HomeMy WebLinkAbout0996 MAIN STREET (COTUIT) - Health s�o�Main�rS'tre�t
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L ��� 10N �--� SEWAGE PERMIT N0.
VILLAGE
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I N S T A LLER'S NA E ADDRESS
BUILDER OR �ER
DATE PERMIT ISSUED `o
DATE COMPLIANCE ISSUED r0. 3 � _
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THE COMMONWEALTH.OF MASSACHUSETTS
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BOAR® OF HEALTH
/ ---.... ...............OF......... .C............!...................................................
W Iq
Appliration for Diip.ao ai Worka Tonstrnr on ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: ,
-- f - .' ............... IQ.L T................................................................
Location-Add s or Lot No.
........ /._V.... ..G ®. ................. ... - �41 .......................................................
_.. ...
a ......�.�. �' ..... ... ................................ ...® A
Installer Address
UType of Building Size Lot............................Sq. feet
�. Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder
Other—T e of Building No. of persons................
a YP g -------------------•-----... p . ------------ Showers (----)..— Cafeteria.(...-_). �Other fi u es -•--••---•-•-•--••-•-•--------••-••---------------•--.....•-•-••--•---------•--•-----•----••--•---•••--•... ..
Design Flow..............���...............___..gallons per person per day. Total daily flow..--.......UIP......................gallons.
W
WSeptic Tank—Liquid capacity/M.4allons Length.....Z..... Width.-..;_'._;... Diameter................ Depth................
x Disposal Trench—No- -------------------- Width.................... Total Length............p._:._.Total leaching area....................sq. ft.
` Seepage Pit No......./----------- Diameter.............. Depth below inlet..... Total leaching area..Za.ad..sq. ft.
Z Other Distribution box (1,er Dosing tank ( )
Percolation Test Results Performed by--•-----------•---------•--•••.....-•
. -----------•---•-...----•-•--•--.... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit....--.............. Depth to ground water....................,...
tz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa ter-----------------------
................................
Q+'
O Description of Soil--���' -- -----'�'J- ,----•----------------------•---..._..--•---•-------•--.....---•----._._._.............. -
x
U -•......................••-----•.......-••--•-••--•--••---•-••--••-•---••-.........------......-----•---...••-----------•-•-•---.....-----•--•-••-•----••---•--------•---•.
W ---•-----•-----------------------•----•-------•--••---•--•-----•--.....---------•-•---•••-•-••----- f�------- --- ,s.....----------------- .. ..
. U Nature of Repairs or Alterations—Answer when applicable..! . ��� lAee
... ..........................ewl-i /��
------------- --
r --------- ----- ...... 5 ..��aC..
Agreement: 0;/
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 ydersigned furth agrees not to place the system in
operation until a Certificate of Compliance has been i d by f
ed........ ••. .
Date
Application Approved By--- . --•-•- -• _. . .. ..................... �j� �Da---------••--•--•
Date
Application Disapproved for the following reasons:................................................................................................................
.................•--•-......---•-----•--...--------------•-•--•-•--------....---••--------•-••------....---------------••--•----••------••••---•-•- a ' ...........................
Date
PermitNo.-•-.......•........................................................ Issued-... .............................................
Date
No.....do...- S>8 Fps...:.:
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........r .0
-....OF.-......... ...0^...Ott...................................................
Appliration for Dispatial Warks Tonstrur ion Famit
Application is
hereby made for a Permit to Construct or Repair
an Individual Sewage Disposal
System at-
.14............................................. .............. ............................................................
• .-'2-Location-Add ss or Lot No.
...C ...V......................................... ..... ........................................................
.1........................................ e it
-----------------------------------
...... ........................................
Installer Addres
TypeW-13-itiRding I/ Size Lot............................Sq. feet
U
Dwelling—No. of Be(Tiooms....... ..............................Expansion Attic Garbage Grinder
Pk Other—Type of Building ............................ No. of persons._____________________._._._ Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow..............//0....................gallons per person per day. Total daily flow_._._....... __._.._....__.________gallons.
P4 '-.Septic Tank—Liquid capacity/M.4allons Length-----OF.*..... Width.....10'7.... Diameter________________ Depth................
Disposal Trench—No_................... Width_._._ .__._._ Total Length_.____.____._____ ..................sq. f t.
Total leaching area..
Seepage Pit No......./.......... Diameter.___.__..___.._ Depth below inlet.....4.......... Total leaching area..o!.449..sq. f t.
Z Other Distribution box (4#lr Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date_............._..._..._________-_____...
Test Pit No. 1................minutes per inch Depth of Test Pit_.___.___________._. Depth to ground water.____._._..._._.__._.__.
fi Test Pit No. 2................minutes per inch Depth of Test Pit___.._._.__________. Depth to ground water........................
0 Description of Soil... ;,A
................................7..................................................................................................................................
U ..........................................................................................................................................................................................................
......................................................7.......................................................
............
..............airs or applicable._ ___'"Nature of Re a* Alterations—Answer when applicab.04..y
It ;.. - I X_ �
40.4.... .
...7W.k... ................4alAW....../A4
Agreement: A,4040 op;/
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT 7-2 5 of the State Sanitary Code The ydersigned furth agrees not to place the system in
operation until a Certificate of Compliance has been by
r. of M,
........ . ......... .. .. ........... ................................... ........ ................
Date
Application Approved .. ..................... ------------------
Date
Application Disapproved for the following reasons:..............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued..........................................Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................OF...4i ....................................................
Trrfifiratr of Tompliattre
THIS IS TO CERTIFY, T_hat the Individual Sewage Disposal System constructed ( or'Repaired
b .................. ........
y 0.......0� ..........................................................................................................................................
........... ................................
at........................ ..... ..............................................
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.0.4......5>1............ dated________________________________________________
THE,ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM ILL FUNCTION SATISFACTORY.
Inspector_DATE.-.. .................................................................... ----- ------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No. . .............OF.... ......................................
FEE.
CAk
to
.............
Bisposal lvorhg Toptrurtion
is hereby granted.. - . ._._ :K1.Permission .... .......... ................. .....................................................
to Construct Repair n ndividual. Sewage Disposal System
atNo---------------- ...... ......... ....... ------------- ............ ..................................
Street
as shown on the application for Disposal Works Constructi5p,"it No ................ Dated ........................
2..................................
y Board of M V.4h
DATE.-.... ...........��- 4".----------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS