HomeMy WebLinkAbout0032 HEATH ROW - Health ' 32 Heath Rovv��A�►�
Marstons Mills - -
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Disposal Works Tomitrnrtiun Vveratit
Application is hereby made for a Permit to Construct (� ) or Repair ( ) an Individual Sewage Disposal
System at:
...................� ...�e�� ...._�� _...... s! ! -. ..........------------------------------......---------------------------.---.------.
�+ ocatio - ddres
Owners Address
a .. . .SDI ,...o`a... q..Id- - ' ......................................................
Installer Address
QType of Building - ` Size Lot__y4_� ....Sq. feet
U Dwelling—No. of Bedrooms...�...................................Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other_fixtures .. _
-----•-•---•--------•------------------------------------------------------------- --
W Design Flow.... gallons per person per day. Total daily flow__.•.........6i 0......_...•.-_•._gallons.
WSeptic Tank—Liquid capacity/_'5._®1�.gallons Length................ Width................ Diameter------------_--- Depth................
x Disposal Trench—No..................... Wi th._...____._.._._.... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......2........... Diameter. ..0..... 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........................
GT., Test Pit No. 2................minutes per inch Depth of Test Pit____-__-.._-___-•_-- Depth to ground water........................
ai --•--------- ..............
o Description of Soil___. _ _ __
x = - - - -- - .............................
V -------------------------•--------------------------•-----------------------------------------------•--••-•---------------------------------------------------------------------------------------------
W ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------•-
UNature 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 TITLE 5 the State Sanitary Cod The undersig ed further agrees not to place the system in
operation ti a Certifi a of ompliance h e s ed b hhe bob of health.
Da e
Appli tion Approve y.. --••---••-•-•---•-- -•.........
Date
Application Disapproved for the following reasons-----------------------------•---------------------------------•--------------------------------------........_..
--••-•---•-•.....................•----------------------------....--•---•-•------------------------•-----•------........-•--•••-----•-•-----•-•----••••----••--•----•--••---•--••••--•-•-•••--.........
Date
PermitNo......................................................... Issued.......................................................
Date
ASSESSOR'S MAP NO. a,92 PARCEL
CAT10N SEWAGE PERMIT NO.
VILLAGE nlp# o0-15
--5 _ems k 4F , d
I N S T A LL 'ER'S 'NAME i ADDRESS
/Y
BUILDER OR OWN ER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
Y
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- THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH n
_................OF...................---••
t Pphrajtion for Disposal Works Tonstrnr#iun rrntit
Application is hereby made for a Permit to Construct (� ) or Repair ( ) an Individual Sewage Disposal
System 6 f P_.14,1,.M1_4. : : ldz-----------------------------------------------------------------•---•----..........--
ocation-Addres Lot/No' -
..............doyw...1 :_._r� .� = - 9. y e , .�w- ..........--
W f! Cr �.tY / !.C{.. Address
Own
Installer Address ,�/
Type of Building Size Lot_:C__4_�� .....Sq.. feet
Dwelling—No. of Bedrooms... ....................................Expansion Attic ( ) Garbage Grinder (t.� P
Other—Type of Building _______________ No. of persons............................ Showers
a YP g -------•----•------------•-----------------P--"- ( ) — Cafeteria ( )
Other fixtures _. ------------------------------------- ,r► -----
'41
W Design Flow___ ____2��j__..._____._gallons per person per day. Total daily flow..____._____ _9__________________gallons.
WSeptic Tank—Liquid capacity._.dQ__gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No_____________________ Wij th.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._.__�----------__ Diameter_(V__jP___._. Depth below inlet____________________ Total leaching area..................sq. ft.
Z Other Distribution box s Dosing tank ( )
Percolation Test Results f Performed by Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water___-___________________-
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.............-•• _
DDescription of Soil-.. ..............-......----------------------------------•-------------•--------- ---------•-----._.......__.
x
---------------------------------------------•----------._.._..-------------------•----•---------------------------------------------•------------••-------------------------••-•••---•------..-.._._.
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 TITU of he State Sanitary Cod The undersi ed further agrees not to place the system in
operation a Cer e of ompliance has bee ksed b} the 4bo,r of health.igne = � /�j c .__ bd
�
Ddte
---Application Approve BY ------ ---••- " -- ---------------------- ---- -;t_ .......................
Date
Application Disapproved for the following reasons:..............................................................................................................
---------••--•------•-----------------------•---•-------------------------...-------------------•----------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF........................................_...._......_.......................-..�_...
(9rdifirFatr of TnntpliFanrr
IO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by...
:_ !. -- •-- -----------•------------------•--------------------------------•-•-------_----- -----------------------:-----------•--__---••--------•---
Installer
has been installed in accordance with the provisions of TIT, o e State Sanitary Code as described in the
application for Disposal Works Construction Permit No. - Y
dated •---------------------------•-
THE ISSUANCE OF THIS CERTIFICATE 'SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
DATE................................................................................
Inspector
THE COMMONWEALTH OF MASSACHUSETTS (-,,
BOARD .OF HEALTH X" VA'CtO"
,c� "rr6 G ........................... .............OF......................_-_...__..------...------.. __._..._ _._..._._.... . J
No.S:? 010
... .......... r _ FEE.---•••-
1
Mop 1 k Taatptrttrtiorn rrntit
Permission is hereby granted:... -•---•-------
to Constr cctty( �Qorr- pai ) n I dividua . e wage - po$ System
atNo ' -~ ------ ----•-••••••---••--- •- ..............
.. (/}j
reet
as shown on the application for Disposal Works"Construction Pernat,ANa_ e �Dated._,,.z.... ...... ..................
r
Board of Health
DATE.......... v ------------------•-------•-•-----
` R ? FORM 1255 A. M•.SULKIN, 'NC_ BOSYON
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