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Home My WebLink About0089 CAP'N CROSBY ROAD - Health (2) C04 . No.. F�a... ..✓................. THE COMMONWEALTH OF MASSACHUSETTS .BOARD HEAL di _... -. . : of -, ----- _. .. ..................................... Appliration -for M,ipoiittt 10orko Tonutrurtion Prrunit Application 'is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SY. m aV i _ o1'� ... ---•........ -- ddress o Address ........... -- ........ . ....... •••..................................... ......••.............------...... -------- •-•--.............--•-------••••--.-.-. •-----.a ''® Address d Type of Building Size Lot...° �6------.Sq. feet Dwelling—No. of Bedrooms..._. ................................Expansion Attic ( ) Garbage Grinder ( �) Other—Type of Building ._._........��- ................ No. of persons..... ........•........ Showers ( ) — Cafeteria ( ) a d Other fix ores W Design Flow............. 0.........�.� gallons per person per day. Total daily flow.........4-40®......................gallons. WSeptic 'Tank—Liquid capaci'fv ......._...gallons Length. . ._.. Width..._...._...... Diameter................ Deptli................ Disposal Trench—No...._-.-_----_--.--. Width... g g q. x ................. Total Length Total leaching 1rea........_...........s ft. Seepage Pit NO../®AAA-.------ Diameter...40?�--_- Depth below *nlet.�/�....... ... Total leaching area------------------sq. ft. z Other Distribution box,-(---) Dosing tank ®�i?--• %��— Percolation Test Results Performed by--- ✓� -----.-��--- c `! 'v,.:.`..... Date---.........• a - ,� Test Pit No. I................minutes per inch Depth of 'est Pit.................... Depth to ground water_........_-----------_- ra, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....................__ P4 . ........... ......... .......................... -------------- �.... Description of Soil :" .-.. ' �� .._: .G +c" V --•---.. ----------------------------------- ------------- W - V 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 Article XI of the State Sanitary Code— The undersigned further a es not to place the system in operation until a Certificate of Compliance has been is ued by the boar ?of health. IX Signed:�.... s' --1` Application Approved B % 1j ,a- _ ------tate tPP PP Y - ---------Application Disapproved for t12e following reasons:..........:........':._....._...._..__....._._.........-.........-............... ..................................................... --......-•-------------•--............................----------•---.._...------------.-----------------.-------------------------------------.........--•----------------------------------------------- IJ/ Date Permit No......................................................... Issued.-- .I...(P ---- -- L. ate . ----------------------------- - (;7 No......................... Finc .f-�..•................ THE COMMONWEALTH OF MASSACHUSETTS BOARD *�OF HEAL, . / ............ .0F...... /.. '�`<�`vv '.._l ' .... r'� Appliratinn -fur Uhipniitti Works Tonstrnrtinn Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at. ....._.._ _-_`1.............................1...--...-..----•-.-•-••_"._--•--- •--__----•- _.... ........................__.............._..._....__._.._..-•-•--..._..._...........-- / ioca4ttfttfion Address J�U/ CorLot Iyo;� /^ / ..--• ........... :.•-•-.._..��..Lr.�� :... /....................................... •............................. ......Sr: Ow ^err ................Address fjInstaller Address UType of Building Size Lot...`' �.`�ac!........Sq. feet: ., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ----------------------------- No. of persons..... Showers ( ,.) — Cafeteria ( ) QOther fi-'�,tllres ------------•---•--------------------------------------------------------•--•----- ---•--...._.................---•-•.. .......................... W Design Flow........... ...........�IQ0-_-__.gallons per person per clay. Total daily flow........... ..................gallons. WSeptic Tank—Liquid capacity------------gallons Length-4�- ___ Width._............. Diameter_---- .......... Depth.-..-_---------- x Disposal Trench—No..................... Width.................... Total Length-------------------- Total leaching area-. ---._---.--_----sq. ft. Seepage Pit No.lPo�0......... Diameter...j___---------- Depth below inlet-. -.- z...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) p J- � IA 4— 2- 1 7 ,_. � it - W .Percolation Test Results Performed by------ Date---------------------------------------. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water ....................... LT, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ G = ------------- ----------------------------------------------------- x Description of Soil------------ t ••.' .................... �` ---- .--�--t� ��Cs.c U -•-------------------- ---• --------------------------------------------------•-•------•-------•----------••----•----•--------------------- 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 Article XI 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. ja G 11 t � '% '` , � f2 Signed---------�-------=-------------•----- -_------------•---•............••--- � � Application Approved By-.--. �"�/ •'� _ - / Date Application Disapproved for the following reasons:................................................................................................................ -------------•---------•----•-----•---------------------------•-•----•-----------------•-•-•------------------••-----.----•-•--•--•-•-----•----•--•-----•---------------•-•----•---•--. -------------- D e PermitNo......................................................... Issued........, ................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O.F HEALTH ........ ,..........OF...... .e2.-)4 ............................................... y 101rrtif iratr of 1091,11m Purr THIS/IS TO CEPTIFY, That the Individual Sewage Disposal System constructed (�or Repaired ( ) y.._� rL�,>; _,/ nstaller f l �.. jOLt� ••._.. .L� �.--- r(d has been instal ed in accordanc tth the provisions of tcl'e�XI of The Stag itary Code as described in the application for Disposal Works Construction Permit I �a�`�?r,�_ _______________ dated-- ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE r SYSTEM WILL FUN TION SATISFACTORY. ec-------------I.................................. < DATE----- [- ----------6............................ Inspector.....--...... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF) HEALTH i Np s :Z,.�- ---------- �i n tt rk nn tr nn rr44 V Permission is herebyranted_____ ___ c'�_.___----- �� " to Constnt3ct ) or R . ir ( ;) ri I-ndtvidualrSewage Dispos 1 ystem�i �r r / at NO-- -------------- ` �, � �� 3 z `z ------ - -- - -----------•--- �. . /- treet as shown on the applicationior Disposal Works dInstruction Permit No- .JJ Dated --/f/J�_An._�.7t .............. b �y Board all oS ......................•----------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS j T C1 - O F2.,4z avr — (('�� r C" �L i 36,!-a i IIV. N n t �-- ' a* < N 2163 3 pR,v { , Scale 1" - 6.01 BUILDihG LUGAT.Lulu rLAN Being lot # 6 ad shown on a subdivision plan entitled rCrosby Hill Bast" in Center- ville, by Charles N. Savery r Inc. , Hyannis, Mass. , dated Aug. 21, 1973 and recorded. Barnstable Registry of deedsOF s in book 277 .Page 98 Oct. 2, 1975 Thomas k w JACKSON � Builder No.8937 Charles F. Stanley QISTER� Centerville , Mass. �; SUR4