HomeMy WebLinkAbout0047 POPLAR DRIVE - Health 47 Poplar Drive
osterville
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No....... Finc..... ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF 'HEALTH
_ of ... .. ---------------------------
Appliration -for Ii,4putiaI Works C otuitrurtion Vrrufil
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: _
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... 1�-------✓��'-- E-------------------f �1 "......--_---------------------------.---.-•-------�--------.---.------•-------.---•--- --
Locaf dr s or Lot No.
Owner -Address
a /fit - --------------------zly.0-�-r- f&Z)._If Z..
--------------------------------------- ---- -
Installer Address .r- Ov
Q Type of Build, Y Size Lot..fJj_D_ ------------Sq. feet
U Dwelling—No. of Bedrooms_.___.._. ___-Expansion Attic ( ) Garbage Grinder ( )
PA Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) Cafeteria ( )
Other fixtures ----------------
W Desi n Flow______________ _ ® gallons per person per day. Total dail flow............................................ allons.
g ,�� P P P Y Yg
9 Septic Tank--t Liquid capacity/l£'--_ 'gallons Length---------------- Width---------.-__.. Diameter---------------- Depth...-.-_--.---_
W Disposal Trench— 0_ ____________________ Widtli_._.__.__�epelow
en�t ?_ Total leaching area-,._--._----.------sq. ft.
inlet_______ _____ ____ Total leachingarea_--_--.-------__-_sq. ft.
Seepage Pit No.....................Diameter__�
Z Other Distribution box ( ) Dosing tank ( ) OAS _ .�G — �� '— '5/7-
Percolation Test Results Performed by-------- ----------------------------------------------------------------- Date--------------------------------------..
Test Pit No.. l................minutes per inch Depth of Test Pit_................_. Depth to ground water..----__-_--_-.-_-.
fZA Test Pit No. 2......_.........tiiinutes per inch Depth of Test Pit-------------------- Depth to ground water-_.-.----__--_--_-_--.-.
a+ ............a--- �--t------ -- -- .............
Descri Description f Soil-------- �`.. �' � �1��'�.... - -- -�--- �`
P
y
x ------t- v -f +�4
14
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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ssued by the board of health.
Application Approved BY........ ---- - ---- at
- +
Application Disapproved for the following reasons_____________________________________._._....--•-•-----•---------•---•--•--......-•-•----- Date ......----••-
--•-•--..._..---•-----..._-•---•------•----------•------•-•-•---------------•---•---------------•----•----•---_..-•-----•--•--------....---••--•---•------•----••------------•-=•-------•---• ..........
Date
Permit No......................................................... Issued.---&- /-�Z_ -A
Date
`------ --- --- - -_ -- - - - - - --- - - _
- -Sit.----------
_ -..
No........ -._`j?....... s a• FRic ...j.® .. .
THEE, COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,....:....---OF.......
Gi4 -.------------------------------
I
� lirtttiutt -for Di,ivuiittl Marko Totuuurtiott Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( x• ) an Individual Sewage Disposal
System at . '• `'
J rje �l/ 1 ' ..-------- .��----------- ---- 7
-------------------------------------
-
�y / /�'/ .L __..._ /mil�`
}Loci !! !_ 5� -- !_.lC v _ �_t./`l' � rlL(__o_.._V_r.. ...� �!4 TG ,
Owner ress
In`sttallei Address D t �
Q Type of Building. Size Lot-./ _o_______________Sq. feet
U Dwelling o. of-,Bl,edrooms---_- - -------- -Expansion Attic
( `, ) Garbage Grinder ( )
a, Other—Type of B'tulding .......:........:........::: No:M p'er"soles------------_._-._..:•__.:-- Showers ( ) — Cafeteria ( )
Other fixtures ------------ �`='---
�" nn -^�
W Design Flow_______________3,/'_ ..................,-:"gaallons per person per day. Total'daily'flow_-__... --~.-. -gallon~
WSeptic "I;ank l Liquid capacity/Yllons Length................ Width---------------- Diameter.-_._. -------- Depth-__------_----.-
x Disposal Trench }jo_ .................... Wid h.:.__-. .'"- T a n Total leaching area----.---_-_- -____aq. t"t.
r / D-pfI4J5 Seepage Pit No___ _______________ Diameter_ ._ e elow m t..._._- -_-- ___ Total leaching area-----------f_-•---Sq. it.
Z ` . Other Distribution box ( ) Dosing tank A/71.
'~ Percolation Test Results Performed bY--------- --------------•---•---•--•'•---•-•--------- ................... Date----------------------------------------
' Test Pit No. 1---------------minutes. er inch •,,Depth of Test Pit-------------------- Depth to ground water----------------------
Test Pit No. 2_j._____.__._.minutes per inch Depth of Test' Pit.................... Depth to ground water'-...........:-----------
-t�''
escription f SOil--- �'.. ra„ _ ----
x - -; - -------------------- --
. ----- -
V 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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of health.
yved13
Application Appro -= �Q". . - 7
_'Date
Application Disapproved for the following reasons:----••-------•••-•.......-..............................................................
- Date
PermitNo........................... ......................... Issued----• -•---------------------•--.....................
Date
Y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF .HEALTH
wr i. ; _
...... .. ..Z!f(.... ...............OF'..........` ..,G f.!fr!�!IIG - .. ........ ............................. ag y
F„ (grrtifiratr of 0.1,11mplinnrr
T IS IS TO CER IFY, at the Individual Sewage Disposal System constructed ( or Repaired
by a ? ast- ..., --- --------
__.
�I Installe . •••-
Q�/f� J�1' •.--
.at1, _
has been installed in accordance with the provisions of Article ,e XI of The State.Sanitary Code as-described in the
application for Disposal Works Con struction•:Permit No---------- ---------------- dated'._10_",2_ ...............
THE ISSUANCE,OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SAT FACTORY.
DATE-4_-°"...~-- � ........7 -=---------------------•-•-- Inspector
THE COMMONWEALTH OF MASSACHUSETTS '
•: BOARD OF --HEALT
cc! o F
w ......... ........-- -.....-. `
No -----•••=-••••••. FEE...�•�-•••-• ....
;xs *...:� Dur;:V111i 1 Morkii T mAr licit rrrmit
Permission is hereby granted_____A110_*y..M_2Zkj .......................................
to Constr jA or Rep 'r ( ) all Individu Sewage is
yste 1
Street
as shown on the application for Disposal Works Construction Pe it N `------ ----------- Dated_. -'."-2 '�-7'Y,____•:_____
yy r Board'of Health ~
DATE_-_I-a'4 j` Z-l-- ................................................
FORM -1255 HOBBS & WARREN. INC., PUBLISHERS ,,
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