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Home My WebLink About0117 SANDALWOOD DRIVE - Health 1 1.7 SandleNvood Drive Cotuit A= 010-015 I LOCATION SEWAGE PER T NO. VI 0 ACE _ INSTALLER'S NAME i ADDRESS S UILDE R OR DATE PERMIT ISSUED ht DATE COMPLIANCE ISSUED �60 -�1 OP No.` `.8 � � r �lY S,. "9 Fas_. THE COMMONWEALTH OF MASSACHUSETTS �--�' BOARD OF HEALTH 40, [Ow V�I................OF... .A1� 7 37 ._........._...._.... a ' I p Appliratiun for Oispusal Works TonsuvrIWn rumd Application is hereby made fora Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal fj System at: ................»»»»..» !>�. ��wo ......... I°Z....--.........-----............. . .».` »......-•----.......»»........»:..... ................»..»»»».....» oca Address. x�i........... .......-•-•-•------•--...-----... -- I ot .N--........... .............»...» ... Own ........-•-•--•...........................Address Installer Address Type of Building Size Lot .23! ....Sq. feet �.. Dwelling—No. of Bedrooms...........3...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of persons.................._.._...... Showers — Cafeteria Q' Other fixtures ......................................••.---•- W Design Flow............S .........TT....... .gallons per person per day. Total daily flow........''*' aS.<:�............gallons. WSeptic Tank—Liquid capacity.l.�Aallons 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..24)05 ..sq. ft. Z Other Distribution box ( ✓f Dosing tank ( ) 1-4 4 Percolation Test Results Performed by ��,� �.N��.....�-`1 00ff2.P&ate....... ...... 4 Test Pit No. 1.....-4—.. ...minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ................•-------------•--.......------....-•-------........------------..............-•:--...-•----............................----...._._........... .0 Description of Soil..:...--•........................................••.---• ---•••-•----•... ................ -•--....-- --------- xtJ .{...t�.0... v. .............. - ....---.....-- W ......................•--•--••••-•..... ...... ...._................ 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—The undersigned further agrees not to place the system in _ operation until a Certificate of Compliance has been issued by the board of Signed......... ... rIssuedL . ...... . ........... �d. ... Datt Application Approved By....--. ......... ... . ....... ......Date Application Disapproved for the following reasons:.......... .... ...............................................................--- .............•----..........----•---•-•--•--...............................-•-•----.....-----------•----... -----•-•-----••--•-•---•-•--...........-•-----••----••--••--•--....» Date PermitNo...................................................»»» ued....--•---••---.........----................._..._..... Date r' THE COMMONWEALTH OF MASSACHUSETTS L } -- BOARD OF HEALTH Appliration for Disposal Works Tonstrudium Vern fit Application is hereby made for a Permit to Construct ( v�or Repair ( ) an Individual Sewage Disposal System at: ................_.. ............ 4......-•.......... ............ '...... ................._............_. Location-Address ,— or Lot No. ................_..-___....._ :^' ........�:� )..�::j......... ...................................................................................... ... W own Address ••••.................... Installer. d.. ; -r ............................. •-•-'Address............................................... Type of Building "' " ` Size Lot.20t-`2l,Q....Sq. feet. V Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) p4` Other—Type e of Building yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures W Design Flow............._C%Z,_�>..._.................gallons per person per day. Total daily flow..............3.axj?............gallons. WSeptic Tank—Liquid capacity-_. allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No.......... .......... Diameter...........��-.... Depth below inlet.......... 2.... Total leaching area ft. Z Other Distribution box ( vj Dosing tank ( ) 1 n •' Percolation Test Results Performed by. . . ` ! ?_ .. .......A:_ ��.86Date...... Test Pit No. 1.......�-minutes per inch Depth of Test Pit .....?........ .. Depth to ground water........................ G=, Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ �+ --••------.--•-----•------•-•----...-----•-••... ......................................•-•.............................................................. Descriptionof Soil. ......-----•-------•----------------------•----......------•--•--•••------•----.._.. W -----------------------------------------------------------•- --------------------------------------- •-------------------- --...----.........:...._.._..... ..........•. 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 TITIZ 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 Signed......... � .... . Date Application Approved By_ �Y' : _........... / 15ate Application Disapproved for the following reasons:..........I_ ... ..... ..........................................................................--- .......................................•-- •---••-•-•--•-----•-•-••---------......----•---................. ..•---•.._..----............................................ -D�•---........— PermitNo..................................................._.._ Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F..................................................................................... (Inrtif irate of Tomplianrr THIS IS TO CERTIFY, That the Individu SewagDisposal System constructed ( ) or Repaired Z ( ) Installer at......................... -,r ..------. .. .. ..t!---- .0;2 '---•--------.---------•-----•---------•--------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... - y_ ....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C S ED AS A GUARANTEE THAT THE SYSTEM WIK FUjdCTION SATISFACTORY. DATE.i'2' .. .3 ��............................................................ Inspector - ............. THE COMMONWEALTH OF M ACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... FEE...�.10........... Disposal Yorks Tonstrurtum rrn tt Permission is hereby granted.......... =,`` ...-----•---� .. •.......................••.....__- to Construct ( Lop Repair ( ) an Individual Sewage Disposal System atNo............ ... ................ ............... .............................................................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... tooa d of Health - --•----••-----•---------------•---..............._ DATE............................�.......-----...----�"' �t....................... FORM C-1255 CITY& TOWN FORMS, INC.369-9708 .. S t ►J D A T- _ ►.J G LC. F A M I t_`( ;3. fJl O =-► i p/�1LY FL ow 3016•P. � I �� :z •� 5EPT'C, -rAtiK = 330x15o% = A9iG.P. o Lj ►000 GAL. .t o15Po.5AL- Prr vSC ►voo GAL. ' it 5 I p�Y✓A�t_ A2Ga 150 S.F. X ,2•J .3? 5 G.P D. -- T 50TTOM n2E.A- �o s.r. _ � Clg p TAOL ' fl "�oTA G- DESIGN = .4.25 G.P D. 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