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HomeMy WebLinkAbout0133 MARINER CIRCLE - Health 133 Mariner Circle"� � Cotuit. J fll 1 LOCATION SEWAGE PERMIT N0. VILLAGE 1oly � % INSTA LLER'S NAME i ADDRESS GUILDER OR OWNER Yet DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED YA 0 50 3Er No..................--.... .............. THE COMMONWEALTH.OF MASSACHUSETTS ~ BOAR® OF HEALTH .................OF......jl..?t Applira#ion for Disposal Works Tunstrur#inn thrutit i !Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System a , ,�/ ......... - ..�.�-'�- .. ,, - ... ............................................-----.... ocation- ress or Lot No. ® �✓'�d �����C�'Z' �wner - . ......................•-•----.. ........r................_................ ............................................ .................................... fit_.... ............... Installer Address Type of Building Size Lot.. ---Sq. feet Dwelling—No. of Bedrooms.......... .... .....3........Expansion Attic( ) Garbage Grinder ( ) Other—Type of Building . No. of persons-------- ---- Showers ( ) — Cafeteria ( ) Otherfixtures . --•-•---------------•----•-------------------------------•-----•------------- WDesign Flow.............. saw........................gallons per person per` day. Total daily' flow............................................gallons. WSeptic Tank—Liquid capactty.l��.gallons Length..J.0._.O.. Width........_.... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..............I...... Diameter...... 1........ Depth below inlet......c?.......... Total leaching area..................sq. ft. Z Other Distribution box ( I ) Dosing tank y( ) / Percolation Test Results Performed by..._._ 4! ........... ..............:..'_...._..__.. Date... ........ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water. ._._ ._. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground watens.Vd a -- -- - Description of Soil.... .°c. ... .. .. -•-•-- ------ ... ...............---------------- j! x7................... ------------------ V ..................................... ---------- .........................4•-•------------------------•----------- -�y° ... ------------------------ --------------------------------------------- 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 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 ' sued by the hoaA of health. Si ne .. �- Vat;e�F,Application Approved By.....-- ..... ..._��...... .--------... ---- ` ` ..._ / Date Application Disapproved for the following reasons: --------•----------------•---------------...--•-•----•-•......-------•---- ....................................................•-•-----•------.....•••---•------•--•------•-•------•--------------...-------------•----•---------------•------------------------•----------••-•---- Date PermitNo......................................................... Issued....................................................... Date No(�;Kf FRic THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH, Appliraation for Uhipoti of Works Towitrnrtinn Prrutit Application is hereby made for a Permit to Construct 0<), or Repair ( ) an Individual Sewage Disposal System '.. - .................... � a . or Lot No. .................. Installer Address UType of Building Size Lot__: �.CDO-_.Sq. feet Dwelling—No. of Bedrooms.....______________________________---------Expansion Attic ( ) Garbage Grinder ( ) p,,, Other—Type of Building __ !" G^'��'_.... No. of persons.....__..:....(6... Showers ( ) Cafeteria ( ) P1 Other fixtures - ------------------ ....------•-----------------•-----------------------•--------...-------•------•---•----------- .................-••------• d W Design Flow............5..�T ....................... per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity.-!C gallons Length...14 '.k. Width....... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No______________�..... Diameter.......1� Depth below inlet.__... .......... Total leaching area.................. ft. Z Other Distribution box Dosing tan]# ( ) '—' Percolation Test Results Performed by............�! !"W _.�`...........................' ... Date...v9 Z-�______________. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..___.�l j ? (z, Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water._ ___:__ .___.. .. D Description of Soil...._ _ _ ___.... '0_:'?:` _ -------------------------------------------------------------- ----------- ------- ---------------------------------------------------------------------- . •--••------ 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 TITIE 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,bythe boa of h lth. r j ate Application Approved BY--- ` '` �/ � ..---'� Date Application Disapproved for the following reasons--------------------------------- ...............................................................................................................................................................--...................................... Date PermitNo.......................................................... Issued-.................................................:...... Date THE COMMONWEALTH OF MASSACHUSETTS !s BOARD OF HEALTH ' U.L1...........OF_... !/�:'/7/S�11�/£.-•---------------------• (9rdifirtttr of Tuntph attrr IS IS TOC at the ndividual Sewage Disposal TI� , IFY, at System constructed ( ) or Repaired ( ) �1' by ..._._.. / f C Insta �,� at.. ---------- ••------- ------- -------------------- --------- ..../_!"1_-- ....................... has been installed in accordance with the provisions of I:, r of The State Sanitary Code as described in the application for Disposal Works Construction Permit,)N ............. dated_./4- "`d .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION Sj%TISFACTORY. r J DATE......................................1 ��J •�-..................... Inspector......... s.�rJ.............. .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.......�/...J......... � ......................... No.:..... .f_ ....... FEE GI....°��.... Uhipoo of nrkp Tonotrurtion famit Permission is hereby granted.....-fyft ._...(a' ��! ___ C" �--- .....--•---•...................................: . to Construct X) or Repair ( ) an In iv 4 al Sewage Disposal ,System - } /' atNo............................. .... 5 -=Gl.!�2----�Gr�'=�./--- `T'..=-�.. �._- f-------------- ........................... Street as shown on the application for Disposal Works Construction Permit_____________ �_ r ed.._ 4�.......... }� = •-•-• • ---_- rd f a DATE... �---�`-�-~-----------••--•......................................... Boa .tlri FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ;+ GEA JEizAL- NOTES .a I� aL.t_ E.L.,F�/. 'S}��w� AR.Fc M�cA.�! SEA L,Es�/Fs L aa�sEv ot� u s c G.s . 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