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Home My WebLink About0105 BAYBERRY WAY - Health i v�. .:y!s -arrL A = 091.—008 —001 Osterville -7 1- I 0 hOq S E A C E PERMIT NO. L L A 6 E c7e/ -cfl�aal INS T A L LE 'S NE A ADDRESS U I L D E R OR "OWNER DATE PERMIT ISSUED / ... .� DATE COMPLIANCE ISSUED �_ '- i i S \il i Pt i f F 1 1 <f _ / / — oo0 0Fizim f. I THE COMMONWEP.�,.TH OF MASSACHUSETTS BOAR® OF HEALTH ...._....,-..................... ......OF.................................................... ..,�.; ..:..-.. ' j t Appliration or Uhipaii al Works 6ntitriumn prrntit = . Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• .01 a3 � . .. - .................. ............•---- -` ^'� ...., �G tion-Addr s ! or Lot No. r.,_...... ............... ....---.I..................................... ... Owner ress .R •.............................................. ......... ✓1 ................................... Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-----: ................................Expansion Attic (/Vo Garbage Grinder pa, Other-Type of Building _ _ ............. No. of persons__---_--____-_-.-__--_______ Showers ( ) — Cafeteria ( ) WOther fixtures ........._--•-• --••-----•----- -- . ---- -------------------------------- _- - W Design Flow. O-----------------------------gallons per person per day. Total daily flow----- .....13.a,0..........gallons. WSeptic Tank—Liquid capacity&MIQ..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 --------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ RiI ---•---•----------------------•-•-------------•------•-------•-••--•--------•-------•.....-•-•-...••.........----------••-•---•.....................---.•••-- 0 Description of Soil...............................................................-•-------------•------------------------------------------------------------------------...------.----•- x U ----•--••••-•-•--•-•-.....--•-----•--•.....----•--------------------------•---------•--•••-•••-•-•-----••••-•-•---••----------------------•••------•--••-------•------•---•----...-•-•-•-•---•--------- W x -•---•----------------------------------------------•--•-------•----------------•-----------•-•-----------•--•-•-----------------••----•-----------•-•------...----••--•-------•--••------------•------- U Nature of Repairs or Alterations—Answer when applicable................_._..._____....._.._._._______..___..........._.................._............_. .. ....----•....---. Agreement: The undersigned agrees to install the aforeclescr'bed Individual Sewage Disposal System in,accordance with the provisions of TTT1E 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 board of health. Sl ed .. ......................... a+A' ... !/ te Application Approved B � _. - ---7-- - Date ,r. Application Disappr e o the following reasons---------------------------------------------------------------•----:----.= ............................... ----------------•---------------------------------....--............................................................ Date ;a Permit No......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................-OF....................................................I..................................... Appliration fore Ripposal Marks Tonstrurtion "Vrrmit Application is hereby made for a Permit to Construct or-Reepair an IndivijdCal Sewage Disposal System at: .................. .... ....... -------6.--s..... L ion-Addr or Lot.No. .. ............... ..... .. . . ................ ................................. .... ..... Owner �Ssl.......... ..... ........................................ -------------------------------- NZ.... Installer Address Type of Building Size Lot.........................._Sq. fee U Dwelling— No. ok Bedrooms...... .................................Expansion Attic Garbage Grinder Other—Ty PL4 pe of building ............. No. of persons............................. Showers Cafeteria PL4Otber fixtures ----------•-•-- ••-•••......••• . . =................... ............................. ---------------------------43-9,Design Flow.._!:;V. �o............................gallons per person per day. Total daily flow..... ........ h.........gallons. 9 Septic Tank—'Liquid capacity&M.O..gallons Length................ Width._.............. Diameter__.--_--.______- Depth................ Disposal Trench—No..................... Width................._.. Total Length..................._ Total leaching area....................sq. f t. Seepage Pit Nc----_------_--_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by........................................................................... Date........................................ Test Pit 'No,, I................minutes per inch Depth of Test Pit-----7.............. 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 ......................................................................................................................................................................................................... ....................................................................................................................................................................................................... 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 TITL, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in L operation until a Certificate of Compliance has been issued-by the oard of health. Si. ned_>� ........................ ff dte—_ .. Application Approved By.._.. ....... ........................................................................... ................................ ...... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ............................OF.................................................................................. %Trrtifiratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed Repaired by.................. ............... ................................................................................................................................................... Installer at...................................................................................................................................................................................................... has been installed in accordance wit i the provisions of TITIZ 5 of The State Sanitary Code/as/described in the - �/ application for Disposal Works Construction Permit No.. 01��- ...IL:!n .e....... ...2....... dated....../......./ / 07.................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................. 5/. _(A`-- Inspector.......... _.Aeo------------------------------.................... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF......�:........................ ....................................... ........ FEE........................ Z Disposal Works Tonstrudion Uvrrmit Permission is hereby granted..... ......../................../../I.Z................................................................................................. to Construct ( ),.,or Repair an Individual Sewage e y Disposal S stern f at No.............................". I / 1_ /' ----------------------*................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No.... Dated. --------- ........ ................................... . ........... .... .......... ----------- Board of HealthDATE............................�-'?;? ...................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS l C I { 1 dv � i F T "r M + � � I � I f !4)AT-EX_ 4 I I j Iv 3 � P?l _ y 14 �_ .. �_ `z'S �1 '~ t►v�! t ' -' __ . .__ .. - DISC r �.f�:-� � ,r- -Y-� t_.�k'� = G�r� X -z. 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