HomeMy WebLinkAbout0178 BRIDGE STREET - Health 178 Bridge Street
Osterville
A= 093 — 029
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Wo.24 53LGN
UPC 12134
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LOCATION ' 5EW6,C;E PERMIT MO.
WST&LLER5 IJWE ADDRESS
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BUILDER 'S Q L "F- ADORE SS
DATE PER"IT ISSUED a--: L 2-6�-
D ATE COMPLI & ACE ISSUED :
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No. y�--•-•_-_. Fica...��-.-........ .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF 1H A H
�fiL�1!V- --------_.OF.....f.L) ..:..... .. .....................
Appliratiun -fur Diipuial Workii TonMrurtiun VPrmit
Application is hereby made for a Permit to Construct ( ) or Repair (i/) an Individual Sewage Disposal
Sy�at
pPation- dr ss or Lot No.
•--------------•-----.........
W caner Address
Installer Address
Q Type of Buildings Size Lot----------------------------Sq. feet
U Dwelling r No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
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..................... 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 "Pest Pit....._.............. Depth to ground water...-.-_---_-.--.-._---.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.-------_------------.
M ---------------- --------------- --------------- --
ODescription of Soil---- G - =- ---•-------------------------------------------------------------------••-•---------
U ........................................................................................................................x
------------------------------
W ------------------------- ----------------------------------------------------------------------------------
Iterations—Answer when applicable._...._ �_.,� �_ Q�. _._.__l/-`.
--------------
U NaturQ_of Repairs
-- - ---•• ----------------------------------------------------------------------------------------------•-----. ------------------------------------ --------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b issued by the board of heal h.
Sign ---- ......... -4-4------. ..3-5 ---7-�----
Date
Application Approved By------- , __ / '~c ' ~
Date
Application Disapproved for the following reasons:....................-...-- -- ------------------------------------------_•----------•-------------------
Date
Permit No._ E.-----•---/{-- ----------•--•-------•--_- Issued......... .'".";4R;_......
Date
a
.• • a '►
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�...............OF......
5 .. .1`.r. ..................................................
Apli iration -fur UisVoiiat Worbi Tomitrurtiott Vrrnift
Application is hereby made for a Permit to Construct ( ) or Repair (�_fan Individual Sewage Disposal
System at;r
,
J _ _4
1� . .r......r �._ �.�
! Y Location-Address or Lot No.
.................................................-................................................ ••-------------•-------•------------------•---•-•--.........-----•.............................--
' Owner v— Address
I _lei
--•--•-----------------• ............................................... •----...-•----. ..................................................................................
Installer Address
UType of Building,, Size Lot__ _________________________Sq. feet
-� Dwelling" No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons..__-___-_-__---__-_-___-.-- Showers ( ) — Cafeteria ( )
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--------------------- Diameter-------------------- Depth below inlet-----............... Total leaching area------------------sq. it.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by---- -- -----------------------•-------•--......._..._----------•-----... Date----.----------------------------------
,a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water-..-_-.-_____--------_
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...---------------------
0 ------ --- ------------------�.._.. -......---------------------------------•----••-•--------.........---------------
O Description of Soil__.__"_._(����_e.._._.... �'�--� � ..... ��
x
U --•------------------------------------------------•-•---•------------•-----•-•--•••-----------•----•--------------------------••----•------------------------•--.....---...._._........--------------
w
V Nature of Repairs or Alterations—Answer when applicable._.____.) /:"^ 0 /-', / - /
----------------------------------- ------ ------------
✓ 'J , I
- ---- - ----------------------------------------------------------- -------------_------ ------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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 d oL health.
Sign . - - - `'-- ... _._1G •--- - " --• ----..................7-.....-
Date
Application Approved By GA - ---- ---------• -L�,/ --- li
Application Disapproved for the following reasons__________________________
--------------------------------------------------------
Date..............
------•------------------------------------------------------------------------------------------------•-----------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................... .................................................................
(Irrtif iratr of TOUtphaurr
THIS IS. TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by 111/f ---»./oir r r--
yA Installer
J
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No --_-_�l U........................ dated_--_-,3_-_ 1.-. --------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
U
DATE ..........."............................. Inspector �',
r-
THE COMMONWEALTH OF MASSACHUSETTS
'�. BOARD OF HEALTH
f. .:.....................OF...
!../�. . ,._,
No.---- ------...... FEE---'...:... .........
Di-spatial Norka ClInwitrurtio$t_prmiit
Permission is hereby granted------ ' =' = ;1 `!��Q.....•.I .;.....`..._../ { t r_:
------ --------------•-----•-•---•-----.-----
to Construct ( ) or Repair (�,)' an Individual Sewage Disposal System
at No.---- �' =�• -<4 !Ir!'`, , !l�
----------------------- -------------------------------------------••----.------. -------------•-------- .............................................................
� 1'� Street —�/ � /^
as shown on the application for Disposal Works Construction Per No.____ _ _�._.__. ated... ............�____.
3
DATE--.. /^ .................................. Board of ealth
-l---------------------��
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS