 9 - -=lam = S -�' ..__ has been installed in accordance with the provisions of TITLE r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.---. =_ �._._ -7----C7...... dated.....11. ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS•A GUARANTEE THAT THE SYSTEM WILL FUNCTAON SATISFACTORY. r i DATE. .�.��{0. -' Inspector. �' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ��] - -�J1 ..��_ ........OF........�jG�. ..► _` -% -.... .-•........................ N ..... FEE....................... Disposal Works Tuntrnrtion f rrmit Permission is hereby granted.----------•.� ..... -------------------------•------ to Construct ( ) or Repair ( (�®an Individual Sewage Disposal System atNo...................i ► -•--• 1 y tit t�._� ...... -.,.,. -----•- ----• ----•-----------------•••---------•------•--•---...........--_... -� Jtrect �,;� as shown on the application for Disposal Works Construction Permit No- -..-!_1-1__ D:ated.--- ---c-'/ '.._.... DATE. / Board >i lr�al�l� ` 7------------------------ I -