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HomeMy WebLinkAbout0488 MAIN STREET (COTUIT) - Health I"g ffa✓�� � 4 S� N SEWAGE PERMIT No. �©+ >� _ VILLAGE INSTA LLER'S NAME A ADDRESS- � e S UILDE R OR OWNER _ a �JS DATE PERMIT ISSUED �1 -e5 DATE COMPLIANCE ISSUED . - � �� �� X v� �'8 >: � � g No....��.�1. Fizz......�®l'6... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /..,CPJ.. -------.-.OF............. �c�.� L't..-.............................. ApVt1raation for Dhipvii al Works (futuitrurtion Errant Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at• -,- e _ ddres r Lot No. UWE._..._ _..._ ---... -•---•-•••_.. (Owner Address rr a ................................ .. --- of T...----........ .-•---•-•-------- -w��Ca �A�A.. . Installer Address Type of Building Size Lot _4�._�l......Sq. feet aDwelling—No. of Bedr�__.__ _____ __________________Expansion Attic ( �, j Garbage Grinder Qjb 04 Other—Type of Building _.__1C�Stl��t+!��'�1_ No. of persons____________________________ Showers ( ) — Cafeteria ( ) a Other fixtures ---------------------------•---- - - . W Design Flow____.___�j _0...................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity_.(�:2_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......................................L .. -------------- Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water_____________-______--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------------------------------------------------------------------------......................................................... 0 xDescription of Soil.....................................................................-.................................................................................................. V .._..-------•--------------------------------------------------------------------------•--.....---------------------------------------------------------------------...__------------------------------• 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 TITi Uj 5 of the State Samt —The undersigned further agrees not to place the system in operation un -1 A Certificate of Co, ance has been issu by the r o lth. Signed •--------- ----•-------- -• ..................... _._. � : ry ?D'D.(a.t`1e 4Plic'atio Approved ... Date Application Disapproved for the following reasons-------------------------------------•------------•----------••-----------------•----------------------........_ ....................•------...---•---.....------------------•-----------......-----------...---------••----------------------------------------------••------------------------------------------ --- Date PermitNo........................................................ Issued....................................................... Date -� 6-1 No.. FEB..... .Q a..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF.........- �- - - Appliratiun for llhipaa a1 Workii Tomitrurtiun ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at ................._.Ail - - - .�. �_�................... s'bVeatiom.t-Addre _ r Lot No. Owner Address �. a �." .................. 5 ............................ ......._._.....--••••._...�e` u..:a C_+-�.1.1J�.5L................................ Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedre�s ......... ....._//____________________Expansion Attic (�� Garbage Grinder aOther—Type of Building ___Ccc T�_y�Z+�±.l.. No. of persons____________________________ Showers ( ) — Cafeteria ( ) d Other fixtures w Design Flow......... C-'>....................gallons per person per day. Total daily flow............................................gallons. 04 W Septic Tank—Liquid capacitylCM--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______________________ "` a ••------- -------------• ........._`, Date Test Pit No. 1................minutes per inch Depth of Test Pit________________.__:�De p - p pth to ground water________________________ rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......._................ P4 -•-•-•-----••-•--••-•--------•---•--•_______________•----........_----___________.__-•••••.._............................................................... 0 Description of Soil........................................................................................................................................................................ w VNature 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 Sanit_ C-gde— The undersigned further agrees not to place the system in operation until-A until-A Certificate of Compliance has been issu. by the 1 a alth. t f' Signed-•-••----- .....•- --............-••-----•----- - --- Date - .-�j try ` _r" plicatio Approved By__.___-----•--=••---•------••••----�-•-•• 6 � 1�' E f- f - Date Application Disapproved for the following reasons:-••••----------•-•----------•-•••-•--•••-•----------•-------•••-••--•------•-••••-•-•-____.___--•••---•••------- --••-•.................•--••••-•--•-•-•-•-•••••--....•-•--•--....•-•••••--------._._.....--•-•....-•••...•-••-•------•--•-••----•-•-.-•••-•-•••--••-------------------------------- --•--•----•--- Date I PermitNo......................................................... Issued------_____._..._-•••------ Date THE COMMONWEALTH OF MASSACHUSETTS . —'BOARD O HEALTH 14W.%................OF............. -.. ....... .....:_.....-----...... Trrtifirtt#r of Toutph anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (k) or Repaired ( ) bY.......A&?.C:_k•:._.CD.PJ5 K.................................•-----....-•--------•••••----••-•------......_....__...---....-•-----•--•-......---•----...-•-•--............_....--•- Installer F has been installed in accordance with the provisions of TITI'E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ............ dated......Q_1/�_��-y____________________- THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CON RUE® AS A GUARANTEE THAT THE SYSTEM WILL FU CTIO SATISFACTORY. rr , DATE............... 1. . ��....•----•.................... . Inspector.:`,.:O-j i-• ----- •-•••-••--•••--•.......----••-••-••...........-----.._. THE COMMONWEALTH OF MASSACTTS j BOARD OF HEALTH ...............OF...............-----.-..-•-•---•-.......----•-••-••••.-_----_:_.......-........... FEE....:................... tle 1 ur�� �un��rttriiun prntif Permission is hereby granted______ _ GI.........................GG1VS" to Construct (/'� or Repair ( ) an Individual Sewage Disposal System atNo.--LD'i....P---I........ a___n.... .....ca .A:-•........---•-.••------------•---•-•-•-••._...------•---••--------•-••-------•-•-----•--••--••••-•........... Street as shown on the application for Disposal Works Construction Perm No.-Fr4 y `%_ Dad _____________ ....................................... 1-c "�-• Board of Health DATE. ... -- .f _�__._._...-•-•-•- ..... :__ FORM 1255 A.`M.-sULKIN, INC., BOSTON . i.Wo GASMA(iE 6QAwDraw- �L�4�/ 4'/t/' t '7 r-s ow : 11Ox 3 = j SEPTIG TPNK a3ox15O'/• R95G.P. u4E- 1OOo GAL. ► M ' ;r,R otSPoSAL Prr us>~ tvo0 CAA►-. } a�- 150 BOTTOM ARE.Ai , i So S.F x 1•0 :' S•o G.PQ• � . wTA�. Dr.S►`N * 425 G.P 4 . 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