Loading...
HomeMy WebLinkAbout0562 MARINER CIRCLE - Health ,�1�2 rrr�te�� Cc vr�.�, Cdd�=�- -- � THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH dN..............OF..... � d�........... Appliratilan for Disposal Works Tonstrudion ramit Application is hereby made for a Permit to Construct (>Q or Repair ( ) an Individual Sewage Disposal System at• Q _ o / orlLot No - a .... Lo.catin - s . ......... ..--. ...... ....�'�......... .......7 .......... wn r Address .. ...................... ...... *------- ---Installer -------•------------------ Address U Type of Building Size ...Sq. feet Dwelling—No. of Bedrooms.......... ....3......................Expansion Attic ( ) Garbage Grinder ( ) PL, Other—Type of Building No. of persons......... .............. Showers ( ) — Cafeteria ( ) .< Other fixtures ----------------•-------•---•--• . W Design Flow.................5_�...............gallons per person per day. Total daily flow...........3.3.©.....................gallons. WSeptic Tank Liquid capacity/O.M..gallons Length.,/10.-6'... Width.-„6 nO... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-___-_--------------sq. ft. Seepage Pit No---------I.......... Diameter.....X........... Depth helow inlet... ....._. Total leaching area...,��_ r Z Other Distribution box ( f) Dosing tank ( ) aPercolation Test Results Performed by---/Vrf�__.. _....__ Date_._._._ � __ �__..__. a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.__ fZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water./..� 9 .............. •---•••••--------- -------- O Description of Soil d - -- -•�- .. . ..................1.-----------------------•---•--•------------•----...----------------•---------•------------- x ......(a :3 . L� .1 $ `'"`,'`-------------------------------------------------------------------------------------------•----••-- 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 i ITI.L 5 of the State Sanitary Code—The undersig ed further agrees not to place the system in operation until a Certificate of Compliance has been 'ssued by the bo of h h. ' Sign .---- •. . ----•----------------------•--- -•--- � Date Application Approved By....... ... ............ .. ....... .�....._........-- .......e a_ Date Application Disapproved for the following reasons----------------•----...--------•----•-------------------•----------------------------------------------•-•------ --•--••------•---------------••-------...----•---------......•-•-••-••••--•--------•------•••-------•-•......•••-•...._....-------•-•------•-------------------------------•-----.... ••-----------. Date PermitNo......................................................... Issued....................................................... Date � A J-P LOCATION �- � G� A SEWAGE PERMIT NO. zed �� cC�' VILLAGE ��- - INSTA LLER'S NAME, i ADDRESS BUILDER OR OWNER,f DATE PERMIT ISSUED ei ZZ 3 laa DATE COMPLIANCE ISSUED vki ��� _� s r � V` �� � �. W � �. � :, � ; R�� 1 ` ,�, ,} ., W �,�c�` a No.. �.....v THE COMMONWEALTH OF MASSACHUSETTS _�- BOARD OF HEALTH ........ OGU..../--------------O F.....,/�...iy...... ApplirFation for Dispas al Viarkii Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct (XJ or Repair ( ) an Individual Sewage Disposal System at• � � �� ` ........... .. ....... :.. :............. ..�..... ........................ Location-f' dy�ss/ ""' ' or Lot No C� [ /G tr wit 1 / Y� /k ...................................................... .......... ..................;.r..............._.__._......._.._ ............ ...._ ........................... .. %..�..../«....�. l �wner Address r/ ------ -------------------•--------------*'Ad*'Address* .. � Installer Address U Type of Building - Size Lot.. j.: d ---Sq. feet Dwelling—No. of Bedrooms................... ......................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .............. — Cafeteria a YP g -��=`� ------ •--- No. of persons---------•--- Showers ( ) ( ) Otherfixtures -----------••---...-----•-----------------------•--•--•-----------•-•--•----•-•----------•......-----------•---------------.......--------•-------•-. Design Flow................. ................gallons per person per day. Total daily flow...........3..;; U.....................gallons. W Septic Tank—Liquid Li uid ca acit 1�._gallons Len th_/4../f....... W>dth._,�.-a.. Diameter________________ Depth............__. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../---------- Diameter.......?_�...... Depth below inlet..... ..... Total leaching area.... a.s�. Z Other Distribution box ( /) Dosing tank ( ) '-' Percolation Test Results Performed .............. Date...... ........ a a Test Pit No. l................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_?__'-w P4 - . O Description of Soil-----�.-.. ....�� - e..- - - -- -..................................... x ---------�- C' lc�.0 U x ................................... v--./L..�.......1? f.. , LG ----------------------------...--------------------------------------------.._..------------....---- 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 TITITS 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 boa d of h th. Signe -- .. -- l- P..Dat .. G�2 �1 ...... C� �e � C� Application Approved By..... f'=---•--- ----- •=--....-- ---- -- --•----......---- ( - Date Application Disapproved for the following reasons----------------•----------------------------------------------•-----------------••••-•-------•--------•••---.._ ......................................... -••---------...----------•------•------•----------••-•--------------••---------•----------............................................................ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j ...:��. ..............OF........ �'Lr12� � .............................. .. ................... ... T.er#if iratr of TantliliFanrr TH S IS TO C TIFY, That toe Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.... /? >.-- u-� '�-�---------------------------------------- at. ✓7........................... ? .-- Installe(�/ f/f has been installed in accordance with the provisions/of T + 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N ..- ��Q---------- dated----- _.2 _ � THE ISSUANCE OF THIS CERTIFICATE SHAL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I n DATE..............•--.........--•--------� �� ................ Inspector..---------........ -'-A(r.................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.............. ... FEE........................ ............................. 1 nrk� C�nn��r inn rmi# Permission is hereby granted....... >�............. Q.... ._........._.. to Construct (X) or Repair ( ) an Individual Sewage is csal System at No..// . ..............7.0-----��Zc.........LC . -/r,�� �_ . f... --- - Street �J 'k O as shown on the application for Disposal Works Construction Pe t N. .... ....... .... Dated.._. '_.___....._..................... --- �: 11 L ----......................- �_ Board of Health DATE ------ -- - ---------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .. Nfs»'..n ... s'.'.;_ •.- ;-p...•c �,• •,:: ct '..... .;r+ ..,+�„' .A9;•,. 1p T�.: =%' ___.- `_'' �. ---4t...�. EL.��/. Skbu.�w� AQ..�c Mrr.�o►w.i SSA t..><s�/6� - - - - -- �A'`.�EU of V S.G � G .5 [ae�T�� G3.�►.1 E. 'PiTC-N AL-L- t~t i1ES A M 1+J t►4 Uh� OFF W/F;oof •A;�,• ; : O I (�® \ ® �j�--- A P1 Pr S TD �►.►D t i.J TH�c S4 STD M S :.M 1!!)�E SST t ao'- 5 oz a fl Ut..E AO PVC . � O d-- ALL- `3 E. ►�l K PT(C TAS, fl15TiZ 16c.Tt'►O�J u O r ® L-EA.C►.a►,16r P n-S S"A LL- 8E '»CS%Grt"Eo Fog. N - 20 w E ��fl�►.tGS - -- �-- V-E MD�/C Au- BE"EATIl-1 • I ���E Iw1�/EQT EI,...E/AT'to"S OF L.EAC41,,. PETS FbC_ 4 mt O O �\ a eAz�US of A�o +GKF t.a_. Ti-1 C t.,ay • o Q� O 119 �� NCSTt i EU W F-4E� T►� ��►S�`E►� lS N E.A . J O 0 O ® O O O� Ar-j O Pzt OQ- TO d►iC�� �t 1�..1. .1 Q- a-- V 1, �.E55 oT�-�E2� tS E fuoTE D, A t.>` �l• '' t✓I �� I� � c z yv.l�rAe� I� ,( GOMPOti,�NT'� �Hat� $E 1►.1ST-A•L.�V I�•J O O ® V/ tl.� ACC_C�iZ U A�.1C�. 7E o F T t4a '�TgT�c �! Ty F 1 C A,L D 1 STR1>!5uT-t n�-J 1'?,o� j O 0 O C) 00 (3 0 0 1 T ► 0M -ossT•e,avrICAl soK A -3D c)oo �t► FOQ1.ET� SLoi''rt G TT+.11Z gy Ai`�E.2��-1�+ � G1�FGhS T ►�J�'�T- TC� �'.A L.E i-�r1T To4'.A�.E 7 l.Xrr� Ta+.j rC5 itE� J s-=��.c.E v T►�2o�N o � ; ��" � tt:'� 5 .• � �J OTE AC�ES� M�,►_lt-��ES Tn " C--_ SEPT"1 C- ��� A��:� L��4•=t .S G Pt'T`S Z 145 rG= ►-•�ESN �?nt.� S 10 r , � ---�— /F �11S.-� C�QA.�E _ 1G-1�a � nvE=rz_ ro..-;K. �O�d C�.IEe.U't3� G�-�$--- �A��-•��-.�<_, ��,t gab-sTo.JE: �CbQ'Ki _ N Fr © } u �� - 9� ��� m C ® O m - G o $° L__1 _� 1 b�' GAL X' ° �44 ® O ° >:•15�1EU STD+- ie ID1ST 8�1�/ r m co 0 '� o ® c) ® O � IAXi• . O ir—it.E-V t'' iOo,`r• +�f �C. T'> 6E l�`�EL.t✓ `>1 J.SL ✓ _• � t✓tc A C t•{ �rJ�a P tT' IVc,T T-c.� �.�, e "t,A�r-tSTo.it, HE L EGr E r.j P�.CPO!-:, r=v -- - j q IDE �1C �t -C(TE Q-tA --- r►�U co►�7 PiRopo5eo 5F.\&i^aqE D%sPosAL. M NL�Mt�Etz_ C�� f Dt?canMS <c`7, c Ex�S� 5Po7 t~�EJ ` c> < i GA t_L-OaJ S PEV- PECSOK-) Pam- PAY 1 EAGµ �.•1��, A.eA. PF�'J<�i�.0 �_>c� CPt� nBSEt2✓AT�o._► z�ST t- iLL' �� .: ; l�+A`�►!ST�_'�trE ) MASS. !01 RzoP�'SEL� l�Ju t+��lC-t PiT SC A,L_F- A5 GATE �3 5� .,��t� A.tLcb. ��i0,^i k Z,� - -lC�- V C'� , ',.' (' je k-kF'n►.t o,J --. -PLOT- PLAQ BC�TT`bF� AQ�E,A Fip �-' •� �, O —_5 O u„P� `' � } 'T"'UC"�.; 4�� r� G„t✓t o ;*. � �q �� e..n,t�err v �.���E ►,E E t�1C72 Mo,r., G-t2vSSM1A►.� QE . SCrs. �.� t •' ' 2 2� uO��-•� �L►J'T QaA'� ti