HomeMy WebLinkAbout0112 CROCKERS NECK ROAD - Health 112 Crockers Neck Road ?
Cotuit
A=019=051
I
iP
TOWN OF BA�RNSSTABLE
LOCATION CG�� SEWAGE #
VILLAGE ASSESSOR'S MAP &LOT '0�
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACIL]TY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: 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
�y � o �
o �
��
���� -:
No......Z7>......... Fdl...: .d............
THE COMMONWEALTH OF MASSACHUSETTS
�r
BOAR® OF HEALTH
-. T
Appliration for 15ispusal Workii Tomitrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ),an Individual Sewage Disposal
System at:
/-�1 -, i° -1..1. � --�o6' ------- ------
Location-Add ess or Lot No.
Owner Addres �
�dC!/. ---••----•--••---•................ __/ /�V � 'v ���� �U�
Installer Address
d Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms....: ...................................Expansion Attic ( ) Garbage Grinder ( )
pa Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a Oth r xtures .
d ----•--•--•--•-•---------------•--.....•-•..--_----------------- -------...----•--------------------------------
W
Design Flow...... _...-�.__.__aQ gallons per person per day. Total daily flow.,_. _0_4...........................gallons.
WSeptic Tank—Liquid cap�clty............gallons Length................ Width---------------- Diameter---------------- Depth-----------_--.
x Disposal Trench— 2 q
No....._.�_.. 2N"idth............. Total Length.................... Total leachingarea--------------------s ft.
G/�Ghr� fi�rr/ - b
Seepage Pit No._.loQd....._..Dameter-----------------� Dep h below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
,� 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.-.--.---_.._--.--------
O Description of Spil...................................
------------
U -----------------------------------------------------�-�------. .... / �
W
VNature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue by the , rdjohealthSigned--- --------- - ------- --1--I ---- � ���-� ----- �0
Date
Application Approved By...sie
_1C_..._
- ---------- ------
Date
Application Disapproved forfollowing reasons:...... ............................................. -------=------------------------Da.--------•••••...
---•------------------------------------------------------------•--------------------------------•--•---------------------------------------------------------------------------------------------------
Date
Permit No.....4 /-•--•-•----- - O- 7
------•---•---•----•------ Issued---------------------------------�-�--------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Apphration fox 43ispos al Narks Tonstrurtioaa Vrrutit
Application is hereby made for. a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at_ {�
--- --- -----
Location-Add ess t r or Lot No.
Owner -. Addres ,
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOtlk>LL lfixtures --------------------•-•--------•-----------------.._................................................................................................
Design Flow....._- -.r�_.__.__ ______.____.gallons per person per day. Total daily flow----- _ ------ .....................gallons.
WSeptic Tank—Liquid capacity------------gallons Length--------------_ Width------------.--- Diameter---------------- Depth-------.-..--.-.
x Disposal Trench—No...........;R;i..__..)Width_________________ Total Length-------------------- Total leaching area--------------------sq. ft.
3 OthSeeer Diage stribit ution box' l �iameter-Dosing tank eptl below.inlet.................... Total leaching area------------------sq. ft.
Z ( ) g ( )
a
Percolation Test Results Performed by--------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---..-._-----_--_.-----.
(i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__---____-__-_--_-_-----
a' ------•--------••-......-•-----------------•--................-•-....................-•••--••-•------
Description of Soil----•__--_-__•____________________
xT ------------—---------------------------------------------------------------------------------------------------------
U ---•-------••----......•--•-••--•--------•--------•---------------••-•-.....----.•--- -------------------------•-------
G
VNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
i. •... •--••------------•......--•-------------------------------------------------------------•------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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 TrdgohV.
Signed--,�,,/ ---
----------• -'---------------s�-------------=------------------"� / '.`• si
U
Date
Application Approved B
Date
Application Disapproved for t%se following reasons-----------------•-----•-------------••-••-•••-•-••-••-•--...•-•-•---------------•-•-•.._-- --------------
----------------------•-•----•-•-----------------------------------------•---------------•-••--------_...._
r � �
Date
Permit No. - % ........................................ Issued........... ----`f.- `'- = ---------------•---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.4 ..
f •-r
TpFrfifiraatr of TIMpliaaarF
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed '( ) or Repaired ( )
,. -- --by <_, _��41"gel.``=°"5...---•--......---•••......-••------..--J-......Installer -•--•Y•-•--••-r•'-•-�------••---•---- --•--------------- _ _
at i &/ T� . r - -
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..r:..... - ....................... dated.....V'..-.._'��.�a__-._.' .............
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
No.. _�_ .._ —_._ ___.� ----- .�_ ,�.. _.�_ _ FEE........................
. �i�����al �rk� C�nra�traar�ilaaa Fraati� .
Permissionis hereby granted.........�f----------------------------------------------------------------•-------------------------------------------------------------
to Constr t, or epair an Individual Sewage Disposal
Systejn,
. --• ------.
Street
as shown on the application for Disposal Works Construction Permit No..1`J/_______-•- Dated_____ ..._ _"-• -.`7:_-_-•
Board oth
DATE............----------------------------------------------------•---•-•-••----- %,-.
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
No..- ......... t F�>a -......
THE-COMMONWEALTH OF MASSACHUSETTS
BOAR® PF HEALTH
....... OF..... ...............
-i--
AVVHrafivu for Utgpsal Workii Tonfitrixrfi>ait Vrrtnit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
1 � '� V-1r
ocation- ddres " or t N .
O ner Address
,� ) -
nstaller Address
Q Type of Build- ` Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms-_-_-; __________________1 -Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
P-4 Other fixtures ------------------------------------------------------
W Design Flow.............1�_....._______ ________ allons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tani —Liquid capacity__.___.__ Ilons 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 ( )
Percolation Test Results Performed by--------------------------------------------------------------------------
Date---------------------------------------
aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_-_.______-:_______--.._
444 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.---_--_______--__----._
Ix ---•-•--••--• .. -•----•--•-------•--------------------•------------------
ODescription of Soil--------------------_ ---------------------------------------------------------------------------------------------------
x
W ------------•--------------------------------------------------------------•----------------------•----------
VNature of Repairs or Alterations—Answer when applicable._._.. ---_----------------------------------------___________
------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with IZJ
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bSrQ issued by the board'' of health.
----- -.�/1..!-� • ,
Date'
Application Approved By.__... ._ ..__ ...._ r 7 '
/ Date
Application Disapproved for the following reasons: --•-••. •-----••---
-•-•.......-••---•---•--•••--•---•-••--------------------••--••---••••------------------
=--------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued...................... .................................
Date
No._),ay ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD PF HEALTH
I � 5
App iratiun for 43iupuuttf Works Tonstrurtiun thrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
. t .s*f4CA-ti -.. .. N
/
---:...:_ ..........✓ ------ ................ P
nerAddressO ...... ......................... .......•...--•-----------.•----------
Address
Type of Buildin Size Lot___________________________•Sq. feet
U Dwelling No. of Bedrooms-------_,_ _.._.Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ---------------------------- No. of persons________________•_•----.-_-- Showers Cafeteria
a' Other fixture
(�
W Design Flow................ ................ 1 ns er erson per day. Total daily ow......_.._..................._.._ .._...._._gallons.
--•- -- � P P P Y• Y � -
W Septic Tanl —Liquid capacity_ �O1is Length Width. <Diameter Depth
Z 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
Test Pit No 1....; :;:......minutes per-inch Depth of,jest Test Pit.................... Depth tot ground water--.-_-__-_-_----_---.-.
r14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
a ---------------
O
Description of Soil-------------------., - ;. .: -----------------"---•----------•--- ...............................................................
x :.
..
---- -- ---------
t, Nature of Repairs or Alterations—Answer when applicable._.... .1_.� ________ __ __ ---- -------
�. ____:__.
..
Ir
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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.
Signed --Lk
......... ----------------
`l c tr
Date
Application Approved B -" ' ._ .:_ _____________ `_ _ _____
Date
Application Disapproved for the following reasons_----_______________________________________________________________________________----- ----
_.__.____
--------•--•--•----•=-•-------------------------------------------------•--------••--.._....•-----...__--------.---------------------•-...............................................................
Date
Permit No........................................................ Issued..........................................
==-= •......
Date
"` "n*.< - 4*wt:irst �ra•.Ne �t't"` '3.s",.3 �•n. .` ,.
E COM;MONWEALTH'OF MASS�jCI�USETIS t'. �b�.
,.
BOARD OF HEALTH
,. _ i _
... .. .............OF........ �rq� .�.. ... �.......................
eriT
ratr of (1 omplianrr
T I IS TO CERTIFY, That nidual Se`l ge Disposes stem constructed ( <orRepaired ( )
by-_.. ...... . df
Installs d °`°"""
p
at._p .° _.�_y .t — '� - --- -- - ----�.•-• � � '� � ........ ."
has been installed in accordance with the provisions of Article XI of The State Sanitary Code s desc,Iibed in the
application fgr,Disposal Works Construction Permit No.............1..3._Y................. dated_.__. __ .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS U A UA TEE THAT THPI
^w' SYSTEM WILL FUNCTION SATISFACTORY. �
DATE Inspector___
-----------•......--•---. -- • ---.............................
•-- •"".... ........
r.
x+
THE COMMONWEALTH OF MASSACH,USETTS
BOARD ® HEALTH, . - s
a ........ OF... ! "d et to �°° ................... � �
No. FEE
-
Permission is hereby grante ..... __-_ _: ___ -,. .._.._... ....
to Constru � or zIr Re a Indivl, u 1 Sewrae ,D�,�'s o al S � ema t
at.N0.... i, -=Jr a + Pa P Street ` A n '
as shown on the application for Disposal Works Construction Permit �_ I- .. ated.:.X4 '::._
"2
B rd Hof alth �a
DATE............................................=................................
FORM 1255 HOBBS•&'WARREN. INC.. PUBLISHERS
u k �eas99a�a��
f ot
1 O•b Ra EXISTINl3SEPT'� '—TEM ca �
o°5 LIMITED ,.DROOMS
3° p DUSTING SEPTIC SYSTEM
#OF BEDROOMS
LIMITED TO_._
I c
I f_ � o � J �
Let,W b✓1
I I L
I I �
Q < o Q
• V
--___ ur r».re sir 0 0 _
\
O �\ o: I v/Indow from fem�y room �
�� w e•-.i4:• y� — -
f _
Q HAW-
SEEMS: e e I \
\ c.r...r».Tz
re
«
In °
tP 1 -� PpCI.'¢00}'T _� v'1c`c va mo I G � 'r, , d 'D'•-ry�:
E
x
II
� 8a'S 0000
I is�u'>o� OorQ
WALL LSEGSNfJ: mR 6��so p 00
I I 0 Cxw}ink e}ud well.end con6Ywne}e rsauin. E����3 E � p
I I ........................ q�}ud welly}o bs ramo�ad.. „n•35 o c E S i
C - Naw ndsU}ian wells Jai.'end r.,f}ere, m 6 $s E
• gal_
c E 110
'b
' '-O 1/2• DRAWING TYPE:
�ieaond Floor•plan,
4 O'-b 9/D' I m'-9' I♦'-m'
SHEET NUMBER,.
OO
% •B• S a
a sfi8a
:o•-%. Im.m. 19•-e• � a6ao3���6636
piw Sfig �' fs
V a••�yo-7r71�Qu�.
Id-!d' g�_B• %'-1• g'-1' ,'-41/O" 4'-9 1/O' ,'-9 I/O' - FtF �B$yys$$�1``m V •ag6u � ° gE
o y
c c c i c i c c z L *15
iP �•� �'r
E ♦ "I��p
a"s �a•
�ySQ y¢
1►J `r
Andy•wn•W7¢II 910/t-TW49%f „ AndYw.n. 49'10/II- Wow%x
• '• r.a. -9 9/w •%-w)/B ♦ rO.%'9 G/9••%'w)/B'
Iw`HWI I - I I 1.1•ryu¢1
uvPlcFoart _1 O R
- L �L L
� oeoF-Dort•r ''� 4 I P 41 C W lV p
' O _. _ y� 1 4'.4'f 1 r o• �. I I I'-e^ 0 � N
f f wYn.bw W e ii 0 ___ � , Y •�
rom tlr 9mil -
-I 9/9• :• � _______ I r Andwr�wna(•w I9? � = ,
I(F{ ww
0 � :i � iE _ ar.:..w. I I l „ •
® � las/w• yr I1 _
\ �, - I I • RM4LY p oi)rt Hww+-n,r lo*'.ryodN m000GW
c e o v I �.r..�.,w•_y � � � I I - �
♦
w
e c� wx .we I 1 m
Ane.rwnaols �L •. ii I I I rvw oNe w.¢ p
"' r.o.II'-o%/B'Y 9'-O I/2• f i ./wY a/e• I - w/AnYyo•F-•d GAtur.d prY.k ' � '_
• :: � too-wo%:I .......: _......
� •. :: a ��e ....w•.. n �. ^ � ...�... _....�_..n._..
SI I - •I w .n....n+ r.o.V-9)/B•Y r-w 1 s/Im• _ ....+. ....._�._
r.o.4•-0%/e•.s•-o I/4• 5 : ed w,l,.;,�i r.�•: o -0.. o
a
WON E
I
------------
IIFT
Al
Li
I
I
e
' x
d
II
c :sa
u yiY bb o000
ram- S° �a
WALL-I-0-40t - 5$s
I I I O e:.,+;•9.t a w,n.w e aane;r;en,to r,mw;P me E��3n
L
$ L.L
hill
FI-00� i'lN
4
DRAWING TYPE:
Mr9•+ Floor.Pl.n
- i r-1 I/s•
4d-%• 1 m'-o• w•-m• 5MEET NUMBER: '
%I A 2 00