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Home My WebLink About0501 COTUIT BAY DRIVE - Health 06 T O LO CAT l0d�3 SEWAGE PERMIT NQ. L-a 3� �- �( 2 - 310 VILLAGE INSTALLER'S NAME i ADDRESS '7 '�± ( 't- Ro c,It- ®JELL 1 E R OR OWNER R3 Asl DATE PERMIT ISSN E O 0 DATE COMPLIANCE ISSUED �� r Sep I- F 42a►J+ 7 7� c07'U;t FA y D/C4% No......13 - 310 Fps........y....A..4.... THE COMMONWEALTH OF MASSACHUSETTS V BOAR® RJ.,F HEALTH ....-....�-0t�J..L,..............oF......... .M 0.4XI 6.L.&.........................--•-- Appliratiou for Diipusal Works Tomitrurthin rnmit Application is hereby made for a Permit to Construct ( 44/or Repair ( ) an Individual Sewage Disposal System at: - — 5L,........6TVJ:T...............................�0.-r.......IG............................. Lo;cation-Adaak� s or Lot No. . . a . . -6--� -- Owner Address ,Wa ............. ....(fir....- �....._....... ------ Installer Address Aq d Type of Building �j Size Lot....1.__(7.&... �iG ee V Dwelling—No. of Bedrooms................. ......................Expansion Attic ( ) Garbage Grinder Other—T' e of Building No, of persons............................ Showers — Cafeterias Q' Other fixtures .--- ......-•------•-•--•-••- - W Design Flow......................----S.<..........gal s er person per day. Total daily flow.........................3.�......gallons. 04 Septic Tank—Liquid capacity' galfo Length................ Width................ Diameter---------------- Depth................ W Disposal Trench—No. .................... Width......-Q.._._..-.... Total Length-:-..._____..s..... Total leaching area-------- ----------sq. ft. x - Seepage Pit No..........I--------- Diameter..........T-..... Depth below inlet.......4......... Total leaching area.... ;...sq. ft. Z Other Distribution box ( V! ' Dosiag tank ( ) Percolation Test Results Performed by. C TL.-EA,_t _______________ `..1A&2.()&ate ............. a Test Pit No. 1......�...minutes per inch Depth of Test Pit.......f 7- .. Depth to ground water.. ............--. Test Pit No. 2................minutes per inch Depth of Test Pit.--..--............. Depth to ground water------.--.------.-.----. Q+' ••••--------•--•----•--•---•-•••-----•-•----------•----------•-------••...........................••......................................................... 0 Description of Soil........................ . W To •-----------------------------------------------•-----------......••----•••.....•-•---•---•---...••------•-•••------------------•••--•-•••---•••--••--- .. --•--•--•----•-•---•------ Nature of Repairs or Alterations when applicable---------------------------------------- °.-- .!ti-�r�<-.---..---................ V 1. ��r!QNS' '.------ 44 ...-----��''----dz.,'t!u.A.e A................... 'Agreement: ®>.'e,.AIA G o The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL is 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... 1J � —�3 !�� '.f -........ Date Application Approved BY •- :.A /-2-..---------�=--1Z_� _ v Date Application Disapproved for the following reasons-----------------------------•-----------------------------------------------------------------------............ ..-----•....................•----------....-----...---------------------------------....---•-----•----------...--------------------------------------•-•---•••---------•--•••--•--••---•-----------:.--- Date PermitNo....'V.:.3/u................................. Issued----- S - .........................................� ' J13 Date � s No.. .................. FEs................... ....: .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .0-i .t ..............0 F...........:a�.s ._.1. _t .!..i . > ------------............._--- Appliratiun for Diipuual Works Tamitrurtiun rrmi# Application is hereby made for a Permit to Construct ( 4 or Repair ( ) an Individual Sewage Disposal System at: 4_ ........-c.?:t:;Js. !�-` r- 1 Z • .j c1- �"'-- --- ----._.� .). r 1 L Location-Address I or Lot No 1 . •-•••----••••-•-- . .... Owner , P - Address !A ..... -•.................................... ........_.................. Installer Address_ Type of Building Size Lot___._ _. &____ksq. feet U Dwelling—No. of Bedrooms__________________ _____________________Expansion Attic ( ) Garbage Grinder pa Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ) Q' Other fixtures ---------••-•----•-•--•-.---•---- W Design Flow............................g ____._..gallQs Der person per day. Total daily flow......................... p.....gallons. W. Septic Tank—Liquid capacity_ . all tip Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width_.................... Total Length............... .... Total leaching area---__._�.__.__...sq. ft. Seepage Pit No-----------t........ Diameter.__..__....�-_C�_..... Depth below inlet____.___....... Total leaching area.._.. 4__sq. ft. z Other Distribution box ( 1, Dosing tank ( ) 4 ~' Percolation'Test Results Performed by. t.�fCE:±1__F. �1`l la_______________k...I.N�Aate______.. "� . . 7. Test Pit No. 1.........Z e..minutes per inch Depth of Test Pit-------- Depth to ground water----- .............. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................. •---•-------------------•--------------------••-------------------------------- _____---•--........---• ---------------------- DDescription of Soil------------•-------------------------------------•-•----.......-•-•------•------------------.-_----__...._........----••-•--•----•---•-----•••---•-................. -. W -�= ,x --•---........ -••----------••-••.... ---•-------•--------•------------•--•----------••-----------••-----•-------••----•-•-•-- -•--•---- - ------------------------------ !_.. ice.%�w C.�.. U Nature of Repairs or Alterations—Answer when applicable.__...._____________________________________________________________________________........... . --=-----..Gz t��!""----•--- W- ------ Ls .! r_ ------- .......... . :e<r r;!_��. : .................. Agreement: A e i. The undersigned, agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 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..........L.............................. / Date Application Disapproved for the following reasons_______________________________________________________________________........................................." ........................--.................................................................-.................................................................. ........................................... Date Perms No. a.._.. Issued_-------................................................ ._..._..-•-•-••--•••......- Date THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH . f...%,U.1.•........OF.............: Cprrtifirtttr of Tumliliaurr THIS IS TO CERTIFY, That the Individual Sewage D�osal,.System constructed (.• ) or. Repaired ( ) Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... =__:__-_. _' 4 �: :'` E ------------- dated---..._..._. . . ----`=---3..-------- THE ISSUJ NC -OF THIS. CERTIFICATE SHALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEM WI FVfiCTION SATISFACTORY. DATE..... /f° Inspector..... ---------------------•-------•--•------•...................... 'THE COMMONWEALTH OF MASSACHUSETTS BOARD-,OF HEALTH - ! P , ... .. �r� ...............(_,. <...: .........OF......-....,,.:.._....__._.... "7 P...... it .... No...... :._ FEi._.......�......v....x Disposal Vorkii 011,uustr ion r _ i;. Permission is hereby granted = _ ------- •----�.. .................. to Construct ( }' or Repair ( ) an Individual Sewage Disposal System _. L Street as shown on the application for Disposal Works Construction Permit No ..../ _ Dated_._____.::..................... ...........................--.......................................................................... /� Board of Health DATE----•a�.."_��_-� --------------- ---- -- ______ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I W� GAIZ546 O w .. 110 X 3 +-`Sb�/�C II 5EPT1G TA►JK = 330x D15Po5AL PIT v6E ;. %DGYJAtu AQti+a 50TTOM AREA- S.r= x I. o G P a ,k 31 -ToTA 1. p E-SIGN•= .�p '_(�•R D. t r -ToTA1_ DA I t-Y F�-ow( ' j PE2co�QTlo►J RA?E r I''In.► 2/y11N o�1.�55 N. g4.� .. + � lJ� .. t r• a i qo.Z 3 moo* Pl�o x- STo 4P TAW kAL''RICHARDA.BAXTER N " Jo )Na 2ao48 N . 25100 18n.&`38 L4,oiR�OQ' F 9q.3 9'1.4 9G.� 4G G 4b0 SURVE,� COT u 17 !BA`� `�TL I VS- G q•� To P FND 6 tL.q(, - INv,q S. . P TI G 94 8 , II N� QI4,` Ta.NK ii i OL 1000 Gat., 94 �EAcu PI.r 1 INY. INV. j... R44 wI-ru CnTv�, WA5uGD Y 6TvN6 CE2TIFIGO {7l.oT PL-A.W L PR-UFIL� L04A'T►0N ��tTi"v 1T r. s ; NO SCALE SCALE �'I_ G,p' �AT� 5 -4-Si I�o WA -tz tZEN GE G E ctT�r- T H AT 'TNT f 2 Yop 4se 5Ko WN NEREo►a GoMPLYS WITH TH6 �,I P6l�IW V- SOT AND 66TP.�.GK 26Q�►�L6N,ENT� F -C1-I� C -TOWN OP I3 A 114SrA.S:�;LS Ae v P At A a� Courz�- p�A 1.1 321 C� t.00P.TE0 V1JIT IJ NE F D DAT>r 54 $3 ' BAYMaZe WYE INC, REG I VT iGQ6U'1.Aw o 5 u g-Y Tu15 PL&Kl,t f, Novi' anSFA o►d AtJ OST'ELz-VILLS • • Iu5TR.uMEN'l' SuzvC-�-Y -THE ohV 5f's SuouLt> 1I� NOT DC- Val- r�-TC+ (7C:'Tl:.t'-/^I�1CC �'t t.11lG APPLI�p ►JT