HomeMy WebLinkAbout0016 MARSH LANE - Health V V�1� S� l�n� r �(/�l�1��,S
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LO A T ION S WAGE PERMIT N0.
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VILLAGE
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INSTA L L E 'S NAME & ADDRESS
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B U I'L D E R OR OWNER
DATE PERMIT ISS ED . Jf --oz3 -7"7%
DATE COMPLIANCE. , ISSUED --- 1 =- �
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THE COMMONWEALTH OF MASSACHUSETTS
E
BOARD�OFH ALTH ''
OF....... 4
Appliration -for 43hip sal Worse Tutuitrurtion Vrrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................... �----
` Lo do Address or Lot No.
...........V ..................
wner Address
------------ 9N 114-V........................................... ------•-----------.
Installer Address
Q Type of Building Size Lot............................Sq. f et
U Dwelling—No. of Bedrooms________________�.__________________-______Expansion Attic ( ) Garbage Grinder (
aOther—Type of Building ____________________________ No. of persons_______._______.,._________ Showers ( ) — Cafeteria
Q' Other fixctures _______________________________ __
W Design Flow__ __________rGjt7_______________________gallons per person per day. Total daily flow...... _O__.__.......___._._..._...__.gallons.
' 04 Septic Tank i-Liquid capacity_lboogallons Length________________ Width................ Diameter---------------- Depth_-._____.__--.
W Disposal Trench—No..................... Width-- ___________. Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No.--------�.---------- Diameter_42. ..._ Depth below inlet__________________- _ Total leaching area-------.----------sq. ft.
Z Other Distribution box (per Dosing to ( ) l 1°"®a '77
'-' Percolation Test Results Performed b - -d!
a Y A�a. .....____.1.-------•------------- Date 1Z 7
Test Pit No. L.��.._.�,,--minutes per inch Depth of Test Pit------- ....... Depth to ground water........................
f14 Test Pit No. 2................minutes per inch Depth of Test Pit-----d------------ Depth to ground water__._.-_______...__-____-
O , s t -
Description of Soil &_- 1 - t f .�
x -
U ------------ ------------- -- -------MUL-�-- - ------.._....------•--------------------------------------------------------------------------------------
W "
U Nature 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 N,I,,of the State Sanitary Code— The underfkned further agrees not to place the system in
operation until a Certificate:-of Compliance has beetNssueq y the bo of health.
Si a . ....... -------•- - \ •. ------
Dal
Application Approved By--- ' ;--- -
-- r -----an-AU..9-77-
-
�Da
Application Disapproved forthe following reasons:------------------- ._•---..--
._...••••.......................................•_.---------
te
PermitNo................................................ Issued........................................................
Date
No.......7 �•••---• Fxa.. ...'"r"�.........
THE COMMONWEALTH,OF MASSACHUSETTS
BOARD OF,:HEALTH
_.._ 411M?4, .........OF....... ,,�,,.. ,...................................
Appliration -fur Disposal Workii Tonotrurtion Prrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.... .......... - -
14
tl
L do •Address or Lot No
.............. �. _ ____.7 .,.mac_____------__-__-_-•-_-•-__-______-_____ --___-___- _--_- �__�_�__........
Owner Address
---••••----- ..... _t ".k...................................... -•-----•-••-•--------------••-•--- •-----•-----•-------------------.....---
nstaller Address
UType of Building Size Lot............................Sq. f et
Dwelling—No. of Bedrooms................1_.----.-------------------Expansion Attic ( ) Garbage Grinder
Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
QO.ther tures ------------------------------------------------------------------------------------...............
W Design Flow............:• ......................gallons per person per day. Total daily flow-----U1_ :.__.:_______.______...._.....gallons.
W x Septic Tank —Liquid capacitv.I. --gallons Length.................Width. --.- -- --�- Diameter__......_ .--.-_ Depth---------
.--- .Disposal Trench— o- -------------------- Width-.s __--_-__. Total Length.................... Total leachingarea.._...____....____sq. ft.
Seepage Pit No...... 0-_-______ Diameter��1' -. Depth below inlet...__.. _..._. Total leaching are a------------------sq. ft.
Z Other Distribution box (VT Dosing.ta ( ) 7
Percolation Test Results Performed by. ...... '"�-_4_60%.._E.'a�____t .................... Date___10. , _- -------------
Test Pit No. W-'__ r_minutes per inch Depth of "Pest Pit------M-------- Depth to ground water------------------------
f� Test Pit No. 2................minutes per inch Depth of Test Pit.--- ----___. Depth to ground water_.__._.._..___.____..-.
e ------------------------------
O Description of Soil 4 � � - ------------- -------------
V --- --•------------------ . --------
------- - - - ----------------------------------------------------------------------------=--------- -----------------------------------------------------------------------------
Nature of Repairs or Alterations—Answer when applicable.'.: .-.--.-. --
------------------------------------ --•------ -------------------------------------------------------------------------- ------ ---------- ------------- --------------•-- -----------------------
Agreement:
1. 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 underkned further agrees not to place the system in
operation until a Certificate of Compliance has be issu y th bo of health.
Sin --------- ----- - --- ----
A lication Approved B -----•-
PP PP Y cam°* -4 r �L .. �.~.
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------•-•--------•------------------
r -
Date
PermitNo......................................................... Issued........................................................
Date
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
yIr3... .......OF........ . .:��' ! ....Z..................................................
Trrtifiratr of fontplinnrr
THIS I (h CART 1` the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b :I ------ -
at
-nstaller
has been installed in accordance with the provisions -ArticJe XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No� _-_-I_X1-r-___-___-__-__-- dated....f�_y. _".77..............:
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUN TI O N/SAT SFACT®RY.
DATE........................ { 2.4F................ Inspector.-- 6 _ 1 h.... -...... =--------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF 'HEALTH
...OF_......... � .................... ..................•
�in1Pof 1 orkiq otrurtion "unfit
Permissiol i�,.hereby granted d s :- f '-------•----------•--••- ..............................................................
to Constr ( ) Rep r ( ) an I'd,y teal Sew'` Dispos 1 Sy em `
at No.
�. ' .� _ �
Street `
as shown on the application for Disposal.Works.Construction 4Perit zo Dated-.l- ,? � �
---- -- �''
Board of Health
DATE...............................................................--=---------------
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS -
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