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HomeMy WebLinkAbout0715 SANTUIT-NEWTOWN ROAD - Health 715 SANTUIT-NEWTOWN ' o � Marstons Mills A 028 - 010 - 001 r � L0CAT10N � - SEW ACE PERMIT NO. VILLAGE INSTALLER'S NA11IF ADDRESS 0 I L D E R OR OWNER DATE PERMIT ISSUED DATE C 0 M P L I A N C I ISSUED ��a�— �� �.� �� 1 �,,(0. S NP ...... ............... THE COMMONWEALTH OF MASSACHUSETTS to BOARD O HEALTH ------------- Allp irFation f i ear 11ispntitt1 Workii Tnnitrnrtinn ramit Application is hereby made for' a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r?'1.S' Me-10 F.WVL 2©Ad !,-PAv' Coins I�il1S ................__..._. .........L,,00Ication-Address................................... ..........................................or Lot No. ....................................... .. ...................... ..........--...................................................................................... Owner Address Installer Address d Type of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms.................._.:_........... _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons_________________----------- Showers — Cafeteria 44 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 Results Performed Da Test Pit No. ......-_minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ s3+' ...................................... ....._............•••• .......................... Description of Soi14- t_C� -�4 evi.. �"�'...� ......ems.�(!��divVw `��` r � = x x •-------------------------------------------------•-----------------------------...---------...----------------'--_---------------------...--------------------.-----------------------.......--------- U Nature of Repairs or Alterations—Answer when applicable_�ll .!N1 �_ t�►_______ a. �..rr !K...3-- XIsTrk .-- F1�Oi�S �....o.Nc.0L) ............................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 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. Sig ... .. .............. ......................... Date Application Approved By....... ���. •• -••----•---•----•---•-•_.. _...�..... Date Application Disapproved for the following reasons:..........................................•_._.__._..__._____.._....___..__.._•--•---•........--•--•........_ ----------------------------------------------------------------------•----------.....--•--------------....--------....•..-------------------------------------------------------------------------•-•--. Date PermitNo......................................................... Issued....................................................... Date L _ No..:..---..._ ./..... Fss............................. THE COMMONWEALTH,OF MASSACHUSETTS BOARD O HEALTH ........... 0F.......... ........-- :: �-' - ................... yt. -Appliration for Disposal Works C�nns rtion• rr-mi# Application is hereby made for a.Permit to Construct ( ) or Repair ( j an Individual Sewage Disposal System at 7/1 Afew-r-wtq � GtsA i l"fr+ Y 11:t ......... ....._..- -................. -..................-•----•-••---- -------------•----------.....------------•----------------....._.......------........ Location-Address or Lot No. _ iK ....................•.._.... ................................................................................................. --- Oer _.........--•-•-•--.....-•----•.Address Installer Address dType of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a 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 ( ) 0-4 Percolation Test Results. .Performed by.......................................................................... Date........................................ aTest Pit No. I................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........................ ---------------------------------- ----------------------------------------...--- •----- ......................................................... 0 Description of SoilQ� �.�'. -�4 C.__:t' .........................................wt "' / C'�of V S-. /+fig i:v�u S ii c ..'�: a y ' x W •----------•--•-•-••-----------•••--------------•-••-•---------------------------....•--••••-•---••-•••••-------•--......•.--•------•- ------••-}----••-------------•-------------.._............-- U Nat re of Repairs or Alterations—Answer when applicable-)Ja-wl T:SJ� !�:.'".Aa_due ----------••••-•-• ......•. -•-•---- •••.----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITS 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. Sig O'`_ ll F1/..�-. �... �/ Application Approved By------ ,f��/l r " Date 7� Date • ... .APPlication Disapproved for the following reasons:------- .....--•-•••--•-•-------•-•--•----•.......................•---•------•--•._....._ --••-----•----••----••--••--•...................•-••-----•--•-----------------------...........--•--......-----•------------------------------------------------•---------------------------------------- Date PermitNo......................................................... Issued.------.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF VXALTH k '^ a (9rdifiratle of (Somplittm TH S IS TO C TI _ , That the Individual Sewage Disposal System constructed ( ) or Repaired ("') oc Installer at ... ----- . •-• -- ---- -Ae has been installed in accordance with the' -provisions of j off The State Sanitary Code as described in the application for Disposal Works Construction Permit N :._. _ ___ 47. ............. da.ted.._.._----._._.____-__-._..................... THE ISSUANCE OF THIS CERTIFICATE SHALL OT;:BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-•-••--•---•---------...............---.....--•------•--....... Inspector.................................................................................... n� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '.:rOK,, AJ...................0F.._. . ............................ No..... 5�........ -_'" FEE. ........ Disposal Works T-Fnntruldio''f rrmit Permission is hereby granted !'--13-0....dO'�-----------------------------------------------•--............----.....................••-• to Construct (1K or Repair ( an Individual Sewage Disposal System at No....AIZAJ1.C.1-5......._�f1�/SjlK.[ �a'!I✓'------...2 -5.---.1.v.r.u.r01n21V g 1 Z-........MAJZS ANI.....m4k i ............ Street as shown on the application for Disposal Works Construction Permit N1W OW Dated.......................................... Board of Health DATE.....---••--------•---•----•--------=............................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS v7f L � h ° /0 AsBuilt Page 1 of 2 LOCATION 'S SEWAGE PE.NMIT NO. L 9z YILLACE 13 INST A LLEM'S NAME A ADDRESS SUILDEIII �]OR OWN R /Ch.flll,8 NFL�ivti�it DATE PERMIT ISSUED . /D DATE COMPLIANCE ISSUED s F.ca f http://issgl2/intranet/propdata/prebuilt.aspx?mappar=028010001&seq=1 5/24/2017