HomeMy WebLinkAbout0335 MAIN STREET (COTUIT) - Health r ------------
335 Main Street
cotuit
A=022 - 031
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P 335'
STTOWN OF BARNSTABLE
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LOCATION SEWAGE #
VILLAGE C ASSESSOR'S MAP Q LOT ds 1
INSTALLER'S NAME & PHONE NO. G Aw4 e m/
SEPTIC TANK CAPACITY f S'o 0 6,4
LEACHING FACILITY:(type) I4206 eytoe,4, T (size) /boo
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER An A KT14 A
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ��
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LO+C AT 10� WAGE PERMIT NO..
VILLAGE
IN TA L R'S N�AMNE ADDRESS
B U1'LDE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED 3
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No..---�r........ Fu$. ........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Ta_& .. -....O F. �„ / 1'?. ................ ................
Appliration -for M_qp ial Workii Tomitrnrtinn Vrrantt
Application is hereby'made for a Permit to Construct ( ) or Repair ( )�dividual Sewage Disposal
System at: r
-- •--•------••• ••. --...... .....=------0 --------------------------------------•-----...-•------------------------•--------....
ocat- .Ad or Lot No.
.. ...... ••. ........... . . ................ . ... ............................... •--•--•---•-------••----•----•----•----••------•------....--•---•---•-............................
Ow Address
.._--••-•-----•---•--------
nstaller Address
Type of Building Size Lot......... ..................Sq. feet
Dwelling—No. of Bedrooms----........................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ............................... . .
.14 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.
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. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water....._-._.... ----..._.
�14 Test Pit No. 2-__----_.-._._minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----------------------------------------------------••--------•----•------------•--•---------•-----.....................................-------------------
0 Description of Soil..---------------------------------------------------------------------------------------------------------------- ------------------•---------------------------------
x
V _
--•------•.................... ......................................•--•-•--------•---•---....----•---...................--...-----------••-- •-----•------------------•--...-----•--•--------•---
W .................... ._._.._..__........._._.-_.._------------------------•----.--------------------------- -------- --- .
U Na re of Repairs or A erations—Answer when appl' e....-.... A D.-.-
---; -•---- - ------------- -
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article YI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued the board of hea �i
St ne<(_�-,�� ( r- - d
Application Approved By------ Date
--- ----�--------------------------------------------------------------------------- -
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
--•------------•---------••------•--••----•--•-------•--•------••---•---•--•-•--•-•--•••----••---•-•--....------••---•--••-•----------------------------------------- ----------------------------------
Date
Permit No.------�f........................................ Issued.............................
..........................
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
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m / �C(' �J- IL
DATA
No...... ` ......... FEE ...�........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA H
Tnl�� .... ..
Apfirtttion -for DioVoottl Workii Tonotrurtion Vrrntit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
�- -------�.1.- -' ---------.. �..
-�
G ocat n-Addr or Lot No.
Ow _r Address
-= i f--- ..................................... -------------------------•----------•--......-----•--•------._.._..-----•--..__..------------•-••-
nstaller Address
UType of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms-------------------------------------------_Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building __________________________ No. of persons._______._____.___________._ Showers ( ) — Cafeteria ( )
Other fixtures ----•----------------••--••------------••-•-----•-•-----
Design Flow............................................gallons per pet-son 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.------------ ------------- ------------
a
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------.------------ Depth to ground water..-.___.___.___._-._-.-.
(14 Test Pit No. 2----------------minutes per inch Depth of Test Pit_-_________________ Depth to ground water---------------._____---
1:4 -•-•--....-•-----------------•••--•-------------•-•------•-•••-•-••--------•--•-••------•-----•-----.........................................................
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
W ----------------------------- ---------------------------------------------------------------------------------•--- ,
U Nat re of Repairs or Al ratio s—Answer when applies�' �` / l
j--------------•---------• ----- -•- -- -•--------
greement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article tI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued by the boar ofof beaWl.
Signed t=./!��f e`!�-�!` _tf-_ ........ �` '°�, �.
1 Date
ApplicationApproved BY--- ------ el.-----------------------------------------------------•-----•----------•--•------•- .....•-•----------- ---------•--•-
� Date
Application Disapproved for the following reasons:.........................................................................................................
--•-•--._.___.--•-•-----•-----•---------------------••----------•------.._--•-•--•---------•-----•----------------•--------------._._.-.•.---------------...--------------------••------------------•---
Date
PermitNo..........LP........................................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................OF.......... 'f= ° rj•/�i r
'W"rrtifirtttr of Tontlrlittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by.................. _... -•---••------_..••--
Installer
at........... 3 = ��y/tL C rvr�
-
has been installed in accordance with the provisions of Article_XI of The State Sanitary Code-as described in the
.- � r .
application for Disposal Works Construction Permit No-_____._?_ !___________________________ dated..-----------'.._ '__�.____.__________._..__
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
3 6 ` •7 � ��
DATE. --�--1--•--------•-----------•--••--------------------•• Inspector. T ��Gv �
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No......... --•--- FEE........................
o tti xk %Tonstrnrtion PrrvAit
Permission is hereby granted ----------------------------
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo..................-..... ' !'r/- == j 1-••-•• ....................•------•--•--- . -------•--•-----•--•------••-•---•-•••••------••-------••-----....-----••----•-•----
Street 'as shown on the application for Disposal Works Construction Permit No------------ Dated............................................
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DATE_ _ 2— � Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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