HomeMy WebLinkAbout0022 CROSBY CIRCLE - Health 22 Crosby Circle
Osterville
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LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTALLER'S NAME & ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HEALTH
............�� ....--.OF...... � r�' � `� `� '........................
Allp iration for Biupnua1 Works Towitrurfinu "truth
Application is hereby made for a Permit to Construct ( ) or Repair ( AsYan Individual Sewage Disposal
System at: ,
.ocation-A ss or Lot No.
1 ......................... ........................................................
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---•Ow r --.-..-. .-----•-------.Address•--•....�' .. ° ra r�'-----------------•-------..: ...........................................
Installer Address
CType of Building!! Size Lot............................Sq. feet
Dwelling: o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixtures -------------------------------- -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter.---............ Depth...----......--.
W 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 ( )
0-' 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---_------------------
04
O Description of Soil........ P`" a
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U •---•-•---------•---------•---------------•----•---••----------..........--------••------------•-----....------------------------------------.....---------------------••----...--•-----•--.....-----••-
---------------------------------------------•----------------------------------------------•-----••----•----- t ------------ .......................................
UNature of Repairs or Alterations—Answer when applicable-----...`.. .G¢.V................ ..., 5..................
--------------------------------•---.....-•-----•---•------•--------------------------...---......•-•••-•••.....•-••-•---••-••------------•••-••••••••-•-•---•-•---•••••--••••••------•••-------•---•-•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIZ 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 d o11�th
date
Application Approved By....... ............................................. ------....h`--..-`��--•---
-----...--•--•----•---•---•-------•--------- / Date-
Application Disapproved for the following reasons------------------------•---•--------•------------------•------------------------------------------............--
.....................................................------------------....----.............-------••---••---------•--------•---------•-•-••--•-----•-•---•••••-••--•••-•---•••----••-......•••--......
Date
Permit --------------•-. Issued-----4.1------ ............
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
�~�� ��
Applirat/o�� �� Disposal Works Tonstrurtmwn Famit
Application is hereby made for u Permit to Construct ( } or Repair Individual Sewage Disposal
System at:
� �
ins;a�ier Address
Type of Building, Size Lot---.---'------'Sq. feet
[hwelliog_4Z-No. of Bedrooms...........................................
.Expansion Attic ( ) Garbage Grinder ( )
Other—Typeof Building ............................ No. of persons............................ Showers ( ) -- Cafeteria ( )
^� Other fixtures .......................................................................... ...........................................................................
Design Flow............................................gallons per person per day. Total daily flow..................... .
Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench--No .................... Width.--------' Tnta .................... Total leaching area....................sg f t. |
Seepage pit No--------------------- Diaozetcr-.---.--- Depth below iolet---------- Intu leaching arou'--''---.sq. {t.
� Other Distribution box / \ I)oo��� tank
( )
�� ' ` ' ~ ` . .
~~ Percolation Teat Ileunlca Performed by........................................................................... Date........................................
Test Pit No. l................oinutes;cr inch Depth of Test Pit.................... Depth to ground wutcc.--_..-.--_.
Test Pit No. 3................minutes per inch Depth of Test PiL--------' Depth to oroau6 water........................
o1 ---'------'------'--'-'--------'-----'---
0 Description of Soil-_ �--_---'.----'__---------------_-'---'--'___.. |
�
..........................
| U Nature of Repairs or Alterations--Answer when applicable...............................................................................................
........................................................................................................................................................................................................
Agreement: �
The undersigned agrees to install the uforodeoccibed Individual Sewage Disposal System ioaccordance with
the provisions of TZTQ3 5 3f'80e State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance ha:o be7e issued by the b d of health.
����-'�--' _-'�.�-..����~^.�
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���o ���o,u�__�_—_�_� � - ___' -_
Dat
e
Application Disapproved jor �
the following reasons:................................................................................................................
_____
- "="
Permit
Date
'FuE COMMONWEALTH oFmAssAoHuSsrre~-
BOARD 0 F HEALTH
'
~ �
---.����z�/��.--�����- ''-----'
�
m�,
����ti�mr��tr �« Tompliana
, �ERTIFY, Tyat the Individual Sewage Dispo§al System constructed .( or Repaired (4-)
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
THE ISSUANC�E F THIS CERTIFICATE SHALL NOT BE CONS71JED AS A GUARANTEE THAT THE
SYSTEM WILL FU ION ATISFACTORY.
... .... ........................ Inspector............. ........ --------Z--------- -----------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD, OF HEALTH
--�~°��;°�=^��^=-'~^� --_
8Jm__.�--__' -'-'---`-'----�--------����`� Foo Z,{��_�7��,
to
| at rV __'___-__._____-'.-____-'
Street
ua shown uothe application for Disposal Works Construction Pecoit .....................................
' -.-'--_'_-_--
.................
Board of Health
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ponw 1255 A. m. suu,/w. /NC.. 00srnm