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Home My WebLink About1600 PHINNEY'S LANE - Health 1600 Phinney's. Lane Barnstable TOWN OF BARNSTABLE LOCATION /�40 �ii�/�/� �'�' ✓' SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL 3G' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY� w LEACHING FACILITY. (type) a �,p (size) 1J*X �� NO. OF BEDROOMS c� 3 '�`�Gz'/�® .O -�'/¢�✓ OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: �j Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /y$ 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 R. so 17 Lot) 01 No. l Fee— r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Nsposal �&pstpm Const union 3pPrmit Application for a Permit to Construct(J�rl Repair( ) Upgrade( ) ,Abandon( ) omplete System ❑Individual Components Location Address or Lot No eGf 10 �j//p J :/� �� 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: r �j ,► / Dwelling No.of Bedrooms ` `Z L�t Size / �t C sq.1lr_�o Garb dge ide ( ) i Other Type of Building ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 334 gpd Design flow provided gpd Plan Date Number of sheets f Revision Date Title Size of Septic Tank_a/el-Ce 6W-e- Type of S.A.S. CIA`C&lr � �,c'/•3'� � P' Description of Soil J'tete � Nature of Repairs or Alterations(Answer when applicable) �� Q��✓ 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 Certificate of Compliance has been issued by this Board of lth. n Date ale o Application Approved by deDate Application Disapproved b Date for the following reasons / Permit No. (�� y Date Issued / -1 y No. / � 1l "J � Fee IJJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatlon for -Misposal *pstem Cofistruction 3permit Application for a Permit to Construct(j�,,Repain(,) Upgrade( ) Abandon( ) 1omplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. s w i !� Assessor's Map/Parcel oZ.XS+ O_'p w F� �+ Installer's Name,Address,and Tel.Vo. Designer's Name,Address,and Tel.No. Type of Building: r p ) y�) Q�r�� !Garbage 12f Dwelling No.of Bedrooms Lot Size sq. Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) aaO gpd Design flow provided .9 gpd Plan Date �� , '— Number of sheets f Revision Date Title Size of Septic Tank. /4.4fo' /'1S'_4 0 6;4e- Type of S.A.S. C—O<' Description of Soil f'er� ��.✓ Nature of Repairs or Alterations(Answer when applicable) .��.� ®��d✓ 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 Certificate of Compliance has been issued by this Board of lth. S' d Date Application Approved by �,, Date —A � r 7- Application Disapproved b Date for the following reasons i Permit No. )_+ I l / Date Issued ---------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( Abandoned( )by �Gr�OG'r�/l� J'��1�� L C 44- at ,�0 O 400�//v/NGPy� L�'. ZO/'/!!has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�U r)_Y/I dated )( — L/ Installe&/.JI91 `��Gt�l� Designerjl'!//,Q ,�r Jfj��./ao� �✓� #bedrooms Approved desigrvffowj gpd The issuance of t is perm't shalln not be construed as a guarantee that the system will action a§designed. Date 1 j Inspector - v y ----- ------- ,- ------------------------------------------ -------------- --------- -- ----- -- -- --- ---t Uy---------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Hermit Permission is hereby granted to Construct(d� Repair( ) Upgrade(Abandon( ) System located at o /�y,�l'Y .�Yf/�`� Z ^.— and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must Ye completed within three years of the date of this permit. J—P Date ( / / Approved by a r � . Town of Barnstable Regulatory Services Richard V. Scali, Interim Director iwRrasrnet.E. y 9� MASS. ,O Public Health Division '°TEo,u►nt° Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: 201� Sewage Permit# Assessor's Map\Parcel 275 h;0 Designer: In 6. M Installer: Address: 61�1+.�, Address: M 140" iy-ax�6<19�2 �I�C fJ �� 1 tall a 't to ins was issued a erne s On � p (dat installer) septic system at 110DV.1�141 WW b-��' based on a design drawn by j�J� L n {�CIdT S5) �� dated %l IS-4 zz> (designer) Z, certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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 & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in conn_uance with the terms of the I1A approval letters (if applicable) OF III, — � UAVID1�e_ 4 MI SOFA ; staller ignature) —r %0 No.1066 a G. FGIS Te STY 11 rlll1�s'�/' ( e i er's Signature) (Affix Desi mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC IfEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNUL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:ISeptic'Designer Certification Form Rev 8-14 l3.ctoe f �-y Town of Barnstable P# �'iI1E 7� Department of Regulatory Services M�UA Public Health Division Date l Mm ;T r639 • 200 Main Street,Hyannis MA 02601 Date Scheduled Timer ` 3 o y. F Fee Pd. O Soil Suitability Asse sment for Sew e Disposal Performed By Vjj, �-� �. . Witnessed By: IAJ. ]LOCATION& GENERAL INFORMATION Location Address��o Owner's Name !!® ��iiEy�'�l' '6�'d++ Address Assessor's Map/Parcel: �� Engineer's Nam;!�u vf� " , NEW CONSTRUCTION. REPAIR f� Telephone Ik LT Land Use Slopes(96) , Surface Stones'.. Distances from: Open Water Body ft Possible Wet Area f[ Drinking water Well ft Dralnage Way ft Property Line ft Other ft SIM'TCII:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 41 rT Z I Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping fl'otn Pit Face Estimated Seasonal High Oroundwater Method Used: ]DETERMINATION FOR SEASONAL,II GH WATER TABLE Depth Observed standing in obs.hole: In, Deptll to Boll Inottler Depth to weeping from side of obs.hole: in. Index Well#t Reading Date: Index Well lcvol ilt. Groundwater AdJudtment ft. _ . . -�_ Ar,�.factor. A..(j.C3t'nundwtiterLevel,,,,_, I Observation I ERCOLrATION TEST bate Timm Hole## Time at 9" Depth of Pero .Z " 11/j' 'I . Time at G" Start Pre-soak Time 0 Time(9"41) End Pre-soak •'l,� `I / Rate Min.Auch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Diyii ion ( Observation Hole Data To Be Completed on Back--------= ***If percolation test is to be conducted within 100 ' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICPERCFORM.DOC DEEP-OBSERVATION HOLE LOG hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. or si istency, rayel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soll Horizon Soil Texture Soil Color Soil Other Surface(in_) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, ra ]DEEP OBSERVATION BOLE LOG ]Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 1 ' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Scopes;Boulders. Consistency. y Flood Insurance Rate Man: / Above 500 year flood boundary No— Yes ✓__ Within 500 year boundary No W, Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mtiterial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious mattnrial? _. Certification I•certify that on. d (date)I have passed the soil evaluator dxamination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the requir aining,expe ' e e pe ience described in 10 CMR 15.01 1 Signatur Date Q:\S.E7nC\PERCFORM.D0C I ASSESSORS MAP: OUT Z -- --------- - -- -- - ------ TEST `' ]0 L E LOGS �' PARCEL: ---- ---- _ - - - _ . - ----- l) The installation shall comply ►vitli Title V anJ 'I'owu u1�1��3uard of SO I L EVALUATOR: ' \/l C� I lealth Ite ula FLOOD ZONE: �O�_ �1��'L/L�E3L� __ G g lions. WITNESS; -DO I TO VJ 2) The installer shall verily the location ol'utilities, sewer inverts and septic REFERENCE: Z/ ceo c3c0L? '2/6�� Pie, 2 g DATE: V uU1 '0 com onents prior to installation and seUiu base elevations. .... ---. - _. - - ----_- p p b PERCOLATION RATE: t` 1 , 1 , 3) All gravityseptic piping "to be 4 inch Sch 40 ( VC at 1/8 per toot. 'I'Ite first� two feet out of tl>e d�box to the iCaching shall be level. 4) This plan is not to be utilized for property line determination nor any other TH- I 'i TH-2 �_ D 1�/�1L1� ! purpose other than the proposed system installation. �� -- _ �� _ _ 'u t ` � 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over 1110 septic components. 477, 7) The property is bounded by property corners and property lines. 1, '�j g 'jj:�� 8) The property owner shall review design considerations to approve of total LOCATION MAP 3 b design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on (lie plan shall be deemed A= 9 approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material 1 uJL� per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per 1 Title V specs. I I"11V 10)System components to be 10 feet [rom water line. Sewer !fines crossing the — '� ( -1R D —4121tm- water line shall be sleeved with 4 inch SC11401 VC with ends grouted if 07 applicable. The proposed SAS is being installed below the water service OVVK)Z j� 'V �� 2�� ` line. The line is to be sleeved as aforementioned and maintained to place. / S E P'' ' I C SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the t owner to ensure such. \ FLOW E ST I MATE 12)The installer is to take caution in excavation around the gas line if such exists. I \ 13 Tile installer shall veri the location, quantity and elevation of the sewer O J N BEDROOMS AT I10 GAL/DAY/BEDROOM - �•ZU GAL/DAY ) .. verify.the �l Y / N lines exiting the dwelling prior to the installation. / N 14)TIiis plan is representative only that a system can fit on a property meeting p SEPTIC TANK Title requirements.' e V eq u GAL/DAY x 2 DAYS - GAL •`'- .`�._..(, � Vt✓L- USE I500 GALLON SEPTIC TANK �N _ 19 SODA SORPTION SYSTEM G iM13E�J -fix •� SIDE AREA: 7i Ci +1 , 9 0� UAVID _ -�-- — -3- °.7 9 �z / / BOTTOM AREA: 1 p,'7 z 3/1?j ' NIASON 000 , No.1066 SEPTIC SYSTEM SECTION r --- �`--- g� 1 \D ►0 1'l ! b q`� 70 0 h b Dor -R ra I ( GAL1pZ1:/V SE TIC TANK 3 �- I " �6H� j _ gmc� it 12.83 x 2y � 8y � _ ., e?° lbw( off ( _ PoLL � . 53 , a\ — SITE AND SEWAGE PLAN r� 1 - ' 6 �a � k1 �.ocAT I ON : ►�a �>a �w� Ile ►� � i PREPARED FOR : t p` SALE: ,Fl x DAV I D B . MASON F6 DATE: I� Y DQC ENV I RONMEN�TAL DESIGNS °s1 DATE HEALTH AGENT ( 508 ) S 833ANDw2 177 MA Z 7