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0055 SETH GOODSPEED'S WAY - Health
55 Seth d ° o - Good�speed�S:� 1.22-062 Osterville , u a e L &CAT10 � `�`� SEWAGE PERMIT NO. A I /9 77 - VILLAGE s INSTALLER'S N ME & AD AESS Ao B U I-L DE R OR OWNER DA T E KERMIT ISSN ED DAT E COMPLIANCE ISSUED � C� �-� f r. � �° � � n- No......................... r Y F�s.l s............................. �S W(Al THE COMMONWEALTH OF MASSACHUSETTS Q BOARD F H EA ----OF......... Applirtttinn -for Bi-qniitt1 Workii Towq#rurti>Qn Vrrmit Application is hereby'made for a Permit to Construct ( ' or Repair ( ) an Individual Sewage Disposal Syst a � ��!� > �- __mot. = 14_ --- -- ------ Location• ress or Lot No. r .._•...... ...... ------- -------•---------------•----- ----------------- ---- . ......... ..... ` . .................. w w er �ddress Installer Address d Type of Building Size Lot... U .......Sq. feet Dwelling—No. of Bedrooms------- - -----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers.( ) — Cafeteria ( ) Q' Other fixtures L3---------------------- -- w Design Flow_...._..._:5 ----------------------gallons per per-son per day. Total daily flow-------------------- __ ___ -.-..--.-.-gallons. WSeptic Tank—Liquid capacity_'W<<gallons Length---------------- Width...........:.... Diameter---------------- Depth................ x Disposal Trench—No- -------------------- th.................... TV&Length------_----_. -_ of eaching area_--_.------.-----_-sq. ft. Seepage Pit No.....,�/� 1 ........ e6 in1�1 ____--•--- - leacliing area..3�9_.�_sq. ft. z Other Distribution box ( Dosing tank ( ) Q - �G J® / -7 Percolation Test Results Performed by--------------_---- ---------- -------•---------------------------------- Date-------------------------------------... a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..---_--_---.---....__-- �14 Test Pit No. 2.............:..minutes per inch Depth of Test Pit-------------------- Depth to groun water------------------------ /1_ �/1 _ �_� n`G ---------------------------•--••-- - Description of Soil------I......�f-- �� �a` '----------- •-•--•------ -g` v !�w U -------------- ----a------------------ - �- — / -------------------- 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 NI 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 beard of health Si ------- ........... � t<- - ; •--•-•--•------------------------ Dat Application Approved By------ �------ -------- ------•....'-LI-. : -•--•--•--------------•- ......�_...r�..'.�_ ........ Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ...••------------•-•------•---------••---•-•-•--•------•---------•.....---•---------------•----...-------------... ................................................................................. Date PermitNo........................................................ Issued........................................................ Date No.......... _�_.... FEE.. .. ..................„ THE COMMONWEALTH OF MASSACHUSETTS BARD F HEA .Appliratiun -for Bi!yaga1 Work.9 Tonstrurtion Prrutit Application is hereby'made for a Permit to Construct (4--)or Repair ( ) an Individual Sewage Disposal Syste�m atz4,L } c LLocation•Address or Lot No. .: ----_Gt-ram --- /- // �Ow erg A Addddr Installer Address Q Type of Building / Size Lot...... -- -_-Sq. feet Dwelling—No. of Bedrooms---_---_`.� -----------------------------Expansion Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building ---------------------------- No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) 0-1 Q Other fiat res __ t <-2. •-------•--- ----------------------------------------------------------------------------------------- Design __________________gallons per person per day. Total daily flow--__________-___--2__r>---Q-----------gallons. w Desi n Flow_._._...._-._. 9 Septic T:uik—Liquid caacity`���-J--gallons Length________________ Width................ Diameter................ Depth.-..-_--__.---_ xDisposal Trench—No. .............. ..... ` --------------_ Tot I-Length------------_--- of eaching area....................sq. ft. Seepage Pit No...-. �: i�n Dl�i�el'onit................... leaching area__.J�U-�s�'-sq. ft. z Other Distribution box ( Dosing tank ( ) Q /�Gt• �0 `"a/'�- ? ,r Percolation Test Results Performed by------- ............................_................................... Date-_------------------------------------- a Test Pit No. I................minutes per inch Depth of Test Pit-.---__-__--__-_-_ Depth to ground water..................... ... t14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to groun water-_---..--__-___._-._.... .r� �, R t . � " -- Description of oil------- -- ------------------- ..--.. -- -- =f - --------------�--U 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 he beard o health r //I�/ Signed-- � . �"t'` /" ------------------ Date Application Approved By...... �j Application Disapproved for the following reasons:................... ------- -------------.-----.--------------------------------- ---------------------- ...............•--------.........--•---•---------- ---------------•-....................... ---•-----------------------••--------•-------------------•-----------------•--------------------- Date PermitNo:........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS - '- BOARD OF HEA TH ...........Z ...�.. .....O F... ..... � ........................... (15rrtif irate of 05.rrmvlianrr THIS TO CERTIFY `That/the Individual Sewage Disposal System constructed or Repaired ( ) ---- -- ---- - -----------------------------------------• -----•-•••----- - / Installer r .! has been installed in accordance with the provisio stf of :art' XI of Th State Sanitary Code as described in the application for Disposal Works Construction Permit No._�NiOE ................ dated...... -�,-_�' _-----.----- THE ISSUANCE OF THIS (CERTIFICATE SHAL CONSTRUED AS A 6A PITEE THAT THE SYSTEM WILL FUNCTION. SATISFACTORY. DATE �f — Inspector ----- ------------•- c „f ,E COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL-T1 - 4 / .. ........ VV..`............._.... rr. . -- N �/ .�C+ %� FEE........................ � � lark,� Permission is eby granted.--- `2,4 - --i-�-------------- --------------- -`�---------------=------.-.--.------------------- "�- .. to Construct(, or Repair ( an In ividual •ewage Disposal System ` at No...---= ----- ' 'y` �� ! '.......................... . ��� ` '� �.._ Street as shown on the application for.Disposal Works Construction Permit No--------- ---------- Dated------ . _ -------. DATE---•--�----------------------�----------------------.....------------------ . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .;tt I r-)/ L't�TN t f t -,s 0 &� ..(_A Q V, Q Cr a4 . RICHARD � A. BAXTER � � �. C!CQTIFIEI7 p°l.bT P'z.,(s1.! LdCATiC)" 3GAL � bAT /u A 6Z. 4 19 77 C6iZTtP THAT' TNI= �-DUIaUpTiphl Sl~Iowl l PLAI�1 R �EiZcI.1GE 1-IEQ E 1.� CCh&APLVS WIT" Tt-IE S 1 VE_LI► F-- A1.lt7 SET�3AGIG WeQuilm ewTS o -tcWU aF :SAZ STA��L& • REG l S�c�3Z�D 'L.A tJt� 5u eV�Yo tzs THIS C7'i?-AW IS 'JOT PBASE':;P Ott AN ©'STER.V1Ll.E a AiCA.56, II*1'9ft L;PAF—WT SUtZVE"( j;TtAE C3F�Si�TS 5laoait APPt_1 GAtJT 1,bT BE USED TO UErmeM1%1 VDT t_tt1-S GANG GS s Dal/, eta.