HomeMy WebLinkAbout0290 MAIN STREET (COTUIT) - Health ,290 MAIN ST
COTUIT
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Gio MC,) Tgr OF BARNSTABLE
INS LOCATION ( )):',tLL�' SEWAGE # " Q 114
VIL'i-AGE T ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. i-Y�t
SEPTIC TANK CAPACITY I 50�
LEACHING FACILITY: (type) �rn f (size). .�e✓ � Q, �h(� ems_
NO.OF BEDROOMS
BUILDER OR OWNER
S°ERMTFDATE: ) 1 0 1 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
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 facili ) Feet
Furnished by —c
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No. "� � Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes
01ppYication for �Ngpogaf *pgtem Construction Verna
Application for a Permit to Construct(�J Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �00 0 1,t r., Owner's Name,AdM and Tel.No.
cV " Y ON'1h5
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Desig er's Name,Address and Tel.No.
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!„ rjYC.1&1"tT GOY'VS T`l^��la•.."� --yes Cj�n�v'Z�
'oZl►7 14-1 r5�✓''-a C-ra
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Type of Building:
Dwelling No.of Bedrooms Lot Size 45S0 b sq. ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow / 'c) gallons per day. Calculated daily flow Q16�0 gallons.
Plan Date c: c!r U Number of sheets 9 Yam. Revision Date
Title
Size of Septic Tank 1600 6*t._J1j Type of S.A.S.
Description of Soil
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 t ' oard o e lth.
Signed Date- C1 o�i7
Application Approved by Date S—
Application Disapproved for the following reasons
Permit No. ZG zi,�G'' Y Date Issued
mo 4-jp MCN,n T�AYN-OF BARNSTABLE-
LOCATION .` y�r T SEWAGE # - Q
VILLAGE
1 T ASSESSOR'S MAP & LOT n /3g
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY ) 6,00
LEACHING FACILITY: (type) t )1 3,, A_(size)
a
NO.OF BEDROOMS
Aim nCv nn niimrco
PERMIT DATE: I G' COMPLIANCE DATE:
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 wttlun 200 feet of leaching facility),. Feet
Edge:of Wr Hand and Leaching FaciLry(If any wetlands exist
within 300 feet of leaching facili ) `Feet
Furnished by
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C d
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Vi
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No. CN — Q/ ... ,.._,s:,� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
•PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpprtcation for Migpogar bpgtem Congtruction Permit
Application for a Permit to Construct(Repair( LL)Upgrade( )Abandon( ) O Complete System 1:1 Individual Components
Location Address or Lot No. I o 11 )A t Y, s rr a Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
-z 'Z - co8 age �2l _ s-7_
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
a4l 14P5rJ- i Crovcll r0-Q 1 4,AI 15 APJ0Uik. 4
Lj.- .S h -7'7 5-3-5 47019 1� 361`1
Type of Building:
Dwelling's No.of Bedrooms Trw Lot Size 4S 4 S0 b sq.ft. Garbage Grinder( )
Other Type of Building S . No. of Persons Showers( ) Cafeteria( )
Other Fixtures nn
Design Flow I) C7 gallons per day. Calculated daily flow gallons.
Plan Date `T 9O0 iNumber of sheets OYv. Revision Date
Title
Size of Septic Tank 1`2, G Kk1-0,J Type of S.A.S. 1500 c_A-.,-.
��x,sS.vG. u/4 5��.•r .Q •�cor
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
4.
Date last inspected: a f.
Agreement:
The undersigned agrees to ensure"the construe tion 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 t ' Board,of e th.-
Signed Date �C1 ',I-10
Application Approved by Date S
Application Disapproved for the following reasons
S
Permit No. .�7 Date Issued —
„� i
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE MASSACHUSETTS �`
Certificate of Compliance
THIS IS TO CERT at,t a//O�n- ite Sewa e}Dis o al S� tem)Co tructed+( "'Repaired ( )Upgraded( )
Abandoned( )by t� ' I�/i 1 /0 Al
at Z has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Z-07
Installer Designer - t) a
The issuance of this permit shall n t be cons ued7 a guarantee that the st—ey w function as esigned. :V
Date Inspector ,� / 1��,i �! I _(✓Xi> >'(1� �`` '
6/
----------------------------------------
No. Z (fro Fee
THE COMMONWEALTH OF MASSACHUSETTS
2 Z-� PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS
igogaY tern Congtructionerrnit
Permission is hereby granted to Construct(y)Repair( )Upgrade( )Abandon( )
System located at
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 jjjrmit.
Date: 9 ?ry Approved by
�. i
L CAT10 = ��; _ SE AGUE P MIT NO.
HILL,AGE $
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i INSTkLLER'S NAME i ADDRESS 1
9 U 1'L DE OR OWN ER
DATE: PERMIT ISSUED
DATE COMPLIANCE ISSUED
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TOWN OF BARNSTABLE
c&OCATION, SEWAGE # 1
LAGE ASSESS 'S MAP & LOT O22 ] 3 4
L . .' " NAME&PHONE N ',7I
SEPTIC TANK CAPACITY n "
LEACHING FACIL17I'Y: (type) t/,'ale Yo A Ac fd J:(size)
NO.OF BEDROOMS
BUILDER O OWN
i
PERMITDATE: OMPLIANCE DATE:
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
f
TOWN OF BARNSTABLE !
LOCATION; C) WA 1'mil S SEWAGE #/QP�
VILLAGE �� / /l/ � ASSESSOR'S MAP & LOTe22
INSTALLER'S NAME & PHONE NO. E e /oZ�( / ® 3
SEPTIC TANK CAPACITY
I;TACHING FACILITY:(type) " 6�p jLq l (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER G �/
DATE'PERMIT ISSUED: I f's
• Y
DATE COMPLIANCE ISSUED: %�Y�� ` C>2 d
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
w
BOAR® OF HEALTH
..................OF...... ' °(�
. � .................................................................
Apptiration for Disposal Works
Tonstrn.rtinn Vrrmif
Application is hereby made for a Permit to Construct or Repair ( ) an Individual wage Disposal
Syst at: G�.�n e1L �n ( ) J J /d
.....�l y.. _..¢.. :.. .�`."`°A &��'' r.^.SO^^` ..+ � ... •s------•-s-�-.--"-.-.•.1.................. (. U-----------`...............------•-----
Location-Address . r Lo o.
......................y__.To l(---- ---------•------.......------------------------------ ..............................---�� C��,u,�'-_.......��s.. ....------------- �
WJ.......I............ ...all Owner ddress
' .........
staller Address j
Q Type of Building. Size Lot___.__-..•__________________Sq. feet
V Dwelling—�No. of Bedrooms.__•____________________________ _____Expansion Attic ( ) Garbage Grinder (10-1,
'4 Other—T e of Building No. of persons________________•_•__.__.__. Showers —.:Cafeteria
a 6 Other fixtures .----------••-•---------•------•••-••--._._...:
W Design Flow._ _______________________________gallons per person per day. Total daily flow......... Z�•_:_:___________•_._____gallons.
W Septic Tank-I--Liquid capacityJPR.gallons Length................ Width................ Diameter................
Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.........(.......... Diameter.__._ ..... Depth below inlet....4............ Tot id leachi area._...' _�'
.... ft.
Z Other Distribution box ( ✓j Dosing n (
Percolation Test Results Performed by.__. !Oes�t
.�...._. _ _.__. Date.__f_b__=l._:._7_4( ..:...,_..
Test Pit No. ]................minutes per inch Depth Pit___._______.-_-_____ Depth to ground water........................
LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water.................-......
R+' ----------- --------------------•--- --•---•---•--
ODescription of Soil....-"•- •m •= # = '� < - -�/ lw ,� ..................
x
U
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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hag been issued by the board of health.
Sign • --••... .............•-------••--......,......---•--••-•••-•••-----•-•--------•- ..........................
/ Date
Application Approved By...... - l ` % Date -
Date
Application Disapproved for the following reasons: -------------•-----•----------------------------------------•---••----...•••-•-------•_.....
----•-----•--------•---•----------------••-----•--•--------------------._........-----------•----------•-•--_...-------•-•------•••••---•----•--------•--•---••-----•------•--•-••---•---_..._
-- Issued__•- --]. ----Permit No.---•------...--•----•---....--• ----?/--•----ae------
---------•............. � Date
4
NoP i�Z...... Fim..........
THE COMMONWEALTH OF MASSACHUSETTS
s� BOARD OF HEALTH
................. 4 ....................OF.....
..-- :_._:.:.....
Appliratinn for 11hipos al Works Tonstrnrtinn Vrrmit
"Application is hereby made for-a;�Eermit to Construct ( ) or Repair ( ) an Individual §ewage Disposal
Location-Address R Lo o iL
Ystaller O ...
wrier )* ,,Address
......... ' -----._......••----------•.._.....---- -•••-• ,
' Address
UType'of Buildin Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..._________________________________________Expansion Attic ( ) Garbage Grinder (
^, Other—Type of Building YP g ---------------------------- No. of persons............................. Showers ( ) — Cafeteria ( )
°..,.
Other fixtures = ------••• -•••-•._..__...-•-•-••-•.•-•••-••••••••••----•-•-• .................................................
W Design Flow__A.r.................................gallons per person per day. Total daily flow_.____.Z7-0........................gallons.
WSeptic Tank I--Liquid capacityAPP_gallons Length................ Width................ Diameter----------------- Depth................
x Disposal Trench—No_ ____________________ Width - ....... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......J_-......... Diameter..... Depth below inlet.... .. Tot id leach' area.. ;� '_O!....sq. ft.
Z Other Distribution box (U Dosing' n ( ) �
Percolation Test Results Performed by .- Date...`_6_*'Z_'_7f...........
� ,
a•k Test Pit No. L_______________minutes per inch Depth Test Pit_.__._._:::________ Depth to ground water_____._____..._.._._.__.
fZ4 Test Pit No. 2__..............minutes per inch Depth of Test Pit.................... Depth to ground water......._................
c� ...........
O
Description of,:Soal `•_.. .~.. .- ti. -►,.:..:. ---- Z.....-
...--- i
x
... _:_ ._
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 TITLE y g g p y
5-of the State Sanitary Code— The undersigned further agrees not to place system in
operation until a Certificate.of Compliance has been issued by the board of health.
Sign _____________________• ................. -----------------•• ...._.------
------•••-
Date
Application Approved By________ . '_
Date
Application Disapproved for the following reasons:.....................
..........................................................................................
-------------------------------•--...-----•--------••----.....---------1 11...........................................................................................................................
Date
PermitNo.......................-.................................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
P
BOARD O, HEALTH
........... .k .:.. ...OF..... ...... ,.
9rdifiratr of Toutpli
. T S S, TO ERTIF,Y, T he Individual Sewage Dis'o al S stem constructed ( or Repaired ( )
.S'
lost
gip'
has been installed in accordance with the provisions of T1 5 of The State Sanitary Code as described in the
AZI application for Disposal_Works Construction Permit >VTo____ _' ____________________ dated �.__ -'_ : . .___.._____..
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A G RANTEE THAT THE
SYSTEM WILL F NCTION SATISFACTORY.
•-- ..................
DATE... ......... Inspector.-_•--• • •••--=- -••-••.. .......... .:
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
/ ..OF...... Xi .....................................................
No:........ ............ FEE ......................
i �trr irk Tnnitr ,ion ra it f
Permission i hereby granted" ....a _ fP_ .. ...._ _. ..� -r ...........
...........
...._..
to Cos uct ( or ep ) an In iv dual Sew Disposal St j
v � , � `���
at No `r A R'..... ..
Street d
as shown on the application for Disposal Works Construction P t No. : Dated..... `_. I
'T C Board of Health
-----
FORM 1255' HOBBS & WARREN, INC., PUBLISHERS
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