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HomeMy WebLinkAbout0528 MAIN STREET (COTUIT) - Health 528 MAIN STREET, COTUIT A=037-001 l •. TOWN OF BARNSTABLE LOCATION ZZ7117a<, -'J 7 SEWAGE #791`"/7 VILLAGE I ®0 4, ASSESSOR'S MAP & LOT D -00 INSTALLER'S NAME&PHONE NO. j0M 9 i i 5'elJtt C 77 S'-S'17` SEPTIC TANK CAPACITY ISOO LEACHING FACILITY: (type) -0 t,US (size) 10 X a 5 t Z NO.OF BEDROOMS BUII.DER OR OWNER f PERM ITDATE: �-/`e``(?,_COMPLIANCE DATE: y I 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 r N �• C G if CN 43 �n {4 No. �/ - / - Fee $5 0 r_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Mtgpogal *pgtem Congtruction permit Application for a Permit to Construct( )Repair X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 52b Main St . , Cotuit, MA Paloma McLardy Assessor's Map/Parcel Wler'tPr"telsnffidOT1q.1* e Pt i c Service Designer's Name,Address and Tel.No. P 0 Box 1089, Centerville , MA 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 S and. Nature of Repairs or Alterations(Answer when applicable) new Title-5 septic system consisting of 1 , 5�00 gal. tank, D-box and. 2 leach chambers . 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 Bo d of Health. Signed `y l l l� _Date_ , —;—Y 7 Application Approved by Date V — a ?7 Application Disapproved for We fo owing reasons Permit No. 9 - J 7!1 Date Issued No. Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS_ Entered in computer:-Yes ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Of pphratton for Mtopaal *potem Construction Vermtt a Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 528 Main St. , Cotuit, MA Paloma McLard.y Assessor's Map/Parcel I ller's r",bejsp.la 0T fi.b"e pt is Service Designer's Name,Address and Tel.No. j P 0 Box 1089, Centerville, MA 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 tom``' Type of S.A.S. / Description of Soil Sand R.- ... «� Nature of Repairs or Alterations(Answer when a licable new Title-5 septic system ) ' consisting of 1 , FS0 gal. tank, D- ox an . 2 leach chambers. Dateilast inspected: Agree.'rtu ent: j The undersigned agrees to ensure the construction and-maintenance of the afore described on-site sewage disposal system m'accorcTance with the provisions'-otn'116=5 of the Environmental Code and not to place the system in operation until a Certifi= cate of�Compliance has been issued by tYiis,Bo d of Health. r Signed I i Date Applicati©n Approved by Date V - !o- %7 Application Disapproved for Re fol owing reasons Permit No. q 7 - /7 V Date Issued t^ ————————————————————— \ i r .. THE COMMONWEALTH OF MASSACHUSETTS ;McLard BARNSTABLE, MASSACHUSETTS y* Certificate of Compriance THIS IS TO CERTIFY,that the On-Rite Sewage Disposal System Constructed( )Repaired ( X )Upgraded( ) Abandoned`'( Eby i�mAE .R� inson Septic Servf_ce 528 Main S , "Coot! at � �""' '�,�e�,� _ ""'- ha�}iee�n;ccans�u�ted in accordance with the p�ovisi s of itle�and the fo Disposal System Construction Permit No. - dated n %m. 0. ot)inson fir. Installer Designer_____ The issuance of this p e s all not g�eo strued as a uarantee that the s ste w I�1�npCtio •/n as designed !1 Date ! `1 Inspector y �/ g o %tl V ——=———————————————————————————————————— No. Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS McLardy ' Migozar *p!tem Construction Vermit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 528 Main St . Cotuit . MA 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:_� - /,� — 9' Approved by q� TOWN OFBARNSTABLE LOCATION , ,�- SEWAGE #77—/7 L� VILLAGE �'—o� ASSESSOR'S MAP & LOT D � 'OLD INSTALLER'S NAME&PHONE NO. ;.I M C (Zhkj24-;N 5-C-O C 7 7 S-'�7-7 SEPTIC TANK CAPACITY 1 SOO LEACHING FACILITY: (type) -OUCsk t1t (size) 10 X a S Z NO.OF BEDROOMS Z aA3 BUILDER OR OWNER �G,g ' -ZJ PERMITDATE: dx`e`9J,mil COMPLIANCE DATE:- y 12t l 9q 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 0 L NOTICE: This Form Is To Be Used For The Repair Of Failed Septic Systems Only. CERTIFICATION-OF SKETCH AND—APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated f/r G ' aj concerning the property located at 528 Main St., Cotuit, MA meets all of the following criteria- * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. _ * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,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 Elevation(according to the Engineering Division G.I.S. map) .3 B)Observed Groundwater Table Evaluation(according to Health Division well map)_ r SIGNED: DATE AVy-(e LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). ��� m _ ¢Y�� � . � :l t. � (� _ a n � ' TOWN OF BARNSTABLE R LOCATION, � SEWAGE #���� 7 VILLAGE o , ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO.i0M >2aw> 77 SEPTIC TANK CAPACITY I Sb0 LEACHING FACILITY: (type) (size) _ 10 x a s r 2 NO. OF BEDROOMS Z,: BUILDER OR OWNER PVC �y2� PERMITDATE: �`e— - 2 COMPLIANCE DATE: 2 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet pack �F �vsF r 3 30 i V 1 r 5 Z 'e CO,CAT ION SEWAGE PERMIT NO. INSTALLER'S N—A-E A �A�DDRESS S U I L D E R OR OWNER j. c?L 1eS T DATE PERMIT ISSUED -7+ �-�t-�'� DATE COMPLIANCE ISSUED �_ mac,,go `Tco IJ URI Town MIN,.,; 'say; isZ7 South 6`_rM9t,4-0,,A 02 r( Fiz$... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ti�:...OF. . .................................... Appliration for Uispnoal Works Tomitrnrtion Frrntit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at: ------- -`� ».. �.. -------=---------------- ---------------C_eT to - -•--................................... f V\ 1^---- Location-Address or Lot No. ........�1.......v» slL: cal?.`.... ....................... . .- ............... ...................................»..... Address f' 7C<.................... a k 5 fr�.:�':!:^.... ..:.T!l! �................. s .. — to Mtiti3 ��'� ................ M Installer Address Q7i Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms...... .............Expansion Attic ( ) Garbage Grinder Other—T ............................ ( ) e of Building ....._..... No. of a Type g.................. -persons----------..:...:.------.. Showers ( ) — Cafeteria ( ) d Other fixtures - ......: •••••--•.................................. . W Design Flow...............��_._�_.............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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by..........................................•------••---••-....--•.......... Date......................................... a 14 Test Pit No. 1................minutes per inch Depth of, Test Pit.................... Depth to ground water........................ fs, . Test Pit No. 2................minutes.per inch Depth of Test Pit..................... Depth to ground water........................ W ................ ---••---•---------------•---•----•------•----...--------•----._........---............-----------_---- -- Description of Soil.......... t .... .. 7 r�lc �' .. ............:............•....* V ..........................................•------.......- . ------.................. • ------....---•----•---....._..........-••-•...........•--•••--•------...........-••••-•-•-•--- ..........--•... W V Nature of R e airs or Alterations—Answer when applicable......; p ......Q.1�!:+ .:.:...L. .�u. ... --- ----------- $ -��-:�•----ZY.TC1 �....I�A,0.....: �`��`6 c�-.Fj d.6. ,.................................... Agreement The undersigned agrees to install.the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LI' TL: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc ued by e azd.d healt . aY. Signed....... . D Application Approved B .. e�:. y ^: ...... ate y ........................•------•-- -•• --- � i Date Application Disapproved for the following reasons:............................................................................... .........................•-•--•--................................. .....----•---......--•--------.--........•..................--- --•------•-----------•--------....----.. . .......----- Date Permit No....................................................... Issued-........................................... ..........» Date No.. ' f -1,-- car FEs....1.E� .._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applirativi .fur .14sposal Works Tonotrurtiun rami# , Application is hereby made for a Permit to Construct ( ) or Repair ( ��an Individual Sewage Disposal " System at Y •.............._... _.. ............................. ........................................ ........................................ ` Location-Address or Lot No- -••--- �_ ................. ..........................t^ .................... ............................... �;SZ.:_.... -.........-•----•-•.....----...--......----- -�Owner- -'� Address �C rt .�7 , � . ' t 1 •; W+v.. s t -t,, V� ......... ......... ...._. . ._..........,.............................••• -••-•-.................•......----•- -- - ..._..� .......... _ ......._..... Installer Address Type of Building "! Size Lot...........................Sq. feet Dwelling—No. of Bedrooms-------....�..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ........... No. of persons............................ Showers a g ................ p ( ) — Cafeteria ) d Other fixtures --------------•--•-------------•--------------------------------------------------- --------------•----------- W Design Flow..............._ `.............. per person per day. Total daily flow.......: ._ .............. Ions. iX Septic Tank—Liquid capacity............gallons Length................ Width................. Diameter. ........ Depth................ Disposal Trench-No..................... Width .................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... leaching area..............:...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by:...... ..................... _..._ ..... ...._.._.. Date........................................ Test Pit No. 1..............:.minutes per inch Depth of Test Pit.................... Depth to ground .water...... ............... rX4 Test Pit.No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................................ -- ...--•-•--• -----•---• -- O Description of Soil........... - -f".__ ........ .._..e� .! .._ 1T;,............................................................ x U ------------------ -- - -- ------------- ----------• ---- --•••-•-•--••-----•-------------•------------------------------- --•...•-• --..........._...•----- W . UNature of Repairs or Alterations—Answer when applicable.._ l D b s-y n r " � t zc f,.. '®k a � •...... ........... 1 7 ��...-d........................................J' c -- °��-�?•-= '-•- ac °T s _�_.__ .!n'QnCt_�.;..._.�.. � •--•-------• . Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a. Certificate of Compliance has been lssu�ed by the board of health -� a" : � - Igned..:. ..•-••-..._ ..... `---•C" of�"�'.�"f'+ v Date Application Approved By....................................... _..-• Application Disapproved for the following reasons-------------------------•--------------..................._.----------------•-------------.....---•••......----- ..................................................... --••-• ...............•••......_..... -.......... •---•••-----............•..... .................... ..........._ Date PermitNo......................................................... Issued....... ...-••....••••-•--••--..._......_••--....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARDD OF HEALTH (Intifirate of Tamphana TI�IhS IS.,TO CERTIFY, That the Ind dual Sewage Disposal System constructed ( ) or Repaired ( ) by .. -'` / �.... �.� r- - ----•- ------•----_•_________ _ _____•---•-------.... ... -----•----•-- . ...... Installer at._••................1.:�:_�`'_~_........+-/Ili , !+�• - ------•`' t to d ..........................................................-____-___•--------- has been installed in accordance with the provisions of TITLE of The State Sanitary Code as described in the application for Disposal Works Construction. Permit No......................... ....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY cJ DATE............ r} ' Inspector...... tv�ry U 1_-..� _ r _.....::...:... . ..__.._.... ...... .....••• --•••---•••- ............. THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF .. ..... C Z!Z :. No......................... .......................... FEE---... a...... Disploa;-.n1_ urks Tonstra_#ian Prrmit Permission is hereby granted--------- u._v. ...........__ .. .......................................................... to Construct ( ) or=Repair ( ) an IndividuaAewage Di posal ystem atNo. = _ ..__..__..,�A_-------�--------------------•---•-----------•-----------------------•---•--.......... w Street as shown on the application for Disposal Works Construction Permit No......_.. �``�_ Dated.__._____ ��'.................. -------------------------------------•-•- --•-------•--•-----•---.................................... ............................ Board of Health •,DATE...........----r---x- -- •-'2f►r..C`�