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Home My WebLink About0010 MAIN STREET (COTUIT) - Health (2) 126 Trout Brook Road 'I A= 009 —005 Cotuit 1 s I �I I LOCATION SEWAGE- PERMIT IIO• VILLA.GE �2ouT '2acv� INSTALLER'S NAME i ADDRESS BUILDER OR O Will ER DATE PERMIT ISSUED DkTE COMPLIANCE IS SUED- y GCS e .r r 1 No................-....... Fus. .... ��® THE COMMONWEALTH OF MASSACHUSETTS \Y CJ 4 0`� BOARD OF HEALTH � � 91 p.0—W-.0.--..---.-..oF..... .. �_ Y E............................. Appliration for Dispaii al Works Tonotrnrtinn ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: ocation- ddress / e �� 5�t I�p, .....l��9J�...(t... ' `A�.. .... ��. k Owner Address W ............... ............ ----------------------------------------- ------------------------------------..----.---------------•--•---•----------------.-----•--.------ Installer Address d Type of Building Size Lot.-----•--1. .-----Sq. feet 4 Dwelling--No. of Bedrooms............. -------_-..___-.--Expansion Attic PP Garbage Grinder p,, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixt es -------------------=---------- W Design Flow__________ _ _________________________gallons per person day. Total }Iy�fliow-___--_--_-_-_-�-1- ............gallons WSepti� quid capacityW60...gallons Length- ---- Width.......".._..._ Diameter__._.- ...... Depth4..�_C.... x Disposafl No. .....1............. Width__��-......... Total Length.:......_...... Total leaching area.V,-7._�....sq. ft. Seepage Pit No--------------------- iameter.................... Depth below inlet....._.............. Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ~" Percolation Test Results Performed by___ _ ____ � ....._._......._.•_. Date._.�___..�....._.............__. _e. aTest Pit No. 1.... -.....minutes per inch Depth f Test Pit___-� .......`Depth to ground water------------------------ Test C'-- (i, Test Pit No. 2................minutes per inch Depth of Test Pit-------!!.......... Depth to ground water........................ a c ---------------- ---- -d----•------- ---------.:... O Description of Soil--.C''_ 2Z-••-- 1�!i: _ Cl `' � ��----- �-�.i-..PI---- - x c, 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 iITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has iss ed by the oar f h lth. Sind . ••------ �o 090 Date Application Approved By...... ••-•_•. ------...........• .- �-- Application Disapproved for the following reasons:............................................ -----------------------------•---•-----------------------------------------------•---------••---------------...---••----------------•-------•----------•-••---•--------•••--•••-------••---------------- Date PermitNo......................................................... Issued------•---•.............................•-----•---•---- Date No................ ..... Fss.J ................... THE COMMONWEALTH OF MASSACHUSETTS 6L-361 9K BOARD OF HEALTH Apptiration for Disposal 10orks Tnnstrnrtinn ramit Application-is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: 31 � , T'""j� ..... —. .. ..... c' _ . ...... ----- ---------•----..........-. ....... -... .................... ....... �{ �"'� Location Addjr'e�ss / ��„,sa q oft o r j 9�...... -ems':. ; r4`2i ..... ............................. 4,...-..-.-514,L }^�'A:3.25..' :-1GVE.�`��'0 Pc'..... o. Owner Address - W . a --••--.......... ---------------------------------------------•--..-- --------------------------•----- 9q Installer Address d T of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............*w ..........................Expansion Attic ( .) Garbage Grinder 1,06 a. `4 Other—T e of Building No. of persons............................ Showers a Other—Type g ---------------------------- P ( ) — Cafeteria ( ) P4Other fixpres -----•-------------------------•---...-•------- ----..•..------------------------------------------...------•--•--•----- .......---- W Design Flow .... ..).........................gallons per person per day. Total daily flow_:-_-__ .. .. t.............gallons. WSeptiT�#ankt,�,Liquid capacityf%'?�'?....gallons Length _." __... Width.' _:. %. Diameter...... Depths_ -.._. x Disposal rich—No.....A.............. Width_J .......... Total Lengthl ............. Total leaching area .....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. {Z Other Distribution box ( Y Dosing tank. ( IT '-' Percolation Test Results Performed by............... ... ... .................... Date_....._............�.. ...........1 '1 ..... 1.77ground per inch Depth(of Test Pit... .._._�_....... Depth to ound water........................ Gc, Test Pit No. 2................minutes per inch Depth of Test Pit......'!........... Depth to ground water-------- .. Pd •-•--------------•----- ... ------------ " O Description of Soil-0--- =-� `=C� �. �' 't ��' L'�3�� -, ...............................................r s W x • -------- - U -------------------- ------------------------------------- ----------- •--------- .------------- .----------------------------------------------W ----------------------------------- 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 TITLI: 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---- � '. :=ti_ f � 1 �' ;2-- '- -r: : D to Application Disapproved for the following reasons:................... '�W7 "" " --------------•-••----•---------------••-••---•-------------•----•--------------------•----•--------...---------------------------•-•---•••-•--------•---------•------•--------------•-••-•------------- Date PermitNo........................................................ Issued......-•---•--------------------------•-•-•---.._...--- Date THE COMMONWEALTH OF MASSACHUSETTS Y BOARD j F HEALTH t df s<' ............OFF..... f ,'.,r'{ ...................... f�rx#ifgr��r ,af f�unt�rli�anrr THISc S TO CERTIFY, That e Individual Sewage Disposal System constructed (�or Repaired ( ) by = `---------------------------- ......--------- � ".Installer 4 has been installed in accordance with the provisions of •ZT E( 5 of The State Sanitary Code as desc>;�Ibed in the application for Disposal Works Construction Permit t o �_.Bz_ dr dated .`-r .:`. .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY ��/ / Inspector .... � _DATE...................................•---------...._...•--/ = . THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH f........................ ` v.................... FEE.... �^ Eh I rks C�anotrnr#Uan pram# Permission is hereby granted. a-•----• LeC.a . to Construct ( or Repair ( ) an Individu4 Sewage Disposal $ tem ., at No.:-�---. . , _!_Z Z.'.. .t-_r- �� t------ �_E:.r • -d' /` 4, ut Y = - --------- Street -'a------ Dated `.. +� :.as shown on the application for Disposal Works Construction P mit No:... .... ------------------................... ------------------ DATE. 4"1.e / ____________________________ Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ' .r' �F d AR t / to 47 �a �''.� (� �,1'�C Il-.1 L�1,.�„ � ,�-��6!�� - x�- t✓'�� E�_..L_► ivy �-� � / J �� - , � a - r _� 1 r Vt_s <<..►.1 �s �l ( c, , 3 z tip` ,I ` g , —^ Y 1Ej U e Th W '2v _ . I A t►_ ►F Y, "'�J A Aw Alf wk n j \ ell - t 41• ' ti, \ 4 �) t�\� r- \ GR tom•• z *E't TEE -- �►�•►_. --- i�-'_... .__�v ._- � - -- 3 C.G. 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