The URL can be used to link to this page

Home My WebLink About0194 LEWIS POND ROAD - Health 194_Lewis Pond Road` Cotuit A= 020-131 No.... a Fps..... . ................. THE COMMONWEALTH OF MASSACHUSETTs BOARD OF HEALTH 10 r0 = 02.0-( 31 -..-..oF......................................................................................... CIOUu i�� - Avoiratiun for Ui ipwin1 Works Ton.itrnrtiun ramit, Application is hereby made for a Permit to Construct ( ) o Rep it ( ) an Individual Sewage Disposal System at: LotiL.. -•--•••-- --------..... -•----.......... ....... Location-Address or Lot No. .... 'A6L1-�o .1�.�P42J .... .--• Z ..... .............................................• Owner Address W Installer Address Type of Building Size Lot03 jlO��.__.....Sq. feet Dwelling-No. of Bedrooms............................................Expansion Attic ( )' Garbage Grinder (d)) '4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria PaOther fixtures ........................................................ WDesign Flow......5.,.`..5.............................gallons per person per day. Total daily flow..........%.19.........................gallons. WSeptic Tank—Liquid capacity.I.D.M..gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width_.Q................ Total Length.................... Total leaching area....................sq. ft. Seepage-Pit No.......I------------- Diameter._.._ ®_..._..... Depth below inlet..... . Total leaching area..... _P....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 99 aPercolation Test Results Performed by........2?AAT- 2�t. 6.............................. Date_._�.1��_� _-__-----•_-. Test Pit No. i................minutes per inch Depth of Test Pit.................... Depth to ground water-___--_-_____-__-----_-. G Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 •--•.....-•-••------------••-•----•••••-•-•-•--•-•--••••-•-•••-••-•..................•-••-••-•............................................................... 0 Description of Soil............................................................................----••-•------------•----•--------•••••••-•----•-•----•-••-----•......•-•.............-•_.. x 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 iI'i U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee .'ss ky the board of health. Signed............ ; ....... _ z�le . ''.••••. -.------•---------------- D Application Approved By......... •.•-.O............. --•` . ------------------------------- raj -Yal '----•------ ate Application Disapproved for the following reasons:-•-----------------------•-••---------------------------------•------•----------•-----••--•-••..............•--- .................••....-•-•--•••--•--•••......-•••--••••.......•-•••-•-•-----•-••-•-..........•----•---...- Date PermitNo......................................................... Issued_....................................................... Date ..No.. ....._....... FEs...... ............� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Diopoii al Works Towitrnrtion Urrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at: .........................•- ............. .......... ------..---._.-.--------... o R............. .•--•----------............--.......••---- ocpt y-Address or Lot No. �sq» •---..........(.,..................--•...................................... .................................................................................................. W Owner Address Installer Address......-' Type of Building Size Lot%AA Sq. feet .-� Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder (014) a Other=Type of .Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . W Design Flow.......6 -5.............................gallons per person per day. Total daily flow..........I3 ........................gallons. WSeptic Tank—Liquid capacity.'l _gallons �, Length................ Width__.......__..... Diameter______-....._...:,. Depth................ x Disposal Trench—No. .................... Width_-_..;.....__._... Total Length..........7.__.__.. Total leaching afea. ____ ---sq. ft. Seepage Pit No.......I......____.. Diameter-----1P.......... Depth below inlet................ Total leaching area......21A...sq. ft. Z Other Distribution box ( ) Dosing t k ( ) `� Percolation Test Results Performed by.........................................� .��.... �.............................. Date... _....... ....................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--__-_______-__---_-_-- Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-----•_-------•....---------------- I................................................:F.................................................:..................... ODescription of Soil............................................................................................................ ......................................................... x 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 TITIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ' s y the board of health. Application Approved B ............................ ,1• Da e hate Application Disapproved for the following reasons:.............................................................................................................. .........-•-•-------•--•-•----•-•----••-••------------------•-----••----••-----•......--•----•-----•.......•---•••--•-- qy_ ............... Date Permit No. ... 'Issu --•------•--------------•-•-----•-- -----�----•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................I................OF.....:............................................................................... �rrtifiratr of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------•---•-•-••------•----•-••-•--•-----•--•--•--•-•-------------•--••--------------------------------------------------------------------------------------•-----------------•-- /� r Installer at--------------' Y '..........------ ----f has been installed in accordance with the provisions of TIT EE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__°• _` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED :3 A GUARANTEE THAT THE SYSTEM WIL U CTION SATISFACTORY. DATE... - lf .................................................... Inspector......... ......................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF........................... No......................... FEE.25.............. DWpooal Work To trnrtion rrntit Permission is ereby granted................................ to Constru t or Repair ) an,,Indiv: al wa�ge,�. isposal ystem ...... --••-••. ---•--•••-•--•-----------------••••-•...--•••-------••......•-•....•- Street as shown on the app ica ' n for Disposal Works Construction Permit No..................... Dated.......................................... DATE. ----------------------------------------- !/ hoard of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1Zo ov = ' i LAO CGAtZ8AC-S E6Rt QC?B•fZ FLcw a Ito V. 3 - SSO G•PD TI*. v- s ssovISO %• • 4.156.P.M USCG• 10oo 6d.t_. j:>I5PosAL PIT • L sa IOoo 6AL. 1950 SF ,c 2.S • 3`75 91•U BVTTOAA AlZMA• rPO la-. �1 Z ��•� 50 frsr. 1 .o % Tcrr'AL ve6IGW • 42S G.t?D. TbTa t_ �,e•t t_�t' t=Low * 330 6�PD• M1j � � p P.RGDL&T10U RATE S I"11.! Z.MIIJ� OfZ L>r5�,. 2.0 K of pass, 4 WILLIAM ��, or ALAI' ` 1 C. f w. ' N r E N JONE N '9Ist ,p No. 19334 5 i;, b 1UU C'/p hp suK /f.;ria�Vh" I - . 41,uat ,,. , turg p ,v �ZTt~sT ��8Z 3� o• -122-1 t-�- C t>�YIN Adl loco W. 2 - S u6 60 L 4'pva+ v+st Iw• Gac 3 iZ' 'sox , srpnc o e; j I►!V TA w K E IOoo ,►+v. /• �uv t• LsAaA �� I • � Fo T i'• Wi H 0 1 •i,fa�. ,k •� WA4,Ago _ u C_SIZTIFIEO PLC) PL.at� d PROF'IL.� LoCATIo"t� 46 2 AT C � .�' 'C_�-• �l1j tvAj�- • � _ 1 GGRTIF�( TkAT This POOP l`�Xn� SNa"v� Pt At.J RL-FcRE►.1GE -1E:>;taatJ COOAPLYS w i rsA TNa: 5t o� u►•a� `..:c�T �Z aun SETC►AC4 V:cAU1VEAAcwTS OP TNc -�ow►�- Qr Q)NZL-)S.Tp"et�F- UAT6 ,.L�`�'" BA YTC4Z u'�E IaJG. RE(.t,;M-gED L.AWD 5t>ZV:=Yoe I yOT EASC� VN A" OSTEI~V,LLG o MASS• -dais nI-AN 1 .. 114-g�cuAA Cw �,uc,.�tr�{ TI{C. cat=t=,Cz_r ANP Lt C A,"-r G k+-ks tit' BE U��Cn rcl %,)(.s CM