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Home My WebLink About0439 OLD POST ROAD (CT & MM) - Health qr••--• �.�' *av-s-Fy-�-�-7r-�r?mZ7-'r r-Srgrac:y;�r�•.--pT: y-•1��-�e_';;"_::� . 439 OLD POST ROAD COTUIT d A = 054 — 026 i j ! ,I LOCATION SEWAGE PERMIT 630. ocg VILLAGE INSTALLER'S NAME 8 ADDRESS 0 U I L D E R r/OR PNER f DA T E P ERXIIT ISSUED DAT E COMPLIANCE ISSUED OLD 6* 216 No................_....... .. _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a Allp ratiou for lliipus al Works Tantitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at . 2 ._C�1 ..t.�l?< ..PC1a j.................... ................................................................................................. Locatio - ddress - or Lot No. ............. - S �' .................................... ........ ............................................ O ner N �f'�„ Address S Jdv .. a :._ ._.�`�?�.�� '� �'. ..... Yl�l/ .. ..... ............................. Installer Addres..s Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............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........................................ aTest 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 water........................ a' -• -------------------•-- p O Description of Soil------••---��rr� ---�-.Ob 7.---------- x ----------------------------------------........- -----------------------------------------------.................................................. Uw --•-•--•-•------------------ ...... --..At. -------------------------------- Nature of Repairs or Alterations—Answer wlieri __applicable....____ -/10U6....��-16eZj Agreement: i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT I.;,;. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha;b,, n issued by�the board of li alth. ,,�ned ' 1 CY?Y�1�� 1-•-•----_.. ......•-............. Dat A lication A roved B .�...._. PP PP Y / " Date Application Disapproved for the following reasons:. ------------------------------------------------------------------------------------•---•--.------ ....................•-•-••---------._......-----....-----•---------•---•-••------•••--------------.....-- Date Permit No........................................................ Issued.---- 1 , -- -•-- ............... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A- ' 7' L m �C&l DATA �. . THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH ' %) ` ,� ' - ..O F... ..... .....:........�..:........<.....: ............................... Appliration for Disposal Works Tonsirnrtinn Pumit Application is hereby made for a Permit to Construct ( ) or Repair (,?) an Individual Sewage Disposal System at: l ...:.... .... . :%....1:`!:':<:f" ..J..:=rl.....j.....-••-•----•••--- --•-•-. --•-•-•••-•..........•...... ....-•••................••-••-•-••-•••••. r _ I Location-Address or Lot No. ................ ..... =�'-—, =•=- .... ........ ...•.... ........ t.......:!.....7----.... ............. ........................---- .... Owner """ ( / 'Address - --r/ Installer Address UType of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------•-•----- -----.._......------------•-----....-------•--------•------•----- W Design Flow............................................gallons per person per day. Total daily flow.__..............._......_......._..__......gallons. i W Septic Tank—Liquid capacity............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 ( ) `4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0+ !/^ t > , .r,'`' a J r Description of Soil :...........................:...:..............•------•-----------------------•----------- . ................................................. W UNature of Repairs or Alterations—Answer when applicable_.____..:_..:. ._ '........................................ s - ...................................................•----..•..--•---.........---------•-••---.......------•-----------------......-•----------------•----------•-•-•-•----•-•----.........--••-.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LTTLE 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 board of health. r gnedA. ."16W G /` .... r ; .- t ---- _-i•� --'-D"a 0te�"rr-- � .� - --•-_ �..APPlication Approved BYa � ................--------- Application Disapproved for the following reasons:-----------•--- ..........................--------------•-------- ---------------------Dat-e...•-•--..... ..................................•-----..........---------------•--......------........--•-•--•-•--•.••. .................................. Date PermitNo..................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH;-' pj... ...........OF.. f. f.,�,!. :�: I ........................ . . (9rdifi:ratr of�TnmpliFanrr THIS-IS.TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (,✓) Y = z.......... ....................•----------------•-•-----•--...------------......------........--•-•---- Installer at... .:fF :-.-: ....!.•--='-. f .. .. �...`......._ / .._..LI../ f .........................................................> `... Il has Permit been installed In accordance with the provisions of 5 of The State Sanitary Code as delcrriibed in the a No. ` .......x=1.6 dated �� THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WI FUNCTION S TI'SFACTORY. DATE......... ------------•----- ... :f Inspector,...L ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOAR-D OF HEALTH n �- ......................................OF......:............. No......... ..�........ FEE... Disposal Workii Twnstrnr#ion_ .. rrmit_ Permission is hereby granted...:_ ..j_. ,1../'f f_•% /f> _•--. /-• _, •/�-••--__�-/ICY. .. . ........••••-••......•-•..................... to Construct ( ) or,Repair ( r) an Individual Sewage Disposal System atNo.._' '!' l`.....L -- -....1........................................c . _/ i .......................................................... <`. •• _ Street A as shown on the application for Disposal Works Construction P it r:_*01AI, .._ Dated...�_.`�� '"....... � .----- ----t--------------- DATE. Board of Health '. FORM 1255 -HOBBS & WARREN. INC.. PUBLISHERS w i