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Home My WebLink About0234 WEST WIND CIRCLE - Health 234 West Wind Circle'Osterville =121-011-042 F. t i i I i I I I No.-------��_--_G_��' Fps............................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH oF... -.� Appliratinn for Disposal Works Tunstrnrtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......... ....r ,r, D....�1.1_154=�---,. --�/--.�........ ._,l. ocation Address � o t o. .......�� YC.� ��-. __ _. lr7Y... ,l, 91�. ............ p� Owner �y r Installer Address Type of Building Size Lot__/,f'' ,�j_"Sq. feet Dwelling—No. of Bedrooms........... ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building a .................................................................................................................... Other,—Type g 0.yY No. of persons_________16 Showers (�) Cafeteria ( ) d Other fixture W Design Flow______._.____________________gallons per person per day. Total daily flow...........J_.31_Q................gall ns.� WSeptic Tank—Liquid*capacity/&".gallons Length__�f�__�_/Width_____ Diameter________________ Depth__.j6L.�_. x Disposal Trench—No_____________________ Width....... :.......... Total Length___________.____p_ Total leaching area....................sq. ft. Seepage Pit No........../--------- Diameter......... Depth below inlet_______________ Total leaching area-_,�.x.;l_'sq. ft. ZOther Distribution box (/ ) Dosing tank ( ) Percolation Test Results Performed by.....A7.A _ Date....60"=,�_-_��. Test Pit No. 1................minutes per inch Depth of Test Pit____ .___________ Depth to ground water............ f=, Test Pit No. 2................minutes per inch Depth of Test Pit._ �_��___.. Depth to ground water_dt�� O Description of Soil..................... ---------'J .l?`_Cl--------------------------•-------------- --.._....------ V ---------------------------•------------------- _---•••••-•-------•--•--------------•---•------------•-----------------------------•-------•-------------_... ---------- ------- 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 TITLE 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. Signed------ -- -•-----: - ................................ Date Application Approved BY .JZ,r_...t�`' �4_:.�6----- -------- Date Application Disapproved for the following reasons:__....-----•---•-•--•-----------------------•-----------------•---------------------••••--••-••-------•---•_.._. .....................................................................-.................................................................................................................................. Date PermitNo......................................................... Issued-....................................................... Date No........................ ' Fmc........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ............. ................................................. Appliration for Disposal Works Tonstrurtion rrnti# Application is hereby made for a Permit to Construct 9"'") or Repair ( ) an Individual Sewage Disposal System at• ,r .._..._.. /1 r'� --• -If .`.r =`=t.../:�_........:.__..5- ocation-Addr ss s or Lot LJo �r Owners ,-a ................. •----- Installer r UType of Building Size Lot. s._ ,�_1.___Sq. feet �-� Dwelling—No. of Bedrooms--- ____________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building /` .!_+-�C?_✓:�'; . !<_ No. of persons........6......_........ Showers ) — Cafeteria ( ) QOther fixtures ----------------••---------------•-----•-•----------------------------a -------__----- Design Flow_______________ w gallons per person er da Total daily flow_._.__.». _ W ,f g P P P , Y r . ----------------gallons., f WSeptic Tank—Liquid capacity/!A-"...gallons Length_ » i____ Width----- _..__ Diameter________________ Depth__6__".? x Disposal Trench—No..................... ...____ Width__t._..!_._._.__... Total Length................. Total leaching area____________________sq. ft. Seepage Pit No.._._____e�__-__..__ Diameter____._.V�..._»__. Depth below inlet........ Total leaching area_2Z e?.7.sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) 1: Percolation Test Results Performed by __�;_ 0 _.2y," G_ ?�`C_ _ '/mil Date � � R r � Test Pit No. 1................minutes per inch Depth of Test Pit__._ ___a_.____ Depth to ground water___________________: 44 Test Pit No. 2................minutes per inch Depth of Test Pit__ _��/_____ Depth to ground water/ .................... a DDescription of Soil................... �: '�/6-F7 / ( •'``. _ .............................................- - --- -- x (� •---------------•---------------------•-------------•----•---------- x ?------------------------------------------------------------------------------------------------ V Nature of Repairs or Alterations—Answer when applicab r {------------------------------------------------------------------------------................. Agreement: } The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in accordance with the provisions of T I TLE 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 boar of health ,.' ----g �-�_ ,-_-__• - �== -�------- "..C+-.�.-sy ! �.?. ---------Date........»..._ Application Approved By..----•--•-••------• ---•-- ----f--......---- .r.. � ............................. --- f ............................ Date Application Disapproved for the following reasons-................................................................................................................... -----------------------------------------------------------------------------------------------....-............ ------------------------------------------------------•--•-- r Date PermitNo................................:•-----•----------------- �Issued- -•-t--••------•---................................................. Date { I. THE COMMONWEALTH OF MASSACHUSETTSf 'r BOARD OF HEALTH 41 Ordifirtttp of Toutpiiatur THIS IS TO, CERTIFY, That the Individual Sewage Disposal System constructed (-f��or Repaired ( ) by............. --» rn• �J f;�.... %''f ....!....J'ft_/s !�� !-':� .. Installer , J at l..! ._ 1 � t !? I�ir a �J� ' f -a_ il��`" eq c�� G' r- has been installed in accordance with the provisions of TITTLE 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................../O ! = Inspector... :; -•••--•--•--_-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - �� - k o f ...,!�. 5 No. _~. a2. .._.... FEE.. 17b.... .... Disposal lrorw TonstrudiamPrutit Permission is herebyranted____.___t :-4 e=, 7 •�'rt t �> u,1_ Y) C -- 1 - .... S (�O g to Construct 4)' or Repair ( ) an Individual Sewage Disposal System 5 Street X as shown on.the application for Disposal Works Construction Permit'No___ ________________ Dated____j................................... m DATE_ Board of Health FORM 1255 A. M. 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