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Home My WebLink About0236 MARINER CIRCLE - Health oz L O CATION��®*23�6 S E Y01 A G E PER N 0. VILLA-GCE INST LLER'S A ADDRESS B U I L 0 E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ,� �� f �d �g Fss, 0 No..-•... - ��.:.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH ...............OF....Ii .. .1-I- .: ...a--•--•--.-.-.---.--.-.--.-..---- Appliration for Disposal Workii Tonstrurtiun rumit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at• ' l.._.. �....J17..dl..lr.�r .. ...--.. ................................................................ Location ddre or No. - ......... ........ ... .�..9.oAjnS�a !J ............................................... Owner A e ..... ��5_!... �?......... ?-... . ......................................... Installer Address Type of Building Size Lot-_Z' 0Atr --------- feet U Dwelling—No. of Bedrooms.......:..... Expansion Attic ( ) Garbage Grinder ( ) a -------------------- aOther—Type of Building�l �l A. ... No. of persons..__...(®................ Showers ( ) — Cafeteria ( ) d ,,, Other fixtures -------------------------.............................................................. ............................................................. WDesign Flow..__..____________________________gallons per person p�erpday. Total daily flow._:... ..........................gallons. WSeptic Tank—Liquid capacity/0 -•.-gallons Length. l...... Width.!q_.C.--... Diameter................ Depth................ x Disposal Trench—No. .................... Vidth.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-__..--__.I-------- Diameter........CF--..____._ Depth below inlet.._1.-3:....... Total leaching area.. QC..sq. ft. Z _ Other Distribution box ( ) Dosin nk ( ) `-' Percolation Test Results Performed by.. ....64X......M............•......... Date.- /..�..,�6/�,�..-.-.... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................................ 0 Description of Soil----...... ` . . . ...................... - x V ....•--•------•.........•-••-•--•-•-•-••-•••••-----...••---------•------•-------•-•-•.._.......-•-•-•----•--•-••-•..............••------•---•--------••.................•-•-•-....----•----••--•-•--••. W 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 iITLIE 5 of the State Sanitary Code— The and rsigned further agrees not to place the system in operation until a Certificate of Compliance d cge has been ' sued by oar of has li: - Date Application Approved By. . . ... ......... ... .� '7..-?.4.._..��1! Date Application Disapproved for the following reasons:................................................................................................................ ..--•--•-•........................................•------------..............------........-•---•-------••...•-••........•-•-•---••--•-•-••---....-----••-•••-•-•-•-•---••-•--••---•-•............••--- Date PermitNo......................................................... Issued_....................................................... Date No...:..`...._' l.`... Fxs... 3............... THE COMMONWEALTH OF MASSACHUSETTS BOARD-,,OF HEALTH t 0kCi ,)...............0F...��1 .Nopliratiun for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit'to Construct ( ') or Repair ( ) an Individual Sewage Disposal System at: •- --.._.. ...................................................... ... .. . ......................... ............... .......--•••---.........--•------.....---- Location.-Address ,.- or Lot No. :.. . ...7.......... .....�f .... ' ............ ............Owner••-;r ---t-- ••------••- .................................................Address---•--•---......--------.............---... Installer _. Address Type of Building �., Size Lot............................Sq. feet Dwelling—No. of Bedroom_s___........_ ..........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -- ,Ul► -- -�04 yp g;---°---------- ------------ No. of persons........,................... Showers ( ) — Cafeteria ( ) dOther fixtures ........................... ... . • --••-...--•-•----•-------------•------------•--•-•••-•----•--•----------.....---..._......_._...----- W --�Design Flow......__ ._-.5 ..............................gallons per person per day. Total daily flow------ ..........................gallons. WSeptic Tank—Liquid capacity''.'?e2_...gallons Length 'A Width.`, ..... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-----------i--------- Diameter....-__e,, ....... Depth below inlet...!r�_ ..`'..... Total leaching area....T .{:....sq. ft. Z Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed by.. ...................... Date.._ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------•-----------•--•-----11..........................................................................--------•-•-•-•......------........._....._--------•- O Description of Soil t`}'.....`...........Y_�� x g.s_/_--•--•--.....----'--••-•----•---•-------•------------•--------------•-----............-••----•----------••--•-•---•-. UW -------------•--......._.. ............................................................................................................................................................................. 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 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 t =ofth. Sied ---•---. -•--•----••---••-----••-•--• f �` ......... r Date Application Approved BY------ !' r Application Disapproved for the following reasons:---...-••-•---••--••----••-•-•---•---•-•----•-------.....••---••----------••-------•....._..DaYe........---- ...........0..................... ............ . --...........-•--•-•--..............-•-•--•...........----..........•--•---•-----•----•-•-••-----......_.....--•-•-•••-•---------••--.......-- ............•••. Date PermitNo.......................... •---•--------------- Issued-....................................................... Date .F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trr#if irFatr of Tomplinnrr THIS IS TO CERTIFY, That the,Individual Sewage Disposal 8)*em constructed 0<') or Repaired ( ) by ..... ---- -------------------•---................................ q Installer has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works ConstructioU.'Permit No.__. c.__._._.__ da.ted_.... "_% lt...` 7 ________________ .± THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector---------------------------- 1 THE COMMONWEALTH OF MASSACHUSETTS o...:...... BOARD.-OF HEALTH � �. 1..........1t�,..................OF....'!!:�.....:I.:��r'�....:........:..................................... �d N FEE. Disposal Vorks TUon#r ion Prrutit Permission is hereby granted ...............-•••------ _`..._..... _../..-- =s--•-•.. W ........................................................ to Construct 4( r) or Repair ( _) an Individual Sewage Disposal System 'I �...:.at No.. !={� :.. r )'1 fa.}� �L:.j: (. .�.t n..ft l _ reet _: a i � Street as shown on the application for Disposal Works Construction Pero._._... ated....�'":z�...7�.............. r . I =--- -----------• -. ----------- �► Board of Health DATE..... . ........................................ FORM 1255 HOB BS & WARREN, INC., PUBLISHERS ,`- `��`>' '•.• _r • �� 'tTl. `` •;;, ,}. � ',ram � - :�} ��-- 5 _ mod t .0•r 55+5 ''F�•v+sueAaF• r F"ttitsr► G+ttvE t�►�+Kw G�,'AP� - To d i Fi o I fill,I 51-4 17 �j ' 5 Od 1L A Ie �� F tf V. ..r� —t , �lEiN t" !� COAL• (S T. Q O X I 1 , aecw r" !A4r, WAAW jr s=� .at)41"S i CAI Chi I r. 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