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HomeMy WebLinkAbout0371 MARINER CIRCLE - Health twA 0 Zq \7 LOCATION EWAGE PERMIT N0. 71 ZL le- VILLAGE a INSTA LLER'S AME i ADDRESS BUILDER OR OWNER DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED a Lx��rS. m6.r ,`yIF r Ci' Yc Ie No...............yY..._ I$............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD, F HEAL H ®u�u oF.... ..-. ..... .................................................... Appliration for Dispaual Workii Tomitrurtinrt 1hratit Application is hereby madq for a Permit to Construct vZ or Repair ) an Individual Sewage Disposal tep �e Sys at_. - •- •-! •--... -• .......- •-• - • ..... .................. ... .... . ._..- •... .. Location• -A s or Lot No. O ner A, Wof .....Installer Address e� Type of Building Size Lot--- feet Dwelling—No. of Bedroo ------- ...................Expansio Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building _______________ No. of persons__..._�................ Showers ( ) — Cafeteria ( ) p" Other fixtures .-----•----_ . W Design Flow................ ---------------gallons per person peg- day. Total dail flow.__..._....................gallons. WSeptic Tank—Liquid capacity'IMgallons Length__1 .. .._. Width.. ..... Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area.... f . Seepage Pit No____________ _______ Diameter.._...._ P...... Depth below inl t... °........... Total leaching area.. .J.s Z Other Distribution box ( � ) Dosing,��lC ( ) ��++ h aPercolation Test Results Performed by_._._.(.�-� .............. ............. ................ Date..../.vQ: aa........�......... Test Pit No. 1................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--- ... a `- 0 Description of Soil..•.//Q 1C�.--••..••-• ---•-- ----•----- ......................-------------•••----•--------------•---•------•--•-----.....----•-•--•-----------•---••-•-•-•..........•... W .......J&-- .. ...-------- --------- - ----- .......... x -------------------------------- 114` - . 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,- 5 of the State Sanitary Code— The undersign d further agrees not to place the system in operation until a Certificate of Compliance has bee sued by the b f health " Sig d.... ........ .. .... .....................• ........ Application Approved By.........•... -•--• ....... ...................... --- Z-t-`�•-= Date Application Disapproved for the following reasons______________________________________________________________ -- .............. .................................•----------------------------....-------•-••----•----.......--------•---••-••-•------••-•-•••--•---------•--•---•-....----------•--•---•---•-•--•----•----•-•-••......_ Date PermitNo......................................................... Issued....................................................... Date No...................�... >F'�s....��a. ....... . THE COMMONWEALTH OF MASSACHUSETTS lam. BOARD OF HEALTH .....O F..... r........r�' Appliratinn for Uhipaii al Works Tonstrnrtinn fautit Application is hereby for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at:.. .. ................................. ..... ....:_ .. Location-Address / or Lot No. .. - __......_.... ................................... ........ .................. ............... Owner J' Installer Address .— d Type of Building -� Size Lot...... .__�__7_ �Sq. feet Dwelling—No. of Bedrooms•_____________ --�.__....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ..i.`..... No. of ersons.._._. ................ Showers a YP g ----------=--=--------�=--- P ( ) — Cafeteria ( ) Otherfixtures ----------------•-------•• ° ----•-••--------------------------------------------------------.........------._...-----------.......--------------- W Design Flow...................... .....................gallons per person per day. Total daily flow.........._`. 5 0...................gallons. WSeptic Tank—Liquid capacity..I!��I�t'gallons Length.-I!... Width--- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.................:::sq. ft. (1 Seepage Pit No-------------------- Diameter........(..I...... Depth below inlet... ............. Total leaching area.... Z Other Distribution box Dosing tank ( ) a Percolation Test Results Performed by._.._j.�_.!`-t�` `! ._...._.__:_t. ^'U'!.:` :4 Date_._./l'__.:..:.......... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....... ri, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....4f% ..............� ....................'-----------'-----------------------....----------.........•-•-._...••••_-•••-•.................................... O Description of Soil._..�_ .. .....' !. ..____ __. a _ : - + � ................................7�=------...1.41).V-----------I-1rlIu................ ...fir _---------------------------------------------•----------------...------------------------ U Nature of Repairs or Alterations—Answer when applicable...........................................................:................................... --•---------------------------------------------••-------•--------------------------.._..----•-------------....------------------------------------------------..............I......................... Agreement: The undersigned agrees to, install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI;I,za. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beewissued by the board/of health.-. �... _ /,/. i --•................... ;L `3 te Application Approved By-•----- Si ------------------------ -__.....------------------. -........... !/ Date Application Disapproved for the following reasons:..................................................................................................-•--•-•-•-. Date PermitNo......................................................... F IssuedL....................................................... Date x4 TH.E.:COMMONWEALTH OF MASSACHUSETTS BOARDS-OF HEALTHd O F. . -. r r t i f i k tttr $ f�nnt�rli�anrr THIS IS T CER�JpI'FY�, That the Ind''id)ual Sewage Disposal System constructed ( f or Repaired ( ) -•/��by . � . �t-�f i _....C. C,K/vJ---------Installer................................... ..... -•..........................:c.......... \ _ j1141 at .....................................................has been installed in accordance with the provisions of '" ? 'ter The State Sanitary Code as described •n the application for Disposal Works Construction Permit No.:_.._.....���...................... dated_ ._.__°".__ i � THE ISSUANCE OF THIS CERTIFICATE .SHALL NOT BE CONSTRUE® A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTO� �' �''� "'K S fib: X a E~S*V1. Y # ¢ . DATE.E.....-••••--••-•-_-•---- ------- -- ----- .......--• Inspector._..----- -` ........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH_ .............OF........� ,t 1�I f-�j,.{;.`-" ..,. dam/ ... ...................... No................ .:. '' ,-' FEE70 .. .......... �r Displallal drb- Tnntrnrtilan Pgrutit Q J _. Permission is hereby granted__._%_f...... •....._..: !.....�__1.___.e __../ __._._. >�-L to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. ` t1=---- _r�-~-- 1 C? ti �/ I> /2 J / .� 7 �U,t v C,. i.Street as shown on the application for Disposal Works Construction P No___ ___________ Dated. _�.`'�- ----•---.- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - .w� e>A�sEv o.s v s. (Sk > t necr-�a►-- t,l E _...-.-„" -�-.1,• _._. n _ �! 1P t TG.W A+_.,t.. L,t LJ E S K.1 :r»I L) OF � _,,, � ��.�� Uti1L_,ESS CST'+••1E�tS� '�t�.L_+�"�E"U. ` © �- A L-L- Pt PE'S To A..►,�D t.J® TN�c. 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