HomeMy WebLinkAbout1126 PHINNEY'S LANE - Health 1126 PHINNEYS LANE
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TOWN OF BARNSTABLE '
LOC,i%TION lij(, Wwu iJF yL lA w N. SEWAGE # a06 i — �-O Lk
VILLAGE &Yam Ll� ASSESSOR'S MAP & LOT 73-0 Z—
INSTALLER'S NAME&PHONE NO. 6&6i ram►SQ V1J
SEPTIC TANK CAPACITY _ f..6 0 0
LEACHING FACILITY: (type) 02 JDZV 1,JE 115 - (size) t a )t Ot S -.a
NO. OF BEDROOMS 3
BUILDER OR O, t���— 07
PERMITDATE: COMPLIANCE DATE: Z{I�16I
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
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LO,CATION SEWAGE PERMIT NO.
VILLAGE ,
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INSTALLLER'S NAME & ADDRESS-
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BUl DER OR OWNER V
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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4 � OWN OF BARNSTABLE
L .ATION L.,V SEWAGE #
VILL-AGE , ASSESSOR'S MAP & LOT
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INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
O. OF BEDROOMS S PRIVATE WELL O PU'BL1C WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE ' COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No. I t =v Fee $5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ti
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYicatiou for Miopaar *pgtem Cow6truction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot NoAK,4 Z X-, t Owner's Name,Address and Tel.No.
1126 Phinneys Lane, /' Dale Porter
`t' Assessor's Map/Parcel � ^� ®�Z f ���00
Installer's Name,Address,and Tell.No. ['*? Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P O Box 108.9, 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 Gaud
Nature of Repairs or Alterations(Answer when applicable) T i t l p-5 l p a r h sTs t em C.nn s i s t i ng—
of a 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 Board of HeeAlth.
Signed 4v L I�,l ✓ Date 1-,6—S-D
Application Approved by t Date 0
Application Disapproved for the following reasons
Permit No. cXQ)—c20Y Date Issued
—————— —————
TOWN OF BARNSTABLE
I:OCAT)kON _1 i I fiu�i.1 V S 1iA W SEWAGE # abti f -0'`0 Lk
VIIrLAGE j �Clrn wtn, ASSESSOR'S MAP & LOT }73-0 'Z-
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INSTALLER'S NAME&PHONE NO.��i N So 94 sel,-d T t L 7 7 5�-g 7 71
SEPTIC TANK CAPACITY 1 600
LEACHING FACILITY: (type) N-V hJ S (size) i P-
NO. OF BEDROOMS 3
BUtZ.DER OR�i'�y 1 . _eve v�- ✓'l-
PERMTTDATE: COMPLIANCE` DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Welland Leaching Facility (If any wells exist
on site or within 200 feei of leaching tY facili ) Feet
Ed W e of etland and
Leaching
clue Facility
cili an we
tlands etlands exist 8
ty Y
ust
within 300 feet of leaching facility). Feet
Furnished by
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No. Z Ak Fee 150
THE COMMONWEALTH OF MASSACHUSETTS ' Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE} MASSACHUSETTS
k ZIppYication�for rigpogal *pgtem Congtruction vermit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ElIndividual Components
Location Address or Lot No K4 G ��, S Owner's Name,Address and Tel.No.
Z vt n�j
Jsje�s§'sPA4*Mleys Lane, Dale Porter ,
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Installer's Name,Address,and Tel.No. 1, Designer's Name,Address and Tel.No. s
Wm. E. Robinson Septic Service
P O Box 1089 Centerville
Type of Building:
Dwelling No.of Bedrooms Lot Size ? sq. ft. Garbage Grinder( )
Other Type of Building — No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Desi$'Flow gallons per day. Calculated daily flow gallons.
e�
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
San
Nature of Repairs or Alterations(Answer when aD bait and 2 pplicable: ..,. . , r / .
�T_—.teaGTiaYste"ut consisting
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i
Date last inspected:
Agreement: h
The undersigned agrees to ensure the construction andimaintenance 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 Board of Health.i,
V,C C'
Signed Date =<-6
Application ApproNed by Date _!
Application Disapproved for he following reasons
Permit No. t�, r,i J -�C/ `� Date Iss d
—————————— ——-—
THE COMMONWEALTH OF,MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Porter
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( )
Abandoned( )by Robinson Septic Service
".
at 1 1 r% ! __ J._- r „__. _ _ , , _ has been constructed in accordance
c.u L asl'A" -Y.J 1Jp11�, 11. �'
with the provisions of Title 5 and the for Disposal System Construction Permit No. �/J� dated c//� /(�f
Installer wffi T n_L -_ Designer
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The issuance of this ermit`shall not be construed as a guarantee that the syste will functio as desi�ed.
Date c Inspector
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No. Fee $5 d
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
Porter ltgogaf *pgtem (Congtruction Verinit
Permission is hereby granted to Construct( )Repair( j'Upgrade( )Abandon( )
System located at1126
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Pu-'7Tta a �
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: (Ile ., i Approved by ��.(,.�_L G 1 t r, 1 ,l n LA 491-J
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NOTICE: This Form Is To Be Used For the Repair Of Failed
4 Septic Systems Only.
CERTIFICATION OF SIC$UM AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMPr MTMOUT DESIGNED PLANS)
William E_ Robinson.S y certify dm the application f.r disposal works
eousvuetion permit signed by me dated L/ concemmg the
prop" iocated at 1126 PhinneyS Lane, Centerville meets all of the
Mowing criteria:
• The system is coaoacted to a residential dwelling only. There are no commercial or busitwss
with the dwelling.
The is class: as CLASS I and the pacalation roe is Less than or equal to 5 miuuus per inch.
There a no wetlands within 100 feet of the proposed septic s}gem
• There no private wells within 150 tart ui the propose septic:s}stetu
There -no incomm..in flow andlor channe in use proposed
• are no variances requested or needed.
• bosom of the proposed leadring bcd*will wbe located less than five feet.above the
mum adj=W gtoandwraur table elevation:[Adjust the gtoundwater table using the Frimptor
when applicab el
If S.?-S_will be located with 250 fen of air,;vegetated wetlands,the bouma of the proposed
t •facility will Mt be locate less than fourteen(141 feet above the n ximurn adjusted
valet t�rle eletratiotr,
A) cop ofGmmd Sttdaoe Elevatiost(aing GIS Wft aadon)
B 1 G.W.Elevation +the MAX. High G.W.adjustmett
DIFFERENCE BETWEEN A and B
SIGNED:�.
DATE:
(Sketch proposed plan of system on badcj.
sr be"folder dear - e
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No.. _ __ ?I------ _ F$$/... �...Cs.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OX HEALTH
s� ' 1 ......0............ ... ....._'. .............
Appli6flou for Eliiiposal Workii Tonstrurtion Prrmit
r Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..s ' . t �........2-.....
......... ..�.... °�..� � .............. ... .................: ................................. . ... ............ .....
.e..[ ��i A^-.�j....... ... •'Add..s... �iG.....a.....
.. Z. ;.y� .... f or Lot N �® ,y
W Qwner --...- Address
....
.......
. . .
.........
a � ----...... .. .....
----
LA
Installer Address
U Type of Buildings Size Lot... feet
a Dwelling 3L No. of Bedrooms..............3........................Expansion Attic ( ) (Garbage Grinder (410
a4 Other—Type of Building jV :!: --� No. of persons............................ Showers — Cafeteria
aOther fixtures ..................................................................................................
W Design Flow..........4........................gallons per person per day. Total daily flow. ®�?._......._._..._._......_.__..gallons.
WSeptic Tank L Liquid capacity. ®gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No .................... Width___.._.__ ......Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter__/®a D pth below inlet................. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tan s1—
�" Percolation Test Results Performed by.......................................................................... Date........................................
aTest 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........................
�' . J........_...
O tr --------7-
Description of Soil. Z ! ... !�C��n---- _..
w ........... a------ �---- ._..........._ J W
---------------•------------------...-----------.-------------•--------------------------------------------------------------------------------------------............................................
V 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 Article aI 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
"ealth,j
Signed-- - - •-- ------------- —
Date
Application Approved BY /. ••L�Z4 ....
� � '
Date
Application Disapproved for the following reasons------------------•----------------------------------------------......--•-••......-•--•••• -------•--•-----...
....._-----•-•-•••-••-•-.....••-••-••--•-••••...-•••-•----•••••-•-•-••------•-••-•-••......•••-•••--•---•------•-----------•----•-------•--•---------..................................................
Date
PermitNo......................................................... Issued..............................:.........................
Date
g �/9 Finz.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O, HEALTH
N,
. ........... OF...........t ?.-�%......_:... .:.............
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Appliration fear Bitipusai Works Tonotrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at _ Pp
...�'';. � :.�� '... ra°; p�"r .tom?Gs ? �` ''1 ............ .............. .... ..... ....._._...,
iLoc n,Addr ss' or, Lot N �,/�' -
W Owner !Y Address
1� .f......`�` »�:°'p t �. j`'� . .......fir°r� � :l.t°.....��
a .... '0. .................:.. f ----•----------
Installer Address �
U Type of Building, Size Lot... :-� ' ' .-Sq. feet.
Dwelling.�[No. of,Bedrooms............... ........................Expansion Attic ( ) Garbage Grinder VVC)
p., Other—Type of Building &- "k yp g.�l-*! •:.-•-.•-•°gt�No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ......................................................
Design Flow.......... .__..>.................gallons per person per day. Total daily flow._3.!0................__..___....._gallons.
WSeptic Tank-L Liquid capacity_fUgOgallons - Length................ Width................ Diameter.................Depth___-_-_-___._-..
x Disposal Trench—No...._.=K%..._...__.. Width..........aT..... Total Length.................... Total leaching area...._...............sq.;ft.
Seepage Pit No..........�........ Diamet r...14OU D th below inlet.................... Total leaching area..................sq. ft.
Other Distribution box T D so in tank
a Percolation Test Results Performed by-......................................................................... Date........................................
Test Pit No. 1................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........................
a / ••--•---------- -•-•--•.....•- - • ---- ---------- - -•-•_--•--------
i If
O Description of Soil �)..'.LA.....-,1 0 •�1`<� 4' _
x / ---------- •-----------
x -•••--••-•-•-----------------------------••....-••-••••••••...•••-••-•-••................_.......... -------•••--------------------•-------•.......--•--•-----•............•-•••-••••.
V 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 Article XI 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 ofjralth.
Signed---- ._ t / .<'. A..__._. +r
�� Date
Application Approved BY. -l;= t `c�`/ f' .%tc ._ -- ------------ r' -------------------------
ApplicationDa
= /
f c�v fi v� at '6
Disapproved for the following reasons:........................././
..........................................................................
..--••---------------•--•-----------•-----•-------------....----------------......-------•----•.............................................. ..............-...........................................
Date
PermitNo......................................................... Issued.........................................................
1 Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
: :. .. ...OF............. 'f' ✓ .
TrrtifirFate of Tontpliatnre
TH hS"TO C;& TIFY/T"liak the,Individual Sewage Disposal System constructed ( or-Repaired ( )
"�1!�ir?
by....._�. ........_....��...- == -- .................•---- ---- -•-•-•-----------........_................------
f..� =-
'd z„stauer
has been installed in accordance with he provisions of Articl��XI of The State Sanitary 6AAa �,e" l ed-in the
application for Disposal Works Construction Permit No..6c.__ �f. .................. dated-.--------_1l---_---,..____-_ j.._..._...._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARA TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................•--------.....--•--........_......---•••--.......... Inspector.....................................................................:..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH {
y No......................... �G -a,. ...............................................
FEE..........
1 U
Dispoli i Works Tonstrudian amit
Permission.is hereby granted........... :: +...._._._ fr'.....
to Construct () orR�epair/( ) an Indtvidual Se%Narge")">Sposal�S�ystem
at No..y?!�f.... y
as shown on the application for Disposal/Works Construction Permit,No..................... Dated.... ............
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DATE................ _--.. ..... r, .................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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