HomeMy WebLinkAbout0039 MARK'S PATH - Health 39 murlLs Path, II��nni s
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LOCATION °a' SEWAGE PERMIT NO.
VILLAGE
INSTALLER'S NAME A ADDRESS
CL ! U I L D E R OR OWNER
DATE PERMIT ISSUED 2 — js � 95
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.../..-..................OF....19���4477...------.................---.......
Applira#ion for Disposal Works Tonstrnr#inn thrmit 4
Application is hereby made for a Permit to Construct (,,k) or Repair ( ) an Individual Sewage Disposal
System at:
N�
Location-Address or Lot No.
......................_..............................
..
........................
.................. ..........--.................................-----•..............................................
w Own �y Address
ate- .......�<sl!��. .......�-�- .._ 'f -------•-•--•................•----------...............-•---•--•----•----
P Installer Address
d Type of Building Size Lot.t/®g� .........Sq. feet
U Dwelling—No. of Bedrooms........_�.............................Expansion Attic ( ) Garbage Grinder F/O)
Other—Type of Building No. of persons............................ Showers
a YP g -=-------------•---••------• P ( ) — Cafeteria ( )
Q' Other fixtures ................................. .
WW Design Flow......:., ...........................gallons per person per day. Total daily flow---_...__.._ —3c. .....__..._.._...gallons.
WSeptic Tank—Liquid capacity!4da..gallons Length.O.'re"___ Width.��__�ic?'.. Diameter---------------- Depth..•___` .��.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No....:.P............ Diameter.... .Z.`____... Depth below inlet_'-!�7 ... Total leaching area... .....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.G'�P TV&7V G�.�! �c% °vt .. Date___.._..................................
Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water.___...._
44 Test Pit No. z----- -_.._._minutes per inch Depth of Test Pit--._�.?..___._.. Depth to ground water._.tN .,� _OF,y�n�
--•-------•--......--••--....-•-••-••---- -••-°----------------------------•--•-•-•.........------------.....................-------- ¢ \..
0 Description of Soil. ��' Z.ye�u0 ?!i, l "••-2t�`' 2 JvY�v!SSo.L------......•-•---...... ��� ...._ROGER �G
x �� •, �..�.� . �s°s�•v �`��.����, "� a®cep ,� o--.. ®oe % wicz
(� Tom. '� i.... ........................• MI Fdt30
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in rdarice-
the provisions of TX 14 5 of the State Sanitary Code—The undersigned further agrees not to pl the system n
opejzUQu until a er cate pf Compliance h s be issued by the board of th.
GG s
'gned --�� 4 f D e.'
Application Approved By-----. .. ---�:---- ._..•. ..................••....
Date
Application Disapproved for the following reasons:.................................................................................................................
-------------•••-------••--...•••-----•••-•---••------------•-----------......••--------.....•------•--•-•-----------------••---••--------••----•••-•---•------ ........................................
Permit No------s..5 z-�- -•----------------- Issued............ ----------.
— ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
✓w ....................OF.....4�� 4!9'....
.Apure#inn for Biiposal Works Tnntrurtinn t1amit
Application is hereby made for a Permit to Construct (,X) or Repair ( ) an Individual Sewage Disposal
System at:
�4�.w ..............• --•---- •f�..-----•.....------------------•--•-••--••------------•--..•...---•--•-•...---
Location-Address or Lot No.
......................».......................................................................... •••-••••••-•......................................................................................
Owner Address
W
9Q Installer Address
Q Type of Building Size Lot.1� _ _.......Sq. feet
U Dwelling No. of Bedrooms........_ ................................Ex ansion Attic� g— p ( ) Garbage Grinder (Vd)
a'4 Other—T e of Building No. of persons............................ Showers
YP g •-•--....-•-----------•----- P ( ) — Cafeteria ( )
Otherfixtures -----------------------------------------------------------------------------------------.....-----------------------------•........................••-
W Design Flow........X ...........................gallons per person per day. Total daily'+._'.
flow............--?X--=._...._....--....._gallons.
W Septic Tank—Liquid capacity 14!PA-_gallons Lengths �d►_�'.. Width._' L./w' �"'
-- Diameter---------------- Depth_. ~._r4"
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....../------------ Diameter-___-�!' ......... Depth below inlet.31421
-_- Total leaching area.................sq. tt.
Z Other Distribution box ( ) Dosing tank ( )
1_qa �!!5 r?�Percolation Test Results Performed ?"Y... .......
+fr-A-_ Date ." .' s
.............................
..a Test Pit No. 1................minutes per inch Depth of Test Pit..............._.... Depth to ground water-----------.__..........
ri, Test Pit No.&-----A.......niinutes per inch Depth of Test Pit.----o Z Depth to ground water---e0y'Al '
•� . . �H OF
Description of Soil-.' p-!" tac?uO-lp!Y G �''t,L �aRr, s7Y. vso�G.
x
+xy���srC'fV6�. 1F7! G" G i..G:aGD..?...Bs4f79 _
W G� a¢�` �✓� iQ, r__ e!'s34_i4 �'+' -"'/.�o r�Jsd.!sOlj .✓✓?> �at*,Qu�� G��l"m(3�/r MY�S��0420 Z a
..........
U /Zo""/Qg�s �Cin/G ruL� m, •••Cl IL
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Agreement:
. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc ce o Gry_
TTt1lS e / Y
the provisions of �l r:.� 5 of the State Sanitary Code—The undersigned further agrees not to place th ystem
operation until a Certificate of Compliance has been issued by the board of health.
aSigned-----------••-•-•-.... ...........................................................
Date
Application Approved BY••--`" ==� :. ......... •-••••......-•-•••......••--..•••-• `� f -
Date
Application Disapproved for the following reasons----------------•-----------•---•-------------------- ...........................................................
_--- Da t e
Permit No.•...... J. .....�....::......... Issued................. -----�
ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF...:................................I..........------...............................
Tardifiratr of Tomptianr
THIS IS_T.O• CERTIFY, That t e Individual Sewage Disposal System constructed ) or Repaired ( )
b -�'"-
` ----------•-----------••---.---------------------- . --------... ----------- }
�-� nstaller
at.••••--••• ..>R ..............................................................1=Z. ..... �1(�ft i
'has been installed in accordance with the provisions of r IT'LE '.;/,of The State Sanitary Code des ibed in the
application for Disposal Works Construction Permit No-----CR IS.:-1 15.4-_-_-__-__- da.tea___._._`�_ _.l._,�__.___ ..........
THE ISSUANC OF
.IS CERTIFICATE SHALL NOT BE CONST UE® AS A GUAR NTE TI�IAT THE
SYSTEM WILL. FU CTION SATISFACTORY.
DATE..................•... -L'. ...- ............................... Inspector............ . --- . ---
/ THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�/ r .h
No,...........
---•-••• FEE••:... .:..........
Permission is hereby granted............j-_ I_-------•--�-------------._ ��___ ����:'
to Construct (. ) ?r Rep it ( ) an Individual Sewage Disposal System ,
- ---. ,
Street
as shown on the application for Disposal Works Construction Permit N? 'hated ���....................
C,� ..................................
b
Board of health
DATE -- ------------------------------------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS