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Home My WebLink About0037 BAY STREET - Health 37 Bay Street Osterville A= 117-144 I I I I L � 0 C kT ION 7 S E W A C E PERMIT NO. VILLAGE ' , I N S T A LL..ER'S NAME & ADDRESS Ila�y) bar- f B U I L D E R OR OWN ER + I<1-e� DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED -fo n J 1 / Ali �,r No...��s.._....�� XHE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH l J ------ .............OF'....../ ppliration for Uispoottl i0ork,s Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �•'' .or Lot No. ......._ / OA&Y .....�..... ----- .........................•-•------..:...........--- .......----•-........................-^--- Address( - ••.--•- --••------•---- Installer Address Type of Building/ Size Lot............................Sq. feet ., Dwelling No. of Bedrooms--------------------------------------------Expansion Attic (. ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — � yP g ---------------•----•-----•• P ( ) Cafeteria ( ) Otherfixtures .........................-----•----------------------.----•-------------•----------•----••......-------•----•-----.----._. ..._------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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.................................... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..------.--.-----..-.--. r Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GG --a .O Description of Soil--------- ... ..:....... .. �� - - -- - -- -... --...... x x -----------------------•-•-----------------------••------••--•--•----••-•---•----------.....----------------- --j U Nature of Repairs or Alterations—Answer when applicable.----- --- 'C��'.._... ......4............................. ----------------------------•-••--------------•--•-•----•--•------....-----•-•-------•--•-•--•----- -----•---••--------------------------------•--------------------........-----------•--------•----•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'i TLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by e b rd f ealth. -..�d c Date ApplicationApproved By.............................................. ....... 01 •------------ ------------------- 1+ n,- . 'Date Application Disapproved for the following reasons:.......................... ---•-••...........................•--••-••----------------•-•-------------------------------•--------•---•-----------•--...--••-...•----------------------•--•----------------------------•-=----------- Date PermitNo........................................................ Issued....................................................... Date 1, •........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF...... '��jLA +" Appliration for Pispos al Works Tongtrudion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ...................f. ........................................ ..or Lot No. ..._... ............. i ._. _........... ..�. ddress ........................A ------•----•............................... Installer Address UType of Building Size Lot...........................S q. feet �-� Dwelling o. of Bedrooms.......-------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ... No. of persons__-___._____•_______________ Showers — Cafeteria 04 d 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.....:..........minutes per inch Depth of Test Pit.................... Depth to ground water........................ L14 Test Pit No. 2................minutes per inch Depth .of Test Pit.................... Depth to ground water........................ ox � --------- ------------------ = Description of Soil...-------�`. L ty .......... r!� ..................................................................-------- V ..............•------•--•--•---------------------------------•-----------------------..........---._......---------•--•------- W --------•-------------•-....•-----••-•------••--------------------•---•--------------------•-----•--------•-----. --•---•: . x r,, ;�„ ` (, 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 TITT,% 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 the bo A of health Si ne - rye- -•• ✓ ' . �,G ,r`�w g a.....•�' - --- ........ ...... ;%-•�- ----•- ------- Date ApplicationApproved.By........`.......................................................................................... D ate ' Application Disapproved for,the following reasons-.................................................-.............................................................. ..-•-----------------•-•-----•-------••---•----•-------------•-•---•----------•-•---•---------------•-•--•-----------------•-•------•-------•------------••••----------••-----••-•---------••---------- Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ !^ f ........OF...... �ra�r` `'°` .. ............................. Trrtffirate of TompliFatta THIS TO CE,RTIF That the.In ivic�ual SAwage Disposa System constructed ( ) or Repaired (.4) by--------- ,0'f✓ ✓ �'± a' '-- .. .... ''' .. ----- ��a - ................................................................. at...............�s3 a r �jo�°' fi I }per } �,,..................... __ -___ _-__ ............... _N�_ has been installed in accordance with the provisions of TI''12 5 of The State Sanitary Code escr e in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUN ION TISFACTORY. DATE..................... Z` _ _.:.. .......................... Inspector...----------.......- - ....duk .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH QS- y.� 61 ............. I ...... ... 1v J�ll %...... � OF.......' :.'�!..........!'.... �...!........................ f.. No..............:.......... FEE........................... �i��or��1, Permission is hereby granted. ........................ - ......................................' _.... to Construct (_ ) or,Repair,( )'an .Individual Sewage Disposal System r r if }j Street -S as shown on the pplication for Disposal Works Construction Permit No _.____- — Dated..____,�_..�.� .-..-_.. ,r•. ----- .........•-- .. .. .. . ..... - Boar f Health DATE-----------• ...... •---------•---•----•--•---•--•------------•--•-•-• FORM 1258 HOBBS & WARREN. INC., PUBLISHERS _ tt _ S 0CkT.10N SEWA.`GE PERMIT NO. iS VILLAGE 3' IN`STA I ER'S NAME ' 8,,e ADDRE&S t U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED SZ7e/e'� l S J )4 N''�oj_ CAT10 SEWAGE PERMIT NO. VILLAGE Az INST_A LER'S NAME a ADDRESS Z-1 ��v Two li2,l B U I L D E R OR OWN ER DA T E P ERMIT ISSU E D DATE COMPLIANCE ISSUED �� -s j � s � r / �� -lam _ r R THE COMMONWEALTH OF MASSACHUSETTS B�y��OAR OF HEALTH ..............).OWf).......OF.....02i�"Q 12� Appliration for Ui4pniittl Workii Totifi#rnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair (L-)-an Individual Sewage Disposal System ate�:j C �.y__ ---......3.7..... a�)7 1.............. ... ...... �Lo at n- d es r Lot No. .........1 � .., ,�. ...�... ......•.-• ... ........ -� `��.� caner ..1..�...�� . A.. /._Gaf/ie• ress Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons............................ Showers Q, YP g -•-•--•-•------------------- P ( ) — 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 ( ) aPercolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1..........i.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._....................... a .....-----••............................•------......................................................... O Description of Soil-------------------------------- x U ---------------------------------------•-------------------------._........-----...---.------------•---...----------------------------------•----------•-----.........................-•---••----•----•- w -------------- -----------•--•---•---•--------•-------------••---•••----•-•--•-•-••-••-•--•--••--•--•-•-•-•-•----- ........---•---•-•- -------- ------ ------ -jj - U Nature of Repairs or Alterations—Answer when applicable._--_-_ Z 10406..��.�._____. �1 ............. ... ...............•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance /hnasbee issued by the boar f health. /� �jSign ��'��J�•i--d� -- - - --•- - • � Date Application Approved BY --- Date Application Disapproved for the following reasons--------------------------------•---------------------------••-----------------....._....._.......--------.------ ....................•-----•-............••--•-•••----•- ••----.......---.......----•--------•--•••---•-----....---------•----- --------- Date---... PermitNo....................................................... Issued........................................................ Date _ No.....LeL&C THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH -...........i )Lb .......OF......� : Appliration for Ui,ipoiittl Workii Tonstrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( )-an Individual Sewage Disposal System_at: ,r', f_ l Lot at n to cless y�f7 y/ f,.,.. }- , }� Lot.No... ... ............................... ...... ! :-Sx... Q i �•.J .. ...L.fif ...... s. ........................... }r am f T w eF r^a I .. `/✓ press ................ • - Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.............................. .__..Ex Expansion Attic�-+ g— ••-•--•-- p ( ) Garbage Grinder ( ) aOther —Type of Building ...............:............ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other 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 ( ) 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 water........................ 9 ......................>•; _...._r...y t...........7........................................................-........................... ....._. O Description of Soil---...--•------•-----•--........� sl c.... _... xU -----•----------••--••--------•----•--•---•-•--....- -•...................--•----------------•--•---...........---.._......................., xW ------------------------------------------------------ -•----------......---•---------••..........-•---------.... >•-- -----�- �''.. /------------ - > U Nature of Repairs or Alterations—Answer when applicable............:...... ._,. ._. ';}? -(._.__.._. ,e! '1. ............ .. .....--•..............•-------••---•----....---••----.....................--•-•-............-••-• 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 Compliance has befi issued by the boa �* f health { 11 Signed. ' F '° ,, f fif r,e X --f .. r .--•- Application Approved BY-------- ................................................... Date ..............••....................• ........................................ Date Application Disapproved for the following reasons:----•----•...----•------------••---••••...•••••-•-•-•-•-------•••---•--------•......-•-•-•--•--•..................... ... ... ................ ..... ...•-----...........••-••......_......_...................-••-•••-•-••-•...._......_••--•-•••----•••--------•--•--••••-••-----------•---..........--•-•- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH .OF MASSACHUSETTS ._•�, BOARD OF HEALTH J L. OF...... � Ter#ifiratr of Tontphatta THIS-,,ZIS TQ �C R'. T�ICF:Yc1.'That,t> 6�In$vid=l,Sewage I)is psal System constructed )a or Repaired ( 44 - by ,,L °' AC at... �r~' C d �' .:. 1 d [�ll l¢_... ......taller----••--•-----------•-•-•-•-••-•...................... 1� :'j.. ,} has been installed in accordance ,withthe provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE PF THIS CERTIFICATE SHALL NOTZCONSTRUAS'A GUARANTEE THAT THE SYSTEM WIL TION SATISFACTORY. DATE••.. �� ...........••-••-•--..--•••..........--•••-••••-- Inspec ----•••---....••••............................•••••..----- THE COMMONWEALTH OF MASSACHUSETTS BOARD4, HEALTH /�d �1 O F.............. � ...., .f�/....=-) •----•.................. /� Nod.3...7..:._...... FEE...��.v.L�. �t ` Permission is herebyranted_.:->'.U" "...._ 'it°�� ' ,.?✓ ............................................. to Constru (�) Re g' 1 r(y� l �h Ind,i a e�age Disposal System at No ~- .........................................................................................................../had?) �- Street as shown on the applicat' n for Disposal Works Construction Permit No. . ..... Dated.......................................... ................... -••-------••------••---•-•-•-••...................................•- '/� Board of Health DATE - �y P..-----•. ' FORM 1255 A. M. SULKIN. INC..�BOSTON - 8 ' �L ss LOCATION SEWAGE PERMIT NO. VILLAGE' I N S T A LLER'S NAME i AD_DRESS OR OWNER. 6-/ AL e O) Z�/A! KLEY DATE PERMIT ISSUED -�-j�a DATE COMPLIANCE ISSUED s //�� l 3 D :Ir No..4�-?:a5:5 OA R®AO F" FHEALTH Ts VW-)?.............OF.. c�.L�J..I./.:�/.1� ��__..............._.............� J �kn ; Vla Aliptirattou for Bbwsal Works TIM.5trurtton throat 3� Application is hereby made for a Permit to Construct ( ) 'or Repair (%--} an Individual Sewage Disposal System at: .......... �%. ..._ �� _:........................ ...............................- ........-- --- - �ocatio - ddress -• _ _ r I,ot No.' ... - ..� .. ..--- ). ................ ...... : d ..:...:......_....__...-----.............__..... r dress Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other-7Type of Building ............................ No. of persons............................ Showers — Cafeteria Ga 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 ( ) aPercolation Test Results Performed 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..............................................•-----...........-•--•---•----•-----•-----------------•-•--------------••-----------------------------••--...-------_----. x W --- ---- ------- - j U Nature of Repairs or Alterations—Answer when applicable_--------------------A._.�f G,�1 .. Z6l----- .�2✓,� ............ ---------------------------------------------------•-------•-------------------•-------------.......--•-•---....----------------•-------------------•--•--------------------------------...--•--••...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT 1:;. y g g p y of the State Sanitary Code—The undersigned further reel not to lace the system in operation until a Certificate of Compliance has be,n issue, by t e board of healt . ' T Signed *d. •-••• Date Application Approved By.................. --- _4.A1.... -- =L�=B�- . .........-- Date Application Disapproved for the following reasons:-----•---------•------•--------•------------------------------•-----------•----------------•----------........_ -------------------------------------------------------------------------------------•------------------.--------•------•-------•---------------------------------------------------------•-------•-•--- Date PermitNo......................................................... Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT .............1 ... 4......OF.... 7 /c................................ %rrtifiratr of Tootpliatta THI�5L.P! IS C �I�IFY, That the Individual Se age Di osal System constructed ( ) or Repaired by............ ...... �L.C1 Z: C I''...f ••---••--•---••--------•-------•-----------------•-- `� 5 ,� '"� e f/ Installer � /,1 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-------99 ' ......... dated-------____________________________............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... ~ THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P �f l:� ...:.........OF....:. <r.. .. .?...:� - --- ................................. Appliratinn for Bisp&- al,,. arks Tnnitrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (L�- an Individual Sewage Disposal System at: .........: C.............................. ------------ .......------------ JI t N --------------...------....... ...... t ocatio - ddress { ; ro. . �''� °j - 1. ! ,t - .... --------------------------------------------- Qwnr ' ,r�'.., W Installer Address Type of Building Size Lot.....................:......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) a Other fixtures -----------•----•------- •----••---••----•-•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................. xDisposal 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------------------...........................----................................................................................... 0 Description of Soil....................................................................•................................................................................................... x •-----------------------------------------•-------------------------------------•---------------------------------------•-•• -- ••. .. "Z. 1 -= � ---- U Nature of Repairs or Alterations—Answer when applicable--------------------?� '�s !s) `.. . ! �fi _.... ...................................................... -----------------------------•--.........--------•-------------------•-.._.......--------------------------•-•---------•---•--••-•----•........_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i I T s:; y g g p y 5 of the State Sanitary Code:— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued,by the board of health. f A F Signed Ir/,, ?f f/ ` f<�t+A«a�.�!'l✓�P '`'k- --_`--`-`-`---------••-- ---=•.:.................. '"°`•,�.. � . ,/ ; � � Date Application Approved By------------ - =-1.. �:...- ........... -� =�-�......----- Date Application Disapproved for the following reasons-----------------------•--7....------------•----------...----•------------......--------------•-••---•••...._._ ----------------------•..----------------------------------------------------------------...---------•--.-•-••-••.....•••------•-•--••••-•••-----••••-••-•••---••••---••---•••----•---•-•---•••-•------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH 4e �.:.. '.� +.........0F....� .n �:.� . � .�f r'��.............................. Trrtifirtttr of f�untli�anr� THIS IS TO CERTIFY, That the Jndividual Sewage Disposal System constructed ( ) or Repaired by-•-----•----------` ! .. L lyZ�?—r • .... '✓----....szz .......................... ............................................... at -- 5"'....... !� [ ------- .........—..... / ..�f..f Installer .� ;i ce' has been installed in accordance with the provisions of TITLE j 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 CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................•-•---••---•----------......._......------•---- Inspector....-----------•-------•••••---•---••----------•-•••...--•-•------......-•--•---•- THE COMMONWEALTH OF MASSACHUSETTS BOARD_OF HEALTH .t......0F...... .,{ ......................... No. a �� FEE... .............4L UWVvs,�l Works Tandr9own qntit 4_ t Permission is hereby granted - ....................................t'..s..... ... / .................................... to Construct ( ) or pRepair (__Wan Wividual Sewage Disposal System / J atNo.......j..t.�'n..__.�eC.P"' s _._�i ..-.'w._. ! --.d. C... /. _..[_.... - •, Street as shown on the application for Disposal Works Construction Permit No........................ Dged.......................................... 1 . oard of Health # DATE......................��"' 4%Z-X ---.......:......------ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 0 CAT ION- SEWAGE PERFAIT NO. VILLAGE` INSTALLER'S NAME i :, "A0D2ESS ' . t �� ei2 OR OWN ER pk 9 LT PJAI K L E Y DATE: PERMIT .. ISSUED DATE C0MPL'IANCE ISSUED S`a/ - a •U R a " Ir V ,l C A T/s I A M `j L— -SV WAGE PERMIT NO. �C V I LL A G E AV /0 INST- A LLER'S NAME b ADDRESS R tlyR N ® UIL 0N OWNER rhGeeL DATE PERMIT ISSUED may , LSAT E C ® MPLIANCE ISSUEDf 4 ,I bE ' 9 � � jj. y�/.. �- . \n�� i ,C,� 9£' `./ -.,r �E-- r�.o n!T ' � :_� �xr.. � • 4 / /5 No.QL� -,5:, u. N THE COMMONWEALTH OF MASSACHUSETTS BOARDQF� HEA IT H... ........... .. .. .. ................OF... Ji .. ............................ Appliration for Dhipoiial Vorkii Towitriartion rnmit Application is hereby made for a Permit to Construct or Repair (-P<an Individual Sewage Disposal System at: ................... ......(5 ..................... ..................................................... ......................................... ---- Coca - ddrms r t No. 0e, ............................................... ............4�2 .......... .. ................... 0 � M -.; Zk> re.sa...... >ne.r ........... .. . .......... . .....j _( ...........L W.. a lzi� ..................................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) 44 Other—Type of Building ............................ No. of persons._..._.__._.._.......______. Showers Cafeteria ( ) 04 Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length------ --------- Width.........I....... Diameter_.._-........... Depth................ Disposal Trench—No..................... Width..............._.... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No_____________________ Diameter-_______-___._-----_ Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... 4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..._.........._....__._. ra, Test Pit No. I................minutes per inch Depth of Test Pit.__.............._.. Depth to ground water........._.........._... 9 .................. ... ..I........... ------------------------- ... ................................................................................. 0 Description of Soil............................. .................................................................................. U ........................................................................................................................................................................................................ W ---------------------------------------------------------I------------------------------------------------------------------------------------------------------)---------)---------------------7... U Nature of Repairs or Alterations—Answer when appllcpLble---------- ------qAql ........................ ........................................................................ ............ V-0------ ................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'i!L- 5 of the State Sanitary Code—The undersigned further agre s not to place the system in operation until a Certificate of Compliance has be issued by the boar doyof health. V Signed--- ............ ..... Date ApplicationApproved By....... ------------------------------------ ---------------------D_-ate--------------- Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo........................................................ Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A �C(L:�J� IL DATA p � No.P.-�'..�5 Fina......!......�.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH ............................... -•----•--.........---------=------------•--_---- Apphrataaan for 14spos al Works Tiltutrnrtiaan ramit Application is hereby made for a Permit to Construct ( ) or Repair ( :--)-an Individual Sewage Disposal System at: .......... .......::Location-Address 'r...__.. or Lot No. ... ......... - r Owner ,_ Address ......................................... ............................................... -••--._......••-••-•__..._-••---------------- Installer Adddredress dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures -----------------------------••• - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width_............... Diameter................ Depth................ Disposal Trench••r-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........................ Gzl Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................................................................................................................................................ O Description of Soil_____________________________________r_ _ _ � / r''tt x -----•-•-------------------------------------------------•---•------------------•------...----••--••------._._.--------............................................................................... 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 TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in r operation until a Certificate of Compliance has been issued by the board,of health. s Signed � _ � fj r ..........................--=-='. /F Date ApplicationApproved By.................... s.. ` ------------------------------------- ------------------------------------••-- Date Application Disapproved for the following reasons-----------------------------------------------•-----------------------------------------•--••-•---•••••••••-_... ---------------------------------•-•---------------------------------------------------------------------•••-----••-•-••-•••-••••-•-•••---•-•---••-••-••-------•--------••----------------- ----------- Date Permit No......................................................... Issued-.................................... ..........._...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � r ..........0F......:j . ';•{J�"I /J• ............................ ............................ (Iaertifirttte of Toutpli ana Sewage Disposal System constructed ( ) or Repaired (�-j- b -THIS IS.TO CERTIFY, r} _t1r.Individu S+,.-`�-1 .................................)/�,-y J t-' J if Installer J / j ~/ fJ ,1 .. at------ ......... ------ has been installed in accordance with the provisions of TIT F r of The State Sanitary Code as described infthe application for Disposal Works Construction Permit No........ '>-s2......... dated___,__________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ..........�__-••�_i. DATE._......... a g3 Inspector -�- ...............•---------------•------- THE COMMONWEALTH OF MASSACHUSETTS --- BOAR.D---�./OFj rHEALTH, �J-/S>:. 1....... ?' r./:! rf. OF......�.f . ..•'/ .f >�'f r�,'� No.-•-VV..--•-••............ FEE..........:....::....... Disposal lVorkii Taanotrnrtiaan Vantit Permission is hereby granted = ! ..•... -j---�-j--f---=--'---..--- --=='--... ................................... to Construct�(- )-or, Repair (� ) an Individual SewagelDisposall System ------------•---•-... .... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .............. -----------------------------------------•---•----...-•-•-•---.._ Board of Health DATE.................................. ................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS