HomeMy WebLinkAbout0104 WILD WAY - Health 104 Wild Way
Cotuit
A = 027 — 137
I
3 TOWN OF BARNSTABLE
LOCATIO 4-/" , SEWAGE #
VILLAGE '?S ,�T I< !J,d, ASSESSOR'S MAP & LOT��
INSTALLER'S NAME Rz PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY r`4�Zr Zr
r
A LEACHING FACILITY:(type) � -`- `��i%'�t� (size)
i
NO. OF BEDROOMS _j PRIVATE WELL OR,PUBLIC WATER
BUILDER OR OWNER X
i
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No --
C 6/ . v
.0
6 TX�7
C�
FEB...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH.
............OF..............!9. ................................
...............................
Appliratiun for lhspusal Works Tonstrartion rrrnti#
Application is hereby made for a Permit to Construct' ( ..) or Repair ( ) an Individual Sewage;'Disposal
System at
•--- w Lid ..:t�.. _... �..... .......: C, .% . _
�....~. Location nd�r ...or�Lot}..°• - ...
ow er - Address
w .. -------- -----. ......,,�� � c -�---•--------- ------ ------- -------
a ...:: -----
Installer Address
Type of Building Size Lot.!E-: _6.91.......Sq. feet
U Dwelling—No. of Bedrooms.. � --...... ,........Expansion Attic ( ) Garbage Grinder ( )
p`4 Other—Type of Building...... .................... No. of persons............................ Showers ( ) — Cafeteria ( )
p' Other fixtures
d •... --••----•--._..... ...--•-- ••--•-.
W Design Flow... .__..gallons per person per day. Total daily flow.... gallons.,
W Septic Tank—Liquid*capacity............gallons�Length... .._.:__. Width................ Diameter... ....... D th :.........._. �/S
Disposal Trench-No......... ........ Width...-...--........... Total Length... .......... Total leaching area 9' sq-ft.6
�
® �Seepage Pit No........)_ .._._.:: Diameter___________________ Depth below inlet......(a........... Total leaching area.................. ft.
Z Other Distribution box ( ° Dosing tank ( )
Percolation Test Res s Performed by..W.A)..,O....CD eU_E.�_ .. _...0............:.. Date.....1,JnA�..............
,aa Test Pit No. 1. _LA_...minutes per inch Depth of Test Pit...1`........ -. Depth to ground water.J-UQA)e..aX)L
fi Test Pit No. 2... ..._.....minutes per inch Depth.of Test Pit............................ Depth to ground water........................
•
a ._._......-- --
................. ... •--------------•-•-• ......---•--•--•-----•-• ---._...---------------•- •••--
..Description of Soil ................. ..:.
------------•---------_ .. .... ........................
W •--••-----•--•-•--. -----• •---- ..... •-----. ................... ... •..... ............. ....................
UNature of Repairs or Alterations.—Answer when applicable........ ................•:_ ..._._... ...._................
Agreement
r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE Skof the State Sanitary Code—The undersigned further agrees not t place the system in
era ' until a t Compliance has been i y ar o lth. i
Si ate'
Appli ion Approved By... l ....
.••• ...................•. ......•. ate.
` Application Disapproved for the followi reasons:........... ..:...... ...I ___....__:____.........•....___.__.____..........._.._.._...... ------
ate
.............. Permit No.... :�. .5%( �.. .... .......... - Issued............................................ ..
Date
4,1
��• � � `� 3 i( J ' A /,� Arm it\`n�•_,_�
No._. ...._.. F$s_. 1
" - THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF. , `;afiT
........ ......................................................... —�
Applirattun for Disposal Works Tonstrixrtiun Permit
iApplication is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal ,
System at 7_ _
Location •A�iddress - � A /' / or/`Ltot'No. /i 1
Ad
Owper d - --Address
......................................, .,... �F.a{.�. -----•-•---- ---•----- \v
.................ddr ..... ........_
nstaller Address
Type of Building Size Lot..27r'f1.......Sq. feet
U
Dwelling—No. of Bedrooms....S5.................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type T e of Building r ....... No. of persons............................ Showers
W � YP g --------•----=------- P ( ) — Cafeteria ( )
icyOther fixtures ...--••-•.......:...............•...........-------•--.....---•--........---.........--- .............................................................
W Design Flow.....�:.«_�.l.1........................gallons per person per day. Total daily flow....: �>4 ........................gallons.
COY Septic Tank—Liquid capacity............gallons 1 Length................ Width................ Diameter................ Depth.......... � �°�
Seepage Pit No..__....�..
' ..,Disposal Trench—No..................... Width....................Total Length... ........ Total leaching area-,.-4!F!A...
3 l..... Depth below inlet.__..(..
_ ....... Total leaching area............ ....sq. ft..__.._... Diameter.._._�o
Z (�.) y g ( ) :f' .....��. ...-----..•--. Date....&I,...................... ;I
Percolation Test Results Performed b .�!�«..._�'_..!A.a����':,... `� � ,
Other Distribution box Dosing tank ^t'
Test Pit No. L._.___.�!.__.mrnutes per inch Depth of Test Pit___ ___________•.. Depth to ground water... � 1'_1.7.0
f=_ Test Pit No. ................minutes per inch Depth of Test Pit.................... Depth to ground water....................
9 ----------------•------------...............--•---•--...-------.---•---•-•-- --------------- ...._.......... ._...._ .... .
ODescription of Soil--•.............•--------...------. y ----- ----•----•----------•----------- --------------••-•---------------.
-f- }�---...-•-•••--•-•-••-.
Uw •...............
Nature 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 iI rLi~, of the State Sanitary Code— The undersigned further agrees not to,place the system in
r erati, until a ca of Compliance has been issuedly the-bbard of',li alth.
Appli ion Approved B _ ' ._
/ Date /In
Date
Application Disapproved for the folloUA)reasons----------------a..........................................................................................---
r - Date
Permit-No..- ' =- -1�- -- ----- ------- Issued-..........................................
......_..__
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH a
-
a;,Qv�.�......�...OF................. .....,.,,....................................................:
Trrttfirtttr of Tumplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by....•..... ---•-----•----•-•-•-----•--------------------------------------•-------•------i�gtaiiy ----:--.'...--.-.._.-..---.----.-----_--.-._----.---._--._........ .t`...Y.:
at ���...- �°! -.r�.= --.._!' �.................YV t'. c, c
has been installed in accordance with the prQAsions of TITL> 5-of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.... _.�__.. � .......... dated....X�A .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............L)..... .._).Q.......Q ...
._---•---------------. Inspector..... -,- �------- --- ----..........
-------..__ _-- f•-------------------------------------------------------
J THE COMMONWEALTH OF MASSACHUSETTS
�j BOARD OF HEALTH_
No..,..- ...... �. FRE........................
Disposal Works Tunstrurtiutt Permit
Permission is hereby granted..............Ar.
to Construct ( ) or Repair ( ) an .Individual Sewage Disposal System
at No.. �?.._..Z.......L ! f=ice•-�"_Y_ A ........�y( �Y ►.C��,..... .............
.. -=
=~ Street -
t' as shown on the application'for Disposal Work Construct' Permit No ? Dated.._':-:-11.1......1
..........
�PY (it/l -' ------••--......•••.....•-•..................
DATE. hoard of health
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W O T S PLAiIJ DOES
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01:-3CIe QE 0U/�2EMEAJTS OF THE
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MASS• YA�2/"louTH POR7, M,43SS
PRoFE55lOti/fiG. ENG/INFERS fr LAND SUr2VEY0,25 #S'6"09¢ "
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