HomeMy WebLinkAbout1225 IYANNOUGH ROAD - Health (6) b us P o�n�►i5
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113 Burnham Street, Marstons Mills
A=043-022
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UPC 12934 °
N® 153LY
@9AWING%MH
No..{¢-- FuR 2_ ....................
THE COMMONWEALTH OF MASSACHUSETTS.
BOARD ® HEALTH
_ .._-._.OF......-- .... ...�........
Appliration -fur ]iiipufitt1 Works Tongtrurtton Vrrnift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewa e Dip sal
Syst /at: AcT
------ ------- d
. .--
Lo n- ress or L."N -A
w er ✓ dress
a ----•---- ........ - ---4.` __ '.'. - --•-••-•--_------__ .--------------------------------------------------------------------------------------------------
Installer Address
UType of Building Size Lot__-------------------------Sq. feet
0-4 Dwelling No. of Bedrooms...... .. ............ . .........._-_ ansion Attic ( ) Garbage Grinder ( )
Other Type of Building �f e is_,___ ----- h rs �) — a e
a Otl fixtures-,---- ---------
i W
Design Flow.__•- -----------------------gallons per person per day. Total daily flow...._.__________________________________gallons.
WSeptic Tank—L quid 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 ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------.-----
,� Test Pit No. 1----------------minutes per inch Depth of Test Pit..........---------- Depth to ground water------.-_---.---_.-.___-
f� Test Pit No. 2................minutes per inch Depth of Test Pit-:__:___:_______ __ Depth to gr and w t. r-._._..___.___.___.....
x --------------- - y�
O Description of Soil__- --------------- =- -- =----- -------.7s ----------
(�x -----------------------•-- -- ----------------- ------•----•--•------------
-------------- -- -- .. -• ;--•-- ---- —-- f a�-•---------------
U Nature of Repairs or Alterations—Answer when applicable---------------------- ----------;o/..--------------------.------.---_.-...._-..--.-_.-___--
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 4ndersigned further agrees not to place the system in
operation until a Certificate of Compliance h s be issued y the oard 21 health.
Signedf •-----•--- •--•------------ ---------- .......... ---- -----
Date
Application Approved By--- --. '
. - l� l Z ���-3--
--- ------ --
Application Disapproved for the following reasons:------------------------------------ - - ---•----------------------------------- -..•ate--------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Nf"
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
....
Tatifiratr of Tomphaurr
THI S TO tTIF4w*
he Individual Sewage Disposal System constructed (v) or Repaired ( )
byCC----- ••• •• -••-•- ..........
Installer /
at......r- .-JPU--- ......1• ...
-Z ---....... ---- -- --- ............................
has been installed in accordahe provisions of Article X fof State Sanitar Cocle s desc j�gd in the
application for Disposal Works Construction Permit No_____________ _ _ ___ __ dated...= � .�_.%t_ _._________ ......
PP P > ,�--------- yam. _
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
♦.'f.44. -...s..-.-.-..•.w......w.........................................w..w.....................5...........a....a�w.w.....w►r��r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALT
OF
No. �... .. FEE-- ......... 1
��r�tr#t>aEtrrmt#
Permission hereby granted.... ri. ---—--------------------•----•---------------------------------------•---
to Constr ) or R . air ( ) an - dividual-Se e Disposal y t
at No. ���� �q•---- _
street
as shown on the application for Disposal Vrorks Construction Pe o-- _._ __ _ ___ e ______________________________________•-_
.............. ------------- ------ --• -•-•--------••---------_-----
Board of Health
DATE --------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No. y 7---------- Fps.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ � ,� �J
..........OF....'V ../il?f.: _:r `!f-�c... °:. ...................
Applirtt$ion -for Uhipoiittl Worku Towitrurtion Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: �
q 1 t
--==.....-..i_._I.r, .........-li...... ...........----- . .. -•=-•f- ........... ' _re-:t-_......._.Ir/ ......-----` ......1......�......
Location Address V / J_ i or Lot No / /✓-
-- ....... ....... ... ....--------- .............................................................................. ..........
L r
Owner .� Addr s
Installer Address
Q Type of Building Size Lot___________________________Sq. feet
U Dwelling—No. of Bedrooms---•__c.--:----•________----___-____--_._.:Expansion Attic ( ) Garbage Grinder ( )
Other j�Type of Buildingt!7__�� +� r __. fipjern5.:.__ ____. -"?°`_ Showers ( ) Cafeteria (`^ )
Other fixtures ------ -- - --•-----/1 t'' �: `,'�. ._r .. - = � //+-..�.',
d _-•---
W Design Flow--- .......gallons per person per day. Total daily flow---------------------------------------.....gallons.
WSeptic Tank—tiquid 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 ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---•-_----------•-•----- ------.------
,a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...--.-----..--._.-____.
fZ4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.--.-.--_--_--___--._.
1Yi = .. _f ---------------------------
D Description of Soil """ - � : , :77?
x -V ----------•=-------------.............................................................-----------`-- ---•-
x ,� -- --- ----------------! :- ------ ---- ... ----- --
V 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 been issued by the boards/of health. �/,(�
Signed.:=-•--•------••-----••- ---•--------------------- ............ --.............................
/ / J f r Date
Application Approved By----- /-_ /._/..2..Da/
Application Disapproved for the following reasons:------------------------------------- --------------------_---------------__--_---------.------------------
...................•------------•---.....---------------------------•--••---•----------•--.....------•---I---------------------------•------•---•--••-•-•-•-•----------------------------------------•---
Date
PermitNo......................................................... Issued................................ ..................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFj HEALTH `—
/ `�/1n OF........... rl '�... -t-,.
..................:..........
(Irrtifirtttr of Tontpliatta
THIS-IS TO,-CE)?TIFY,f f�That the Individual Sewage Disposal System constructed ( Repaired ( )
Installer
at......•- lam! - .+rt_ //1 r /L+f! -- ----•- ........... ------- ------------------
,��T... -- ./ -tea.-� -�—"
has been installed in accordance with the provisions of Article X --of cyThe State Sanitary Code as desc i., d in the
application for Disposal Works Construction Permit No_____________ ___i� ________. dated..._/A/,..:�.�_���........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............................................................------------------ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� .
No. FEE-- - - ----------
i� to ttl- ork ClI>vn#rnr#iott Vrrmit
Permission is hereby granted )''1` ' F'`'`t, -----`---------------------------------------------
to Construct'(� ) or Repair ( ) an�Individual S wage DisposalSyste,
�--�r- --- -------- - •-•---y-- -- •-- --. ••---
`. - - __-
' A/ street
as shown on the application for Disposal Works Construction Permit No_?--- Date ____..___
G, ------ r-----
DATE-
•------••----------------•---.-.--------------------•--------•--------------- Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS