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HomeMy WebLinkAbout0109 ROOSEVELT ROAD - Health 109 ROOSE'VELT R04D COTUIT - A = 039 156 _ - TOWN OF B STABLE LOCATION �� XD,0,5'e0G !^� SEWAGE # 200 fyg VILLAGE <-D�Gl/� ASSESSOR'S MAP & LOT 643 g/S2. r INSTALLER'S NAME&PHONE NO. I SEPTIC TANK CAPACITY 1,440 LEACHING FACILITY: (type) — (size) IO 1 yd'X•2 ' NO. OF BEDROOMS- BUILDER O O WNE PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 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 leachin facility) Feet Furnished by f1' . .21 33 33 9, y3 (� �qyy - :ISZ No. l� � � Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS >� Lp S� 01ppYication for Migoml bpgtem Construction Permit Application for a Permit to Construct( )Repair(1/ )Upgrade( )Abandon( ) El Complete System LRIndividual Components Location Address or Lot No. Qcz_-ae!> o. !y' Owner's Name,Address and Tel.No. Assessor's Map/Parcelcaliwll 7_�?4� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. g Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(__�o Other Type of Building e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3A�? gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 6 ® Type of S.A.S. C/ X 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 o d of.4lealth. Signed Date Application Approved by Date / ?—0-0 Application Disapproved for the following reasons Permit No. Date Issued ,.�,No. � � s Fee ,.: ``;�"'•£'°'�M� COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,- .�''^ s Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS \` - s ' f 01pplication for Mizponl *pgtem Con5truction Permit .� Application for a Permit to Construct( )Repair(l/)Upgrade( )Abandon( ) ❑Complete System B Individual Components Location Address or Lot No. 1QD f o o�ae17- Ord. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 7 T"/®� Co/�i T 0 3q-/s4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 - 93 \Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building ,0 _ e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow_ ,//10 gallons per day. Calculated daily flow 33D gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank law)1 Type of S.A.S. 9" 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 ofj4ealth. / Signed Date 3/3/0:5� Application Approved by _ Date Application Disapproved for the following reasons Permit No. Date Issued —————————— r: THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r" (Certificate of QCompriance THIS IS TO CERTJEFY that t e On-site�wge�Disposal System Constructed( )Repaired(✓)Upgraded( ) Abandoned( )by Dr to Ze at /49� l a2 SC"e4e17'` /' CD L 1! 7" has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2.lrUr�-/1/� dated �_ !/31?_� Installer Designer l f /► r 1 n The issuance of this pe Gshall not�pbe�construed as a guarantee that the sy§tetUv71,A__'?A.0 will functionas designed.4 Date � � 1 1( R ' Inspector ------� J----------------------- /—�--/----(—�-- No. Zo —/,% ' S v U� �'j Fee I� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwtzpozar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair("V)Upgrade( )Abandon( ) System located at /e)� 445�/r��j`- Y�7 C'D 744,-1 e 7 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: Construct on m st be completed within three years of the date of this ermit. Date: 3 �� G%U-� Approved by '( _ r _ 1/6/99 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, _�D®e�� ©` � 7 , hereby certify that the application for disposal works construction permit signed by me dated ��/vim/�� , concerning the property located at /`©� �d ose t/ej.4-'eoG meets all of the following criteria: /The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. /Thesoil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system /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. /The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor Iifethod when applicable] the S.A.S.will be located with 250 feet of any vegetated 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 Surface Elevation(using GIS information) B) G.W.Elevation Za +the MAX.High G.W. Adjustment. = Z 7, DIFFERENCE BETWEEN A and B SIGNED : __�...._ DATE: [Sketch proposed plan of system on back]. q:health folder.cent i XZ, X��Q�fs /Of 6 xr te •G _! TOWN OF B STABLE LOCATION ��7 �DB�`C�cl7� ✓�� SEWAGE # VILLAGE �� 1- ASSESSOR'S MAP & LOT B 133' INSTALLER'S_NAME&PHONE NO. �Z�41 4uV,— 7,7,1-1r391 SEPTIC TANK CAPACITY rOao G4 L LEACHING FACILITY: (type)T.ur liCd!:j r6) (size) f0/1/d'X,2 ' NO.OF BEDROOMS 7 BUILDER O OWNE PERMITDATE: 3 13-200--f COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5'f Feet Private Water Supply Well and Leaching Facility (If any wells exist �,//� on site or within 200 feet of leaching facility) �y Feet Edge of Wetland and Leaching Facility(If any wetlands exist IVA within 300 feet of leachin facility) Feet Furnished by �C1' 3.3; 9 N3 r' yB' P . i9ya le,t TOWN OF BARNSTABLE LOCATION ;�p eye61- wocko SEWAGE # / �S VILLAGE ASSESSOR'S MAP & LOT Q39-�S(o INSTALLER'S NAME & PHONE NO-ar olo? C�ns�, o" SEPTIC TANK CAPACITY /OQQ 6-19-6GQ//S LEACHING FACILITY:(type�l.i7�Ilra �Q" ,(C, (size) ,� 19 NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDERCROWNER�-J DATE PERMIT ISSUED: �419/�V DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No J -/aq . 9 DPP` L oeAA No..... -_.... •........ Fas....... 0 . THE COMMONWEALTH OF MASSACHUSETTS APPROVED n to ZS7, rva 'onDepa me t BOARD OF HEALTH S OWN OF BARNSTABLE I'Us—ired Applira for BiuVuuttl Works Tomitrur#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (Q4 an Individual Sewage Disposal System at ........�' 9......................E>s��— . �� .------- _.... --•------C --zv..►-------------- -- -•-•-........•----•-----------•------- Locatio •� dr�ss o No. %l/� -- (J 9 4-5�V"Cs_:?, ..:---.fit'___--*!__----....a -.t i _... ------------------- -...... Owner Address a G�1 w • c,v-y,ins--l(� c�4—t®r.3 `7 fog - .. t .✓Y.... --•-- ......................... s Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___.........________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtur .-..---_ d = --------- - ------------------------------ W Design Flow................... __--___•_--gallons per person per day. Total daily'flow-----..--.-.�-_--------------------------------------------gallons. 04 W Septic Tank—Liquid capacity/G�.galIons Length________________ Width--------- Diameter................ Depth................ x Disposal Trench—No. ----------/...... Width...... ------- Total Length....../9...... Total leaching area....................sq. ft. Seepage Pit No---------/-------- Diameter-------------------- Depth below inlet.................... Total leaching area.............._.._sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.................... G%, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.---___-_--_-___----__-. P4 -----------------------------------------------------------•---....-----------------......._--------........................................................ 0 Description of Soil........................................................................................................................................................................ W --- ----------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------_A.- _0--------------`---.____ 1 -s -�. --------)IV Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s een i sue y thyk-oard of health. Signed --------- �� ,........................... .......... /6a, ........ ..... Application Approved By ----- ....... .... ......g ....... . ................... ---------------------------------- ........................................ Dace Application Disapproved for the following rea.ro : .. ....................... ............... ........................................ ----------------------- - .........--- - ............... .. -------------------------------------- ..... Permit No. ---------------- Issued .......... .........../'/J//.'J.} .............. Da.e..... Dafe - No... -• F ��' d a.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH yTOWN OF BARNSTABLE Appliratiun for Di-nVusttl Workri Towitriirtiun rrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: l� -` Z vim- .. ---------------•-.... ----•••--•-••-•----•••----••-•-----•-•--••-- -•-•---• •--••---•-•--•••-•...----•••. `•^7—'��^ Locatiotr-Address o �otNo. _J 10/ '�2#/ ..........._.................. .................. -•----••------••••--••-----•-•--•...........-••••••--........---••-...............C/..�. .........U....\.! Owner Address a e___ � // U ,vST-i`ln� Cs%fd� �Co C>I , 11 � Installer Address d Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms-------------- •�---------------------- Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures .........................-............................................................................................................................ w Design Flow....................14._...............gallons per person per day. Total daily flow---_._._.___.::31-7d_._.._.._...___gallons. W Septic Tank—Liquid capacitvww..gallons L �: ength__------------- Width---------------- Diameter---............. Depth................ x Disposal Trench—No. _.......__�..__.. Width....... .......... Total Length------ _`2_..--- Total leaching area....................sq. ft. Seepage Pit No----------/�------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ 0.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z., Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ P" ..................................... ...................................••••-••--•.._...•---------......................................................... ODescription of Soil.....................................................................................................------•------------------•----------------------------------.••--- x U ••••-••-•••••••••-••---••-•----•••••••••-•••---•••--•••-••-•••-•-••-•••-•••-------•-••••••......-•--•----••-----•-------••-------••---••-•-----••-•................................................... w UNature of Repairs or Alterations—Answer when applicable._--__-A.D-.0______________�n._.___. } _. _.0- ................../ =r-c_i ..•-••-......V`!----------------------------------------•-----•-•••••••••-••-------- .------------.......---------`--.....`------------`Sy .!_ :✓YL...:-----••---.......-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The,undersigned further agrees not to place the system in operation until a Certificate of Compliance has eeen�n issued y tth'e,b-o-a-rrd�o_ff health. / (2), Signed ..... " ...... ---- .......:_................. ......... ,, y � Dace Application Approved By---------- � _ ....'_: / N ' Dace Application Disapproved for the following,reason j ....._......................... ....................................................... .... /--------- .........d------------------- /..... J 4J/ l Date Permit No. `?....�'../. .�..._....... Issued ..-------.._..E(..�/................. P , J -------- Date ---------------------------------------------- --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE GErtifirate of Graylianre THIS IS TO CERTIFY, That,the;Individual Sewage Disposal System constructed ( ) or Repaired (<) by -........................_.................. .<F_� GLU "7 - 1 r-.1.5..�.%A.v..--------..!u J Insc Ile at ..................... .......................................... ------------------- --- ---- . . .... has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated ---------------------.......... -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE'CONSTRUED/AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE `-✓........... .. f- - - Inspector -.. ---------------------------------------------------------------------- ---------------- THE COMMONWEALTH OF MASSACHUSETTS Q 3 BOARD OF HEALTH ..c....� ,.. TOWN OF BARNSTABLE 1 � No. /5 FEE........................ Diupnottl yarn Tnnntrudintt "rrntit Permission is hereby granted......................:%..f�� ..�.G:!�. _'_.. �:{t/Q _ "/V 14�c I/,- to Construct ( ) or Repair an Individual Sewage Disposal System e at No. /6 S r CL is L. L .'G. .-�:.---- r;.................................................... •----••---•-------• •••••--••-------•-••---•--- .•-•••-•-•-••- ---- �j� Street as shown on the application for Disposal Works Construction Permit No. ,-- Dated........................................... �-i �l} ---------- , i � Board of YHealth (! � DATE. --------------------------•-•••- I � FORM 36508 HOBBS&WARREN.INC..PUBLISHERS NOO iz*wUmb..�. F�311=9s_d_e_ THE COMMONWEALTH OF MA6SACHUSETTS BOARD OF HEALTH Town Barnstable Application is hereby made for a Permit to Construct (XV or Repair an Individual Sewage Disposal System at: Lot 54, Roosevelt Road, Cotuit ' tockon-Address or Lot No. Owner ress Type of BuildirX.,; Size Lot_ ...9.t_9QQ....Sq. feet 1� Other—Type of Buildi Uontem-po . No. of persons........?................. Showers Cafeteria (A' 44 Other fixtures Test Pit No. I----2.........mihutesperinch Depth of Test Pit...... ...... Depth to ground wa'ternone...e-ne-ounterd Test Pit NO. 2....... minutes per inch Depth of Test Pit The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys�tem in accordance with the provisions of 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Application Approved oy-.— _ �=_�~--^�_c '--.... � r, ' ^-- ' ' ^ ^�' u*° Application Disapproved for the following reasons:................................................................................................................. ______ Date Permit ' Issuedl Date _- . No.. .. THE COMMONWEALTH OF MASSACHUSETTS t• : BOARD OF HEALTH Town...a................O F.............Barn:stable....------................................. .. Aphratinn for Uh4poii .1 10orkfi Towitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _Lot 54=:.Roosevelt Road.,t...Cotuit Jeffrey E. r ' n-Address or Lot Sarin A. Twaro� 106 Locust Lane! _arnstable ......................-----•---•----•-••---•-- -- ••... -_.... .---_. .... ._.._...- --•----•-- Owner Address James...Dollawa-v................................................. ......1082...Old...St age..-R.Qaa.,....Qente V.111e Installer Address ` Type of Building Size Lot....20*000......Sq. feet approx U Dwelling o. of Bedrooms......_..._.3----•--_.--_-•--_.•........Expansion Attic (ng Garbage Grinder �O) pal Other—Type of BuildingQQ11treMp.R.__.... No. of persons............2.............. Showers ( ) — Cafeteria PO) Other fixtures ....-2----.-WateT--•C------_ ..•. 2�.__laV.__ 1n . ._.}�1. C e_I ...aa.S ______________ -1:4W Design Flow..................�30--••..............gallons per= sax per day. Total dai y flow-----------330---_.--.-----_-----_--gallons R; Septic Tank -Liquid capacity.... Q.Wlons Length................ Width___ -____-__-_ Diameter.-._--_..___-__. Depth................ ,J Disposal Tr ehch—No..._..-_- ._..._. Width........-..- Total Length_.---......... Total leaching area.m............sq. ft. Seepage Pit No......1............ Diameter...61.6".___. Depth below inlet....2.1........... Total leaching area..358.......sq. ft. z Other Distribution'box ( Dosing tank (- -)- ei /V C;6' Percolation Test Results Performed by..._ROnladl___A..-__G1ffOrd_--------•-•-•--- Date_..._9118�78.............. Test Pit No. 1........2-__-.minutes per inch Depth of Test Pit____14__.._._._ Depth to ground water.AgA((_..enCOunter Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water....;. _ rr ® Description of Soil.....2_'.. loam...and---subsoil..on..surface 12' plus medium_ sand ------------....... -- • . . -----------•----•--•----......--•--•----•-........-----...........•-•-..--------------- -------------- ---------------------- ----------------------------------------------------------------•---------------------------------------------------------------------------•----------------------------......_. UNature of Repairs or Alterations—Answer when applicable-------------------............................................................................ -•-------•-•----------------------------------•-•------•---•------------------•----......................--.------------------------------------------------------••-•- -----•-----•................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ned _..:._.... -----------------------------------------------------•-•--- ............................•... Date- Application A roved B PP Y . ,! Date Application Disapproved for the following reasons:........................... ....................----------------------•-------- _---------------•- ... -------------- Date PermitNo.................................................. " Issued................................................... - ^ Date THE COMMONWEALTH OF MASSAC' SETTS BOARD OF HEALA"FI Town Barnstable OF..................................................................................... �rrtifir��r laf fut�It�anre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( for Repaired ( ) byJames.Rollaway_.....•••-••-•----•-•----.._..--•- ......-•••-•-••-------•..._...-•-•--•-------------------•-•---------------- Installer " at....................................Lot...54•j--Roosevelt__ Road, C_otuit has been installed in accordance with the provisions of TI 5 f/The State Sanitary Code as describe l in the application for Disposal Works Construction Permit No::__.. _.... ._....._. da.ted_....-_ _,Gr._.lL........................ THE ISSUANCE OF THIS CERTIFICATE -SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................................. ................. Inspector----- •-•-- .. THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH it �..�"' .....OF............. '.1/►�,!:............................................ G' No.. FEE........................ i n �t nrk n fnr tan rrMi Permission is ereby granted: : � ... to Construct /� r Repair ( a Individualie� �a ' Di .posal y atNo....... • -• f" .......... '��G•. _... . ............................................................ Street as shown on the application for Disposal WorksfConstruction Perm' - ' a �j w 7� d Board of Health DATE........ 1--- � FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS w n LOCATION SEWAGE PERMIT NO. 47- VILLAGE INSTA LLER'S NAME & ADDRESS B U I l DE R OR OWNER DA T E PERMIT ISSUED DATE COMPLIANCE ISSVEDf �� � �. Ct= �s? 2� C� 4 �r , �_ .. �� 1 USPG��G7"� �'/J t , T E M > 40' x �";, j,_V Or M' A E�"t;-I_Tr7 -r •d �- �, E]•f rJ N 1rls T �- Kt.� s . • � �. � � , ,. 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