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Home My WebLink About0033 ROOSEVELT ROAD - Health 33 Roosevelt ROAD Cotuit _ A= 039-140 Lot 38 TpO*W OF BARNSTABLE LOCATION V.0a�G d I 1[(�• SEWAGE# "l�y VILLAGE lid, ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. ��: T SEPTIC TANK CAPACITY LEACHING FACILITY ;type) .. (size) NO.-VF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) 4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,s 3 �qi . 413) 12 . 0 .00 � } it r �- TOWN OF BARNSTABLE p LOCA O J Jl1OSeC SEWAGE# VILLAGE ASSESSOR'S 1 ASSESSOR'S MAP &LOT O y� INSTALLER'S NAME&PHONE NO Q SEPTIC TANK CAPACITY 15-6 • c0len-3 LEACHING FACILITY: (type) (size) NO.OFBEDROOMS BUILDER OR OWNER Mr' d-M rS PERMITDATE: 6-0�0--q60 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 I � � 34 , to 131 TOWN OF RNSTABLE f LOCATION f 1QOSe U�I 2ca BA SEWAGE# CD 32� VILLAGE ASSESSOR'S MAP& LOT da - lq-d— INSTALLER'S NAME&PHONE NO.&bef4- 3.0o( Co (nc . (56a)y3J-Q530 i SEPTIC TANK CAPACffY LEACHING FACILrfY: (type) —i-�'"— �/�:a-c✓' (size) -2— �. NO.OF BEDROOMS BUILDER OR OWNER 1`�t� RNU EQ PERMITDATE: COMPLIANCE DATE: U "l1, Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 E _ 3113 " i (Oil aD - 311 Q f3C- ao� 3 o � C No. Fee THE COMMONWEALTH OF MASSACHUSETTS 4-PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zippricatiou for 0i.5pogal *p5tem Couttructiou permit Application is hereby Tye for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Ad ress or Lot Owner's Name,Address and Tel.No. 33da� �dl �,le T /y19 Installer's Name,Address,and Tel.No. Designer's^Name,Address^and Tel. o. Type of Building: r� Dwelling No.of Bedrooms Garbage Grinder(� V Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L gallons per day. Calculated daily flow' ��V gallons. Plan.Date 512 q 19b' Number of sheets L Revision Date Title Description of Soil ' v A^, S� Nature of Repairs or Alterations(Answer when applicable) NEW -ir sH 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 provisio s 45ofthe Environmental.Code an of to place the system in operation until a C rtifi- cate of Compliance has b ard of Health _ Signed Date Y Application Approved by Application Disapproved for the following reasons Permit No. 962 2 Date Issued No. w;..., Fee i THE COMMONWEALTH OF MASSACHUSETTS _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(p�ticatiou for Mioaar 6peacm Cone;tructiou Permit. Application is hereby T yie for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Ad ress or Lot �. ` Owner's Name,Address and Tel.No. r 33 do Nv� T Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel:No. ,$ z,4* U r- / J S Type of Building: Dwelling. No.of Bedrooms Garbage Grinder( J Other Type of Building '44o.,of Persons Showers( ) Cafeteria( ) Other Fiidtures Design Flow �' gallons per day. Calculated daily flow c--�5 co gallons. Plan Date 't/ -9 b Number of sheets Revision Date` Title " Description of Soil 1 V l v A-A, ' 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 im\accordance with the provisions le 5 of the Environmental Code.and of to place the,system in operation until a C rtifi- cate,of Compliance has b ' s thi oard of Healt Signed Date Y Application Approved by "Y Application Disapproved for the following reasons Permit No. �- Date Issued THE COMMONWEALTH`OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certifira.te of CorrY�Yi:at�ce THIS IS TO CERTIFY,that the On-site'Sewage Disposal System installed( )or repaired/replaced( )on by �/1. 11 CV for as has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.'[?61 dated Use of this system is conditioned on compliance with the provisions set forth below: ---- ----- -- ------------- == .�-=-------- No. 2 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Zigoal *pgtem Cougtruction Permit r Permission is hereby granted to `� to construct(repair( )an On-site Sewage System located-at c7 C 0 r 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. All construction must be completed within two years of the date below. ^� Date: 6- - 1,e' 9/n Approved by L ) APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS (/ LOCATION eLl _ VoSe VILLAGE CD DATEZ APPLICANT y,, p � _r.�vs» c7Jtio �c�Pr FEE ADDRESS VD. dDk ZQ TELEPHONE N0.3S5=�= (Non-refund ENGINEEREo� - r7ePri G, _TELEPHONE NO. DATE SCHEDULED �a, �� (Applicant' s signature) • • . • O O O O O O . 0 0 0 0 0 0 0 e 0 00 • • 0 0 0 M O O O • . • • : O • • • O • • • O • • • • O O O O • • • • • • O O • i O O O • : • • ASSESSOR'S LOT NO:✓�9�/ ® SOIL LOG SUB-DIVISION NAME DATE_ TIME_��-� EXPANSION AREA: YES 'ENO _ X ENGINEER : TOWN WATER �/ PRIVATE WELL ✓ /� r�<�✓ %�!% ry BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests; locate wetlands in proximity to test holes) NOTES: i f PERCOLATION RATE: 2 TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: � 1 2 2 3 � 3 4 4 5 5 6 _ 6 8v�� ✓ g �� 10 10 G- 11 11 12 12 13' i s'G r 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS__ LEACHING TRENCHES 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 RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT l _ k, 4t� q�? i f 39 Dw�a,L�NG Lo 7— /�Z/a,^! 5(9RA/ST7-?6Z 4!—:1 C 074./ 7- �r9- /o¢ N 1 l�rviy It i \ liq. # /oo "' _.,-.._., i _.�'�-�._ 3.5��• \ I I ,� Lc-u A � SCE-GCL / 40- I I 2ErE V LF 9y ` X Ilk 000 � r �N�• ""'!8i (�� MCP OF FOUNDATION r Iwo +! Q *,o CONCRETE COVERS 4"CAST IRON g,r ++� OR SCHEDULE 40 v P.V.C. P{PE MIN. n 4"SCHEDULE 40 P.V.C. (ONLY) 9 MIN , ' I "`��111 ► PIPE- h11N. II LEACHING TRENCH ( /..FE.UIRED) 36 MAX i `- ►, '� \�\ #� `1 `, PITCH I/4"PER.FT. PITCH 1/4' PER.FT t t V y'Q/// 1/H' 1/2_,aWASHEDPRSi0NE +_�, " J n n cn n n n n n Y 1� INV RT EL..N,?3. INVERT _�DisINVERT n '- a � - n (1 n + /L I , SEPTIC TANK EL .Z�Z7 E30X EL. �"�3 3 4 - 1I/2 WASHED STONE /z ' INVERT I Sao GAL. � i�.vER- INVERT INVERT FLOWDIFFUSORS 6 CRUSHED S ONE I _L sts r�, Q , 8 • i G , ___ ' — � \ PROFI LEI OF 3z wo• SEti1rAGE DISPOSAL SYSTEM GROUND *c,T.ER TABLE SOIL LOG TYPICAL CROSS SECTION NO SCALE LEACH I NG TRENCH DATE . . . . . . .,.. . NO SCALE TEST HOLE I TEST HOLE 2 �p DESIGN DATA ELEV. . . �. . . . ELEV. . . . . .. . . .. WASHIE" 36"IMAX t1 \C TAP NUMBER OF 3 _�JROOh1S . . . . . I � STGNE '°� �, 3 o 7 _ .. TOTAL ESTIMATED FLOW ✓ T ��. . . . GALLONS/DAY _ _�_•4' T AREA LEACHING ARA S .FT./TRENCH ,.,2 t ` ,ZAf SIDE LEACHING AREA . . . ./7�. .�?. . SO.FT./TRENCH /3o Z- S G'p D 3/4"-11/2"WASH■ I MG�UiuH o c STONE 2� GARBAGE DISPOSAL /S�O./lE. .(50 /o AREA INCREASE) _ 4,�, 70-A . Lc"HiNG ARE. SO.FT. f � I PERCOLATION RATE lS 7�JA,vTl'�'b.M!�!�j/�EA. INCH /Z , -AA,,e7- %' i LEACHiNIG AREA PER PERCOLATION GROUND WATER TABLE APPROVED . . . . BOARD OF HEALTH . ."� ..'rVATER ENCOUNTERED DATE ,o OF AGENT OR INSPECTOR a WITNESSED BY : EDn"+a '� � sT y .TG�zk' 38 �. L N BOARD CF HEALTH LoT 1�3Kivo. i.iY 0 5 -�► I .sW4W 4G ' N4W"O'C E N G i N F.E R .�ooS�"1/CZT /�0!9l� `"; I f,- ",;- P e-47CAV-4 rv� CvTGi/T. . j'�=L ��►NNAi P� PETiTIONE>R D /ee-00; ;