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HomeMy WebLinkAbout0040 BITTERSWEET LANE - Health 40 Bittersweet bane Osterville A= 141 —006—003 �r y 0 s> No..... ..:...? ... Fms.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® PF HEALTH .rZ) .�.............OF...... . ✓.e.��-���-------------------------------------- ApplirFation for 11hipos al Works Tuaaitrurtion Famit Application is hereby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: /,C� ® 6... ........................ ....... ...-----------------------............---- Locat' ddress or No. Owner Address W a -• Installer---.-- --------------------•-•-•--------•----•------- -----.--------------------•---.---.------- ---- nst Address Type of Building Size Lot_5!5--t-..ty rsq. feet U Dwelling—No. of Bedrooms....`...`- ----------------------Expansion Attic ( ) Garbage Grinder A)b aq Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .-----... -------•---- WDesign Flow........................... .........gallons per person W day.. Total d i y ow......- _0................. �o�js. et WSeptic Tank—Liquid capacity-f CWgallons Length....'3�--. Width.. ..- ...: _ Diameter............ .. De th-. 2. x Disposal Trench—No.......... ......... Width.....I............. Total Length.................... Total leaching area---.................sq. ft. Seepage Pit No............/------ Diameter....... --.-.-- Depth' below inlet............... Total leaching area.ir.70 ....sq. ft. Z Other Distribution box Dosing a Percolation Test Results Performed by G ...... '. Date......1® a Test Pit No. 1....._:Z- nutes per inch Depth of Test t_---1 .....----.- Depth to ground wate .... . p� Test Pit No. 2................minutes per inch Depth of Test it.................... Depth to ground water............---.....---. t .: . . _`. - ° -••••--•------ : � �O Soil W ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------•-------. UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------•-------------------•-------------------------------------------------------.....-•-•--•---•--------------------....----------------------------------------------------------------•--•---•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewa sposal Sy tem in accordance with the provisions of iITI.L 5 of the State Sanitary Code—The un gn urtl r agree o to place the system in operation until a Certificate of Complian has bee by oar of li ne --- ..-- --- ---- ----- ------- ----------- --------------- ----- Application Approved B ..... Date Application Disap oved f o the f owing reasons:---------------------------------------- ---------------------•-------------•--•--- ............................ ••-------------------------........... ---•----- .................-......---.....-•---------------...---...--•-----•-------------------------------------------------------------------------•--•--- Date PermitNo......................................................... Issued....................................................... ».� Date �i No.ja.... Fps.. ..fir .......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® PF HEALTH .._ .../1 .N..............OF...... AGI . App irFa#ion for Disposal Workii Tnnstrurtinn ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: Loca' n ddress or No. �`... ..... 1,t .... ........................................ .�= .. Owner Address W a •--•--•---------------------- -- -•----•-•-•---•-•-... •-••--•-•----•--•-••------..........-•---..................•_ ...........-•-•-•---•--•----••--- Installer Address � Q Type of Building Size Lot.3lOt-/—/1$-+Sq. feet U Dwelling—No. of Bedrooms....�i�?.. ..................................Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons____________________________ Showers — Cafeteria a Other fixtures .__....._ . ' d W Design Flow.......................... __.......gallons per personry .day. Total dairy„flaw--_---: ._ •0.................. WSeptic Tank—Liquid capacity..!.C%�gallons Length.- -..."7,�... Width._ .` ..... Diameter________________ Depth_._! x Disposal Trench—No. ................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft. Seepage Pit No....._.._...j------- Diameter....... .---.... Depth below inlet..4............. Total leaching.area. 0....sq. ft. Z Other Distribution box-41 'ram Dosing nk j I Percolation Test Results Performed by..... - % Date �© v` '�... a y�� --••••-••---••-•-•-• ----------•-... Test Pit No. 1.._.�_:-minutes per inch Depth of T*tt. ........... Depth to ground wate�v .../p2 Test Pit No. 2................minutes per inch Depth of T .........._... Depth to ground water........................ ---•----.------ O Description of Soil.... _G __ .. .. ...... -- •------------ W ••-•--•------------•----•------•----•---------•-•---•--•-•----------•---•---------•.....................•------...------. ......-------•------•----••••-••-•••-•-...•-••---•.----.....-•-............. UNature of Repairs or Alterations—Answer when applicable.................. ...........................................................................:.. ----------------------------•---•--...........---------•---------•••---•---•--••---•---••-•-------•••---...•...----•--- ----------...--•-------•--------------------•--•------•-•-••-......---••-.-•-••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewa 'sposal Sy tem in accordance with the provisions of TITLE 5 of the State Sanitary Code— The un gn urttll r agree o to place the system in operation until a Certificate of Compliari as beef: e by oar of licaifh. Sine _._ •••.•••..• ..�....... ' ) Da Application Approved By,_-' ._`._..,/�s_` . ............... � �,. .. -• •••••------- -------------------- ,,,•_''' /' � Date Application Disapproved f o the/f o�lowing reasons:-------•---------- ................................ .......................................................... ............................ .......... ..._._...........-•----------------............-----.....................---••---•---•---••--•--•......--•-•-............•.... ......---.-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA7 ram.. • r t 00 _..__ Trrtifiratr of ToutpliFatta b T . LaA, That the Individual Sewage Disposal System constructed or Repaired ( ) s�/ Y , f ,t' f (Installer has been installed in accordance with the provisions of TI 5 State Sanitary Code de� ribed in the application for Disposal Works Construction Permit No.. '.°'. ._..7.._....._. dated--- .. 7--.�_..------._._._.._... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRl9 A A GUARANTEE THAT THE SYSTEM WI L UNCTION SATISFACTORY. ' DATE..... -j `,• ........................................................ Inspector-•-- ...... ..---•-----•---•-------•--•----•--•---.......------...----••--- THE COMMONWEALTH OF MASSACHUSETTS BOAR F HE T ............................................. No L.'_...a. FEE. Pork ag trudion Vamit Permission is he eby granted---------- ter. to Construct �Repair ( ) an Indi ew�age--Disposal stem at No.- �, sdfw8 Street' ......... e� ---.... � ---------•-•---� ---- �� , ,'� " as shown on the application for Disposal `Yorks Construction Permi Dated------- ----------------•--_!----::--•-. �___ ' Board of Health DATE ..-Z• .......Z/ ------------------------------------------ ------ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS J LOCATION SEWA E PERMIT NO. 11 �� - 2- '7 S' Fr v1 '/l,o I �-I 606 003 INSTA LLER'S NAME & ADDRESS Z4 Yc 11 BUILDER OR OWN ER : :,. �Gt Y►� C y a �✓ d.Y Oo IODATE PERMIT ISSUED ,o _ :2 ..... �-�� DATE COMPLIANCE ISSUED �� -.. � I � � 1 S EYi'1 G 'r A,&4 G • )C` a Lb C-� j r:'r'k��t> I v1sPOSAI_ PtT V;E cY.� PLr7 ( S�JLt. - - BoTTOAI► AQUA 50 1 b 'I �' ::... ........ TOTA. -C>w 6rN -row ' Nalp3044 PEYrCAt,.AT,oN eA1t l°Itil OF k F _ -------- I _ r , .p No 19334 Q �, JO Q/ATE (4 f - 1 _ ' i S�O1aAl E���' • 4 rp PE L09 � owV. e1, _Z - Sort. T36uK a ur! 4 1 ��0 47 1�d1/. t t501.. 941 �!y a. r r. _ ,V ..- .. ..-... -.y PI T Q�'M LAC� ��, . WtTu 7 Play uQs�;, 41NUIC aw--o; AL 16 CTOML 1 CEeT I Ft�a Ro'T• PL-A D p¢o Fr LG- l.c.�aroot.I SC--,Q_L� D l G¢r'1F`Y TKAT THE `- J�� PVk:;qLS4ko, y "EjLE.o►.1 Comps-Y AND liar AGW. R�Qu�er`Mr.�tT3� OF •rw& �f2 .�� 6 tCA1tit_�rti L• -ro"J" oFr RRI-iST�PAE LxA- DL^-t �c P t U FUPr1 PA•r� �A x,re t, u�c E ►�c. ¢s�vsre Tzel> LAWo WEVOper. 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