HomeMy WebLinkAbout0422 TURTLEBACK ROAD - Health 422 Turtleback Road _
Marstons Mills
A=062-007
s
THE�COMMONWEALTH OFu�ALTH TS
�} ;.... . . _ llwo,��_oa7
...........OF........... .................. .....................
ppliratiuu -fur Mtipuual Worko Tatuitrurtiuu Vrrmit
App 1 9 reby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Syst t: ,
... .........
---------------------------------
�.,Ca�ti.n Address r. •- or Lot•No. G -
wner Address
W
Installer - �'<.,. Address
QType of Building Size Lot_ ._.. ._. _OO....Sq. feet
V Dwelling No. of Bedrooms............. -Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building _-_________________________ No. of persons.---_---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures•-------- ------------- -
d ;s ------------------------
tllons er erson er day. Total daily flow_ .._gallons.
W Design Flow = g P P P ----------
WSeptic Tanl Liquid capacit _..gallons Length___ Width..._.....____ lliam er................ Depth......._....._.
x Disposal Trench—N . .......:........ ... Wicltl� ___. ....._. ... al LenPFle
-_. -.-- f�Tot eaching area....................sq. ft.
Seepage Pit No. ------_.. Diameter e _ .._ ota leaching area.. sq. ft.
Z Other Distribution box ( ) Dosing tank ( , )
Percolation Test Results Performed bY-------------------------------------------------------------------------- Date------------------------�--r�`
aTest Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water..------d
(i Test Pit No. 2................minutes per inch Depth of Test Pit----------.......... Depth to ground water-..---------------------
P4 ..............----------------------------------------------
------.. .,_... ---------
O ..
Description of Soil----..........................................-...............
�- --t-" ' -- - =- -- �1-� =--f------ -
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the, system in
operation until a Certificate of Compliance has is ued y t rd 'f health.
Sign ...`
XApplication Approved BY `�
"Date
Application Disapproved for the following reasons:........... .............
easons:........................... .
••-•-••-••-------•-•--------------------------------------------------------...........................................................................................................................
Date
PermitNo......................................................... Issued..... , ....... _ 7
Date
No _ Fug ...............
THE COMMONWEALTH OF MASSACHUSETTS
fz BOARD HEALTH
"
-. .......
mot' ' .......................................OF......
Appliratiuu -fur Diupuiittl Workii Tiltutrurttun Vrrmit
Application is hereby made for a Permit to Construct ') or Repair ( )' an Individual Sewage Disposal
Systeat e f t dfr
Le
' ./ ' s... r ._�.rt�: -• i f° Es "# = y - --•-- _ _---•-------...
� ` --
A,'� t l ocation-Address or Lot No.
o,:. 11 Y ' =sly' IF I
•i�!�lwner ` Address
W # ------
Installer Address
d, Type of Building Size Lot_ �f ----Sq. feet
-'� Dwellin g No. of Bedrooms___________________ Expansion Attic ( ) Garbage Grinder ( )
Other,—Type of Building ersons....._.__-__,_
g -•-------•-•••-•-•--------.. No. of P •-----------• Showers ( ) — Cafeteria ( )
Q' Other fixtures ._____.
d .---- ---
..�+
W Design Flow _____________________ _._ t_._gallons per person per day. Total daily flow_ .__.._ gallons.
�,+,
W Septic Tanl�Liquid capacit +_-_gallons Length---------------- Width- -----.- Dian
per................ Depth.._.._____.__...
x Disposal Trench—N . ------_---- Wi th----- ---- -�a�l enple .
- _'`% Tota leaching area--------------------sq.Seepage Pit No.:__.__._�.._______ Diameter�>t ..._ w _________ tal 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..___._: ._ ..
G= Test Pit,No. 2................minutes per .inch Depth of-Test Pit____________________ Depth to ground water------------------------
----------------------------------- -----•--------- •---
O
Description of Soil-------------- - ----------................................ -- -•----- --Mr' Gy O
x
W t7-
-------------------------------------------------------------------=-----------------------------------------------------=------------------------------------------------------------ ...............
V Nature of Repairs or Alterations—Answer when applicable----------------------------____.-.-_-._.._.__-_.-.-_-__--.___---:.-_--_-_--------.__.-__.._. �.
. _
Agreement: l
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 Complia66e4111N bee issued;by the bo'rd/bf health. k
M✓ :Sign ✓, _ __•:5 £ ___{{ _ _z_ 1 f __...............
F, s� " f,9 µr z x p r a D e `
Application Approved BY•--' ,
Date
9 - --
Application D ___isapproved f or the following reasons_ _________________________
----•----••---- -----•--•-•------•---------------- -----•-------•------ -------------t.-----•---••---__--. --
Date
Permit No.......................................................... Issued.�- ��` .....
Date
y _
THE COMMONWEALTH OF MASSACHUSETTS
" BOARD OF HEALTH
.F ..ter.; l zt? .....!OF.....��. .�,��s tom. .�f.. ........................................
u
Trrtifiratr of ompliaurr
xTH S TO.. RTIF hat t e Ind• al Sew Disposal System constructed ( ) or Repaired ( )
by ` _ t ' -
i a
at"-•-- --•- •- f
!/
has been installed in accordance with the provisions of Articl ��++_of The State Sanitary C I as d scribed in the
application for Disposalk.Works Construction Permit No----___�1iC1!"'_ _______________ dated_. ----- ''5-.............
THE ISSUANCE OF THIS -CERTIFICATE SHALL NOT BE CONS UED ARANTEE THAT TIME, '
SYSTEM WJLL UNCTI N SATISFACTORY.
DATE : = Inspector k�.i%�'� �'
r/ THE COMMONWEALTH OF MASSACHUJ%k TyS
BOARD j9F HE, T r
f ... .. .......�......OF.... .......
No.
FEE
�E Z14
Permission is,hereby granted"".•--- `&........................ - ------ --••- -- --- -- ` . --" •---------------..............
toto No ( P vidua' Sew e ispo Syste
Const ct o �Re it . I d � bg - - ----- ------- ----- --------------
�`' .-
� •- Street-
as shown on the application for Disposal Works Construction it N 1_. __ "=3_ __:___ Dated__.__ ..............
= f
;i f_____________________________
'y7 � Boar of
4 DATE..... ..:.. -- ,,..�..._-- -- ..............
1255 HOBBS & WARREN. INC.. PUBLISHERS