HomeMy WebLinkAbout0193 REGENCY DRIVE - Health 193 Regency Drive
064-046 Marstons Mills _
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5EW QC,E PERMIT MO.
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DATE.-PERW7-T -155UED
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D ATE _COMPLI_�t�10E ISSUED : -(_^ Z�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE LT
-1 .�....... OF....... .- ...
4 ,
Apphration -for Diipuiittf Worbi C atuitrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst t• ��G��
� r-- -- --ocation dress oLNo.7w
.......... .. . . ...�•-----.. ---------- - ......... -• -------- • ot...............
�........---•---•..............
Address
Installer Address
Type of Building Size Lot--------------------- ------Sq. feet
U Dwelling—No. of Bedrooms-------------7 --_-.Expansion Attic ) Garbage Grinder ( )
a Other—Type of Building f No. of persons_...__.__ ('� ( )
�_____________ Showers — Cafeteria
Otherfixtu e 3..-4 Z.- ------- ------------------- ----------------------------------- -----------------------------------
Design Flow.__.____.___ .................gallons per person per day. Total daily flow---_-_-- ��-- —
Design W .
WSeptic Tank Liquid capacit✓ __gallons Length________________ Width...... Diameter---------------- Depth....-.--_--_._..
x Disposal Trench— o..................... Wid,Jtli__.. .._.._ T tal t __ ___.�__ T al leaching area.--_.-__--_-.------sq. ft.
Seepage Pit No______ ___________ Diameter.l. .__..� ow m et=_._______n_.__._�l"otal leaching area...._...-__.-__--sq. ft.
z Other Distribution box ( ) — Dosing tank ( ) .��— `�C�/�'! — �/, —
aPercolation Test Results Performed bY------------------------------------•••-•----•------------••--•-•--_..... Date----------------------------------------
a Test Pit No. 1................minutes per inch Depth of "Pest Pit-..___-_•________- Depth to ground water---------------------
G%, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.-.-. _-----_----___-
WW _
—
-
O Description of Soil � I � - L-----
=
--------- --------------------------------
U Nature of Repairs or Alterations—Answer when applica le----------------------------------------------------------------------------------------------..
--------------- -------------------------------------------------------------------------------•-----------------------------------•---------------•-•-------.........._..._.....----•---•---------.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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.
S• n d.... --•----------•-------------••-----•--•-•--•------•------------------------ ----------..---------------•...
- Date
Application Approved B
PP PP Y.._..y �� � -- 7
Date
Application Disapproved for the following reasons: . . . ........................•---•--.......... -••-------------•--
Date
�f
'Mq V Iz Per it o. Issued........................................................
Date
No.... ------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE LTH
..... .OF.......
AplslirFation -fox DiopooFal Works Tomitrurtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S steyffri,at: f \
Location?A'tdress p or'Lot No
_i USA `1, ! ,R t- r�, 6'ti' wl+! �..
...........; -
Address ,
.............................`�'--' .............�.....�'......`-`=-'.... -......==.....---
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
U DwellingNo. of Bedrooms----------------- ----Ex Expansion Attic 1 Garba e Grinder
— P (�6 ) g ( )
aq Other—Type of Building . -...... � � !4�- - No. of persons------- -- ----_--•-. Showers ( ) — Cafeteria ( )
Q' 11
Other fixtu .e ' -------- -�����1
-----------------------------------------------------------------------------------------------
W Design Flow..,----------------------------------------- per person per day. Total daily flow----------3�U--- ----------gallons.
* Septic Tank—Liquid capacitv�/'q gallons Length................ Width--_-_.--.----. Diameter------..--_---- Depth.-..------------
Dis ----------------
Disposal Trench— o- -------------------- Wid/th__-- --.-_- -__ o al ti _ .-. T al leachin area-------------------- it.
Seepage Pit No._-_-- __..•.._._. Diameter_1- -.-_--�� ow in et............ .....�l otal leachig area..-.------.---__-.scgj. it.
z Other Distribution box ( ) - Dosing tank ( ) t 6- �1� - G- 0,0 - 7-r--
'� Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------_-
1:14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-..------__----------...
---------------------- -------------:1...........Z...----_----.'•-----•-•-•--••-:--------••-----•-•--------••••----•------••--•-••--•--------•---=---•----
O Description of Soil--- - -R / ^--� -� - - ". ,c,•�
x, -- -- ---- -------- ---- -
s ..� — ••_---j• 4_ -
W y� /
---------------------------------- --------------------- ---------------------------------- � -� -•----
U Nature of Repairs or Alterations—Answer when applicaele-----------------------------------------------------------------------------------------------.
-----------------------------------------------------------------------------------------------•----------------..-_......-...-----------------------------------------------------.-..--.......------..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article aI 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.
S)ned -••-----------------------•-------------------•----•--•----••--•••......--- ................................
Date
Application Approved B ...
Date
Application Disapproved for the following reasons:.............. .............................................-----•-------------•-•--...__ --------------
...................L ,
�/'e." Date
Y Permit% o..��.--�-•-`......� ..................... Issued........... .......Da t. --------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD.... .F HEALTH
0 .............OF....... . ................
TwIprtifirate of Tomplittnrr
TV'i
IS, CERTL Y That the Indiv' aldeX
e Disposal System constructed ( or Repaired ( )
by .... - -�-c -------- -- -
taller
has been installed in accordance with the provisions of A The State Sanitary Code as described in the
application for Disposal Works Construction Permit No f 7 {� (}.. ' ,
------------- ---- -------------- dated------7-�-�------- ---`3----••-------
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARZa,.-k�j.
HEALTH -
/ Ll.............OF....... .......................................------.... l�
No.-------- FEE-I.----...............
%svola 'IT x k i �o �tr�trtioat tPermission is ereb ranted----...... �r�l �C"Q- t /;7
�/� Y g f �
to Const or R re/an n ividual - ewage Disposal Sy to
at No.' �' � _ y = screed
as shown on the application for Disposal Works Constructi�nPrit N . ................ Dated_.- .-�-- .7 ._--....._._..__
__y---- -- ---------�� --------------------------.� � Board of Health �
DATE. L1....�---7- --�5--------------------------------- - ---•--
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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