HomeMy WebLinkAbout0511 MAIN STREET (COTUIT) - Healthr5ll Main Street
'Cotuit
A= 021 — 097
TOWN OF BARNSTABLE
WE J JM- ) -17 SEWAGE
VILLAGE CZ�M[ T— ASSESSOR'S MAP & LOT I --
INSTALLER'S NAME&PHONE NO. Ell LLB
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS ,\
BUILDER OR OWNERLL—
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
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No. ---•-•--- F:�$... :D...................
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OR HEALTH
' dU)..'W OF.......... ;.
App traflvn -for i!i viial Works Cnonstrurtion Vrrmit
Application is hereby made fora Permit-to Construct_(X or Repair ( ) an Individual Sewage Disposal
System at:
.......... t?a -------- --------• -----.`e....----....•3----------......--•-•-•--------------------------••---...-•---
Loc tin Address or Lot No.
Owner Address-4'S
------------------ --- 4S.- �S
W
Installer Address
Q Type of Building Size Lot...-`4 + !o.......Sq. feet
U Dwelling—No. of Bedrooms-------- ---------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—.Type of Building ---------------------- No. of persons_.-__-_-___-_.__-_.-,._-. Showers ( ) — Cafeteria ( )
a
Q' Other fixtures .-------•-----------------------
W Design Flow--------5- ----------------------------gallons per person per day. Total daily flow....--_ZoP--.-_._-.--------.__...gallons.
USeptic Tank—,Liquid capacity-11?q®gallons Length---------------- Width---------------- Diameter................ Deptli---_.--.-..._.
xDisposal Trench—No--------------------- ti h-------------------- Total Length.................... Total leaching area:.'-----------------sq. ft.
Seepage Pit No.100P...�..�Diameter. .............. Depth below i let----.--_____-__.-__. To�httal leaching area._.__'-- _.-_--sq. ft.
z Other Distribution box ( ) Dosing tank ( ) V. 7-36--r A/ /6 1
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. L. ___.-minutes per inch Depth of Test Pit____________________ Depth to ground water....---._-_.-.j..__F--
Test Pit No. 2-----_----------minutes per inch Depth of Test_Pit.................... Depth to ground
t water...........--...__----.
•-------------•------...----•-•-••-----•---•-------
Dc 0
es ?? ------- - ------------------------------------------------------
w
VNature of.Repairs or Alterations—Answer when applicable------.------------...-------------------------------------------
-- ---- - ------------------------- ------ ----------- --------- -----------•------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
t.'
operation until a,Certificate of Compliance has been issued by the board of health.
Signed •-• ---------------------------------------------------------------------- --------------------------------
,�/ Date
Application Approved By---- ` � o" �"` L�I'� f o-----/-"
l°
Application Disapproved for the following reasons::. .................. :-...--...---------.----......................-___.---.Da -_--------_-_..
Date
PermitNo......................................................... Issued........................................................
Date
No.. f yf---------- Fas..��................._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
ile------------------------------
App iration -fur Bi!iplaiitt1 Works Tonistrurtion
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System t
}� �--- --- -------- Gp ----------------- ----------
. {'! '
Location- ress or t No.
IOw�n/er Address
Installer Address _
d Type of Building Size Lot...o"LG1 ._�1 ....Sq. feet,
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons.----_...................... Showers ( ) — Cafeteria ( )
Otherfixtures ----- ........................................ ----------------------------------------------•-------------------------------------------------------
W Design Flow................. v.._...._....._ gallons per person per day. Total daily flow.........,�.�---__--____------.--..gallons.
WSeptic Tank-A Liquid capacity/gallons. Length................ Width_.............. Diameter_---_--_--__ Depth-__---._----.---
x Disposal Trench—No. .......:............ Width... ,,pp Total Length_--______-___-_--_ Total leaching area--------------------sq. ft.
Seepage Pit No.______/___......_.. Diamet r . .........._ iDepth below inlet____________________ Total leaching area________...___._sq. ft.
z Other Distribution box ( ) D' osing tank ( )
aPercolation Test Results Performed by---------------- ................................................. •--- ---------------------------------
Test Pit No. 1...............minutes per inch Depth of Test Pit..._--__•___-_____-- Depth to ground water------------------------
LL, Test Pit No. 2------- --__minutes per inch Depth of Test Pit...............:::.. Depth to ground water---------.-__----_---__-
_I..___._.__'.. �
=
,.......-
yD Description of Soil___________Q_ _ /X-
x elra
U -------------------- ...............................................................................................................................................................................
W ----
UNature cf"Repairs or Alterations.—Answer,when applicable.-.--_--------------------------------------------•__-____-----.^-.---__._._...............
' Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitar� 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...
Date
Application Approved By------. .--- ---•------------ Y-----
Application Disapproved for the f lowin�ons---------------- ------ I�...--�� •
' Date
Permit No.= •--••-•--•-•------------------ = Issued----...........------..................................
Date„
' THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... „ ...... ....................OF.... ;�.�.
j�` `"�rrtiftr� P g�I112t�tItMYtXP __ �;
THIS IS TO C RTI hat-the.;Individual Sewage Disposal System constructed or Repaired ( )
�,. .r
�(, ``AA � In t ller
t........ = P t� j` ........... y �------- - •---------•------------------------•--------------- -........ ...........
has been ins alled'fn accordance with the r isions of Article X1 of The State Sanitary Code as described in h p y to
application for Disposal Works Constructiq�n Permit.No:_:__.:r_
//��/y- -�--.................. dated---�-��-``-------�t-,,-/�----------��--//-------------------•
THE ISSUANCE OF THIS CERTPF1.dk E^SHALL 0? �E CONSTRUED AS A �J IRAPIT> C�FHAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
� DATEInspector.:'---------•--•------------------'-------•-----------------------------------..... --------------------------------------------- .._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
No..{�.LJt."�C....__.. •...74a
j/(,., /9 . _ I'EE_..j...�'"�1
Di,np iial ur ii n urtion Vrrmit (�/ f�
Permission is h5preby grantled_---•.. -- -- --- -----• -- • -• --••-...---.-------....--................
.. -
to Construct ( or Repair ( al Se age sa System
at NR+r-
�------ - -----------------------------------------------•-------
Y I K-ff t l �-- Q , j;,L. ee L
as shown on the app tl-cation for Disposal Works on tS ruction Permit No...................'. Dated_. .. __.._ ............
......... .
Board of Health
DATE---------- = --------------------------........ ------
FORM 1255`'HOBes & WARREN.: INC.. PUBLISHERS - -
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;-`LOCATION : &C,E PERMIT UO.
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VILLAGE
WSTQLLER•S W&NIE ADDRESS
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bUILDER 5 Q &VAF- e ADDRESS
DL'xTE PER"IT 155UED
D ATE COMPLI &&ICE ISSUED - >
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