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Home My WebLink About0046 MAIN STREET (COTUIT) - Health a`�! �an ��rrl�./v - - J - - -- - - _ � . TOWN OF BARNSTABLE `LOCATION MAt^ S SEWAGE# 4 -5 VILLAGE C 01- 14 ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY UUy LEACHING FACILITY:(type) P tT (size) / aW NO.OF BEDROOMS I r'3C OWNER 14 a�TMA^ PERMIT DATE: 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 S 2cTun [)/ 0 J � r i (3 A � Iy� aae o_ o 3 a.S a3 y 3 3a� y �ssrss�� yu�P= L 3 l�:nQeeL S" LJ C A T ION S E W A G E PE RMIT= N0. lYjo,x) sr VILLAGE INSTA LLER'S NAME i ADDRESS d UiLDE R OR OWNER Awm DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 "%ASSESSORS MAP NO: No 0------------7Y PARCEL NO.: Finc --_D........ ---------- THE COWiMONWEA—L—:T—H-07rffXSS-ACHUSETTS BOARD Off-t4f ALTH ............ro_Vi/............OF................. Appliration for Uhipooal Mirkii (futudrurthin Fautit Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System at: Location,Addres - ------***---------------- .........*or Lot-No.--*--,*--- - -- ------------------------------------51!9-WE---------------------------------------------- ----- - ----- �ne Address ........................... ...... - ------------------------- .................................................................................................. Installer Address Typ.e of Buildin Size ----Sq. feet U Dwelling—No. of Bedrooms.._........ .......................Expansion Attic Garbage Grinder a Other—Type of Building ......ach ..... No. of persons.........9.................. Showers Cafeteria (A0 Other fixtures ............... .............................................................................................. .......Design Flow............................................gallons per person T day. Total daddy flow............................................gallons. ,s.0en /—L 4, ... 1:4 -Septic Tank—Liquid capacitYAIOWV�gallons en th.. Width—Y Diameter---------------- Depth' Disposal Trench—No......I............. Width Total Length....4M__- Total leaching area....................sq. ft. M( ---------t- Seepage Pit No./ D ... Depth below inlet..... .............. Total leaching area............--....sq. f t. Z Other Distribution bo,(/(-�� Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.................................... 1.4 Test Pit No. I................minutes per inch Depth of Test Pit..........._......_. Depth to ground water.._..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...___..............___. ----------------------I.............................................................................................;...................................... 0 Description of Soil......... UX............................m........................I...................................................................................... ....................................................................................................................................................... ................................................. . 0 ..............................................................................................................a--------------------------------*----------------------*---------- .--------- Nature of Repairs or Altesations—Answer wheA ap Hate j 7%*-------V AID_ ....rfrt, TVV4A--7........ . . ....................14.191, ............. ............. Agreement: �e The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin accordance with the provisions of TITU 5 of the State Sanitary Co —The un rsigned further agrees not to place the system in operation until a Certificate of Compliance has been i d by, rd of health. Signed d.1 ./... ... . ......... ................................................. ................................ I Dat Application�'Approved By..... 7 ............ .. ........ ........... .......... ,g?f...... e Da e Application Disapproved for the following reasons:............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo......�.......................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF_-HEALTH Appliration for Bispaaal orks=Tomitrurtion ramit | Application is hereby made for u Permit to Construct ( ) or Repair ( \ an Individuzd ' Sewage Disposal ' System at: n Z Address --'_------' .......................... ____--------------_-'-------'_---'--'---____'-' Installer ddress � Type of Building �. Size Lnt2_4./.F(u.......Sq. feet Dwelling--No. of Bedroomu---'--'.a.........................Expansion Attic Garbage Grinder VxA Other--Type of Building /u&ob............. c6 persons.......3................ Showers (/ ) -- Cafeteria We) 04 ~� Other fixtures_ ....-'__....----_--_.................................................................................................................. Design Flow .. gallons per person per day. Total daily flow- " Disposal Trench No. sq. ft. Z Other Distribution box \ / Dosing tank ( ) | Percolation Test Results Performed bv.......................................................................... Date........................................ 1.4 Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water--_-.-_-_� �44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth toground water........................ m4 - - '-''---- --'-... ---------------- --------------- _''_-_----------_-'_------'---_-______ �� of So --------'---------'---------------'-----------------------------'--- -----'----`---------`------------`--------------'-----`-`--`--'''---'-----`----------`----- ----------_-_---_.------.-----.--'-----_-----'----_.. -'- T6e undersigned agrees to install the oforedescribed Individual Sewage Disposal System ioaccordance with | the provisions of I TALE 5 of the State Sanitary Code-`The undersigned further agrees not to place the system in operation until u Certificate of Compliance has been issued bv the board of health. ` ."j. --__- .. ---------------' -' Application Approved By------...-- ..-......---..-'.'.--'....'...................-------' -''--_---v.-.v------- Date Application Disapproved for the following reasons:.............................................................................................................. _ -------------'--------'----'----'---'--'--------------'-----'-------------------------------'---'----- Date Pcro6tNn--'."-.2 ST .............................. Iuuu«d ....................................................... Date THE COMMONWEALTH Or *vAssAcnussTrs | | BOARD__OF HEALTH ............F -''-----'At � (9rdif ira4tr In outpliatta ..T�p Y That the Individual Sewage Disposal System constructed or Repaired IS TO CERTI by-- e, Installer has been instilled in accordance with the provisions of TITL�� of te Sanitary Code as dje ,5cribed in the application for Disposal Works Construction Permit No........4 �»��,--..--^--x-' ' dated...... THE ISSUANCE OF THUS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F000CT ^--- ` ^^E-_=................ _____ ________ __ ____________________________________ � . � � ` | THE COMMONWEALTH oFwAssAc*ussTrs � BOAR ......XzF-.- ...................... � -- , F � Permission is hereby to Construct ("I or Repair an Individual Sewage Disposal System Street Zi Board of Health ` '