HomeMy WebLinkAbout0070 OXNER ROAD - Health (2) -10 A?d ., Ca.�:
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THE COMMONWEALTH OF MASSACHUSETTS
B- OARD /IPF HE L H
--------OF...... ........ ... . ... ... ...........................
�,� Appliration -for 473Wpo,ittl orkii Tutu �rnrtion Vrrniit
Application is hereby*made for a Permit to Construct or Repair an Individual Sewage Disposal
PP Y ( ) P ( ) a P
Sy t em=t G . C
Location.Address o /` M No.
•__• -_ _ - f'�'-- _ ...............•_____....._......._ _ _____ _ _•___ _•__/ Y�•___• ------................
,�]'�" ,y ner - Address
Installer Address
PQ U Type of Building/ �� Si e Lot..��_ __-3_.Sq. feet
Dwelling ,f—rNo. of Bedrooms............................................Expansion Attic ( Garbage Grinder
P.,., Other—Type of Building ____________________________ No. of persons....._---------------- Showers ( ) — Cafeteria ( )
aOther fixtures -------- -----------------------------------------
W Design Flow.......... 8____________________gallons per person per day. Total daily flow_-_____ _-®!-----__ _...__.-...gallons.
/ --
WSeptic Tank—Liquid capacitr/o®0_-grallons Length_.._....... Width.....4.......... Diameter------------- - Depth.-..-----_.
x Disposal Trench—No.'..'*-__` ._ _�'_"'Afidth-------------------- Total Len gth-------------------- Total leaching area.._----._--__--_--:sq. ft.
Seepage Pit NoZjO�4!0_ __.. am eter.................... Depth below •nlet,_r�________ _.__.. Total leachin area._-_.._._.--_-__-_sq. it.
z Other Distribution box ' Dosing tank ( ) 49 ! e� � 4 z c-`l c,
Percolation Test Results Performed bY------------ ............................................................. Date_-----------------------------------....
Test Pit No. 1----------------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
x
= Q % -
water_:.�_-`. :. _.--_
c-------6��_
--------•----r_-------- ----G K - -
.._
.....Descrpti f i � '
--- ----- --VW ------------------------ ------------------------------------------------------------------------------------------------------------- ------
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 \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i s ed by�hd boar f health.
ned.,.. . f� ate
Application Approved By---�...-- --_�L,Pc . _ ... se-
Date
Application Disapproved for the following reasons--------------------------•------••---•-••------•-------•--------------------------------------------------------
.................•---•------•--•-- ... ................................... -----...----••---------..----------------••----•--•-----•--------....•----••---•----....__....-•------.....------•-•-•-
Date
PermitNo......................................................... Issued........................................................
Date
No...--z- --- -----• ...........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD .OF HEALTH
tl•..�/`,�.,,-----------OF....... )sLL� �........................
Appliration -fur Biiprriitti Workii ( onstrurtion rrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at•
Location-Address - or Lot No.
-"Owner Address
Installer Address -
Q Type of Buildin / _ Size Lot... d" .. Sq. feet
Dwelling—No. of Bedrooms------------------------------------__.-_.Expansion Attic ( "`) Garbage Grinder --
p`.., Other—Type of Building ---------------------------- No. of persons_--_-_' ---------------- Showers ( ) — Cafeteria ( )
P-' Other fixtures ---------- --------------------------------------- ----------•---•--------------------------------------------------------•----------------------
Q
w Design Flow........ ..t-? 4l�------------------gallons per person per day. Total daily flow............................................gallons.
P; Septic Tack—Liquid capacity*'t_`r'.gallons Length_-__-_'f------- Width___f....___.. Diameter--..._____--_ Depth._....;_--_---
Disposal Trench—No. r_'".i�...t_'Width-------------------- Total Length.....__.___......... Total leaching area--------------------sq. ft.
Seepage Pit No.''_j_ t'_ _'_ Diameter.................... Depth below jinlet-_-__-______--_..-_- Total leaching area._--._____._....--sq. ft.
Z Other Distribution box ("'-) Dosing tank ( ) a/1_ ,/- C-� ` -.2 C `7C
aPercolation Test Results Performed bY------- •------- ......................................................... Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit_----------------- Depth to ground water--------................
�14 Test Pit No. 2___•-__._.--____minutes per inch Depth of Test Pit..............I------ Depth to ground water.-_--.._._-.---_----____
tY -------•---•------ . X-----------
------
O Description of Soil-----'=-- L!.r' = �ram!' `% , i -�-_/.LG--'"'---�-t--- ----
w
------/---� = ...........................`1- r r... '
UNature 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 NI 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.
S igned---- i?`
./ J. "" ,
.
to
_ �
Application Approved BY . _'-.�--....,�' ;�I!�'I--. ------------------- ------- _-__------ ,
Date
Application Disapproved for the following reasons___________________________________________�_ ------------------------------------------ ......•-••-
_.__
---------••-------------•-------•-•------------------------------------•--•-------•------------•---------------•-•-------------------------------------------------------------•------•----------.----
Date
PermitNo......................................................... Issued....................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
e.
.. /?�t...........o F.............../ .r��s,��,�,%,jcr .. �...�.......
(EIrrtifirate of 10.11,11mliliattrr
TH�I�S IS_TO CEyRTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by --- ---------
h 'r
in 11er"^--
_.
has been installed in accordance with the provisions of Arti'ple I of TheState Sanitary Q9de a descr-ibex in the
application for Disposal Works Construction Permit No------------------.-------
---------------- dated........_.....!'... f C.p
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E AS GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
'-.DATE-------� .�•• ` -4o-----2 ----- --------------------------• Inspector---- --•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF 19, EALTH
....... . .... > ......O F.......... .
� ,��...�....... ..... - ................... f --�
No._------ --------- FEE......f-..............
Binvoli k _�Tomitrurtilp Prmit
Permission vbereby granted.-'
............................................
to Constr ct ( ) or R -air ( ) an Ira i dual w f ;ispo aystem
(}Pry
Street �
as shown on the application for Disposal Works Constructiort Ptlo-------- D atetl_..._ .-----J_�.__.��-...
/ U
off-1�,� !' _
1 / Board of Health
DATE. . --- --- •-- •-----....
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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CERTIFIED PLOT PLAN
Being lot 29 as shown on a
subdivision plan entitled
I, hereby certify that "Crosby Hill East's in. Center-
the existing foundation ! ville, by Charled N. Savery
location is correct as Inc. , Hyannis, Mass. , dated i
i shown and does c6nform ! Aug. 21, 1973 and recorded i
with the building setback; Barnstable Registry of deeds;
OF reouirements of the Town in book 277' page 9$.
of Barnstable.
o Thomas A April 27, 1976
� . s -- - .
go JACKSON
No.8S37
;- Builder: .
Q/STENO Charles F. Stanley
'S..0 yo .Signed. - Centerville, Mass.
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_. . . . .� _ .,....... ., ........