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Home My WebLink About0027 DONNA AVENUE - Health 27 Donna Avenue Osterville A LOCATION SEWAGE PERMIT NO. VILLAGE 1427 I 0-72, s? 0o illI al, ,/'I�r 05/-1/-u l' //r ST Ll R'S NA & ADDRESS S I N �. A E M E r 3UILDEIll OR OWNER AFL✓ v C DA T E P ERMIT ISSU E Os-- DATE COMPLIANCE ISSUED ��' ,�;�) - , . `�•-.. ..� �, �' �_ U nn c��` �� 7 � �, No------------------------ Fins..a� _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH �C�ca. t .-----....OF............... /.../1.3j .... Appliration for Ui ipas ai Workii Tonstrurtiun Vautit Application is hereby e�f�Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at: y ............ `la.........74�!�✓F�..f -----------------------•--------------........----•----.....-•---••----•--.........---..._. Location-Address or Lot No. �L a l Q__�%c... Uzi ---.�sn �.�/� .vi✓ .. .Pa" -- :..... � s. ---••---•----- s�.rf..--.... . ... Ownsr Address a ... ... ....... . = ------ ---------------------.- --•--------------•-.---------------.------------------------------------------.................... M Installer Address Q7i Type of Building _ Size Lot...&7j.ta?S ------------Sq. feet U Dwelling—No. of Bedrooms............ ...........................Expansion Attic (Alb) Garbage Grinder (yec) a aOther—Type of Building ............................ No. of persons......... �'�...... Showers (�j — Cafeteria ( ) dOther fixtures --------------------------------- •,.�.---- ---- ------- -.••-••-----...-•-•••---••-------•--•-•••-•-••=•--••----••-----•••--•- W Design Flow.......................//_�k..........gallons pereraen per day. Total daily flow........_.•_---•--•----.. _3. _._.._ lons. WSeptic Tank—Liquid capacity/5AO.gallons Length....... Width....5....... Diameter................ Depth..._-------__._ x Disposal Trench—No.................... Width.................... Total Length.................:...Total leaching area....................sq. ft. Seepage Pit No........ Diameter......1.Q.._..... Depth below inlet................ Total leaching area.. s+. ft. Z Other Distribution box Dosing ( ) aPercolation Test Results Performed by....l�nlp.-.... ........................................ Date.....e/12 �...... ,.� Test Pit No. 1.).__....._. .minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T4 Test Pit No. 2._ ':'`_fiinutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•------------------------ f ---------•--.......................................................... Description of Soil............................!!Z_. •----1'-•--••----.........--••-------- --•••- •. U ---•••-•-•••-•----------•• i 3° e- "°==="`-------�� ------------------------------------------------------------ x •-••-•-•-•-•-•---.....-•-•----•-••......----•---••------•---•----•--•--•••••••••--•-----•-••-•----•-......-----•------------••-•-----•--••--------•••••--••••-•---.._..---•--•-•-••......-----•-----••-- 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 TITI,I 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. S- ed.................................................................................... `�sj� t ?vZ ate n--` 1 Disapproved_ ��---•.................. _Datel�/{--�( Application Approved By..... ... -/-"-/- --- Application for the following reasons----------------------------------------------------------------------------------------------•-••••--.......---- ...------:------------------------•---....-----•..------------------ -----------------------------------------------------------------.....-- i r _ Date PermitNo....................................................... Issued..... ` �.............................. Date No....... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................... Appliraftain for Bispviial Works Tonotrurtion 11amit Application is hereby madeJI3t�'a Permit to Construct or Repair an Individual Sewage Disposal System . y.. ......... a...... ......................................................*.................... L Ad 'ess or Lot No. _os....................... ............................................Address .............................................. OwnRr ...... ................................. .................................................................................................. Installer Address % U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder P64 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ....................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............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 I Results Performed by.......................................................................... Date........................................ W Test Pit NO; . I....:..........minutes per inch Depth of Test Pit.................... Depth to ground water....................___. 44 Test Pit No. 2................minutes per inch Depth of Test Pit...___._........._.. Depth to ground water........................ 9 ........- . _...................................*--------------"--------------------------------------------*-------- ------------------------ 0 Description of Soil........................................................................................................................................................................ W 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 TITI-E 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. Si ed.::, ----- ------------------------------ -------------------------------- Application Approved By.._... ... ........................... ..... Date Application Disapproved for following reasons:.............................................................................................................. ViIi ................................................................................;....................................................................................................................... Daft PermitNo......................................................... Issued-------- ---------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF........... .............................................. Tatifiratr of Tampliatta TWH/VIS CERTA, That the Individual Sewage Disposal System constructed �®r Repaired cted Rep by..... ........ ....... •..... .........*... •............................................................................ ............ Insta!,*Y� ......... 7----------I— at....... ....a.J.'s.... .......................... has been installed in accordance with the provisions of IZ=r,- of The State Sanitary Code as d r�� the application U L_,,, ytc for Disposal Works Construction Permit N S7�Z_�------------ plicati dated... .................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT.BE CONSTRUED AS A GUARANTEE,,THAT THE SYSTEM WILL_4VNCTION SATISFACTORY.' DATE....... ln`s�- F7'... . ...... ----------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD 0. Ic ... .:AL . .... .......'OF............ . . ... ......4 ... ..... .......... ......................... Fn_.,�.............. is— hereby Permission ij 3W y granted... ....................................................... .......... 0 ori epa' an`Individual- r�ge Disposa^_ .�tem at ....... t Co No. a s ow r Disposal Works Construction Per 0...... -ae ..... s shown n the application ealth 1D v..................... .................. ....... ... ......... ................. • Boa DATE.................m.............................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS + u � �� LI� r r � � �� "� ° �'' � • � 1{thy£ '� t ` '� � mil• _ �F� ,,pp� 1� �a. �.�' • ;�, ' AIAV cv *� '•rkl ti'Z �4�c ° .. Q i rJ � � �A 4.y.'L/ .��I/1 .... . ,•t' •; � � r, �' l P�f: ex 1:I-o-,,4' V) S�6BCRT G� 1 P.i `7 r+� SLi` itl� ",,I/ tio.Z216� C� �� ! : Cis;F LEGEND CERTIFIED PLOT PLAN ElffiBTIMG` SPOT ELEVATION OxO $x1ATiN® CONTOUR"--- Q --- t' i 1 � -FiN18l E`D SPOT EL—E A= iaN F"03"E0 CONTOUR Q IN APPROVED BOARD dF HEALTH 'b SCALES' `rI -� 0 ! DATE } DT E AGENT A " M"E ENG/NEER/N6,C4. IN CLIENT,; r I CERTIFY THAT THE OPO ,y ra; r fiso o BUILDING SHORN ON _THI y PL.Ali: R.E REGISTPED JOB NO. CONFOMAS TO THE ZOM"' . 1 LAND DR.BY. AIL- R. , �- • -�„ OF ®ARKS a t t - 8 CH. By t � ti s SJAM S: !lEETJ OF i i �: x, A . dl fj d zt n � tj aA IN y � I o V Zn- r`rr waeV"X An v 14 oa o ri t r j Y/ • R y re � eo ob4t ,: a . . . . . . _ x � _ �h �► Spy o � .� � a � . . • . •� . . . `�� O` .y . IA'A ` i � . c.. � AZ �. ` huM 4°. a . •eo o � � Y zz 3` .'`t � y � � � y ono C pb9eo• :•�a �� 0 �'� o � 22ZkA • _so. N�Il.6� O11�Ot1 �y IN IA Ll - .. .}•� c a y . p A � t �rw � � N wy � yy