HomeMy WebLinkAbout0468 COTUIT BAY DRIVE - Health ��� C 33 ��
LOCQTI N_ ' /p.,3 5EW C-4E`P-ERMIT 1.10.VILLAGE-
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_pQTE-PERMIT 1.5.5UE.D- -
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�JvO�� THEBOARD
OFHEAL� ETTS
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Application -fur Dispuutti Works Luaa�fr�trtivaa rraa�it
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System�yt: 2 _
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ca on-Address /! or
lsf� C1 t !...N.N.l N.c.ff fl,n------------- -----
Owner Address
Installer Address ?
U Type of Building Size Lot... ✓_Pi_5P�*---Sq. feet
., Dwelling X No. of Bedrooms................... ......................Expansion Attic ( ) Garbage Grinder (X)
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures -------------------------•----•----•-------------------...---------------------------------------•---•-----------------------•--------•-•---•--------
W Design Flow___________________(51D---------------gallons per person per day. Total daily flow.........����-------------------gallons.
WSeptic Tank—Liquid capacity-gallons Length................ Width_.............. Diameter................ Depth-----_----.-----
x Disposal Trench—No.............�. Width-___.-------_-�-_��1,Total Length_-_-___-_-__----_- Total leaching area--------------------sq. ft.
Seepage Pit No.._.�....____... Diameter---l ./XDepth below i�et.................... Total leaching area---_-.-_ _-.- -__-sq. ft.
Z Other Distribution box (�f Dosinytank ( ) ~ 0/- /V - 7y2-S-'`/6 .
aPercolation Test Results Performed by---------------------------------------------------------------.......... Date---------------------------------------
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water----------------........
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------------------------
G -------------I" r ------- _..
Description of Soil--- �1� 2 - w Y ...`.---z %Zse--/!
------------------------------------------------------------•--••••--•--------•-•-----------...-----••--•-----------------•----•---..... ---------------------------------
U 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 a rees not to place the system in
operation until a Certificate of Compliance u h p p e ed b e bo of health.
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Application Approved BY . ....•-- ---•-=/- 10 � r-------
Date
Application Disapproved for the following reasons:----••---------------���(((.......-----•-------------------------•-•-•-•-•-----•-----.......---------••--•-......------
..................................•._...-•----------------------•---•---------•-••--•--------•-•----...........---....--•--------•--•-------------...----•---------------.......------.•-•---------------
Date
PermitNo......................................................... Issued.......................................................
Date
No......................... Fsa......../.. .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
Applirtttiun -fur Uhip itt1 Morkii Tonitrurtiun Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
E�D 7-(,).1-r ;.&
. ---1) 7
---------------•---••---------••-------
cat' n-Address / or Lo
I3E2T �.. ...........U/V n/t 1.1 6¢l. ._.T7_/`(t7V5.�..
caner Address
a HSUN` �9{30)?69 L
Installer Address
Type of Building _ Size Lot....tiJ.._�--------------Sq. feet
Dwelling X No. of Bedrooms__________________ _ _________________Expansion Attic ( ) Garbage Grinder (X)
aOther—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures --------------- -------------•------------•-.......................................................................................................
Design Flow--------------------�5�- ......_-------gallons per pel son per day. Total daily flow-------------? ________-_--_--___gallons,
WSeptic Tank—Liquid capacitv_A gallons Length________________ Width................ Diameter-----.--._...... Depth----------------
xDisposal Trench—No- _____________ 2,__ Width__________-_____-SpTotal Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No----- .......... Diameter,___ ftepth below inlet____________________ Total leaching area----------.-------sq. ft.
z Other Distribution box ( AT Dosin tank ( ) - o d /V c';7-1 - T-z (,-- 7 6
aPercolation Test Results Performed by----------------- ........................................................ Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water--_-_______-__--_-____-.
(q Test Pit No. 2................minutes per inch Depth of Test Pit...................... Depth to ground water---------------------
O Description of Soil---- a--^0.----�......----le�0 t ��-- -- �-✓ - -2 - �r -----------
rJ�c,�c,,,�
x
U -------------------------
W
x -------------------------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 \I of the State Sanitary Code— The undersigned further a rees not to place the system in
operation until a Certificate of Compliance as seen is ued by he boof health. p
ig d--- -''•• --- !!' -----L --�G (�
Da
Application Approved B p�
PP PP Y s' - - - --•-••--•-- •
Date
Application Disapproved for the following reasons:.........._.........___________.................................................................................
-----•--•------------------•-••-•-------------------•------------•-•---------------------------------------------------••••------------------------------•------•----------------•-•-------------_------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
?lJ�t t..............OF........./ -..%.--.-...-..........
Tutif irttte of fI'umplittnrr
TH IS TO CERF Tha the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b ........ G' 1.Ce 4 -
Y • --•=��ti��-_�-�).���•-�_-----..................... Installer��/'Jj iM/ - -•-- ---•---- •------- --- --•----_____
at...- ................ --- ,�_ ..
has been installed in accordance with the ovisions of Ark ArkR XI of The State Sanitary Coc as -described in the
application for Disposal Works Construction Permit No.____...... ._�_______________ dated__ -X4_ -.7_l�_..__.___..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATES r�-�--- Inspector--------- ---- - .......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
`7 b
....... .r ... OF_.... . ...........................
No........ • ........... FEE---&..............
T14
Permissi n i hereb ranted__7.._._Gr'!lH • -..__...._Y g ------------------'•-------•---•-•-•--•----••_-----
to Con at stru ( or R��epair ) I' pd `idua ew e Diss 11 System
_.---------
Street _•": r�
as shown on the application for Disposal Works Construction r it N _______ __4,440.7z
Dated_...._!."._�U__^._7 G__.._..__._
-.--.. ----'- ------•--------------------
Board of Health
DATE................. ..............................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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min• �� Li,�e
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hereby Certify,..that the PL O T . PL AN
Foundation is located as shown_
®nd..conforms to the Zonin 34
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.By- Lomas of the Town of GR C OTUI T BAY . SHORES- ,*
r -TE. �"
90HAN'viiN
CorulT, BARNSTABLE. MASS.
Sco/e / = 40 Sep. 8 , i 76 .
" " GRETE M. BOHANNON R.L.,S.
�J West Bridgewater Mass., 02379