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Home My WebLink About0009 BRAMBLEBUSH DRIVE - Health oss- cc)f� r I 541 Santuit _ .4p Cotuit . P /�-- _) A = 007 030 � IS S t3aM �ma U L C T10N # I SEWAGE PERMIT NO. p VI L —A G E INSTALLER'S . NAIVE A ADDRESS �MD'6�A)q 9 p O U I L 0 E R OR OWNER yb -� a DATE PERIDIT ISSUED 16 �o �z. �DAT E C0MPL.1ANCE ISSUED �_ Z/,�� l!► TTI 0 J No .::.�1. ..... FxR...� ................. THE COMMONWEALTH OF MASSACHUSETTS (. 010g� BOARD O HEALTH OF... ....:... 0-liL.�.................... Appliration for Uiipnsal Works Tons rurtiun Pamit Application is hereby made for a Permit to Construct () or Repair ( ) an Individual Sewage Disposal Systemat: --•--• --.......... .. ...................................... ......L.. ion-Addd ss or Lot No .. r�iv�_✓..% 5_ J .j!i,�lti..._._... Q---J�%/�UC��76 — 7..S.J_!�l %_. _.f(!1:.... W caner Address ........................... ................................................- ............................ ......._. Installer Address dType of Building Size Lot.q; �.66 ........Sq. feet Dwelling—No. of Bedrooms. ____3...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Buildin !�!�a No. of ........�P................ Showers ( ) — Cafeteria f4 YP g - = -- ( ) W Other fixtures -------------------------------------------------- ••. •. W Design Flow........ s..........................gallons per person per day. Total daily flow_...._..._ ......................gallons. WSeptic Tank—Liquid capacitye01'd...gallons Length./'O._.6_.". 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 t ( ) '-' Percolation Test Results Performed by.. .._D ✓...................... Date 4.. ...4.7,,l._f ---- Test Pit No. l......C\.....minutes per inch Depth of Test Pit-----/_!F......... Depth to ground water.--,IV Test-Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+ ------•-----••-•-•••.•••. ••••..•.... ....•-•----•................................•-•......_... ....._.........--•-•-••--••-•----••--.....---•- ODescription of Soil..........4111.10t�. f......./-2***4:---,.:�? 1-h------------------------------------•--------------.. x W UNature of Repairs or Alterations—Answer when applicable......................................................:........................................ ----------------------------•-------------------------------------------------..._....----------------•------•-•---------•----•---------•------.....--•-••----•------------••-•--------................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with he provisions of L I:'L: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ion until a Certificate of Compliance has been issued by the board of health. Siged..........................................------------------------- ---- ---- -- .� . . .may--- Date .•-------------•------•--------•--•-•-----•--•--------••••-•--••.............--------••-- Date Issued-....................................................... Date - No: ^.r✓P.11r..... Fim.... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ;�_� '7r // O F......./................ .. ... ... /f!� Applira#ion for Dispooul orko Tomitrnrtion Vamit Application is hereby made for a Permit to Construct ( /) or Repair ( ) an Individual Sewage Disposal System at: • Location-Address / J or Lot No. - ... .. ........:.............. .. .: ::...----...........-.---....------ .... . ............................ :.:r ......................... -.._..: --- ...._ .....- Owner r Address „r W . . � Installer Address ' Type of Building Size Lot..:- ......Sq. feet V Dwelling—No. of Bedrooms........`.................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..........._._............No. of persons......... ............... Showers ( ) — Cafeteria ( ) d Other fixtures -------•---•---------•--•--••--•--•------ ... W Design Flow..........................................gallons per person per day. Total daily flow............ _ ..........................gallons. WSeptic Tank—Liquid'capacity_!.........gallons Length_!-........... Width................ Diameter._C.........__. 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.... ��% ' '.:�:.___��r. `:°:' J Date... .........................." a Test Pit No. 1.......%'......minutes per inch Depth of Test Pit.......L"......... Depth to ground water____�J ':.._`.__. rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .............................;;••-•--••---- --•..............•.....---............--•---------...---•-•---------------•--..._-•--...•----•---....----_•--•-- D Description of Soil.......... ._/ !_!..._..... .. ' U ••-•••••••••-••--••-•••-••---••-•---•-•-•-••-•-•.....•---••---•-------•.............•••-•-•...--•-••••------•-------•-------••••...-••-•-•--•-------•••••---•---••---•-.....---•--..............•....... W x ••-•••••---••---------------•....•••-------••-•••••••-••••••-••••••••-•--------••-••--•-....----••-----•••--•............................. ............................................................ UNature 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 TITLE 5 of the State Sanitary 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. Signpd•-•---•---•••-•----•---------•......................••-.......---....••----...._....•. ............... f D Application Approved By or�e ln!`yr=•--------------•--•-----•----•-•-•--............._......•-•--........._ ..... s %:*3 Date Application Disapproved following reasons:............................................................................................................._ --......--•-•-•--------•--•------••---•--•----•------•--•••-----••.............•......-------•---------•.••.._...........------•---••-••-•...-------•••••-•-••--•••---------------------------•--------- Date PermitNo......................................................... Issued--•-•--•----•----••---................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................OF.....: %�% ........................ .................................. ..... Tntifirttte of Tompliana THIS IS TO.CERTIFY„ That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...,.- .< ------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------•----- — Installer 't has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code As Uscribed in the application for Disposal Works Construction Permit No., �_-` ___________________ dated__.A!_.�0V THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �p DATE.................................. ., 1.1 v....----------...----•-----_. Inspector.............-•••-------------•------------•---•.................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF..... ;t%/_fin rr,! No._. .....- �r FEE.., 13ioposal Works Tonitr ion amit Permission is hereby granted...... _ '...._..... to Construct ( )' or Repair ( ) an Individual Sewage Disposal System. atNo. .1 '. ' -' ................................................. ........................................ Street as shown on the application for Disposal Works Construction Permit - / - ated.. . r -----•-•-•-----•--. .............. r . ..{-".." ................................... DATE................................................................................ oard of health FORM 125B HOBBS & WARREN. INC.. PUBLISHERS Y, xr� —_------- — - -- - --r 6�iErJff'1CAL.. N©'►'�'S -A-L L f WOV A.) AR sF M• "Soo o►J (/-$, act �' ®u tlr 4„uh QN w►1� 1 D 1CN ^LL 1.1WE'a /►• Miq,Mu" A► _..r._ l _ �; / � ,;; _ 1 � ,�,,.. Uw►Lr S� C'J7'N1Gl�r#E mar'1 It O. �l�V� c�• I � � ' � ' f t'� G^ sC.iri fa D U�_6 A p P I.J,c r� i � � l..flr�•Gr��l6, 17fF SHALL... 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