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Home My WebLink About0087 HINCKLEY CIRCLE - Health 87 Hinckley Circle Osterville A= 142— 032 I i I � G LOCQ ION :487 SEWO CxE PERMIT UO. VILL-AGE - - - - - - - WSTLILLSR 5 W&NAE ADDRESS �ff LOA- -C a; CD7 BUILDER 5 Q &MF- tADDRF-55 DINE PERMIT 15SUED 3 — -- D ATE COMPLI W-ACE ISSUED : lone u1 -r�Kk ASuESSORF.MAP NO- I Z PARCEL NO.: THE COMMONWEALTH OF MASSACHUSETTS i. l OAR® OF HEALTHS -- �� -----.....oF............ ......... ....... ................................. Applirta#ion for -or Works Tonotrairtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy§tem at .....:. .........l. l - �---.' --------------------------------------------------------------- � tion-Address or Lot No. Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............ ._•....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Othert re ----------------------------------------------------------------=-------------------------------------------------------- . - -- w Design Flow...... _ gallons per person per day. Total daily flow.................. ................gallons.' a Septic Tank—Liquid capacity:...00gallons Length................ Width................ Diameter__._-___.___-._• Depth................ Disposal Trench—No....................: Width_.{.`.__,._,._.__....._ Total Length.................... Total leaching area_;-t-•-..__-------sq. ft. Seepage Pit No._._____- ____.. eter........ Depth below inlet................... Total leaching area. ............sq. ft. Z Other Distribution box (r Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date.•-•-•'b---------= ---------------- ..l 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........................ ----------------------------- •----- -•------------ ----------------------- ---------------------------- --- •--•-•••........... .............. ---------------.----- 0 Description of Soil......................................................................................................................................................................... w UNature 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 j i L i� p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in p p dbythe dofh 1 operation until a Certificate of Compliance has be issue Sin . . --- •.... t------ e - Application Approved By--•-.---• ------------•............. ...... ._fir _._ _... (�cam(% --------------- - Date Application Disapproved for the following reasons:................................................................................................................ ..-------•----------------------------•--------------------------------------•-....----------------------•.........._......---•-••-----•-------•••-•-••••---•---------- ............................. Date Permit No.-------- Issued Date 4 r. THE COMMONWEALTH OF MASSACHUSETTS — OARD OF HEALTH ..............._OF........... ................................... Appliration for Dispmal Works Tomitrartion 1hrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .. - - >--,, c//� .............................. Z Z.... C................... ................................................................... V70-/_/ 1,evation-Address .49/L/ _or Lat No. —e— / L/ ................_ .......................... ............................................... ................................................................. Add,e. '07 C-,7 -9,4 .................................................................................................. ................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___......._..... .......................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Other-fLxWr 'Design Flow____.___._55. ...............gallons per person per day. Total daily flow__........- .................gallons. 1:4 Septic Tank—Liquid capacityl-000.gallons Length................ Width._............._ Diameter..__......._.__. Depth---------------- Disposal Trench—No. ........... Width_{{.`.__,,._,,.:_._.._._.. Total Length.................... Total leaching area....................sq. f t. I.... Seepage Pit No--------co------- meter......... .... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution bcx Dosing tank Percolation 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._......._..........__.. ............................................................................................................................................................ 0 Description of Soil....................................................................................................................................................................... x M -------------------------------------------------------------------*-----------------------------------*----------------------------------------------------------------------------------------------- t4 ........................................................................................................................................................................................................ 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 T I T LE 51 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health Si .. .... g '7 j ------- ate Application Approved By........ ................ _4.......... ............... ............ Dale Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................I............................................................................................... Date Permit ............ ......... .... . Issued ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD - F HEALTH ............ ....OF.&.................................... ......................... Tatifiratr of Tampliaurr T IS TO CERTIFY, t th I al Sewage Disp2os Sptem constr1VZtd IV) r Repa45d b -------------I ....... .... .... Irtattert��4 at............ _4.4�............ --------- ............ .. .................................................................................................... D has been installed in accordance with the p -ions of T 11 TIE 5 of The State Sanitary Code as de, ribed in the application for Disposal Works Construction Permit No-_.::� ..........7.� 7HE dated--------- &�, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED As A GUA�-, NT E- -THAT T----------,A SYSTEM WILL FUNCTION SATISFACTORY. DATE................. Inspector................... --------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOA I F .... -, � HEALT . ...............OF ..... . F.. .... ....— EE/_�............. oLdtWorki ivnVamit Permission)s herebganten A�.X...... �............................................................................. to CoTtruWK ) or Re air an i 'dual *fie,Dis System ------------------------- ............................. ... Street as shown on the application for Disposal rks Construction Permit Dated.._....... ... &------------- :::; 1 c-4, ................................................... ...................... CY 1:7 Board of Health DATE........................9...............Z................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS TS o O G,ar i,- o z C� er)C, oF,-e8 =rvn r-u6cr), n ou-r 6�u for ��JO�' 11+� GUrreL� Pee— r pLL also oUAA-- a)(?- an bUA C��c� �r 4:13e- or, seq e. c-r>��a h ��11ou Ar)� ��ec, C-) cc te- C� 1��--� S-i •r�,�-� �n c�c�� a�P I�c�cn � �a n C� �nd ��'►��r,d I, e re L n ) r'-..l /