HomeMy WebLinkAbout0280 JONES ROAD - Health 280 JONES° �
Marstons Mills
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LO CAT ION SEWAGE PERMIT NO.
VILLAGE
INSTALLERS NAIVE b ADDRESS
BUILDER OR OWNER
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DATE PERMIT I S S U E D
DAT E COMPLIANCE ISSUED �lp _ 7�n
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D "j' Ob 1 THE�O/"CIT®AO��FUASS;CHU u TS
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Appliration for Diipuual Works Tongtrurtivit Vautit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
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Location Address or Lot No.
Owner Address
W C. ,D 1.4 Aw/.- /YT ✓z►��-`: --......./.�1' 4...........................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............ ..........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............... No. of persons__........_.._...._...= Showers — Cafeteria
Other fixtureo............................ o- a
W Design Flow....................G .................. per person qr day. Total daily flow.................. .............g-41on ii
R: Septic Tank—Liquid capacity- _gallons Length___°' _.. Width...4_n ___ Diameter________________ Depth....`;..u.
W Disposal Trench—No. ................... Width.- ...._.._..._.. Total Length.................... Total leaching area....................sq. ft.
x - W -
Seepage Pit No----------- Diameter........: r.s. Depth below inlet...... Total leaching area.... ....sq. ft.
Z Other Distribution box ( Dosin to�k ( )
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Percolation Test Results Performed by !_ t t .. '�.. @ �`(s r.� ��.. Date..._......&.41 .a.,.......__.
Test Pit No. 1..... .._._minutes per inch Depth of Test Pit------- ........ Depth to ground water.........:............._..
r-, Test Pit No. 2......:. minutes per inch Depth of Test Pit........1 4 .... Depth to ground water____.........................
P4 --
� Description of Soil.... �"2,Z-- �:5--------- •----•--•--- •---------•-•--....-•................••-•----•------------------•------•--•------•--•--.....-------
-•-•- ........... .-• _._.
x �., �� ----- --- -- --
V ...... .............. .__._ ...--__-__---__------_-----------.°_....._..._....__....__..._......._.__..___.
W .------.... .-- - ---__-_ - ---:���
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UNature of Repairs or Alterations—Answer when a licable............... ...............................................................................
----------------------------•------------------------------------------------------............---••-------------------------------------------•-•--------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLE! 5 of the State Sanitary Code—The undersigned further a rees not to plac the ystem in
operation until a Certificate of Compliance has been issued b he boar health.
a.
*Date
Application Approved BY• � e
Application Disapproved for the following reasons--------------------------------•------------------------------•----------------•--------------•----------.------
-•----------------------------------•----------------•-•----•-------------------..._.._..-------•-•••----"--•------------------------...•--------------------•-----------------•-------•-----------------
Date ,
PermitNo...................................
.w_t D
ed......F.7 _��2............---------•....
Date
(� C
N(Y FRig.............................
THE COMMONWEALTH OF MASSACHUSETTS
r� BOARD O F !-i
OF....j ...:::. ...............................
Appliration for Disposal Ifor ks Tonstruriion Vantit
Application is hereby made for a Permit to Construct ( �) or Repair ( ) an Individual Sewage Disposal
Systemat_........ ........ ..•-•-----•--•--•----•-........._......----------•-- •. - / .
Location-Address or Lot No.
......................__...............
-------
-.Owne..-_-_r.......................................... ..............................................Address s s-• , .•---------.._............_................
W ......._..--•-•........:.................•---............•......___..... ................................. ......:..
Installer Address
Type of Building Size Lot............................Sq. feet
Ub
Dwellin 5-No:. of Bedrooms............................................No. of ersons__ Attic ( ) Garbage Grinder ( )
a g3q, Expansion
pL1 Other=Type of Building .............. ........... p ._____.____._______._____ Showers ( ) — Cafeteria ( )
Other fi ubes
---- - ----•-•-----•_______________
W Design Flow_____ .__ ...____ __ gallons per person-pe day. Total >iy flow..........................................__
'd 't `al ps.
WSeptic Tank—Liquid capacity _____.gallons Length................ Width................ Diameter................ Depth................
Disposal Trench 1. •.. Width ..._ Total Length �' ..__ Total leaching area... . sq. ft.
Seepage Pit No ...... Diameter ._...... __. Depth below,inlet.................... Total leaching area___ ._ sq. ft.
Z Other Distribution;box ( ) ' Dos in �t ' ) f � G �•-71
a Percolation Test Resins Performed by.. ______- d4»-°...........--=-------- Date.......... -�..--__-----•----
i- ..
1.4 Test Pit No L.,_� ......minutes per mch*�-pepth of Test Pit______ ..... Depth to ground water---—______________
Test Pit No. 2__ ............minutes per A.ac'11'-"-'Depth of Test Pit____________________ Depth to ground water........................
O Description of Soil'---........a -
.,x 1 i .
.�•� r� •- -------•------------,---------------- ----•------..............................................
w .................................................
UNature of Repairs or Alterations Answer when ap licable________
Agreement:
The undersignes•i°.agrees;toinstall 'the aforedescribed Individual.,Sewage Disposal"System in accordance with
the provisions off TITIS 5 of the State Sanitary Code—The undersigned further agrees not.to place the system in
operation until a Certificate°of Co Hance has been issued by the board of health,
' Si d........ ------------------------------------------.....
.....--•-------------- -
Application Approved By... �t ..4� , !
Date------• --
Application Disapproved for the following reasons._ -----•--••---------------••--•-----------•---=--•---------------------•------------ --...._..---.._..
•--------x----•----•---------•----------------••----...._...._.....---... .--•--- •-------------------•----------------•-•- .........
..................................R.._.__.____ a ............
a. Date
PermitNo.........................................................:41 Issued...........................------•
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF-, HEALTH
s .............. tl+/.s'.1........OF.......... .GG I...................................................
(grr#ifirtttr of Toutpliattrr
TH IS TO CE FY, hat the Individual Sewage Disposal System constructed ( ' or Repaired ( )
bya _-. - ............................ •-_-
at, -
., taller t,/ .,,! i
• T ---------
has b en stalled in accordance with the pro4sions of TI r j�,T State Sanitary Co.4 as�efji� in the
T�'-
application for Disposal Works'Constructio i Permit No.... _____-_•_________________ dated_.___._._.___._:_._...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE
SYSTEM';W L FUNCTION SATISFACTQRY.
DATE........ _2
.............. Inspectbr.....:..
THE COMMONWEALTH OF MASSACHUSETTS
k BOARD OF HEALTH
.........� .....OF...... ftiL ..................................................
No..:......... ........... FEE........................
.
Permission is he eby granted.)a �q�rividu
�l�....-- ...................................... -----•........----•-------•-••-------.............-----•---
to Constr ( or pair-( 1 S Page Dispo�lyst
_..- - � ..
r
.........at No..... .1 ..-
?R Street
as shown on the application for Disposal Works'Constructionr No Dated....."._. ` 7
-- ------•_r.......
............ - .. .................
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-- -••---•-----•--------••--•........_
Board of;Healft `
DATE.............. ,..
................................:....................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -
THE FOLLOWING
IS/ARE THE BEST
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