HomeMy WebLinkAbout0310 HOLLIDGE HILL LANE - Health 310 'lli-hg ,Hill Lane
Marstons:Mills
A 081 - 009
LOCATION �' SEWAGE PERMIT NO.
VILLAGE G
INSTA LLER'S NAME & ADDRESS
1 `r C � a
8If R OR OWNER
A-NU`S
DATE PERMIT ISSUED 7�
DATE COMPLIANCE ISSUED /2- - �8
o
�z
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
A—<s(� Application is hereby made for a Permit to Construct _P_�or Repair an Individual Sewa/Disposal
Systeni at:
Owner Address
Installer Address
Type of Building Size Lot_Y.Y
Seepage Pit No........ Diameter....joW Depth below inlet-.6.............. Total leaching area.,I— - ....sq. t.
�r. Mkm� _/.. .......................................................................................
The undersigned agrees to install the aforedescribed Individual S age isposal System in accordance with
the provisions of TLITUj 5 of the State Sanitary Code—The undersigned fu th r agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of Ilea
'------
Date
Perzoit No'- --'- "
---
No......... -•-••-•---... FEx..............................
THE COMMONWEALTH OF MASSACHUSETTS
~ F; BOAR® OF HEALTH
ur '
App iratiun for Iliquii al Vorkg Tongtrnrtiun Vamit.
Application is hereby made for a Permit to Construct lam) or Repair ( } an Individual .Sewage Disposal
System at:
!L M l ----••-•-•------�CG /
o at".-Address or Lot No.
l�l�x���i. �.--•--- --....--- --••-•......................................•----.
L
Y+ !z .,z:
................•..._....-•-•-• -.._ ....................
Owner
a Address--._---•----...--•.---•..
..
.....,..................
Installer Address
Type of Building -� Size Ldt_ %,U�_0...Sq. feet
U Dwelling—No. of Bedrooms..........__..:�.___..,,.,..................Expansion Attic (No) Garbage Grinder
a
p, Other—Type of .Building ..t4l.A.............. No. of persons............................ Showers ( ) — Cafeteria ( )
PaOther fixtures --------------------------------....................
Design Flow.....11,40.............................gallons per,f*rsenn per day. Total daily flow........... ........_..........gallons.
WW 20 allons Len thy_� '�.. Width S!.` o".. Diameter................ De th-5`_r ......
Septic Tank—Liquid'capacity4. g g p
x Disposal Trench.A No..................... Width _.___.._...._._._ Total Length.................... Total leaching area---.._..._.//_. ._.sq. ft.
Seepage Pit No......../..._.._. Diameter... N---,. Depth below inlet................ Total leaching area. _616--sq. ft.
Other Distribution box ( Dosing tank ( )
"" Percolation Test Results Performed by._ ,c2/.Q4 ...A:_.. 1. FnR yZ' ....... Date...8AZ.....
�
Test Pit No. I.._..4.Z....mmutes per inch Depth of Test, Pit..../3.`......: Depth to ground water........................
Test Pit No. 2...21;�.r•._minutes per inch Depth of Test Pit../ __........ Depth to ground water........................
--------------------------------..............._.............................................................••---••••---...........•--•--....._......_..-•--
O Description of SoiL�`e!``.... v ' M t Sv! a/ 1t► -�` r--CDiq& 4.••-•-•..5AA.A--------_--
IV
Up �rL JET +�"+ s
yT" .. •
UNature of Repairs or Alterations—Answer when applicable.._.............................................................................................
------------------------------------------•--•---••-------•-----•----------------.......---------------.......---------------------------------...-----------------------------------.......••••.......
Agreement:
The undersigned agrees.to install.jhe aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT�.;;,.
p 5 of the State SanitaryCode— 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
2 Date
Application Approved B�?....._.""",� 4-........ ... /'W.
- -
,.._ - •, ,,,. Date
Application Disapproved for the following reasons______________________________________
---. .
Date
Perinit No..........................=............................. Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
NW E
BOARD F HEALTH
......... ... .. .....
OF:..... �...................................................
Prtifirtttr of Taut iianrr
THI S TVfCERTIFY, That t e Individual Sewage Disposal System constructed ( or Repaired
by `" /� ...
In t Il'er
has been instal e in accordance with therovisions of T �t1r o�fhe State Sanitaryode, s de,,;� bed in the
application for Di. s a Works Construction Permit No..': _..__. ......................... da ...............................
•...:�..... . ..._....;_.._._..
THE ISSUANCE OF THIS CERTIFIkATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
DATE.:.. ....I
••' -7--Td........ ...... Inspector Z .-•--•--••--•..... .....•...................•-.---•-
r
THE COMMONWEALTH OF MASSACHUSETTS
K BOARD HEALT _
L
. .....OF........ ..'
.2
J��Q.._.--..._ FEE... .... .......
1
Diullos ai I
u Tunufrnrtion unfit
Permission is reby granted.-_i... .'
-----------------•--••-------------
E.-
at I
to Cons�r t ) or . n e r ( Individual Sewa p/osal st ,� �
....
Sree
as shown on'the application for Disposal Works Construction P N/o -,,7_ _._.__ _ Dated-__P.. /. 7�
r'!
,.. - .
rBoard of Health
DATE----= -----...
-
FORM 1255 HOHBS & WARREN. INC.. PUBLISHERS - ••
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