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Home My WebLink About0408 COTUIT BAY DRIVE - Health ? � �� C�� e µ ` LOCAT-.ON SEWAGE PERMIT NO. VILLAGE a7D I !? T A LLER'S J NAME & ADDRESS B UI'LDE OR // OWNER DATE PERMIT I S S U E D Q d DATE COMPLIANCE ISSUED 77 / u �� r/� 1' �. .�Y� M ., No................ ....s FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................................-.-.....O F......................-..-.--•----..-..-.-------------------------•--..................... ApplirFa#ion for Uhipos al Works Tnnstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ��1111 J ....... k_✓.r_T...........B_Ax........ k.e.. .---- ....................... -6.. Location-Ad ress or Lot No. ................ ----------- P".......................... Owner Address a ........... .P1 ,V....................................... ----------- -••----••---••• ------- ---------------------.......--------=- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-_____j....3___________________________Expansion Attic ( ) Garbage Grinder (' ) '4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria a' Other fixture ---------------- ------ - W Design Flow.............. ..............................gallons per person per day. Total daily flow......... --___--______--_________gallons. WSeptic Tank—Liquid capacity/Q:?D._gallons Length________________ Width................ Diameter......-..--..... Depth................ Disposal Trench—No_____________________ Width. f..__._-.__... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------------- Diameter_______ __________ Depth below inlet.................... Total leaching area__.?1�e...sq. ft. Z Other Distribution box Dosing tank ( vn i AFaa e /� 77 Percolation Test Results Performed by--_._..__ __�___ ________________________________ _____-_.______. Date..._______.____.._.______ ,aa Test Pit No. 1....I.........minutes.per inch Depth of Test Pit---- ..... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ................••-•---•......_..........._........-----•----•---•--......................................................... rom........ dO Description of Soil............. p � r.d..e......./. r .............. ----•--•••------- UNature of Repairs or Alterations—Answer when applicable------------- �00,0_ ........................ vjocmzG-__--_._..... ---------------------•-------------------------------•----•------------------------._.........._...----------------------: .-----------• >_._............. Agreement: -The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance,;with the provisions of iITLYE 5 of the State Sanitary Code—The undersigned further agrees not to place tl e system in operation until a Certificate of Compliance has been ued b board of health. d Signed .................... .... ._ Application Approved By•-•--• -�/L----=------------•......--••.............••-•••-•------•--••--•••-__---•-- .......... l�. G-_-� V Date Application Disapproved for the following reasons---------------••----•--•---•----------------------------------•--------------------------------------.....::... Da te Permit No.---• -- __a..._ -__l.......... Issued............................. Date �._ W� . 2 • r rllel No •.............. �.. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................O F................................. �e Appliration for Disposal arks onstrnrtionr'"pumit K Applicatidh is hereby made for a Permit to Construct (. ) or Repair ( ) an Individual Sewagsposal ' Systehi at: .-.. . �y may► or eLot No } ................ .ldA: ocation A ress � .. �._j �'• 3 /F"*... j�`;3Eklf'� ....................... -•-.. ---•-_-- Owner -•----•-----------•-•-•------...Address - ' a ..._._. 1......................... .....•••••. Installer Address Type of Building �� _ Size Lot............................Sq. feet Dwelling-No. of Bedrooms ................ ....Expansion Attic ( ) Garbage Grinder (` ) aOther—Type of 'Building ............................ No. of':p rsons._._..__..................... Showers ( ) — Cafeteria ( ) Q' Other fixt Design Flow.............................................gallons per person per day. Total daily flow--------- ..gallons. WSeptic Tank—Liquid capacitVIO-O._gallons Length................'Width................ Diameter.............___ Depth................. x Disposal-Trench No. ..................... Width..__............. Total Length.................... Total leaching area.... sq. ft. - Seepage Pit No. I-. . Diameter...... .'........ Depth below inlet.................... Total leaching area._ .sq. ft. Z Other Distribution box (601 Dosing to ( i i '"' Percolation Test Results Performed by._.......�.-"--.t.. .____ � .... Date._. .._�: _.______.. Test Pit No. 1....I.........minutes;tper inch Depth of Test Pit__/.............. Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .............r........._--•---•---" ••• ••-• -•-" ••.. ....................... D Description of Soil_________... ... .. ............................................. W -=--•----------------- ----------------•--------------- ----------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_....:___ � f � ........................................................................................................................... ��"'"'s................ v d ma's 1" Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE1 5`of the State Sanitary Code— The undersigned further agrees not,'t �pla�e the system in z+a. operation until a Certificate of Compliance has been` d b "board-of health ��, red,wa;�" 4: �t,Ta•' .*.,i� �� '�.�' a^:ad '� ".er' �., .. .__ Signe $ i Application Approved By......... A .... _._ ......... .. r 'L ' r .._____ ..... • 4 3 +,.wr a :Date _ice Application Disapproved for the following reasons:------•--------------•---------------•-•----•---------"-"--""-----------......---------------"-•------.......... t_ tiwr Date- PermitNo..rAL!...--.................................. Issued...................................................... Date TI ,,)gQMMONWEALTH OF MASSACHUSETTS14 "aMe BOARD OF HEALTH s ................. ¢a OF...... ... 4...................... ✓" : . : Trrtifiratr of Tompliattrr:. - w THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (` ) or Repaired ( ) by ''; e •t °` f. --•••-••••••--••......--•-•-•-"--"-•--•-• "-"-•"•--"•-••"-•-••••••-"--••"•-•.....................""-•-•..... ..- --"- ' Installer i ..fit, at + �¢ has been installed in accordance Wirth the pro ioi of TITLE 5 of T.,h' State Sanitary. Code as described in the nth application-for Disposal Works (MiRtRktion Permits r •,. ...................-- dated--.-.. -.,...,. x v_�-. 7 - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GURANT . TI AT THIg. SYSTEIVI 1dYILL FUNCTION SATISFACTORY. ._ S_ i DATES- `` Inspector �= THE COMMONWEALTH"OF MASSACHUSETTS 'r f 1444 `- BOARD OF. HEALTH Ir3AI6►ia�► ooG. � c� ......../� .... .........OF......... ................................. 0.......... ,�. .. No.... .Vf.....:... FEE............ ....•..... Disposal or u Qkyonotrnrtion� Pratt t, of • ! Permission s hereby granted !.. i ...d. ................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System _ . �r at No.. ...._ :�,tp`.A. 1 --Z-4-�"`.tal-f_'....... �'.. 0 44. ;'�'- tip`' ------------------------ Street � p......._ Fy' to � ,�,rs as shown on the a plication or`Disposal Works �QnsArticf on P�it No._ '___.___ Dated :'" r 7 7— 77 i'rvT. -° s Board of Health DATE .... -"•- "-- lF"3 # FORM 1255 HOBBS,& WARREN.'.INC., PUBLISHERS � v �, - ' �et c use,'_ �`s,. o.a,� h ' �.�.: k � � �1 �e , �'4�y r •I w s f., e' i •k �ek. ! v ? t t Rt , �' C Cry�4 ` L_0 r Z OF 4Vg ROBERT a 1 sa� , y l « s 1 F _ t^ S c CERTIFIED PLOT PLAN. a , "NEW ,, OONSTRUCTION ONLY • � ' . —_— x:. TOE' =OF e:FOUNDATION IS 2— FEET IN ;.'ASOVE LOW POINT OF ADJACENT A ah " t, S L 4A AS ROAD " 4. . SCALE j� t.. 6 )' . 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