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HomeMy WebLinkAbout0290 COTUIT BAY DRIVE - Health 290 COTUIT SAY D COTUIT A = 056 031 - -- 4 j TGV N,E)F BARNSTABLE OCATION ZQ® C® SEWAGE # VILLAGE C® tO z�T- "` ASSESSOR'S'M�AP & LOT�✓�6 d�/ INSTALLER'S'NAME'&PHONE NO: 77 SEPTIC TANK CAPACITY A,060 e v� LEACHING FACILITY: (type) .44h aly-.5 (size) ®m a 00�W ' NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: ��`� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Witer 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 BCI r7 .. - r No. �9 - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: les PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0ppYication for 0i5p0al *pgtem Cons�truction V—errmtt Application for a Permit to Construct( )Repair( V)Upgrade( )Abandon( ) El Complete System IFKhvidual Components Location Address or Lot No. Owner's Name,Address and Tel.No. zq� cor�r�-may - Assessor's Bap c h� a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �ryaGorf7 CO�lb�` 77 Q' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building PiW�'eNo.of Persons Showers( ) Cafeteria( ) Other Fixtures ,J 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 �6X 7®� 7 > 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 by th' Board Signed Date Application Approved by Application Disapproved for the following reasons Permit No. lZa'y Date Issued TOWN OF BARNSTABLE LOCATION Z9D SEWAGE # Z �Z5-3 VILLAGE_ LO t6e��T- ASSESSOR'S MAP & LOT 05—'-L INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 0,6G p t ? LEACHING FACILITY: (type) A � (size) 16 X 0/a xd� i NO. OF BEDROOMS BUILDER OR OWNER i PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table to the 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 j within 300 feet of leaching facility) Feet Furnished by /IL I o. i . ph .mod O .�F y �y ds 6-ate � a�v ° .�' -No �-�. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Mi5paal *p5tetn Construction 3permit Application for a Permit to Construct( )Repair(,Y)Upgrade( )Abandon( ) ❑Complete System L�'It►dividual Components Location Address or Lot No. 2-f,,57 Owner's Name,Address and Tel.No. W `P Assessor's ,-vex C�r,�'r`'f.s Map c a� y��j"T' Installer's Name,Address,and Tel.No. / ✓ Designer's Name,Address and Tel.No. &rfaGOe%Clv15r Type of Building: Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder( � Other Type of Building e 7 es'_'eNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow PC/) gallons per day. Calculated daily flow � � gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /r15 / � Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 41 J� �C", 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 i Bo d-of Hea th. -- Signed i Date Application Approved by Date /0-f Application Disapproved for the following reasons Permit No. x: ,a OK-* Date Issued W; -Foot/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTWY, that the On site Sewage Disposal System Constructed( )Repaired (1--)Upgraded( ) Abandoned( )by f. � at C/� V 1,7' Chas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit � -- JF�dated /. f If- A0,_0JPW Installer Designer ZI;1\ o r Cl The issuance of this permitsha] 'sot be/co�strued as a guarantee that the syste' 1 will functio/Yn;i es2.gn�ed.v Date /J �1 Id i Inspector � �/ � � b /Tf���i IL —:) — ------- -----------O,5O Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS migpoat bpgtetn Construction 30erntit Permission is hereby granted o Construct( )Repair( Upgrade( ,)Abandon( ) System located at Z �d CO J`�l �y ✓� / ���`�� 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.pfsmt. ' Date: Ad � '' y Approved by �J ✓ mil -'yam 5z 1 NOTICE: This Form Is To Bets ' For the Repair Of Failed Se tic Systems. Only. CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 10117100 concerning the property located.at ZQ'� CO�`Z!�)`�� / meets all of the following criteria:. /The failed system,is connected to a residential dwelling only. There are no commercial or business uses.asscciated with the dwelling. V/The soil is classified as CLASS I and the pe coiation rate is less than or a ual o minutes per inc'M There are no wetlands within 100 feet of he proposed septic system /7here are no private wells within.I_0 ee;of the proposed septic sv_stem. rI here is no increase inflow and/or change in use propose There are no variances requested or needed- The bottom of the proposed leaching farlity will not be located less than Eve feet above the ma..'dmum adjusted.groundwater table.elevation. [Adjust the groundwater table using the=rimotor .method when applicable], Ilf the S.AS. will be located with 250 feet of any vegetated wetlan ds. the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please.complete the following: A) Top of Ground Surface Elevation(using GIS information) x B) G.W.Elevation L7,J +the MAX High G.W. Adjustment DIFFERENCE BETWEEN A and B ZZ-c SIGNED : DATE: /P!/711 0 (Sketch PwPosed plan of system on trait]: T.bomb folic:art • L 0 0 . o for qex� V 1. 0 A T ION SEWAGE PERMIT NO. 4� —.,.f6 - - . VILLAGE CO /ul 4 INSTALLER'S AME i ADORES *-re ck S U 1 Lp E R OR OW ER of � DATE PERMIT ISSUED DA-TE COMPLIANCE ISSUEDa ' ae s , , ° //0J`S� e `'`130Y THE COMMONWEALTH OF MASSACHUSETTS " BOAR® OF HEALTH ...._.. ..:.'. . ..............OF.........................----•-...._..................................................... Applira#iou for Bhipoii al Works T mitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........Z_O.Z-...-9V...!!: � . ., :..© ------------------------•---•-------------__ .........._._..._.._..._..............--- - -- ------------- - Locatio - dress or Lot No. re� ..�2�9 ......... ..... ... ��� .X. !lst.S ..Ma-'---....................................------- Owner t Address W ..... 10_ ... ......................... .......Paco.-��x Y._....P�/l',/f--_................................. 1.4� Installer ddress d Type of Building rr-'�� Size Lot............................Sq. feet Dwelling—No. of Bedrooms._._.____�.3_............................Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 Other fixtures ------------------------------•. - W Design Flow........... ...Q-...........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. Seepage Pit No-------------------_ Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................ f� Test Pit No. 2.................niinutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' ---------------•--••--•-•-•--•----------------...----••.._..---------- -----•-------.._..---._..........----•------.........-----••------•--•......---•-. ODescription of Soil..................................................................................--....................--------------------------------------------------------------- x 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 TITLL 5 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/thhe(board of health.. Signedr /-"--`-- to e'i -Z'� Application Approved BY ................... Application Disapproved for the following reasons:.............................................._.............._____________________ ................................................... ................•--.....--------•.....--_....._.......---------------------------._...-•--••-•----------..__.._.__....-------•-•-----••-•-•-••---...-- .................................................. Date PermitNo......................................................... Issued....................................................... Date No....��n' .:.rt:J Fine ................... THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ............. ...........................O F........................................--------------------._......................._..-- Appliration for OWpoual Workii Towitrurtion Vami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at �y f ........... t.. ...�.�K 4 : ��4.a.' f r .. ...... ....-•.............................. .................................................... - Locatio - .dress or Lot No ...... a.: 1. ..�, ;.. -------------------------- ....... _,d _ a! �.. *..........--•---------------......----------- Owner If Address a '.. ► ? .a. 'r :....... I../...& ................................... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___......_ .__..Expansion Attic ( ) Garbage Grinder ( ) U — '� Other—Type T e of Building No. of persons............................. Showers Cafeteria CAI YP g ---------------------------- P ( ) ( ) PI Other fixtures ................. .......................................-------•--------•---------------- w Design Flow........... 7 _.. c,.S��_•-.....__._gallons per person per day. Total daily flow.........s. .4 ...............gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width......._............ Total Length.................... Total leaching area....................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........................................ ,4 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------------------------ -----------------------------------------------------------------------------•-------------------------- -------------------------- ---........................ 0 Description of Soil........................................................................................................................................................................ x w VNature 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 TITIE 5 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 tthhe/board of health. Signed........ .L....°..... ---•-----------•- ! .�f. to Application Approved BY :��.% '.. ' ' Date Application Disapproved for the following reasons---------------------------------•-------------------•----------•----------------------•-•-. -•----------..... ...................•........---•------•-------------•----•.....---•---••----------•....---•--•---------•----------•-•• •--•----•--•------•---•••••---••----•••------•--•------•--•-•-----•-•----------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................I.....OF.................................................................................... Turdifiratr of Toutpliuurr THIS IS TO CE IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by1�..�._..... -i --------------------------------•-------------•---•-----......--------•-------•-----•---------........------------...-----.......---•----- y Installer. at.............. *'.....�� !` ---•---------------•------.....----._.....---•-----------•---------•-•------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._.,9.2 Y Y1............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI CT RY. DATE..................................... � U.__.. Inspector... ........ --A-f r-•--------------------------------------.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '7 t .............OF..................................................................................... FEE.... .Zr................... Disposal.Vorkv Tonstrudiou jArrutit Permission is ereby granted'---••-...... '_ =----------------------•-•---•----------------........------•--....--•--•--........ to Construct ( ),pr Repair ( ) an Individual Sewage Disposal System r . Street as shown on the application for Disposal Works Construction Permit No... ................. Dated.......................................... -------x= ....................................................... Q ....................... Board of Health DATE........................ --�/-�--0------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS C:4-CoAl 7- n. 771--77 7,- F 77-'-,,7/- �,—r- 47 44 V le, '-,C- A? --O"F C6-40 A514e/ Ael—_ I—4L9AV (:;7,op,447,D,-- w 7- 0 0 16 Is A IVIA1. 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