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Home My WebLink About0203 EVERGREEN DRIVE - Health IE203 Evergreen Dr. v t, A= 125-068 _ Marstons Mills "-� - LOCATION �� SEWAGE PERMIT NO. VILLAGE iNSTA LLER'S NAME R ADDRESS r ,'o eca i R-+Rr J-:;'xc,sv g i' �d U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Y ' ; �:. .q�. f ++ 4 :�'S f � � GuS � _ _ ..� _ . �w� � r �° '�.�.. .� ., ��r �- x� - , . � ` � " � " '" ,: ��,, 3 l TH,_r COMMONWEALTH OF MASSACHUSETTS \�(�y"�✓`� BOAR® OF HEALTH �• -- --............... OF...................................... ::.::...... XV11liration for Disposal Works Tonstrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......risZ _ G....�rQ c ocation r.. ....Address sr� ........................ ......------..........-----...........------------........------....-----.....---•••••----........ - -or I.ot - /rX-• �cisr+, ... ' `........................................... .St1s�`•. /l:! N3n Owner Address .......C aa...._..-••••---•--•-•-.-- •-••-•-••------•-••..................•----••---•-•----•-•-•....----....----•-•-•-.....-----...._.. Ins er Address UType of Building Size Lot.................... .....Sq. 'feet �--� Dwelling—No. of Bedrooms.-_. ..................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building .•-------------_-----_-____ No. of persons ._ _ a � ---•----•---------------•-•---------••---.P �----------------- Showers (� )--- Cafeteria•(----)- d Other fixtures . W Design Flow........... ........gillo�ns per person per day. Total daily flow.....MO..�iP�...............gallons. WSeptic Tank—Liquid capacity a4lons 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 ( ) Dosing tank ( ) Percolation Test Results Performed by-----------•-••-•--•-----•---....----•--------•-------•••-----•-•--••---_. Date--------------------- �-4 Test Pit No. 1................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........................ 0 a ---•----••-----------•-•----..............................................................-................................................................. Description of Soil.................................................................................--•-----------------------------••---••---------------...-----•--•-••-•-...-----...... V .....-----•-•---•--••------•----••--------•---•-----••-----------------•-•---------•----.........-•------•-----------•-----------•------••--------•----...••----..........------•--••._...---......•--•-- W x ••--••---•-••------------------------•---•---•--•------•••---•••-•------•-•-•••---------....----------•-----------•--------•---•--•---•-------------••------•••••••--------•----------••-•--....-------- 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 TITI.1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the boaaAof health. � Application Approv y------- - ---• ......................................... ..?....-•Dat�....... Application Disapproved for t f oll ing reasons---------------------------------•---------------------------•------------------•-------••-•---•-•••--.......... -------------------•--••---...•-----....----••........----•--•- Date PermitNo.............. ..................................... ' Issued........................................................ Date No......................._ FEs............._............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH `.........................................OF...-.......-....-..-..-.. Appilra#ion for 11hipos al urk i Tnnitrar Linn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: IR Locatyon Address or t o , - +r_, s./ ,••---------------------------------------- -- `. '�'rIP. � . ! �''4 ` `;i — ........................... ' O±w�ner a Address--j •— - ---- -. C�}.4.�.�1 3e�!!'!::__.._._.. "1:.............•____..... ......__..................•.................._.........._........_................................ InN41er Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___ ________________ __.__.___.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.....6.................. Showers (/ ) — Cafeteria ( ) P4 Other fixtures r,t Design Flow.......... / :o10%s per person per day. Total daily flow____, ......gallons. a Septic Tank fi—Liquid capacitygM Length________________ Width._.__.________.. Diameter_________._.____ Depth___________..._. W Disposal Treiirph—No_ ____________________ Width..................... Total Length.................... Total.leaching area,...................sq. ft. x Seepage Pit No............... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (' ) Dosing tank ( ) Percolation Test Results. Performed by........................................................................... Date........................................ Test Pit No. ................ 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........................ t� ----------------------------------------- ------------ ----------------------------------------- ------------------•------------ ------- O Description of Soil____________________________________ -•----------- - U ------------------------------•--•-----... ................................................. - .._.. - _ - .------. --------------•--•------• ----- _...----- - -------------......--- --•------------ W V Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordan e witli the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to la tl}e stem in f operation until a Certificate of Compli Ts i sued by t e bo of health. r y ig ....... .............•---...: ....... Date Application Approved By__ r Date Application Disapproved for the following reasons----------------------------••-------------------------••------------------------•-•--------- -----------•. 47 Date PermitNo-------------------------------------------------------- Issued-..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................:.................................................. �. (Irdifiratp of Tomplitanre 54 by O 4ER u Sewage Disposal System constructedOoer ReY, That the II T ed ..-- ---=� --- ------- ----------- ---.........-------------------- ; -......._(......)._= at__ 11 __________ _________________________________V ___________________________________Insta `✓_________________._.._.____ _____ .�._____._________ c� has been installed in accordance with the provisions of TITLE" 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_............................................. -THE ISSUANCE F*THIS CERTIFICATE SHALL NOT BE CONSTRUED -A GUARANTEE THAT THE SYSTEM Wl FU TION SATISFACTORY. Z ,,,//� DATE.'.T. ..... ... _tor ... ._..THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �J No ------------- FEE....................... ywo permission is hereby Red..-; 6,�F-• .t. = -----------------•---•-•---------•------••. •--••---.................... to Construct ( ) or, epai ( ) an Individu wage Disposal System - at No ............................. ...................------•--•---••-------- t7------------------. = .. =� Street as shown on the application for Disposal Works Construction Permit N _____ _____________ Dated.......................................... • / ...................................................................................................... .ram Board of Health DAM,... ..........................•--•--•---•---..._...-------•----------------. FORM 1285, A. M. SULKIN, INC., BOSTON 15, . .�+.nip'_ r. 1,.•- A z�4�4> -7 'Oe .44 ' o 1 �</,�Z5 7-;4 .e!:�4 �7/7 7,1 '41 ol oe, 7�e 14e 4:;%e5l 7�5_5� `57 �Io 4:0 AIV 71 4 �4 Z�A 00 ew 4A 44 77 VOI D�V.�r. 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