HomeMy WebLinkAbout0559 ROUTE 149 - Health 5 5 9 ROUTE 149 -
Marstons Mills
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THE COMMONWEALTH.OF MASSACHUSETTS
BOAR® OF HEALTH
...........................................OF.......................................
Appliration for Biipnoal Works Tomitrn.rtinn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
�OSystem at: �' t � 9 �1 ;
.... �-�. j:T.�za ... ............G? ............. . ................................i5_ 1--�...............................................
QQ \_ • - ..-&sqation-Address or Lot No.
.
...: .........................SS^ ......................_......... .....
IL
O ner \ \ Address
1e�: ... .........1.
Installer .....
Address
Type of Building 44
f Size Lot...............:............Sq. feet
�., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Building No. of ersons........I................... Showers — Cafeteria
Pa Other fixtures -----•--•-----------------------------• .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............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 tank ( )
Percolation Test Results Performed by.......................................................................... Date.....................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........._.............
Test Pit No. 2................minutes per inch Depth of Test Pit-------------....... Depth to ground water........................
p[, ............:.......................................................................................--••---•-•--------------................................
0 Description of Soil..........................
x
V -•------------------
•..............
--••----------------------------------
•...-••-•------------------
------------------------------------
--------------------------------
-------------------
-----------
..
•-----------------------------------------------------•---.....------••-•---•---....-••----••-------.-
U Nature of Repairs or Alterations—Answer when applicabl _1________ ______�.Y..A0..........Q
' 4Ic-...10, ------------•-------------------•--------------------•-------•----•--•--------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance ha by t e boar lth
igned........�.............. ....... �� •. .............. .---
Date
Application Approved By... ....
Date
Application Disapproved or a following reasons---------------•---.....--------•-----------------•------•--•....--------•-•-----------------------•-•........._
........-•...................•--------------•--------------..............-----------...........----------•-•-------•-•----•-------•-----------•-•------------•--•-••--•----•-•------•-•--••••-----------
Date
Permit No......................................................... Issued_.....................................
..................
Date
/ ! , ► Ile,No.flzn J.z FEs.Zj..._...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-•........................................O F.......................................------.
Appliratiun for UiipusFal Warkii Tatuitrurtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................__.........................---...-......:........,......... -------------- --------------------------- --------------•-----------...-•..............
....
Location-Address or Lot No.
.......-^-•••----•--....................••---------•--•--..........._........................... -----•-•••-•---•---•--......_......_...........__.....-•--•-••-•-.........---•-•---....--•---•-••-
Owner Address
w _
Installer Address
UType of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other-T e of Building .............................. No. of persons............................ Showers — Cafeteria
04 Other fixtures ...................................
d -•--•---•--------------------------------•------------- -----•• ---------
.----------
•-------
w Design Flow............................................gallons per person per day. Total daily flow_._......_._................................gallons.
WSeptic Tank—Liquid capacity............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 tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-•••---••••-----••-•-----•-•--•-••.............••-••-••--------•-•-------------•---••-•---••••---••.........................................................
0 Description of Soil----------------------------------------•--------------....................----------------------------------------•---------------------------•--...........---•---•--
x
c.,
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 TIT1Z- 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.
igned ........ -:........................................................ ................................
Date
Application Approved BY /---•--•---••
---•---------------------------------.-.-----•-----------------------------------•----...........•-••••••------- Date
Application Disapproved or e following --------- ---------------•-----•----- ._......_._.
...................................•-----.....__.....----------••---...-•---------.......-•----......---------------•--------------------•........... ...............................................
Date
PermitNo......................................................... Issued...................t=..................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trrfifirtttr of Tuntplitatta
THLf TIFY, That the Individual Sewage Disposal System constructed or Repaired
�}
g P �' ( ) P
bY--------- -------------- •--•. ...... ---.-•-----.•--•:......--•-
y� Installer
at.------ (-_. •-•-ti ••--------- --•--
has been installed in accor ance with he provisions of TIT,L;,rS 9 tate Sanitary Code as described in the
application for Disposal Works Construction Permit No....................... ... ........... dated......................................._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................ :'. ........... Inspector..............................L..........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF.....................................................................................
No......................... FEE........................
iu �� Quanitrttrtiun rrnti�
Permission is hereby gra ._
to Construct -3n i• ewa a Disposal S stem
atNO....__... .............................................................................----Street---•-.... ..............................................................
as shown on the ap cati for Disposal Works Construction Per ..................... Dated..........................................
..... ...✓"....._...
�j ---------------------•------•------•----------•-----
,/ Board of Health
DATE------- -------l........- --------------•-----------......_._
`'"`. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
AsBuilt Page 1 of 2
I
LOCATION SEWAGE PERMIT Np.
V I L 99 E o79 -UIS
C fig; let Irl) _
INSTALLER'-S� NAME i ADDRESS
S UILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
Cltan oaf
4 36` if
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http://issgl2/mtranet/propdata/prebuilt.aspx.mappar_079015&seq=1 8/17/2017