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Home My WebLink About0064 MICHELLE AVENUE - Health 64 MICHELLE AVENUE Cotuit A = 027 — 079 Q W PERMIT N �. L10�A��N �Wrelle Ave- SEW A c EQ VILLAGE C 4 INSTA LLER'S A — i ADDRESS iC 8 U I L D E R OR OWNER DATE PERMIT ISSUED <�?S DAT E COMPLIANCE ISSUED 14 O d No.. F�$... ..✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD HE L Appliratin f x B Vn; �a1 nx s T trnr#inn ramit n is hereby d r Application er by ma e a , rm o ons ruct ( or Repair ( ) an Individual Sewage Disposal System at: V .oc Ad rpes�� s or Lot No. � /"� .:.. ................... -•. ................ ........... . .... ............................................. Ow e d ss IT � ' f... ------- ,1 J�,/ ----------------------- ------------- Installer Address Type of Building Size Lot..R Sq. feet U Dwelling—No. of Bedrooms-------------------------------- -----Expansion Attic ( ) Garbage Grinder ( )U, Other—Type T e of Building No. of persons............................ Showers Ga yP g --------•...............•--• P ( ) — Cafeteria ( ) C4 Other fixtures --------------- --------------- - - ----------- W Design Flow................... �--•_----•-gallons per person per day. Total daily flow---- ��.... gallons. W Septic Tank—Liquid capac�"Rt..r ns Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No_________ i._.__._.___.... Total Length...._............... Total leaching area....................sq. ft. Seepage Pit No------------ .... Diameter........a........ Depth below inlet.......�y....... Total leaching area2.M.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ �4 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........................ ---• ------------- ---•------•----- - - --—.. ...--------- O Description of Soil....... .... .... _. ................................................... ----------- V - . -----• - - ------ -----------�.. ------................................................... 1Z-- ----------------- ........................................................... 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 iIHE 5 of the State Sanitary Code he undersigned further agrees not to place the system in operation until a Certifi to of Compliance has bee is d y t board of health. �7 IDate Application Approved By--------- .- 0................................................. J l l -g-z---•--•---- / ate Application Disapproved for the following reasons---------------•--•---------•----•--------------.............................................................. -----=-------------•-----------••----•--••• --- Date Permit No. • -----.......... ----•--•------- --------------- Issued_............. c $ ....... Date r h NoNk THE COMMONWEALTH OF MASSACHUSETTS BOARD O�F HE&ILJ&. :. Ap irativit for Diipug al Works ��rnr�iun rrutit Application is hereby made for a Permit to onstruct ( ` or Repair ( ) Individual Sewage Disposal e System at in DAM �//c' � � �,p� ............•-•-. .. " ..------•--------•-••----- ....................... ..... .........r o J.. .. ..._... •_•... :� f o t No.......................................... I r Lo th.z Installer Address , UType of Building Size Lot_.`.:.:''�.-._:..:......:.Sq. feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic ( • ) Garbage Grinder ( ) a Other-'T e of Building 04. Other—'Type g ____________________________ No. of persons............... Showers ( ) — Cafeteria ( ) Otherfixtur .........................................-----•---......----- -•--• _--....... W Design Flow........... ::__gallons per person per day. Total daily flow____-_- �..................gallons. WSeptic Tank—Liquid*ca.pac !"Ai -gallons Length................ Width................ Diameter..............-- Depth................ x Disposal Trench—No. . ............... Width .............Total Length.......... `'...... Total leaching area.. , .-. ..._.sq. ft. Seepage Pit No--=--------- ----- Diameter........ Depth below inlet........L...•.. Total leaching area .....sq. ft. z , Other Distribution box ( ' ) Dosing tank ( ) Percolation Test Results .. Performed by.......................................................................... bate........................................ Test Pit No. 1...........:....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:....................... O Description of Soil...•--- -• - ;;..................................................... -----•-----------------------------------=--------•-- x ----••- 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 he u dersigned further agrees not to place/thheyste in operationii a Certifi to of Compliance has bee is..............� t board of h..........................ealth................................ ....... -7 nod_ Application Approved By............. • =............•. -•-- -1 _..... r Date Application Disapproved for the following reasons:............................... -----------•------......----------•--------------•-•---•---•--------••..._..._ D Permit No.... ......................... Issued --- - ------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA4 ........... ........OF..... ....................................................... %rrtifiratp of (P ompliFaurr THIS IS TO CERTIFY, That the Individ ala age i wsal_System constructed ( or Repaired ( ) by.......................... ...... ....xt •-----........_-•-•••....--••--------..........----•- at:......................... -.•• _ ... Insta r � has been installed in accordance with the provisions of YTI F 5 of The State Sanitary Co etas d4scribed in the j application for Disposal Works Construction Permit No.... _"`..54!................ dated-............... _ :.. ____--•-...______.-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � �t DATE .. ' ------------------------------------------- Inspector . --------------------....... THE COMMONWEALTH OF MASSACHUSETTS ::BOARD HEAj OF........ No...t.................... . r". FEE........................ :..! Vx Permission is he granted -------•--- ................ .................................................... to Construct ( o (;Repair ( ) an ndivi uaI Se e D1s Sy f -: . . ' as shown on the application for Disposal Works Construction Permit No.._15--4 -.... Dated.._./! �_71- _:::................... --- .... .............................................................. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON 4 1 S/N6L_E F.4�1/L Y �— 3 BE0�2ooM 219 +� SE.�T/C T,4.c//f = ��0�1(/�'O�o =�9S G.P.O. I� _. ._ /�.5•�r.� /a/. j -/cam a \ BoTloM.4.eE,cl .SO TOT,4L_ L.4/L}�FLoK/= ,.33DG.•w. � - �E,f/G�t/ �.E".�.G'OL4T/4�t/.P�1T�.' /"/.t/2•�//�l/. U.C�LE� , v PtT-R S d e 1 : V�i s '! S. �^ fir# �•x, �=` / _ C��' .f &1'phrn�. "t.S T Ems%N�' E TFsr-Ho<-E �'-�S'�S • - • �rn FG• _ /U/G' '- Z cS.aL. 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