HomeMy WebLinkAbout0047 MANOR WAY - Health 47 Manor Way -
osterville,
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L0>C.AT ION a J� ,SE AGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME & ADDRESS
B UI'LDE R OR OWNER
DATE PERMIT ISSUED lr _
DATE COMPLIANCE ISSUED
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No.._._...... ;y � Flea..../...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
AVV ' -an fur 0� u tti urk� (�uri #rixr#tuY� rruii#
Applica ion i hereby made for Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
e �S"-.-.. •-------••-------.................... - � -------------------------------------------------------------------------------------------------
ocati •Address or Lot No.
Owner Address
Installer Address ^ �O
Q Type of Building Size Lot_-.......-.•/.______________Sq. feet
U Dwelling—No. of Bedrooms-----3.................................Expansion Attic ( ) Garbage Grinder (V
Other—Type of Building ____________________________ No. of persons...-a____-____________-__ Showers (:7 — Cafeteria ( )
a Other u s ----- --------------------------•.
Design Flow-.-._-.-..--&................. Mons per person per day. Total daily flow.__.._......����
W g g P P P Y Y ......gallons.
Septic Tank—Liquid capacity/' --gallons Length________________ Width............... Diameter................ Depth-------___--_-
xDisposal Trench—No..................... Widtli___.2_ --------- Total Length--------gzP_ Total leaching arca..�-�Q_-- -----sq. ft.
Seepage Pit No..................... Diameter..:................. Depth below inl t______ ______ ____ Total leaching area_-____-__-_____..sq. ft.
Other Distribution box ( ) Dosing tank ) d �'•�'- 7
Percolation Test Results Performed Date-------------------------------------.
Test Pit No. 1---------------_minutes per inch Depth of TdFd Pit.................... Depth to ground water---_------___-__----.--.
LT, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground
a - - p _
_ water_------___-__----___---
: ...
O -- - � � --
.-
-----------------
W --•_...-_- ----------------------- z � ------
Description of Soil------ - - ----- - ---_-. -•--
-U -- -'-••.f -------------------------------
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 Article XI of the State Sanitary Code— The under}gned further agrees not to place the system in
-operation until a Certificate of Compliance b- the ahQAealth.
C
- Si d----- - -` I- --------- ---------------------------------------------------
Date
Application Approved By------- ---- -- --- --•----•------------- •• ---------
Date
Application Disapproved for the following reasons_----------____••_.... .✓ —
-•-••-•••- --•-•-••••••••-•••••-•-•--•-•-------------•-•-•••..... -•-----------
••-._-.......-•-•••••••-•••••------------•----------------•-•_.--------..---.__--
Date
PermitNo......................................................... Issued........................................................
Date
No......................... r Fps........./THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... - ---------OF........................:............................................................
Appliration -for 43Wpoml Works Towitrurtinn Vanift
Application is h reby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
system t: /
atio AX 1 or Lot No.
Owner Address
W
Installer Address
UType of Building Size Lot__________________________Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ----------------------_--- No. of persons..______---_-__-____-_--_- Showers ( ) — Cafeteria ( )
Q, Other f�c-tuy s -------------------------
W Desi n Flow..................... ................... ..gallons per person per day. Total daily flow............................................
..........�.....r.._�_
g - g� P P P Y• Y - - gallons.
WSeptic Tank—Liquid capacity .gallons Length................ Width................ Diameter__---_ ---.---_ Depth.--_--_--.-.._
x Disposal Trench—No. .................... Width.__ J---..... Total Length--------- Total leaching area....................sq. ft.
Seepage Pit No---------------_---- Diameter----------•......... Depth below in l t........-..........._Total leaching area._-.__----___-_sq. ft.
z Other Distribution box ( ) Dosing tank .) D ��� 7- 2
b � 3— 7�
Percolation Test Results Performed b .. 'L__ _ �L _S._....n. Date._"._____..._._....________________.
a Y-------t% �
Test Pit No. I................minutes per inch Depth of TIst Pit...._...._....__._.. Depth to ground water...------_-_--_._---.
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_---._-----.--.--_----.
----------" ------•---••------------------•..•--•'.••-•Z--••--•--••--.•....
G L-- -- - C ;----•---•-•---------------•-----
Description of Soil - _. l l o `er=�� �� a- `� u� cc
U --•---•-------------------•----------------------------. ?�,. ... =
M ••-----•----..--.-_--------.-.._-------------_-•------•_--------------------------------------------------•-------------.--------------------------._.-------_-----_-------------•--•-----------
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 Article XI of the State Sin' ary C de— unYssigned.further agrees not to place the system in
operation until a Certificate of Compliance hay bee crss ed ,-/y toaf f ealth.
-.--a__'_A--------•----•------•-••---------------•---_--__ ................................
Date
ApplicationApproved BY----- ----------------------------------------------------- �� -------------
Date
Application Disapproved for the following reasons:----••------------------••----------••••----------.-_------------------------------------------------------•-•--
............................•----•------.......-••-----------•-•-•-----....•-•-----••••--•--••--••-•--•••••-•------------•........._...---.....------------_.._..--------------......------....-••-•----
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
t1z.L� BOARDff)' HEALTH
..........................................OF....................................................
Trrtifirate of Tnmphanr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by........cl _ •• .......................................................
, =
` I / /7 .. �� ----
at.......................................................................
,/VIp ------ _- ----------•---------------•-------------------------------
has been installed in accordance with the provisions of : 'We' XI of he State Sanitary Code as described in the
application for Disposal Works Construction Permit No... .'.......5-- ______________ dated..:'.f-_.'__9�---7.6.................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE /I'�. / �A
------� �a��(`' �------�"��----------= `� � ----•-- Inspector'.---- ,�_.�.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA LT
5 ��iL��
No......................... FEr,/
�i��a�tti nrk� ��an�trnrtintt rrntit
/er -ssior ereby granted---------------------------------------------------------------------------------------------------- -------------------------------------••-
to Ce ( v 1� �aird(� ) Individual Sewage i4p`osa/ ystem
U
.� I "
Street ,
as shown on the application for Disposal Works Construction Permit" No/............ .... Dated...A......
��7
y --------•-----
-,/ 7 7 v—U �tBoard o�f HIth / 7-1
'
DATE---------------------------•---------------------------------------------------- %S
- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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