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HomeMy WebLinkAbout1177 PHINNEY'S LANE - Health - 11 iWPhineys Lane a TOWN OF BARNSTABLE P l LOCATION .1 7 �'✓�'qVG'�-5 f� SEWAGEO# p�l VILLAC E I r���20 i S ASSESSOR'S �IAF&L0 INSTALLER'S NAME&PHONE NO:. ©��dG� l SEPTIC; TANK CAPACITY _AW 6;1. 6- ` LEACHING FACILITY: (type) ) le 6,e4 (size) NO.OF BEDROOMS BUILDER OR OWNER �CeC%et PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility f 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 r�/ .within 300 feet ofleaching facility) Feet Furnished by • t ,�Man � •t � •�• �� a a ON 4 l 11, i. f� I Fxs... J... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apphration for Di-tipwial World Towitrurtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair K) an Individual Sewage Disposal System at: / . .-•3 �.1 m3/S � - ` 'tom lS .......... ,,.,Location-Address �?:�_`--___......... .. --- --- y�----.....V ��.IC�c: �i6;J �1? t Noi �JS /VI r t1 S ----------------------- Ad res Wa �G✓�1�1A�........CUGoJ- 7Ce�a'►.-r --- = l •------ Installer ��-_;����-' :�> '' �' Address Type of Building Size Lot______________ __ Sq. feet Dwelling— No. of Bedrooms------------___________________________-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..........................._ No. of persons------------------------... Showers ( ) — Cafeteria ( ) Q f Other fixtures W Design Flow-------------- gallons per person per day. Total daily flow... . -:---___-__---_--gallons. WSeptic Tank—Liquid capacity o__gallons Length________________ Width-.__--.__'_---. Diameter.-.-..__-..-_.-- Depth---------------- x Disposal Trench— No- ------1.......... Width......��e-.... Total Length....._W ..!-_- Total leaching area---__. --sq. ft. Seepage Pit No..................... Diameter.................... 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..................... Test Pit No-,2----------------minutes per inch Depth of Test Pit.--__-..--_______- Depth to ground water--..-__.-_--__-----_--. ODescription'of,Soil......................................................................................................................................................................... x W ------------------------------------------------------ -------------------------------------------------------------- ---------- -- U Nature of Repairs or Alterations—Answer wh n applicable.._�N �._ _..s.S� IL477V --�......- G x' ....... ................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of-the State Environmen 1 Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant as en is e the board of health. Signed ------ ----- . ........ ...._. .......................... ----------------------------- t, Application.Approved = 1 ' Date Application Disapproved for the following reasons: ....... ..._.....................................__....... .............. .... ........ ..... .. .... -. .................................. - ... ............... ..................... ...._....................._._._.... . .. .............................---------- -i /_--Date Permit No. ...... J.. ......................'h............... Issued -------G-----.' -:-. C ---------------- Date V11"'07 a y THE COMMONWEALTH OF AMASSACHUSETTS f BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di_npn�ial Wnr1w Tontitrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair (<) an Individual Sewage Disposal System at: -------•------------------------------------------------------------------------------------------ -ocation-Address or Lot No. I`�/ �'v!v4)�.f� C a...............................oM ;VVt 4 )6). s All/K.s ------------------------------------------------- Oa ncr Addres aGt. 7... .. Installer Address d Type of Building Size Lot............................Sq. feet 0-4 U Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building _.......................... No. of ersons________._-_.___-___._.._- Showers — a yp g p ( ) Cafeteria ( ) a' Other fixtures --------------------------------- - W Design Flow.............. ----------------gallons per person per day. Total daily flow--------------- __-_-------.--__gallons. W Septic Tank—Liquid capacitv/�_�-.-gal Ions Length____________ ___ Width._.--_------_ Diameter_._.._-__._-- Depth----------------- x Disposal Trench--No. ------Z.......... Width------�--__ Total Length...... Total leaching area....7 .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........................ �t Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 .� Description of Soil...............•-•---•--•---._....-•----...-----•-•--•----•------------.....--••--------.-------•--•---•---.......---•--•-----------......-••••----•-..............e _- x W -------------------------------------------•----------------------------•---------------•-•--..-.-------••-•------------------------------- .......................................... U Nature of ReDairs or Alterations—Answer when applicable._1N_ `-__ ---------�-- ...�5� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environment 1 Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance' as b en iss e by the board of health. Signed .-..... / -..-_ .... .......1. ....--U - Date •-"" Application.Approved - - ..................Y................ ..-....._....... --.---.--_..--..----_---------_-------_ � ��- - ..� Date Application Disapproved for the following reasons- -----------------------------------------------------..--------------------------------------------------.------------- - ---------- ---------------------------- ---------------------------------------------/-------------_..........._-----...........----_--------------------------------........-.__...._.-...........- ... .. ....._............ Permit No. -----.1. � b-.,� ------- Issued ----- - `Date Dace THE COMMONWEALTH OF MASSACHUSETTS 2— -D/2. BOARD OF HEALTH TOWN OF BARNSTABLE U�EiC�t�t.CM�E II� ILII�C��i�iYiCP THIS IS TO CERPFD� That the Individual Sewage Disposal System constructed ( ) or Repaired ( �') by ------------------------------------------ .----------- ----- / �,? /-Wl lAj6q taue N at ---------------------------------------------- ------- / ------......------------------...-..-----5......- .---� - --.-.-u--------------------------------------------- has been installed in accordance with the provisions of TITL of ��eet -te nvi-ronmental Code as de tribe in-.-- the application for Disposal Works Construction Permit No. ---.�'..�... 1�.��t....- dated -'.�.'�r`---- -.-..� THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... ... .._. -C� ~ z / -- ------ Inspe P,---- ............. ? � '------_-------_—mm_®— THE COMMONWEALTH OF MASSACHUSETTS -----" �`BOARD OF HEALTH TOWN OF BARNSTABLE N FEE...`70 Difyo.69AVorkii Tonotrudion "rrntit Permission is hereby granted--------- �! � —L' _ ..............�^..:_. �''�!DN to Construct ( ) or Repair ) an ir Ovidual Sewage Disposal System Street as shown on the application for Disposal�rks Construction Permit N�-!_-� --- Dated...... O/ G / Board of Health DATE........=P r-------------/--------------/-..'7._�•----------------...------ FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, so T l hereby certify that the application for disposal works construction permit signed by me dated ' , concerning the property located at e--1-3 Url e— , L-24 ,Od meets all of the following criteria: `-• There are no wetlands within 300 feet of the proposed septic system u There are no private wells within 150 feet of the proposed septic system —• The observed groundwater table is 14 feet or greater below the bottom of the leachingfacility ty -L;�There is no increase in flow and/or change in use proposed '`• There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. 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