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Home My WebLink About0099 POND STREET - Health 9.9 Pond,St. A= 118—030.' 002 1 - Osterville - i' No.../J::77. Fps.......`®.0 ....... D® THE COMMONWEALTH OF MASSACHUSETTS ' BOAR® OF HEALTH T&t .....�e.� ,�.�----..._.oF.... L ----------------------------- \' ApplirFation for Uh4pooaal Works Towitrurtiun ramit i� Application is hereby made for a Permit to Construct Q< or Repair ( ) an Individual Sewage Disposal 1ystem t Lof- ion-Address r Lot No. .... Owner Ad ess W .................. .................... Installer Addre s / Type of Building Size Lot..../ . t U Dwelling L—No. of Bedrooms...............-�1�_...__.________.____Expansion Attic (A0 Garbage Grinder ( ?s Other—Type of Building _._._.. No. of persons............................ Showers — Cafeteria (` Q' O er tures .. W Design Flow._ --`41.1J gallons per person pe t day. Total daily fqw______..._1��x '__________________ Ions. .....--- WSeptic Tank—Liquid capacity!��gallons Length_lU_.-__- WidthAk�A... Diameter---------------- Depth.--.:_ '_.. x Disposal Trench—Nq_ ____________________ Width.. Total Total Length............ Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter....... Depth below inlet.....___.._......... Total leaching area._ PJ _....sq. ft. z Other Distribution box Dosing tank ) f l Percolation Test Results Performed by._..k,�� f --/`��% -Z&4109)Date_.__.................................... aTest Pit No. 1_..._._. _.__minutes per inch Depth of Test Pit---/9-_-__:_-- Depth to ground wafenccu Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 . ....... ......................... O Description of Soil D-1-=--t�----- 1 _ ......0.6 1�,3/L.-t--•- --/ ........ 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 TITLE 5 of the State Environmental Code—The undersigned.further agrees not to place the system in operation until a Certificate of Compliance has been issued the oard of health. � - r Signed .... - --- -------------------------------------- .. ...... Dale Application Approved By ............ ------ � .--�------------------------------------------------------------------------ ----- �-r7e^.^J? Application Disapproved for the following reasons: ......................................................... .... .......... . ...... ................................ ............... . ....................................... ................ ... . ..................... ...................... ................................................... ........................................ Permit No. .......G 73......2.7.� Issued --- -------------------..Da.... -- -------------------------------- Dare No......................... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF- HEALTH , � � L App ira#iun for Disposal Works Tonstrnr#iun rrrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System, t �_ ....... -. ..........G .................. ..:. ---.......----.----_---- -•--...-----•-----------................................. Lo ion-Address W/ r Lot No. Owner A ress Installer �/l� 7 A.d re s / d Type of Building Size Lot..__.... . . ...... q--feet U g— Expansion Attic ( lJ Garbage Grinder �, Dwelling�No. of Bedrooms................. __.............. Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' O xtures .. W Design Flow._ er -f... .�........._gallons per person per day. Total daily low----------- ............... gallons. WSeptic Tank—Liquid capacity l gallons Length_—/ ..... Width..:P... Diameter................ Depth.•-_�.-.... x Disposal Trench—Nq- ------------_--_ Width_._..._._._....._ Total Length....__J.__.._ Total leaching area....... sq. ft. Seepage Pit No--------------------- Diameter.......... ...... Depth below inlet.................... Total leaching area...T/_ ....sq. ft. Z Other Distribution box (V)` Dosing t�� '—' Percolation Test Resu s Performed by..__ '� /� _. . _ . _.�`��U 'j Date- a—�' lC U ,aa Test Pit No. I......___G�___._.mmutes per inch Depth of Test Pit..` .......... Depth to ground water.CY /-^' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' t _--------------------- I ' --(.........F.............................. •---•-------------- D Description of Soi10 ' -- ....- --tom---•-•--��'�� G f---L�-.... ......^w/c H. -`�.-•-••--- U x� yy.?� . f W1?! ram=". ---------- ..................................................... ••-•---•---------•-----------•.........•--•----------------•-•--•---•-------------•---••-------••---•---......------•------•----------•••-•--••--•-----•---•---•-••••--•-...._......---•--••--•-•-•---- 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedjjK the board of health. ,Q d� ? Signed ....-:%;�.=�'".\�..�"':..... ................................................... ....�.----�--...-----L....--Z------- Dace ApplicationApproved BY ...,:,- ........ .......................................................... ............................................. - .,5....-.�.J llace Application Disapproved for the following reasons: .................................. ........................... .. .. ....................................................... ............................................................................................................................................................................................... .-.-.-------....Date ---------------- Permit No. ( !�.............................. Issued ....................... -------------------------- Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,lvim._k.).............. OF ---il ....I------. ----. Certificate of (farayltan e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (k) or Repairedby ( ) -------- - - -------------- ----- -------------------------------- .............................. at ---------4�.r......� ....... ......... 4-AA:------ ----------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ............% 7.7........ dated. ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... ..................... .......... ... .................................... Inspector -....................................................................................-- -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH . Zru')ti.........OF.. �l..N..!1. .. No.... .._...!..�... i FEE........................ Disposal Vorks TDunu#r ion rrmi# Permissionis hereby granted.......................................................?.........................................................................------.----- to Construct ( ) or Repair ( ) an Individuaewage Dispo�sal-ySstem at No. .?j` 1 �= Acwo--- ;•i# �,� Sc "C;-•- _'�f......................................... treet as shown on the application for Disposal Works Construction Permit No._................. Dated.._._...._................._._............ ........................... ............................................................... DATE........... -----•-----------•-••------------ -- Board of Health FORM 1255 HOSES & WARREN. INC., PUBLISHERS �\Lo K Soy. =g95cT� S�-�I'�L`Tp.►u� : 3�X 2ac�90 = l0�00 Fx�s .. 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