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HomeMy WebLinkAbout0204 BLACKTHORN ROAD - Health _ 204 Blackthorn Road A=047—010—002 Marstons Mills , LOCATION �� SEVIAGE PERC3IT G0• f�F VILLAGE 1 W S T A LLEWS NAME b ADDRESS 0 U I L D tE R 012 OtIC ER CS� ir4 DATE PERMIT ISSUED 3 j� DATE COMPLIANCE ISSUED ? vy i d 17 i U S7q'' �3i Fxs.............................. V 6,�,THE COMMONWEALTH OF MASSACHUSETTS �jl�� ' BOARD OF HEALTH ......O .n...........OF..........J -a:- -�J '..�-................... Appliration for Mipatittl Workti Tonstrnrtiun 1hrmit Application is hereby made for a Permit to Construct (L,-) or Repair ( ) an Individual Sewage Disposal System at Location-Address or t No. P.�....... ............... . �.`�r�-. ... GC.� �... 1.5.. �$-:..---•................................... �d ess i.4 '.........._'• lC..-'�: ............................ L lX1 .._ ................................ Installer Address S` �q Q Type of Building Size Lot_ __ ____Sq. feet U Dwelling—No. of Bedrooms..............3.........................Expansion Attic ( ) Garbage Grinder (� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. . w Design Flow............1,L_p....................gallons per person per day. Total daily flow._.......33'._ ....._........gallons. WSeptic Tank—Liquid capacity\QO allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosirw—tank ( )a _ q '" �.__Percolation Test Results Performed by..:�P_CU4A&A........ ./ ..... ........ Date...._.1.�. .t .'. ..... Test Pit No. 1................minutes per inch Depth of Test Pit----- th to ground water......................... L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --•-----•----------------------------------•------------.•.........-----------.....-----------....--......................................................... Description of Soil--Qr`oJ- �9s�._ClIM.........Ej......._..jo_A» p`- -'x ---••-. ---- v a� 1' - �- � ._...✓,�.Cavr ---------- —.. w VNature 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 TITLE 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. ��yy Signed.... l u- .. `\^. -..Q. ._... C(JJDate ApplicationApproved By................................................................................................... Date Application Disapproved for the f oYowing reasons:-•-•............................•---•---...------•-•---...------•-•-•--•----•---------•- •......---•-•.... ............................................................------•-----••...._....:-----.................----..............----•-----------•--•-----••-•-•----••---••-•----......•.....----•----------- Date PermitNo......................................................... Issued....................................................... Date y- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�7 ..........OF...........�� CL11-a.` .�e- .......... Appliration for Disposal Works Tonotrurtion Frrntit Application is hereby made for a Permit to Construct (Ll�or Repair ( ) an Individual Sewage Disposal System at: � M. ! ...----...-'------------- . ....--------..........---................ Location-Address c. 4 4 or tot No. ..aM.�.�.......\�..........s.m Ck.:..--••-•-•............. .. a:t A�-_.�-�u.. ....... --..--------....------..................... a Own r -` d V _ � s _._...... ................................ Installer Address Q Type of Building Size Lot_.._...\............. q. feet S Dwelling—No. of Bedrooms..............'_._. ....._..___--__?E ansion Attic ( ) Garbage Grinder aOther—Type of Building .............J............ No. of�persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ........._-•-•• •------•--••••••-••--•••••-•-•••-•-.............................•-•-----••........--- Design Flow............. �_ __.__. gallons per person per day. Total daily flow....... ....... .d....._......._gallons. Septic Tank—Liquid capacity QQ allons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosingtank (Percolation Test Results Performed by---.-�UAL_................A.---� _. .___.'. Date...-_-!q __.aX.'. 3.... Test Pit No. I................minutes per inch Depth of Test Pit.............____--- Depth to ground water........................ G=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ •-••••---•--.... -•--•-••--••-•-•••......•----•--••-•••-- .......---•-------•.._...-•---•--•.._.......-•-------------•-•--••-----••--..._................ O Description of Soil_.0. .Q.A.)_CAM........L-:..._....: J)'-'�—'-Q--�'�- ----- ---------- ` Q"S2 - =' ..4 1Y1 --!----------------J%... ._�-..................................... W ,J 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 TITLE 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. Signed.••--•_ �s✓..`y. 1........ _,•. !Y� � ................ ....... --•-. LI/ Date ApplicationApproved By...............-••--•-•••----•--••----••-•---•-•--•-•-••-•...•..................................• ........................................ Date Application Disapproved for the following reasons:.................................................-------..................................................... - ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .............OF........ �(L M..k.�c.,l,ol-sue.............. (9rrtif irate of Tontplianrr THIS IS TO CERTIFY, That e Individual Sewage Disposal System constructed (.—,)'or Repaired ( ) at. a �l]C _4C.A 'V Y w L Installer (1'�C�1 D J n ......•..... ............ .... ..•_-C...._........._......--•- ----••--••••---••------•---••---••-•- •-••-•-- -••••---- ------- --•-•-. ..........------...._ has been installed in accordance with the provisions of T�L F of The State Sanitary Co asyrbed in the application for Disposal Works Construction Permit No.p.- ff__________________ dated-.�_.._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BXCONSTRU D AS A GUARANTEE THAT THE SYST.EM WIkLjFUP1 ION SATISFACTORY. �DATE._..._.-•-•-•- - - ..------•--------------------------•------••---- Inspect—or..... . COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No�!..7..... '. v�-??..rl...........OF.............. .���.� :.... }.�..4.`. --............... FEE..J..v. .... Disposal Works Tonotrurtion "Vrrmit Permission is ereby granted........ Q " lL ....... 's--....................................................................... to Construct ( (or Repair ) an Individual Sewage Disposal System at No..:..5*.A '- .G� ��4. .' ..!�--._.......--- ------ 1 !J. Street as shown on the application for Disposal Works Construction Permit No..... ... ..'` Dated.......................................... � - Board of Health DATE..............•------------•-------.......---------------------------------••--- FORA 1255 A. M. SULKIN, INC., BOSTON t U x1 ; . 9s9 1 _ 97 9 ,s 97.7 /(/V (5-4,�Q4G65- G,Q/Np�. S-A:'T/c 774,VX-f =�33oX/ o = y,4sc�,.�,� ��� 97- 7 . C-*4 4- : 9 7 S/t��L1�.4GL 4,0 `-- t. PL�QGo,C4 r/crs/.P.QT�:/ "/.✓Z Mist o o 7-- 17Z 'S 9� , ��---• �' ,�✓✓. 11 l�.�v��. /ca�sc� �is�r. 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