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0851 MAIN STREET (OST.) - Health
851 Main Street A= 117 - 173 Osterville a s •. ° m d I! � e o� t � . . x No... ...........-------- Fus.o...................... s THE COMMONWEALTpa OF MASSACHUSETTS 1T3� Boas® of SEA T ......../_..... . .. 77.........OF.....` ..... .�._....�..........�........................ Appliration fnr Uii�rnaa1 nrkii Tomitrurtinn rrnti# Application is hereby made for a Permit to Construct ( or Repair ( ✓) an Individual Sewage Disposal System at: �s:....e ..�..Lje.......... ........................ a .... ocat n- ddress • o No. ner Address W Installer Address Type of Building S /ize Lot_______ __ _____7...Sq. f V Dwelling—No. of Bedrooms............................................Expansion Attie Garbage Grinder jd '4 Other—T e of Building .............. No. of persons.....................__.__.. Showers — Cafeteria a Other fixt re ;3- W Design Flow....................._...-.____.gallons per person er day. Total daily� flow.:.....__.__ ..__........_.. _gallons. WSeptic Tank—Liquid capacity ©.q.gallons Length.a�,J .._ Width._6...._-____ Diameter................ Depth..._6......_. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........j_.......... Diameter-----f---__-.... Depth below i let......6......_.._.. Total leaching area__APZ...sq. ft. z Other Distribution box (� ) Dosing to b '-' Percolation Test Results Performed by.......... ...... . . �v /'" o' :�' Bate---/------- ,� Test Pit. No. 1................minutes per inch Depth of Test Pit....._..._._......__ Dt to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ----------------- ------------------------------------------------••----------------------------------•-------------- ODescription of Soil............... .'---•-•--•-•-••-•-•--••----•------------------------•-------------•------......-------------------------•----------... x V ---------••••-••--•-•-----•---••--------•--------------------•••--•--•---••------•-----•....•--..............---- ---------- -----•----------- W �.. ------------- UNature of Repairs o lteration's—Answer when applicable_.: .. '_ ......._...�_�� �'Y� _. ..... -----------------••-----. "' �°.;�al..... ................._... ---•--.......... ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI 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 ....................................................... ---------------oke ---- ' Date Application Approved By.........P.•. �. v p.� 7:1 .,`,. -.,...-_. Date Application Disapproved for the following reasons----------------------------- = '�.---------•-------------------------------- -----------------•-•------------------•-...--•-•.....----....._....-----------•---------•----------------.....--•---•-•••-------------...••-••----•-------------•-••---•-•••-----•--•••----•-••---....... Date __Permit No......................................................... Issued.....t................................................. -- - Date No............... FEB .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTT ................... .................._OF......& ....................................... Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: — ...... ......................... .. ......i .............................................. -e A�la-5 S . .......................... Locaty*bn-jXddress AV ;i� .. . ..... ne . Address .... ............................ ................................................................................................. Installer Address Type of Building Size Lot.Xqz_�.............Sq. f t oms.........../.........U ....................Expansion Attic Garbage Grinder Dwelling—No. of Bedro h9 A/0 i7� P4 Other—-Type of Building ............................. No. of persons__..__.__.__._.____.___.._._ Showers Cafeteria ( ) QI Other fixtures ...................................................................................................................................................... Design Flow................ ................gallons per person per day. Total daily flow............//..a.....................gallons. 9 Septic Tank—Liquid'capacit/00.9..gallons Length.r,__s1._._'. Width..6...I..... Diameter________________ Depth._..____.__.. Disposal Trench No..................... Width.................... Total Length._.__._________._._ Total leaching area....................sq. ft. Pit' 01 .... -I below �let_,fi............ Total leaching area...-2.1;�Z....sq. f t. Seepa - No......../........... Diameter_._..f-------- Depth , ge Pit Z Othir Disffibution box Dosing to Percolati'op Test Results Perfo ed by..___..___ . .... f)ate... Performed N 1 ............minutes'per inch Depth 0 pit.. Test NQ D ground water_._._._____. _._.__._. Test Pit N&;'2:..............minutes per inch Depth of Test Pit_._.._......._.__.._ Depth to ground water.__.___.._..____...____. ..........I.... ...................................................................................................................... 0 :Z� Descriptionof Soil....TJ.......................... -.t-----------I........................................................................................................... ------------ ------------------- --------------------------------------*--------------------------------- ----------------------------------------------------- ................................................... . .............................................. ................. U Nature of Repairs Answer when applicable_ " • ....................... 114,100 ���yr�� -0, ............... ........... 0 ------------------ ... ...........'s 1 0 Agreement: The undersigned agrees.,to install the aforedes' cribed Individual Sewage Disposal System in accordance with the provisions of TIT:_.: 5 of the,..State Safi1fary�C6de—T-he.-bndersigned further.agrees not to place the system in operation until a Certificate of Compliance has been.,issued by the board of health. rSiane . ........ ...................................................................... ............I............... Date ?Application Approved B ...... . .. .... ouo- -- -- ---- —7,Date Application Disapproved for the following reasons:........................ ----------------------------------------------------------- .............. ................................................................ ........................................................................................ V 'n ---------------------- Date PermitNo.................................... .................. Issued........................................................ Date K THE COMMONWEALTH OF MASSACHUSETTS BOARD E L OF......... ... (9rdifiratr of-Tompliaurr THIV RTf-M -That tne IndjXidual Sewage Disposal System constructed or Repaired . ...................................................... .............................................. InstAer at...Ave.... ...... ............. ..... .................................................. has been installed in accordance,with the provisions of rj;� ate Sanitary Co;Iq as descri in the ...... ....ij.j.4 date �t_r. .............. ..rapplication for Disposal Works Construction Permit No____........ . ........ d...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................................................. Inspector.,. .................. 7 1......................................... ...... ......... 0"I T IS Of THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 EALTH No.:...... 0 ... .. ...... F!.......... ....................................... FEE...... 7..... Disposal 11 Tolt ion Vamit a Permission iy Xea, . .. ....... . ...... ......................................... ......................... _�a�y' gra ted to Construct U7 Rep i an Sewage s osal $ys at No..,.... ........... ........ L R m,age Street as shown on the application for Disposal W.-brks..Consfruction Pern;it'go...... /noz Z.A..4.jr...... .......... ......... ... ... Board'o He th DATE........ ....................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _4 vL J,OiCATION SEWAGE PERMIT NO.. w VILLAGE - INSTA L 'S A M E & ADDRESS 4z� B UI12E R OW JE , DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �;�p •i: of u t a �r Strq ►Ju���0� IJv�.. Ffi � 40, 8 9 OL a Y ew /eacA f P�. Q0 F"V I.V61W 777 c-•r7 T f/e c ". s tQ o_ x C Z a � v a C e <J I �N OF Ma OF FRANK � � FRANK .. CQNERY CONERY Nj No. 6573 40 ,fl�N0. 5232�J Jf� v I �1ll.,', ' 'T s . � TA77 V s S/dam ' - 10 AS Ca.