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Home My WebLink About0438 MARINER CIRCLE - Health CD�� O Z.,4i0 �y 1 03nssl 3 :)NVIldN0 31d0 03nSS1 111Nl13d 31r0 o 2 /i pl y ? /ri N3NM0 SO M 3011 n 0 / t(' _. SS3V00r I 3NVN S.V31 r1SN1 3orlll a '!� X�R 7 6?j - II 'dN 111r d 39rM3S 011r � 01 i V C—xpV1Vs1w PISS PIT 1 r�NK L v L) g VA No6lJop, ® mil THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF....... ..... ----------------------------------------- Appliration for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit to Construct (PQ or Repair an Individual Sewage Disposal System at '44 ----------------- or L, Add ............. . ............................!�. .... ..... ... .. ... ..4 ................................................ Lo Add or o, .. .... ..... ........................... ..... ... .. ..... ................................. ........ ....... .................................................... caner A4"rs .................................. ................. Installer Address Type of Building Size Lot..,c,1_,...0, 00 Sq. feet U Dwelling—No. of Bedroo C;?- - - -------------------------Expansion A tic Garbage Grinder ( ) '26 . . ...... No. of persons.......... ................ Showers Cafeteria ( ) a Other—Type of Building Other fixtures............................................................................................... ..................................................... < ... — — 9- Design Flow............ d.3...................gallons per personyer day. Total Lilv_ flow...........:7.0.0....................gallons. 00 04 Septic Tank—Liquid capacity/dOW..gallons Length. ...... Width 1 Y!"__ Diameter-------_------- Depth................ Disposal Trench—No. Width.............._.... Total Length......__......... Total leaching area_._.._......_.._ ft. Seepage Pit No-----------/.........D,i'a---m"e,t e r....../�------- Depth below inlet.....;-7!3...... Total leaching area..Q�i.�.. .sq. ft. Z Other Distribution box Dosing to /( 01" 0-4 Percolation Test Resu�ls Performed ...... ..... .... Date..S./.Vo/. .......... Test Pit No. 1_4:_�-------minutes per inch Depth of Test Pit.................... Depth to ground water./11,01. Test Pit No. 2................minutes per inch Depth of Test Pit..._.._...._..__.._. Depth to ground water. ................................................................................. 0 Description of Soil------ . ........ ...................... -------------------------------- ;0 ...................... .................................................................... ------------------------------------------------------------------ ........................................... ------------------------------------------------------------------ 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 TIT!.- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued�by t160board of health. ign ... ............. ..... ......... ,44eex ..............w ate .... .... . .... .Application Approved By............ 1--iw 14 lu ...............A-4*.....Z.?.,..... Date Application Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... Permit No......................................................... Issued.. ....Date....... Date No......-•--• ....._...... Fps..., ..._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' .-----!/..Y''.'?(....................OF........... .: Appliration for Dispnna1 Vork.5 Tonntrnrtinn Prrutit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at* 1..- --•••- ....X .................................................• ./s• a as[iti Il it/�L.. --------------•----------...........---.....•.' KLocation•Address o. ..............•...--___........................... _....... -----------_--•--••-----...--•-•--------•-....-•---.........•.......-•------......--- aOwner /� Address✓� G! / 1l G t1....... !!r' f/s!.1r!I"s .....-- / Installer Address Type of Building Size Lot..:�6.,:___/ �J U Dwelling—No. of Bedrooms ....Sq. feet ............. ...... ...................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building + ��f*�! ___.... No. of persons......._.�4............. Showers ( ) — Cafeteria ( ) Other fixtu fes. `' ...................--............................................................................................................ WDesign Flow................5_,.: ........._..._..__..gallons per person per day. Total daily flow............ . '........._..........gallons. WSeptic Tank—Liquid capacity&?7r0_gallons Length_,e?_.' Widthk..�!.!.. Diameter________________ Depth................ _ x Disposal Trench—No. .................... Width.................... Total Length.._..... ....... Total leaching area..........i.r-sq. ft. Seepage Pit No...........�_ ---- Diameter....../ /....... Depth below inlet.....7_ ?....... Total leaching area.. _� ..sq. ft. Z Other Distribution box (,/ ) Dosing tank( ) Percolation Test Resul s Performed by. . s�r.!lLrt_/ LfUt✓ a .......................................... 022 l y� 'f a Test Pit No. L. "t....._..minutes per inch Depth of Test Pit.................... Depth to ground water_; >.e................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.rKi?_l/. ------------------------------------------•-•-•--------------....---•----..------.-.-----.--•--.-. -----•-•---------------•--------------•-----•-----.------ O Description of Soil................................ �'F_.................................. aI< � (/ -- -------------------- ----------- -�----------t•---•-•---.......----•---•----•------ v -------------- '/lire: ` _ = �." ............ ---------------------------------......................................................................................................................................................... V 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 TIT L i- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliane has been issued by the board of health. ire ' ' •-_---- Date Application Approved BY-----`---•- .F ' ! ------------------------ ...... ..... Date 'r following reason �Application Disapproved for thei .............................................•-------- == ' Date �o Permit No.......................-:. ..... Issued_---------..._....------------.---•-----------•------•- ------------------•---•� Date rU PTHE_C1 dMN1 WEALTH OF MASSACHUSETTS ;dtiaz.'a_ BOARD OF HEALTH Y d N ;,.. Tntifiratr of (tuntpliatta THIS IS TO ERTI�Y,/That the Individual Sewage'Disposal System constructed ( ) or Repaired ( ) Installer at.._.�I.............7 ------.�/' ��!°!'f�_.... .rf�f _...-'------•-.'--_...`......------•--...-••----••-•--•-••-•-----------•-----.............-----•--••-- has been installed in accordance with the provisions of u 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No: .. _�'�__.._.._... dated_ -.: ---------------- THE ISSUANCE OF THIS,gERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI L FUNCTIO SATISFACTORY. DATE .._., .. ... Inspector r s THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 F ref°? ✓ f ,.................................... No...::... .......: FEE........................ Nspo,sal Worb Tnnntrudion raniff Permission is hereby granted...... Z Zle.... fA. ,':: :+-:........ to Construct (jC) or Repair ( ) an Individual N age,Disposal System ; at No....../'`"fix ./.........� e__4::. .,r f-< . .'-' �° •---p K ......--.. ._ . 1Street as shown on the application for Disposal Works Construction P•er No..... ..... .....`` ated.__..................................... / Board of Health DATE_.,? ..................... --•---••--- FORM 1255 HQBBS & WARREN, INC., PUBLISHERS y 1 Y i C-'?AjJC-• _yP} ` FtfvlSN G�AC C�r4�r,N viPADL" _ C-elt ' .4 IV rc To .v-1r y.�`/•�y\j,�i�i \fir`, .. r b'To AT I ._.__-^--- -----��-'•• T , � IPE/Nf3�C.G�U c:O�t;C � ...�-_.�---- ' D (,S T 6 t_-)X .ri ! I . � i (Z.� ` 1 C,@uSNGrO S'fO�VE ..SEPTIC T.4.V K Tc Ge L6 V,-L- _ c .N1D• of •EfE�tP461�l� . � 4 � 'd, � jv G°RL. f fg .ems}►�✓' �:� �'-`' r. � + Q!„// �rf ��' �'( fr j � j' '� - 4 t L rEiy�G'j!�/q+'t�• /�1�.� ,f'.rt�t�rlfl'►� � � ��' { W j r: c� �'C-[y. ; ..may,:�`M-[7• �,� y ol w. 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