HomeMy WebLinkAbout0024 ASPEN WAY - Health 24 ASPEN WAY
Osterville
A= 120—054 ,
C
TOWN/O,F BARNSTABLE
LOCATION eA //�.� '�` SEWAGE #
VILLAGE Q ASSESSOR'S MAP & LOT 3 2® ®5 6
INSTALLER'S NAME& PHONE NO. i (r/
SEPTIC TANK CAPACITY 1,006
LEACHING FACILITY:(type) l000 (size)
' NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE DER41T ISSUED:
DATE COyiPLIANCE ISSUED: / �d
VARIANCE GRANTED: Yes . I`10 �`/
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
` o.vJf1.................OF......... LF
.M4 2S.Tv4.C3 ...
Appliratiuu for Dispuual Works (�uuitrurtiuu irmi#
Application is hereby made for a Permit to Construct ( ) or Repair ( V<an Individual Sewage Disposal
System at:
....... ---------------------------------------•-•-• ••-•--•-•--------..__...........----•-----
Locat' Address or Lot No.
A.:..... �(z��r✓i£rz �`-1... Asg.a �n 1_�..
Add
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.........._3.._..... ....__..__Expansion Attic ( ) Garbage Grinder ( )
Other—Te of Building 1 Other—Type g 0 ............ No. of persons............................ Showers ( ) — Cafeteria ( )
h L�
dOther 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... jo 9-4A'Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-_-____-_------_-_____
W
Descriptionof Soil---�A.' ----- �----- ? ------------•-----•------•------...---------------------•-.......................................................
x
c.� -------------------------------------------•---------------•---------------•- --------------------
•-----------------------------------------------------------------•-------------------------------
W
U Nature of Repairs or Alterations—Answer when applicable-----------------------------------1.+_0_t'?O.......y&).......O.V iw
-----------------------------------------------------------------------------------------------------------••-------------------------------------------------.........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of -T
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has een issued by th board of health.
Signed..... .f�"" ......... . C �_!4-... ....=
Date
Application Approved By...... ... ..._
Date
Application Disapproved for the following reasons:..... ...•------------------•--------....-...................................................................
--•-----•...................•----•--------•-••---•-----•-•-------••---•---•--••--------••--•-••-----••-•-tee►2r./ -•---•••...._....----------•-. ------•--•---------------------------------•-------•-...------
DatPermit No..... ..............
. ------------ Issued........................................................
Date
No. - ----701 im FR ......---JC`- `----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
o T LC
...........................OF........ _�,.A lis
.........................................................................
Appliration for Dispaiial Works Toustrurtion rumit
Application is hereby made for a Permit to Construct or Repair ( V<an Individual Sewage Disposal
System at*
.
5.............. ..................................................................................................
.... ..... ...... ...........
ALocat1e5,Mss,, ,,, ,, ,._, or Lot No.
............................I....................I.................................... ....... .......W.A.�............0-ST-4...............
-F_ C 0�qXncf � 'd ,S!;A......
S 9 01 kA
.................................................................................................. ......................................... .......O.S? ...............
Installer Address
Type of Building Size Lot________________________----Sq. feet
U
Dwelling—No. of Bedrooms__________________________ ______..__Expansion Attic Garbage Grinder
'RA V)0r,
a Other—Type of Building .......................... No. of persons_._____._____.______.___._._ Showers Cafeteria
Otherfixtures ....................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily fiow............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length________________ Width.__.__._______._ Diameter.____..__.______ Depth_______.__.____.
W Disposal Trench—No. ........ Width____________________ Total Length______.___.._____.__ Total leaching area....................sq. f t.
�141 (...*.......
Seepage Pit No.__1_j0_'_0....0__c:Q__ Diameter____________________ Depth below inlet__._.______..._..._. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Per-formed by.......................................................................... Date........................................
Test Pit No. I................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------------_---------
0 Description of Soil..,5_....A..v)c I........I-------G--i?----A---V----Ej--------------------------------------------------------------------------------------------------------------------
W ...............C........................ ....................................................................................................................
U ........................................................................................................................................................................................................
W
.......................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable---------------------------------i.10.0_0......t.A_).......0.\a.Z_[10W
........................................................................................................................................................................................................
Agreement:
.The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TILE 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 tlx(e board of health.
Signed. ......... ......J/
................. ---V-1---------- --------------------------------
Date
ApplicationApproved By..-- ..... ....... . ....... ...... .................. ........................................
Date
Application Disapproved for the following reasons:.... ........................................................................................................
........................................................................................................................................................................................................
Permit No---- ?, -.R.. 170/------------- Issued--------------------------------------------Date
.-------
D z_
tc
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
��e\ ye v,\ ,4 A.b)..�
.........................................OF.... .............1.................. ..................................
Trrfifiratr of Toutpliaurr
TO,�ERTIFY That tke Individual Sewage sposal System crnstructed or Repaired
b ...V\ .......... ........R ............. ..................................
............................................... .......
�j tristaller
at...... ........... ........... ... .. ..... .. ... ........... ..................................................................................................................................
has been installed in accordance with the provisions of TIZE 5 of The State Sanitary Code V desc 'b9d' in the
app
lication for Disposal Works Construction Permit No._ __"_____-e,?- .4�91... dated...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILLFUNCTION SATISFACTORY.
C
DATE........................... (.................... Inspector._._.__..._......... -• . )•...........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................................................
No-Z .. .
f*... 01 FEE..60........
laispagal Workv
Permission.,is hereby granted. ........ ....... Min rmit...............................................
...... .. ............. ..... ............
or i an Individual Sewage Disposal- System
to Construct ( ") Repai
at No...-�_'( 45-d-le P1
............... .................. .................................................. ----------------- -- -- --- ------ - -------- -
Street
-Dis osal Works Constructijlf`v�rmit No
as shown on the application for �_ Dated._. ........ . .........
............ .... . . ..........
Board o H �th
DATE...............................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS