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Home My WebLink About0028 HIGH STREET - Health 28:High Street -Cotuit t - - - - -- -- - - - \ A = '035 048 I I it • i TOWN OF BARNSTABL.E LOCATION_aS l I �� • SEWAGE #� � VILLACC_0�i/�%� ASSESSOR'S MAP CA LOT a3T'ottv 4 I.NSTALLER'S NAL'Ic PHONE NO.A � Lim SEPTIC TANK_ CAPACITY LEACI-ING FACILITY:(type.) ize)�� _ NO. OF BEDRQOMS PRIVA'!'E WEI,L OR PUIII.IC WAT RJUAIL BUILDER OR OWNEPti`��®� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ L VARIANCF G RANTED: Yes----- ---No �p Id Ally �� s. ,Oro �. No._. .... Fins....IS.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH j-. .... .........OF...................... . ........... ..... Appliratiun for Uiipuiittl lgorkii Tunutrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( L)"an Individual Sewage Disposal System at• I /, .� #4! .. ...... ....."--"---------"------------"-"------------------:-----------•-------"----------------•------ .-.oca'' [� ress I or Ut No. " �o•- -e --------- -... " ----•-"-"--•-•-"--•. -aar.ss---......."""--""-"-""--"•"--------- -- indt {Installer Address U Type of Building Size Lot_._�r�j�_-_____Sq. feet Dwelling—No. of Bedrooms..__....................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----•-------------------"-------_. ...... -"--"_--"..------------------ .._•--------- Desi n Flow.._....•....................................gallons per person per day. Total daily flow__._._�/ W g �®g P P P Y Y � �------------•-•--•---------gallons. , * Septic Tank—Liquid capacity......_.....gallons Length...1.7/.... Width...... ......_ Diameter.....•.......... Depth_-_•-- _._.. xDisposal Trencl--No. .................... Width........:........... Total Length.................... Total leaching area---_................sq. ft. Seepage Pit �QD:�___.. Diameter........... ...... Depth below inlet.................... Total leaching area...........:......sq. ft. Z Other Distribution box ( L-r Dosing tank ( ) Percolation Test Results Performed by...................................................................••••• Date....................------------------- aTest Pit No. I................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----------.............. W' O Description of Soil 1L - 9.A./LS�------ -- .......................................................... x ............................-•----••••••-••••--••••-••--•-••---•••••••......•••••-•••••---•••----...•••....-•----------••--•----•---•---•--•---•••-••••••••••••••-•••••-••-••......-••-••---•-••-•-•---- W •-••-•-----•----•------------------•--------•---•-----•••••-------......--:..........--••••---•--......-••••••••. . --------- .. "•- VNature of Repairs or Alterations—Answer•when applicable..._..__ : ......-- .i.. ..f ._ .... ........................I.................... ......................................................................../-------------------------------------------------------------- ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T:i.L y g p y of the State Sanitary Code—The u d ned " tl:er agrees not to lace the system in operation until a Certificate of Compliance has s by th b ar, of th. Signed .. •. . _ .. ............ ......... .....7. ,z.. ..l��r ate Application Approved B -• ••.•• ............................ .--•------7/.- /Pe.. -----925r- Date Application Disapproved for the following reasons:---...----•-"--•------------"-"".....--.---•••••-•••-••••----••----•------•---•••-••-•--••-•••......-•••••-- ---"--"---"-"----........"..-"---"-----"----•----"------------------•-----•-------......---•------""---"---••••---•••••-••-•••••--•-••••••-••--•-••••-•••••••••-•••••••-••...•-•----••••••••-•••._._--•- Date PermitNo....- .' - - . Issued....................................................... Date x r � No.. ;; .... �Q Fps.... .. ---•--...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF.............. Appliratiun for Uigpoual Works C omtrurtion 'Prruat Application is hereby made for a Permit to Construct ( ) or Repair ( Ly an Individual Sewage Disposal System at . . ... .. .�.!h..... t.... �.7 t .... .................................................................................................. ; ocatf4r11•Address v or Lot No. a� ...:� ......... t-- . -•--•-. ...............................................................................----•-•------••----•----. •------•--------------••-•---•------....------ W a ti_ 3 �I:{•L!i !.. �` O�netn � ... l.q 1�;'tt 3 p 1 jddr ej ....= ... Installer Address Q Type of Building Size Lot_-_ _______Sq. feet Dwelling`rNo. of Bedrooms._..4''....................................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QIOther fixtures ----------------------------------•-------------------------•-------------••--------...•---•--•---------------•-•---------------------••-----•-•---- d W Design Flow.....................................f4.._, gallons per person per day. Total daily flow...... f. ............................gallons. WSeptic Tank—Liquid capacity ....__gallons Length...1.2....... Width.....L....... Diameter................ Depth.......:-_---- x Disposal Trench---No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No. _.---._'._:%__--. Diameter...........io...... Depth below inlet.................... Total leaching area.................. ft. Z Other Distribution box Dosing tank ( ) .4 Percolation Test Results Performed by.......................................................................... Date....................................... 14 Test Pit No. I________________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---_.-__--_______..__--. oDescription of Soil yf = J_!.LC. . ............ I...............t, �-- �_,.'--'a-'t114__ -•............................................................ x V .............................................................................................................................................................................................._.......... W -1--�•--J --- t U Nature of Repairs or Alterations—Answer when applicable.___-___ - ._.._._. ._..._� ---•-------------------•---------------._.....-----•---------••---------•--•••----•-----_------------------••-----•--•-.- -------------•--••-------------•--------••......-----............•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with -:' �'7 1'1-_�. the provisions of IT � 5 of the State Sanitary Code—The d signed -urtl:er agrees not to place the systeir in t operation until a Certificate of Compliance has be 'ss by th `b' ar,'d of lth.� ti, r ` Signed..... �...._` t .......-•........ ... ............ .....I r Date Application Approved By...... r_ -• --------------------------- ` �--------- ' f, Date Application Disapproved for the following reasons:............................................................................................................... •--------------------------•-•-------.....:_...............-•••--•-----.......•-------...--•---.....--•--•--•---------•..._...._....-----•---••-------•-•--••-•----••••------•---------•......--•------- Date Permit No... ., = �� Issued....................................................... {} Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tr�r .............oF............./ . .- ? ............ ..,............. (Infifiratr of Tootplianrr THIS IS TO CERT�FY, That the Individual Sewage Disposal System constructed ( ) or Repaired bI €..':==`.........------•--•-•...-•-....-•---....�`--------------•-------•-•-••----••••----••---•...•••--••...........•----------•-•-•-....--------•-•- y----------------• --•-------- ( Installer at " = _ ... .!, .---•---------------------------------------------------------------------------- has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .:____ 3. .. .......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... "--�9.1.b.t$er........................ Inspector...---------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /i! � ............. y�'I ...................................1 r..........OF �, . �Q N FEE f a.— .......... 11iu.Vocal Works Tottotra#iort rrtnit Permission is hereby granted......___ _r.......... _,Ga�f� :_ to Construct ( ) or Re air. (k an Individual Sewage Disposal System atNo................�.6----- -------- ----------------------_.:_(!' --- ------...---------------•--•--------•----•---••------.....--.....•-- r Street (f � � as shown on the application for Disposal Works Construction Permit No.-�Q�:.:___J:._ _: Dated.......................................... �t �` Board of Health DATE--------.......7 ... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS