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HomeMy WebLinkAbout0170 OYSTER WAY - Health N � t:4 r r t S•r F " 170' OY46t.: �' �ay�� Osterville A= 671 —y 004; 004, 4, R, I 3 f 0 TOWN OF'BAItNSTABLE °'-7o 0 ysTEcq Lt EATION VVSA. Wye SEWAGE # �8S `J[tLAGI ® i "ASSESSOR'S MAP 6t LOT INSTALLER'S NAME & PHONE NO. 312 - . I SEPTICTANK CAPACITY / { LEACHING FACILITY:(tgpe) (Size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER L ,i t, c -P r,,oS' 09/- ELL 1 DATE PERMIT ISSUED: 4 DATE COUPLIANCE ISSUED_ �— — VARIANCE GRANTED: Yes No �� � g .77 , 0 TOWN OP nAR-_ISTABLE LOCATION d EWAGE # ;�r - ze VILLAGE a� /2 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. S!,PTIC TANK CAPACITY J LEACHING FACILITYArype) (size NO. OF BEDROOMS PRIVATE WELL'OR UBL1C WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No No.... " ! Fi$... ti�..2.... THE COMMONWEALTH OF MASSACHUSETTS i1 . BOAR® OF HEALTH -................ d.�U. 1.........OF....... OLZ Appliration for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: � -- t . � -0.�.. ........... :....... 54 .... ....... � ..." S.......................................... -� - . ............... Location Address // or Lot No __ fL✓i. .. --S1twIA- -�1. loll ... C� tJ��rLL/ic.a.�j ...... VIA Owner ................................Address ..---•-------•---•--- Installer Address dType of Building Size Lot___°-d�_..�L-__ U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) -Garbage Grinder ( Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------- . W Design Flow......................S.S...............gallons per person per day. Total daily flow__._.........________._&6®_......gallons. WSeptic Tank—Liquid*capacity.l&_V?gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._......`.Zl,_._-__-- Diameter.._.....®...... Depth below inlet........ Total leaching area....�'-7_.3.2.sq. ft. z Other Distribution box Dosing tank ( ) / '-' Percolation Test Results Performed by.:�i l- JJJ 9i�oUW.4..., QG_ ��'._.Os._.__ Date...g W.�..!.�n aTest Pit No. 1.....z-.....minutes per inch Depth of Test Pit-------M....... Depth to ground water_-____--_-___- --- f= Test Pit No. 2.... ......minutes per inch Depth of Test Pit........`!...... Depth to ground water.................... •---....••------------------------------------•------------•--......-_........_-------------.------•------------------------ -........ •--- ----------------- --- ODescription of Soil............................................................................. IJ ... A . Ai�U -------------------------------------------------• ........ 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 TI A'U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operati tiila>CC tificate of Complia as been is ued by the board of health. r(0� Signed....... �------- t..................... Date lication A roved B -•-------------••--------------- •----•.. ..-"�3 ^ St- P PP Y zto.- -� J Date Application Disapproved for the following reasons:................................................................................................................ -------------------------•••-•-•---------•---------------......---...-•--------------------••------....-----•------.........-----•--------------...._....---------------------------.........---••_-•-•- pp.. Date Permit ....-----••-•---•----•. Issued....................................................... Date r '1 AA kV t7 No..S 136 Fps... r�u- ....._....._ t THE COMMONWEALTH OF MASSACHUSETTS ,\ BOARD OF HEALTH i3._.... oF...... �.�d 5 J .!3.rs.----------'......................... Appliration for Disposal Works Tonstrnr#ion ramit Application is hereby made for a Permit to Construct ( � or Repair ( ) an Individual Sewage Disposal System at: U�l.. l2r �n!(�. - ....�. -...-•..................... ....._•••--••-..__..._..-- -'� - .....:..._.:. ...... -�=�na :fie=S-•••-• -- Location-Address ! or Lot Nor► ... t Lv4 /�. �E1 V trl.. _vf A' ti�t� :C .......... !�==1JY: 4rL/L�?...... ......................••• ..._...... Owne•--..__.... .... .... y� Address �� .....�.?t.2�1 Address....... ............ Installer d Type of Building ^ Size Lot_ Dwelling—No. of Bedrooms................�f'-_....._......_.____.Expansion Attic ( ) Garbage Grinder '� Other—Type T e of Building No. of persons............................ Showers — Cafeteria P4 YP g P ( ) ( ) aOther fixtures . .---------••• ••••••-•---•-•-•••-•---•--......-••-•••••••••••---•-•-------•••••---------••••-----••••••-•---.......•••--•---•-•••.............•••-- W Design Flow......................9...............gallons per person per day. Total daily flow........................�a�0.......gallons. WSeptic Tank—Liquid capacityAS;�gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-•--__?:-.___-_. Diameter.._.._!.®....... Depth below inlet........6P....... Total leaching area....53.�..sq. ft. Z Other Distribution box (✓) Dosing tank ( ) Percolation Test Results .Performed by. ►� ! 1• 1 �-... eG-...©' ---�-� 4=---- Date....0.1..... � ............. aTest Pit No. 1....z'.._..minutes per inch Depth of Test Pit.......1.2........ Depth to ground water------ ........... Test Pit No. 2................minutes per inch Depth of Test Pit........K3n...... Depth to ground water.....`................. R+' --••••-•-••••••-----••-•-•--••------•••.............••••-•--•--•---••-•...._.........•••••-••---•---......................................................... 0 Description of Soil---------------------------------•-•---•--:---••-------••-•--•----••--_.....f••••••--••••-•••••-----••---......••-•--•-•••-••----•••-•••-•••-•-•--•---•......••-__--- x IJ> 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operat n nti a C rtificate c Complia has bee ued by the board of health. 7 .. SI ned .......... _1_c,. ....__ rc- .. ..... D Y Date PPlication Approved By........ ^'. -- .. -= --.- eDat Application Disapproved for the following reasons----------------------------•-•-•---------------------------------------......---------------------.....- ......••-••••....••-..._••--••-••-•-----•••-•--•.......•----••-------....•-•••-•-•.............•---•---•-••------••-••--••-••-•••-•----••-••••••----••••---•••--••-••••••••••----••••---•-...•----•-•-•- Date . r Permit No....a�:_" I:�_ ----• .......................... Issued......................................................_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T.... ....................... ...................................................... Tatifira a of (gomptiatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( VI/Or Repaired ( ) by---------------- .-:.--•-. __.......-•----......--•-----•-----------•--------•-•-----.....-••-----•--•---•---••-----•......................................•--------- / Installer �(O�.— Oil•-•---'----•-•---,-•---------•------------------------•------------______--------------___--•__------------------ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the .-_�2.(3............... dated___..__... ..................................... application for Disposal Works Construction Permit No....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ..... ........................ Inspector . - COMMONWEALTH OF MASSACHUSETTS BOARD`.. OF HEALTH .. ....................(�WtJ......OF.... .P. ! . ` 1 r'�vl '................... FEE..... -........ disposal Works Tonotr ion ermit Permissi?0i) hereby granted............ .s-!!-?:r...-----t C�---------•...................................................................... to Construct or Repair ( ) an Individual Sewage Disposal System atNo.............-••• T..1-_.(�.-1---------------•-•---�. � ...W... Street -''\\ as shown on the application for Disposal Works Construction Permit Nq� ::1. 6._.. Dated :........................ .............................. -------- .•. -•--•-•••-•...... / _ Board of Health • DATE--------� . Board FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS �L•'�'VEL STABL c AS c - � `���� �� � �,, .I. 6 �M C>+.raY� � !Q:, rat#, ? � {_d N far I-tR ,rx d,. '•do 1 -.� S ,h! ' :< - RROTT0�1+9:� // .�13 8±'..� r ✓ t,! a -y' }L r". . .i.k.d 'fi ,:.If C F .. •V EL i.G.. 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