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HomeMy WebLinkAbout0538 COTUIT BAY DRIVE - Health l��`3� �� ��� U ��� �3 c��i�" �\ i i LOCATION 3F1 SEWAGE PERMIT NO. VILLAGE �o 7 e)l 7 INSTA ,LLER'S NAME & ADDRESS B U I L D E R OR OWNER DATE. PERMIT ISSUED ----/ �o OAT E COMPLIANCE ISSUED ��/ A/Z ,{o 1�2�u'AT� D2>>1u ............... 9 THE COMMONWEALTH' OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F...........................-----.........----------------------------._...........-------- Appliration for Bhipwial 10orks Toutrnrtiun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . Locatyo Add ss or Lot No. 'S. `r - .e k .. �� �........................ ---...................:--•--•--•----------------•-----............--- wn r Address _v ivrn_oi.................. .......-----•-•------ Installer . Address Type of Building Size Lot................ ........Sq feet Dwelling—No. of Bedrooms.......... ..............................Expansion Attic ( ) Garbage Grinder pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------•--•----•--------------- . d - -------- •--•-. ---- .... ......... ------------ W Design Flow........... $..........................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.l.15Q---gallons Length....!o...._.. Width.....�5 Diameter__.NIA....... Depth..5.7 x Disposal Trench—No._._ti( ......... Width...t,JA......... Total Length_._.NlA_....... Total leaching area___.NJA........sq. ft. Seepage Pit No....l__&A....... Diameter......8.......... Depth below inlet.....!.......... Total leaching area..49!_!!-....sq. ft. Z Other Distribution box (v-1 Dosing tank (NIA) Percolation Test Results Performed by.....f3yl.KiS. '<............................. Date_....9 'L! XP �� __............. aTest Pit No. 1_!�..1_.5?�._minutes per inch Depth of Test Pit.....Il.......... Depth to ground water.u4q _ewco�,uTee� Test Pit No. 2._i4hI .....-minutes per inch Depth of Test Pit.....!:lA........ Depth to ground water----QA............. R-4 ----------------------------------------------•-•-------....------•------•-•-••.......••---•......--......................................................... 0A� Description of Soil............. to w co D... oA M.............•------•---•••---------- W (� - IS` YELLe>W SA14b-" gv(3Sor L (� ........................... ......._._......_...------...............•...........•.... ......--•----- -------------------•----- ----------------1-8„_.fin"......AAE—D.u�n :rz?--- ---SA�.JD . U Nature of Repairs or Alterations—Answer when applicable------uWA-----------------------------------•--_--__--------------_---_-•----.-------- .........................................................-............................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL i'. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ssued by the bo d of 1 ealth. Sied � ---------------•---...( .. .--••- ---- /� •--•-.... ••-•••--•••- Application .Approved BY.. _7- •.... -•••-••..................................................................... '�= ---;............... Date Application Disapproved or he following reasons----------------•-----••----------------------------------------------------------------------------------•----. -•-•--------------•-•-•-••••---------•--•••-----....----•---.......•••--••-----•-•--••--•-----••-......•.--•--••••------------•--•---•------- - - - ----------------------------- Date PermitNo......................................................... Ic .................. FEB ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF---------------------------------------_............................................. Appliration for Disposal Works Toustrurtion. rt-trutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .....L.014:4�... ............................ .................................................................................................. !') -I or Lot No. Lb ......................... .................................................................................................. Address W . '( ................Atj..)A_j'�k........... --------------- ... Installer AddressQQ Type of Building Size Lot...........L!.............Sq. feet U I Dwelling—No. of Bedrooms____________ ..............................Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( Otherfixtures ...............................................................................................................�6................................... Design Flow_:__..._.__ __________________________gallons per person per day. Total daily flow____._._____:___ ..........................gallons. 04 Septic Tank—Liquid capacity............gallons Length________________ Width._.._.___._.__._ Diameter.._:____________ Depth_______.._.___.. Disposal Trench—No_ .................... Width_.....___._.._. .__. Total Length.._.__._...___._._._ TOtal leaching area....................sq. ft. Seepage Pit No_____________________ Diameter_._.._.._.....__.._. Depth below inlet___..__..___.___.._. Total area..................sq. ff. Z -Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................z................ Test Pit No. 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.._____.....__._.__._._. ............................................................................................................................................................. 0 Description of Soil................................................................................................................. ...................................................... V -*------------------------------------------------------------------------- -----------*..............*.........**"*--------------­-------------------------*............................ ------------------------------------------------....................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable......................................................................... ...................... ................................................................................................................f,............................................... ..................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 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 bomd of health. -Dat. ApplicationApproved By../.... ... ............................................................................. ........ - ---------------- e Application Disapprove for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date V.- PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................I....OF..................................................................................... Tatifiratt"of Tampliana IS CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.... . ..............................................................)............................................................................................... ----- --- Z o � ,Installer A, .... ................... --- ----------------------- at...4........ ........ .....�22(.............................. has been installed in accordance with th IF sions of TITLE Sanitary a. described in the _5 of The State Sani s;� application for Disposal Works Construction Permit No V.......A/ ..... dated__ ............. ---- ---------------------------------- THE ISSUAN9E OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W- 1-Le FUNCTION SATISFACTORY. If or a DATE.... ....................................................... Inspector,,,,,"'!f!��............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD"NOF HEALTH .�...........................OF.......................................... .......................................... . ...... ........ FEE....7.... ............ • No./ Permissi ited.... ................... to Constr Z.on is�fier by grai -----------------------------------------........... of. //T1 pet '0-/) rRepai,r5��---an.�IndividiiinI Sewage �s osal System at ........... ...... ......... --- --------------- T------- ..._%F............e: ....................... Street _/�ated._4�,o--- ---- ................. ---- --------------------- as shown on the application for Disposal Wo onstruction Permit No................rr:p ........................................................................................ Board of Health DATE................. ................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS rq y /2"�.E /MOTE /F E/TNER. THE SEPT/ A pR 4. f E,4 c.y r�vG P/r ,4 irE Mo.�E Tl r L0.w i !B i+9/As. rRAG , f► ?4 'ONER I SAI AZ/. �rO ,®ROUaR7' TO 4,TA®�:�frN EiYTRA +. CCNGf�t'TR 4'AYC PlP� JS+EAYy C^ ST Pe4=lT S'hH,4 4 L !3E US E.0 M/N. P/7 !F/N 17R/VEM/A`Y C 4- 1, 97.5 C'OYE05. 8 Op&-R F7 :le F TE r— G3�AoE CO YE.4 CLEAN .SANv. 2'LAYER a IRON:P/PZ . M/Al.P/TGY. . GPI L.. • o e o • . s . ° t r a os' ! SePrIC 7r�i/VEC D/ST o e 4 e v ° • • .• o t e • • • yyASh'FO STZ7NE BOX o • t � e s e eo a wee • °� a l ♦ .p FFf�CT/VG' s s , 1VA51/EO STONE c � PRECr45T SE�'PAG£ ::a D s • dlV6��� @`L,�Y�T/O/4L.� L50 8_x 2.S•,` 3�'-1 Gf. CU a b.• t r ° s '® ®-® ®.a ® eo P/T.OR EQU/V_ '; so INYZA77 AT 01/11-D/M6 G4 s or a�7-cAPAc_—.iT v/D1 8 F7: ®IAA. : C(s�Z r0vL.aTl®1v� /NL ET, 1 ®✓nE'T SEP7'IC TANK . 9.3.3 FT, _-Tc)TA-t_ cAPAc-rr( : S 54 6/ l/ElCE�`D/SY/�/�dlT!®R/. BOla' FT. ,SECTlO/v ®� CrR®t/!1/® W.�1Tf� TA®�E j ®uTLr"TDISTRr®tdTi01�6�X 92.9A7I ' /Kd E7''.LE.ACRIVre F,/7' 92..7 FT,C��a5E�A�a� 0/a�®�d4 4 S�..�T'�/" -rA����`�d®/� LCH11VC AVM DZ5/CdN CRl7EMIA TCALE . . . Ala9ENSltal�l �/!JAf8ER ®C,6Evl�OoAIs 4 CARdACE D/54P05AL. 4olN l - !f >J� .SOI�, L"OG TOTAL s7-/l+ 'y"Ee7, Fto e"t/ 44a �.60�./o.A yr SO/L TEST ! ..$®/L TESTS 2 'tf NUM8ER ar Z-111AexrwG A/7's_ l fFeEK 95.0 r-gL&'j! ®ATe O,F- SOIL. TEST �� 1 bVlTNESSED BY e9C)r-rOM LAACl//NG P--,R P/P fOO.C.� `tT J,t,%OD t�4.jtr� Ptige®X1.1'r•/0" HATE Af Liss 1•IlNyI/NGN TOTAL 4eACH//Yl ARE�6 402.�L SQ F3^ � •• F�RCOL.�7'/OM R.4T� � T/f�'✓ /�7lN.�lNCH ACMo/vv�r4REA 402.2 Sip. FT. 6 i 5�©� qss 0r,i��' . �� �+��9 Z D7" 2-1C.0TO17 ar rv', CO 7 f. o ,ORSE I'v No.10951 4 El-DREDC ENCYd/dI. 1 G C® l mc. � L o,o:, 7/Z MA/N ST. 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