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Home My WebLink About0029 OLD OYSTER ROAD - Health 29 OLD OVSTEIa ROAD, COTUIT A=020-130 l i l Q TOWN OF BARNSTABLE LOCATION �" ®� Dinh/ �-�� ''f SEWAGE# 2 F, 7 VILLAGE 4!! d l �.y ASSESSOR'S MAP& LOT L&LD- 13 0 INSTALLER'S NAME&PHONE NO. ?d -7- l� SEPTIC TANK CAPACITY 4 LEACHING FACII.TTY: (type) ' ® 7®-0 (size) NO.OF BEDROOMS BUELDER OR OWNER J PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater/ty(If ttom of Leaching Facility Feet Private Water Supply Well and y (If any wells exist on site or within 200 feet of l ) Feet Edge of Wetland and Leaching Fwetlands exist within 300 feet of leaching fa Feet Furnished by ems!` Yw ��+ t F 4 $50 No. n Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfpprtcatton for Otgpooar *p5tem Cow5tructton Permit Application for a Permit to Construct( )Repair(g )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 6 O t q l� Witt O�y�t e r Rd. Owner's Name Adaeessgannd Te�,ll.No. l J Assessor's Map/Parcel 4 2 8—13 6 9 Instal a's e,N Addre ,and Tel.No. Designer's Name,Address and Tel.No. m Robinson, Sr Septic Servi e P 0 Box 1089 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) Pump and. remove 1 , 000 gal tank and. relocate a new 1 , 500 gal tank and. D-box. 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 bed o ard of Sign Date W� Application Approved by Date Application Disapproved for the following reason Permit No. Date Issued I TOWN OF BARNS�TABLE r� LOCATION ` /� / � ,�/ 1:✓'� /`�•� SEWAGE # ` +/ 1 VILLAGE_ D l L l ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. /�o % �� "7 — ;' _Z, SEPTIC TANK CAPACITY a�� LEAC �'�HING FACILITY: (type) � � (size) °� C, NO. OF BEDROOMS BUILDER OR OWNJJER J r' 0 ,1 PERMIT DATE: COMPLIANCE DATE:1.� Separation Distance Between the: Maximum Adjusted Groundwater Table to th ottom of Leaching Facility Feet Private Water Supply Well and Leachin acility (If any wells exist on site or within 200 feet of leachi facility) Feet Edge of Wetland and Leaching Fac' ty(If any wetlands exist within 300 feet of leaching fa ' 'ty) Feet Furnished by M _ � i /C E a f J $50 No. Fee THE COMMONWEALTH OF MASSACHUSETTS =-;3-red in computer: +/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Migogal *pgtem Couttruction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. t O l Outer R d. Owner's Nine f ddtiess d 1el.No. l c1 aegu n Assessor's Map/Parcel 42 8—13 6 9 Installe 's N e,A dre ,and Tel.No. Designer's Name,Address and Tel.No. Vim '.obinson, Sr Septic Servi e P 0 Box 1089 CPrtPr-yj11e , - 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 d y, Calculated'daily flow gallons. Plan Date Numbeo' pfs_ C j' � . Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Pump and remove 1 ,000 gal tank and relocate a new 1 , 500 gal tank and. D-box. 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 of7itle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been-is Lbyt 'Knd ea, e ` 1 ✓ i Q`om0Sign Application Appred by 1 t _ J! Date: Application'Disapproved for the folio(ing reason t t i Permit No. Date Issued T J Se uin THE COMMONWEALTH OF MASSACHUSETTS . g BARNSTABLE, MASSACHUSETTS c 7 J�ertit sate of Compliance THIS IS TO CERTIFY, that the On-site ewage Disposal System Constructed( )Repaired ( X)'Upgraded( ) Abandoned( )by Wm E. Robinson Sr, Septic Service , PO Box 1089, Centerville at 29 Old Oyster R d., C o t u it , MA e;rh e ,constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ted Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �, - �� Inspector "A — No. � �— — > -------------------------Fee $50 THE COMMONWEALTH OF MAS SACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpogaf 6pgtem Cougtruction Permit Permission is hereby granted to Construct( )Repir(X )Upgrade( )Abandon( ) System located at 29 Old. Oyster Rd ,a Cotuitbl 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 mu t be dompl ed" 'thin three years of the date oft ''s pertntt. Q Date: / ��/ Approved by A,// / -30 NOTICE: This Form Is To Be Used For The Repair,Of Flailed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A 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 concerning the property located at 29 Old Oyster Rd , Cotuit 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) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: f DATE 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). �� _ _,� . , .. :� . . �� E �'�`.. AsBuilt Page 1 of 1 TOWN OF BARNSTABLE &/" LOCATION Q � /2:/L �"� SEWAGE# VILLAGE e,-d L T ASSESSOR'S MAP&LOT G LD-13 O INSTALLER'S NAME&PHONE NO. �- c - 7 7 S_. ?7 Zo SEPTIC TANK CAPACITY 4 0_(5 LEACHING FACII_ITY: (type) / (size) 4 4,- NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 11T,3 6 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to th ottom of Leaching Facility. Feet Private Water Supply Well and Leachin acility (If any wells exist on site or within 200 feet of leachi facility) Feet Edge of Wetland and Leaching Fac' ty(If any wetlands exist within 300 feet of Ieaching fa ' 'ty) Feet Furnished by t (Z),` w t � L �'1 th SC ol I http://issgl2/intranet/propdata/prebuilt.aspx?mappar=020130&seq=1 4/7/2014