HomeMy WebLinkAbout1208 MAIN STREET (COTUIT) - Health 1208 Main Strt4
033 - 012
-- -- - - — -- - ��� — — Cotuit
J 'TOWN OF BARNSTABLE
LOCATION ! ® 14"eOl d! "r SEWAGE#
VILLAGE 607t/1 `i_ ASSESSOR'S ^MAP&PARCEL
INSTALLER'S NAME&PHONE NO. tfX I S 1 I k1 �1
SEPTIC TANK CAPACITY 44
LEACHING FACILITY:(type) . 0
(size)
NO.OF BEDROOMS
OWNER L). De` yy--c c,1I i o
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
OUT
.AA k
r v
No.._.....r.
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
a
Qton.....0 ...............................
App ira#ipu for Bigpoii al Works Tonstrnrtiun Prrmi#
Application is hereby made for a�Pyermit to Construct ( ) or Repair ( {T an Individual Sewage Disposal
System at:
......
_..... - .-�.. i.. �...................... -- ------------___--------___-------______--__ _-_______------ ._...........__:... -
cation-Address ----or•Lot No.
w r —� dress
Installer Address
Type of Building Size Lot............................Sq. feet
' Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building _______________ No. of persons___._--._-_..__...-..--.--_. Showers — Cafeteria
dOther fixtures .•---•:•---••-•-"•••--•••--••• "--••-•-•-•-----•--•--------------•-----"---•-------•------.........._•--•------------_•----
W Design Flow...............
.............................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ i
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........................................
aTest 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........................
�+ -
0 Description of Soil.... _ •---...---•-----•-•-•••------------•----•-•-----------•--•-•"-------------------------••-_--•--
x
U .....••••-•••---•--•••---••------•••-•-•--___••--•---•-•--••.........................•---------••_...-••-•-•••--•--•--••••-•-•--...._••--••------•--------•---------........-----•------•---•••••-------
•"-••------------------- --------------------------------------------------------- -------•---------------------------.-...:-••---------- •- -•••"••____....._..--••-•••=--•-•____._.....---•--••-
U Nature of Repairs or Alterations—Answer when .
-•---•-----•---------".......................•-----••----------••------•-----•---•--••••----•---------••--•--•--•----------------•--•-•---"•--•--•---------------..._...-••••"------••-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of iITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee sued by the boar f h It .
...:.....:
�Signe C
_.
ate
Application Approved By.. .� z................. �1-- ._
Date
Application Disapproved for the following reasons:----____............... ..............................................................
..._......-•------••-----------------------•--------------..:..---...........--------......_._._......--'--"-•--------•--•--------•---------•---....................................-•--••------------
a Date
PermitNo......................................................... Issued_.........................��------------------------
Date
No................�� F�$ � ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
3 -------. ---- .
ppliration for BwvosFal Works Tonstrnrtinn Famit
Application is hereby made for a Permit to Construct ( ) or Repair (lr%'f an Individual Sewage Disposal
System at: i✓► �T � �
..:.......--. .................... ...... ..........
cation-Address r. or Lot No
Installer Address
UType of Building Size Lot...................:........Sq. feet
j a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons...... .............. Showers Cafeteria ( )
t d 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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.............................
w Test Pit No. 2................minutes per inch Depth of Test Pit........_........... Depth to ground water........................
^- ...................................
..............................................................................................
0 Description of
W . . ...
U .
---•-------------••-•---••-------...-•--•-•-••-------------........-----------•----------------------•-......-•-......--- ----..............................................................
U Nature of Repairs or Alterations—Answer when applicable._..f �_ _ R x l•t ... ~-.-- }. C - .
..---•--•-----------------------•---•-----•-----.....----...---•--•-----••---•--•••-......._-•---•-
Agreement:
N The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT i s. 5 of the State Sanitary , ode—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance ha e C suedPyy he 1 lth.
Date
Application Approved By.. .. • ..... {-- _•. •--•---• ' - ...........................--
Date
Application Disapproved for the following;reasons-.....................................................
.......... ----•-•------------------------------------------------------------•-----•--
Date
PermitNo.................. Issued.....;,...............................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
( ntifiratr of ToAtpliFanrie
T LIS IS TOy CERTIFY, That�the I�nd,*vidual Sewage Disposal System constructed ( ) or Repaired C e)`
.: b �..-'t tl F e,.J�.. e ..1 i-ev E ;. ..K C. .'�,. ' C.. ........................... .....................................r..............._.--
y t,,
} 'Installer
has been installed in accordance with the provisions of "' F ` f he State.Sanitary Code as described in the
g
application for Disposal Works Construction Permit „_ ......�e�_._/T............. dated--- P._" _
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSY ED AS A GUARANTEE THAT-THE
SYSTEM WILL FUNCTIONP� SATISFACTORY.
....:..r� 7/.........-
.....................•-----...------_. Inspector:..--- -----------........ •. .....................................................
DATE............
THE COMMONWEALTH OF MASSACHUSETTS
�� BOARD .OF HEALTH,,.,-F-
-.-�F .7...... ................. 1 D sma ....................... FEE. '!�!.�e.......
Disposal Works Tonstrnrtion famit
Permission is hereby granted. . , --•� l" C� .? ".. ..,.. 11= - •.
to Co st•suct ( ) or Repair ( -man Indivld al Sewage Disposal Syst
at No --, . . . --�-T -------- X-V. ................Street..-...... C.�':
Street
as shown on the application for Disposal Works Construction Permit ............. .........................................
7
oard of ealth
DATE...••-•••--•-- -----•-•--•••--•..:_•-•-••-•••••.......----• .:..... .
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS "
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LO CAT I0� SEWAGE PERMIT NO.
VI LAGE
I ST LLER'S NAME i AQ�ESS
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DATE PERMIT ISSUED 2-
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DATE COMPLIANCE ISSUED y►�i� � 7j�
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LO CAT I0� SEWAGE PERMIT. q0.
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1 ST LLER'S NAIME a AQkRESS
.B R OR OWNER
DATE PERMIT ISSUED
DAT E C0INPLIANCE ISSUED 9--�p2 7
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