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HomeMy WebLinkAbout1221 MAIN STREET (COTUIT) - Health 1221 Main Street Cotuit A= 01$-061 4r p � I i � I �r f r ! 4 r TOWN OF BARNSTABLE LOCATION J N 4--1 �'�,�e d— SEWAGE# 3 e-+ ILLAGE of i,t, ASSESSOR'S MAP&PARCEL S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 4 _62n 6 _ LEACHING FACILITY:(type) (size) _4jt;1+C NO.OF BEDROOMS =�� l-1 0-44L-G44-t OWNER & PERMIT DATE: 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility --d` Feet Private Water Supply Well 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) N Feet FURNISHED BY f '?a�IZI Ok- � y vpp by '7/Y 1 3 t�felf lie No. �y�'1' 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftphCAtion for loispoBAY *pstrm Construction Permit Application for a Permit to Construct( ) Repair Upgrade(< Abandon( ) complete System ❑Individual Components Location Address or Lot No. /o1oZ 1 �-j5'f. Owner's Name,Address,and Tel.No. o+tl- C A C nhe taoe�,Inc Av• GOx Pc364. Assessor's Map/Parcel /19 (o 1 %as p4-LL p Installer's Name,Address,and Tel.No. 50� L/� - 90� Designer's Name Address,and Tel.No. Syl (�r�lo�`i.Cars+rce_�-u°vr,,T.ne P.o.�x ''7Ot/ .F�etvr�ewe zZ✓►e q3'�rtilc�.vn Sf• Ar hfo 0ac�q� Type of Buflding: A,;(e 5V g-7 9(—/ Dwelling No.of Bedrooms Lot Size �o,'��7 �� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 6 O gpd Design flow provided �e0 gpd Plan Date v r ben a., 'O10(q Number of sheets I Revision Date Title!i4e 5 �La( MatAn S Qo . MI Size of Septic Tank '150,0d y.0 14ao Type of S.A.S. So �y ,L )t Description of Soil o-iu SCLj I v S4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenanc f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental C and n o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Dated /9� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. t^J � Date Issued 7= . � .r / _, Fee �. s t . ,THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN'OF BARNSTABLE, MASSACHUSETTS Yes 01pplicatlon for,]Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(,,ov)' Upgrade( Abandon( ) [complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. /o Assessor's Map/Parcel 0.4 1U1 .; Installer's Name,Address,and Tel.No. 60S- t/.;Z8-ff 9a -P Designer's Name,Address,and Tel.No. -S6FS 3e, tII�L- Q r�lctt�►'y S� L4 ' Type of Building: -Dwelling No.of Bedrooms `) Lot Size /0, e796 SP sq.,ft. GarbaFe G-inder,( ,;) ,f Other Type of Building No.of Persons Showers( ,,,),C,afeter1a(..,4,)� Other Fixtures Design Flow(min.requir&) `J 5(� gpd Design flow provided 5(e U gpd Plan Date 4/1111A,% .�--;;lhl 0. Number of sheets Revision Date Title PLC C v. !�L 001 -eAJ t ,t4 A Size of Septic Tank Type of S.A.S. _k0b S., f'=�as' a4& L ?i^ ,�'�W Description of Soil Nature of Repairs or Alterations(Answer,when applicable) Date.last inspected: _ g s A reement: The undersigned agrees'to ensure the cons tru�c1od d.mai fie ,4of the Ad6re d ertbe*tI-site'sewage disposal system in accordance with the provisions of Title 5 of the Envtronmental Code an' d no place the system m operation until a Certificate of �a - Compliance has been issued by this Board of Health Signed Date Z4 ,.-� Application Approved by ,; Date Application Disapproved by i 1 t -e Date for the following reasons Permit No: a015 Date Issued p — �j — / -----II---- ------------I`-----------------------------------------------------------------------------------,---------------------------n ?,.O/kK 111131, pq THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage/Disposal system Constructed( ) Repaired(t4 Upgraded( v)' _ . Abandoned( at I as l me?,Al S k has been constructed in accordance with the provisions of Title 5 and the for Disp osal'System Construction Permit No. C?la �—%L dated I k- `t Installer ,�ct�, Ct, r, „ i r�nv,L Designer [ , r J, V #bedrooms Approved design flow rjZl gpd i; The issuance of tl pe t shall not be construed as a guarantee that the system will nctio a designed Date Inspector _ +. No. a01 1 J D l/ Fee — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS p. Misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade{ Abandon( ) System located at /,-I!,( 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 mustbe completed within three years of the date of this permit. Date — / Approved by 5, (, NOV-21-2019 07:02 From: To:15087906304 Pa9e:1/1 Town of Barnstable Regulatory Services, .� Thomas F.Geiler,Director � ]Public Heal*Division n awy° Thomas McKean,Director 2001Vdain Street,Ayannie,MA 02602 Of9.co: 568-862A644 Fax: 508-790-6304 lkstaller&Desigger CcrtiAeation Form. ]Date: 1,I.',()I 0 Swage Perwim �/�- 348 y Assessor3s Mapwa reel ]Designer: J)DOUN 0AKaAjMM.k 6 Installer: &MLO-r-13 UNMWOR Address: qg2 NtMN ��� (o_�!l_ Address: . —V_Jpjd�a — WJA MN A 02160 OnI:. LO i issued a permit to install a septic system at 122 I Gi.l I S+. 1`,0+1)I based on a design drawn by (address PU dated 2.0 (designer) - I ceffy 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 distdbudon box and/or septic tank. I certify that the septic system, referenced above was installed with major changes (i.e. . gmatea than 10'lateral relocation of the SAS or say vertical relocation of any component of the septic sy t in accordance with State&Local Regulations. Plan revision or certified t by to follow M OF Afq DAN(ELA. (In.9tallWi ignt�ue) OJ N � CIVIL No.46502 aisleL 0 10 AL a�` (Designer's Signature , (Affix Designer's Stamp Here) PLEASE RETURN 0 S A+1 FMIC MALTH A ®N. CERTIMCATE 07. CoNgLUXcp, M& MT BB ISSOLID MTM BOTH MS FORM AM AB BUII.T CARD ARE Ii=IVBD Al TJM BA STADJB]PMjCBEALTHD 0N. !RANK Q:Hcdtbi/SeptkM=igaer Ccrdfieadon Form 3-26-04.doo ' J — avb rV►"7C(CI " Town of Barnstable P# 1 "' yeti Department of Regulatory Services BARMASS.LE, . _ Public Health Division Date '' + . y MASS. .. 1639• 200 Main Street,Hyannis MA 02601 H•c rFD MA1 Is.E Date Scheduled vh Time Fee Pd. DO Uy ai) Soil Suitability Assessment.for Se e Disposal Performed By: (�(GZ cCP Witnessed By: J LOCATION&'GENERAL INFOI-dA--TICN Location Address Jf Owner's Name wQ I Ca aq 1 wl f Address Assessor's Map/Parcel: /�'/ Engineer's Name .0 W NEW CONSTRUCTION ✓ REPAIR Telephone# G—oe 34)- ^ Land Use n6e_5, / _ o CbF'�s t eU Slopes(/o) Surface Stones Distances from: Open Water Body�_ft Possible Wet Area ft - Drinking Water Well ft Drainage Way co t 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) s � i©, Cv VQ ►U,5-6f Parent material(geologic) n u-r_6enipsifsDepth to Bedrock + Depth to Groundwater: Standing Water in Hole: t V C t Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HI Method Used: GH WATER TABLE Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft, Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level Observation PERCOLATIONTEST 'Date Time � A Hole# �s Time at 9" Depth of Perc J r 60 Time at 6" Start Pre-soak Time @ g Time(9"-6") End Pre-soak Rate Min./InchL f�?; Site Suitability Assessment: Site Passed_ V Site Failed:. Additional Testing Needed(YIN) iV 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 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 -t bt(( DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture' Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Consistency-%Graved Its DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Consistency,%Gravel 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 AS �a Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No X, Yes Depth of Naturally Occurring 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? ca If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature ot®a" Date Z � 1 Q:\SEPTIC\PERCFORM.DOC L 2r_0" IIr W5T.WDW. FILL IN E45T.WDW, EX15T..•WDW. I z N C) 3 I O"CUBBIES F RENOVATED I I d EX15T. ZZ c) ' �c BATH ° I I I DEN ;s I I I o ._ w CENTER DOOR BETWEEN FILL IN EXIST. DR. TUB AND 51NK5 EX15TING HALL j, r: r; DATE: 01 /30/2013• IIValcol: t .t Re nova t 1 ons SCALE: 1/4"= 1'.0" SECOND FLOOR PLAN I - .- - '- ` � � •' • , - -�'-f ice, �-f^• ,r f - 1 t ,'`� }•,��fij �;It777'� ,t�i1(f"�� E 1� �� `�; ;� �� � �,���tn i�u �{��R; `�' �'`�� �1�1 ��� �..�•� � � t � � � � ' Fir � • _C� �v �`� t GT U!'17f A S,,