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Home My WebLink About0709 MAIN STREET (COTUIT) - Health ` r7,09�1VIain Street ti.,,F . 1 1 i I h /`I LOCATION , SEWAGE PERMIT NO. VILLAGE ' INSTAL ER'S NAME ADDRESS d U 1 L D E R OR OWN ER DATE PERMIT ISSUED 2 DATE COMPLIANCE ISSUED RS �� _: � �� `�i �' �I a�� .,, � � i , � `� ., � G �� _ . � � �., �� . s,• j�3�:W ry'� No.............. ....... F ....1:.��............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F..........................._............ Application for Disposal Works Tong rurtiun amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• --.. ...........................•••. o No. Address or Lot No. n r Add s 0 i . ...... Installer _ i UAddress Type o Building- Size Lot.., . . _ ----Sq. feet Dwelling No. of Bedrooms._..6....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------•-------•----------------------------------.......--------•--••-•-•---•---------------•---------•-----•-........-•---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid ca.pacityV!?Pgallons Length................ Width................ Diameter................ Depth...._..._....__. x Disposal Trench—No..................... Width.................... Total Length..._................ Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 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........................ ODescription of Soil---. . ----------------------•------.-.-.---.-------------------------------------------------------_----- x U UW •-•-------•-----------------•-••------------•-•-----•---•-•----•-••---••---•------•-•-----------•---------------•-----•--••-------•--•--•-••. .y�-- Nature of Repairs or lterat ons Answer when applicable.__t �.. :�V,., A :..�! ................................��"' ` ' ---- --- ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITi U 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 boar o health. _ A�ined LC ' . at................•..... ...--• ----- --••-....-- Date Application Approved By...........,�:� ...........`.........._...._.._..............._......._._...... .................................... Date Application Disapproved for the following reasons:----•-----------------------------------------------•----------••---------------•----------------------•••------ -•.........................................................................•----------.......--------•---•-------.......••-•----•---•-•------------•--•------•---•-------------•---------------------•- te Permit No........................................................ Issued_.... ................................................. �5� Date .................... Fps... ....... ,THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................._... Appliration for Disposal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct or,Repair an Individual Sewage Disposal 'System at: .. .............7"1.. � ................ .................................................................................................. 3n-Loca )tt' Address or Lot No. , ..... 6'.-14 ._ ..... ........ . ... .... .............................................. ...........................................................................14 ner &�d ...... . . ....... . ----------- ... ... Installer ........................................ . .4 ....... Address Type of Building Size Lot-120 0_0"-"'__.Sq. feet U I edroo Dwelling/No.No. of B ms..&.....................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No, of persons._________________________._ Showers Cafeteria Otherfixtures ..................................................................................................................................................... Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length________________ Width_____.____-___._ Diameter__-_--____-_____ Depth_________.__._.. Disposal Trench—No_.................... Width___.__......._._.__. Total Length.__._______.________ Total,leaching area....................sq. ft. Seepage Pit No_____________________ Diameter._._____._....__..._ Depth below inlet_.._.___.__________. Total leaching area..................sq. f t. 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------------------------ rX4 Test Pit No. 2................min utes per inch Depth of Test Pit_______.________..._ Depth to ground water..____.____-________.... ;4 ..... . ................................................................................... ......................................................... 0 Description of Soil--.-- 4- h ............................................................................................................................................. W - U ....................................................................................................................................................................................................... •--------•--------------•---------•---------•----••••---•------•------•-•----------•-•--------•----•----•--•-•--------------•---•-•-- r --------------- ..................... U Nature Re airs or Alterations—Answer when applicable... ................... ..................... ........... .. ...... ........................................*---------------------- -------------------------------------------*----------------------------- Agreement: The undersigned agrees to,install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issped b the board,�ohealth. / I ned. ....................... ae � .............. ...... ........I....................... ApplicationApproved By...........- /Pa-...................................................................... ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ..............................................................................................................................7------------- ----------------------------------------------------- Date PermitNo......................................................... Issued.....3i.................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... Tt rtifiratr of Toutpliattrr lil THIS IS TC�XERTIFY t the Individual Sewage Disposal System constructed or Repaired , by------------------- ...... ................................................. ...... . ............................................................................................... '7bq ......stal. at.. ........... .... . ............ �4....A........... n.. .................................................................................................... has been installed in accordance with the provisions of TITLE5 of The State Sanitary Code as described in the `application for Disposal Works Construction Permit No...... S.... Z4"1.....2 .... -......... .... dated-.----__ � �� !' ! ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON RUED AS A SYSTEM WILL FUINCTIIPN SATISFACTORY. RITE® AS A_=E DATE.................. ............................... Inspector_... ........ ---- ........... THE COMMONWEALTH OF MASSACH S TS BOARD' OF HEALTH ......................................OF..................................................................................... FEE....)..... No .... . ........ Disposal F�rks Tonstrurtion "pautit Permission is hereby granted__._____.. t —. ..e"A....... (_QA................. ...... ........ ................... ..................................................................... to Construct e Mar Individual S\, or R ,R:9 , ewage,Disposal System . .......... at No.._�."TP. .......................................... ...................................................................................... Street ii as shown on the application for Disposal Works Construction Permit No..7�§74_4)ated..!.5!.. z V, -------------- . ........................... ----------- ....... ..., Board of Health DATE------------------ FORM 1255 A. M. SULKIN, INC.. BOSTON