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0095 BAYBERRY WAY - Health
95 Bayberry Way _.y Osterville A= 091-008-002 t y t F 0 a . .o No ... ....... t FRs... ........... .--.._ THE COMMONWEALTH OF MASSACHUSETTS �� ® �'✓ BOAR® OF HEALTH ---.".....".. . ......................OF................................... �, a App iration for. Dispaa i al Works Cnumaraxrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r L ion"-'Address or Lot No. `°"'�" """� .--•------------------------------— -- -- - - - - -- ner A ess a ...... . --------------------------------------•-- _.......... :............•...........•..... Installer Address dTyp of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.-_•-J�. -----Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building p ( ) ( ) . __._.___._.. No. of persons.........................:.. Showers — Cafeteria 0.' Other fixtures ................................. . _ W Design Flow......;MIO...........................gallons per person per day. Total daily flow___ 6_................._...........gallons. WSeptic Tank—Liquid*capacity/#Cao_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______________-_---_.__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -••.....••••---••--••-•••-••-•-•=•--••----••••---------------------------- * ------------------•-----•--------------------------••••-----•--•--------------- 0 Description of Soil........................................................................................................................................................................ x U --•••••----••-•-•-••••--•-••••--•---••••--••-•-.........•••••••---•--•-------------••••••••....--••-------•----...-•----•--•--•-••••--•--•--••••-•---••.......-•••----•-••......--..................... w 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 TITTLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of om 'ance has been issued by the board of health. p ate Application Approved B / Date _ Application Disapp ve for e following reasons----------------•---------•-•-----------•--------------••----------------------•-......... ---....----. ..............................'------......•--...--•---. •••-•-........ Date PermitNo.................................................................... Issued_....................................................... ! Date r Nov: ....... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ........... ................OF.................................................... Appliration for Disposal Works Toustrurtion "Jprrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: - - .......... ....CAM. - ..... . .........- -.......... Lo ion- dress or Lot No. ►ION ......................#6....................................... ner A%ejssj ----------------------- ...... . .............................. Installer Address Typ f Building Size Lot............................Sq. feet U :a Dwelling—No. of Bedrooms...... ._A ...................Expansion Attic Garbage Grinder Other—Type of Building .10 No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow......:33.a..........................gallons per person per day. Total daily flow....V.96 ............................gallons. 04 Septic Tank—Liquid'capacity/tV.U-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. f t. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------................................................................... Date........................................ o-4 Test Pit No. I................minutes per inch Depth of Test Pit_._.__.--.._....._.. Depth to ground water........................ "-4 �1;.4 Test Pit No. 2................minutes per inch Depth of Test Pit.._..........._..... Depth to ground water_.__._..............___. 9 .......................................................................I----------------------------*..."....*........---------"---------*---------- 0 Description of Soil........................................................................................................................................................................ ........................................................................................................................................................................................................ U W Z .................................................................................................................................. ..........................................I.......................... 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'T T LEE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in II operation until a Certificate of romp *ance has been issued by the board of health. ................. ;k 4...... -e ate ApplicationApproved B .. . ..... ...................................................................... .... - ------ ...*......Date ........................... Application Disapp, ve 0"r• e following reasons:.................................................................................... ............................. .. ......................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARP OF HEALT I �............................OF..P ...................................... At Trritifiratr of Tontpliattrr T 0�_S T� R That the Individual Sewage Disposal System constructed Repaired b, ..... ..............................................t..................................;>.................... ...... .............................. , -0 at..... .......... .................... ...... ............................................,/-------------------------------------- has been installed in accordance with the provisio ns 0 T I 5 of The State Sanitary C/oda, ribed in the F �S S application for Disposal Works Construction Permit No.-a.k 0_6,3 _jo; f-...... . .............. dated--- . ........................ ..70 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... .....................k.L",...... .).................... Inspector..... ......................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR7P, OF "" H OF,/ .... . . . . . . ................................................. _V-.2... FEE.J..-�.. No.... ............ Permission is reby granted.... . .......... ...........................................................•. Permission is u a� an Individual S to Constru J�6 ew Dli osal S.Ystm . ... .... / &Z K. ..................at No....... .... ..... i............. U_W_-7 ...13.3-, -') I W.- 4�_ ...4i__ ------------------Ic 't - _/-" ----- I e -___ Street as shown on the application for Disposal Works Construction Permit No----L?4.J. Dated........... ........ ................. DATE........�'-_11,2-'2-, Board of Health ............... . /..................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS \ � d 3 �" �u► i o.� � 2 AS `" 5°u ---- —3 Z3Z ti LOCUS MJkP 2000 n Z i.O Ac-. QPL.A.rav Al MAP C( V l�.'2C EL g r- ' _— �� 8-� t-A e 3 4-1 t ,q c- or USE 17C 1 QE5IDENTIAL. ZOW,E {�� I 1 f • / �-, s8F^ 4 9 Z w 1 J/ I / , ok y row v 4-0 J 9 /I 43 A c OD m o � ca \ — f.ti d, 0 7G4 pL A rV oc ` O rwa P�J F AQ�I �oTAB�.� w\ At�1N0 A^,�S S S E w G S V C3C�I u l 5 '1 O 13 A L AN o Co v RT Z c. G 4- Z.4 Qr_T►-TIoVIIER P,4,N1ELl� C V./AL►LER � >�- �- ^� - +� 40 OCT 1 19 B L3A2NST�C3LE pLAtu �►�N(� �OA0.� . No.� IZ � �^�, ` AF�L'jZO�/ALUNI7�2 ,-N� SUaL� �`✓ ISIOty BAX7E2 8c ^l�(E 1NL. C--OKIT20L. LAW NoT (<.E-QU�2EL� �EGISTEQEp L ^N � SU2�/t�(U�S T'�Z V I t.._L� MASS I. N A T "'C!-.I �S A�.,T V 4�.- "a v r2 a� S`( A M A ►--.x -T N G GZ O 0 Sam t na A L(-0 2 O A eJC.E- UAT E W I T tJ 'T ►-.tc. L_ANM Go0e'T- ► NST2UGT1ONG O� Iq--7 I oKj Q T-1Crwaawrti C2�� �1T't. r . c > 1..At�►© SURv�YoQ... �r� } 3x w I A VE- .