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HomeMy WebLinkAbout0548 COTUIT BAY DRIVE - Health r ............ Fps.. (/................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o. ... ...........oF....... A►2.► : ......... �S ............................................ Appliratinn -far Biiipaaiittl Morkii Towitrnrtiaan Prrntit Application is hereby made for a Permit to Construct ()<) or Repair ( ) an Individual Sewage Disposal System at: •--•-� �•�.�..------�e.-r�, ��r_.... .. .... •Cam •�`--------------------------------------------------------- _ Locati -Address o Lot No. .......'l�1.�►.C�>k��_.r..... :.....� TgN_11 ......... ......... __ _�-i ,�... ,` i� a ......... W _ Owner �`�� /' Address Installer Address Q Type of Building Size Lot_._____3_�� "` Sq. feet V Dwelling—No. of Bedrooms_-.-_--__._4............................Expansion Attic ( ) Garbage Grinder (X) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ••--- -----------------•------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. C4 Septic Tank—Liquid capacitv2c©Ogallons Length---------------- Width................ Diameter-----.---------- Depth................ xDisposal Trench-2 No. Width_----------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter____________________ Depth below •nlet_________ ..__.__ Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) 4iO ' 10� ,— `� 7L aPercolation Test Results Performed by.......................................................................... Date--------------------------------------- ,� 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------------------------ ------------------- /r - V t f O Description of Soil------- ..... 6 - Gw cx� ------------ ...................__2.. 1 _� - • .....� r/..-----------------------------------...-•----.....----------- W UNature 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 fur her agrees not to place the system in operation until a Certificate of Compliance has been issue by the oa o he t . Si = rR l Da e Application Approved By. .._ ------------- ----•- ----•_ . . ........................•--- •.... Date Application Disapproved for the following reasons:......................••..._...••-••-•-•--•--••-------••---•-•••-•---•--•••••..........--••••......•----••----- ----------------------------•----------------------------------------------------------------•----------•.._--------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date PY.9..� THE COMMONWEALTH OF MASSACHUSETTS —��� BOARD OF HEALTH ..1_...._-. .O.W4. _ ..-- .OF........ A !?...S. l ......................... ApVliratiun -fur Dispaiia1 Marko Tonstrturtiun Vrrntit Application is hereby made for a Permit to Construct (X5 or Repair ( ) an Individual Sewage Disposal System at: acatiot Address or Lot No, r� a Owner � '►- ' "Address -•-- Ia •--- ---------------------------------------------- ---•-- ---•--. ---...-- -•-t-•c-)-,- lz,v -r- -a-----�-.----,-,..... Installer Address UType of Building ..!! Size Lot........ ?-��?...Sq. feet �-, Dwelling—No. of Bedrooms.-----------4----------------------------Expansion Attic ( ) Garbage Grinder ( � aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ............................................................................... W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity_2.ap4�allons Length................ Width................ Diameter__--_-..---.- Depth................ x Disposal TrenchL2No. ._J0.0.-V.... Widtli.................... Total Length_................... Total leaching area---._.--_---...__---sq. ft. . Seepage Pit No-------------------- Diameter.................... Depth bel let___::.___ :_... Total leaching area----.____...--_. sq. ft. z Other Distribution box ( ) Dosing tank ( ) —ow it1 /��r ', �`1O— 7 aPercolation Test Results Performed by Date --------------------------------- ,� Test Pit No. 1................minutes per inch Depth of "Pest Pit-....................Depth to ground water...--.--_-----._.----- fZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.-.---.-_-.-__--. -- ------ ------ ---------- Description of Soil.------- �° ' - - ......._r a ..................... U - - •--------------•---------•-••----------------------------••-------- W x ------------------------- --- ---...----••----••-•••--------•---------------------------------------------------------------------------------------------------------------------------- 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 agrees not to place the system in operation until a Certificate of Compliance has been issue . y the boar of�he th. el 06 �� ; f �.------ . . Date Application Approved BY Si.- .... ------------------- .... l� Date Application Disapproved for the following reasons:-------•------------------•------•---------------------•-------............----------.........--------••-•..._.. .....--•--------------•-------•---•---••-•----•--•----------••--------•----.:_..----.-----•------•--••-•---•....---------------•-----------------------.._.._.._..-• --•---------------------_-_ Date PermitNo......................................................... Issued..................... .................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ..`...`..........................OF....... a .N .rrlt .!`.............................................. V.1rrtifiratr of fI'unt;ilitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (`� or Repaired ( ) bY...........-- *1At.---- A,..------_JAa�'d'--�-D--------•----------•- Installer t� at--------------Aot'r.. --u-----------C-0-" I`T----- A-y----- i ........-'---cn 7n-1_T__........................................................... has been installed in accordance with the provisions of :fir lele NI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._I - --.-_ ------------- dated------ ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .............. --------------------- Inspector----- --• ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O1 FF HEALTH� No..l g ..__.. d .:. .........OF.... f "'" � c.............................. ll� FEE..l._•--............... �. Cnu �ttutt �rrtntt Permissionis hereby granted--- - -`-'- - ••- --- �.:_.�.- - - -�--._a-----------------•----•--...----------------•-----------....._._......---------- to Construct ( or Repair ( ) an Individu 1 Sew e Disposal System at No.--•------../�A ----'Z-�?`-------- �+"-amu..l--r--. .. f12 Vt.--: . ---V=0'�',� --'---------------- A}� Street as shown on the application for Disposal Works Construction Permi4' To..,!._ ._.. &bated---- �, t / " // per_ DATE------- ---------- ------- -------1-.=...._..---- ----�--------------• Boar d of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS «, .+I' - VA r rs.rJ'' r ._ { >,:: - / `�' F .F. '* k• "` s� �d r � }'�� P :M� ..",�,',`- i� �,. ��ti.. • - - - r. - ..' 4 a' ',- *.f � I�w :.>,.-. }, J "•n `reµ, ,tw i - _ .. , x..- ! .. s,., - � �� ^sr•K �. era ,��'>. ! .�'- rJ<. }x� l J: � - �• -( Z r `'4 eta i^ Irk 'tv ,� .� � '�• �'s______.� �l� D i '�%- _ - a ,."s � + , •'r*i � 'rye '. 4 - )'. 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VILLAGE INSTA LLER.',S NA ME & ADDRESS ,/ ,2G��:'� 'f. iraw ✓/i�LCC�t'. B .U1 DER 40 Ts i F E PERMIT ISSUED COMPLIANCE ISSUED ��� _ � pop 6