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HomeMy WebLinkAbout0214 COTUIT BAY DRIVE - Health 214 Cotuit Bay Road Cotuit - — - A= 056-016 AsBuilt Page 1 of 1 AR t QQ � ' 1'f•� I — 32.E � 6 +� � 3 — ax- 3 y— 3o ,- 17 3a y 7 - —T-17.2 0 LOCAT1OKA SEWO,GE PERMIT 1.1O. � w IMSTQL LER'S 1JWF- ADDRESS r BUILDERS W hMF— �. ADDRESS DATE PERWT 15SUF—D D ATE COMPLI &MC'E ISSUED wtp:Hissgl2/intranet/propdata/prebuilt.aspx?mappar=056016&seq=1 1/13/2014 1,46(-f LOCATION ' 5EW6,64E PERMIT UO. IWS-TQLLER'S W&NAE ADDRESS BUILDER 5 1J &ME ADDRESS DATE PERW7 ISSUED D ATE COMPLI &MCE ISSUED : zr=�`�� y w� o ► �2l� �vrrre C'Y�oorNfi�.✓ s 4 OF No...................... Fw$....1 .............. THE COMMONWEALTH OF MASSACHUSETTS Qf BOARD HEALTH L V..4.....OF......... .. ......'e i' ........-.-.-...--..._.....-...-.-.-.-... ApPration -for �i,ivn ial orkii (f otuarnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �- -e of tion-Ad ress 7e� Lot No- Own Address ,wa --••----•-•---•----•----....-•------•---- .7'-dwk .._..-•---•---••--•---•---__... ________________—._...----•------•-•-•- Installer Address U Type of Building Size Lot---- {.ram--.Sq. feet Dwelling—No. of Bedrooms____ _______________________________Expansion Attic ( ) Garbage Grinder per-, Other—Type of Building ____________________________ No. of persons--_________:______.___._..._ Showers ( ) — Cafeteria ( ) Q' Other fixtures w Design Flow....... .1"-P...........................gallons per person per day. Total daily flow________ _0......................__-gallons. WSeptic Tank—Liquid capac-ity_J,57A�allons Length----------------'Width----------- .._. Diameter................ Depth-_--______-___. x Disposal Trench—No_ ____________________ W�th___ ___________ __- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No... _AD4V Dt& ePer.... -Kl5epth below 'nlet Total leaching area. Seepage ft. z Other Distribution box ( ) Dosing tank ( ) '`(�� Percolation Test Results Performed bY.......................................................................... Date--------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit........,----------- Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water------_---------------- ---•-•----- -- - ---- -------------------J Description of Soil----- g( �r�'' - - - G - - c -----------------I---- 4-------- -- - -- ---=-- w V 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by the board of health. >� D Signe l�� _� IG'47 �-� ---._...•_.-----•-•- -------------- - __._-_...--••--------•- z ate Application Approved BY E ••--• . --• •--•- -.°.�. ------------------ ----� ---- Date Application Disapproved for the following reasons_________________________________________________________________•_-._..._________..___........._____-__.-••-•--- ------•-•---------------------------•-----._....._..._--------.._-------...-•-------•-----•-•--------•---•---------•--•--•------•--•-•---•-•------•-••----------•---•=-----------•----------.._..__•••-- Date PermitNo......................................................... Issued........................................................ Date -... --- ------------------- ------------- ---------- • b� THE COMMONWEALTH OF MASSACHUSETTS BOARD Pf HEALTH ... OF......... ......... ................................................. Appliratiun -fur 43hipoat Worko Towitrurtion Vrruift Application is hereby L,made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: oc ton-Ad ress r Lot No. Own Address a ... Installer Address T Building Size Lot..._ __R G .f....S . feet U Type of Bu d g S . � q Dwelling—No. of Bedrooms--.-_-_�................................Expansion Attic ( ) Garbage Grinder O�- aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures --•------------------------------- W Design Flow-_--_-_-XV...........................gallons per person per day. Total daily flow...... .........................gallons. WSeptic Tank—Liquid capacitvJ Sr+ %gallons Length................ Width------.......... Diameter................ Depth.-..----_-.-._- x Disposal Trench—No-________________ W' th..._..___..___..._. Total Length.................... Total leaching area....................sq. ft. 1OdU �'�K t�oL Seepage Pit No._Z._-______._____ Diameter.................... epth below nle,t,r�....�..}.�....... Total leaching area..----.-----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) v�' ®v - " �G aPercolation Test Results Performed by-------------------------------------------------------------------------- Date.................................. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...._---_-.---.--_...... ri, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.--_------_----_-_--_. 0 _ ----------- �........ ------ Description '�( O of Soil.--- -------------r--- ra- ` T'� '° ' `= ---)--------1 --Fv-----�-s. b ` V - ------------- � ------- ..--��s'1�- - . �...�t�:_� / ------------------------------------------------------------------------------------------ W 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued by the board of health. S24igne ... ....... i� �C'� -------�-c:7o�---- Date Application Approved By--------- -f�" . ---- . ..... ................... l Date Application Disapproved for the following reasons:--•------•-•--------------•--------•--•---••---------------------................-•-•••---•-•-•--------•----•••- ...........................................•••----------......•--••-----------------•---•----•---••---•---•-----•----•---•-•------•-•--------••----•..-•------------------------------...---.._...------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O�f7 HEALTHG�-�C� (...........'� ..........O F...........Q/... 1i ............................. Trrtif iratr of f�uutpli�tttrr T }>IS 0 CERTIFY, That the Individual Sewage Disposal System constructed (�or Repaired ( ) by �� �- ------- - ---- ------------------------------------------------•--• �l/ifj at - ��� � = --------------•-------------------------•----•------- has been installed in accordance with the provisions of A tic XI of T e State Sanitary Code as described in the application for Disposal Works Construction Permit No_��.___� :.a_______________ dated.... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. \ DATE......... ^��;2; - ------------------------ . Inspector--- --... --------------•------- --------- ------- THE COMMONWEALTH OF MASSACHUS TS 7� BOARD F HEALTH .............OF..-. lPf. ..................... No......................... FEE--- 1�............. B"'i 1- Tunirtrurtivat Prrutit Permission is ereby granted..•-.• / - � .............................................................. .---------•-•-----------------------------`....-•-•-----•...........-•-•-••...--- to Con truct ) or epair ( ) I tl vi ual wa e sp a] Syste}i at No.... ..... . '�- g a St et / as shown on the application for Disposal Works Construction Per 't o_____ ___ ____ _sue ated..�'`._-. _ :.7 ?......_.. 1 ------......) — - - -- -- - ------•----------- Board o ealH the DATE----- ------------------------------•--••-•-------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS --� e 5 , 02 l.. C� �,� -�•--Z -G�j Lei c'��/�+�T t11 641. ,a'AIM) m 4 Z' r ry 4 4. G� � I C ERTIFIED FL)O-Tilk or. acAry©y COT U 1 T , P,SS. 8/11/76 A. � �✓ k - z 3 -r G. BAX1 14 , *Nt4?404$40 LoT �s Pi- f31� ZaZ PAGE ZF, / CE�'TrFy THAT THE FOU 'Ai'lTio/y BAac-tEt� XYE. NC, S.y01�/fV /��'�'Et�i1i GGNFG�'MS TU THE REGi STD REl7 LAND SUk Yp�t 5 T*,�` TO pv A/ OS-r S tit V i 4-l..e. s M A S s� . �rq E'N�Tig�31 PET iTI O►J E /I�-,.E V L E I-R U ST