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0607 MARINER CIRCLE - Health
607-Mariner Circle 'Cotuit '- A = 023 -'033 ti 1. S. • eg f � i.. q Lj 3 i �.. i I - Tj �. . e 4 1 .._` 1 60-7 LO CAT 10 SEWAGE� P,MIT NO. VILLA//GE INSTA LIER' N ME i ADDRESS G U I L D E R 04 OWN ER DATE PERMIT ISSUED ��- 3 - DATE COMPLIANCE ISSUED /���L -� �1 '�... ` ^�. V- �� �. .� q W � �N I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ....................OF.... ............. .............................................. Appliration for Disposal Works Tontitrnrtion 1hruat Application is hereby made for a Permit to Construct Kor Repair ( ) an Individual Sewage Disposal Sysat' ....- • .....................................................o .............••- Lo NLa ...............» .......- .......... ..--• ..........•• ......•••... •-•--•........................... _64 a Installer Address UType of Building Size Lot.s .. ......Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Buildings No. of persons Showers ( ) — Cafeteria ( ) 04 Other fixtures W Design Flow.............. _.gallons per person per day. Total dam flow_.._ ��..._........_.----------...._gallons. WSeptic Tank—Liquid capacity,,* ..gallons Length./,E/V.... Wldth__6..._..... Diameter................ Depth..... ....... x Disposal Trench—' No..................... Width.................... Total Length.....................Total leaching area........_. .......sq.ft, j Seepage Pit No............. ..... Diameter................. Depth below inlet.....4.A......... Total leaching area... sq. ft. Z Other Distribution box ( j Dosing A.,� ( ) W Percolation Test Results Performed by...... ?� ..... _. :....... ``�.... Date.....,1 ........... 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._ ._ :._......._.. O Description of Soil.... v -•--•--•-•---•--•••---...--- • .•. -/-i 11_ ---•---••••-•---------- - . - - --•----• ••-•--- .. -----•--------•-•--•----•------- -•- • -••---. 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 TITLU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beerh issued by the b d of Ith. " �® - Sie -- ......... . • - -- .......................................... 1�f ® ate Application Approved By...... ..: .................... ............../ e -- -�+ Date-------------- Application Disapproved for the following reasons:--................ -----.._..------------------------------------------------------------------------......•---- ........--•-----------------••---•------...----------------....--•-------------------...---•---------•----•-------------------------•--••-------•-•-•--•-----•----•---••••---•••----•----••--------•---- Date Permit No....................•----•--•----.....-•---•-•--•-----.. Issued............................ ........................... Date •. s No................ ...... Fim..s. .V.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•---....fGL%l�~1------------------OF...... /: !=L!JLCvi... Applirtttion for Bi ipasal Workii Tnntrnrtinn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at Locati u-Add es or Lott No, -. . ., `� e s. ................ Installer Address U Type of Building 3 Size ......Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building 116 f"� - _ No. of persons.......... ..�.... Showers ( ) — Cafeteria ( ) QI Other fixtures,-•---------•-•------•• .................................. W Design Flow............... ....................gallons per person per day. Total daily flow-------- :Z�3.Q..................gallons. WSeptic Tank—Liquid capacity.&?_-gallons Length.&../A...._ Width._.,S...�.... Diameter................ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....... ......-serft. Seepage Pit No............../..... Diameter.._..., --- Depth below inlet.....U__.......... Total leaching area... sq. ft. Z Other Distribution box Dosing tak,�, '-' Percolation Test Results Performed by.......1!.: ........ Date...... 11 ?f! ........... a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------ .d...I..._...__. (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._. 1 9 ................... --••--•-•-•---•--•--•••------------=------••-----•-------.._..........--------.......-------- O Description of Soil----- ---- tc=------ G� U .---------------------------------------------ac.------_„ .....::- .:--..........................................................................................------------. x •-••-•-••-•--------•-----•----... �yc�---------11Lt....!_.=::,�-. '� J 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 TITILS 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 boa�S of health. Si e f. ` Date Application Approved By...... `�� /` ` :..................... �-l.....3`D 0��•'•.._._ Date Application Disapproved for the following reasons-..........................................................-................................................... - .................................•------------------------------•-------.....--------------••-------...--------------------...................................................-........................ Date PermitNo......................................................... Issued_............................ ............................. Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH `..............OF.....!> r`'t..�J-14� ................. �rr�if irtt#r laf`�f�unt��i��t�r.. TIT .S TO CE IFY, hat the ndividual Sewage Disposal System constructed ( or Repaired ( ) by - - ` ,1--------- � .._. --------------- . .............................. / � �,/ Install �/ _ / d at..................... �••• =(" '- j-------- G� :l am has been installed in accordance with the-provisions of r 5 f� he State Sanitary Code as described in the application for Disposal Works Construction Permit No._,a._:.__ -7__5? '.............. dated_--�.___�1`___ ' tG�.�.__..__._. THE ISSUANCE OF .THIS*'CERTIFICATE SHALL NOT, BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... .........•-•--.........-------------•...... ....---• ----••.•... Inspector ..---•---•-------•••-_.... . �:' -$.: THE COMMONWEALTH OF MASSACHUSETTS BOARD ..OF HEALTH, No........ ... .. FEE... " Bispos ;1 nrkg T onot-��/ ' to r nti# Permission is hereby granted...... r:%.............4.-e.�-....__ R - to Construct ( or .Repa r� ) an Individual Sewagpe Disposal Sy,gem at No....................... 1 �...f ,� �/ t-a= 1�--- ----------- Street as shown on the application for Disposal Works Construction Per o._____:__. .f s ted....//'................................ -----•----- !' r..... l "Z Board of Health �} DATE...... �- I.3 -�d 4/ Y FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _- - -' IQ—A�.� E�,E�/ St-�.✓•.3 AQ.E MEa►J SEA L.�`IE� o►J U 5.C 4 � 5 CaecT�►.� v��„J E ♦� r ---- _ --L�----- --- �-- Ptt�N A��- 1-i LJES A tic i J , Mvj'-A OF %b'/Vv c' Vr.1 L.CSS OT'*4EZv.)ks F'�t F=k E"7. o 0 1 O j A L-t_ P{PE5 To 4�"D +o.1 T►-}1W- 5Y S$TD M S µA.Ll-. 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