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Home My WebLink About0054 PRUDENCE LANE - Health mom -- - LNO C A T ION SEWAGE PERMIT NO. VILLAGE_ I N S T A LLER'S NAME A 'ADDRESS BUILDER OR WNER fk Ai DATE PERMIT ISSUED ng �- DATE COMPLIANCE ISSUED lb Q/ { Its {G� F i E { -30 No. ............. ,LO7 Fxs..`-S ...... ....... THE COMMONWEALTH OF MASSACHUSETTS �;. 5 ' 00 BOAR® OF HEALTH ............... ---- '..... .. .................OF......................................-'---------------•---......__..._...__..__.._..._... -Applira#ion for Uhips al Works Tanstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• . ieve .......�..---.._.._.........- -------6¢ ------ ----- ---------------------/ .70C----------- .........---•----........................ ..... Locatio -Address or Lot No. Own Address 14 Installer Address d Type of Building Size Lot.../91.coo........sq. feet- U Dwelling—No. of Bedrooms..........3!!.............................Expansion Atic ( ': ) Garbage Grinder Other—Type e of Building !v . ......._. No. of persons........................... Showers Cafeteria a YP g P ( ) — ( ) Q' Other fixtures .......................... ... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. ,W Septic Tank—Liquid capacity/1-W...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------�2......__.. 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-___--._--_-____•--_-__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------................. x ODescription of Soil------•-----••� lzelA----- ---------------------------------------------------------------------------------------------•---.......--------- x V ------------------•--- ...--------••--........_.....•--•-------------••--•--•--•-----•--••....•••------•------------------------•-------•--•--------------•---•---•-•-•--••-•-••----•-•----••-......---- W -•-----•-------------------------------------------------------------------------------•-••••-•---------------•----------•------------------------------•---•--------------•--------•---•--••---•--••--• VNature 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 TL I Ti LE 5 of the State Sanitary Code—The under i ned further agrees not to place the system in operation until a Certificate of Compliance has been iss d y t r of ealth. Wily ned........... .--- ...................... -----/.Z �L.. . a -� Ap p t lica on rov d !� � a... �-.--_--- -- ... . -- ....... ........................... ---- -- -- re Appl i tion Disapprov/d for the following reasons----------------•-------•---••-•-------------------------------•--•------....................................... ..........................................................-•--•-••--•-•---------•---........-••--------•---..................._4...------------.........----- -------•-- -------------- r Permit No.._...`. - Issue,d��'. i' I.- Da t No................. Fizz.....— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................I.....OF.......................................................................................... 'Appliration for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ......6 Zo I ............... ........*. ...... .jz........ ............................ ........................................... Locat* Address o��t No. 5JLQ.................... _ 2.; ........ -------------- ---------------------------------------------------- CL��_C.)1....... Ow Der Address, 7'-Z IiU W1110A s t4ge 4U4 .................................. ................................................t................................................. ------ Installer Address Type o.f Building Size Lot-19;A ........Sq. feet U Dwelling—No. of Bedrooms..,......— ..............................Expansion Attic Garbage Grinder (1-ol Other—Type of Building ..AA �............. No. of persons....._.._.__......_..__..... Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9' Septic Tank—Liquid capacitAw-----gallons Length................ Width.._............_ Diameter-----------_-- Depth................ Disposal Trench—No..................... Width.................... Total Length.........._......_.. Total,leaching area....................sq. f t. Seepage Pit No......A---------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No./l................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........................ ---------- --------------------------------- ......"----------------*--------*.......**------------------*---------- 0 Description of Soil.............. __- 5_�4 .............................................................................................................. ................................................................................................................................................................................................ U .............................................1-f............................................................ .......................................................................................... 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 T 1T IZ4 5 of the State Sanitary Code— The and ned further agrees not to place the system in by t 0 iss operation until a Certificate of Compliance has been iss iealth. Signed............. . ....... -- -------------------,------ ............ .... Da 0 pp, ic prow ...... ........................... t............................. ... Da................ Date Appl' tion Disappro ed for the following reasons:.........................................................A. .... ,"1.11,_ ............................................... ....................................................................................................................................................... ............................................... Date Permit No.--------.'.............. ........... Issued_--------1.............. ............................. Dy THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... F. (9rdifirate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewafe*-Disposal System constructe4 or Repaired ..✓..................... .... dA ... -------V........................................................................................ by-------------------------------- .......... ..12.�:.. / W - Installer at........... ... ................................�P ...........t......ev..................................................... has been installed in accordance with the provisions of 5&� e State Sanitary Cod as described in the 1�a I ?q. (application for Disposal Works Construction Permit No-------5�_Y------------- ............ date( ----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUA�;RANTEE THAT THE SYSTEM WILL U9NCFION SATISFACTORY. DATE..... ......... .. ........................................ Inspector........--. .. .... . ..... . ..... ... .... ............. THE COMMONWEALTH OF MASSAC SETTS / BOARD 9F HEALTH , . .......OF...../-f .................................... No .................. Disposal Works %'Donstrurtion rrrmit f. Permission is hereby ranted......_...&11,,s- 1_3e0jr� G,,U .............................................................. ............................................................ to Construct ) Clndiv Mua S wage Disposal System atNo..... 0........... ................................................................................................................................................................... Street ................ as shown on the application for Disposal Works Construction Permit No... ............... D ated-----I_... e-1 ....................................................................................................... j DATE----------------------------------- -----------------*e ---------------------- Board of Health -- ........ ......... FORM•1255 A. M. SULKIN. INC.. BOSTON DATE JOB NO. LOW & WELLER, INC. 5/2104 84-094 P. 0. Box 119 477 Main Street PROJECT YARMOUTH PORT, MASSACHUSETTS 02675 Test Hole - Lot 86 ' LOCATION•' -- ' Prudence Lane, Cotuit CONTRACTOR .OWNER TO S.. HUNTOON O'Loughlin WEATHER TEMP. O at - AM 284 Wakeby Road 'gat- PM .y PRESENT AT SITE i r. Marstons Mills, MA 02648 G. Low Ron Gifford, Health Agent THE FOLLOWING WAS NOTED: a TES!, Hi RFSl.1LTS. 4 0 - 36" = Loam and Subsoil ; 36" = . 144" Clean medium sand No water encountered A THE TEST INDICATES THE LOT IS 'SUITABLE FOR INSTALLATION OF A SUB-SURFACE` SEWAGE SYSTEM. • COPIES TO �� D O�� • ,l SIGNED j _ . o _7f - -� I soo 6AL 92.23 -- , - - - - - --- - --- ---_.__ L � _ 9s`Z 9 ,GAO 9 Z.7 5 SE f?'t 1 G 42.a0 ►--- ' " --- d :X L L E A G r-) PIT p — -- -- -- - -2.a? 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