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Home My WebLink About0355 MARINER CIRCLE - Health �� 11-�Q.t new C'�rc� _ C`�1 t'�e�- � -� '� � LOCATION �� SEWAGE PERMIT ©0. VILLAGE I N S TA LLER'S NA E_ & ADDRESS B U I L D R 0 OWN ER DATE PERMIT ISSUED D A T E COMPLIANCE ISSUED le12- �� Jt�- �g a6 — ��t- 8 6y � Sony ag �,�- �� 1 No................ ... t` ' FEs..`?. ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF 'HEALTH /...`✓.. -.................OF.....� Appliration for Uiipnsal Works Tontitru.rtion Vamit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal Y .. ...... .. ... .........- �---- - Aq---.- ---•-- �� _ or Lot No. . Sl.._ oca.......Ad•.............•. .. w � .............. W .................... .....................•• ............................................... Installer Address Type of Building ` Size Lot.c�42/.42W.Sq. feet �-, Dwelling—No. of Bedrooms............ .:........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building a yp g�iat1�� ...'No. of persons......... ............... Showers ( ) — Cafeteria ( ) Otherfixtures .. ----•----------------•--•---•--•-------•-••...•.---•-......----•-•---•-•-••-------•......----•-----.....-•-.....------......------....--------• W Design Flow..................a J�..........gallons per person peer//day. Total daily flow......... .....................gallons. WSeptic Tank—Liquid capacity./ gallons Length/A.Z.... Width._,_/__..... Diameter................ Depth................ x Disposal Trench.—No. .................... Width.._.................... Total Length.....................Total leaching area .... .... ft. Pi No.-•------- ----••-- f / / � Seepage t / . Diameter...... ......... Depth below Inlet.__..�9.......... Total leaching area.. w. Z Other Distribution box (l ) Dosing to ( ) a Percolation Test Results Performed by..... ...-00 ... ...... ............ !"V Date. ® ��_. a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...... rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W .--.. -- -------•-----•----------------------------------•--------............-••-_...••......................................................... Description of Soil.. -- -------------- ---------------- ----- �' - 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 iITLI 5 of the State Sanitary Co — The undersign rther grees not to place the system in operation until a Certificate of Compliance has been i ued by the boar ealth. g ....... ..... . ...... .... ............ Si ne late Application Approved By.............................. . Date Application Disapproved for the following reasons:.............................................................................................................. ................--------------••----------------------------------•----------------------•-- Date PermitNo......................................................... Issued....................................................... Date •-LSD• ,�.� No........... ............ F�s..........�o.....---. THE COMMONWEALTH OF MASSACHUSETTS BOARD DOE HEALTH -.......' :...................OF....../ ll(�� Appliration for Dhipasa1 Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct ( a or Repair ( ) an Individual Sewage Disposal System at: -.... . ..,:. ..... tio .. can ^a e`/�-Cf' C •-- .. — /r Lot No. ............... ... 'P/ ...._.._�.......f............................................... ..G. ........ --•-•-•----•••-•...... .... • .......... W Owner ✓ f�dd ss / rcrr�� a � L� J .�.+%U < .. -----------•----•-....- Addres-------------•--............................ ------•-•------ ---------- Installer "ter // Type of Building E Size feet Dwelling—No. of Bedrooms................. .........................Expansion�lttic ( ) Garbage Grinder ( ) pa Other—Type e of Building " ' - g ; (�� ( ) ( ) a yp g •---�(:'----•-_-•------. No. of ersons........_.=:•--•-•-••-_-._._ Showers-----•------ Cafeteria --...---- Otherfixtures . ----•----------------� ......-•--•-•--•-•--•-----•-•- ............. ...... gallon W Design Flow...................: ..-_ljgallons per person per day.4�Total h daily floDiamet .�a_---._ Depth..___._._....5. 9 Septic Tank—Liquid capacity.....:--gallons Length_��-_.l_._ �' W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......___...........sq. ft. x Seepage Pit No...........Z------- Diameter.......__ _._.__ Depth below inlet.....(?: ..•..•. Total leaching area.......) Z Other Distribution box Dosing tank '-' Percolation Test Results Performed by__.... .`.. -�..?� ' `_.. ��! .............ttG/t�l, a Dated �/ � ,..a Test Pit No. 1................minutes per>nch Depth of Test Pit.................... Depth to ground water..... (i, Test Pit No. 2................minutes per inch Depth of Test Pit._____.....__z...... Depth to ground water........................ Zw _---•------------- --------------------------------- ------------- ----- O DescriP non of Soil-- y- C-. Q' _� ....:........:.:. .. f -- V -�--•-•-.- ..................:�`=t'' �--...-------- ...•..---------•------------- x , 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 TIT1_E 5 of the State Sanitary Code— The undersigned,furth er agrees not to place the system in operation until a Certificate of Compliance has been/issued by the boardpf'health. Signed . .( ` �. :r�f ' -•-•--.. 'C .............•--•---•---.-•-•- --•-•-•--...........•-•--••--•.....__ _... ApplicationApproved By.............................................................. ........................... Date Application Disapproved for the following.,reasons-..........-..................................................................................................... -•----------------•-------•------------••----------------..........--------------.......---••--•---....---••-•---•----•••---••-••-•---••-------••••---•------•-•-•---•••••------••••---•••-•--.....----- Date PermitNo................................................ ----•--- Issued....................................................... Date ,.y THE COMMONWEALTH OF MASSACHUSETTS •�J BOARD-OF HF4ALTH f..f......�...............O F.....,!,.. C........: :....../.....1/r.'".LS� .,:... ....................... Ttr#if irFatr of Tantpli'anrr THIS IS TO CERTIFY, That the-Individual Sewage Disposal*System constructed �( or Repaired ( ) by '..... .... -----•••...............••••• ----•-••. . . •.... •---••••-•----•--•......••----•-•-•--••------ Installer." � at........ I - ................................U.CiL s ✓- � ��1 has been installed in accordance with the prov> ns of TI'� ;ry 5 of The State Sanitary Code as 9 described in the 1 application for Disposal Works Construction Permit No.. .. ......-„_ .._a............ dated_..._ a THE ISSUANCE OF THIS CERTIFICATE SHAL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................... /-.11� ,�f,1-------- Inspector 4/X� a t 'i THE COMMONWEALTH OF MASSACHUSETTS BOARD �OF HEALTH Poe; U ...........0F.....��.J........!..2c..... I/CL......y..r�........................... , No......................... Disposal Works.Tonstration ramit Permission is hereby granted..... �. ��J�� :( __. ,�t-...':.?..._..._.........�. '� to Construct (,X) or Repair ( ) an Individual Sewage Disposal System al. No. -;�-^e-' ........t..._,�-.-treet...__C _.:,_..�! .cam. .. _ ... as shown on the application.for Disposal Works Construction Ff rmit o................... Dated...f_ �y 7l`/yam oa o eal[�j/ DATE.- °._-- c3d'1--d•-••-•-••-•-----•-•---•••................................................ / FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS rrwrr�nrilQM� OTES '�: ;R, --——— - ---ti ��"�►�-.L.- �.�...�,� ..�}-•tt�f�.� +Ax?.� i�'1�.At�.l ��A t..+.�5�,1�L.. TG !`mil►+�.)t►y"t tJ►�+'� d t, ,, . / _... N- 7- 4" �J 0 V.�® ® ci `y Ap Ly O { Q(j � Q ', •�/ V V `�t v c�t Z'5` A� �,£ 1E F+Lk_ �j kT" Ic 1 0 0000 000 �0 Ow ONE", (Doo 0 o (D o t 0 (000 0 (D �-- t4• � Q � "v c.•= y�...►�T��.� �...c��1 w�E f�-s-� °s��.t..�.E.t. `��. t �'��C�► t#�# -rumo Good 00 h .c; .� c��.�C . .�� - t --_--tTt. .e ea+ • " irt. 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