HomeMy WebLinkAbout0145 GREAT MARSH ROAD - Health (2) a !o - iag - 003 - c�ti-�wrQLe.
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" THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
-------. .....OF.......
..
'1 Appliration for Dhivoiial Workii Tontitrurtion ramit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
3 6 ;�..a- `+1 1 sZ ti p= '=�� ��'��1� ._.... -- .....
................_..--------•---••-•--•-------•••...................-•-------------•-------•---
Loca on-Address _ or Lot No
.... .
Owner Address
alley ....Address
Type of Building Size Lot---1.7,_.?_.`,.5-------Sq. feet
U Dwelling—No. of Bedrooms.............A..............__-__._________Expansion Attic (v'� Garbage Grinder ( )
pOther—Type of Building C +�.............. No. of persons........_i.................. Showers (1 ) — Cafeteria ( )
Otherfixtures -----------------------------------------------------------------------------------------------------------------------------------------------------
W Design Flow.............. .....................gallons per person per)ay. Total daily flow_-______-__-30------__-__-___-_-___gallons.
WSeptic Tank—Liquid capacity_l _c_� ___gallons Length__ el._..... Width---K.......... Diameter....(a.`..... 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 to )' _ .
Percolation Test Results . Performed b ___________________________________________ 74
_....... Date._. .___ ?__._.. ,._
Test Pit No. 1...� _______mmutes per inch Depth of Test Pit... ---------- Depth to ground water...b1n-ysc...K!^w
f= Test Pit No. 2.._!�Zminutes per inch Depth of Test Pit..,/.t�?____--____ Depth to ground water_{Q sue.E�
....
O Description.of Soil..... ----�-----•-•. ..... -' ' .....
\� _y.. .........UA�:�....... _ -................................................................................................
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 of the State Sanitary Code—The undersign(MArther agrees not to place the system in
operation until a Certificate of Compliance has bee iss, cYby the board oalth. r
ate
Application Approved By......... ....... . --------•------------------------ ........ Z v' --------------
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------•-
--....--•-•---•--•-••---•-------------•-••••-•-.....-----•--••-•••--••---....-----•••------•-••--------......•-•---••-•-•---------------------------------------•--------••-----------•----•----•--------
Date
PermitNo......................................................... Issued.......................................................
Date
.0..... ....
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEAL TH
...................OF.......&«!Ands .......
..................................
ApplirFa#ion for Uhivoii al nrkti Tomtrnrtinn.ramit
Application is hereby made for a Permit to Construct (y,) or Repair ( ) an Individual Sewage Disposal
System at:
r
1;�: ....... ...... -cw. .�Aj.--a'- ftsn-------------------------------•----
Location Add ss or Lot N
Q ✓a._...... ........
---- �"•. ----------------------- Vie:. .. ---C9...............;
Address
_
C C�v!
Address
d Type of Building Size Lot..... ..Z- .......Sq. feet
Dwelling—No. of Bedrooms.............i...._..._.. _.._.._...Expansion Attic (�K_) Garbage Grinder ( )
Other—Type of Building .-C-A54f�-....... No. of persons............t.............. Showers ( t ) — Cafeteria ( )
` Other fixtures --------------- --------------•-•-•--------------•-...--•-••••-•-----•-------•----------------------••-----••••-•--•••-•......••-•---•••--•--•--•----
W Design Flow................
__________.__.__.____gallons per person per day. Total daily flow_____._.__ 3 0
.......
WSeptic Tank—Liquid capacity..kQ1C.Vgallons Length....Q........ 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 ( ) t
'_ `..-� ------..
Percolation Test Results Performed by.......�+- .....
..................... Date....! _ �. `�
Test Pit No. 1__S—z < c-C j�f
...___minutes per inch Depth of Test Pit----- Depth to ground water.91�+.�_.4�.
tx, Test Pit No. 2..f.---------minutes per inch Depth of Test Pit......AZ'....... Depth to ground water---;-�,VA
--------•-•--•---------•-•--------------•-•• -
D Description of Soil.... ........� - S •••••• .."_.., `''^= - `
3 t
W ----••---------- ------------------------•-•----••-----------------•----•---........•-•••-••-------•----••-•------------------------•--------•-•----••••••--•••--•-•-•------•-............-•-•-•-•--•---
U Nature of Repairs or Alterations—Answer when applicable.-............................................................................_..._..._...._.....
-•------------------------------------------•--------------•------------------------•••.............•--•-•••••--------------------------------•-----••-•--••---•••••••--•-•--•---------••-•-•--•--••---.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewye Disposal System in accordance with
the provisions of ;.: t: of the State Sanitary Code— The undersigned"fu°rther agrees not to place the system,in
operation until a Certificate of Compliance has been isss�uued"by the boas; `r `l lth. .
/ • �
-fined.`, ''"'-y-----�--------- . -------------------- ----- ----------------- -
a
Application Approved By................................................` --
------------------------------- _. .. ---------- -----------•--•---
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
---.........•-•--••••••-••---------•--••••-•-•-••---•---•••••-••---•-•-•-------••--•....•••••-----•-••-•---••-•......••--------- -•-------•-------------•-----•••--•---•-•-----••---------••----..._....
Date
PermitNo......................................................... Issued-........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..�.. .c^�..✓�.............OF............w>..�z..S. .F: . ......................
Trrtifirtttr of Tomph anrr
THIS IS TO CYTI PY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Ins alley q -,
_ . -&
has been installed in accordance with the provisions of .:. j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N ......... . ................. dated.......---------------------------------__......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................. Inspector...................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. A .....N..........OF..... .CR/d n S
No::..................... FE ........................
�is�rrr,�aa1 nrk� �n ,��rnr�imrn rrani�
Permission is hereby granted----,�C_° '------A''t.Z.--- .............----......................................................•.........
to Construct (}j or Repair ( ) a Individual Sewage Disposal ystem -�
at No.....L ' :.....----..(1— -- . ...j ==-`••-•��-----.---- C_QAe'.7:k
at t - ...........
Street
as shown on the application for Disposal Works.Construction.-Permit N ..................... D ted.------------------------------------
r
,Doard of Health
DATE /' ' --------------------------
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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I:EGEND
9STING SPOT ELEVATION Ox0 ��t:'" her$ CERTIFIED PLOT*
ISTJNG CONTOUR -- - ® — i a�closFRr,
.INISHED SPOT ELEVATION 0.0
ti 7-IM9'9NED CONTOUR - 0 - v BUPltKI$
WC.22162,O�) j IN
COVED : BOARD OF HEALTH
� e;STE�\��� ;
- .DATE AGENT SCALE:
DATE _ �i�
�'IV C�INEERING CO I Al 1 C L I E N T�_�e�
— I CERTIFY THAT' THE PROPOSED
EOISTEP�E REGISTERED JOB NO. �'0 � - BUILDING -SHOWN ON THIS PLAN
CIVPL LAND CONFORMS TO THE ZONING LASS:
ENGINEER SURVEYOR DR. BY OF BARNST
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HYAfyNIS, MASS. SHEETS OF — DATE REG. LAND SURVEYOR'
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