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Home My WebLink About0443 MAIN STREET (COTUIT) - Health /�L4-� T►1cu,n I;frcCv ,, LOCATION SEWAGE PERMIT NO. 7 �f VILLAGE INSTA LLER'S NAME 6 ADDRESS B U I L D E R OR OWNER X97 r, -7 llea 6<,l DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED O J4 c rZ z -4 fn r� - - - - - - - W t9 L O lu ON F � O W � f.- No................ ...... J C) Fmc............................,ri THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................................--...O F...............---•--.................. Appliration for Uiipnsal Works C unstrartiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......... T-•-- .........................•-•-•--- / Location-Address or Lot No. • . ••---• ....•---•••••-•---•..............: ....••.........----._.....f'l1 ----•-----------.....---- owner Address �y................................... ate... sue ..J 1V V ....� 1'�!-7......... pq Installer Address VType of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms....3...................................Expansion Attic ( ) Garbage Grinder ( ) pay, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures . -------- --------------------------------- -- d W Design Flow......... 5.......................gallons per person per day. Total daily flow......_-313_p......................gallons. WSeptic Tank—Liquid'capacrtyl .gallons Length----_d...____. Width.... ....... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..........�........Total leaching area....................sq. ft. Seepage Pit No.... 0.. Diameter..... Depth below inlet__$............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a . 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........................ a ---•-------•---•••--•-••-•••--------••--•---•-•-•-•----•......................................•••--.......................................................... 0 Description of Soil...............................•-------•----•-------•-----------•-••---•---•---•----------------------------------------•------•--------------------••••...-=----------- "� W ----------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable-----CQ ?.1.2- _�JL _r b -------__-••... ...........a•�...... -'a .<7,EYI-1........... Z ......t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA 12 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 1 /...... Si ned•. . .............. ---------....-- ....... ..` Application Approved Y --------------• ...._...........----- --- .... -G� �fZS� Date ............................•.. Date Application Disapproved for the following reasons------------------•-----......-----------•---------------------•-------------•--•----------------------••-•-••... -....................................................................................................................................................................=................................ Permit No.........13.;: .... Q..................... Issued._..._._....__.�J � `� D Date Fsc............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................._....-----------...O F..................................._.. Appliration for Disposal Vorkii Tonstratrtiun Vprrtnit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . .. 1 C'.rs.�r✓ ._...................................................!..!...... ..._..•-----------------•---•----••-------. .........-----._........................_ Location-Address t N or Lo o. .......... r /''J ........................................... ................... ............................................................ Owner ? Address WW1 •----i--- c5lrs P ._. « f� 'K --... r�` °� ....... ....6-.... Y �-�---•------•............. ..•--- ... ..... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms____�___________________________________Expansion-Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons___________- Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow......... __6________________________gallons per person per day. Total daily flow....... _ _......................gallons. WSeptic Tank—Liquid capacity!_ gallons Length._.. ........ Width_.._.-{_------- Diameter----_............ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total•leaching area....................sq. ft. Seepage Pit No.....2.Q_Q Diameter..... Depth below inlet___ ,.6........: Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed.by_ -------_---------______________ .:. __ .____________ Date___ ____.__...___________.._.______.. Test Pit No. I................minutes per inch Depth of Test Pit .......... Depth to ground water........................ f� Test Pit No. 2.........._.....minutes per inch Depth-of Test Pit:_'`._:___________._ Depth to ground water........................ a ........................................................--•..........:.......:...•--.........•------...-••-•••--«:::.....:...•--•--•--•••••------..._..._._ 0 Description of Soil________________ x W ....................................................... ------------- == UNature of Repairs or Alterations—Answer when applicable_____,_G � '�C .._� � ._ Y '..__ Agreement: r; 0 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 been issued by the board o Signed r r' ................-.......... . / Date Application Approved B°y........ == - • �r f '. .. _� ......- .. ..------------------ ..._ .. Date Application Disapproved for the following.reasons:..................................................••-•-=----•-----------•-•--••-.__...--•-•--------•••--••...... s - =............ .............q w Date Permit No..... •--- ------------- -----:.. Issued 3:_.... gs Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................... Trrtif irab of TuutpliFanrr THIS IS•TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by................. St ........1-.... --------------------------------•--------.........._..-----------...---......._....----._....._..------ ,��, 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...... .......... dated-... ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...:..... r�....,_:' .�J --- ----------------------------------------- Inspector----•- - .............. ----- ............ -....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH % - �• G.ht/Vt.!.........0F.......(5 �,r•n. i` «:.............................. _..� FEE.•. ., Disposal Vork.5 Tonstr udion rrntit Permission is hereby granted1� c _ti-...... `�" -. .......................................................... to Construct-( ) or Repair an Individual Sewage Disposal System atNo........�4_ -I-. :.. +t'!11 c.-1 !.._._. ............ -•-------------------------.__--.---..--------------------------- ....................... Street as shown on the application for'Disposal Works Construction Permit Nod_��_'�Z____ Dated___-��_.�lp ----------------•••n ._.____ -ti _ _______________yam; _ _.._ _.__.•__:r_t_-______-_________.._...__..._.._..« ...-- � Board of Health FORM 1255 ORBS & WARREN. INC.. PUBLISHERS