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Home My WebLink About0027 OLD OYSTER ROAD - Health -1 OLb 6� ls� -0-0-IU."Vr 011- a7� ' ► LOCATION SEWAGE PERMIT NO. c9 7 10 Z- dph VILLAGE I N S T A LLER'S NAME i A-D0RESS i U 1 L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � _� � dQ _ �� `� ��,� did I I, � _ - J� THE COMMONWEALTH OF MASSACHUSETTS / BOAR® OF HEALTH ................... ..............OF.......................................................................................... Appliration for Disposal Works Tonstrnrtiun Vrrmit Application is hereby made for a Permit to Construct (Zr Repair ( I ) an Individual Sewage Disposal System at: ) ll y 9.7. lJ`d .1'e �ocati Address o. Lot No. O n .- Address r Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) ............................ No. of persons__..._....__..._......_.___. Showers — Cafeteria Other—Type of Building p ( ) ( ) W 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........................................ 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........................ ............................................... •----------------------------- .......... •-•-••..••••---------- ----------------------- •.-----.------•-•---.---•- ODescription of Soil........................................................................................................................................................................ x V ----------------------------------------•----------- --------------- •---------------- ----•••••••---------------------------------------------------------------------•---------------•-------------....__ ---------------------------------------------------------------------------------- --------------------------------------------------------------------------------- - U Nature of Repairs or Alterations—An wer when applicable..._________��QC2..__..---�1_.1 /_____________ %. ......................... -------------------•------------------------------- 1 `........ 7�n �J Agreement: The undersigned agrees to install the aforedescribed.Individual Sewage Disposal System in accordance with -the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the bo o health. ne - � ' *' ------------•-- D to Application Approved B ... ....... . ........ _-L? y............ PP PP Y Date Application Disapproved f o the ollowing reasons:-•---------------•---------••--•-------------------•----•-----•----------------•----------......---------------- .......................................................--------•--------......_..------•------•---•...---------•-------......._....--------••------•------- .......................................... Date PermitNo......................................................... Issued....................................................... Date i. Fxs.. ........_......-......_ THE COMMONWEALTH OF MASSACHUSETTS 15 BOARD OF HEALTH .........................................O F.........................................------.-----------....-.......................... Appliration for Bhipoga1 Works Tomitrurtilart rrntit Application is hereby made for a Permit to Construct (Villor Repair ( ' ) an Individual Sewage Disposal System at: C/^ .....----��•---=�---......old-------� '-�-�=------.........='C��......... ----------------.....----.....-------------------..........----------------------------........--- // j/� ocatioa -dress ` or Lot No. lle l-i-/;tv.............�!E4..... ............................ ............-............................................41 11.!e fX_................._....._ ox9r le. Address •----:_a�h�_IL.L`�°'r. .......... ... '_'_..... ....................... ......... ----------- 3. / .t...--•-------...--------................•-^•---•--.... Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------• . WDesign 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 ( ) Percolation Test Results Performed by.......................................................................... Date........=............................... aTest Pit No. 1................minutes per inch Depth of Test Pit----:............... Depth to ground water_-_____-•--•--_--_-_---. f3 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 --••--••---------------------•--•---..............--•-•------------..........._.....••.......•-••-......-••••-••.......-••........ ....... 0 Description of Soil-------------•-----..........-------•-•--------------------•---....------••----------------------------•-----------------------------------------------........_..----- V ------------------------- -...... ._.....-------------------------------------- •------------------------------------------------------------------------------------------------- ------------- ------- ZI ----------------------------•----•••••••-••-•••••••-•--•---•---------•----------•-•---------•--••••-----•--•---------•------------•-•--•-----•••..... --- _ U Nature of Repairs or Alterations—An5wer when applicable............�Ppl).....�_I�l �l Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beed issued by the bo .d o ealth. . ..,Si'gne,,- r!'...sit.�............. '....------•---•----•- ----=' '----------------- / Date Application Approved By.... `-c: `F -----•----------------•-----.._...---•--...------....._..-- ...... ......�-` . ......... Date Application Disapproved f or°the following reasons:---•-------------•---------••-•-----•------•-----•----------•---------------------------•-•--••---._....._••••-- ------------------•--•-------•---•-••----••-•--•---••---------------•---------•-•--......---•-------.......------•-------------•--------•-------------••---•-------•----...----------Date--;--....-•--- PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 ..........................o F.�aA ,. .................................................. Trrtifirtt#r of Tompliaurr IS IS TO R``�pT��IF� Y, That the Individual Sewage Disposal System constructed ( ) or Repaired b CcIS ...........—UGam.••-•--•••. •_-_.. . -. . --- 2 7 G� fjR Installer at --------------------�-"�....--aak -------............................................-•-------------------------------------------------------------•-----..........---------------- been installed in accoadance with the provisions of TITLE 5 of The State Sanitary Code", o . as `scribed in the application for Disposal Works Construction Permit No...... �_�_�....�............... dated...;/ -. .................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. > DATE................................................... Inspector..................... .............................................. - ---- i 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HALT .............................OFCt No. .._ _4........-..._................................................... ................... .r FEE....... ............... Moo apt Worko Tnnitrnrtivit rrutit Permission is hereby granted... lae'e 42 to Construct ( ) or Repair M an Indivi. al Sewage Disposal System atNo........... •(2la.....psm5l ' :...J .... .....................-........................................................ ---- Street as shown on the application for Disposal Works Construction Permit N °�_.` fi_'�___ Dated....__.,__-z: ............. -------------------------=--------------------•-•-------••- Board of Health DATE----------------------------------------�_�=✓lr�+."'.--•----.._._... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS