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HomeMy WebLinkAbout1485 OLD POST ROAD (CT & MM) - Health 185 Old Post Road Marstons Mills A= 057 —065 Fig... ... .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliratiun for Disposal Works Toustrurtion Frrmit Application is hereby made for a Permit to Construct ('f or Repair ( ) an Individual Sewage Disposal System at: .---- Location-Ad ress or Lot No. W Owner ^��[�,� / Address ....... ..... ............;'Y -„ - e---•""p..... •••^-•••--•------•.....•-•-•••---•............---.....__.....___................................. Installer Address Type of Building Size Lot....131-gb..........Sq. feet �.. Dwelling—No. of Bedrooms..J......................................Expansion Attic ( ) Garbage Grinder (hlb) Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) -- Cafeteria ( ) QOther fixtures . --------------------------------- ---------- ------- w Design Flow_5 .................................gallons per person per day. Total daily flow........3- 0_..........................gallons. WSeptic Tank—Liquid*capacity O.00...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__.__d.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.._6f(_1.CMY.....�?!-...................................... Date.'T..7_19_......... _.__.____.... a Test Pit No. 1................minutes per inch Depth of Test Pit...l2-._........... Depth to ground water_NQ! E._._..__. fr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.----_____------.-.---- _+•-------------- l /cZ �....... --........._.............--••••--------•-••................................ o Description of Soil "� ......=- .... ....s .......... $ /�1 x w 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 iI'i 1E 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.( lr�. �GMa.ti� ............................................. -........................ �,. Date Application Approved BY .._. �-f'.. / / ------------ Date Application Disapproved for the following reasons--------------------------------•--------------•---...---------...---------------"--------------------....._._._. .........................-........................._.......................................................................................................................•----------•-•.....------------ lJDate PermitNo....................-.................................._. Issued_---�.`-1-�-----------............................- Date A..t • J tea,•,,, a 40 +r J/ rrol Fm$...l ............... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH _.1... 4o_%)._A)..............OF......... 51�. .1V.'�� �� ............................. Appliration for Uispoott1 Works Tontrn.rtion tlpraati '., Application is hereby made for a Permit to Construct ( ✓f'or Repair ( ) an Individual Sewage Disposal System at: ............. . ©t..............sa.....fi r...---�. ...�`i4:5 ...........----------------...--•---------. --- ...Lo. ion-,Address ...---•---------------------------•------.or Lot No. o ner Address W ..............:- • . ..........................._ - Installer Address Type of Building „ ; Size Lot....13,,Ak..........Sq. feet Dwelling=No. of Bedrooms... ......................................Expansion Attic ( ) Garbage Grinder (A16 aOther-=Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ................................... W Design Flow_4: ............................ gallons per person per day. Total daily flow_.._...3JD-.....:_...................gallons. WSeptic Tank=Liquid capacity Aj.....gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ................... Wid h�-.--__-----__-•-_-- Total Length....... .......... Total leaching area....................sq. ft. Seepage Pit No....1............... Diameter. 6_..___.__...._ Depth below inlet... .............. Total leaching areaxROO.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 14 Percolation Test Results Performed by....B .XTF. _15 ........... --- Date. "7.` F-, Test Pit No. I................minutes per inch Depth of Test Pit...12............ Depth to ground water.NOd19...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' -------------------------------•.......................................................................................................................... 0 Description of Soil..ao ....4.t%4:.............c 'ha! ---------------------------------------------- V .:...:.....- ...................••......---- ------------------------------------------------------------ W ----•--•----------------------------------------••-----•-•-----•---------•------------------•---------------------------•------------•-•----•-------•-----......------••-------------------••-•----•-•-- UNature of Repairs or Alterations—Answer when applicable..................... ......................................................................... Agreement: ` - 9 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. 'g clfAlmlk,. 141S._................................................... , 1 'r'�o...._.... Date Application Approved By....... .._ ............ tL. ' ---------•--------- / > �--------..._ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•-••--••-•-••-•••......---•-•-- ................................ ---••----------------•-------.....------------•-•••-••-•-----------••--•-...---------•--...-•----••----_....._-•-•••---------•-------------•......•-- ..............Date:. PermitNo............. Issued = =--......................................... Date ` THE COMMONWEALTH OF MASSACHUSETTS n<'' BOARD OF HEALTH t .w..+tl...........oF...¢'...., ....................... TrrtifiraW of TompliFanrr T IS IS TO CERTIFY, Tat ndivi ual S age Disposal System constructed (t/<or Repaired ( ) by--•--•--••----- ----- ----- F -��- 64............................................ ...................................... Installer at._.3_�� Ml S L.S 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.15Q tya_.q................. dated.-..00-_.,t!lt__��.4............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CONSTRUED AS A GUJARANTEE THAT THE SYSTEM'W71 L 7.N...CTIQN,SATISFACTORY. l � DATE.. .. ....... .:......... Inspector -.. ----------- ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No 80`g.'t. ..........OF........, e?. 11.. ./J�.. r...-•----•------------- ......................... Mipos al Vorkv Tonotrurtiolt prrmit Permission is hereby granted............................................................................................................................................. to Construct (vf or Repair ( ) an Individual Sewage Disposal System atNo..1.1044......d5l---4A...................................................................................................................................................... Street as shown on the application for Disposal Works Construc • rrriit No..................... Dated.._ -------------------------------- • / CW�/`� 7„7 Board ealth DATE--------'-�--- -••---- -••-•-•-------•-.....---•-•-•...................••----- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t �' 416 UO (�Ar�AG� (all�.JUF1Z bal L�4 F tAw pro 3 = 33o G•Pv. i rEf�l-1 G TA+�l IC = 330 J IS G % = Q-9 5 6.P.D. Use 1000 6A,L. � l �ISPOSAL PIT USE loco GAL-. , I3�,•Ld, - low SF 14 S lS G.P.D. I 8o-r MAA ae>=a So sr-. 22 �9 7 I � sue. � ► .o - So E�.PD. � ToT,AL -VESIGKl = .4'ZG G.RD• Iz U` e ToTAL DA k L-( FLokk/ = -33o 6.PD. I `J ep . PE2GDL&TIO IJ CIO Z.m 1 w, o2 L" I1_ i�.G ' jof 93.o ra„c r 44 00 93.0 OLAD Po s- "TssT Toi- P-4o loo.o " �Y -Box 91• Sepnc Z Iuv t T'A kWL loop 90.0 1►1V• ' ' GAL. L+v, i• LAN 9o•S 40•] ;; PIT To -k wr WASHED 5T-Wr �A.lJL7 c.S Z T l l=%E lD p Lo-r t=L.A," PQ.o�-1 lr� kt�D ►2' Lo CAT 10 lrl�Af�TDV7 LLS �.!o 1 CMVTtF-( T�4AT -1�Tt Fa7Uiir,;3"(jpl,i Sl�c�c/►.1ct.lCE NE:QCo►_1 W ITI-A TOi�: Stogy LII-1� �O`I~ 3 ,&Wt:> �ETL�ACIG C-4c�tREMc+-1Ty of Z'►aC- ?p PL B LI'_ 323 Plo 3 C!A'TC REGISI'C2ED "Wo 5uev`Yolz: Tt-AlS PL-A" I tJOT ?-b,SGD o" AN 05TF_VV% t-G o tiCASS• 1lJSfC':JMC=�J i t�UI;�/I_�( 4• Tt{ �P�Lt C_A"-r 'DAVIT., I l:r �,>'_ u•,cc� T'c, l)r.-_TGv.MI►JL-'- i..O"V l_1 W� - DAVIT., tJ OCAT10 S EA G E PE RM N . �G1 � T�� o�- ` VILLAGE INSTAL ER'S N ME i ADDRESS • U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED J 4� �d i "`l`. .3� i �� �i � l� � ��