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HomeMy WebLinkAbout0657 MARINER CIRCLE - Health 1�.5'1 �n1C��'��eFZC� r�C� ��- oz3 -G3� _� C, s7 ; LOCATION SEWAG PERMIT NO. zlo� .3/ Spa- J�-.Ord — VILLAGE INSTALLER' NAME i ADDRESS e UILD' R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ID _ � - �h No /— Fizs...�� t. .._....... ............. THE COMMONWEALTH-OF MASSACHUSETTS BOAR® OF HEALTH 1..C�GI�r. .................OF...... ...... Appliration for Uhipasal Works Tonstrnr#inn ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: — ..... ..y.. . .......ate ---...-•-._-- ..........-•-•---••...................... Location- s f n or Lot No ..... _... ....... �. ...: J ---• � --•------------•------------------- O � r s a �. .. . ----------------------- --------------------------------------------=---------•---...------------------.........---•-•••-- Installer Address Type of Building Size Lot_ ,r--��� .-.Sq. feet U y Dwelling—No. of Bedrooms............. :._.._.__Expansion A tic,( ) Garbage Grinder ( ) Other—Type of Building No. of persons------. �p ( ) ( ) W ___._.._.... Showers — Cafeteria Otherfixt s .----------•--•----------------------------------------------------------------------------------------- - ....................................... W Design Flow.:......��..........................gallons per person per day. Total daily flow-------3 .....................gallons. W ."Septic Tank—Liquid capacity/ ..gallons Length,f�r _1 ..___ Width, . Diameter....:........... Depth................ x Disposal Trench—No..................... Width...... ..._......_.. Total Length........._ Total leaching area...... �sq. ft. Seepage Pit No............ ...... Diameter..... ::.f p �••- .. g •.�.--.-- Depth below inlet--- Total leaching area-- ---C%� Z Other Distribution box V ) Dosing ( ' ) �� Percolation Test Results Performed by..../. Date..._ . ..... _.. a -•--------.... a 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 water_ __ -----------•-- --------------- ------------------------- --------------.•---- O Description of Soil.... .". -------- t_ 6- -------------------------------- _ •-" ............. -•:---... W .................................30... . !-- -- �....-----------------•-•--------•---•---------------------•---•-•••----•---------..............-- 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 TITIL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ssued b rd of ealth: igned. ...... ...-�U---------------- --- A..t..... ate Application Approved BY L -------.---•--•------- -•--•---`��-- --...-- Date Application Disapproved for the following reasons:------•---------------•-----------------------------------------------------------------------------------_--•-- .................•--•-•-••-•------...--•----------------- ....-•--••-•----------.... . ------. -------- -----------•------------. . .. Date PermitNo......................................................... Issued....................................................... ; "Date '. a No...........yr..ti.. / Fxs............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q................OF........ �.1t.1'dLJ.G ^ t. ......_.... Appltration for Dispotial Works Tonstru.r#ion ami# Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: I �- �.�... ' --_... -- --------------------------------------------•-------.........-------- Location Aje / j or Lot No / r( yt .....................................8 /yl O er re s ..................................................•••-•--------- Installer Address UType of Building Size Lot-_;�/._!V­` ......Sq. feet Dwelling—No. of Bedrooms_____________ _ __________________________Expansion A tic,( ) Garbage Grinder ( ) p, Other—Type of Building _________________ No. of persons____.__.__V....-_____._. Showers ( ) — Cafeteria ( ) P4 Other fixt Xs -------------------------------•-•-•------------------ -----------------------------.._..------ W Design Flow_________-�_S_________________________gallons per person per day. Total daily flow..____. _a_�__Q.....................gallons. WSeptic Tank—Liquid capacity- _gallons Length_ .l_`�_ Width.,' ___ Diameter................ Depth................ x Disposal Trench—No.�__________________ Width ....... Total Length.................... Total leaching area_.__.� _�sq. ft. Seepage Pit No_____________________ Diameter......�.�__.......... Depth below inlet___./. 3e .__. Total leaching area_____________..__pfe Z Other Distribution box (�/) Dosing t nk ( ) .� Percolation Test Results Performed by.____`1f_e!}l �'�`'.__ �....:��.'1._.____ Date__.__ G �✓ 1 /- a Test Pit No. L_______________minutes per inch Depth of Test Pit..._______._________ Depth to ground water_ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.- --- ----------------- ---------------------- •---------------- •-•------------- ------ •....... _---------- ------------- •------------------ D Description of Soil____ _�..w '` x - 1 , -------------------------- .....- ------------ ------mow-.....�... 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?.1• 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 t OoAr-d of health: a igned--= ` = f �.?---........... -- - Date Application Approved By..--•---.... 1 _a Date Application Disapproved for the following reasons: ------------•-----------------------------------------------------------•--------- - -----------------------------------•---._..... -------------------------------•-------_._ _..------...._ Date PermitNo....................::................................... Issued_................................................ ..... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ,HEALTH �.............OF...... .. ... Trrfifirab lad,.(Il lutpRaftIrr THI >IS TO C744 �at the I ividual Sewage Disposal System constructed (� or Repaired ( . ) by------- •-•-••-• ..--__- ...... ...... ................................................... _ I alter at- �-�.....: ,� � ---------------- /` has been installed in accordance with the provisions of T i 5 of The Sfate-Sanitary Code as describe in the application for Disposal Works Construction Permit No ` ._��,f'/___.___. dated... :_...�_r�,�_____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... Inspector � . ..................................•-••...... .................. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .................... OF...------ C1 �2 _...._........___....... .../.z.,3.. FEE._ . ....... Permission is hereby granted-------�G .......!�C_4 e� - to Construct ) or Repair ( ) an Individual Sewage Disposal System atNo.---- - -- -------- - ---� _--•--• ----- --- tl "�`�j------.F - i�j.... � )' �i J�Ci'K Street �- --•---- .-`_ ..__ �.).._---- as shown on the application for Disposal Works Construction P r it No___ _____________ D�ated~:'t9~ (! ---- ---------- =-------------------•------•--- -----f-�-.-.--.+---- I B f th --•� DATE_.."'.---?-- A X -- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r- -- - -►G�. Cam.. CiEAJE'V-AL. N OTEg I 130.'SEt-) o owcr(-.)" C�-�►.1 E. �� �+I ---- --- -�_ -- -- ---- V -- PITGN AL.L- �-i►JES P. M tKJ ("L)h� oix v&b-VF<X:yr A�,�ss c�-�►Eew is E ��1���. I • .:,;�� � o \ � o \ © � AL - PI PE5 To A"O 1►J T1}J- SV STE M S 1-iAA..L. - 0 2d" I - \ 1 --- --- -- -- t�E GA ST t zn•J � �a le fl U L.E Ao P �/•C . 4 '� ALL. 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