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Home My WebLink About0040 IRONWOOD ROAD - Health 40 Ironwood Road - — - - - - - Marstons Mills A= 056— 002 — 024 No.....V.22 F>cs.... ......:. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH Appliratiun for Dispusttl Works Tonstrurtiun Permit Application is hereby made for a Permit to Con ruct l Y l or Repair ( ) an Individual Sewage Disposal tP121 at � r - -/ �� ........................ Ec.t A re s Z&= t No. ess .._.._ .......... --- ----------•-•--•-......... Installer �- Address p� •'� . Type of Building Size Lot.._.V...�.9114q. feet .-� Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type T e of Building ........... No. of persons............................ Showers p, yp g ................. p ( ) — Cafeteria ( ) 04 Other t es ................................... . W Design Flow............. ....[_0._..__._ � allons per per day. Total daily flow............ WSeptic Tank—Liquid capacity..I__.._. allons Length................ Width:....;..........'Diameter................ Depth................ x Disposal Trench—Xo..................... Width.................... Total Length.............. dotal leaching area...................sq. ft. 3Seepage Pit No.. Diameter....j..-�-.—:.... Depth bel w inlet.�.s.s...... Total leaching area_2S(-S...sq. ft. Z Other Distribution box ( Dosing tank ) Percolation Test Results Performed by............ .......... ..... . . ,........1f............. Date....I...�. .. ...... ••�� minutes per inch Depth of Test Pit_ Z Depth to ground w ter.. Test Pity No. 1.__....--.-L . .. . 44 Test Pit No. 2................minutes per inch Depth o 'Test Pit.................... Depth to ground water........................ a `• ...................•------•--•--......---•-•---•---•---..................---........--•-----•---........-----....---...------ ODescription of Soil... :.. -- . . --........................................................................................................................... x 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==- 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. p Signed......... .....( P- ._ ---- Date Application Approved By............ ...!�=`•....•`-".... •---•--•-•----•------------•--------- ......... Date Application Disapproved for the following reasons:............................................................................................................ •---•-•.............................................•---•---...-------•--.....................................-•--•-------------•-•--------------..........-•----•---...................................: Date Permit No........w.. -' .> ---------------•--• Issued........................................................ Date No...............Ij �.� FEs.......'................ ' THE COMMONWEALTH OF MASSACHUSETTS � 1 1 • r i BOARD OF HEALTH ........OF......... A s. - C..= '............. Appliratiou for Diupuuttl Workii Tongtrurtiott V.ermit x Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ..... .___..__..�....._..Loc t'" AI_ Tess Y -- - - ._...._ ,1% -- of t No. .. .....'�.........5&4��.............. •-_...._.. ....................................//Owyne ,_. L��Q ....--•-•---- �]✓/Jy/.j.'_.C� _..._. .Address-- .........--•-.....••••••••-.. a ......................................... -• ...._ ........... __..._. ..........___-_..,................._..... Installer �""""�� Address ''/� '"''�/ Type of Building Size Lot.__ ., ....��... feet U Dwelling—No. of Bedrooms............. ..Expansion Attic ( ) Garbage Grinder ( ) �t 04 Other—TType of�Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 Other fixtures ...................................-$� -•....•----._---••----_ Design Flow............. ...�_ ._......SU/gallons per person per day. Total daily flow............6e �,�...........gallons. Septic Tank—Liquid capacity._/.____.gallons Length................ Width:..... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length...................... Total leaching area....................sq. ft. See a Pit No...._:. Diameter....! P.. . Depth below inlet-,fz s_.�:_____. Total leachin area.2•:. S _s ft. Seepage - r sin ...- P g 9 z Other Distribution box (A_ Dosing tank( � f Percolation Test Results Performed by........ -....._._. l r�r< ............��............. Date.__....o.... /. . ..:.. as Test Pit No. 1...� _.minutes per inch Depth of Test Pit �. ?�g. Depth to ground water_. (s, Test Pit No. 2................minutes per inch Depth o Test Pit.................... Depth to ground water........................ - .................•---------------........................................................... ODescription of So •-••--••.............•----.........-----•----...._...•••••.._......••••• r ----------- w ..................... ••---•-••-.-•---••-•••--••-•--•----•-••••••••-••-•--••-•••••.........--••----••-•••••---•...............•--•-••••••••••-•----••-•--•--••••...••••-••____....._-----•-----•--- VNature of Repairs or Alterations—Answer when applicable ,.:_......................................................................................... st Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with G the provisions of TITL_- 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. Signed.._...._ Date Application Approved BY % -. -•----------------•-- !_c'......................... 1 -.. Date Application Disapproved for the following reasons-.................... -PermitDate ---- -----••........................ No........ ' ' �r ------------------- Issued.----------------- ` • - ---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o,/,/f.G� ........OF.............le' ............................................................ Trrtif uttte of Tomplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (.,0) or Repaired ( , ) by............... `r:....> /'1'� _.........--•-------.....f.�..-----------------._.......-----•.........•.---•---•-•---•-•-------•------........................................ Installer at................. �' t has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..........�-_ dated............. .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION, SATISFACTORY. DATE...........jam. �f v ... Inspector.._____.. .._-•---------------.,-.�....r .�...._,._, ..A�..A....e .-_ ----------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................... Disposal Works Tonutru liort rrrmit Permission is hereby granted............ � to Construct O or Repair ( ) an Individual Sewage Disposal System - e at No. = e_�r " ------ .../!A ��rac } C ............... -----------•-••................ Street � -- --- as shown on the application for Disposal Works Construction Permit? No ._r__:,___._�__ Dated...__^.................................. Board of Health DATE........... ................................................. x �\ � ��L7i•�-t i 4 Z.MukituP&L WaTIF-2 evbl�aPS�E . ,� �� 3,PIPE Pi'T��' 1�¢I/FT UtJI,�� pTUEes.�tsE 1�OTED. 4, V45e,&t.l t�.cati1lr Q.LI.+�2�GAST ►.itTS 4P�+�o ` f S. P►96 JoI Nils 'S�I.I.. 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