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Home My WebLink About0409 MAIN STREET (COTUIT) - Health 409 Main Street, Cotuit I i i '1 III i f x TOWN OF BARNSTABLE LOCATION ��9 / �� 67' SEWAGE VILLAGE Cofcrl� L ASSESSOR'S MAP& LOT-! �-,5 INSTALLER'S NAME&PHONE NO. �ya�'7�oly l Ca�sT 7-2 SEPTIC TANK CAPACITY l S oO G k C- LEACHING FACILITY: (type), A"Id, T(size) / 3 3 IK G � s NO.OF BEDROOMS BUELDER OR OWNER PERMTTDATE: COMPLIANCE DATE: 40r-'1 �- � Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility t 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 aching facility Feet Furnished by �� 0 �a 6 L. �� 6 - B- 'O 9 .� �. i S �_ �_ No. e 7 6 s Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Oiopozai Opotem Construction Vertu Application is hereby made for a Permit to Construct( )or Repair( k�an On-site Sewage Disposal System at: Location Address or Lot No. /'d�J /�I y Owner's Name,Add ss and Tel:No. CO y`Ge/`T Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,ffvey�Gv � ins. '7 7 Type of Building: Dwelling No.of Bedrooms�3 Garbage Grinder �� Other Type of Building �JZ&Mf No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 r3 e gallons. Plan Date Nu ber of sheets Revision Date Title �� e` I dg o` 0 Description of Soil Nature of Repairs or Alterations(Answer when a licable 10— v �. ins IZ 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 W�;,Vth / Signed Date 7lZ �v Application Approved by 7 Date a-S 6 Application Disapproved for the following reasons Permit No. / �O ��V& Date Issued QZZ ' �Z /7 , No. C& ..��,'..�.=� � � �� Fee THE.COMMONWEALTH OF MASSACHUSETTS e PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS' 2pplication for 0i0000l 6potem Cottgtruction Permit Application is hereby made for a Permit to Construct( )or Repair( van On-site Sewage Disposal System at: Location Address or Lot No. 9i y� S y Owner's Name,Address and Tel.No. / Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer'(Name,Address and Tel.No. ti I Type of Building: Dwelling No.of Bedrooms_ Garbage Grinder,(.G)''y�' F Other Type of Building f/,-. �i No.of Persons Showers( ) Cafeteria( ) f Other Fixtures Design Flow gallons per day. Calculated daily flow _3� gallons. ' Plan Date !_ Number of sheets Revision Date Title iI Description of Soil Nature of Repairs or Alterations(Answer when ap licable) ®e 64 r �• - y4 ` Date last inspected: j Agreement: f 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 s B.and o e th. Signed Date -,h—Zoew Application Approved by ` Date -94 Application Disapproved for the following reasons 4 ' F Permit No. 9 b /�a Date Issued l ' ! • -- -- ---------------- -• -i-- S i f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(�n i4 by ,� e _ l.D&'4,9X-577- Installer I at �T� �i�To�,�T has been constructed in accordance with the provisions of Titles and the for Disposal System Construction Permit No. dated Date Inspector .? / *' i — � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. r C' ... 7r/1 --------------- � -- No. 2Z -0� Fee T Ito E THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS" &!5pogaf *p!6tem Construction Permit Permission is hereby granted to �Clr ��L/j ill ��57`✓�/f'�i to construct( )repair an On-site Sewage System located at No.# Stree �'. and as described in the above Application for Disposal System Construction Permit 6;3 ;_. ite V 1 j No. Da The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: %— o2-S l Approved by Board of Health � s Poo oI- ob o � , q® PQ AJ w CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CUNSTRUt TION PEINIH'iVVITIIUUT DESIGNEI) PLANS) re�&l—jV hereby certify that the application for disposal works construction permit signed by me dated 7/zs/?V concerning the property located at 1-1&4? 1h411-V 6 7_ Go 14e meets all of the following criteria: V within no feet of the proposed septic system T ure arc no wetlands I p opo to � _ here are no private wells within 150 feet of the proposed septic system 'he observed groundwater table is 14 feet or greater below the.bottom of the leaching facility • ere is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED.: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAttach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submittedl. t _ ..x„c�-+'-r n'}. :,,a•Ets�' Y:ut 391�xt �' ' tin fi.�.';.F>�_.��:.:z�s �*..+d.�v� .� .r � ,L^�. .,T fir. ':,, � ;. },i�a ,yt�-^ x: t - . �