HomeMy WebLinkAbout0564 MAIN STREET (COTUIT) - Health 564 Main Street
036-021 Cotuit
TOWN OF BARNSTABLE
LOCATION 5�� /f/��� ��I J�� SEWAGE # / 5
VILLAGE Gd,jdr 7 ASSESSOR'S MAP '
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INSTALLER'S NAME & PHONE NO./ yU
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SEPTIC TANK CAPACITY 0 0
LEACHING FACILITY:(typeezl_,�(_p[ Q �00`Cize)
NO. OF BEDROOMS PR VAT ELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
APPROVED BOAR® OF HEALTH
Barnstable Conservation Department TOWN OF BARNSTABLE
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Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
... ,��1`� . t fUl r-- ------------------------------------------
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� on Address or Lot No.
..../.--------------_------------------ --/-r........................................ •-------•--••-----....-----._...........------._..............----......•.........................
Owner ress
aGam/-/f /?�� oG•%IiCJ.� S --------------`I. ,.. ._... .......
Installer Address
d Type of Building Size Lot............................Sq. feet
V Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---__-_-._-__-_____-.----_. Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter................ Depth................
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........................................
Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water........................
LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 .....-•------•••-•--------------••••-•••--••-••••-••-•••-•--•••-••-••-•----•••-•••-••...•-••-................................................................
0 Description of Soil......................................................................................-------------------------------•----....-----------------•--.....................
x
w
x ........................................ .................................................................... •---------•-..... ......_........----•-......•-
U Natur. of Re airs or Alterat•ons A1tI ver hen applicable.... .t�..............5 ;�f�'�_.......
. ........�y.. . <`- �..1. ------------------------------------------•----------•-------------------.-------•---- ......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance as • e ssu by the oard of health.
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Signed .. .. ... 1/...P
--....... .............. ........................................... Dare
Application Approved By ................... .....`' .-- ,3............................................:............................. ...%..a._-,...
(.`L..p..Q...''j
Application Disapproved for the following reasons: ....... .........:......................I....... ...............................................................
........._...................................................... ....................................................................._....
Dare
PermitNo. ......... ...j.......... �p..�---------------- Issued .............. -- ................. '. ......... ..........
Dare
...........
THE COMMONWEALTH OF MASSACHUSETTS
V/
BO NRD OF HE-AUTHTOW OF BARNST;A1BLE /
/ 3 fur
hration Diripw3al Wvrki5 Tomitrurtion ramit
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Application is hereby made for a Permit to Construct or Repair �anlndiv�iu�-Sewage Disposal
System at:
.....s ........./. ......... .....0 .-.............................
.............. ----------- . ...... .............
cation-Address or No
jW >
.. ...............
Z110........................................ ..................................... ----------------------------------
Owner Address
................................... Cst...............;I---
Installer
Type of Building Size Lot................. I feet
U 4ft
Dwelling— No. of Bedrooms-------------------------------------- -----Expansion Attic Garbage Grinder
aOther—Type of Building ___________________________ No. of persons___-_____.______--_____.____ Showers Cafeteria
Otherfixtures ......................................................--------_---
-------------------- *,-*----------------*.........................*------------Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liqu'd capacity------------gallons Length________________ Width______.___-.--_ Diameter__.__._..._..... Depth....__..._..._..
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._......_..._......_.........._.....__..
Test Pit No. I................minutes per inch Depth of Test Pit._.__......__.___._. Depth to ground water......._._..............
fZq Test Pit No. 2................minutes per inch Depth of Test Pit.._.__.....___._.... Depth to ground water....................._..
04 ..........................................................................:.........7---------------------------------------------------- ........0 �Description of Soil........................................................................................................................................................................
-----------------------------**--*---------------------------------------------------*****'*-------------------------------------------*--------------------------- ------------------------
...................................................................
--------------------------**-----------------------------------------*-----------------------------------------------------
U Nature of Repairs or Alterations= nswer when applicable--- ................. ........
........... ............... .... ..............................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental 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 ................ I. .................I-------------..........................
................Date... ... .....
Application Approved By ...................)_ --------0..It__ ' ... ------)
Date
Application Disapproved for the following reafons: ............................................................................................................................. ........
Dare
PermitNo. ..........-.;5--._------- ................. Issued ....................................................................
Date
——————————————---—
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(11-ertifirate of Tomplianre
THIS IS.-TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by ....... 9 a................ ..... ............................................................ ...... .......... --------................................*....................
lnstalle5
....a- /.N� ....................................................... .........................
-7-------------------
at
A has been insta led accordance with the provisions of TIT11 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ...... ------- dated ... 0..., tq./9....3_......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- 17� 0_2 r-7 Ali
12...... ............ -- ------ ...... Inspector .................................................................................................
--------------------------------------------- ------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
2 FEJ- ..............
No.....
Disposal Workii Towitrurtion Wrmit i
V
Permissionis hereby granted.-,.................................................................................................................. ....................
to Construct or Repair ( k")"an Individual Sewage Disposal S st m Y/
at No... el.. 7......................
. . ......................... ..........................
----------1777
as shown on the application for Disposal Works Construction Permit No._X3_-.L4/z;- Dated...........................................
......................... U .................................I............................
DATE--------------.----------;---: ............................... Board of Health
FORM 38808 HOBBS&WARREN.INC..PUBLISHERS