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HomeMy WebLinkAbout0214 COTUIT BAY DRIVE - Health (2) 191 Main Street _ Cotuit -- A _ A= 056-016 TOWN OF BARNSTABLE LOCATION A 1 '('n 06 Yv Sfi' SEWAGE # - %Z Y 7- VILLAGE j� l,� .7 1 ASSESSOR'S MAP LOT00'7- J06 r i I 4t-77 INSTALLER'S NAME & PHONE NO.CA { SEPTIC TANK CAPACITY ) 11 p LEACHING FACILITY:(type). L.c4r I— b (size) I 0Vlb NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER S 1,` ` K, O O m 01 r ll DATE PERMIT ISSUED: l9 J © �f DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ✓ coo t . 10 to No.-- 1..�.� xs. .s.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Dis#nsa1 Works Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (-X" Individual Sewage Disposal System at• Ct I „ 1 ... , ...................................................... ........................ ©.L....................................................... ... Coca ion-Add_Address �._\ Q rtor ot1^). ................ .�:L.. .._-.... ... -.....`.'��............. y................... .........................................................` .._......--------------.:..........�.M-- W .�,.._..�. wn r� \C��� ` 9�7 �.�' ti S �ddress /� Ol5 `e T , � ' (4- Installer Address Type of Building Size Lot............................Sq. feet .-� Dwelling—No. of Bedrooms........................' ................... Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ---------------------------------- • W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... 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........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fN Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ............ ......... -- . • . .- 0 Description of Soil....................... a +C'�i `` ................................... V ---------------------------------------------------- ---------------------------•� - ----------------------------------------------------- •------------- ..------------ .......... W U Nature of Repairs or Alterations—Answer when appli ble.--_____-------�ksj.... -�S-_�-__--__-._-_N.-C ....:_.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ en 1 Code—The undersigned further agr es not to place the system in operation until a Certificate of Comp,' nce s bee is ued by the board of hea_lth. r ^� Signed ......... ..................�....... - -!il QM................... ................. ------------------ Date ce ApplicationApproved By ----------------------------- -- --- --- -------.............................----------------------------------------------------------------- --------------------------------------- Dare Application Disapproved for the following reasons: ... .. .... ...................... ... ................................................... ............................ ----------------------------------- ----- --------------------------------------------------------------------- -- ------------------------------ ------------------------ --------------------- --------------- -------------------- Da. PermitNo. .. ................................................... Issued ---------- d �1..._1 ....... Date t No................_....... FR .1.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Elhipaiial Workii Tnnitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (_�an Individual Sewage Disposal System at, -•- - ` .........- - • •..............•-----------........... ...........................-----•-•-...... ----------.........-..................--- Location-Address ' or,Lot No. - .................................... �... 1.... e ► ► �� s tea. caner , Mr ddress Installer Address Type of Building '� Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------------------------------------•-------'----•------------------.................-----------•---------•-------------•-•-----------_----. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No----_------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4.1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ----------• -----................... ----------------------------------------- -------- -------- --------------------------------------------------------- ODescription of Soil...................... �� '`� -= 1 �t .--------------------..-..--------------------------------------- V ---•---•---------------------•-------------•-•--•-•••----•----------------•---------- . ---------------------------------------•--------------------.....-----.....---...---•--...__........ W x ----------------------------------------------------------------------------------------- ----=--------------------------------------------•---•---------------------------- --•-••........-•-_.... U Nature of Repairs or Alterations—Answer when applic ble._------------------- -----vn..�__-- � _ -�............. O� ------•-•----------------•-------------------•------------------------- --------- - -------- -• fi ---------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ ental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce Js bee is ued.by the board of health. r 0 Signed ......... `----------------------- -----------------------------`- ...........---.. r---------------------------- .....--........... Date ApplicationApproved By --------------------------------------------------------------------------- ----- -------- --------------------------------- -------------- -------------- -- ---------------- Date Application Disapproved for the following reasons- ------------------ ----- -------------------------------------------------............................................... - - - ---------------------------------------------------------------------------- ----------------------------------------- ------------- -------- ....-----------------.................. PermitNo- -------------------------------------------------------------------- Issued -----......... .. .... -- .cl-----I.............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifi a e of Tomplianre THIS h 0 CERTIFY, That the Individual Se age Dispo aLSstem constructed ( ) or Repaired .-----`--'- Installer at .� ..... . t---t---------------4 ..-�-------\ .......-.--...... .-. ........---_------------------------.......................................... = has been installed in accordance with the provisions of TITLE 5 of 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 SATISFY�CTORY. �Q l7 ( ) DATE.... . .. .. . ................................_............................. ... ... . Inspector --------..........---.......--- Q-----------=-- --_---....-----........................ (.J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �p , No.... .. �7 FEE.................... rrmiiLs 1 Permission is herebyranted:..._. ____�-t_. "._._l__�__0........".':...._. ''� g . ...... .... . .... ............ to Construct ( ) or Repair r an Individual Sewage Disposal System at No......................................... �...........__.. ,� �t l a.+.- _t__ ._.__ - .• .---------.---------------------------------------------- Street as shown on the application for Disposal Works Construction Permit N _Dated------ -----------------------------� -----------------------•----------•--------••---- t Board of Health DATE------------------------- ----- .._..: ....................... FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS