HomeMy WebLinkAbout0005 PHILLIPS ROAD - Health 5 PHILLIPS RD.
HYANNIS
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TOWN OF BARNSTABLE ._
LOCATION _ �n a 111�� Q
�+ SEWAGE#
VILLAGE
'1 ASSESSOR'S.MAP 291�OO�&,:LOT
INSTALLER'S NAME&PHONE NO. 114 77 Sy 7 7-,' 1 `
SEPTIC.TANK CAPACITY,. — }
LEACHING FACILITY: (type) (si'ze)
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NO..OF BEllROOMS,.
09
,i;f B;UII DER OR.OWNR,
PERMITDATE: COMPLIANCE bATE
Separation Distance BeMeen the „ f EMI
1Vlaximum Adjusted Groundwater Table to the Bottom of Leaching Facility :Feet '
Private Water Supply W--ell anFd•Leachin Facili
ty. (If any-weIls'exist
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on site or within 200 feet of leachin "facility) Feet
Edge of Wetland
.and Leactung Facility,(If any.wetlands exist
wathin:3Q0 feet of IeaIung fac1llty) Feet « x �f f
Fea
urnished b
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TOWN OF BARNSTABLE
LOCATION DES A SEWAGE # ADO 1 - 3LI
VILLAGE-- r� +w ASSESSOR'S.MAP & LOT ��/-00,(
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 1000 CF hT R'
LEACHING FACILITY: (type) a A rn (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: 0-4-0) COMPLIANCE DATE: 9 01
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 siie 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 _
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No. 7,vv /—Ly - + Fee$5 O —_<
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Miopool *pztem Construction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
5 Phli s Rd. , H annis Karen Rubino
Assessor's ap ar
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P O Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system consis—
ting of a 1 , 500 gal, tank, D-box and 2 precast leach chambers
with stone all around_
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B rd of alth,,
Signed Y Date v �"
Application Approved by Date —
Application Disapproved for the following reasord
Permit No. 1Z4V I- JOY Date Issued �o y
?.vv / Feed
No.
4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L
PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE., MASSACHUSETTS
Zipptication for �Digpozal *pztem Construction ermit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
5 Pl�li�s Rd. , H annis Karen Rubino
Assessor's ap, arc
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P O Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank "'W Type o�S. .S.
Description of Soil Sand
9
Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system consis—
ting of a 1 , 500 gal. tank, D-box and 2 precast leach chambers
with stone all around
Date last inspected:
\Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B d of ealth�
Signed r Date L•�
Application Approved by Date
f Application Disapproved for the following reds h s
Permit No. Date Issued w L/ d
------- -- — -------- --------------
THE OMMONWEALTH OF MASSACHUSETTS
ARNS BLE, MASSACHUSETTS
.� Rubino cQrtt 'icate Of eOYnp riaCe
THIS IS TO CERTIFY,tha the On-site Sewage Disposal System Co;structed ( )Repaired(X )Upgraded( )
-Abandoned( )by p Wm. Ej. Rbinson l Septic Service _
at 5 Phillips —Rd. , 1 nnis has been constructed in cordance
with the provisions of Title 5 and the for Disposal Systetfl Construction Permit No.Zen/- 3 Ny dated
Installer Wm `'E Designer
The issuance of this peimit kLall of be construed as a guarantee that the syste fun t'on esigne
Date 0 Inspector
71
No. — 7 ZS OC�p Fee $5o
THE-COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Rubino
lfopogai *pgtem Conotructfon Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at 5 Phillips Rd. , Hyannis
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 b completed within three years of the date of this perout. ,
Date: Approved by
uses�N&116F-.This Form Is To 1&*Used For the Repair Of Failed
Septic Systems Only. -
_ cl�rr�cA�o»of sxE�cc�el w»D aPP>�atcA�or�goy a m>�osA><.
WORKS CONSTRUMON PERMIT rfHUUT DESIGNED PLANS)
L W i l l iata E. Robinson,Shy cerffY dm the application fir disposal woes
coorsanu6xn peremk igmed by we dated ` ollum-lung the
property located it 5 Phillips Rd:, Hyannis meets all of the
Mowing criteria:
• The failed system is aonwood w a readmal dweltiag only. There ace no commermai or business
uses associated with the daeRing/e
The soil is classi as CLASS and tLe pereoladon rate is legs Man or equal to 5 minutes per inch
Thus sre no wetlands wider 00 feet of the proposed scpuc a}-7em —
There art no private wells 150 kd of the Proposed sepuc sysWrt
There is no ismease in attd M dam=in ux purposed
• There are no negaetmd or 000dod
The booam of the Ong bcd&y,a ll.emde tomud h m than five tisu above the
.9 table elevation-[Adjus the Bmwmtwmer table using the Frimptor
mediod when
• if the S.kS. be lasted wish 250 An of any vepwied wedands.the bounm of the p vposed
trashing wiig nst be located lcm than fourteen(ld1 far above the umdumm adjusted
table acvaum
Please ttte fallowir
) Top of Gmand So*=Elevation(tiftGIS k&fmaeoul '-S-0
Eli G.W.1•aet+ation *the 1irtAX ll'tgh G W t
DIFFERENCE BETWEEN A and S Z Vr v —
SIGNED: 45<1
-----�--� DATE:
[Sketch PfgP od plat►of system on ba*l.
.�traLb fdda_�brt
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L0 CA-710ItjK SEWAGE PERMIT G0.
c p D.
VILLAGEh� u� e
I N S T A LLER'S NAfSE & ADDRESS
L
GUILDER OR OWNER
\ ,DA_TE PERMIT ISSUED
DATE COMFPLIAN-CE ISSUED
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No.�l....3 .............. ..
THE COMMONWEALTH OFMASSACHUSETTS
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-:-..............OF. ... . U
............... ................................
ApVliration for Disposal Works Tonstrnrtiun 1hrutit
Application is hereby-made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
....... ..... ..... ... .... ---- -----_. .......
Location-Address or Lot No.
......................—.........................................................................: .............................................
-----
Add .......--------
Owner ress
W
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (. )
Other—Type of Building .............. No. of ersons......_..................... Showers — ( )yp g -------------- p ( ) Cafeteria
Other .fixtures .------.-•------------------------------------------------••-----------------•---------------••--•----••-----....---•----------....------....----..._.
W Design Flow.......C..................................gallons per person per day. Total dais ow.....3:2_�.__.._....................gallons.
WSeptic Tank—Liquid capacitylZ,.--.---gallons Length---�A....... Width.....--_.... Diameter.. ...!y�Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No..........j........ Diameter....... '_.._..... Depth below inlet.................... Total leaching area..��.....sq. ft.
Z Other Distribution box (` Dosing tank ( - )
•-' Percolation Test Results Performed by....•....................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ . ,
'= a --------------------------------------------------------------------------------•-----------------=-......-:........_...----•-----•-----------•---------......
0 Description of Soil............................................................................................................................................._......--•-••-••------•----
U.x
x =-----
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 L IT IL- ' 5 of the'State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is ed by the boar of ealth.
jigned..... -==--------=- :..... •-- ------.------ -- ------------• -- _.._.
' Date
Application Approved ..:.--------------------•--•--.............----------------- ---------------
=�f
Date
Application Dis prov for t following reasons-------------------------------•----•------------=-----------------•--•-•-----••-...............................
................•........ .._...... .•---•-------....----------------•------...--------....------------•-------•----•-•----------•••---------------•---•-----------=--••••--:----••------_-----
'Dade
Permit No...........:........ ...•--..........---•-------....... Issued------------- -= •...
Date
No-Llr/......... /--- Fps. . ............
st THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..........................................................................................
Appliratiou for Uhipoii al Vorkg Tonotrur.tion Trani#
gat
is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S.. ..... .... ...•-••---••-•......--•-••-••--•••-•-.....••-----•••--•• --•......_...•-•-•--•••••••••-._....••-•••-••--••••-•••-•-•••-••••---••-•-•-•-.......----.......--
ocation-Address or Lot No.
_.. .
Owner. Address
W
Installer Address
U Type of Building b Size Lot............................Sq. feet
1•4 Dwelling—No. of Bedrooms-------- ____.....................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons, Showers
a YP g ---------------•----...---•- P ( ) — Cafeteria ( )
Otherfixtures .._......_•-•-• •-•-••-•-•••-•-••-•-•--•-••-•-....••.••-•-•-•-•--------=•--------------••-•----•-•----•••-••-•-••..............---•••-•----••_-----
W Design Flow_._•6G`. ...............................gallons per person per day. Total daily flow.._........................................_gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length........_........... Total leaching area....................sq. ft.
3 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. 1................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
U ............................. ................-----•••••-•---••---••--••-•-•••-----••...•--•------•--•-•--•-••-••------•-----••--•--•-----•------•-••--••-••---•••••-•--•--•-•-•--•--•-----------••---•-
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 TIT TIE5 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.
d
Application Approved ......... =---•-•........ ......................................... .......... f= 00 ..
Date
Application Disap ro for ' ollowing reasons:...............................................................................................................
.....-----•--------------------•--•--•--.......-------------•-------.....--------••••••---•-•••--•---••-• •----•-•-------------------•-•---•----...--•---------•----------...--••--- ------•-------
Date i
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....................I....................OF.....................................................................................
TurrfifirFa#r of TompliFanrr
T T(9 CERTIFY, That the Individual Sewage Disposal System constructed (�r Repaired ( )
by .l .••-•• ••-••••••--•-•••••-••-•-._...•--•-•-•--•---------••••---•---•••-••--•-•--•-••-•-•--•-•••-•••-•-------•••......-••...--•---•••-•••--••-•-•---_•--
Installer
at-- ••.
----- ----------------------•-•------•-----•VUARANTEE
---•-- ---•---------------
has been inst ed in accordance with the provisions of TIF rr of The State Sanitar e in the
application or Disposal Works Construction Permit Nq. ..1.: �J//.,/............ dated. .._ .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...............................................�v/_. 1 ............. Inspector........A 14g2 .............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,,;;OF HEA
" G..� :....................0 ....... ..... .......... .._._... ..----------.........................
FEV::1................
Map aal tr ion anti#
Permission is eby gra LL
............................... •• •• .................... -••••--•--•••-•-•-•-•--•-•---•--••••--......-••--.....•••-...._-••••••--_..
to Constr ( or Re ( ) an div al ge D sal stem
atNo. •• --- .............,f --- •--••---•-•-- -•--•--•---•--•--- -Q !$
— -` Street..... ..............................•....
as shown on th ap ication for Disposal Works C6hstr 11i'nermit,FhQoN..^3�1_- Dated_.6_ _. .f__... ........
tt ' Board of Health
DATE..............-----� .f
----------•---•----•--•-----=------------------- =-'-'',,'
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