HomeMy WebLinkAbout0026 FLOWING POND CIRCLE - Health 26 Flowing Pond Circle
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Osterville
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LO�CAT ON � EWA G E PE MIT NO.
VILLAGE
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INSTALLER'S NAME & ADDRESS
B U I'L DER OR dWN ER
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DATE # ERMIT ISSUED
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF 1-1 MASSACHUSETTS
g BOARD OF HEA T
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Appliratiun -fur 43iuvuuttl Worko Tonutrurtiun Vanift
Application is hereby'made for a Permit to Construct (61 or Repair ( ) an Individual Sewage Disposal
syst t............
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w. Loca o ddress or Lot No.
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;tte� —j -•-•-- ---- ...... ------
W, ' Address
staller Address - A
Q Type of Building Size Lot.. >_ _ __Sq. feet
V Dwelling—No. of Bedrooms-----__------- -------- - ---------Expansion Attic ( ) Gat bage'Grinder ( )U
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
0.' Other fixtt res ------ ?_ --------------------------------
W Design Flow.......Za____ __ -----------------------gallons per person per day. Total daily flow-__-_________�________________..........gallons.
WSeptic Tank—Liquid capacity.' Ions Length................ Width---------------- Diameter---------------- Depth..-.---_-.-.--.
xDisposal Trench—No_____________________ Wic�]ti _--___-_-_-_----__. Tot th_.._.___:.._:_____.. TotaIXachi rea.._.----_--_._--_-_sq. ft.
Seepage Pit No. -�``Di !,� D. r 1 �. _WaHe ng area------------------sq. it.
Z Other Distribution box ( ),, Dosing tank ( ) �/ G
Percolation Test Results Performed by-------- ---------------•------•---------------•-_----•--•-----•---------- Date---------------------------------------
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...---_-.-----.--.__-
GT, Test Pit No. 2................minutes per inch Depth of Test Pit.................__. Depth to ground water------------------------
I...........................
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Description of Soil-- ��-r •. .............
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x
w 1 �- -----------------------------------•------. ------------------------------------------------- -------
x ----- -------- -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.-----------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ---------------------
Agreement:
The undersigned agrees to install the aforedesc'ribed Individual Sewage Disposal System in accordance with
the provisions of Article NI 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 boa d of/health. //�J O
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Sign . ........ ........... ._ /1 --- -••------- ••-•-•
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Application Approved By------ ------ - '-------- ` -----
Date
Application Disapproved for the following reasons:----------•----------------- -------------------------------------------------------• ---•.--------------
........-•---•--•--•---•-----••--•-••---•--•-•---•--------------------------•-------•---------------•---•-•---•--------•-•-.......•-•---•--._...--••---- -----------------•'----------------------------
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Date
PermitNo......................................................... Issued.----------------------------------= •--•------------
Date
t.
4 No.. Fizz..............................
{ THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH.;
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AVp irFation -fur 43641oiial lVarks Tonstrurtion Vrrn it
Application is hereby'made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal
System at: /�
........................................................... ' �. t� �'..f�t_ t 1.�'s:�f/}.
Location:/Address �! ;> J or Lot No.
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Owner /' r Address � /A
....-�-��ZJ./ . .................................................................................................
` Installer Address
Type of Building Size Lot_. :�!4' __Sq..feet
U Dwelling—No. of Bedrooms-----------........___________ _____________Expansion Attica( ) Garbage Grinder ( )
J
Other—Type of Building :........................... No. of persons__.__...............:_______ Showers ( ) — Cafeteria ( )
dOther fixtures --------=`''`,.fit . -------------------------------------_-•----.---=r----•-------•--------------------------- -----
W
Design Flow_______ .-__ !................';__..gallons per person per day. Total :daily flow.............,:2- _----_-__--.-__-.-gallons.
P; Septic T:nk—Liquid capacitvf� Hons Length................ Width'---. --- Diameter _._.... -__-- Depth........ ....
Disposal Trench—No Widtly_________________ Total,}L-ength .._....__.._. Total leaching'area----..-._---. _---_sq. ft.
Seepage Pit No.._._.� `. �fT Diameter[o - Depthbel �'v`nlet j _ y� 'Tota`leac'-'Ii"it .t____ ___ ______sc. it.
z Other Distribution box ( ) Dosing tank ( ) Q + ti«► "g 1
Percolation Test Results Performed by-------------------------------------------------------------------------- Date--_--_-_--------------..---.--------._..
a Test Pit No. 1................minutes per inch Depth of "Pest Pit_.<`_�-------------- Depth to ground water.-__-..--_-----..-_---
fi, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth. to ground water--.-.---__-----__--_--
a' ,tr
D Description of Soils-- - f_. s '"
x ---------------•••----- - 1`' --- -- > Ty:.
---------------------------------------------- -------------------------- -
W
U Nature of Repairs or Alterations—Answer when applicable-------------_------------------------
--------------------------------________.___.._...__
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._..--•------------------•-•-•-•-•-- r :•-----___"-- _'tt.- •- -- ---------- - ----------------------
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Agreement
The undersigned agrees'to' install ,the aforedescrih -Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code l''Th`e undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
i ne " X.,S 0 . -'-
ale
Application Approved By------ _ ..
.. * ate
Application Disapproved for the following.reasons:..........---------------- ~'
r„ Date
Permit No................ - Issued.
Date
i-- HE COMMONWEALTH OF MASSACHUSETTS
��� BOARD OF HEALTH
of > '' .............�/.�-�+'
3 r �er#ifi �f 0.11,11utpliana
THIS IS TO CERTIFY, That/the Individual Sewage Disposal System constructed �`/i`) or Repaired ( )
1r �-
' Installer /"-•
by-
------------- ---------------------------------------------------------------------
® has been installed in accordance with the provisions of . t YI f The State Sanitary Code as described in the
' ..' application for Disposal Works Construction Permit Nog__. i ,dated---- ' ... " '' ..7..-----•--
THE ISSUANCE OF THIS CERTIFICATE SHALE. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL
FUNCTION SATISFACTORY. &I �N!--- N
DATE. ector._.._......
-----------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r�r i..1ti. .. ...OF...........................................................r......
No...... •--- FEE -- -------------•---
�.t^ �rk,� C���,>�trurti>�tt rr�tit
Permission is hereby granted........-�%--'----`= == '; ``.._.:.?...'_r.._. .....................................................................
to Construct (. ) or Repair ( ) an Individual Sewage-Disposal System
at No......*.......2(• :...1, r =......•--° :........: ...•.....••.==`- `-f � !�„"r='c�;.
Street
as shown on the application for Disposal Works Construction Pe o '_- ,f�D1 _.4!!4_1 -I -•-•-
Board of Health f
DATE...................-- ---------------
FORM 1255. HOBBS & WARREN. INC.. PUBLISHERS
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