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Home My WebLink About0819 SEA VIEW AVENUE - Health 89 Seaview Ave Osterville A= 113-003 a p l CATION s SEWAGE PERMIT NO. VILLAGE I TA LLER'S NAME 6 ADDRESS ® U I l D E R 0 OWNER DATE PERM-IT ISSUED MCI r DATE COMPLIANCE ISSUED e.�1 tU2 sly' No,-V.1 ....... Fizz A................... THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH � Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Add�ress or Lot No. Installbr—) Address � -'p __- _ ---~ oo .. . ~_^ Sq. feet Dwelling- � . of 8�drom � -_-- �r6l�r----------'_ ' / ) 04 Other—Typeof Building ............................ No. of persons............................ Showers ( )'-- Cafeteria ( ) 04 ' Other fixtures ----_--------'--_---_................................................................... Design Flow...........................................gallons per person per day. Total daily flow........................................... . Septic Tank—Liquid cupucity---''.gallons Length................ Width................ Diameter----_.. Depth------- D�you� Trench--No. ---- --. Intu ..--_--_-' Iotu leaching area....................sq. 8. Seepage Pit No.------- Diaoetcr-L-_-.-' Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) '- Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water.-_---'-._. f14 Test Pb No 3................minutes per inch Depth /f Test Pit................... Dcothtoorouodwuter-.---------. 94 ---_--_----'_--_--'-_-------_----------'----'-'--'----__--'--'-----__-_� Descr� �� ofSo�---_----------------------'-'--------------------------.--'---------------'--'----- -_'--__.__----'__.-'_-_---___.__--_---_-_------- -..-_-----_-'-__-.-------'-'_-----'-.. �� .-_-------___.--'.._-.-----_--.----_-.---'--.___--.-__---'----_-_--'________. � �� Nature of orAl�zuboox--Anawerwheo ---.-------_-----_-........................................... � __- -_--_'-__------._-_---____- '�~-_-^-^. The undersigned agrees to install the afore6escribed Individual Sewage Disposal System in accordance with the provisions ofZ[THE 5 of the State Sanitary Code The undersigned further agrees not to place the system inoperation until a Certificate of Compliance has been issued by the board of health. S ...-.. __---- ......................... ~ Application - By .. -___--_-----__-- ... Date - Date ` ' No FRs...... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F........ Applirtttion for Disposal Works Tons rnrtion remit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at /mot..�:� ' ......_..- ......................... f _c'rtlL �J .................... -- .. .... --- i Location-Address _ or Lot No. -/- Owner // rJ J/ / Address...................................... ............................................................ l # `•. ...;:! ! ..................%:�...:� ..:..... c f� Install ` C. Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-----=c...................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------•---------------------••----•---------.....-------------------------------------•-•---•---•-----------•-•-------•••-•---------•--•---. 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. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------------- ............................................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_................. P4 ---•......................................................................................................................................................... ® Description of Soil........................................................................................................................................................................ x U ----------------------------------•------------------•------------------•••---------........._...--------------------------------•-•------------------.....•---------------------•------•-------------- 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` ITLE; 5 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. , . ' .j r, Signed---- =........................__ �L::�:--�.---•-----------•-•--- Application Approved By.........— ""=�� :.. ____ "' , ate ................................................ ........................................ Date Application Disapproved for the following reasons-----------------------••----•--------------------------•------------------------•-----------------------....---- ----------•.----.-----•---•------------------------------•-----------........------•--•-•--------•-----••-----•---•--------------•----------•-----------------------------------------------•----------- Date PermitNo.---...---.............................................. Is-sued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH .....................OF........... .. �rr�i�irtt#r laf ft�rrnt��tttnr�e THIS IS TO CERTIFY„That the Individual Sewage Disposal System constructed or Repaired by ( ) -- ........... ..........•-•••-------------•-------------•-----•-------•••---•-•••------------•-•--••--•--...---.....------......••...----••••. Installer at................. a .--3•---------•---Ste'-'..--.��`.,,-------- 0.. has been installed in accordance with the provisions of Tn- / 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. __. .......... date3................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. 8./-—4------------- Inspector--------...� n V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No., ............. FEE........................ Disposal Vorks TUInstruction 3phrmit Permission is hereby granted......... %!'X____.__. - _= :...................................................................................••... ••... to Construct ( ) or Repair (�')- an Individual Sewage'Disposal System— / / it Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... i,�i� Board of Health DATE........................ // ._....... ....................... - FORM 1255 HOBBS & WARREN. INC., PUBLISHERS