HomeMy WebLinkAbout0140 GARRISON LANE - Health 140 Garrison Lane
Osterville
1 A= 114-0054
1 River Rd.
, . .:erville
114 063
i
P`
i
i
UPC 10247
No. HH163GN
HASTINGS.UN
LOCf .TION ' 5EWo,C4E PERMIT UO,
lw T L R•5 IJ 16 ADDRESS
*11L D E R 5 t.ItFE ADDRESS
— At song— — �
Dl�►TE PERMIT ISSUED '_ lam' 74— — — —
D ATE COMPLI &IaCE ISSUED : T-A f
41 1
"tit "t
00"
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL
�I /Q.11✓ALI_..._--------OF------------2l� ,� Ii�<.S`X -�---.._..........................
: pphratiun for Bhgpoiittl Works Tomitrurtion Vrrnift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at*
Location-Address or Lot No.
z
Address
n,ii -••---Address
Q Type of Building Size Lot----------------------------Sq. feet
Dwelling=No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
P-4 Other fixtures ------------------------------
W Design Flow________----- ---------gallons per person per day. Total daily flow-------------- ____________---...gallons.
USeptic Tank—Liquid capacitv_./ =P_ta-gallons Length................ Width................ Diameter---------------- Depth---_______-__...
xDisposal Trench—No_____________________ Width---_................ Total Length_-.................- Total leaching area-____-_-..__---_-___sq. ft.
Seepage Pit No------I------------- Diameter_/ � __ _d" __ Depth below inlet____________________ Total leaching area------------------
it.
`
z Other Distribution box ( ) Dosing tank ( ) d'/—"-
aPercolation Test Results Performed by........................................................................... Date........................----------
Test 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__--_-_____--____.__-.-.
w ________________________ ____________ ________________________��___..-.__._._._.___-_-____ _-_-_-_..___- - _ h_____________`6 -.
`_ /
Description of Soil--------• ------- -._�..---•<--'-•------�-`•••--••--•••••------••----•----/------------/_------ __----•-•
x
U ---------------------------------------------PiC — ---- ------- ---•------------------------------------------------------------------------
W
UNature of Repairs or Alterations—Answer when applicable------------------ ------________-_________-_
••----•-••--------------•-•----------------------------------------------------------------------••--------•---------------------------•---------•---------------------------------------------------
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Dis System in accordance with
the provisions of Article XI of the State Sanitary Code— e un rsign urth agr s not to place the system in
operation until a Certificate of Compliance has been ' d y t oar eal
6 � �.. /�e
Sig ..---Da
Application Approved 7
Date
Application Disapproved for the following reasons:....................... ------------____---------------------------------_____-___-----------------------------
Date
17
PermitNo......................................................... Issued---- cl ............
Date
THE COMMONWEALTH OF MASSACHUSETTS
• BOARD OF HEAL
OF............ .......z...ple
Aliji ir4$filn fvr Bhgpviitt1 Workii Tam5trurtion Vrru it
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
...............
------------ rt/ ............ _..1 _'Y g------------------------ ---•••----•-------•----••----------•--•------------- ..........................................
Location.Address or Lot No.
. i Ow� ............. ------------------------............----
� Address
Installer ' Address
d Type of Building Size Lot_________________ ---------Sq. feet
U Dwelling—No. of Bedrooms.___-___-_. 62 ..........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------------------------•------------•-•-----•-------
W Design Flow---------J s___------.__-_-gallons.per person per day. Total daily flow.............. _d7w________-_.__..._.gallons.
Septic Tank—Liquid capacity_/A-0.0gallons Length--------_------ Width---------------- Diameter................ Depth----------------
Disposal Trench—No. -------------------- Width.................... Total Length------------_------ Total leaching-area--------------------sq. tt.
Seepage Pit No....../............. Diameter..�!jf2mO._ Depth below inlet__.-__-______-_.___. Total leaching area------------------sq. ft.
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.._________-_____.__._.-
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-_._____-________-. -
----------------------- ----------------------------------•---•--•-•--•-•-•----••------•----------..............................•-----------•------- -----
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
U
w
VNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------- ..........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Dis System in accordance with
the provisions of Article XI of the State Sanitary Code— e un rsign firth agr s not to place the system in
operation until a Certificate of Compliance has been ' y t oar al
c Sig %C -
D 1 ��
: a �/
Application Approved By- --- --- ----- - <. _ ` ...................... LJ_...
Date
Application Disapproved for the following reasons:------- .............. ---------------------------------------------------------------------------------------
C` ----••-•------------------------------------------------------------------------------------------•--•---••------------•--•-------•------•--------••------•-----•-•------------------•--••-----........
Date
PermitNo...-------•--------------------------------------------- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... .. ..:.......OF..... ...................
rrnj�dividual
iratr of fUum hattre
THIS I .T ER FY ' aat t� Sewage Disposal System constructed ( ) or Repaired
j��j 4
by _:';� �� - �.� '(- ----------------------- ---------
r M L Installef
has been Snstalled in accordance with the provisions of Art' I of The State Sanitary Code as described i the
application for Disposal Works Construction Permit No. _C.. .... .t `.,��x-_.._.._.. dated_.__ '..<..~ "......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE_ THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...........................................------------------------------------ Inspector.................. ------------------------------------------.....------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH � •
TJ �► � w .... . OF........ �! Y��`I ................ .
%spalitt1 i k, Cn r �tr " at rrutit
Permission is hereby grante .__.
r'%� . --- . --- --
to Constr ( ) or Re ai ( an In 'vial Sewa ispos� System
...at No � '
---- - - -----
��,.
Street� /
as"shown on the application for Disposal Works Construction P No..._ ted_.__�e.-
Board of Health ;
-
)DATE......1
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS -+
ksBuilt Page 1 of 1
LOCAT1OKI : SEWaC,E' PERMIT WO
V i L.Q CE
IKWI T L R S U ADDRESS
bl�ILD tJIE '�DDRE SS
OVA";
D L P E R KAI 1 SSIU ED
.D AT,E COM'PLI &&ICE ISSUED;
-
ittp://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 14054&seq=1, 10/2/2012