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Home My WebLink About0090 MILNE ROAD - Health 90 Milne Road : w 119-054 Osterville' it o r 3 � ' c r . " , e A p r , r L0CA°TION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S ; NAME & ADDRESS .R UILDER OR OW ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED s`�/ ' �. O� 1 � G O _ 0 R , � -�: '� _ l,� ;� � � � � �' � �, � �� ,�, 1 �� ' �� s c b � ��---.-_.._ r *� ��''02 Fxs...�....�_0....0_ No. .. .......••---•-•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH G 1.U..�.............. ...OF.. °f . (..l..f2... ......................................... Appliration for BiiivniiFal Workii Tomitrnr#inn 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System�At: ...: O IR ....... _- -- �------- - -------------- .........................._ - - ----- -----..... / Vn-Address / or Lot No. a �/. wnr Address/ . ........... .�. ------------------------------------- -------------------------_....... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (1/0) '4 Other—Type of Building No. of persons............................ Showers — Cafeteria Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow_...........................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter--.--.-.:------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.--.......--........ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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........................ p4' ----------------------------------••-----•----------------------------............--------•-----......-•---•----•-..........---......-----•......----•-••••-- 0 Description of Soil....................................................................................................................................................................... W ---•-•-------------------------------------------------------------------•--------------•-----•-•-----------•-----------•----------•-•------•--------•-----------------•-•-... ------- x Nature of e a'rs or Alt rations—Answer when applicable. ...-��G.!y!a.�1.�......-�....•.�l°s_fr°p 1........_ .. U � ., ---------� •-----•------•. off--..... �------.. '2!�=-�----------�.UQ I./---.4�:/-.,../ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System_in accordance with the provisions of TITI.E4 5 of the State Sanitary Code— t igned further agrees not to place the system in operation until a Certificate of Compliance has be of healt4. g a ned ... ............... DtApplication Approved BY------• •---- ...... .... -� 4.1 .... Date Application Disapproved for the following reasons:-----••----------------------•--••-----•----------------------•---------------...---•----...---••-•-•••-•-•--. •-••••-•--•-•-----------•-•-------------••---••-••••-------•-----•---•----•---------------.._........••------••---•-•-•••----------..........---•-••--------------------•-------------•---•--......_.... Date Permit No.- ( .................. Issued......................... THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF H A TH , ' Applirttiion for Disposal Works Tonstruriion Errant Application is hereby made for a Permit to Construct ( ) or Repair (") an Individual Sewage Disposal System at J . �f 'o ati n•Address or Lot No. U r�y�e S P - i !� - r_. ._.. •• --------------------•--•---•----•---••-------•---. . ..................-----•..... .....---•--••---•-_......._..................... a ner � r,a_!.............4.>�w��s..................................... __..C (f R I/ 9ddress....__...._..... ....._...... Installer (( Address UType of Building Size Lot____________________ _____Sq. feet 1-1 Dwelling—No. of Bedrooms......15......................................Expansion Attic ( ) - Garbage Grinder Other—Type e of Building No. of ersons____________________________ Showers � ., YP g ---------------•--------••-• P ( ) — Cafeteria ( ) d Other fixtures _---••--••-----...--•--•---•-•------..... -------- ---- -••-------------------- W. Design Flow.............................................gallons per person per day. Total daily flow...............______.._.....___............gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width......_......... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ ls.l Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 __........ •-------------------------------- -•••----------- •--------- •---------- •-••••.......... ••--.... -... •---- •--------- •••-------- _............ •----------- Descriptionof Soil.........................................................I.......--•-------....---•-•---••----------•-•-•••--•----••-----•-•--------------....-•----....__......••_--_.. x w U Nature of Rep#s or Alt e�rations—Answer when appli ble_.__r ! •. ............ 3 �d f / dUfK.. .. Agreement: G /4 ✓/- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI14 5 of the State Sanitary Code—.T e undersig ed further agrees not to place the system in operation until a Certificate of Compliance has be�� y char of health. .Signed_ --.. .\ _.... Application Approved Bye.�71 , .� 1 f_�i ......... ---- -•------ ---•-• ! Date.. Date t.Tf`g Application Disapproved for the following reasons:.............................................................................................................. ------------------------------•--•-•--�./....__...--•--.._^.--.-..__...-_..................•....._........................................ ......_.._. .........---•-•. Date PermitNo......C................................................� G _ Issued-....................................................... Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA T ... ?. ? ...................OF...... .. .. ... '..:..: f°.....__...._.............._... Trrtif irtttr of Tomplittnrr TH IY-"**TjQzCERTIFYT at the,Individual Sewage Disposal System constructed ( ) or Repaired by---- = '� "......r .f ..� !---- --------------- •--------•-• -----•-----------...........----......----•-•-- ------•-- ::: at......... 12.e..- =I S ( off has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod as de cribed in the application for Disposal Works Construction Permit No_ �=?.......................... dated_..:. � _.f_� :.��'°a................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO A S ACTORY. DATE °mil ' Inspector.::....._._G�... :. ..._•--•• ....--- _......----••-•-••••-- THE COMMONWEALTH OF MASSACHUSETTS ,.•-�''T BOAR OF H A TH 02 ....................OF..._,:..! ...1../ ................................... No..�.................. FEE..r ................ 19W.Vosal Worko Tonotrurtion "prrmit Permissionis hereby granted ...................................•-•-------------••------------_..-•--••---...---••-----............._..................._...... to Construct or a air ((,�..fi� n Individual ewage Ili sal System atNO... f1. ""''i i� �•� -------�-;��%-...---....-c.:.% ...-,•- ------------------- Street as shown on the application for Disposal Works Construction Permit No................ }:J_':: DatecrIZS.A4..J "` �, ----••-•.................. �_ L .�f YP 4. ( *�+^N' 2__---_._....______.--.--- DATE....... Board of Health s .. . ' •. FORM 1255 A. M. SULKIN, INC., BOSTON