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HomeMy WebLinkAbout0007 MARINER CIRCLE - Health C a�� 023— c�`-FU ---- �-- - �� CATION wau,�� SEWAGE PERMIT No VILVAGE ,4 INS LLER'S N A E i ADDRESS BUILDER OR OWNER too DATE PERMIT ISSUED -8-�� DATE COMPLIANCE ISSUED - �2-6 - 3(O . 3 q3 a No......... ... ... Fss. d.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE ,L(/T� H 7©G(J"............OF.... 1 iQXS�... U/ ----------------------------------- Appliration for Disposal Works Tonstrnrtion rnmit Application is hereby made for a Permit to Construct X.J03>1--- ..A. I'l Ia 4".elt� U.....1.4..C...... oor44/... Repair ( ) an Individual Sewage Disposal S Step At .4.. - n resS or Lot No.� ........./ O ner -------S r W ... .... •.............................. .••---........----•----......_..-•-.............------•. a � M Installer Address Type of Building Size Lot,.;20-( )...,.Sq. feet U Dwelling—No. of Bedrooms............ ... _....Expansion Attic 1; ) Garbage Grinder ( ) WOther-Type of Building No. of persons........6................ Showers ( ) — Cafeteria ( ) Otherfixtures ............... •----..........-•-•------------------.----.........------------------------......------.......------------........._......----------• W Design Flow...........57�___________________gallons per person per day. Total daily flow...........�5���...............gallons. WSeptic Tank—Liquid capacity....._,,;,__.gallons Length................ Width....... t..... Diameter_______--____.__ Depth................ x Disposal Trench—No_ ____________________ Wielth__/�_ra_.._.... Total Length.... Total leaching area.__.. q. ft. Seepage Pit No.------./-----.__.. Diameter.......'..... Depth below inlet.... Total leaching area . ft. z Other Distribution box (� ) Dosing t ( ) ''" Percolation Test Results Performed by__._�rW ..... ..... ....................... Date..�!.-OF �r........lt�7....... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water - . ._....__._____. Lr4 Test Pit No. 2................minutes per inch Depth of Test Pit------------------- Depth to ground water.G%u . . . ... ...----•--------------------------------------------•-•............................................................. O Description of Soil.--. __ �4wt.._._P ....... x (sa..`-. .- I Of U ..... W -------------------------------0...1y---------- --- -- . -----------------------------------------------.................................................. 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 iITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h*bDeen'' ed bAthneVjpd of/11i.�ethh.Sig ----- ---------------------- --•----- D e Application Approved BY ..__ �-- - ----- --. -- ----------------_ ------1-e---- Date Application Disapproved for the following reasons---------------••-•----------•---------------------------------•----------------•----------- .................. -----••-------------------------------------------------------•--•--.....-------------------------------• Date PermitNo......................................................... Issued-....................................................... Date No...._.....v..� :. FEB....> Ll............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .1....--......OF...... /. .STf/............................................... Appliration for Disposal Works Tonstru.rtiou' rruti# Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal S st at• .-yam 1.. �;' t�riir{�!.{, / Cl �`` - -.. ................ _ _...- ................................... - - ._ .... Location'-Address /J or Lot No. / Owner ! �l�/ 2lddres ze - � f . a11�f_-- -- �-•--•-•-•----_-----•-•- •--•-•--•-••----•________________•---•-•-••----______---•-----•----•--•-•----__-_-_--•--•--•--_-__ � Installer Address / !.i. d Type of Building � � Size Lot.��(<? �.....Sq. feet U Dwelling:=No. of Bedroom s_______________ .......................Expansion Attic ( ) Gar age Grinder ( ) Other—Type of Building �14'F14' __._ No. of persons._._____*! ............... Showers ( ) — Cafeteria ( ) aOther fixtures . -•------------------- •---•-•--------•---•••••..._.. __ _ W Design Flow..........._' _ _......................gallons per person per day. Total daily flow__._..._..__.__ . ' ...............gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width....._.,....___. Diameter________.___.__. Depth................ x Disposal Trench—No..................... Width.. ___._.. Total Length...... __--_...... Total leaching area......_..f sq. ft. Seepage Pit No.........j.......... Diameter......./......... Depth below inlet..... /.......... Total leaching area=- ..�--�)_..sq. ft. Z Other Distribution box (�) Dosing tank ( ) 1— '-' Percolation Test Results Performed by....... .................. - =?? 1:'4___. Date... Test Pit No. I................minutes per inch Depth of.Test Pit.................... Depth to ground water..._..�_,..._.._.....- (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-,__-- (�. -. .... •--•.........................•-•-----•-••...........••-•-•-••-...-••......................................................... ODescription of Soil. �' �_f .:. =• •-•--•---------------------------------•-----•----------------•----•-•--- ---------- __. U --------------------- -------- - UNature of Repairs or Alterations—Answer when applicable.....................................:......................................................... •----•---------------------------------------------------------•-----------------------............-----•------•-----------------....---.......------------------------------•---•••---••---•---...----- Agreement: The undersigned agrees i to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI':TIE S 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. , Sig ed ........ D to Application Approved By..... -• ... ••---•__--•------- 6�ate Date Application Disapproved for the following reasons----------------------------------------••-------••--•-••-----•---•---•--:....................................... -•----••--•-•-••-•--•--•--------------•----------------------...----------...-----------•-•-----•---••--................................................. ..................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................O F...............:...................................................................... `: (9rdifiratr of Toutpliunrr THISIIS TO GERTAFY, That-the_Individual SeWage,,Disposal System const acted (�or Repaired ( ) by....... ` ....�`..... C.r_r cr Gcc�� GG. `'���__ --- ��,c /�lc c ------ ---- r � Installer has been installed in accordance with the provisions of 1 / j of The State Sanitary Code,as de-cri d in the application for Disposal Works Construction Permit p_i__4� .............. dated,__./;--.`., "- .... ................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONYATISFACTORY. 1 / o %f DATE.......................................... ...`! . ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... FEE}, •-•............ Disposal Works Tonstrurtion Vgrmit Permission is hereby granted....., ?.... ....... .- to Constr ct (,X�) or Repair ( ) an Individual Sewage Disposal S�stem� 1 at No..� _5 .. 7 !! f c < < �i �r`�� . • �-------••-•----'-Street--/ as shown on the application for Disposal Works ConstructioAPeSpIt XNo _.•........ Dated-/.!.-)F...........................------------------------------ Board of Health DATE... - - - FORM 1255 HOBBS & WARREN, INC., PUBLISHERS -. -.. - ___ _. 'a�`'X �;,:.. s .•»; s :rt ..FIR f.: -? '�"�a': 1, ,. i.-' ar.4�r�F '{ � yz _`� ,�� - f "•f .fit �.4. "' '`�'�"��1''Y 4Y i t7 y.`.•. ' a. -- -- n QtTcN AL�., L_tvES A MWtMo�.j cw vb"/ r ---- � �-�� � h,►..!L.ES'S CJT�-►�E't+�)tS� �f'EC.t�ri�. m 0 3Q--- ,A u_ PI�s �-ro ou o j,s Tn+4 5�3►'t**j S� l -- e)e c.^sr teo .3 cc �• 2 •.9 � � --, � I � � Q 00 (0 O 000 � AL.L. `.'SEPT'+C TAalks, C�15TQ�1ytJT1,+t�a,3 Ti�G R r�►�..►t1 r 2,0 4e L_OA > r..l C-1"s Au.. 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