HomeMy WebLinkAbout0020 ASTER ROAD - Health 20 Asters,�16
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Marstons Mills
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LOCATION SEWAGE # ft-(,o
VILLAGE 22/1&lf ASSESSOR'S MAP & LOT't-�
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /Do0
LEACHING FACILITY:(type) (size) 4,00d
NO. OF BEDROOMS.PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER m t5 �� • r�+
DATE PERMIT ISSUED: ,� ►�--
DATE COLIPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ✓�
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No.--.�2:437-- VD� Fss .
THE COMMONWEALTH OF MASSACHUSETTS 3 -7
BOAR® OF HEALTH
.. ....................OF..... Y... .[....
....................................................
Appilratioaa for Mipusaal Works Toaastrurtiou ramit
Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
....................mmva...KL. 1ank.I:h........................ .4,5�r_.-.... '� --•-- ----------------- ---------
Owner Address
a �?7 r.............................���� �2lust _1
......................• •. .__.......... -------------••••-
Installer Address
Type of Building Size Lot_______Lf5.¢LSn..Sq. feet
V Dwelling—No. of Bedrooms.__Thimc-co........................Expansion Attic p) Garbage Grinder (A/b)
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
a' Other fixtures ____________________________ _
W Design Flow..................................._-`r-__4F._gallons per person per day. Total daily flow..._...._.__._______...____.3.�9?.....gallons.
WSeptic Tank—Liquid capacity_lM.O.gallons Length_;_-(a"___. Width_ _�-Ad.'_ Diameter................ Depth.�&_`'..
x Disposal Trench—No_ ____________________ Width.................... Total Length..................... Total leaching area....................sq. ft.
Seepage Pit No....rryv......... Diameter....LO----------- Depth below inlet__._4........... Total leaching area... ... ft.
Z Other Distribution box (K ) Dosing tank ( )
`-.
Percolation Test Results Performed by.... ______________________ Date--;/-;-----------------
a,___ .oiGcx�_1 __
,aa Test Pit No. I.__._:eZ-------minutes per inch Depth of Test Pit_____4s3________ Depth to ground water... .......
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water _.
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Description of Soil__
x 1'-7A o } tyYlc$tufYlS#hd.....................................................................................
c_j - �4 SATU�RYU ••-------•--.....•••-•_•••-•--• k�IE,
WILSON `+
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02
U Nature of Repairs or Alterations—Answer when applicable.______..................................................... A._`. .. 3�...t
---------•------------------•-------------------------------------------------------._.............----•-----------------------------------------------------..-------------
Agreement: ervfll:o'
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc anc with�,lQ.�f.
the provisions of TITLE 5 of the State Environmental 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.
Signed .
to
Application Approved By ---.--- ......
Application Disapproved for the following reasons: ..................... ............................... .. ................. ...... .... ..........................
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------.............................--- ----------------------------------------
Dace
Permit No- --------------jF ..--- --.�37...---......
.. -- I$$ued ...............'- -- ----'.... -.-.......--- -....----.. ......
Date
No..�l.....37 Fxs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Dinpusal Marks Tonstrnrtion ramit
Application is hereby made for a Permit to Construct (X) or Repair ( } an Individual Sewage Disposal
System at:
........................... ..............•--•-•--•••.................... •-•------•--.................-.I.----•-
L
K. �oca /�
tion-Address or Lot l�p.
�i..rr�4 atll ....
Owner Gt s
4:0 ................ --•---...........................•. ..............•...................................................................................
Installer Address
dType of Building _ Size Lot------- �feet
Dwelling—No. of Bedrooms............................................Expansion Attic �Vo) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures --------------------r...................
..•...-.-.---------..........----------------------------------------�---------------------
W Design Flow............................................gallons per perso,perrday. Total,,daillyOfiow..................
........_� .....gallons.
- .�..
W Septic Tank— 000
Liquid'capacity._....._.._gallons Length................ Width__.._...
...._... Diameter-_-___--_--". Depth_- .
x Disposal Trench—No..................... Width.................... Total Length..........i......... Total leaching area....................sq. ft.
Seepage Pit No......'0_`�`_-____-- Diameter...I_®--__--___-_- Depth below inlet-__ '............ Total leaching area...�....sq. ft.
z Other Distribution box � ) Dosing-tank, (• ) .
`-' Percolation Test Resul, Performed by-_-J_'_.`4&_s c>L i.............................................. Date_-:50 �L
a Test Pit No. I_.._ ....._._minutes per inch Depth of Test Pit,......`........... Depth to ground wa """-......
f= Test Pit No. 2.........:......minutes per inch Depth of Test Pit.................... Depth to ground J�
t�- .. fc9> Iitl it°�} 50650,s
l = _ ------••......•-••.......................••--•----•-•-•--......-----............
..............
Z - /} j '�?llcc�t t!tvt :�d STEPHEN
Descriptionof Soil----.----•--F --.---_. --------------------------•-••-•----------------•----------------------------------•--•-•
,4 A( —& G/� ALLYN
................................................)_... G`f--••----- -•-----------•-•---------- --------•------•--•
W 6--. '-j- J )0i(-C(tur=Q y .._._.. W1L"SZS1V...._.
x No 90226�
V Nature of Repairs or Alterations—Answer when applicable........................................................ \-
..•-----•----------•..................•----••-------••••••-•-•••••-•••••••-••••••--•--•------•----------••-••---------------••------•-----------------------•.-- N
Agreement: G,uic�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System n accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issuedb board/of health. /�
Signed-_, '
----------------------------------------------------------------------- ----- : . ..
Application Approved By ---... ---'� - --------------- �
.----- - ------------------
Date
Application Disapproved for the following reasons: .......... .............. .......................... . ..........................................................................
--------- -- - -- ------- -- -- - -- -- -- .................--•---------...............---.........--------.......................... -- ----..................... . .....-- ........................................
Date
PermitNo- ----------------Q. ......... .��- ... .... Issued -----...----- -- ......------..............---------.....--..
UDate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-------- ---- --------------------------- -----------------.................................................Tertifirate of Qlumplian.ce
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------C° ' > - ------- '
Installer
at -- •<oT S ems.> `2 ` '' a �'
............. .. ................-- .......-- .......----------------.. ...--...........................-- . ...---.............-----------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..-...-.r`. . .......-f- ---.��-.- ... dated ------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE 8C�STRUIED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
s,
�� Inspect r •
DATE..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No....-F 7.✓../ FEE..... .J ......
/ RapoAnindividual
nrkn Tans r� n unfit
Permission i,�s reby granted_... . :.:..:...........•--_.,.... ..............,...............................................................
to Construct ( -) or Repair ( ) Sewage Dispo S stem
Stree
as shown on the application for Disposal Works Construction Pe > A! ... D?Ad_ _-----
` .......................................... ..........................................--••-
Board of Health
DATE...............................-................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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