HomeMy WebLinkAbout0145 ACORN DRIVE - Health °
- DRIVE
145 ACORN.
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144-019 OSTERVILLE y
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l0 CATION S E W A G E PE RMIT NO.
VILLAGE
INSTA LIER'S NAME i D D R E S S '
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED 3 g5
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Fmc.............................
THE COMMONWEALTH OF MASSACHUSETTS
SOAR® OF-.:.HEALTH
S[
..........................................O F..........................................................................................
Appliratiou for Disposal orkg Tonstrnrtinn ami#
Application is "hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal.
System at:
a
e L cation-Address, r or Lot No. `
`cr`(YR.ta�— .... 4'�� ..... ......:. -`- ......_..... J.r.. ..x4
Own - Address
N
�2. Installer Address
Type •-.
Type of Building Size Lot............................S q. feet
".:Fx
Dwelling—No. 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...___._�Sa_Q______.____._____.___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 ( )
a
Percolation Tesstt 1_Results Performed b - ------•••---••--•--....•••-•---••--••-•••-•-•-•••---•------••• Date........................................
Test Pit minutes er inch Depth of Test Pit____________________ Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....-..................
....................................
--------------------------------
_...........
_.......
•.......
_---
-------------------
__-•---------------------•-••-----
0 Description of Soil................................................................................................ ------------------------------------------••-------••--•••••-••-....---
x
U
x -----•----------------------•---------•-•------•••--------------------•-----•-----;-•-•-•-••--•---•----•--------•----------------------------------•----------------•-••••-••••-•••-••---•--•--•---•----
U Nature of Repairs or Alterations—Answer when applicable........(:D_10........Z_._1�- C�LC......f�. trSx fly
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'LI"LILj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance h issued by th board
igned_ - -----•--•• -••- •-•-•----- -•--.....-••._....-
................................
Date
ApplicationApproved By- ........... ....................................................... .....
Application Disapproved for the f oll ng reasons______________________________________
Date
Permit No........ . Issued_ � 9�
------------------------ ----------R
Date
t'.
Fxs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................ ....................OF........................................
....
Applip, #ion f>ar.}Uiipusnl Works Tnnitrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
......_. � ,. ........ .....................................................
Location-Add res ( or Lot No.
•---.... 2.. :�6�Ct.'.o-- ..._.. .,1V_,y?_Zl._y%1................ ........... ............... k I:l7!l ..AC
Owner"-� Address
A.
............. ..........
......6..Z....... :' ! 5_ F .7...
Installer Address
UType of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms_._.S...................................Expansion Attic ( ) Garbage Grinder ( )
Other—
Type of tuBuilding No. of persons............................ Showers
Cafeteria
a Other fixtures --------------------------•-------------------------._...------------------------------------------------------••••.--- •(-•-•)•-
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 ( )
a Percolation Test Results Performed by.......................................................................... Date..------.
---------------------
Test Pit No. 1-4.........:....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 water........................
M ••••-••-••-•------------••--••-••-•••••..........•--•••---•--•-_..._--•........_---••........................................................................
0 Description of Soil........................................................................................................................................................................
W
U Nature of Repairs or Alterations—Answer when applicable _ _ -l.,n ..jp, a2.
.c?�--Z=� C�. L " �a-.s,i a?e �.0 a .--CvV
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 Compliances n issued by the board rhea
igned �. 1?- - .J
Date
Application Approved By................... 4.11 ........ •----• `T '
Lam:
to
Application Disapproved for the folllyng reasons------------------------------•-------------------------------------------------------------------._...__..__._
----------------------------------------------------------------------------------------•-------.....---.._...----------...------------------------............................................-----•---
Date
Permit No....................................
:- Issued...------..__...:::-
...---•----------- .........................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........................................O F.....................................................................................
Tntifiratr of Tnn pffitnrr
THIS IS TO C, RTIF�j, That th Individual Sewage Disposal System constructed ( ) or Repaired ( )
by------------------------------- , { ' 4 ---
Installer
at �� i ` a
4L�. , ` ;
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._:` dated_ ---- .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED S A GUARANTEE THAT THE
SYSTEM WILL FU I
CTION SATISFACTORY.
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DAqE._ 3 8 --•-•---•-•-- :•_........, ;. Inspector ='...
...V.............................................................
THE'COMMONWEALTH OF MASSACH SETTS _
BOARD OF HEALTH
x ,
3
........................... ........OF r
FEE. ?..................
No2.5. ..
i �r�or �t1 n ko QUnn #rnnr#irrn anti#
Permission is hereby granted......:....... .......... ............................................................
to Construct ( ) or Repair ( an Indivl d 1 Sewage Disposal Sys,
at No........ -' ". k ... Y -f
Street
u
as shown on the application for Disposal Works Construction Permit No$.......��7>.._�' Dated....�_" -.--._.
_....
/ o o ea lth0.
* '
DATE.............. --- .....................
FORM 1255 A. M. SULK N, INC., BOSTON. y
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REVISED
DRAWING NUMJBER