HomeMy WebLinkAbout0025 GALAHAD CIRCLE - Health 25 GALAHAD CIRCLE '
hA= 145 -065
Osterville
CI��TIGN� ./ SEWAGE PERMIT NO.
VILLAGE 1
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INSTALLER'S NAME & 'ADDRESS
BUILDER OR OWNER ,
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEA TH
iU----.......-_-...OF............ ..... ... .... ... � .......................
Appliration for Disposal Works Tonstrnrtion Prrmi#
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Application is her by made for aPermit to Construct orRepairan Individual Sewage Disposal
at
..... . L .� ----------------------- .... . . .....................................................
L ca on-Addreor t
.... --. -::...• ----•- --........
Owner Address
'W1 - •Installer -- ---- -- - `.71"-
. ----- -------•-------••------•------•--------------Address-•-----•
U -----------------------------------------
Type of Building Size Lot............................Sq. feet
.Dwelling—No. of Bedrooms._._.._ _________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
a Other fixt 1ps ------ ------------_---------:.
WDesign Flow.......... -----•-•----------------gallons per person per day: Total daily flow......... .°._- ...................gallons.
WSeptic Tank-t Liquid capacity/..gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width...R__X_(_.. Total Length.................... Total leaching area---S510.1------sq. ft.
Seepage Pit No..._/------------ Diameter.................... Depth below u let..-._ Total leachi area..................sq. ft.
Other Distribution box (� Dosing tank ( ) L !
_•.. . .
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'~ Percolation Test Results Performed by... __. �./ f�................. Date...
Test Pit No. 1................minutes per inch Depth of Test Pit________---_--_-__- Depth to ground water--___-_______------•---.
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_.__._._........._...
0 Description of Soil.------ _& �1?l�'�`I 4�_.:. . --------
x -z .._..
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 iI`I'l:^. 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.
Signe __. .......
s� 1: • � ---••-•-•••••....---•-•----------------•--•-••••... •• .........................-••••-•---•...
Date
....2. fAPPlication Approved By-----••
Date
Application Disapproved for the following reasons:----------------------------------------------------------------- -------------------••--••--••••......
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.....................................................................................................................---.............------._._.....------......
Date
PermitNo......................................................... Issued-.......................................................
Date
Sal
No.._....'•--____._....... Fmc..........................._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TI'H.
,!. ..... OF..:..
App iration for Diipusal Works Tomitrurtion ramit
Application is herby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
Syst at
.... c ......................•• ---------••-• ........ . ..........................................
• .. c ion ear or .-t o.
..... j ....._ ............... . -- ..7...... .�.......
Owner Address
w - .. --• .! 1 A-•- R
M A
Install , Address
Type o Building `A Size Lot............................Sq. feet
U D elling—No. of Bedrooms.____:_,. Expansion Attic ( ) Garbage Grinder ( )f-•� "________________ -_-•
a~ Other—Type of Building .............----------- No of t f ons________________________---- Showers ( ) — Cafeteria.( )
Other fixts "�
------------------------------
W Design,Flow.... gallons per person per day. Total 1i4.ly flow_.._._ gallons.
WSeptic Tank'/-Liquid capacity .gallons Length________________ Width_. Diameter__.___ _________ Depth___________.__.
x. Disposal Trench No ______ Width__ _"X 4-.- Total Length_________ _________Total leaching area__......sq. ft.
Seepage Pit No t./... j ��Diameter _______ _______ Depth bel ow}nle .�. ....._. Total leachingarea..................sq. ft.
Z Other iDistribution'box,mil" Dosing tank ( ) L� f- ;Z3- 7c�-
''" Percolation Test Results Performed b . _.._ _1_._:_____._/� ................................. Date_:_,t_____2_?.:.l _..........
aTest Pit No. I................minutes per inch Depth of Test Pit____________________ Depth to ground water.........................
t
(s, Test Pit No. 2................niinutes per inch Depth of Test Pit.................... Depth to ground water...................
O Description of Soil ,� - - c.. z ..___
x .
__R_...._____________
U
............................... _________________________________________________________________________________________________________ `.
W ---------------------------------------------------____________i�___-__-____-_________...__..........................................................................V41...._...........
UNature of Repairs or Alterations—Answer.,�hen applicable.._________________________________________________________ ____________________________________
-••---------------- ------------------------------------------------------------•----•-••------------.....----------------------------------------------------------•-------------•---....._-•-••••--
Agreement:
The undersigned agrees to ,install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT�.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.
Signed..................................................................................... ..--•-•-----DaYe._.._..._..._
Application Approved By ________________ f'? =Date
r
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------
...•••••................••-•-••••••----•-----•••••--••••----•-••----•--•---•--•-........-••--•••-•-••-•••----•-•--•••-•-••••--••-•••----------•----------------•--------••---•--_... -•--••-•--•••-
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.,. :.:.....`...� ..................
!'_"yl�' rt�y.. ..OF.........;. C� ���r� -
Trrtifiratr of Toutpliattrr
THIS IS TO C 1ZTIFY, at tle Inodual Sewage Disposal System constructed ( or Repaired ( )
•.> - - Y .............. ____ _______ _._•_.__..______ ......__...__....
by :. � _,c .�" `^...
f nstaller /�✓
has b/en installed in accordance with the provisions o�T TT 5 of The State Sanitary C6de as described inrthey=1
i. P > Y 76'
application for Disposal Works Construction Permit No. _. ____.._S_ ._-L.__._._____ dated .__L�1.� _=:..1 ________________
THE 'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
--------------••-•----•-•-----•.._._._.. InspectorP -•••-•� _DATE._...._..j�'"/l. _.�.� --•------ ......
THE COMMONWEALTH OF MASSACHUSETTS` '
0171-2
BOARD OF HEALTH
+ _
No........vel......_..... FEE..............:.........
Disposal •k on � trait
Permission is hereby granted____. _ - _._:._: _.::__: _...' _7� t
p_. ..
to Construc ( r'Rep 'r ( ) a I ��aidu S�'v�rag isposa�l f, �,
Gf A__,
at No. ff''.•,, � ? 4 v-�� Q_ _U_._.... -�:----- ��1-....-- ------------•--....
Street
as shown on the'application for Disposal Works Construction'Peri fit No ..... Dated__;k_�`�.`:`�. / 7 ' 7r
Board of Health
DATE__. d..................................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS (!1
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