HomeMy WebLinkAbout0284 SCUDDER ROAD - Health 2 34 Scudder Road
Osterville
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD
OF....... - .. ..........
Apptiration for Disposal Works Toustrurtion Vrrmit
l Application is hereby made for a Permit to Construct or Repair an IndividuaY Sewage Disposal
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System at
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------ .......... ---•--•--•-•----•- A ..................•----•-•---•-•••--•-•-.
Location-Address or Lot o
pwner /�yt jAdds ess P
14 Installer Address
Type of Building Size Lot__ I . 9 -.._._.Sq. feet
U Dwelling No. of Bedrooms_____________ _ -___-Expansion Attic 4 Garbage Grinder
per-, Other—Type of Building -=..• No_of
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 inl t_..__... _ ....__ Total leachi area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) � G •� .3� �/�-<�
a Percolation Test Results Performed by..........................................................................
Date----------------------------------------
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----_-___-__________-_-- .
Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_____________________-_-
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UNature of Repairs or Alterations—Answer when applicable._____________________________________________________________________________-----------------
------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual aSgspge Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code I he undersagnedurther agrees not to place the system in
operation until a Certificate of Compliance has beeff-itUd b tie o ,d o lealth.
Application Approved BY a /���
Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------D--e--------------
.._..---•--------------------------------------------------------------- --------------------------------------
r Date
••---- Issued.. - --- ----- C�
Permit No. -•... .._..---•--
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THECOMMONWEALTH OF MASSACHUSETTS
BOARD OF H� � '
........-OF.7,;
.. �....---•-•--........
Apptiration for liiipao ai Worko Tomitrurtioaa Prraatit
Application is hereby made for a Permit to Construct ( ) or Repair (/ an Individual Sewage Disposal
System
✓o iLW S A
L cation-Address or Lot o.
C's �V; - dr ................................•-... G�6__&!E IAIIN...�l�
�wner TAdd ss
a n Fl /
----------. ------- ------------------------------------------ --- ? l/...................
Installer Address
Q Type of Building Size Lot__/$_A1 ...... feet
V Dwelling—No. of Bedrooms------------- ..........................Expansion Attic (NU) - Garbage Grinder (yG,o
pa, Other—Type of 31c�i �e rr- r�yVr` Sbawas
P-4 Other fixtures ......................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W Septic 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 inl`e�__..._..___._____.. Ttjal leachi area--------------_---sq. ft.
z Other Distribution box ( ) Dosing tank ( ) Z/
a Percolation Test Results Performed by----------- ..............................................................
Date-------•--------------------------------
,� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water___---__-_--_-___------.
PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_---_--__-:___-__--.___
a' _ t-- - ' _ l--
D Description of Soil------------------ ----•-d - `��------------------------ ----� --- -- -- ===
W --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable---------------_------------------------------------------------------_-----------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------
Agreement:
The undersigned agrees to install the aforedescribe Individual S age Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code he un ned urther agrees not to place the system in
operation until a Certificate of Compliance has b- d b he d ealth.
- �a 7/ <
Application Approved By-------------- ----------�-•-------------------- ---- ,
f-------- ----
Date
Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------------------•.-
--------•-------•-•---•-----••-•----•------------------------•---•----••------•---------•--------•---------------------------------------------------------- --------•-•-............................
/DaPermit No.-------= =- ---------------- - -= _ Issued f -
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA4.gH
........OF............
.........................................................................
T� ;ifirate of 'W"Ump iaatrr �
THIS j�- T CTIFY, hat "1 ndividua�Sewage Dispos 1 System constructed ( ) or Repaired ( )
(�"
by---•------ --J-•-•--------------•-- -••-••----••--
�� 4 InstalleY
at - ---------------------------------------------------------------------
has been installed in accordance with the provisions of Article 0,I - The State Sanitary as reed in the
application for Disposal Works Construction Permit No......................................... dated---- �_�...___.`.................
TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL F NCTION SAT.' FACTORY.
DATE------ ----- -- ---f. ...... --- Inspector....................................................................................
TH,E MMONW,EALTH OF MASSACHUSETTS
BOARD °•OAF, H.EAL`T _.
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No......................... FEE_..................
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� -�Permission�ts'hereby granted �/ - ---------------------------------------------
N. to Construct ( o'r Repair ( ) an Indi iduaY Sewage D sp ya St m
at No.........
= -
Street }
as shown on the application for Disposal Works Construction Pe wit Dated___.
-- -- ,.mot
Board of Health
DATE................................................................................
.. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS q
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