HomeMy WebLinkAbout0087 SCHOOL STREET - Health 87 School =Street
Cotuit
-- _Y -- C= 035-017 -- — — --
I
s
_1
LOCATION :' 5EWO,C,E PERMIT UO.
IM57D LER•S W l /AFZ ADDRESS
41119S5; - - - -
5U1/; D R 1. &"F— ADDRESS
DIN7E PERN VT ISSUED ''? -7_I�L-(J —
D ATE COMPLI & aCl E ISSUED ; — — _
r
orn /4vs L
oV w POOL
THE COMMONWEALTH OF MA�SACHUSETTS
BOARD PF HE TH
----OF ,6LZM .....................
Application is hereby made for a Permit to Construct or Repair an I dividual Sewage Disposal
System a
Location-Address or Lot No.
dressi
Address
Dwelling—No. of Bedrooms-------:9 Garbage Grinder
Design Flow--
----gallons per person per day. Total daily flow.......
z Other Distribution box ( ) Dosing tank ( ) -
1.4
U Nature of Repairs or Alterations—Answer'when
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordanlce�`,with
the provisions of Article XI'of the State Sanitary Code— The undersigned further agrees not to place'the system in
operation until a Certificate of Compliance has bped 2iu�ed b th bo d of health. . .. .....7
Dat
Z------------------------------------------------------------------- ( ... -----
. . Date
'.........'----------------------------------------------------------------------____-----------------------------
No/ ----_.... FIzs...U�.r. .............._
t.
THE"'COMMONWEALTH OF MASSACHUSETTS
BOAR®?�FH E L
04 4
Appliratiaan -far Dispaaaial Marks T anstrnrtiaan Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair f(<) an Individual Sewage Disposal
System a
7=•
� ^....-----------------------------'--------------._...._.. V"" -
- Location-Address � .w � or t l�o.
{r.ter. np' �r .k � ,.•
-----------------------------•--------•--------- i-. ,,,,���--r----- .............---•--............................... -- -
Owner /;i ress
W
(� /
, �` j/
e
^+� Address
UType of Building ize Lot..._ _. '.._.Sq. feet
., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic..( . ) Garbage._Grinder ( )
Other—type of Building ____________________________ No. of persons_-._--:_-_-__-__._•.- Showers I Cafeteria
0.' Othe xtures .....................................................
•-:---------•-----•••-• ...:..??
W
Design Flow.....-•----_.7--F6
.............................. per person per day. Total daily flow...... _. _.__.___._.__._..gall ns. .
PSeptic Tank—Liquid'capacity.I.M_gallons Length...):D:..__._ Widtli.._y`a.._...... Diameter---------------'Deptli----
Disposal Trench—No_ ____________________ Width-------------------- Total Length----- a.___---- Total leaching area-----.----�_•��.��_,,..._��. ft.
Seepage Pit NoJ_ ------- Diameter....... Depth below inlet_....._.......... Total leacling area.A.�____sd. ft.
z Other Distribution bo ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date---------------------------------------
,� Test Pit No. 1-----------------minutes per inch Depth of Test Pit.................... Depth to ground water-..-_--..-_----..---__._
w . Test Pit No. 2.._.. . ._minutes per inch Depth of 'Pest Pit �?'-'_... Depth to ground water.....::
--------------•---------------------•--------------------•----------
O � -
Description fi: a
,,. .
U ::
W ----------------------------- - ------ -'------------
V t/` Nature of Repairs or Alterations—Answer when applicable._... .W.A�-_�._-__ 1 ... _ .. -.._..
-------------------------------------------------------------------------•---_.......---•--......•..-----•-•---•-------------------------------•----._..._...........•---------------------------------
Agreement: "�'
The undersigned "agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the,.system in
operation until a Certificate of Compliance has beefI ned by?th bo rd of health.o'er ,.: ;igned f
4 ��� Date'
Application Approved _.__
Application Disapproved for the following reasons----------- -= 7-----------_-----------------.--------=-----------..... ------•--•----••-•
••-----------------------------------•---------------------------------...........................................................•------------•--------•-•--•-••---••-•-•-----------•••------•--
Date
PermitNo......................................................... ,Issued--------J-..........................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
i
BOARD 10F HEALT
p' r' '1...................O F.... . ........ ................................
Trrtifirutae of Tomphattrae
T, IS 1O C T F That the In ividual wa isposal System constructed ( ) or Repai ( )
------ --��4 . ....................................................... ------•--••-----•-
{� Inst er ....
has been installed in accordanc with the provisions o ticl I o he State Sanitary Code as described in the
application for Disposal Works Construction Permit 1 -----7Q ...................... dat ..d _. _ ..................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AA GAR'AWT4E THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. /�
DATE---- � � Inspector... ----- ---•••--- -
THE COMMONWEALTH OF MASSACHUSETTS
'rt BOARD OF HEALTH
.7 .......................... ..................
No......................... t-FE --
Bin lia �/�Y Taniitrnr iaaat
&er.rission is hereb r .!._ __._...... ._..__.__touct ) or ai ( )ranIndivi al age isps Syat .....---• . ( �
Street
as shown on the a lication for is osal Works Constructio P mit f' D� �'.... ._ '`
... '------ -- ----------- - . -- -- --- --- --- ---------------------------••-
DATE-- -
`7 *_/4 .•-••----_. ..........._.........-------------•-• o d of Healt
••--•--- ---------------- .
FARM 1255 HOBBS & WARREN. INC.. PUBLISHERS
4
------
at