The URL can be used to link to this page

Home My WebLink About0481 MAIN STREET (COTUIT) - Health I Mail T<25 0._ 7- .7._3� Fps.. 0 , N, THE COMMONWEALTH OF MASSACHUSETTS Y L BOARD OF /H�EA TH ..... .. ......................I.........OF..... ''G LL ..... . .................. Appliration for Uispaoa1 Works Tonstrurtion Vamit Application is hereby made 4aFeit to Construct ( or Repair ( ) an Individual Sewage Disposal system at: �P ��/ m �A X 1 Lc� 1 � � �Y ....................................�/f................... r - - --.---.--•--.------ ----- C ----------------Locati n d or Lot No. --- -...Owr _j Address f Installer Address Q Type of Building Size ----------Sq. feet U Dwelling—No. of Bedrooms......... ........................Expansion Attic ( ) Garbage Grinder (� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fixtures --------------••••............-- • . W Design Flow............................................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..................... Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-, Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-..-_-____-_____-_--.--. (Tq Test Pit No. 2................minutes per inch Depth of Test Pit------------_....... Depth to ground water............_----------- a ------------------------•-----------------•--••-••-•••--•------••••-------•---•--•----------••---•--......................................................... 0 Description of Soil........................................................................................................................................................................ 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 further agrees not to place the system in operation until a Certificate of Compliance has been issued the b h red.••--0� •--••-• ----•- ---------------•-----•------------------- aApplication Approv BY ---- -- -------- ----------------- Date Application Disapprove or asons:--•---------------------•--------•--------------•---•-----------•-•--•-•---•-------------------•---•••---------- __----••-----------•-------------•--------------- .---------------•-----------.. ------------------ Date PermitNo................................................._....... Issued........................................................ Date ........................ - THE COMMONWEALTH OF MASSACHUSETTS BOARD Q.�F HEAtz� ..._......._........._..._............OF.........:...:...: .� Appliratiun for Disposal Works Tonstrnrtiou runfit Application is hereby made for a Permit to Construct ((-)o Repair ( ) an Individual Sewage Disposal System at: ' � CJ ......-•--.. ----------------••--•-- ----•----•-- ---------------.._ .... Location-Address }� or Lot No. f � ` 3.. ........ ...... � . t..r ............... .............. j 'y r .. "'" '.................................... a Owner ' Address t ............... ^ 1. ...... f f...= g ................ .......... ('� d ......=� i-1 �. •-------------•- W R�.. f' f` r` lei..,a, s ` Installer , Address � Q Type of Building Size Lot-._.`'�. ..Sq. feet U Dwelling—No. of Bedrooms.......... '.........................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/...gallons Length................ Width..-..---.------- Diameter................ Depth.-_-.---------- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet---................. Total leaching area....-.-.---.--._-.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........._....._--_---. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---.---_._...-..--_----. a --•••------------------•---------•-•----•-......•--•--•---------------------------•-.......------------------•-•-------------•-•-------------............... ODescription of Soil........................................................................................................................................................................ x U -•------------------•-----•-----------•--------------------------•-•---•.-----------•--•••-•-----------------••-•-...--------------------------•--------------•--•---------------------------....------ 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 further agrees not to place the system in operation until a Certificate of Compliance has been tssu d the b afd of ea/,n/17 f s ... C° e ter'• ! -• ir d ' __r.... ---- -- -------- ------------ Application Appro By-- ----------------- _ __�_:_- -- __= t�. ��a �.__. ..�..��.= f-- -- / Date Application Disapprove cJ/f or thejf ollowing reasons-.................................................. ............................................................. ................................................. J Date PermitNo...............-----•---•-------•--••-•------•-----•---- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH ..........................................OF....................................................................... 'rr#ilirate of Toutplianrr THI"�S,T CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) I 1 e •• has bee i talled in accordance with the provisions\of-'Arti h-- XI of TheState Sanitary Code as described in the application for Disposal Works Construction Permit No.. .._ //— !��............... PP P ........ ..... dated................................--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................................... ----.....•--•-----... Inspector.................................................................................... a THE COMMONWEALTH OF MASSACHUSETTS 1� BOARD OF HEALTH OF No . ... ............... Disposal // gar Tonstrnrtion "rani# �+ Permission is hereby granted....j ..:yl__r<_.:a � i ------------------------------------------------------------------ to Construct ( r lYep�aix )_.an i a1 3ewa isp'osal System F—•. . at No. = =' ., Street as shown on the application for Disposal Works Construction Permit .... ............... Dated.......................................... 't Board of Health ........ DATE 1f FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS" • • c • U w l co si THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH r. ..........................................OF.............................................. 4 Trr#if irtt#r of Too plUtUrr �S CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -- ----------- Install at .. - . --.....� -- -- Q? .----•----•-----------------------•-•-•----•----•----•-••---•--------------- has bee in accordance with the provisions of Article XI 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 CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................... ------------ THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF HEALTH .......................:..................O F No.•-•-•�•------•-•---- FEE ------------- �t��t]Qt��ti nx C�IIYi�$��t$tdYlt �PrI$it$ Permissionis her nted.................... --•--- •----------------------------------------------------------------------------- to Construct ( i ' agP-� 'salSystem at No..---••--------- -----•----•• --••-• � c`.--r` Street as shown on the application for Disposal Works Construction Permit .. ............. Dated----.------------------------------------- ••-••-...... •.-•--- ------ ---...................................................... Board of Health DATE................................................................................ FORM, 1255 HOBBS & WARREN. INC.. PUBLISHERS V. SC-s'TIG TA�.ie.L•• ,�cZAO p�p„ �j, ; ,� � , � .'.�i�` �,� � �-•Jf � �,i „ u��' ISoo . of 5 PoSAt_ 1 P I T• ' �U�� 3�1'it/!� .. . i � • : ��. � i , . . �� ,��i` • ~; _!. rj I DE��A t.L A�tboa t ; 22ly SF ,�' F IPA;I 411 i tip SUx '' t r -, I �.{ + . . •) ,. r -ip 98 LAC / ` / •• �,� � � �ivi •► � //b :r' -�� :.i. _. Tli 14 154" l a :� .. • BoX. , Tr'�r Sf.PTIG . ::.: -.:.• � r :�I .� * S, ! . ' • , . ._...., .• _ 141J. � .. '(AUK. . .. � .. � 3 " lit 1 i C E2 T l F l za T�I..oT Pl-A pp SGAL� f pt F-ZC--.WG� 1 c.acriFY TµAT To•4U you. Tio►J 5 U 1-4 E QE.,o N ' CO IK F L L•1•-`(S . W l T H T fs. ri IDELI 1J OF THE A►.�D SkTBAG�C K�QvIeE-MF+�.1T'i TUv.�" OF ` Loc-&.-rt3� W1T141N ' .THE FLoOG P AIU. I I SZ—tSTr.. Qa=� LAUD ';ozv `{OEf, I ! T"(r, ?LAW 14• JOT BASED oU AU 0-KTZoMEuT OtTE-ZVIt_t� MI►.S/S. T41r• oFFsr•T; il�outb uoT t3� USer> APPLIC A.W r Tp_ 7pMTr-ZmIWrr- V.oT UuEX. kg �31�1�