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HomeMy WebLinkAbout0200 WEST WIND CIRCLE - Health 200 West Wind Circle Osterville A= 121 —011 - 019 1 \ L0CAzTvION � #raoo SEWAGE PERMIT `'-K(P.' GOT 5C, tJES$,4ND CIRCLC 434 - 904 VILLAGE CDSICPv)LLF INSTA LLER'S NAME a ADDRESS S Pic P D `FHFC) 14,4(2 o l s a 4 C>R-jl'A T Pd, 'C)R. s , YAp-M M)Tt-1 e U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE IS UED ) aylgs C � �f !. w.ram. w..• LOCATION SEWAGE PERMIT N0. „c: t (o e.s� tea► C�i��.\` C��imc � g VILLAGE INSTALLER'S NAME & ADDRESS R UILDE R OR OWNER DATE PERMIT ISSUED q ® y DAT E COMPLIANCE ISSUED _ w �£hR � p^ v lie 3t. 0 �� • Fps......... O........I THE COMMONWEALTH OF MASSACHUSETTS •-. � BARD OF HEALL H ro.-IN..V1.....OF-�.../3- Applira ion for Disjloa gal Work.5 Tonotrurtion 1hrmit Application is hereby made for a Permit to Construct (. } or Repair ( ) an Individual Sewage Disposal System at: oca on- o t ........... .. J�!,1t1� '.-•- -- 1 J 7� __,p.............-�-•---�.. ll. 1f ........... n r ,� Add ss -•- � Installer Address Type of Building Size Lot...l ....Sq. feet Dwelling—No. of Bedrooms____________ ...........................Expansion Attic ( ) Garbage Grinder ( ) _.__ No. of persons__..._.__. ------------- Showers (,� — Cafeteria Other—Type of Building -OW ( ) Q' Other fixtures _.. ------------------- ...................... per person per/d y. Total daily flow.______......3-3.0........_._....gallons�, - WSeptic Tank—Liquid capacity/ gallons Length.l,O.,�____ 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. Other Distribution box ( �) Dosing tank ) / '-' Percolation Test Results Performed by.___�. W-.. ,l�,a.,p 6:9W, Date._.._i�..__:_ Test Pit No. 1................minutes per inch Depth of Test Pit... Depth to ground water--_-. ._ ....�.,�./.. Test Pit No. 2................minutes per inch Depth of Test Pit...!-.�j1. __ Depth to ground water.:A-- Q+' --•--- •--•---- -----------•...................................•-•--•----...__.._..---_----• 0 Description of Soil......................... .LC_ _�_ ... ,- _'D ----•---- U --- •--------------------------------------------------------------- ---------------------------------- .--__------------------------------------------ W •---••••---•-------•.....----•-•••••••••-•••-•••-•----••-•-----•----•---•---•--••-••-•-•--•••---•••----••--•----••-•-•------------•••--•-------•----••-••-•--•••....................................... VNature 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 iITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until-a Certificate of Compliance has been 'sued by the board of health. Signed... .......................... Date . -/ _ e 'f_ Application Approved B ................................................. -. -�---- PP PP Y ---- Date Application Disapproved for the following reasons:........................................................................... ........................................•................................................................................................................................................................ Date PermitNo--------------------------------------------------------- Issued....................................................... Date ��_u.�aa�u.�a.uu.►u�ura X0................_....... .............................. THE COMMONWEALTH OF MASSACHUSETTS •�. BOARD OF HEALTH ......OF...... .�,�..4„ r. ApplirFation for Disposal Works Tono#rnrtion Vrrmit Application is hereby made for a Permit to Construct ( 3 or Repair ( ) an Individual Sewage Disposal System at: I •-ocation-Address Address w _ A Installer '` Address U Tvpe of Building Size Lot_.Zj...ae 0_...Sq. feet Dwelling—No. of Bedrooms...........y3---------------------------Expansion Attic ( ) Garbage Grinder ( ) pa-, Other—Type of Building INo. of persons.......... --•-•--------- Showers ( � — Cafeteria ( ) Other fixtures .P-----------•--------- w Design Flow.................. ...�.----------•__gallons per person per/day.T l daily �° dons; , WSeptic Tank—Liquid*capacity/.C%,A,2.gallons Length./O.,�_-_ 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.f� .r'sq. ft. OF Z Other Distribution box (T) Dosing tank( ) a Percolation Test Results Performed by.... _ _ ' _(�l... __ ✓!_ ✓ ;! j:26- Date..... Test Pit No. I................minutes per inch Depth of Test Pit.__._.._:_.._..__.. Depth to ground water.___....:....__._=..2,. Test Pit No. 2................minutes per inch Depth of Test Pit...l4:Zj...... Depth to ground water. ��, ! F c , a --•------•.•-•--••---•-••-----�------------.--�............... o Description of Soil................... - f_. ___-�...-.- .... x 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 TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in Si ned.._. slued by the board of health P P Cl ., operation until a Certificate o Compliance has be��i t���-�-f -� �G�-�� _.... Date Application Approved By................................. y--__-----....-•......................••---•--------....._..-- ........................................ Date Application Disapproved for the following reasons:-------•------------•--•-------------------------------•----------------------------....._..-•-•--•--•--........ --------------•-••--.............•-•---.....--•---------•--....----------••••-•-------•----•-•--........_........_....-•-••--•-•-------••----•---...••-----•----•-••-•••---•••-•••----•--•--••-----...__. Date PermitNo......................................................... Issued....................................................... Date THE-COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...7.1.....OF......j..: Trdifiratr of ToutpliFanrr THIS ISeTO CERTIFY, That the Individual Sewage isposal System constructed ( ) or Repaired ( ) by...'_._... -J �?- ra [ / Installer / has been installed in accordance with the provisions of TITIF; 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_..-------------_............................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ".'.. ,� ` 5.................................... Inspector........ ...- ---- THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALT �� No......... ............... FEE....................... Permission s hereby granted....._P.. t '�. " .....................................'— "' ?`...........cf to Construct ) oriRepair ( ) an IpdividuaI Sewage Disposal System, at No..._-. - " i!ir r .i J i. ✓v vv. 4 Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Board of Health DATE................................................................................ FORM 1255 A. M. $ULKIN, INC., BOSTON - I . At PL CD P cl 21 j j i T ! 1 1ST t ly- X�z o 1 691, R -------------- Vt 9 � • ' i � EL�EV= LSL -F-1 o t�-- - 0--At.L E,.E_%/. S 14nw-i L; Ae-F M fc AAJ SEA► L-%VFi L �y � �'-———— - ------M �5C D t7++t .{.=,ice„ 5 �'_� VI►Tt�P1� PL.�.wItE PCiCW kLL L.WE�, ^ MIj.mL)?A OF UN I-E b� CSy Nt�C�)t9 E 3PEG►F 1 ED. a�L.L- Ploff S -rC AWID td TFiE SYST�M 5 Nate U ' OC C^ST I2JCV►J C*r- AO P\/c-. 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