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Home My WebLink About0115 PINEY ROAD - Health 115 Prey goad -- Cotuit - A= 020- 081 is k Oho ��--� Y TC:VVN' OF-BA. t:'dS`1ABLE 9Z .,.t LOC.,siDN_. L_l_ > e . __--- SF,�Y1�.'�I~. VILLAGE ASSESSOR'S MAY F r.(.),fcgo LI_I?K s NAMF 141014E NO.C-�-rt SEPTIC; TANK CAPACITY;��1 LEACHING Ft'._ILITY:(ts ) J' .Imo' _ hi'. -Cr Ii jZC?L�?►iS PRIVATE TE rd'E1:i. C?F. 1'Lfk3L:L.0 WATER BUII DEI OR DR'N^ DATE',P—ER'kl ISSUED: _. DATE C01111PLIANCH ISSUED: _ ,.YAP.iANC 1~.'C•I?r11VTD: 'a'c;s. �d��a� t� � ��- j .� �8 o } �� _ � v 1 • �� .� y�: t �ti. r, a- <. .-. .-ter A � ® j No.... ...®.. Fim,go c� THE�OAFa®ACTH OFu c TS HEALTH V , .. ...!`1.........OF................... ApplirFa#inn for Dispati al Works Tomitrnrtion Vanfit Application is here de for a Permit to Construct ( ) or Re air ( ) an Individual Sewage Disposal System at, .J�. ......... �. c. ...... :.. . -•--•-- ........ ... ..... ..... --•-•- ----- .._.. .---...-•--•-•--•--.... .---...-•---•-••---- �p ^ Location-Addre t No l II� r -• ... - -- -- W caner..... .. .`....A S�...........Mgs_�p.... .. a Installer Address M UType of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms........................:.................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building __.... No. of persons.......................... Showers — Cafeteria a' 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--___-____-_____---_---- 1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................................................................................................................ 0 Description of Soil....... V ..............•.......................................................- ..................------•...•-••---•-----••--••------••-•----•-----•--••••••-----••-•..........----•---------••-------- W •-•--•---•-••-- --------•------------•----•--••••-•••---•-••--•--••---•--•••----•••-•-••••-----------••---•--•---•------•--- r --------- �` �f U Nature of Rep rs or Alterations—answer hen applicable.. -_. .................................. ------------------- S- �`'�--------...-•-- L C ess ---•--•. ti Agreemen The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'l U 5 of the State Sanit y de— The undersigned further agre of to place the system in operation until a Certificate of Compliance h s been ss by the board o health \ Date Application Approved By-------•------- -} . ... '` -..-.- l/ Date Application Disapproved for the following reasons-----------------------------------------------------------------------•---------------------------------....... ----------------------------------------------------------------------------------------------------------•--••-•----••------•••--••---•••----------------•-•-•---•••••---••••-•----•----••--------...._ cc�� n p Date Permit No.........c�. =- J(s. Issued_.... -•-^--`��- ®� Date Add LOT No...&Z-3.14y. THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH HEALTH (\ .........OF................\7.. ..._.."r... ..... ........... Apfiration fax Dispotial Workii Tomitrurtion ramit Application is her de for a Permit to Construct or Repair an Individual Sewage Disposal .0 System at: - 9 ................ ...........71 ........ [� )_ ' ................. ........................ ...... . -----------------.................... - Location Addre?,,, d Lot No ....................... .... .... . ....I....... ..... ...... ............. Owner )Kj [bar' A ...*'***-------------AL----n-e--s- s 7 . . Installer ........... Address Type of Buildifig Size Lot............................Sq. feet U Dwelling,—No. of Bedrooms......**----------.............................Expansion Attic Garbage Grinder Pq Other—Type of Building ----_--------------------I No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width________________ Diameter._._.........._. Depth_...._...._..... Disposal Trench—No. .................... Width.....__............. Total Length_,....._.........._. Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.._........._._._... Depth below inlet.................._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.,__- ................................................................ Date--------------......................... 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._.___.............._... P41 ..... 7............................................................................................... 0 Description of Soil........ - ----- I ... ------------------------------------------------------------- - --- ------- ----- --- ---------- ------ ----------------•--- - U --------------------------------------------T........................t........................................................................................................................ W r I .............................................................................................................. ----------- ----- .. ...... ......... ............ Nature of Repqirs or Alterations—4nswer hen applicable.. On-) C U ....................................... ........ - ---------- ......................... C -- ----:: . ......i.P..._;........ Agreemen 00 � I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI T LE 5 of the State SaniV-f7i!':Rde—The undersigned further agre not to place the system in operation until a Certificate of Compliance h s been)ssy(4 by the board o health. .......... ... .................. Qo.) - -7 ...a�-187 Signe� ... Date Application Approved By................ .. ...0.:_dt�. -------7.. Date Application Disapproved for the following reasons:................................................................................................................ ................................................................................................ ....................................................................................................... Date C11 PermitNo.._.....!�Y . ................... Issued----- -------•........................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........VDi�� r - Y,-.:, ..........................OF..............?.Z� -K........... ............ (9rdifiratr of Tompliattrr. THI(?I TO CERTIF�1, That the Individuki wage DispAal System �onSructed or Repairejby............ ........6, ..........4............ .....V.��........................ ............. ......................................... Installer..........13..;�..............\:7--_".� .... ............(2 ............I.........................0.........(.... ............................................... _X.' has been installed in accordance with the provisions of T.'T'�" 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___._. ...tq- y... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONJA; IT SFACTORY. ........................... .. DATE..........07. ............�i_ Inspector....----...........------ ....0........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARDQF HEALT�L L 0(,L ..............OF......... ........... .................................................... No......................... FEE....................... Diego Wor onotr tilt rrufit�' , I -I, � V�!Q-Y-11,'r '\ %,- , Permission is hereby granted.... .......................................................... to Construct ( ).,or ke,�kiran Individual Se qisposal System at No........ .......................................... ...... ..... ..... ............................... ')-------------------------------------street----- as shown on the application for Disposal Works Construction Permit No. Dated-------- ...................................... e ...---•---------••-•-......--..._......---•-....•. DATE---- ................................... Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS