HomeMy WebLinkAbout0103 WILD WAY - Health I
103 Wild Way ��'� ---- -- _--_
Cotuit
s A= 027-135
i
' II
No. Ul 3
—T Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplitation for Disposal 6pstrm ConitTUCtion J)rr mlt
Application for a Permit to Construct( ) Repair(* Upgrade( ) Abandon( ) ❑Complete System (Individual Components
Location Address or Lot No. (p3 W 1 L,0 WA*4 < p t v jT Owner's Name,Address,and Tel.No.
LOS
Assessor's Map/Parcel 0 o'j [�j S-3 W L-G( q C T
Installer's Name,Address,and Tel.'No. 50$—477— 88,717 Designer's Na e,Address,and Tel.No.
ev4PG-sc�d�C G A&JTWAUS,=s �A__
s-r �
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
L- c- ct+-4jLae i=azo(k G4c)us(9 -To ��..
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Hea
igned Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
� q l
Permit No. C�po Date Issued 1 1
----------------- ------ ------ ---------------------- ------------------------- -------
• a
No. 0/ Y 7 Fee v�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplicatioB for Misposal *pStrm (Construction Permit
Application for a Permit to Construct( ) Repair K Upgrade( ) Abandon( s) ❑Complete System [Individual Components
Location Address or Lot No. 1 o3 W I Lj) WAN CO ii v 1 r Owner's Name,Address,and Tel.No.
11ZAssessar's Map/Parcel d a'l 3 S MVq Cx 0�ARC C T
Installer's Name,Address,and Tel.No.509—477— 98,717 Designer's N e,Address,and Tel.No.
Type of Building:
j
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(.•' )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
1
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
i
i
i
i
Nature of Repairs or Alterations(Answer when applicable) `J
i
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
i
.accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
I
Compliance has been issued by this Board of Hea
r
{ igned Date
! � I
Application Approved by Date
Application.Disapproved by Date
I
afor the following reasons
q
Permit No. 10) 3 Date Issued 1
-- ::..—--- - -- _ - -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
.THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired X) Upgraded( ) k
Abandoned&)by !;U4)QeXDr--
at ..j O:; 1A1 l&b LeJA�j COT V(—r has been constructed in accordance l `,
with the provisions of Title 5 and the for Disposal System Construction Permit NO )r*'P� 3 LI dated ( � I
Installer 52AP6 mC Designer 6jlA
#bedrooms Approved design ow t ./A : gpd
The issuance of this permit hal not be clo st -ed as a guarantee that the system wild"fin cti t�,_s designed: I/1t 1 f
Date ,Y / Inspector r �y f "Ff
------------- ----------------------- - - ----- ----- ---------------- ---
No. L 3`T 7 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposaf 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( )
Systern located at 105 W I Lb W AV C 0-r U!T
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction m st Ibe co pleeted within three years of the date of this permi.
Date- !� `� f Approvedb
l®� TOWN OF BARNSTABLE 7" v
C,1 6
LOCATION %J L.l7 '> SEWAGE # o
VILLAGE '-A .,
e� ASSESSOR'S MAP & LOT ' z
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
t�
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 09�Lr ?� (size) r
Q
�`�--�--, I.NO. OF BEDROOMS PRIVATE WELL 0R�PfLIC WATE �'
BUILDER OR OWNER,-L G
DATE PERMIT ISSUED: /,z
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No " �
�1 LV ` ,�
d 7 1.
Fic
Nol __ Z-2s
THE COMMONWEALTH OF MASSACHUSETTS
HEALTH
BOARD OF
a • ,f
�'► !(.! ................
...OF..........�....�/eN T�}; �_ ............_......_...._:._.
, ppliratiun fear Disposal Woris- Toftstrnrfi�n frrmi#
,� r
A Application is hereby made for a Permit to Construct ( ) or Repair ( ) .an Individual' Sewage Disposal
System at
-•••-... LocatioPtas
....» nL. :fit............... •-
w Owner t Address
a ....._...... - - .d ._. .. ..... ..... ..................... .....:.. ....:-•.......................................................
Installer Address
Type of BuildingSize Lot..°.�l.�.t_�_�_2_..__.Sq. feet
U Ex Expansion Attic Garbage Grinder
Dwelling'—No. of Bedrooms..------•---=................................. P ( ) : g .-
04 Other—Type T e of Building No. of ersons.__......_ ........ Showers —
Ga4 � YP g --..............•------••--- P --.._.. ( ) Cafeteria ( ) •
dOther fixtures -----•-•---•-•---•--•----•---------••-----_•... -----•----------------------------- --- -------
Design Flow... P P P Y Y gal
avo........................ lons er erson er da Total dail flow._. JQ.... .. .... Ions.
W W Septic Tank—Liquid capacity............gallons Length___ .......
_..Width .............. Diameter-- ______.._ Depth ..:.........
x Disposal Trench—No.................... Widt Total Length .... j Total leaching area-__.:,. ._ sq. ft. '
Seepage Pit No..../.............. Diameter..'.l .......... Depth below. inlet._ Total leaching area..(..[...A
Z Other Distribution box ( Dosing tank ( ) ' 1
a Percolation Test Results Performed by..___L(O�___ ..__.1.).G__ __ _ .t .. _............... Date ..?__. _.____._ _.._.....
l
Test Pit No. 1__.__._....minutes per inch Depth of Test Pit.._.1_______________ Depth to ground water..._ 6ok..
44 Test Pit No. 2..... .__.:...minutes per inch Depth of Test Pit.......... :..:..... Depth to ground water........................
x ...:. =
.........................................................
O Description of Soil.............................................
--------------------------------------------------------------------------------------------------------------------------------------•--------------...........------------------......•--••...........
U Nature of Repairs or Alterations—Answer when applicable..................................................................................................
•• -•• -•-----------•----------- -- ........... .... .....
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
?visions of T I'i U 5 of the ate Sanitary Code—The undersigned furtheryagrees not t lace the system in
io nti C p ance has been by e b h lth.
Sign ,.Co ... .......................... •-•---_....
e
APPhcatApproved BY----- ---•----• -----------•....... ..................................................... -•-•�--•-4 ........ •
Date
Application Disapproved for the fol ng reasons------------------..........-............................................................................»..»»
.................•--••-...................._.._.....__--••••••-••-----•-•-•---•-••......--•---•-•..._.......-•••-••••--•••._....•--•----•-•-..........._•-------------•-••--•••----•..._••-•--...._._.
Permit No.•••••..3, ---_5�Y.7................ Issued......----••--• --.._......:...»._»D�......
Date
'1.�-..'�`"'^_..�."...f_.r-�-.��� _ _.. - .... ._....,: .•-,�-..._�....ice•..-"-.-.w2.� ,.w-wr...»�..�' .ar`w_.,."y_�y...+>.«..•-....,..-�e � w`.-F^� .r ---_ �'+
!' / J ('
THE COMMONWEALTH OF MASSACHUSETTS r
BOARD OF HEALTH
..................OF.......... �e 12 �5Tf�, '/ ................................
ti
�. Appliration for Diopnsttl 19jorksZonstrurtion 1ernti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.-�.:........ - ,° r . ---- t--•---------••----_..- ....._... G.Go r L -------------------- -.
Location ,
,4 : ot i u r Aft-,
tt_u
., � ---- d
r
a 's
CO Address
a - .......• •-�- ner...tea. .. ................... .................•-..................----•----................._...---•-----------...........----
Installer Address
Type of Building Size Lot_" c._ 9.9._.___Sq. feet
U Dwelling—No. of Bedrooms_._. ................................Expansion Attic ( ) Garbage Grinder
'4 Other—T e of Building .... No. of persons............................ Showers — Cafeteria
I04 Other fixtures .............•---•----•-----.._..-•---------._._....--.--•--........._..._...........-•------------._.._._...... ... ........
W Design Flow..._� .4'1 .._.gallons per person per day. Total daily flow.....��50..........................gallons.
WSeptic Tank=Liquid capacity............gallons Length................ Width................ Diameter........... ... Depth................
Disposal Trench—No..................... Width..:................. Total Length.................... Total leaching area...................sq. ft.
3 Seepage Pit No____________________ Diameter.. L.�___..... Depth below inlet.. . ..........
Total leaching area..OU...sq-ft.6 1'.6
Z Other Distribution box V-) Dosing tank ( )
'-' Percolation Test Results Performed by..... ______� �';.__�_4` 2 J 04 7 S' Date.. r•-•---••--- ----
,4a Test Pit No. L_.C..1_.-_...minutes per inch Depth of Test Pit.__fl�. . Depth to ground water..A ���Y...��"z_
fs Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ••.... ............ .............•---- ---......_.........._.._...................._....... . .---.....----_..._.
to
Description of Soil..... -`
If-
f�
> :.._.. l:l �J -
w --• ---------•--•"-•-•"---------"-----------------------------------------------------•----
x •--- . � '-U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
. .. ...............................•-------•-------•--....._......---•------•---•------------•-•-•--.........._....---•--"-•-•"__--------......_........__..._ -•-•-------•----..._.............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
provisions of TITLE 5 of the ate Sanitary Code—.The undersigned further agrees not to place the system in
open ton until Ce fl E m p ance has been issued�by the board3ofhealth. /r1
....� �' Signed ' " -^ " _�' .......................
/ /
."..._ _
_ w"• M1 nlw L3Q�� _ l J !► t� Iate�
APPlicatApproved BY--- -------------••----•---------•--__,-_-•----------------------------•-••-•-•-----_..... . W 1
Date
Application Disapproved for the following reasons:).____________.........................................................................................._--
---•---••-----•.....................................................................•------•-------•--•--.....-•-------.._............_....-----••---.......-----•------...--•...-----•••--•----......._ .
Date
PermitNo........(t9 d_----__.. .: ._` .............�.�. Issue ------..._....------....._.._.....-------........--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ........7 «.:....OF................ ��- ..:................_.............__...
(Irr#ifirate of Tantlrliitnre
THIS IS TO C RTIFY That the Individual Sewage Disposal System constructed O or Repaired ( )
by...............................�'F._�-. ._� .� :��'-....-- ....-•-- ---------------..............._.. .---. _. .............-•-•--.._..._..............
1 t l Installer
at.... \ [1...........................t �/� .. i r {J
has been installed in'-accordance with,the provisions of TITy 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__....._!.�..-ate ........... dated........
�.._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................... 1 ^ ' CiC Inspector... ._._:... -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............�+ .:{.
WL ...OF...... aV1 .....................................
r Flay. .............
Rapanttl Works Tonsirttr#ion Vanti#
Permission is hereby granted.......... ..._____"_________________•
'- to Construct ( ) or Repair ( ) anj.Individual Sewage,Disposal System,
at No.. ___. . ......� ._._....�t� 1 j,...-----.......'_� �a...................J�t--.1.4.).............................................................. .....
---
Street �� y ,
as shown on the application for Disposal Works Construction Permit No.____`..........:.. D'ated..�.t.......�`a...:':.�.�.�... ......
.
/ I VW '
Board of Health
DATE............. ...................:.
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