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Home My WebLink About0092 CEDARWOOD ROAD - Health - 92 Cedarwood, ` A= 019-044 __ - - - - --- - -. Cotuit 1 4 0 No��__.25 Fimx THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................._0F......... .......�............. Appliration for Dhipasal Works TomAr Prrutit Application is hereby made for a Permit to Construct or Repair �it) an Individual Sewage Disposal System at: C—OQC�-,j 0 D Cl a, ................................................................................................ ........................................................................ Location-Aodress or Lot No. ........... ......................................... . ................•.... . V.\.!... ............ .. ............ c 0 �k - Address z! q)o ce� 7............... ....................................V..!A....... .... . ..........1: . Installer Address .. U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............. ...........................Expansion ttic Garbage Grinder Other—Type of Building ............................ No. of person .. ................ Showers Cafeteria Otherfixtures --------------------------------..................................................................................................................... Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank,=Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Tf&nch—No. .................... Width................._.. Total Length.................... Total leaching area....................sq. f t. Seepage:Pit No..................... Diameter.......:............ Depth below inlet.................... Total leaching area..................sq. ft. z Other,.Dion box Dosing tank Peifciolationstributi Test Results Performed by.......................................................................... Date........................................ Test',Pit No. I........... ....Minutes per inch Depth of Test Pit.................... Depth to ground water....................._.. is Test-Pit No. 2............h.-minutes per inch Depth of Test Pit.................... Depth to ground water.._......._............. ...........0.................................................................................................................................o............... .... ` Description of Soil........ ....................6.................................................................... .... ........ .......................... ....................... ------------- V ............................................................................................................................................ ...........................................................I i.2............................................................. ��\- -------------------- ------------------------ Nature of airs or �lteratio!&� --------- ............ ................... �wer 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. I'll,S i g n e A',-1— ssn .................. �0, ............ Date Application Approved By........... ........ . -- -......... ---------- ....... ------ ---------- Date Application Disapproved for the fo I winging reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date -———-------------------—----------- ----------- 0 N 52, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ........................OF Disposal Works Tonstrurtion ramit Application is hereby."made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ......................................................................................... ............................................................................................. Location-Address or Lot No. ................................................................................................ . ............................................................................................ Owner Address .......... .......... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers Cafeteria Other fixtures ........................ --------------"----------**---------------*-----------------------------------------"---------------------- ...... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid*capacity............gallons 'Length................ Width................ Diameter................ Depth................ ................ 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 )-.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water........................ 64 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water....---................. 0 04 . ............................................................1................................................................................................. Description of Soil......................................................................................................................................................................... UW ..................................................................................................................................................................................... ... .................. ....................I..................................................................................................................................................................................... Nature of Repairs or Alterations—Answer when applicable................................................ V . . ............................................. ......................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Di'9p osal Systernin 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. Signed...................................................................................... ............Date.............. Application Approved By............... .................... Date Application Disapproved for the foywing reasons:.........0_t.....................................I..........................................................--- ...................................................................................................................................................................................................... Date PermitNo.................................................... Issued.................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................I.....OF..................................................................................... Tntifiratr of Toutplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.............CA&.Im......i ..............0...............................0.................................................................................... Installer at........... ......CZ1>AkUXM_0......S.7.1.........4 02VJT.......................................... ---- ---- has been installed in accordance with the provisions of TITLE5 of The State-Sanitary Code as described in the application for Disposal Works Construction Permit No........ ........ dated..............r.................................. THX ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM-MILL FUNCTION SATISFACTORY-', I)ATE.............. • . .............. .... .................... Inspector........ .. .......... ........ .... ............................... J STRUE1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V� ....................... OF................................._............................�* ....................... V; ............... t. ................. Fn..... ........... Disposal Works Tonstrurtion frrutft Permission is hereby granted........0....... .!�......I At-c.o........... 4 .................................... to Construct or Repair an Individual Sewage Disposal System atNo.................3-4---------- .......ST. ..q...:0...............street.eet........q5.................................................R........... as shown on the application for Disposal Works Construction Permit No..p..........49... Dated..........�St) ..... ... ........ -------------------- ... ...................... 4 DATE.....__. ............................................. Board o f Health FORM 1?55 A. M. SULKIN, INC., BOSTON LOCATION SEWAGE PERMIT NO. •VIjLLAGE -Oil,/ C o -..A IN T LLER'S NAME i ADDRESS ch Q UI DE R OR OWNER S -m G a V_ DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED Y Q