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HomeMy WebLinkAbout0067 OLD KINGS ROAD - Health 67 .OLD KINGS ROAD, COTUIT A r TOWN OF BARNSsTABLE LOCATION 2 ©le.� �y��,5 � SEWAGE# '` d VILLAGE / ASSESSOR'S MAP& LOTD / 'D® INSTALLER'S NAME&PHONE NO. ' r Fr? SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L1-" /"1 o'L'o "3 (size) 10 NO.OF BEDROOMS �Z BUILDER OR OWNER PERMPTDATE: 7 —1 -,2 - 9 7 COMPLIANCE DATE: —1 F—cr J Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom /e.- Privateility Feet Water Supply Welland Leaching Facility (Ifon site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlan within 300 feet of leaching facility) Feet Furnished by , , .,, �1� y aY ,. -4 ..� A - .� ,. �... _ • �� � -V:, M �� �� � _ � i\o �: �... ....._..` ..� ,_. �.�._.�,e_,_. ,1 � fd\ � No. ' Fee$50.00 THE COMMONWEALTH OF MASSACHUSE iS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for ]0igpo!9a1 *pgtem Comaruction Vertu Application fora Permit to Construct( )Repair( )Upgrade(xx)Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 67 Old Kings Road Owner's Name,Address and Tel.No. 4 2 8—6 7 7 8 Assessor'sMap/Parcel COtuit, MA 02535 John Ponte Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Service PO Box 1089 , Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq. ft. Garbage Grinder(no) 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 sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic system consisting of 1500g tank, D—Box, and four stonepacked infiltrators'. 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 's Bpard of Healt . Signed Date ) Application Approved b o Date — Application Disapproved for the following reasons Permit No. Date Issued 1 7- -, TOWN OF BARNSTABLE LOCATION SEWAGE# ` S VELLAGE �' a 1 r ASSESSOR'S MAP& LOT Q! INSTALLER`S NAME&PHONE NO. 95'- �� � SEPTIC TANK CAPACITY LEACH NG'FACU,ITY: (type) (size) NO.OF BEDROOMS Lf ? BUILDER OR OWNER PERMITDATE: "l 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching cility Feet IV) Private Water Supply Welland Leaching Facility (If any well xist Feet on site or within 200 feet of leaching facility) ; Edge of Wetland and Leaching Facility(If any wetlands st Feet. within 300 feet of leaching facility) Furnished by i 1` t n- Wit' C� r ` 1 � 1 No. 0 Q �✓ 1 Fee$5 0.0 0 THE COMMONWEALTH OF MASSACHUSE S Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for Mgozal *pgtem Congtruction 'Permit Application for a Permit to Construct( )Repair( )Upgrade(XV Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 67 Old Kings Road Owner's Name,Address and Tel.No. 4 2 8—6 7 7 8 Assessor's Map/Parcel CotUi t, MA 02535 John Ponte O Z T Cs f Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Service PO Box 1089, Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(no 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 sand f R Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic system consisting. -bf 1500g tank, D-Box, and four stonepakked 4.1 ift i/iltrators. Date last inspected: r 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 B d of fl a . Signed Date Application Approved b Date - . 'J Application Disapproved for the following reasons r- - Permit No. i* Date Issued �. THE COMMONWEALTH OF MASSACHUSETTS Ponte BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(Xx)Upgraded( ) Abandoned( )by Wm E Robinson Sr Septic Service at 67 Old Kin S Rd Cotuit has been constructed in accordance with tree provisions of Title 5 and the for Disposal System Construction Permit No. e n!jld , dated 9 r/7n e-7 Installer Wm E Robinson Sr Seat Sry Designer A - The issuance of this pehnit sh'all�nyottibbe construed as a guarantee that the system will function as designed i Date 75 J Inspector 4 --------------------------------------- No. Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Ponte PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS 'Wigpogar *patent Construction Verntit Permission is hereby granted to Construct( )Repair(XX)Upgrade( )Abandon( ) System located at 67 Eld Kinds Rd 1 Cotiut, MA Installer: Wm E Robinson Sr Sept Sry 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:Co struction must be completed within three years of the date oft 'LQit. Date: �'�/ / Approved by 1 NOTICE: This form is to be used for the repair of failed septic systems only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS I,William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated Q`14—4 ' , concerning the property located at 67 Old Kings Rd, Cotuit, MA meets all of the following criteria: * ere are no wetlands within 300 feet of the proposed septic system. ' ere are no private wells within 150 feet of the proposed septic system. &fhe obseved groundwater table is 14 feet or greater below the bottom of the leaching facility. *Where is no increase in flow and/or change in use proposed. ;--There are no variances requested or needed. SIGNED: i " DATE 1 l (� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan should be submitted). s r Q