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HomeMy WebLinkAbout0130 MINTON LANE - Health 130 Minton Lane Marstons Mills A= 174— 024 7 i i L C CA ; ION , S E WpA G_E PERMIT NO. �6� f� ���fir► ���P l� 5 ���� Y! LLAGE INSTA LLER'S NAME & ADDRESS B U I L D E R OR OWNER �b DATE PERMIT ISSUED �_ ,z FL DAT E COMPLIANCE ISSUED r y 1 II ell r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH , �licJ.*"7..............OF.... '4// �Sd-' -4 -le............................. •l-��k 13j� ppliratinn for Roposal Works Tunstrnrttun Funfit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sy ean t �. - --. : ....... ................... �� Location oLt No. .............................. ........... .. .....1...�2 Owner Address Installer Address d Type of Building Size Lot....�15' 7J.�q. feet U U Dwelling—No. of Bedrooms___-- .-. -------------------Expansion Attic )09 Garbage Grinder ,(vf(T) Other—T e of Building No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other xtur W l Design Flow........... ....................gallons per person per day. Total daily flow..........Z 0..................gallons. WSeptic Tank—Liquid capacity/ Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length................. Total leaching area....................sq. ft. Seepage Pit No.-_----_________- Diameter.................... Depth below inlet...................... otal leaching area......... ft. Z Other Distribution box ( ) Dos ingxau �, )A `` C/ a Percolation Test Result 5 Performed by. / _ f? ffiA .! �.. Date_...�� /.sq. y-. Test Pit No. ...minutes per inch Depth of�est Pit........ _../... Dep'l�fto ground w�a r--_-Test Pit No. A�l_ ._minutes per inch Depth of Test Pit..../ _...... Depth to ground er___ ----- Test - - -------------------• --------••-- 0 Description of Soil------...".... -: -------------- -------- - -------- -- ------- ............................... W -c en • ----------------------------------------------------------------------------------------------------------------------------- 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 iITL L 5 of the State Sanitary Code—The undersigned further agrees not to place/thesyem in operation until a Certificate of Compliance has bee ' sued by the d of health. g ........ � CalSi ned •- . Date Application Approved By.................... -- ••-•-------- ------ - ----- ---------•------------------ .....•-�=. Date Application Disapproved for the f oll ing reasons----------------•-----••---------------------------------------------------------•---------------......------.... ..-•-----------------------•••-•-•...---------•....--------_...�.......•-••••--•---•-----------••-----------•--••••-•-•-•--•......----------- ��------ - ------ -----------------••------- PermitNo.....-- .... ...---------------------------• Issued------...... ...................................... Date W� --------------------- -- "No................-....... FEs..........................._ S t +* THE COMMONWEALTH OF MASSACHUSETTS .._. BOARD OF HEALTH y✓t�' r.J"s�...............0 ... sl /C4 Ime .......................----- Appliration for Disposal Works Tnnntrnrtinn ramit Application is hereby made for a Permit to Construct (t_,);or Repair ( ) an Individual Sewage Disposal System t .... ! ?. f e ......... 60,171Xr"`.L. .1 ....e!.XK- .t.............. Location- dress or Lot No ^f+'� Owner rr Address .I ' ? ................................................. Installer Address Type of Building Size Lot.._'-/:5- 7J- q. feet Dwelling—No. of Bedrooms.._.:,:,: ...............................Expansion Attic, Garbage Grinder,(76) 44 Other—Type of Building ............................ No. of persons......._.................... Showers ( ) — Cafeteria ( ) QI Other fixtures .------•-------------------------------------------...--- W Design Flow.......... ......................gallons per person per day. Total daily flow..._......?r, .d...................gallons. WSeptic Tank—Liquid capacit/f .gallons 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 '-' Percolation Test Results Performed b � �! Date.... Y Test Pit No. 5._ _._.minutes per inch Depth oest Pit___.. _.. Dept to ground water.._. y� 44 Test Pit N, �R_ _._minutes per inch Depth of Test Pit---1 ....... Depth to ground water.l........................ a ------ , x -- .................: ............... ------;-•................................................................................................ O Description of Soil_.:! •.V � ....... -" a -r - ' - r. ?.r'r .t. ►r__. - ------------- ----- -------- W ----------------------------------jtk-C e '�a 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 TIT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by the rd of health. r /_4F'7 Date ApplicationApproved BY .................................... ............................... ........................................ Date Application Disapproved for the following easons ------------------------------------------------ Da te PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL &Z�................OF....�rGl.e� , ;.TZ ....................... Trrtifiratr ,af Tout h anre TXS IS TO CIFY, That t e Individual Sewage Disposal System constructed Repairedby------:.,���.t�2. ........�,a 1. t -•----•---------------•------•---------------------------•-------------------------••-•----------------------.-.----.--._-------- Ins er has been installed in accordance with the provisions of TITLE r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... - ......... dated---.._-_J....................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CON RUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �DATE...... r ......................................... Inspector---zi: THE COMMONWEALTH OF MASSTTS -- BOARD OF HEA�^LTFP d.. ,1 .............OF...(�; d / } .:( : ,/ .................. ..,, No.- FEE... .. Rnpnnal Workii onntrnr#' rrntit Permission is 11=by granted d` S -/- to Construct� or Repair ( ) an Indivi al Se /s rage Dispos ystem at No.---.¢ rs �= ' .. ' �''.e '�^�� �s~ l -----------------•----•-------------------------------------.............. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .................................•---------------...------------------------•----------•---•-•-----_.... Board of Health DATE S3L . FORM 1255 A. M. SULKIN, INC.. BOSTON F ;. .c: - _ dw p • .' t i7 ' ,2' Eg 4 l4 ',LM �' y. 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