HomeMy WebLinkAbout0137 REBECCA LANE - Health 137 Rebecca Lane
Osterville
A= 146-055 /
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� .............Fas..r..D.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HE T
.......OF....
................ ..................................
AvAration -for 'Uhiposal o7or
T strurtion Vantit
Application is hereby made fora Permit to Construct Repair ( ) an Individual Sewage Disposal
Syst t
---- ............... - ----- -------------------- -------------�.� ---' ......
e c tion-Addr (s.�sLJ— or Lot No.T
—f��(' Own ` ••••••Address
2 -
Installer Address
UType of Building Size Lot_�'S_��__�____Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
�-1
aOther—Type of Building ---------------------------- No, of persons............................ Showers ( ) — Cafeteria ( )
Other fixture_s� = •--__.__-•-•---•----------------
w Design Flow...... �_�__--_p_.-gallons per person per day. Total daily flow.............�_.__l�_62...........gallon,.
W Septic Tank—Liquid capacit/aMallons Length---------------- Width................. Diameter�"'gl
---------- Depth...----.--.-----
x Disposal Trench—No..................... W . ................... To gth....._.. ..--- -_-- T 1 lea area....................sq. ft.
Seepage Pit No....../&l'C_�D � e -=- -- - a eac _area----------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) �C7p- le- /? '7
aPercolation Test Results Performed by.......................................................................... Date____-__--_---------------------_-------.
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water....--_.------.--.-----
fZ4 Test Pit No. 2________________minutes per inch Depth of Test Pit--_-_--__._____-_--_ Depth to ground water------------------------
O Description of Soil ---d ...... � •-•-----". ... -
x -- /_=- l - � ..
w
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 NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b issued b lie board of healtl
P Y G'
igned... ---- _____l�/---_----------
--...•. - ` Date
Application Approved BY--------- - ----- - ---- J��E -- --- ------•
Date
Application Disapproved for the following reasons:.._.. ----------------------------------------------------------------------------
----•--------------------------------------------------------------------------------------------------•---•-••--•-••-----------•--•-----•---------•------•--•-----------._....-------------•-----•--•--
Date
PermitNo......................................................... Issued...............................................••_------
Date
P bra
FE s..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE4,LT-H'
--.. ......... .`4--ewfV_' "........OF.... ".'..... ...................•-�" ..................................
Applirntinn -for Bi,gvv,ial ark!,�_ tstrnrtion Prrntit
Application is hereby made for a Permit to Construct �' or e air an Individual Sew age Disposal
Systern,at:� l �
.................----
f Ld anon Add r ss A o Allr Lot No.
...
�,J Owne �/r,//,�//'rr ��J Address
UAddress
Type of Building Installer
/f Size Lot. f_._ _" .__Sq. feet
.� Dwelling—No. of Bedrooms--._______G__________.......................Expansion Attic ( ) Garbage Grinder ( )
aq Other—Type of Building ____________________________ No. of persons......................_----- Showers ( ) — Cafeteria ( )
Other fixtur s. . �.- - ----- ---• -------------•--•----
W Design Flow...... � _ �-___—gallons per person per day. Total daily flow............. .. ___� �--------.-gallons.
WSeptic Tuck—Liquid capacity/ � allons Length................ Width_.............. Diameter---------------- Depth---------_.-----
x Disposal Trench—No- -----_------. -__ Wul€i°-------------------- To ength........ ________.. T�,�lea 'ttg area--------------------sq. ft.
Seepage Pit No....../`-fe--�/r_6�Diai "_°�---_ D if �w e _.. G-_- -._. To aIea ttTig irea�-G----------.sq. ft.
z Other Distribution box ( )II Dosing tank ( )� /U' /y '
aPercolation Test Results Performed by----------------------------------------------------------- -__ Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Kest Pit..._-_-___-__-___--- Depth to ground water....-.-_----.._.__------
(% Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-..--.---__--,------.._
o � C ------ •. ..............I-
Descriptionof�Soil- i ....................... '-=`--------- ------.._---- ------------�� ---T�---. _...-------•-------- ------------------
x -%z--- / ,,j� e '� -
c.� ----
"�i •••% "
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 Article XI 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:- f
J.
(�, lam,"1, , � ���e✓t /,�F �/ /� t/j
igned.... . •••-- ----• --—------------------------•--_._._...__._...-
PP PP y--------- � ,� - r U Date
Application Approved B ___-_-- --•__-----•_-•-•- _" _ -_ ---�.li� ,._ .. ---------
Date
Application Disapproved for the following reasons:----••--------••--••-----_._-_--•----------------------•------------------------•-------------•-----------------
•••---....-•••••-•--•••---••--...•----------•-------------------•------•--• ----------------•--------•--------------------•-------•••--•-----------------------•------------------------•---•-------•---
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA THE
I
.........................................OF...'� !'?r t'���.... ✓'��
. ..............:.................................
Cnrdifirate of fInntphaurr
THIS S,TO CERTIFY, hat the Individual Sewage Disposal System constructed or Repaired ( )
`�, Installer f �
-----------------
at_-------- 11
-✓f t! f.�F .✓ r
has been installed in accordance with the provisions of Ar 'I of TI State Sanitary Code as described in the
application for Disposal Works Construction Permit No..... .......... ___..__. dated..-._�----_Z_C- .�_�__.____.
THE ISSUANCE OF THIS CERTIFICATE SHALL, NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILD. FUNCTION SATISFACTORY.
DATE `ti -- --�y-----_------------ -- Inspector.
0?_1`2 -------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
OF
No.............••••••••--- FEE......' .............
Di�p�a� 3unxk,� C.YP�t�.�-..."..n°..t��rrntit
n
Permission is hereby granted_______ __.a_ ! G'"L-_.____._.__. `-.'�,•�
to Construe( fj for Repair ( )�an Individual Sewage Dfsposa] Systrfi�
,r
ee
as shown on the application for Disposal Works Construction r it No_ ____ ____ ____ _ d-------_-_.-----__-.-__-_________________
elcee
3 Board f Health
DATE_/1._`. .. ...
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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