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0331 MARINER CIRCLE - Health
331 (Yla.rc ne.�- 0 �c(,e PAT ION SEWAGE PERMIT No. VILLAG INSTALLER'S AME i► ADDRESS 111111.1) R o OWNER Qcar DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 36 ,� a q- -•4._dam •. - -'�( ..-• No.. ..........._a �-✓ 7`� ---- Fss...`.3.a THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH J ®ram ..............OF......S Appliration for Disposal Works Tonstrurtiun JIrrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Sys.... at......� .................................Qf f ' • .... -- ... .... . . . ...................................... oca dress orLoNo . -�• .........._......S - .. .......... •............ ............ ......�•.. ..._......... ............ cae- n ` ................... .. .....••. ......_..a Installer � Address U Type of Building Size Lot...dQ,.� -.Sq. feet .-� Dwelling—No. of Bedrooms.. 3 ...........................................Expansion a �A• ttic ( ) Garbage Grinder ( )Other—Type of Building No. of persons.........K2............... Showers ( ) — Cafeteria ( ) Other fixtures . Design Flow................: ._._..._gallons per person per day. Total dail flow___....... W � ---- g P P P Y• ��®------•--------•-----gallons. W Septic Tank—Liquid'capacity/QVV.gallons Length/D.Ab... Width....._ Diameter................ Depth........... ... �p � x Disposal Trench—No..................... Width.................... Total Length_....... __._---:--.Total leaching area-__-.. ___ q. ft. Seepage Pit No.............�----- Diameter.......-9..'._._•Depth below inlet----&X......... Total leaching area.._.........--....sq. ft. Z Other Distribution box (/ ) Dosing t ( ) Percolation Test Result Performed by...... � ---•- ---.- --. ... Date.._f�l r 7 ----- Test Pit No. 1.- 2---_-minutes per inch Depth of Test Pit.................... Depth to ground water..._ f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.��(/(// 0 Description of Soil....��_-G........ . ..... .. U --•--------------------------•--- -----•......---------•--•••. . 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 TITI LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by the boa f health. �^ Si ed... ................ ..... )a Application Approved By. Date Application Disapproved for the following reasons: ---------•-------------------------------•--------- ...................... .................................•--------....-----------•--------•-----•--••----•------....-•----.....----------------.....--------------•-----------------------------------•------•-•----•----------- Date PermitNo......................................................... Issued_....................................................... Date L No._/_`-`(�/-/L/�%,-J).7. Q... FEE..... .�,wr' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 41 /.C1........................OF. Appliration for Diopooal Works Tonitrurtion Prrutit� Application is hereby made for a Permit to Construct (4 or Repair ( } an Individual Sewage Disposal System at f/ / -....................................... /.Location-Address /J or Lot No. ...............................�.........._.'...........____---..._........��L•�..__.._ .......�!._......._. .i �. Owner J �(�j ii�j, �dddessG���-- W PLC -t c�ti /// .... .... .................. ....._..... ,-� Installer Address Type of Building Size Lot---__IC __ ,=..Sq. feet �., Dwelling—No"of Bedrooms__.___::__.z�_________ _.____.___Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Buildin �� f� � yp � ____________________ ____ No. of persons..........6:............... Showers ( ) — Cafeteria ( ) dOther fixtures .-- ..........-.......... .............................---•-•-•••••---••••-•-•-•-•---•--•----..__.._.......••••-•._._..........••--•..__.......... W Design Flow................... L:)_..____...........gallons per person per day. Total daily flow.......... ....................gallons. i WSeptic Tank—Liquid'capacity./ gallons Length_/......t Width_____ ________ Diameter................ Depth................ x Disposal Trench—No ____________________ Width.................... Total Length______ _.__._..____ Total leaching area...... --� -,sq-rt. Seepage Pit No______________.___._ Diameter__._.__.7.._.. Depth below inlet_ ..`..._.___. Total leaching area__.-�_.........sq.ft! 11 Z Other Distribution box ( / ) Dosing tank ,( ) Percolation Test Result Performed by.......j/�it-t '_(/�`L: -= �1 ,_-)-k,1V`-'_�._ Date--�f -�1'- •7,9 .a Test Pit No. L_ - ._:_____minutes per inch Depth of Test Pit____________________ Depth'to ground water..... 1..: __✓f_1 (s, Test Pit No. 2................minutes per inch Depth of Test Pit__.___......,______._ Depth to ground water../! 1-!`/. a :. - ---•----------------------------------------------•••-•••-•---------•---•---•••--•--•--•-.........-•••-•••---- o �, Description of Soil--- = 7c'Cc::'`:.:...........:..: •---------------------------------------------------------------•------------------------......._•-•••---- - W _______________________________Lf_ ._____f'.���___..__... !_1•-.�_._._.�r��.�..'�__...______ 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 TITII� 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 board;of health. Sied.......__f__ ' ................................................... .................. d d- Date Application Approved By..... � ' ,-,� .-AO...... W. Date' Application Disapproved for the following reasons:_..-= _____________________'_________________________...__.____________..._______...___.___ - 3 ...............................................................................................'<:7.::.....____________________.____________.._________.___________________._____..._________.__...._.._. Date PermitNo......................`•-••••......-•-•--•-•----•--_.... Issued............................••--•-••.......:_......._.: „ y Date THE COMMONWEALTH OF MASSACFiUSE TS ryW r BOA`�R�D,, OF HEALTH,.--' �✓ f%r f�rr��fartt#r of� (�ont��i�nrr ,4 THIS IS TO CEj2TIF.Y That the Individual Sewage Disposal System constructed ( or Repaired ( ) ` ra y........ :. jj ^^ Install has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the N application for Disposal Works Construction Permit - __:_ -----7.0_________-____ dated----- V____ THE ISSUANCE OF THIS CER'P 1CATE SHA NOT BE CONSTRUED AS A GUARANTEE"THAT THE SYSTEM WILL FUNCTION SATISFACTORY. J . �1 _....- Inspector 'XDATE...................................... _-.................---.:_................. THE COMMONWEALTH OF MASSACHUSETTS _--,�•-�' BOARD OF HEALTH ........OF.........�-).��.t-.J't4.................................................. 7 r1� �...�•••--••••�-Via...... FEE. .�............ Permission is hereby granted 6cr-�.:__ ,� :!.::.?C_�.C/ ..tom)------ .....' f L=C to Construct (,1�) or Repair ( ) an Individual Sewage Disposal System y N r__.._.....i...__.------- .._...__ ________________________________________________________ as shown on the application for Disposal Works Construction Pit No. p __�_'____ � � � h l B5a odd of`FI alfli DATE•• -.. `8 ........................................... ,. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS d I . V CiEA JE2-AL. W OTE5 '� --- iy, 1a--4�.� E�J. s�-�ch✓�J ME A,...1 EA. =�.�;�� .• � � ���� l.)ti1LESS C?T�Et2�+JtsE �f'EG.tFtE�. 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