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HomeMy WebLinkAbout0450 OLD POST ROAD (CT & MM) - Health 1 450 OLD POST ROAD; COTUIT A=054-027 , f , A hI TOWN OF BARNSTABLE c , C- LOCATION 6 t 0 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 02AL`60,i e;-;_Ci SEPTIC TANK CAPACITY /6 i LEACHING.FACILITY: (type)je. Q cA3 17 (size) NO.OF-BEDROOMS 2) I BUILDER OR OWNER PERMTTDATE: Y-3^Tg' COMPLIANCE DATE: 1 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 i No. — e. -�"� Fee 1-3— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppficatiou for ;Digpo5a[ *potem Cow5truction permit Application for a Permit to Construct( )Repair(14upgrade( )Abandon( ) L ec`omplete System ❑Individual Components Location Address or Lot No. I b Owner's Name,Address and T 1.No.oy« P M o'4t,421 ter,; 4,.,A = cor;f-e Assessor's Map/Parcel LSD Old pc�pl--j;;A , 5�A I Installer's Name,Address,and Tel.No. D igner's Name,Address and Tel.No. Type f Building: Dwelling No.of Bedrooms _ Lot Size 3 o sq. ft. Garbage Grinder( ) Other Type of Building 4t"wz No. of Persons Showers(j,�afeteria( ) 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 Nature of Repairs or Alterations(Answer when applicable) 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 Board of Health. Signed Date L/ Application Approved by Date Application Disapproved for the %lowing reasons Permit No. s 2� _ Date Issued ------------- ---- — TOWN OF BARNSTABkE LQCATION 1Jo SEWAGE# 0�0 VILLAGE C(4" ASSESSOR'S MAP'& LOT' + INSTALLER'S NAME&PHONE NO. 02-A fir:-vi j 8 SEPTIC.TANK CAPACITY.. '%d 2�0 LEACHING.FACILITY: (type.)'( "�� c�►` (size)_� 6 a NO::GF BEDROOMS- WELDER OR OWNER PERMIT DATE: y-3 COMPLIANCE DATE: 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 Edgeof Weiland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ------------ e IA „ s, No. vU Fee THE COMMONWEALTH OF MASSACHUSETTS ;,Entered in computer: "~ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes 01pprication for Digpogaf *p0tem-Conttruction Permit Application for a Permit to Construct( )Repair('VUpgrade( )Abandon( System ❑Individual Components Location Address or Lot No. q -0 0i Owner's Nam"e,Address and No. Assessor's Map/Parcel catll��- ►j5�Cats �c �� ' 1 C� 4,3s ti a© S Installer's Name,Address,and Tel.No. Dekigner's Name,Addr lsand Tel.No. ��Da�toie3—Sasy 3 I`� m 6�r c Li-ica. AA A DlgoR Type of Building: Dwelling No.of Bedrooms _ Lot Size D sq. ft. Garbage Grinder( ) ,Other Type of Building n �No.of Perso s,. Showers afeteria Other Fixtures C ( ) 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 .1 Nature of Repairs or Alterations(Answer when applicable) Date..last inspected: "{ Agreement: { 4 The undersigned agrees to ensure the construction and maintenance of the afore described on-siteaewage disposal system in'accordance with the provisions`of T1tle'5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t is Board of Health. Signed Date `Y^ Application Approved by Date L!- m r Application Disapproved for the llowing reasons Permit No. - Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at .SS O has been constructed in accordance with the provisions of Title 5 and th for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - 1 Inspector --_----- — — — -- ------ No. ©b Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *pztem Construction Permit Permission is hereby granted to Construct( )Re air( )4 Upgrade( )Aban&on( ) System located at and as descrt4d 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: Approved by 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 ENGINEERED PLANS) I,Joseph P.Macomber Jr. , hereby certify that the application for disposal works construction permit signed by me dated 4/29/98 , concerning the property located at 450 Old Post Road Cotuit.Mass. meets all of the following criteria: • There are no wetlands located 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 within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: 0 A)Top of Ground Elevation (according to the Engineering Division G.I.S. map) r B)Observed Groundwater Table Elevation (according to Health Division well map) —3 SIGNED : DATE: LICE EPTIC SYSTEM 1NSTAL0ER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). q:health folder.cert , t �'1 e �M 0 • i I TOWN OF BARNSTABLE , G LOCATION SEWAGE # VILLAGE . ASSE SSOR'S SS ORS MAP LOT INSTALLER'S NAME&PH ONE NE NO . 'SEPTIC TANK CAPACITY / "ZXo LEACHING FACILITY: (type)'[ =`�eV (size) 6 b r•. NO.OF BEDROOMS__ BUILDER',OR'OWNER PERMTTDATE: tl—3— COMPLIANCE DATE: 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 I ' . 1 t i .j f i l I i i • i No. a '�' 7 - Fee 5 O.O O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for JMiopogal 6peum Com6truction 30ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 5l)Complete System ❑Individual Components Location Address or Lot No. 450 Old Post Road Owner's Name,Address and Tel.No. 7 6 0—8 4 2 2 Cotuit,Mass.02635 Betty Griff Assessor's Map/Parcel 0 2 6 3 5 � y a 450 Old Post Road Cotut Mass. Installer's Name,Address,and Tel.No. 7 7 5— 3 3 8 Designer's Name,Address and Tel.No. 7 7 5—3 3 3 8 J.P.Macomber' & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Oo) Other Type of Building RES No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 1 1 0 gallons. g P Y Y Plan Date Number of sheets Revision Date Title 1500 gallons 2-500 chambers Size of Septic Tank g Type of S.A.S. Description of Soil Loamy sand to sand t i Nature of Repairs or Alterations(Answer when applicable)Omitting cesspools. Installing 1 -1500 gallon tank 1 -Distribution box. 2-500 gallon chambers packed in four feet of stone. 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 is ed by th' $� d f Health , Signed s-� Date 4129198 Application Approved b Date y —30 Application Disapproved for the following reasons r Permit No. 9 T` Date Issued 1Y J 0 r �_ n Fee- THE COMMONWEALTH OF MASSACHUSETTS "I—EnteriM in computer: Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE., MASSACHUSETTS application for ni5poal *p5tem Construction j3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon('' ) XXomplete System ❑Individual Components Location Address or Lot No. A 5 0 Old POl t Road Owner's Name,Address and Tel.No. 7 6 0—8 4 2 2 Cotuit,Mass.02635 Betty tariff Assessor's Map/Parcel Q s 02635 `/ OZ 450 Old Post .toad Cotut,Kass. Installer's Name,Address,and Tel.No. 7 7 5—13 3 8 Designer's Name,Address and Tel.No. 7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber &eSon Inc. Box 66- Centerville,Mass. 02632 Box 66 'Centerville,Mass. 02632 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder('10) Other Type of Building RES No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 ' gallons per day. Calculated daily flow 3 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 gallons Type of S.A.S. 2-500 chambers Description of Soil Loamy sand to sand Nature of Repairs or Alterations(Answer when applicable)Omitting cesspools. In s to i l i ng 1 -1500 gallon tank 1 -Distribution box. 2-500 gallon chambers packed in four feet—of stone. 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 ode and not to place the system in operation until a Certifi- cate of Compliance has been is ed by f Health n Signed-; .A Date 29 8 Application Approved brm� Date 130 —f Applicationisapproved for.the following reasons " -` ==7 4F Permit,No. 9 - Z71 Date Issued 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( �, )Upgraded(XX) Abandoned( )by J.P.Macomber & Son INc. at 450 Old Post Road Cotuit,Mass. has been'constructed in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No 3 dated' 9 Installer J.P.Macomber & Son Inc. Designer J.P.Maeombpr & So)a Inc. The issuance of this permit shall not be construed as a guarantee that the system will function•as designed:�s , „ Date Inspector k 0 / NO. 2 7 ----- �------------=----=—=Fee $ 50.00 _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS wizpo.gat 6p.5tem Construction permit, Permission is hereby granted to Construct( )Repair( )Upgrade�X )Abandon( ) System located at 450 Old Post Road Cotuit,Mass. l 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 thi e it. Date: `10 Approved by ( .., _...M ► _ C APPLICATION FOR PERCOLATION TEST AND OBSERVATION P S LOCATION_ Lpr47- Zell NO. VILLAGE e`OTU/T� DATE //-Z'�� APPLICANT_ G® ----, FEE /0e7 kADDRESS ' TELEPHONE NO. (Non-reftindabl, ,ENGINEER 3A f •Jy� �i�'C.� _TELEPHONE DATE SCHEDULED- / �•^- �� -Y-S (Applicant's signature) O . . o o o . . . . ^I0 . C C . . . O C O • . 0 0 0 0 . . . . C . . . . . . . . . . . . . Y.C . . . . . . . C . V . . . . Y . Y . . . . ASS] SSOR'S MAP & LOT NU: SOIL LOG ��// SUB-DIVISION NAME DATE. Nd1' 9 TIME �o9 EXPANSION AREA: YES NO _�,Q,r� �•• )/� �/C.. ENGINEER:'?'' TOWN WATER o' PRIVATE WELLj',4/t2rc� BOARD OF HEAL'. S14f) siJ EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in prokimity to test holes) NOTES: I r • M � 3-4- �. I Pp' U 10, -� 2 A1e6 V1� . I lr 42 1.00 a.\ �' . •� to t e.so nc. PERCOLATION RATE: i14 2�4111J /L TEST HOLE NO: f ELEVATION: TEST HOLE NO: 2_. ELEVATION: lF /D;fA A any 4%,., �a 3 o Aw,y Sour, 3 g I-CA. 4 4 - P' 5 5 G 7 Mv�. h . 8 8 SAAD ' 9 9 10 /o• 10 itJ 11 11 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: • LEACHING FIELD < LEANG PITS LEACHING TREN:CHE§ UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER- ASSIGNED -ON PERC TEST APPLICATION . ORIGINAL: COMPLETED IN ENTIRETY BY P . E AND R TURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT