HomeMy WebLinkAbout0042 WIANNO AVENUE - Health 42 Wianno Avenue (Post Office)
Osterville
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THE COMMONWEALTH OF MASSACHUSETTS `
BOAR® Off` HEALTH 1/1-Cjg
...........................................O F..........................................................................................
Appliratiun for Diupuua1 Works Tanotrur#iun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:System
/ .�........... .............................f ....................., Jl...........
Loccation-Ad reAget� �/!{! or Lot No.
C..c/a ... /��=`i.��------.Y:C.�:....` ..... t�� :�.c6JL.a._ ......................................................... '____'.'........ .........
ff r Address
Installer Address
Type of Building Size Lot............................Sq. feet
,., Dwelling—No. of Bedrooms..... .......... _----
.-------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building 4_4.- ,No. of persons______________•-____-__--_ Showers ( ) — Cafeteria ( )
a 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—_N ..................... 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I.........."___minutes per inch Depth of Test Pit.................... Depth to ground water--_-_---_____-__--___.-.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--------------•---
O Description of Soil �l _..` _. � -------•-"---------"-"----------------------------------- ---•"---•------...•-•-"-••--•--•--"----"•-••-•--....._..
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c.� --------------------------------
...._._..-----------------------------
•----•----------------------------------------------------=
W ----•"-••"----------------------------------•-••-•-----"•-----------------------•-•---•--"•-••---•--------------•--•••.
Natureof Repairs or It ati ns—Answer hen a licable___ _e-j /UGC
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 boar o health.
Signed._ ` � �....7�_ "---•-"---""-•---"---•••""-••"
D t4
Application Approved By.. ----•• . " ""•"-•......-•-""-•-"•-••-"--.....•-""" .......9.-➢` � J
Date
Application Disapproved for the following reasons--------------------------------------------------------------•----------------------------------------......••--
................•----"-•"-..........•----"•--•--_....-------•"""""-•----"•-----•-•"-"-"".......""---"""""--•--"--•-""---•---------"--...--------"-----------------"--•----•---•------•--•-"---•••--"--"-
Date
Permit No.......................................................- Issued-._�� t-� �
Date
QQ r
No... ...Y..-........ ` L Fss... ............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
f ................. OF..........................................
Appliration for Disposal Works Tonitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
-----------------------------------------------------
� Locatio -re s � •or Lot No.
............. _ --------------
--------------------
--------- -7._... _-•-__Y ........a:p• .....__'
Installer ••-
Address
Type of Building Size Lot____________________ ______Sq. feet
�-, Dwelling—No. of Bedroo s____________ _ _ ..................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.
W Septic Tank—Liquid'capacity______.____.gallons Length................ Width._.__:_:__:___.. Diameter________________ Depth_..-------------
x Disposal Trench— 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 ( )
1.4 Percolation Test Results Performed by ------------
Test Pit.................... Depth to ground water........................
0-4
44 Test Pit No. 2................minutes per inch Depth of Test Pit.....:.............. Depth to ground water........................
a -
Description of Soil. �:' ;
-•---------••------------•--------------• ------...------•----•--------------•------------••--------••---
U .......................................................... -------•-----••••••------------•------------•-------•------•-------•----- -----•--------•---•-----------•--/- •-----------•---•-••--•------
VW -------•--••---------------------•••--•--------.__--•- •••-- r rf -••----•-............_.
Natu Repairs or Ite ti s— ns ee en 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 urther agrees not to place the system in
operation until a Certificate of Compliance has been i d by ar ealth. � (
0
Signed........... ------ ----- ----•- --•----------------------------- --------•-•------•--
Application Approved By---------, � _R .r✓' ! d�1
D
_----_- ---•- - --•...............
Date
Application Disapproved for the following reason : -------------•----•------------------•------•-----------------•-------•--•••----••....._...__
..---•------•-•-----•-•--•-••--•-------------•---------------...----------...----•------------------•----•-------....--••-----------•-- ---------•--------••---••---- .............................
6 —1
Date
PermitNo...................................................... - Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........................................OF..........
(9rdif iratr of Tout pliattrr
THIS IS TO CERTIFY, Th t the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by.. ---- -,- ;, -------------------•-••• ---------•--•--....•---•--•--._...._._........----•-••... •---...--••---••-•-••--•-......----_....
Ier
at........ ................. .../
has been installed in accordance with the provisions of T W.F , 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No 'f_>:�________________ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATI- FACTORY.
DATE....._.:--•---......_-••••-•----•-=-----••-� 1/kV.-----_-•-•_. Inspector...........- _z. ..........................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No... ��`. ? .....................................................................................
FEE..:15.............
'Dispo.sal Works owAr ion unfit
Permission is hereby granted.--•--------•--- .........................................................4�..........................................
to Construct ( ) on pair ) an II11v1dual Sewage spousal System A'
ram"
Street j �-�t A
as shown on the application for Disposal Works Construction Permit No...................... Dated_____ f._ ._G_T �.T_....___._......
Fy.
Board of Health DATE................................. •---npo '
FORM 1255 A. M. SULKIN, INC., BOSTON ,_
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LOX 10 SEWAGE PERMIT NO.
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VILLlCE 1.
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I N S T A L ER'S NAME i ADDRESS
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� OR OWNER
DATE PERMIT ISSUED
DAT..E COMPLIANCE ISSUED .. Zd �. �.�
L0CA 1 .� � SEWAGE PERMIT NO
VILLAGE
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INSTAL ER'S NAME i ADDRESS
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*tel R OR OWN ER
DA T E P ERMIT ISSU E D
DAT E COMPLIANCE ISSUED � � � ��
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