HomeMy WebLinkAbout0129 HINCKLEY CIRCLE - Health 53 Briar Patch Road
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k . Osterville
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L O CATION S E W A G E PERMIT NO.
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VILLAGE
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I NSTALLER'S NAME ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED 22
DATE COMPLIANCE IS(SUED T �"
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No.u.............. Fzis..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7 ..............................
03 ...............OF...........
14 3 Ayphratiou for Dispaiial Works Tonarurtiou ramit
Application is hereby made for a Permit to Construct V/) or Repair an Individual Sewage Disposal
System at:
P........... A.:...
L Address or It No.
Ttion-LV3 ��Qt_4 ?--.-P
At
................... ........... .. ............
r
..... ...
Address
.............. .....
Installer
Address
Type of Building Size Lot____L ......Sq. feet
Dwelling—No. of Bedrooms.__......3............. ................Expansion Attic Garbage Grinder ( )
Other—Type of Building ...... ........... No, of persons............................ Showers Cafeteria ( )
PL4Other fixtures ........................................................................................ .............................................................
Design Flow..................5r.................gallons per person per day. Total daily flow--------3:F7" .............gallons.
W ---------------------
IY4 Septic Tank—Liquid capacityljO!4M..gallons Length:��!TP.... Width................ Diameter__-_____-__- Depth...._........_..
Disposal Trench—No. -----_----....... Width ....... Total Length......_............. Total leaching a rea.-..................sq. ft.
Seepage Pit No............I........ Diameter.__. Depth below inlet...... .......... Total leaching area.:Z�..t.5Mq. ft.
Z Other Distribution box ( V� Dosing tank ( )
Percolation Test Results Performed by.... .......................... Date------ ..........
Test Pit No. .1......-L....minutesperinch Depth of Test Pit__--1y..... Depth to ground water...
Test Pit No. 2................minutes per inch Depth of Test Pit..._.........._..... Depth to ground water-___-__.........._..___.
.............................L)................................ ---------------------------------------------------------
0 Description of Soil--------------------....... 1Z i _�., ...... ......................... ......I--- ------
-------------*---------------------------------------------------*----------------------------------------------------------------------------------------------------*----------------------------
--------------------------------------------------------- ......... ............................................................................... .....................................................
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 TL 1'1 11 5 of the State Sanitary Code . .. ....
—The �ncdlersigned further agrees not to place the system in
.s The ' f "I'operation until a Certificate of Compliance has b e b e d of health.
bee s i
Sign( ... .... ...... . .. .... . ..................................... . ........*A7a/t;e
ApplicationApproved By............................I.........-:_.a....................................................... ........................................
Date
Application Disapproved for the following reasons:..................................... ....................................................................
..................................................................................................................... ..................................................................................
Date
PermitNo......................................................... ISSU4.......................................................
Date
No........................ FEs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........7.G'.lf+.(/.�1...............OF............ .W—)q.1 ..1:..A.P.L.e...
Appliratiou for Uiupniia1 Workii Towitrurtion amit
Application is hereby made for a Permit to Construct ( V/) or Repair ( ) an Individual Sewage Disposal
System at:
....L U........................L:..�L.pLTJ. A...L_ _1 G
----•- ...........
Lo ation-Address or Lot No.
C �, - f�� I�LPh cis 2r DI r� iyI`i i N1a
....................�_._........._._.__._... ......_..._ ........-----`� 4 ....__0....T.... ......._..Y................. .....
•___• ..._.. -y---
Owner Address
W
Installer Address
i , �uU
Type of Building Size Lot..... �________________Sq. feet
Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building ____-_- ..._....._ ..._._._.. Showers —
Other—Type g (. _ No. of persons__________________ - ( ) Cafeteria ( )
dOther fixtures -----------•--- --- --------•---••---------------•----------------•--...-----...--•--•-----------------•...---------............•---
W Design Flow....................? ................gallons per person per day. Total daily flow........='-�-...........................gallons.
WSeptic Tank—Liquid capacitv.b. U_gallons Length_`%J._P.._ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width... .__..---------- Total Length...___.......t..... Total leaching area....................sq. ft.
Seepage Pit No------------I------- Diameter....- --------- Depth below inlet_.....�___...._.. Total leaching area_Z.'.l4?q. ft.
Z Other Distribution box ( ✓f Dosing tank ( )
aPercolation Test Results Performed by----- ......................... Date.......1�_:-�'.' '�
Test Pit No. 1------- '_._minutes per inch Depth of Test Pit.........w..... Depth to ground water_-_- ..........
fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--_._-_-__-____._-._...
W •-------------------------------------------------
••-------------•-•......----------....--••-------:---------•---------------------------------------------•-
O Description of Soil------------------ ---4,2-- .....1.�° ' t f' v � � V i 2 �Z / l�l _....................................
% h1-C
x
V
W
VNature 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'111 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......................................................................................
Date
Application Approved By------••-----•-••-••-••••--------------•...••••--•---------••-----•-•---..._..--••----------
--- ----------------------------------------
Date
Application Disapproved for the following reasons:.....................------•---•-•----------------------------------------------------------------------•-•--.
---------------------------•---•----------•-•--••-•----•-•---...-•-•-------------........--•-----•-------...----------------------------•-----•--------------•••----•-•---------•... ------------.
Date
PermitNo............................. Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Vrrtifira#r of Tlautpliunrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Installer
at.....................................................-------------•----•---------•----•---------------.-------------------
has been installed in accordance with the provisions of TITL•, 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----------------------------------------- da.ted-...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILLf ION SATISFACTORY.
r ----- ----------DATE..._.__ _.....
.. Inspecto
THE COMMONWEALTH OF MASSACHUSETTS
3^,908 BOARD OF HEALTH
.....................................OF_.....------......................................................................
No......................... FEE........................
i rya 1 ion Pirrutit
Permission is �y gr C •--•-_.. . . �--_�.�..
to Construe) dr le air Indiviu e.wage o'sal t
atNo.........................................................................................................
Street,
as shown on the arflicatip for Disposal Works Construction Permit l _. 11_•-.-_____- Dated..........................................
.................................-------------------------------------•-----------------,.._......------
........................... Board of Health
DATE.............................................; - ' •
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS