HomeMy WebLinkAbout0080 ROBBINS STREET - Health 80 ROBBINS STREET
Osterville
A = 141 — 074
No . .�_--- Finc'-0?.................
THE COMMONWEALTH orMAssAo*ussTrs
BOARD OF HEALTH
......OF....... ........................................
��~~° ��
�����������u� ��� ��x�������� ������ ��uv�44���mwu� ��rrmit �
� Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal
s at;e2
-'u2�� �
---- ''------`------'''-------------------`----'
A"��"
-__- -'-_-____---_--_-__--'____- -_-_.--_-----_'__--_---.—_.-.---..-___'- �
�a� ���
Ivne t� DoOd��p Size Lot----------------------------Sq. feet
DvrcU' --2�o. of Bedrooms------__---.---.-.Exyuonin� Attic ( ) Gncba�c Grinder / )
Other—Typeof Building ---------- No. of persons---------------------------- Showers ( ) --{Cafeteria ( )
(}tbcr fixtures ...................................................................
------------.-----_--.--__----Dcsign Flow--------------------------------------------gallons per person per day. Total daily flow------- gallons.
| Sep|icI:ok--LiqnN .--'-galoos Length................ Width............... Diameter................ Depth------
Di000az Trench--No --------------------- Width-------------------- Total Length-------------------- Total area--------------------sq. 6.
Seepage 9b Nu_.----_ Diameter.................... Depth below Total leaching area-----'-Sq. 6.
Other Di stributioo6ox ( ) Dosing tank ( )
~~ Percolation Test Results Performed bv------- ---------------------------------------------------------....... Date......... ----------'---'
Tes Pit No. l----------------minutes per inch Depth of Test Pit.................... Depth to ccouoJ water----------------
�14 Test Pit No per inch Depth of Test Pit.................... Doo16 to ground wutc,'-'---.'--
0
D of Soil
-_-.---_-------_-___---__�---._-_-----.--_-___'-___----_----------_--
-------------------------------------------- .........................................................................................................................................................
U Nature of
-----------------------------------
| =s^=e^="`'
The undersigned agrees to install the uforcdexcribcd Individual Sewage Disposal System in accordance with
the provisions of �
operation until a Certificate of Compliance has, e
ssued by thie,�,ar/of yealth.
_'"-_� ----_--_ .......
Date
Application Approved By------ .......�. ' ....................Da
'
~^ u"� `
Application Disapproved for the following reasons:................................................................................................................
| -------'--'---'--'-'--------' -----------'--------'--
Date
Permit
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
O F.......�P'!4.. ..! ....................................
Apphrtt#inn -for :41!ipoiial Oorks Towitrnrtion Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair (0 l an Individual Sewage Disposal
Sys at: �"''' ,
...V W':.:.._ .._. .. -- ------------------------------- ---------�------__..._ .._..-._--.-_......._._........_....____......__._.......__....
L a' n•A r ss ��° or Lot No
--------•••-•. ----- ------ '=••- --•--- ....._ v ira
W Ow ' Address
Installer Address
Q Type Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.-____-___-_____-_-__-_---__ Showers ( ) — Cafeteria ( )
Q' Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow---:-..--__-.-_------_--------._....------..gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width------------._.. Diameter---------------- Depth.----_-_-_.._.
x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..-.-.----._-__-_-sq. It.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation.Test Results Performed by_--------------------------.......................................... Date-----_----•- •-_------------------
,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.-------.__--..___-----.
44 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-------_-_-__-_--_---. -
p4 ------------- -------------------------------------------------------------------------
••••---------------------------------
0 Description of Soil----------- ------------
x
W
U Nature of Repairs or lte at ns—Answer �y h�en�applicable_____________ _____ ____________.___..._..............._.__.__________..____...._..._____.......
�" 1�`" "�
---------------------------- --------- _� --------------------------------------------------------- ----..-----------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary e—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ee iss ed by the, ar "of alth. +
Signed... 'CG'1�H
p" Date
Application ApprovedBay---
44� ..0......
r
ate
Application Disapproved for the f ollowiing reasons:.............................................--•.................................•-•-------•--••.............--
---------------------------------------------------------------------------------------------------------.--__--_._---_-_._---_-_-_-.-_-_-_-_--_---_--.-___-_-.-....-.........___._..........._..........
Date
PermitNo....91--------------------------------------------- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF FWALTH
........... .J.......... C}F................... ...................: �- .................:
Trrt firtttr :of-.0ampiittnrr
THISrV TO CERT Y, T,ktat the idual ewage Disposal System constructed ( ) or Repaired ( _
bY--------------
--------------- --------•-------------------------------- -----
--- -----
alle
has been installed in accordance with the provisions of Article X1_.Qj The State Sanitary Code as de crib/ed.,in� t e
application for Disposal Works Construction Permit No--------- �?_......................... dated................_1 ` ..
THE ISSUANCE OF THIS CERTIFICATE SHALL, NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WIL FUNCTION SATISFACTORY.
DATE- -•••--. -•-- _.. -ly ......-------------•-------------------- Inspector------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA-LET--H----
No.......f FEE........
�i��rr�tt1 a�rk� � �nrfin$ �rrmi�
Permission is hereb granted.__.__ �n4
_.... ....... ....f ..
to Construct or
P
Ir andu Se -ge-----:----:sal System-------------•--•------------------------------------•------....-----
at No. i ..
Street
,,rr��
as shown on the application for Disposal Works Construction Permit No-----c9�_. Dated-_-----... .- ..................
--..... r
Board of Health
DATE a" ---------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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