HomeMy WebLinkAbout0171 MAIN STREET (COTUIT) - Health A�
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LOCATION SEWAGE PERMIT NO.
VILLAGE
INS/TJA L 2E ' NAME i ADDRESS
S U I L D E R OR OWNER
DATE PERMIT ISSUED 9 �'
DATE COMPLIANCE ISSUED
i
AIN syll-
No._.........
9-j_ Fss... ....
THE COMMONWEALTH OF MASSACHUSETTS
<txa
BOARD ® H EA ' T
-----------OF........... • .............................
for Dig anal rk Tmitm inn Urrmit
Application is hereby made for a Permit to Construct ( ). or Repair (k< an Individual Sewage Disposal
System
at: �. �-� � .---...C��t - _..........................
.............. .�..-•-- - ....... .
Locatio ddr ss or Lot No.
/��;Z.5114 S NIA----------••--------------------------------••-- ...........,,
w --•- .. ..........
� ••--------------•---........----•--•- Installer
Address
-Type of Building Size Lot......:......... Sq. f
U Dwelling No. of Bedrooms._ ...................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Buildin ............... No. of persons............................ Showers ( ) — Cafeteria ( )
Q, Other fixtures.-----------•---------------------------•------....----....-----------•-•-----•---------•--•-------•---•-•-.........................-----•......•-----
d. gallons.
W Design Flow...............��...............gallons per person per day. Total daily flow............................................
04 Septic Tank—Liquid'capacityZ.99�gallons Length---Z........Width_J.......... Diameter._....... Depth--._._......
W Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area.._.--,----•--•-- sq. ft.
x •� ft.
Seepage Pit No.Z.6° _..... Diameter....Id..._...... Depth below inlet.....4.._........ Total leaching area._2..�_ sq.
Z Other Distribution box (k-Y Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----------------------------------------
.
� Test Pit No. 1................minAutes per inch Depth of Test Pit.................... Depth to ground water....................
_._..
w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
RS -----------------------------------•----•--•--•------------.......-•----.............------------•--.......................
0 Description of Soil...............................................................................................................................................................-•-----•
V -••.........................--•-------•------••-----•-----------•-----••--•.....................•---------•-----------•---•-•-----•--•---•------------•--•----••--•---....--•-•............-------•-•-
.--•-------------•-------•------•...........................--------...---------------------•-----------------------------•-----....---•-••-----•--•----...-•----------...--......... ..
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-•--•----•--••----•.................•-••---•--•----.......-----••------••-----••----•••••-•---......._..---......--------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
TITLE 5 of the State Sanitary Cod —T ndersigned f r agrees not to place the system in
.the provisions of T I�,..:.
operation until a Certificate of Compliance has been 's ed ar h. '
y �
Signe . --------•--- ..... ... a $
.Application Approved B . ... • Date..... "-------- -------
Application Disapproved for the following reasons:----....-•---------------•--------------------------•------••----•-•----•----•-----------.............••.•••---
...................•-------.....---.......-----••--•-------............-•-'--.........---......... �..
-
.................. Date
PermitNo------------------------------------------------------ Issued------................................................
Date
�s �� /7 a
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
I A ,
m / �C(�'J LI
DATA
a
Assessor%s office(1st Floor):
Assessor's map and lot number
Board of Health(3rd floor): t''l
Sewage Permit number
Z BAL33TABLE i
Engineering Department(3rd floor):
00 .630.
House number MIN d
Definitive Plan Approved by Planning,Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BAR.NSTABLE .
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO
'J
TYPE OF CONSTRUCTION19
1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location \ �
Proposed Use A�k
Zoning District ,�'` Fire District C
Name of Owner 1 °.� u� `` .L' Address I L m
Name of Builders -( � ` �� Address
�4-Name of Architect •'"" �' Address
Number of Rooms t Foundation t...' Y1 i v J i
Exterior l t_ 0(-,J'. Roofing t �;
t,
Interior
Floors
Heating -
�, . C Plumbing
Fireplace $ )C) Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
I
OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name r -
Construction Supervisor's License
- i
i
TIi0A5AS., Z, T� AN. Ao A-G23T-027
No 33�—Permit For Finis GLrac:e/Conver_t to Apartment \
Famil del 1 i c{
Location 71 Main Street —
1
C�t t I
Owner r ; � i ; -,n A Themes r •
Type of Construction Frame
Plot Lot
Permit Granted FebruSi 0
ary 27 . 19
Date of Inspection 9
Date Completed 9
I'
i
a
i
PERMIT COMPLETED 1/1/
if
I:
_ Amy
No...............q .. Fps... .......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® O HEA �'T
-----------OF....... -------------------------
Appliration for Uhip i al Works Tomitrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (oj an Indiv-i^duual Sewage Disposal
-• _ •.... ------_.�................•-•_... ........................._...... .�" ...............
• --
Locatio ddress or Lot No.
.......................................................... .. .................................................
Installer Address
Q Type of Building Size Lot............................Sq feb't
U
Dwelling—No. of Bedrooms___ ______________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building r ...._ No. of persons__.•___--___---•-___._______ Showers ( ) — Cafeteria ( )
a YP g ..;,
dOther fixtures ------- -----------------------------------------•---•••---•-••••••-•...•----•-•-•-•-•--•-•...-•---••••-•-•--•-•--•••---•--•......-•-•••-•---....•. "
Design Flow............... ... gallons per person per day. Total daily flow............................................
W g �=-�--------------g P P P Y• Ygallons.
Septic Tank—Liquid*capacity
I�®—gallons Length-_-V.........Width__.!........... Diameter---040------- Depth...4..........
W Disposal Trench—No. .................... Width...•......._._._._.. Total Length.__......_..._....__ Total leaching area..__.:........... sq. ft.
x / TT
Seepage Pit No./A1.d..._..... Diameter....Id...__..._. Depth below inlet.._..l�............. Total leaching area..2__�O�fsq. ft.
Z Other Distribution box (k,�j Dosing tank ( )
Percolation Test Results Performed by......................................................................... Date........................................
a
Test Pit No. 1----------------minutes per inch Depth of Test Pit-_--_.----._________ Depth to ground water.......................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 -••••••--------•-------•-•••------•-•-•-•••-•-•-•------•-•-•-•••••••••••............•-----------•......................................-.....................
ODescription of Soil................................................................................................................................I
U -•••••-•••••-••-•------•-•-•-•••••-•-••----•----•-••-•••-••---•••-•-••-•-•---•••-••--••----•-------•-••---•--•••••-•••-•----•-••----•-••---•----•••------••--•-•--•••-•••-•----•-•--••-•••-••-••-•------
W •--••-•------------------------------------------------------------------------------------------------------------ _..-----•••-----•-••--••-------•---------•--------•---------•--••------•-•-
UNature of Repairs or Alterations—Answer when applicable._.----.........................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the rovisions of ii
p 5 of the State Sanitary Cod —T ndersigned £ r agrees not to place the system in
operation until a Certificate of Compliance has been 's ed ar h. q
Signe ..... •_ ........... ...................... ••-- ...../.... �.. .
.Application Approved BY•---•.. /l ........ ... .........................
Date
Application Disapproved for the following reasons-------------------------------------------------------------------------------------...........................
....-•--•••-•-••-•-----------------------••-------------------........---•---------------•-•----------------•-••.....--••--••---•----------------------------•----•-•-••-•----••----••--•-••.................................
Date
PermitNo......................................................... Issued_._,._'- ��----------..........--------------•-•
Date
•
No...._.....�j.��y Fps...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEA T
Appliration for Uiopoiial Worki,,Tomitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (p 5 an Individual Sewage Disposal
' System at
7�
SS
. _ i ................:..... ...........v......... ......_ `. .......................
^'" Locatio - ddres or Lot No.
,!�'G:�.k�..S"tr.i� ----------,..''`,.. ?..'e......._. ._.......---
Waj44
0 .jv �d9G�r/L/ 'u/.ves /�/• �`'.6
-• -••- .............••........- ........A{--- 3
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms___ ______________________________________Expansion Attic ( ) Garbage Grinder
P-1 Other—Type of 'Building ............................ No. of persons............................ Showers ( ) - Cafeteria ( )
Q' Other fixtures ..................................
w Design Flow............... Y....._....._.._...gallons per person per day. Total daily flow......................._...... ._.......__gallons.
WSeptic Tank—Liquid capacity/AOV_gallons Length--- Width_J.._..... Diameter-- -______ Depth...0.........
x Disposal Trench—No..................... Width.............._..... Total Length............. Total leaching area----- ____._.._�/_-sq. ft.
Seepage Pit No./-&.'0.a.__._:.. Diameter.... Depth below inlet.____�P__........._ Total leaching area.�._�d_�!+_sq. ft.
z Other Distribution box ( f Dosing tank ( )
'-� Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per,inch Depth of Test Pit.................... Depth to gro>knd water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------_................
Ri k'
_______________________________
0 Description of Soil................................................................... �.......,. .....
x
w
UNature of Repairs or Alterations—Answer when applicable------------------------------------------------...............................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the rovision of t T
p 5 of the State Sanitary Cod — T undersigned f r agrees not to place the system in
operation until a Certificate of'Compliance has bee -s ued b ar th.
Sign e ..... .• _ . = 9 -
e` � a
Application Approved By...........!f •.. .....-, . ------ __19........- ----------
Date
Application Disapproved for the following reasons:-"----------------------•-----•-•-• -..........................................................................
------------•-••••------.............. ----- -•-------•------------••......••...===-------------------------•-•---
".x Date ae
Permit No Issued
Date ;
THE COMMONWEALTH OF MASSAHUSETTS
f� £y
"BOARD`-OF HEALTH
.......... ....OF......... .E7 .A..............................................
r uErtifiratr of Tompliaiirr �
THIS I 0 RTIFY, That* Inai ual Se ge Disposal System constructed ( ) or Repaired (
__.._.... _. ..
�'Itnstall
has been installed in accordance;:with the provisions of T ��T�x., 5 of The State Sanitary.,,Code as describ d in the
a P
application for Disposal Works Construction Permit No._D .. L I dated �.i. �.______._
THE ISSUANCE OF THIS ,CERTIFICATE SHALL NOT BE CONSTRUE® A A GUARANTEE THAT TIME
SYSTEM WI L FUNCTION SATISFACTORY. "�'V`
DATE.. ns ec"tor �7L/cr�L j
t. ra., +.ht a .7, � 4 ,-5.r..;;•-!.i,- ,lr,#..��"s>`..i.?.r�.Jn,+-ik%4•i;i�#'V7 � g",'�^��^,r e,T.' -- n s:±<�x� i T„,.• �,i+�'�'`�'�'+4d'.��`,ti'!'A•"';
.4.� ;o.r.d
µµF.MI 'd�AW^ '""^ V7Eif `Sdk�F" �5k"A'�" •"-' -
�E`COMMONWEALTH OF MASSACWUSETTS _,...,. ......�.�.,,•..,__.."_�._..w.,,,.,�,:v,,.-,,,,.,.�,..»•,.-_.•--.•-�.,—..,...«,�,^"
BOARD F HEALTH r
_ ����l €:- ...........7-
. • OF .....................................................
No......... ��:. _ FEE. 4/
iopo11 `ko..-W no - io yr , if
Permission is hereby grante _ !!1!:_ _- 4_. r _ --------------
to Cons ( ) or par an Indivld 1 Sevt�age s osal S s
�rr
at N � ' LtELf-- '
d%� street ��aa
as shown on the application for,Disposal Works Cono.
ection Permit . •,__________ __ ____ ted_:....,1_____� ....•--
-
DATE---------� ...... .......
Board of Health
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS "
r
Town of Barnstable P#
Department of Regulatory Services
BARNSfABLE, s Public Health Division Date
MASS.
v� 05 �e� 200 Main Street,Hyannis MA 02601JOP
/►/�
�FDMA't► r f + �
Date Scheduled ti v + ' 'p `Time' 3 Fee Pd2 '' r�I
(h;Soil Suiility Assessment for Se
Performed By: Witnessed By:
LOCATION&:GENERAL INFORMATION
Location Address 7 Al4 1.. /r g,,,+ Owner's Name Frt1er,CA11
C®7 T Address P, L).L�CX
^n �1 C D T 44-Y
Assessor's Map/Parcel: Y A a p (�3 � 'PCi r-cz,�aV7 Engineer's Name j) cue t- _ A r�
e^ o�
NEW CONSTRUCTION ' REPAIR r 'Telephone# 0 7 y f
Land Use k\�t 1 eL k�4L, Slopes(%) � Surface Stones
Distances from: Open Water Body 3 ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
A
C75
+
Parent material(geologic)— `�+ Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: %0y1 Weeping from Pit Face DV�A
Estimated Seasonal High Groundwater n1.0 W \-Z PK
K� yDETERIVIINATION FORwSEASONAL HIGH WATER;TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOL'ATION.TEST-a Date 1 Tu'i,eVvi`;
Observation e
Hole# ` Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ 0 T, Time(9"-6")
End Pre-soak Ot
Rate Min./Inch �� � ��(:� _!Sea w(3ut � OML5 1 ,
Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division 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:\SEPTIC\PERCFORM.DOC
1
ole#DEEP,OBSERVATIO HOLE LOG H N
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
� 0 �� g F �� t� Y�311 i�I��i,�
_ DEEP OBSERVA H TION OI;E LOG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
LEA,-- %—
l t 1
t>� b T�[f a(=SAhts� kt 3 1 h3r%c- j Rom—
%A'iDI �y� 5A4 7-," ifs L hOtne. V,00s-e-
DEEP OBSERVATION;HOLE;LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Graven
C)
r' rl
DEEPOBSERVATIONHOLELO.Depth from Soil Horizon Soil Texture ry Soil Color
r Soil Other - L�
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones, oulders
Consistenc %Gr.el :�
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? • ;
If not,what is the depth of naturally occurring p rvio� us material?
Certification
I certify that on'�Lk 7�� (date)I have passed the soil evaluator examination approved by the
Department of Enviro mental Protection and that the above analysisiwas performed by me consistent with
the required tr efining, pertise and experien6edescribbedd in 310 CM R 15.017.
Si nature - 9 v ' Date
g �
Q:\SEPTIC\PERCFORM.DOC