HomeMy WebLinkAbout0724 RIVER ROAD - Health 724 RIVER ROAD.
Marstons Mills
0441.
ASSESSOR'S MAP NOS `lcl PARCEL
LOCATION I�/ `� sV' /SEWAGE PERMIT NO.
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YILLACE
I N S T A LLAR'S NAME a ADDRESS
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B U I L D E R OR OWN ER
DATE PERMIT ISSUED ,9/Y- 'y v
DATE COMPLIANCE ISSUED
30
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...............
THE COMMONWEALTH OF MASSACHUSETTS
._80Ae R® E HEALTH
--------------------/OutlN .......t':
.OF........ 45.1"4. [-
8. .E----•---------.....----
,ppliration for Disposal Works Tonstrn.rtion Prrutit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
_FAt �2 ► evs 1«s t lb rr V Ass�sssrzs u�bmy- 3 iTs�f log{
Lgg.c.ation-Address or Lot No.
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�t �ct"� C Address
Address
Type of Building Size ......Sq. feet
Dwell
er
aOther—Type Type of Building oms.....J................... No.\j�1,of persons nsion Attic (moo)Showers (Gajbag Cafeteria (JO)
Other fixtures -•--
W Design Flow...- °!�-:_.-- S.................gallons per person pFr�day. Total 4ilyaflow--------�.30...........................gallons.
WSeptic Tank—Liquid capacity.A!? ._gallons Length_ _,width...4`IP.__-- Diameter_____________ _ DepthQ......(2....
x Disposal Trench—No. ................... Width____...T__......... Total Length.............r,.. Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter......./�. .... Depth below inlet•-_-��� ...... Total leaching area..9 ...sq. ft.
Z Other Distribution box (,,,/) Dosing tank ( )
a Percolation Test Results Performed by..... ..................................... Date.AgW_.3c4omF3_........_.
Test Pit No. 1..... per inch Depth of Test Pit------PZ....._. Depth to ground water-._."-----PAW)2'
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water........................
............................................................................................................................................................
O Description of S �I.S............
U ..
...........................................2t '1 -� -/�f
--------------------------------
-----•---------=........................................................................................................................................................................................
U Nature of Repairs or terations—Answer when applicable_______________________________________________________________________________________________
Agreement:&t
The undersign d agrees t�instath foredescribed Individual Sewage Disposal System in accordance with
the provisions of iIHE 5 of the State Sanitary Code— The undersigA further agrees not to place the system in
operation until a Certificate of Compliance has sued byAtkear o ealth.
Signed. . ••--------------- - -'..------.--_._ Uej
ApplicationApproved By----•------------------------------------ ------ •-------- ----- ..... .........
Date
Application Disapproved for the following reasons: -----•-------------------------------------------------------•----------------•-----------------------..----•-
........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
No------------------------- Fxs..................._.........
THE COMMONWEALTH OF MASSACHUSETTS
.,..BOARD F HEALTH
_ .G�11 ..oF............: .l .f'1- ........................ $,
-I
Appliration for Disposal Works Tontrurtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
i.3! .`'%A IL
Location-Address or Lot No.
................................. ................
;L ✓j Owner C Address
....................
ty✓ sra2le�� Address
Type of Building Size Lot.&3Y$�h?__t_..._..Sq. feet
Dwelling—No. of Bedrooms....:3.....................................Expansion Attic (No) Garbage Grinder 00)
Other—T e of BuildingNo. of persons............................ Showers
�-' � • ----•---------------------------•--•--------- ( )--- Cafeteria ( )
Otherfixtur •---•-•----•-•--•--•----•--••••---------•-----•-•-•-•••-••-----• ----•-•---
w Design Flow..:, ^'.....S ................gallons per person per day. Total daily flow_-__._.330---•--•-•---------•----------gallons.
WSeptic Tank—Liquid capacity.R�...gallons Length__` --...._.. Width.�4:'I�?_t.... Diameter................ DeptW'`..(,.e._-
x Disposal Trench—No..................... Width______.._.__....... Total Length.__........._... Total leaching area....................sq. ft.
Seepage Pit No.........I.......... Diameter.__.../..�........ Depth below inlet.._...:........ Total leaching area.Z -' ....sq. ft.
Z Other Distribution box (✓) Dosing tank ( )
Percolation Test Results Performed by.... ..................................... Date.J.+1M-_36alah3......
Test Pit No. 1..."Z.:.-....minutes per inch Depth of Test Pit...... ___ Depth to ground water_._"" ._S'! ' .12'
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ......-••••-. -----••---••-•-•-•-••••-•--•.......•-••••---•--•.....•----•-•-•--•.............•--•-......-----------------•-•••.•..------------------- -----
ODescription of Soil.!)--�____-Lur-m_ _:S+'f 1. ......... ....____- --_---------------•--------------------------
.., C- njui>.----•----------------------------------------•--------------------------------------------
w
U Nature of Repairs or Alterations—Answer when applicable......................................................................................:.........
................................................... •-•••••••-•••--•-•...----••-•--•-•--...----•-•••---------•----•-----------••••-----•-•-•-•••---••---•-•---•--•-•---••--•---•-•-••-••---------------..
Agreement:
The undersi e s 'o� e ore escribed Individual Sewage Disposal System in accordance with
the provisions of i .I f the State Sanitary Code— The underslgn�q further agrees not to place the system in
'sued
operation until a Certificate of Compliance has by the
ardealth.
Signed. -` ---------- y
Application Approved By-•-•----•---------•---•......•........ - ' } S j- -----------
Date
Application Disapproved for the following reasons:•.... -------•••••••-••-••-------•--•••-•---••--•--•••---------•-•--•-----••-•---•--•-•-•---•--•-------•_...--
I
..................................................•-----------------------•----------------•------------.--------------------------••--•--•-•---•••-•••--•---•--•-•••---------•-•-•-•-•---•------.......
Date
PermitNo.......................................................- Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... .N.............OF.............L%Gk!!/1!..... .................................-----------
(Inrtifirttte of Tontpliattrr
THIS IS TO CERTIFY, That the Individual,Sewage Disposal System constructed )C) or Repaired ( )
by........................
(� I V:. ..............v ..�r:... .
't �� Installer
at = ---•--...-- ----•----• --
has been installed in accordance with the provisions of TIT TITiz, 5 of The State Sanitary Coll ash scribed in the
application for Disposal Works Construction Permit No.. h ------ dated---
----------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �-'-
DATE............................1.. . ---•---------•--- Inspector.............../----._---..--------------------------•-•----•--•---••-------•---
THE COMMONWEALTH OF MASSACHUSETTS - - -
BOARD OF HEALTH
....Q 1:N........OF...........- . : '.�........ ....... -
...................•••.......
No....... -•--3.6 9 FEE..... ........
Disposal 10orkv Claim , udion Prrnti#
Permission is hereby granted.. ......-----•-••....................................................
to Construct ( ) or Repair ( ) an Indivi ual Sewage Disposal System
at No.•--••-•••••••---••---------•--•--••--•---------.--a-' . N d. �. y ate .nn r
..............................................................
Street r —
as shown on the application for Disposal Works Construction Permit No.._........._..'_�'f'Dat d.... .. ...... ....191 �.��........
-------------------------------------------•-•-- .......��.....-- ......-.............
..................4 4 ' Boa f Health .
DATE. . -t='`......---•--••------•-
FORM 1255 A. M. SULKIN, INC., BOSTON
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