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Home My WebLink About1895 SANTUIT-NEWTOWN ROAD - Health 1895 Santuit-Newtown Road, Cotuit A = 023-016.002 --_-- ---- - --- —_- A Road - Cotuit � :UPC 10230No.144,63 NA8TIN@8,UN TOWN OF BARNSTABLE � ?'� �• - LOCATION ;,t SEWAGE # VILLAGE CC 9J ASSESSOR'S MAP & LOT -Or INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 4all-19 LEACHING FACILl TY: (type) � -- / 3 G g* (size) s2,�G'ra i NO.OF BEDROOMS BUILDER OR OWNER : PERMTTDATE: 5�� _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 Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by .� � � -a .__...._.�___ .___ � i a No. Fee oro THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppYication for Digpo.5af *pgtem Con.5truction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. j ig-S Owner's Name,Address and Tel.No. rh/L T A ct44 2(3 Assessor's Map/Parcel r �0 , Installer's Name,Address,and Tel.No.(R®Nt s, e lCcjs,u F /&q Designer's Name,Address and Tel.No. 7� U Pq4 t t#-.A P-D 117 A-J RCYJ S 1cC u a4 1 act , /-/7') 01 e) Type of Building: Dwelling No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 U gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank to ls0 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2-u c4 A L� oZ 96 O 6 A� �/V e t ch A-s 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 b this B rdofflealth. Signed Date Application Approved by Date Application Disapproved for the following rea Permit No. `� Date Issued No. '• Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: JZ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Miopaar *p5tem Cou5truction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. B S SAI-4-i4 t4 e w o w t Q Owner's Name,Address and Tel.No. t-h Yl. T A c(4 4R O Assessor's Map/Parcel Installer's Name,Address,and Tel.No.R0 Nj r E!K«u A 1 K) Designer's Name,Address and Tel.No. �� u►4 l(�y Rn !'hA��t �e-� �A (c VC[AU6�r�� , Type of Building: Dwelling No.of Bedrooms 2 Lot Size sq.ft., Garbage Grinder( ) Other Type of Building No.of Persons ' Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 U gallons per day. Calculated daily_floW...tf• gallons. Plan Date Number of sheets Revision Dated, Title Size of Septic Tank /10 G0 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when ap licable) 2--c4 A (;A LP A &4 or S 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 Boaz ealth. , Signe Date ell , 5 Approved by Date 'Z i Application Disapproved for the following re o s Permit No. '�'� Date Issued ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERJIFY, that the On-site Sew a Disposal ystem Constructed( Repaired( )Upgraded( ) Abandoned( )b 0 at E h baen constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -s dated Installer Designer k The issuance of this permit sh 4 notJbe_c(o�nstrued as a guarantee that the sy t,�Jm will function a4lesigned. Date t ( ��"1 Inspector0 - I No. --------------------------Fee 9 ;q;) 7T THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS M!6poar *p.5te Construction Permit Permission is hereby gra t Construct( )Re air )Upgrade( ) band -' ) ' System located at J '�" W/►� ) w 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:Constru pion phust be completed within three years of the date of ith s tit. p Date: Approved by 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, �aktldC �= hereby certify that the application for disposal works construction permit signed by me dated c�/ f/ % , concerning the property located at ` 7S— /.)2"ww 2® 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. • The soil 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 method when applicable] • If 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 +the MAX.High G.W. Adjustment. _ ' DIFFERENCE BETWEEN A and B SIGNED : �j C('✓/�� .° DATE: [Sketch proposed plan of system on back]. q:health folder:cert +� r - , -� �-e_ p 2.U o I'� ,. a � �-I=�-�-�-�_ c�'��- � ��. TOWN OFBARNSTABLEQ. 1 LOCATION 9 J �i��-A i f ,i,J l�t/rt dSEWAGE # 4^ VILLAGE ASSESSOR'S MAP & LOT " -oLIO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: size 4�? I lx i NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: ZA GG"q COMPLIANCE DATE:-3 i 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 9� Ell �_