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Home My WebLink About0411 COTUIT BAY DRIVE - Health 43C77 6t qi BaY\ : , a � w2<* f ve. w« § 0 504/ . � m&{\ LOCATION SEWAGE PERMIT NO. VILLAGE INSTA�L �RS NAME ADDRESS o � �d U I L D E R OR OWNER Qa DATE PERMIT ISSUED DATE COMPLIANCE ISSUED d� �wAJ �A 4T No...... n. FimB............................... THE COMMONWEALTH OF MASSAC USEFtS�' BOA R® F HEALTH ................................ .. .....&.................................... Appliration for Elhipasal Works Tomitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal $Ystejn at: 7' --- -eA -- - -- ----------------- --- ---- ....... . ...... .....Z'.. k.I / .. ........................................................ I Loc7 or Lot No. .............. ...... .......".................... .......................................... ...................................................... e.. . Or Ad&ess .....D EV . wne ...... 5-7 ................ ....... 1.4 Installer Address Type of Building Size Lot U ---Dwelling—No. of Bedrooms..........%3............................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other fixtures ..................................................................................................................................................... Design Flow............................5-.57----gallons per person per day. Total daily flow__._.........�..�.o.............. ns. P4 Septic Tank—Liquid capacity...1,50(kallons Length_________________ Width.._.__.._._..... Diameter.__............. Depth..- Disposal Trench N .......... ......... Width.._....I.._..._._..I........... Total Length...._.._ ......,.- Total leaching area___.._.......__07-----sq. f t. Seepage Pit No-------7--------- �i eter.....IGPI Depth below inlet.-A n.�........ Total leaching area.,?.,3.. .....sq. ft. Other Distribution box Dosingf nk ( � V-31 q,.L —!P Percolation Test Result Performed by...__ k................. Date---- ........mi Test Pit No. I nutes per inch Depth of Test it........ . ..... Depth to ground waterC>Q_7!tY7.._j')L, 44 Test Pit No. 2...L__-Z_minutes per inch Depth of Test Pit..__ . .... Depth to ground water_____-- ............... P4 ............ . .................................................. 11 0 Description of.Soil..........5...; —._4 -.t......... .......... .:�.............................................................................................................................................. ....................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribe Indi i a/1S 4' age Disposal System in accordance with iv Code e 1. 1 , "he 1 e sig d further agrees not to place the system in the provisions of TITIZ 5 of the State Sanitary o,�,/e e 0 r r of I y i Is operation until a Certificate of Compliance has been s ed b e boa of health. Signed............ ......... ....... .................................. ................................ Date ApplicationApproved By................__62. .. . . ........................................ ......................................... Date Application Disapproved for the following reasons:................................................................................................................ .................... .................... ................................................................................................................ .. ... .. ...... .................................... 12 + , Date PermitNo......_.. ........... ............... Issued....................................................... Date 1 No. Lf aoC 1. •. Fzes...... ............ _ - THE COMMONWEALTH OF MASSACHUSETTS ;. BOARD OF HEALTH � , rP ---- OF...-.d.. ........................................ Appliratiou for Disposafigorks Tonstrftrluatt Frrutit, Application is hereby made for a Permit to Construct ( or Repair. ( ) an Individual Sewage Disposal Syst at ° �/4� f f ; , ................3.--_.. ......� 1� 7 �. .._.......'� �G!�_.__�i...._...�.t_z��..... ........................................... .. °" " " Locayr s;�, or Lot No. ......................, ^---.....................�..._..._••^ .- .............................. ............................................. - ............................................... W Owner Address a ...... ................ ................................................__. -- ------- Installer Address P' UType of Building Size Lot..... ... .'"'Yet g— ..............Expansion Attic ; I—, '"Dwellin No. of Bedrooms..._....�„ �_ ____________ .. Garbage Grinder e) a Other—Type of Building ........ ------------ ----- No, of persons............................ Showers (. ) — Cafeteria ) Otherfixtures t: .....--••••......... •-••------•---•---•-•------••--•-•-•............. ..----•-............••---- W Design Flow...........................� --gallons per person per day. Total daily flow _ ... �✓ ._ to s ` WSeptic Tank—Liquid*ca.pacity._1� gaIIons Length.............•.. Width................ Diameter................ Depth,'.._"`_�_.._. x Disposal Trench—Np Width ... ........... Total Length ._.e.. Total leaching area.. • sq. ft. Seepage Pit No... „�_...._ D ameter.. ..._.... Depth below inlet . ......... Total leaching area?,-' ........sq. ft. Z Other Distribution Dosing tank ( • -�'' `-' Percolation Test Results Performed by.... .......vA . z- ° ' --_ Date.. w .. ---------------- Test Pit No. 1._ minutes per inch Depth of Test Pit.......i _._._ Depth to ground wate V -._--_:Z, , ti 4.w " - 44 Test Pit No. 2...L_:"�:_minutes per inch Depth of Test Pit...: . ....... Depth,to ground water........................ R' .. l i Description of Soil ----- C' ` __ .r� � ........ . _l - --- --- ............................................ x -•--•••-•----------------•-••------•---••----••-•-•----•-•-•-•-•-•------••••-----------•--•--------------------------------------------•---•---•----------------------------------•---•-.....--•---•---- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...----••------------------•-------•--••--•-------•----•-••---•---------------......---•-•----.....-----•--....----------------------...------------------------------------------.............._----•- Agreement: The undersigned agrees to install the aforedescribed Individual ewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Cod — They ders' ned further agrees not to place the system in operation until a Certificate of Compliance has been ued b,'/the bo d of health. Signed........ ... ...... ............................................... ............................... N Date Application Approved By--------- -:: _ .......................................... ....................................... Date Application Disapproved for the following reasons---------------------•--•---•------------------------....------'•-----------.................................... .................................. --•---......---•--••-•-----•-•-••---•---...-•--•......................•-•--•---........-•-------------•-------•--•-•--------••------.....-----...Da......-•----•--- Permit No.••••..�F ^ ?ZL\ t..... Issued-------------------•-•----•--....._......-- ......•---...... ^ -- •---•----••- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................................I......OF Trr#ifirtt#r ,af (9nutplitttta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) for Repaired ( ) by .....----•--•--•------------------------------•------.....----......-•----.................----...-•----......----•--------- �'�� Installer at.............................. -- f has been installed in accordancwith the prow si of TIT S of he Statry Code as,described in the application for Disposal Works Construction Permit No------ _ ------__- dated__________________ THE ISSUANCE OF THIS CERTIFICATE SHALT. N, 'T BE dO� TRIBE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... I Inspector........ .-----...... _ ----••------- ........ THE COMMONWEALTH OF MASSACHUJSETTS BOARD OF HEALTH IW Diu a� �t1 Work. Tons trt iatt rrutit Permission is hereby granted 'jy�:w: =� j---•-••--------------•-•-------------••----••------•-----------._.:............ ..._. -•---- to Construct,,(/ ) or Repair ( ) an Individual Sewage Disposal System k atNo. �` 7.c.... f' -'`' .- `�._... ------------��'1 ---- -------------------------------- ✓G_ f �_ CrJ liif✓%........ Street as shown on the application for Disposal Works Constructi n Permit No..................... Dated.......................................... DATE. --------------••-•----••-------•-•---...-----•--•-------._.....-----• - Board of Health FORM .1255 A. M. SULKIN, INC., BOSTON i < GK AC VA ` 7,13 y ? ?I — I t ` C�a - _._ ..---- r At t X r { ' tA - " .,_:qy,+. r`�,. ve 't fa+ •o t AT 'kilt .. e w '.. ►.rjT'- L.CxklEj) G 1 U 1t