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Home My WebLink About1074 SANTUIT-NEWTOWN ROAD - Health 1074/kZ1E�0WN' ,Pp4q-0 COTUIT A = 027 047 Ij i� TOWN OF BARNSTABLE �NN1'�lllrj J LOCATION /07U i.IEWtOCJA_) {R,OAD SEWAGE # a600-50(, VILLAGE Cd,+U t l ASSESSOR'S MAP & LOTD INSTALLER'S NAME&PHONE NO. ti2o�c N sc�N 5�afl SEPTIC TANK CAPACITY l CEO 0 LEACHING FACILITY: (type) bpw we Its (size) aX-6L5X l_, NO. OF BEDROOMS BUILDER OR OWNER tSc AQ C Y[� PERMITDATE: 6c co COMPLLANCE 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 Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r r c� �7� $50 r Fee No. "V THE COMMONWEALTH OF MASSACHUSE S Entered in computer: lies PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Tigpogal bpgtem Congtruction Perron Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 1074 Newtown Road, Cotuit Bill Burdick Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PQ Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 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 Sand Nature of Repairs or Alterations(Answer when applicable) Title—5 l e a eh systefit consisting of a D-box and 2 precast leach chars with stone all around. 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 Environmentab Code and not to place the system in operation until a Certifi- cate of Compliance has been ' e by t ' o of Health. �c �1- Sign b `' , Date Application Approved by Date Application Disapproved for the following reaS64 Permit No. Date Issued TOWN OF BARNSTABLE �. II j. LOCATION 1�-2 1.1 FLJ T6CJ/y ROAD SEWAGE # �2600-56� VILLAGE Cdfyt k ASSESSOR'S MAP & LOT O INSTALLER'S NAME&PHONE NO. Rn6rJ5wN l SEPTIC TANK.CAPACITY l CEO O j LEACHING FACILITY: (type) L JE IIS (size) -fix t�S�lZ NO. OF BEDROOMS . .. oZ j BUILDER OR OWNER �c r2tJi PERMITDATE: 2 160oC> COMPLIANCE DATE: j 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 i 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 r i 10 i o r 4i . $50 Fee THE COMMONWEALTH OF MASSACHUSE S Entered in computer: n ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS 2pprication for Miopoml *pgtem Con,5truction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 1074 Newtown Road, Cotuit Bill Burdick Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 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 Datek Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand .M'. Nature of Repairs or Alterations(Answer when applicable) Title— ; 1 rma nh a, c t carp consisting of a D-box and 2 precast leach chambers with stone all around. Date last inspected: A. 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 Environments'Code and not to place the system in operation until a Certifi- cate of Compliance has bee by h' d of Health. Sign d i " 0 Date Application Approved by � X-p Date Application Disapproved foc•the following reasops P Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Burdick Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 1074 Newtown Rd. , Cotuit has een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. � ated Wm. E. Robinson Sr. �j Installer Designer � The issuance of this ermitrshall Io�eotrued as a guarantee that the s s e it.fu etio ash esignedJ� r C Date p 7 Inspector �� --- No THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Burdick lwiopooar bpztem Conotruction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) Systemlocatedat 1074 Newtown Road, Cotuit 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:Construccttio`.n u t bfre.�eo /p�let/ed�within three years of the date of this a11 -, ;,_ Date: f> ✓ C/C / Approved by / 116199 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) W i t l iain E. Robinson,S�eby certify that the application for disposal works construction permit signed by me dated ' S— , concerning the properly located at 1 074 Newtown Road, Cotuit meets all of the following criteria: • The ed system is connected to a residential dwelling only. There are no commercial or business uses ted with the dwelling. The so I is classified as CLASS I and the percolation rate is teas than or equal to 3 minutes per inch. There se no wetlands within IM feet of the proposed Septic system — There e no private well,within hU teat of the proposed septic system Ther is no increase in flow and/or change in use proposed • jethod are no variances requested or needed. • ottom of the proposed leaching facility will tube located less than five feet above the mum adjusted groundwater table elevation.JAdjust the groundwater table using the Frimptor when applicable) S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed ing facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the fellowiW. A) To of Ground Surface Elevation(using GIS info P ( g rtaauon) B) G.W.Elevation +the MAX High G.W. Adjustment DIFFERENCE BETWEEN A and B _ 1� SIGNED : DATE. [Sketch proposed plan of system on back). y:twaM folic cen . .--. `�, � ,_.. .r' .�.. �� . � � �� r �� No....�1J..�_.. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH /y Appliratiuu -fur Bfuvusttl Workii Tomitrurtiuu Vrruiit ®n Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System a at .Address or Lot No. •_ __ - --------- ......L __ 6................................ .................................................................................................. wner Address W a Installer Address - ,�/ d T pe of Building, Size Lot_Z_0,__71-_.�.Sq. feet U Dwelling No. of Bedrooms------�_ 3__________________-_-_-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtur s ----- W Design Flow................................:gallons per person per day. Total daily flow........ .._......_______._.°..___gallons. WSeptic Tank-Liquid capacit __.:...gallons Length................ Width-.____. .....-. Diameter................ Depth_.____.__...--. x Disposal Trench— o. .................... Wi th._.___ ... _ ota Total leaching area....................sq. ft. Seepage Pit No....ZC_X_ .......... Diameter -_-. ept o in et__.__-___.......... Total leaching area._-_.____--______sq. ft. z Other Distribution ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date------------------- ---- 1 a Test Pit No. 1................minutes per inch Depth of Test Pit-.._____.___-___--. Depth to ground water.. _. ... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------- -------------------- .. c. :.: Description of Soil - == ✓ ............. .. . LPl- - Y ----' --- --- ' x U w -- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------........ UNature of Repairs or Alterations—Answer when applicable..--............................................................................................ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed I. vidual Sewa isposal System in accordance with the provisions of Article \I of the State Sanitary Code—T undersigne urt er agrees not to place the system in operation until a Certificate of Compliance has n iss the board o ea i. gne = .... ...... ... .......- -- --- -__---------_------------- Date Application Approved By-- - ---------- ---- s ate Application Disapproved for the following reasons:.................................... --- -•--•....__...---------......-•--•---••-•-•••--......---•-•-•----•---- -------•-•---•---•---•---••----•----------------------------------------------------•-•--••-------•--•---------......•-•--•-•••-•....._..----------------------------------------•---•--------------•--- Date Permit No..................... .................................. Issued........................................................ Date No..... l 1` .-- Fa�.;,�5 . ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _.._....OF..........��. 4/cam v yi A t Appliration -fur Uiopu, ial Works Towitrurtiou Vrrmit d� Application is hereby made for a Permit to Construct Repair ( ) an Individual Sewage Disposal System aV } f�} L�ca6o -Address or Lot No. .:..____. ._•!.•_____ �� °i�fA ................................ ._•.__.__.__•__________._.___....-•-.____ Owner Address ........•................•---•-•-•--------- V Installer Address ��--��tt T of Building Size Lot- ______d__f._�` .Sq. feet Dwelling—No. of Bedrooms_..___ � ----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) Cafeteria ( ) a' Other fixtures __..._a_______________________ __ d Desi n Flow............... r--- W g .................._/gallons per person per day. Total daily flow..................__..____________....._._..gallons. WSeptic Tank Liquid capacity gallons Length................ Width................ Diameter................ Depth.-----.___..__. Disposal Trench—No..................... Widdth._..__,____ `Y- Total l] t ,::_____- �_.... Total leaching area--------------------sq. ft. x !%� _" D beiow i�.�......... Total leaching trea.-••--------------sc ft. Seepage Pit No....._,.............. Diameter.. p v . g< 1. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by---------------------------------------------------------------- -------- Date............ -----------------•---41,1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water... - ri Test Pit No. 2................minutes per inch Depth of Test Pit.-____--___-._______ Depth to ground water.......................Ix .................. — -- r~��/'�� J=4 Description of Soil.____________________________ra._..___�.� ,, ��-----�c'----- -------- x ------------------------------- W •------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- VNature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed jIdividtial Sewage-Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—Tndersigne further agrees not to place the system in operation until a Certificate of Compliance has .e n issued'A y the board of- ealth. gned. `�. = tom'' r -------------------�. •.... - -- Date Application Approved By......_.. :.__ '�I-I----------�__-!r��l_.LC.i-r-.(----.- ----- �._.J- T fb t Application Disapproved for the following reasons------------------------------------- ------------------ ................................ -------------------------------------------------------------------------------------•-------------------------------------------------------------------------------- --------------------------------- /I— / Date PermitNo. .............................................. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH "IT .................... /!, OF..................................................................................... IWITIrrtifiratr of ITIomphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) r - f Installer' at ` ....... = - ....-•--_____,__-•------•----------------------------•--•----•------•.----------------------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code_.as described in the / application for Disposal Works Construction Permit No------ :`-_' _`�_____________________ dated...._._____.__="_.�! 7✓ 1 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 ' OF No......................... FEE....... .............. DitiVoottt,- orki`Towitrurtion Vrrmit Permission is hereby granted___________�__��<.� ...� _r:�.._.........____.._ an to Construct ( ,ror Repair ( ) _ 1 dividual Sewage. Disposal System at No,--- I r r �-'� ------------- -------------- -------------=-•--......----••-••••-•----- . -- ---- --'- -- Street as shown on the application for Disposal Works Construction Permit ` -.'__..... Dated....... %-----..�:.._........ ------.............. � DATE..... j ram-G--------------------------------------- Hoard of�Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS R �I L 't49 at Ilk OT 9 /ye mi-wti I. 3 S uTu, G n� �. S 7 3� 3 s lJ 44- ti Ar� �`' r,