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Home My WebLink About0383 MARINER CIRCLE - Health g3 (Y cu-I ner ctrO--o- 8 0Z,q— O(A— c�� i i No 31-2.. Fps..`,�.d................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1-...........OF...... / �1�°KTC.I . II..L�fe_.. ............... ApplirFatuan for Disposal Works Tonstraartion Famit Application is hereby made for a Permit to Construct or Repair -( ) an Individual Sewage Disposal System at* _- .... L cati /-.Addd Lot No. .... ..... ....... ... ....... ...........•-------....- ---- O �//� �s T W U S � � Installer Address Type of Building Size Lot..a7 .c�v�._�---Sq. feet a Dwelling—No. of Bedrooms..........j..�.__ ................. Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of -No. of persons......(v.......:......... Showers ( ) — Cafeteria ( ) Otherfi_tures --------------------------- ..................................................--•-----------------------------------.....------------------------ W Design Flow............. ..................gallons per person Der day. Total i� iow____........33.d..................gallons. WSeptic Tank—Liquid*capacity.I.Q�.gallons Length_...-- ". Width-_'4._�.�. Diameter................ Depth........ ...._. x Disposal Trench—No......... Width.................... Total Length..................... leaching ar ft. -- . Seepage Pit No.............. ...... Diameter.......X........ Depth below inlet...°'3........ Total leaching...._ J... q. ft. Z Other Distribution box ! 1) Dosing tan ( ) _ • aPercolation Test Results Performed by_...... ..l7S°i .....4.eQ vv..... Date......4 ._ �...._.5,7_�..... 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-_ /�_ 44 Test Pit No. 2...........__....minutes per inch Depth of Test Pit.................... Depth to ground water. C.) O Description of Soil...........-0= 3AR.�A -6°...i..--...----•• ----------------------------•-•-------•----------- -----....._..._.. W ------•--------------•-••-•----��6=....) 4•'- ....-------�� •��------------------•---•---------------•-•-------------....---------•----------- 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'I'LL, 5 of the State Sanitary C — The undersi furthe agrees not to place the system in operation until a Certificate of Compliance has be ued by the bo of healt Signed--..... � ...v/ ? o Date Application Approved BY --------�---�" a 'I Date Application Disapproved for the following reasons:............................. ...........................•---•-.......................... ----......•... --...-•----------------------------------•---------------•-•----------------------------•-•--••----------------------------.------------------------•---•-----------------------------------•-.._._..-- Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...�D..L'V ..............OF......f�' � .. ........f=/L ---.......------ Appliratiun for Disposal Works Tontrnrtion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at•. --.........l, _.........................•---- --- .�...... _....... {� r•f ...................................... on- ddis Loca r/ ��( a t1 A,/(e is/! — or Lot No. .... / ••--• —._... •- t ........................ ..........•............... ....... �............_...- .. —f/ Owner //A'ddrAs / l ..........i.s alley--. -----'—-------.--•--------- ---------------------------------•------------..dyes------'-----------------.------------------- ' Installer Address -� - UType of Building - Size Lot.d. ..�. __�_._.Sq. feet f•, Dwelling—No. of Bedrooms......................-}..................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building ��+ i +'� �� No. of persons ��................... Showers Ga YP g ---------------•--=•------- P ( ) — Cafeteria ( ) Otherfixtures ...........................J........................................................................................ .......... WDesign Flow................-._.t.._..............___..gallons per person per day. Total daily flow.....................L.................._gallons. WSeptic Tank—Liquid capacity C r .gallons Length../..' Width.. Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....._-............sq. ft. Seepage Pit No.............I___... Diameter.......o�......... Depth below inlet...:_'? Total leaching ai-e'a _�f �___._sq. ft. z Other Distribution box ( f ) Dosing tank ( ) f ).-IPercolation Test Results Performed bY-------- Date Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water... fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water./V.�..IV Q+' •---------------•••---•-----••••-••-•••-•••----•---•---.....-•--•------...........•--•-•------------......................................................... O Description of Soil............ \' �=t i = x 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 TITIZ4 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 �D�te Application Approved BY •,, -.........-•--- ------ Date Application Disapproved for the following reasons:................................................................................................................. ........................-........................................................................................................ ••----••••-•--•---------------•--•••••-----•--••----••------.....-•---- Date PermitNo.................................................. Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �.. BOARD OF HEALTH ........! G... ...../............OF.......f�.fl�..t�. ... ii.... .............;..........:..... Trrtifiratr of Toutplianrr THIS IS TO CERTIFY'That�the Individual Sewage Disposal System constructed (X) or Repaired ( ) by = --•-•----------------------•••----•---•--•••........-------- / 1 Installer / at... i-•/-1---•./l-•----, 1/..._...._'. ...--- ' ! f r./ j= IAI ...... ....................................................been installed in accordance with the provisions of T•1 1of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. �............... dated_...._.._-__.._._....._..............._........ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. a.,, .1 DATE...--••--••-•--.......--•.............................��.._.._...._--•--- Inspector........--------- !-L!v -•------.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -00011 b ............... .............I...........OF........./... ...f....!.....-• ......_....A ' ` N�•.I-,�- FEE... .............. Disposal Workii Permit,-' Permission is hereby granted ----------------------•--•---------------------------------------------- to Construct (/) or Repair ( ) an Individual Sewage Disposal System / -•----•-•----------------------------------------------------------- at No..... ................--'j........0 / / / .1 . Street' . .as shown on the application for Disposal Works Construction Permit No..................... Pated......... ............................... -•� ogoaFd of Health DATE......... ?. 1 FORM 1255 HOBBS & WARREN. 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