HomeMy WebLinkAbout0066 SHELL LANE - Health 66 Shell'Lah {'
Cotuit t
A= 019 -'002 x,
L.0 C A T ION 5 E W AGE PERMIT NO.
ea' 13
VILLAGE
0/9—o9a
INSTA LLER'S `NAME i ADDRESS
6 U I L DE RL. OR OWNER
DATE PERMIT I S S U E D S
DATE COMPLIANCE ISSUED 3 !45
1
vJ
}
o
No...���6 F�$... ....r.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
-4BIP��.---•--..0F............... y� J_ ..........................
App irFa#iun for DiupuuFal Workii Tunitrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (L-'jan Individual Sewage Disposal
System
rC. at± 1� ...................4.40./4._....---W......... ..-- ------------------------------------------------------------
Location Address or Lot No.
�1 9.. ........................................................ ._........•----•---------•--------.......... ......._........----.--
K_ yvner o `7 .Address ...................................
Installer Address
d Type of Building// Size Lot............................Sq. feet
U Dwelling� o. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q, Other fixtures ----------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
GX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a - --.•------•--•-----•------•--•--------------•.--•----•---•----------•----------------------------------------------------------
0 Description of Soil............ _.
V .....•-•----•---•--••--••-•-••••••-•-•-----•-•------------------•------------------••---•.._..----•-•.....-----•------------•----•-•••---•-•-
W
----------------------------------------------------------------------------------------------.................................. ^�-
V Nature of Repairs or Alterations—Answer when applicable.___ OC _'/__. ................................................
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 bee issued by th boar of i .
Signed .... --- -- . •• --•--•..
Date
r Application Approved By......ke
• ••--• -• --•••--•-----•-.---•. ••---- ........
..........
.----._...-•----
.............................•------•----••-----.....------------•------•-•----------•-•------------...-----•----------•••••-•--....----•••-----•-•••----------•-••-----•---•--•----.................---
Date
PermitNo......................................................... Issued.......................................................
Date
, a
t
No....................... ..............�
.................
THE COMMONWEALTH OF MASSACHUSETTS {'
BOARD OF HEALT9-1
,,,Af tJ r%„•�lrld O F IO?`1 i e� '? +�,i' ���J�rA - -
.............. .................. ....:.... ....... ....j :!... _ ( ..
Anpii 4tion for Disposal Works Tonstrnrtinn jInUtit
Application is hereby made for a Permit to Construct ( ) or Repair ( '")�an Individual Sewage Oisposal
System at:
V............................
.. ..................................................
.... . ..... t
Location-Address or Lot No. ..........•. -
.._�. .............
. �........................................................ ............... ...... ..... ...... .............. .. .._........................ •___ '
Owner Address
W r/ ..........ji .. 4...... a . L ..'
Installer Address
d Type of Building Size Lot.....................:......Sq. feet
Dwelling� No: of Bedrooms...................... ........__...:_Expansion Attic ( ) Garbage Grinder ( )
Other—
. a Type of Buildiig ._.._.. No. of ersons............................. Showers Cafeteria
____
Other ( •)
. fixtures -----
W Design Flow...................... ._:_..___:____gallons per person per day. Total daily flow......
........................................gallons.
9 Septic Tank—Liquid capacity. ...gallons•' Length .::.......... Width ________ Diameter-:..------ Depth i ......._. ,
x " Disposal Trench-.No.... ............ Width....................Total Length_ . ____._....._ g q.Total.leachm area s ft.
71
Seepage Pit No.-- ----- p g q
Diameter::_ ::_.__ _. Depth.-below inlet____________________ Total leaching area -s ft. .
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by :.. .:....................... ............................ Date...._-_ _--__
1
Test Pit No. I....._.:.....
minutesi per inch Depth of Test Pit___ Depth to ground water_._
_._.
w' Test Pit No. 2................minutes per inch :Depth of Test Pit____ _____________ Depth to ground water_:_ _--.
a -=......--••......::...............•-•••--•-•--•-----•---••--...._._.._...---••-•-•••---•--- -----------•.-- -• .
ODescription of Soil ----•••- 'Z'' -:�;� ',E........................................................................................................ . ---- .
----- ---- ---
------•-•----•-•--........-•••-•--•-•--••-•-•... .
U Nature of Repairs or Alterations Answer when applicable
1
•••....:
..........
1�---------•-••............................................
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 hea th. '
Signed', ... ...P_............................J .✓ ...'.........---- 1=•••.�
f� s
Date
Application Approved BY `vl AM.
. f ..........
Date
Application Disapproved for.the following reasons: ..........._•-----......-••-...._..-•------•--•-•---•-•----......--•-..:_{......
i, •
-- •-- -••• ••• ----. ... .._..
Date
- Permit No . ............................ Issued_.--- -••---. .................................
Dato
p
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH `
r^
.................. OF. .......................................................... I
Trrtffiratr of Tn pltanrr
TFIIS ISSTO CERTIFY,'Tha�he Individual SewagewDisposal System constructed .( ) or Repaired
by...
s j Installer j
at_ %J`�L.r �y/ R 3y. .+F y+6-., . .,,• --- ' ............................ ............ ..
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described id.the
application for. Disposal Works Construction-Permit No-------- - �• 3.... dated........... __ ........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE® AS A GUARANTEE THAT`THE
SYSTEM•WILL FU CTIO _ SATISFACTORY j
DATE.....-------•-•- ��' �� Inspector, = --- ......
THE'COMMONWEALTH OF�MASSACHUSETTS
BOARD. OF HEALTH
0- I ,,
..... ....................................................
No............6 3. FEE........................
Disposal arks Tnn,tr inn rrmit
Permission is herebyranted .__�'y; - r _ �..'_`p.�_'�3:1: .... -•-- -" ' �' --�' r--?�= .�
to Constructty( ) pr�,Repair (4 ) an Indiv>dual rySewage Dt osal S stem '
at No._.C�d.-Ems`-----.i:5-�-i ,J. .�" .� `�' j_,,Y" +1 ._...°.. ...............................x" °✓` ------ ----
--• ---
Street
P as shown on the application for Disposal Works'Construction Permit No..................... D'aated�___®_� 5.'� ....
..... ---- ....
ward of.Health
DATE.....-................................................................=..........
FO R,M ;125.5-,A7 M;SULKIN, INC., BOSTON - tt
z
i
h
r
1
i
Il No................-....... Fps..-° `x ....
THE THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f l
OF. f ,'�T irk `✓. µ .a
..
...........................
App iration for Ropos al Vorko Tonstrnriion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (1 ' an Individual Sewage Disposal
System at: y '
..... ..�.........�--.........f'-- • -•--•---••.................^---•' --^•-•--•----------.._..... .....__.. • ^--------•---- -------._...--------•--
Location-Address or Lot No.
r ti r ir Addr Owner ess
e t°P
a+ljz,t_+
a ..........:.................•-•---•---•-••-------.....:---•--.....__....:----•• --•---....-----•-----.................------.....---------•--..............................•......
Installer Address
Type of Building��rr Size Lot............................Sq. feet
Dwelling i o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures --------------•-----------•---------•--•-•-------------•-•••••-•-•--••---•-•-•••••••••--•••••••••-••••••--•--•-••---•-••-•...--•-••••-•-.............
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 ( )
1-� Percolation Test Results Performed by.......................................................................... Date-----.........................................
Test 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........................
-- --- 3 -••---••-•--•-__.___••••._.••--••----•--•-•-•---•--------•-•--••-•--••-••---•---•---•••-•-•---••-•-____--•---••-••-••--••------•.
D Description of Soil...........
x
W •--••••••-••----------------••-•-•••••••••-•----•••---••-•----•-----•-•---------•-••............------ ----- _.-
U Nature of Repairs or Alterations—Answer when applicable ":=� ' . ,/ ..... ...................................................
.................................•-•'t...
---•-•-'�i .......................................................
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 health.
Signedr` .--" ................................"
l /y� �. V Date
Application Approved BY A .f...l --•-•------------------------
Date
Application Disapproved for a following reasons----------------•------------=----•--------------------------------------------------------------- •-•-_._..
--------------------•--•--•------------•--------------------•---------•----------•------.._._..-------------•--•------------•••---•-••••-•-•••-•-•-•---•----•••-••--••••--•-•-••----••......---...._..--
Date
Permit No.......-•-••. ----------------.............................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH f
Tntif iratr of Tompfiatta
THIS IS/TO PTIFY, That he Individual Sewage Disposal System, constructed ( ) or Repaired ( °�
__...............................................
} ` Installer
-----•- -------•-•-- ------------------------------LE
-----•----------------------------••-•-••----•---•----------•----------------
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........ _S_' _ ----- dated_......... _-..S_-`. S.......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU CTIO SATISFACTORY.
c
DATE.................:-.�..... -�.................................. Inspector,......... ... -•---- ----• .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�a' r
r
K
'`� E�iifi .�.OF........f -' �� . . .+
.
No...._.�.:
FEE. ...•••-•--•••-
�io�rr,�.�1 , or��
Permission is hereby granted /l r�r � f y ' - r Z.. •. .'. ._
,+'" t F''`.r5'f of-•^P't r o < .err 7' w
to Construct ( ) or Repair (4 an Individual Sewage D"p, al System 1
atNo... • -----�:;�'��-_�:_.� ....----. ..:--------- --',-..- -•-•-
Street
as hown on the application for Disposal Works Construction Permit No..................... Dated..... . ._:+. ............
................................ -•----....---.
S ..� $ S ward of Health
DATE...............................................................................
FORM,,125.5 A�M. SULKIN, INC., BOSTON