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HomeMy WebLinkAbout0532 MARINER CIRCLE - Health rriaelnpk cyrr-A . Ca�-� ozLl -0q6 No. ........ .............. .............. THE COMMONWEALTH.OF MASSACkidigETts BOARD OF HEALT .........OF.......iS .................................... Appliration for Disposal Marks (�onstrurfton ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal S tem t: YV .—................... ...... ................iF........................................ E-.C.;iA-XKj------------f ... :;.I'- .....a4av­. .........76.4...................................... ......... .. :................: .............S..... _9ner - , - Address .............................. ................................................................................................... ................... Installer Address Type of Building Size Lot..14 U -jo. ........Sq. feet Dwelling—No. of Bedrooms__.____.__ .......Expansion Attic Garbage. Grinder ( ) .. -No. of persons.........6?............... Showers Cafeteria ( ) Other—Type'of Buildiii,01-41.64- -------------------- 9 04 Other fixtures .............................................................................................Design Flow..............r -------------------------------------------------- .. . ________________gallons per person per day. Total daily flow______:_.___.__.._____.._.____.__._.._.__...gallons. .....................................gallons. 9 Septic Tank—Liquid capacity./ gallons Length/11!6.'.. Width..,5=-O.. Diameter................ Depth...._...__..___. Disposal Trench—No...................... Width.................... Total Length......................Total leaching area....................sq. f t. Seepage Pit No........:./........ Diameter......f-!-------- Depth below inlet_'73........ Total leaching area..,5-,0�_—*kL Z Other Distribution box Dosing tank Performed by. --------- ............. ----------- Percolation Test Results Test Pit No. 1................minutes per inch Depth of Test Pit.__.__._............ Depth to ground water--- Test Pit No. 2................minutes per inch Depth of Test Pit..._........___._... Depth to ground wat A................... e7... ...................................................... ------------------------- ----------------­"......... 0 Description of Soil... .............................. ............... --------- ----------------------------------- ..........*.................?je-. U ............................ 3(a--- ce ..........................�3_ --- N (0. .,KY..................... . ------- ................................................................................................................. 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'L I Ti IL4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued,by the!,kPftrd of�ealthh.e Agned. . ...... . . ......................................... ---;;,------ .............. Date 44 'J�/ ,2,F —d:Zd .. ..... . .:. . ... . .............. ....................... Application Approved By. ...... .. .. ......... .. ..Z�- - ... . ... Date Application Disapproved for the following reasons:................................................................................................................ -----------------------------*-------*---------**---------------------------"----------------------------*--------------------------------------------------------------------------------------**------- Date PermitNo......................................................... Issued....................................................... Date LOCAT ON SEWAGE PERMIT NO. Al VILLAGE INS A LLER' N MqE i ADDRESS Z/ d U I L.D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _ �i,7� ti sy i 1 i i Z. i � d Ull1 s t t No...........�'�.. .... Fxs.. <<.��............... THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH Guy ..............OF.......— ��` ApplirFation for Disposal Works Tonstxnrtinn ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System - t. .... ............................................................rc .�� ..�.. .................................. Location �l ss -- y or 0, . zner Address a •... ✓ ... •••��...L...'�'u.---j-------------------------•.... ---....-•---------•--------........--•---.... dye , ---•--- � Installer Address *•� Type of Building Size Lot__ t_�a1_-------Sq. feet U Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( ). `4 Other—T e of Building No. of persons.........& Showers — Cafeteria Otherfixtures ..........................................................-.....••----------------------•----------•-•---------•.....-•••-•-•------------------------ W Design Flow...............f.:t.....................gallons per person per day. Total daily flow............................................gallons. ��� , 9. W Septic Tank—Liquid capacity....._.._...gallons Length/Q.-_l..__. Width-. :�­::O._ Diameter................ Depth................ x Disposal Trench—No..................... Width---�................ Total Length.................... Total leaching area-__.-_------_..-....sq. ft. Seepage Pit No.........Y......... Diameter.....Z....._.... Depth below inlet-.7..�_........ Total leaching area-. Z . ..... Z Other Distribution box Dosing tank ( ) ✓'' ~' Percolation Test Results Performed by Z1 ?r_a ....... ... . . . s? _L_'�!! - 1' d=- ----------- Date-- c�t1 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.._.. GL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.. G� j ..........................................................0 Description of Soil..0-��'---- •cQ '. : - -----....Y�� ........��r --••- . ...................... 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 TIT1L 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. ` f j . Signed—am — r/c ............................................f . ,_ -----••-------- ..__�J..._.�G Date Application Approved By....... { ' .: .:._..�... - � - / Date Application Disapproved for the following reasons---------------------------------------------------------------------------------••-------- •-••-------......... ....................................................... ------------------•-----....---------------•-•-----------------------------------------------------------•-----------------------•------•------- Date PermitNo...................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........ . ................................... CIntifiratr of TuntpliFanrr THI�j IS TO C j FY, T at the Individual Sewage Disposal System constructed �) or Repaired ( ) �y Installer / �f �� � �, at.... ----.------/--f.y•. .........................--- -�+----•---_� a/01 ... has been installed in accordance with the provisions of�T r of The State Sanitary Code as described yn the application for Disposal Works Construction Permit N -- O T , ., v�----------- dated........ ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION TISF-A�CT`ORY. r DATE... �J�* Inspector_.. ( � ��.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `?2K'.......... ..OF........�/... ? Z?ti:J- cZ - G� �' U No......................... .......---...... Disposal Works Tnnlltrnt' n V I Permission is hereby granted........C=�: �-!_._..1 � �._.._1=:_... � to Con stru (X) or Repair ( ) an Individual Se rage Disposal S tem.a `� at No.._ .. �� /�7ct,'_tl• �- -1��C. 9---------- Street ! I as shown on the application for Disposal Works Construction Per rymr N Dated..... _....'S -----•---•--------------- .................... DATE------. - -;- _ Board of HealthU FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS O 7, E-iEkJE7V-AL NOTES I�--4.L..L. EA-E.V. S>rO\,/ A" MG---A" sE A LXm-\/g L- ' �•'SE'D o� V S.G � Gt .5 t�c��M C�t.�►.►.1 E 1 O ( Q A L-� Pt PE 5 To n ►J THE 3Y STD M S HALL t Q.'O'-j sC-"e c)uL.E AO P\,/.G . 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