The URL can be used to link to this page

Home My WebLink About0456 PHINNEY'S LANE - Health (2) 456 Phinney's Lane Centerville A 230 124 - Sul! J1'Etgctfo lll ® UPC 12534 4 No.2-153LOR Aosr.coNs°�� HASTINGS, MN TOWN OF BARNSTABLE LOCA1ON yS 6 �/� �✓"� �' 2'y SEWAGE # Y"`7� VILLAGE C c '�'� U s� ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO�Q� N;T- -o r -� SEPTIC TANK CAPACITY LEACHING FACILITY: (size) 3-3 J /-3 kf NO.OF BEDROOMS �i/ BUILDER OR OWNER �"'' Z,10 r a r PERMITDATE: /6 r3 COMPLIANCE DATE: qJ1610 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � H � Ilk /Vn 70- No. FeeTf� THE COMMONWEALTH OF MASSACHUSETTS" Entered in computer:' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Zigool *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )"Abandon( ) KComplete System ❑Individual Components Location Addreskor of No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms G 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 O e¢ Number of sheets Revision Date Title Size of Septic Tank e' ® d Type of S.A.S. P— S'o® A 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 this f He h. Signed Date Application Approved '� Date ` 0 l Application Disappr ed 16r thEollowing �greas`?ns � Permit No. 4('— Date Issued No. r,C -1 I�S Fee y �/ 4 �#I eC MMONWEALTH OF MASSACHU Entered in compu r:H j Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS e - G T'aye ZIpprtcatton for 30tgponl *pgten4ongtruction 30ermctt Application for a Permit to Construct( )Repair( )Upgrade((-)Abandon( ) El-Complete System ❑Individual Components Location Address or Lot No. e Owner's Name,Address and Tel.No. Assessor's Map/Parcel ;?, 3 �� re Installer's Name,Address,and Tel.No. T Designer's Name,Address and Tel.No. i? 2 F Type of Building: / Dwelling No.of Bedrooms / 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 C/� ` 5� gallons. Plan Date ��?/�� Number of sheets Revision Date Title e , Size of Septic Tank �^ ` d Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable S 'd s" 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 bp2this Board of He th. , Signed -� .- cl. Date � l Application Approved by Date r °Application Disapproved for the following reasons i a Permit No. 7 00a- Date Issued �� U E THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certtftcate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by /9 /2 e'/ at I- 5 '��r r Y'1 �''� has en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. U ON- dated y Installer '1 '�' �� i s Designer '2- The issuance!ofthks`permit shall not be construed as a guarantee that the cyst in willfunction as yld1esigned. Date L,()bl o , Inspector No. �d U �� Fee 5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &!9pogal *pgtem Congtructton Vermtt Permission is hereby granted to Construct( _)Repair( )Upgrade(�)Abandon System located at - 3 e5� /h' "'-,- e: -- s L ,, _ r ' r� 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:Construc ion must be completed within three years of the date of this�it/ Date:_ u1 �I G,7o t� Approved by Town of Barnstable �FTNE Regulatory Services • . Thomas F.Geiler,Director + BAMSTABM • MASS. Public Health Division i639 �m ° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: �DO+ Designer: �� M • V t E—yFP Installer: A6CH ( O N-5-CE Address: �� - -Box 9 g ( Address: o'-s3 7 On was issued a permit to install a (date) (installer)septic system at 4S(b 'r4 i t,)N g; s LAnl a based on a design drawn by (ad ss) dated ZC� (designer) X I certify that the septic system referenced above was installed substantial) according to P y g the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Loc. tns. Plan revision or certified as-built by designer to follow. YRD (Installer's Signature) 1140 j3AN�P�. IMAI-x�l sign 's Si ature) (Affix Designer's Stamp Here) PLEASE RETURN TO B STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH -THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLE .6L LOCATION y5 6 / /� V-'/°�� 2'� SEWAGE # ' `�� VII LAGS C �' � �!"' ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO&CW SEPTIC TANK CAPACITY r SO 0 LEACHING FACII,ITY: (type?/��2,�/7'd�C�.qS'-'2� (size) —� x /-3 X NO.OF BEDROOMS BUILDER OR OWNER `"'' �'° T PERMIT DATE: /6' COMPLIANCE DATE: ' 0 Separation Distance Between the: Maximum Adjusted Groundw�er Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of lgaching.facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by tll H Q J -7 B9 J3 LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLE NA E i AD ESS .t � BUILDER OR OWN ER DATE PERMIT ISSUED n` DATE COMPLIANCE ISSUED-o1,5 �� ` N � � �' � o � �,�� ii 7 D + ' ., ' � __-______ J No............. Fxs.. ..� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 7 .. . . .. OF... e. ------------•------------- ro�- Applira#ion fur.,Uhip a aal Works Tomitxnrtion ramit Application is her b made r a Permit to onstrucr Repair ( an Individual Sewage Disposal ............. ......... --------------•--••---••-•-• -............................... ------------------------------------------- cation-Address or Lot No. Owner ---------------------------- -Address Install Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of.Bedrooms......... ____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _________:__________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures __________________________________ W Design Flow............................................gallons per person per day. Total daily flow-..'-------------------------- ............... WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth............. x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching a rea....................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........................................ Test Pit No. i................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................. P4 •--•-•-•--------------------••••--•---••-•-•----•••-•-••--•-•-•-••-----•-••-•••..__...._----...._...........................................................® Description of Soil........................................................................................................................................................................ W ------------------------------------------------------------------------------------------------------------- �} U Nat of Re irs or Alterations— r when applicable__.'t �/ - �.Q e �� )---------- - --------------------------------------------- greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT M \ 5 of the State Sanitary ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha ee issued by the board o hea t Sign - --�-- - -- --------- � � Date Application Approved By..... . _._____ =-`�� ---�S'_-_74 Date Application Disapproved for the following reasons:------••-•-----------•-•--------•••---------•••----•--•••--••••-•--------------------•••-----•--•-•••____------ •--......-•---•-----•-----•-••--------------------------------------------•------•--....---•---------------------•-•--------•-•-••---------------•----------------•-----------•------------•--------•--- ._ Date PermitNo......................................................... Issued_' -- v`...................................... Date t� MIDWAY ... ASSESSORS MAP2 U TEST HOLE LOGS NOTES: - •; �,�) TER Wwic lMlnt 'Pong Jti � 'T �:�/(�srI'atop� �4jz �`uRD;'R°IN7b' I PARCEL : 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH Iwoq '�l SOIL EVALUATOR : � -��7R• �E THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF i n f�r� {. k; ,��of A €1 FLOOD ZONE : OON t�1�1ZoLiq WITNESS : PcG? BOARD OF HEALTH REGULATIONS. LO REFERENCE: Y- Iry B �2`�4 DATE: /�} ) 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES c SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO � f PERCOLATION RATE: �. �'" YI� _ INSTALLATION. TH- 1 �(,: �� TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE A DETERMINATION. 19 4) ALL PIPING TO BE 4 SCHEDULE 40 @ 1/8 / FOOT. (UNLESS IDY(Z�o/ SPECIFIED OTHERWISE). LOCATION MAP 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A C � �r7As� GARBAGE DISPOSAL. � M E L�r UNI co R's� 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) G S��(p/ (►� 0-1 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON / T A BASE OF 6"OF CRUSHED STONE. 7, Exr�TtNc� ccssl�ooc s to � 41p ��C/1vsN rt i 5�- No 60 oo!f�rp6� C No ws L /A)y . moov✓N P2ty_ Tb ...w.�c.uS._.w�tnl._( � of--P�Lo , lcA #14 SEPT I C SYSTEM DES I GN IV) .LUI-_V_A-R-f a,- pTL .._V_ot FLOW ESTIMATE BEDROOMS� AT 1 l� GAL/DAY/BEDROOM - GAL/DAY ��:�s�.��.,�Q�!�...rv�i 1�_lJlu yb►�1��_�v___��.�."I�Z�._"__._._ / 4 � 1 SEPTIC TANK 1 \ �U GAL/DAY x 2 DAYS - p rib GAL USE GALLON SEPT I C TANKS J4SW 1 k SOIL ABSORPTION SYSTEM 1 IN, \�c,� Soo `1 VNPq.�\ �, �� . \ 1 Gtf ► `, S w 57D E 6A) 1` L.-5-1ra- I m � S 1 D E AREA: t_('33.5� Zt-(r3�2�k�-k 0, C/ _ ��7. YER�l� � � E\ \ �\ O s BOTTOM AREA: ,�3. k l3 k O -2 322. 'L� \ o \ No. 1140 \ I �GlSTER� G` 4s I /p IDSgNITAR\P� rL SEPTIC SYSTEM SECTION 7moo iv A vis u 52 6 ro' F "I" 711,5W6-4v y lo'S'r�►t� .� oubre Washed SY Sfb�re T3ase ' D-BOX GAL (Uk,�-r-krf L`I ._�f tom. Lam. SEPTIC TANK N I7 _ _Io \ 26 C,o q-� i, j ,i Z � `� 3� y i2 L�avbl� � n pE- s Wa�,lle� She �6ar �zG.ctZ` -. (33.5 x IS'W K 2ro 5I SITE AND SEWAGE PLAN LOCAT ION : �5( IPh lYt✓eq)5 (ANC- PREPARED FOR : 6H (ON lS1,eUG/`7o/t) 30 0 DARREN M. MEYER, R.S. SCALE : I'g �U DATE : 4-7-0't z 43 VINE STREET 17 DUXBURY, NIA 02332 u DATE HEALTH AGENT (781) 585-0293 . Z