HomeMy WebLinkAbout0046 OLD EAST OSTERVILLE ROAD - Health 46 OLD EAST OSTERVILLE R �
Osterville
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LO CAT ION�� / SEWAGE PER!-MITT WO.
VILLAGE
ASSESSORS MAP NOA
I N S T A L L R S N A M E i A D D R E S S
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S UILDE R OR OWNER
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, DATE PERMIT ISSUED 7-•c L
DAT E COMPLIANCE ISSUED / 1�1
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No`....... --=-7 q 9 Fn$................
THE COMMONWEALTH OFUuMASSACHUSEETTS
-. ....Q Z4...................OF.... ............. ............ ............ .........................................
Allp iration for Disputitt1 Works C_rrnstrnr#iun Prrntit
Application i ereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at j�
.. 0---®. .......... ..................... .... ...------.. . ..------......----------....----------...
. .... ...
',/ cc pion-Address -----or Lot No.
- .. f......... .... .•-•= '.--r--•--------.......................... ........................_ ..............................................
owner Address
a .....•-•.............. .............................•---.........-----........---------......... --....----------....------................--------------•---------------.......-----..............
Installer Address
Type of Building Size Lot4..............Sq. feej
Dwelling—No. of Bedrooms,. ................ ..Expansion Attic ( ) Garbage Grinder}
�/
Other—Type e of Buildin ______...._. No. of persons............................ Showers — Cafeteria
Pa YP g ...... P ( ) ( )
Q' Other fix r .....
W Design Flow.............. •. `` _._gallons per persorbpe ay. Total it flow...___... ��____.._______.____ lons.
WSeptic Tank—Liquid capacit} --------..gallons Length.-27 ... Width. .... Diameter................ Depth.-�----------.
x Disposal Trench—No..................... Widt ....._ ___._.__. Total Length........ _.. Total leaching area... __ ___. sq. ft.
3 Seepage Pit No.40� ._/lameter./ . Depth b ow inlet_.__.._....... Total leaching area ._.sq. ft.
Z Other Distribution box (i 4Dosinf 'Percolation Test Res s PerformeaN. .!................®../. ....._..... Date..ZAA-AnTest Pit No. 1________________minutes peh of Test Pit../1__._...__._. Depth to ground water..��..........,__.
Test Pit No. 2................minutes peth of Test Pit.................... Depth to ground water........................
W' ._-_••- ---------------•---•---.......... ---••-----..................................--------•---------.......---------.....•-----............._...
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
V .....-----•••----•----------------•----...........-------•-•-•••..............._........-------------•-•-•------•-•-•----------•-•----•---•--••----------•-----••-•••-.....------------........._....•...
W •-----•-----------------•------------------•----...--•-•-••--••------------•----..............-•------••...•-----•--•••-----------------------.........................................................
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 TITL LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance e i is e y the board of hea .
Sig d... ----•. 1���.�>
atei
ApplicationApproved By.................. •............... /------------------------•----------------------• --•-...... 2. ..!•�_..
Date
Application Disapproved for the following reasons:................................................................................•-•••---•....._............_.._
.............................•-----....-----------------....-----•--•------------•--------...................---........---------------------•---•----------------------....---•--..............---------
Date
Permit No....----.::� ........_..L....I_—,_ Issued-------------------------------------------------------
Date
a Iy..
FzB
�T
THE COMMONWEALTH OF MASSACHUSETTS
---- BOARD OF HEALTH
� ,.
r' .....................oF.................:..:.................
Appliration for Disposal Works Tonstrttr#ion Prruti#
Application is hereby made for a Permit to Construct (t'✓)Repair ( ) an Individual Sewage Disposal
System at
';:> C r '. ..............�--f�'u�. _................------•---•.............. ....................................................
................ . .. ..... ---
�• / L ca�tio'n�-Address .. or Lot No.
l �lJ!!u ..................••-•••--•............... •......--•-•---.._........-•-••---..........•• •-•.....-•----...........--•-............-•-••-
Owner ........-•------•-------•-----------•------.Address
W _
Installer ........Address
Type of Building Size Lotgl>...<..............Sq. fee c
U Dwelling—No. of Bedrooms ..................................Expansion Attic ( ) Garbage Grinder �( e)
H-I
'� Other—Type of Building No. of persons............................ Showers — Cafeteria
Q' Other fiat r
WDesign Flow_______________`-., ____.._... .__._._gallons per person. e day. Total it"'flow-•---•---. ... ____._._._____.____ lons.
WSeptic Tank—Liquid capacityr•4T---gallons Length--------------- Width.-._':' .... Diameter................ Depth...-----•------
x Disposal Trench—No..................... Width.................... Total Length............G./. Total leaching area..............-.._sq. ft.
Seepage Pit No.VIVIA, _._ iameter.. _.l_� Depth below inlet.........../----.... Total leaching area. �� ..sq. ft.
Z Other Distribution box (1/j Dosin t 7 €l r
Percolation Test Results Performed by.__ .!:.:__��!.................................................. Date.-_--_/%..........
-r
Test Pit No. 1.... ..minutes pe inc�� epth of Test Pit_ ............ Depth to ground water........0.............._
fi, Test Pit No. 2................minutes per ifi& Depth of Test Pit.................... Depth to ground water........................
a •-•-........•••-----------•---------•-••..........................................•-•-•-•-•••......•.........................................................
0 Description of Soil.........................................................................................................................................................................
x
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 TITI,4 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...... :: .: ..- - ....-•-----•-•............... 1`j� - -.. f
Application Disapproved for the following reasons:.......................................................................................... Da e............_
••-----••-----•-------------•-------------•-•----------------•---•-------......------------•-----•---•-----•-............-------------•------•-•--•------------------------------------._.... �"
o-
Permit No-------- ems . ------�-1....I---- Issued............................................Date
Date ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD < F HE TH
/ o F............./�.�!'..............�.......
7y
Trrtifiratr of (Soutplianrr _
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constr cted Repaired ( )
by---------------------------------------------------------- ........................................................e.,^`..••-• '--..:...-•---..........................--.._..-•-••••--•--
f � Installer —
at_-.---'�s�= " ..........
l -:- /�.('--.fir----�`----=1`--.----?-a ------'---------------------------------•---------••-•---•-------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No,. .... _._.... dated_._.`' . .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....................................•--....-•---....-••--------•.........._.... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD/OF HE
.....................O F.. ti 1/%w..........' -../u: �
Na5-. '............... FEE......... ....
Disposal Works Tonotrurtion Vprrmit
Permission is s-he.eRbypgranted)�----'•Individual Sew%ge Dsposal�Sy tem�.:-._-•-•-..�•..•-•-'-•--------•---•-----.--•••-•----•-•••- +I
to Construct_ ors e airj
at No.. „-
�............. - Street
/ .................
as shown on the plication for Disposal Works Construction Permit N _-7_j.cj Dated. .__ _a-./`` ..........
// Board of Health
DATEi .------•---•-•.../�......................................
FORM 1255 A4.r''M. SULKIN, INC.. BOSTON
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TOP OF.FOUNDATION .
:.� CONCRETE COVER
CONCRETE COVERS
4"CAST IRON 12��MAX. e�' XO
OR SCHEDULE 40 12"'MAX.
P.V.C, PIPE ''4"SCHEDULE 4'0 P.V.C.(ONLY)
PITCH 1/4"PER.FT. PIPE- MIN. LEACH
PITCH I/4"P.ER.FT. PIT. PRECAST
INVER
jO y -( LEACHING
o T_ EA
ELfpXS•• INVERT INVERT % . �' Q ; PIT OR
.'. SEPTIC TANK DIST. w EQUIV.
. • INVERT, EL.`/.Sc�:/.. . .. BOX .ELr:a:�z� '�: >_ 'i:
• ./1DOO,,, ,.CAL. INVERT INVERT v°' :i; /41'T0II/;
ELM.Y w 3
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EL9lvr`.S� ��� WASHED
L ST NE
7 W DIA.
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PROFI LE OF ^/b GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
P- 7,
SOIL. LOG' WITNESSED BY :
DATE ? f/YG:.... .TIME..... .. .... . . . . . . BOARD OF HEALTH .
TEST HOLE 1 TEST HOLE 2 � S/Ico�'�; , ENGINEER
�ELF,V. n. . .. . . . ELEV.F.. . ... . . . . . . . . . .
DESIGN DATA
NUMBER OF BEDROOMS
TOTAL ESTIMATED FLOW ,0, , , , GALLONS/DAY
BOTTOM LEACHING AREA �,.�J• , , , SO.FT./PIT
�t SIDE LEACHING AREA f c5,-� . SO.FT./ PIT
GARBAGE DISPOSAL . . (50% AREA INCREASE)
TOTAL LEACHING AREA
. :a SQ.FT
PERCOLATION RATE .,'MIN/INCH
LEACHING AREA PER PERCOLATION RATE .. SQ.FT.
l✓D :WATER ENCOUNTERED
NUMBER OF LEAC ING PITS . . . 6AIL7. . . . . . . . .
APPROVED . .. . . . . . . . BOARD OF HEALTH 7T �y• •3GJ ; l!`3 .`•'•�
DATE. . . . . . . . . . . ��iA•c - y5 �P�1.
• •AGENT'OR• INSPECTOR s �4'
• �`' ,Sc f/�pU.c[-' `.!D Pj vF OF F M,qf
70 c xloSS
BI �,
J. ACO �� ,
UPPERCAPE ENGINEERING 1 I 814
�j � 9 t. to
. . . . . . tP.O. BOX 616 ,.� LAc1S1E
PETITIONER,, /��• •� E, SANDWICH, MA 02537 `21,p NAT�'�; `•
. . . .ST. . . . 362-6281