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HomeMy WebLinkAbout0026 MOUNTWOOD ROAD - Health 26 MOUNTWOOD ROAD MARSTONS MILLS A = 150 - 082 i I i „I I I I I I i LO CA; ION SEWAGE PERMIT NO. M G U YV i LJ�r 7 7 ` �-- VILLAGE dpa, p? m s INSTA LLER'S NAME i ADDRESS C)yK ro B-U I L D E R OR OWNER j��xg P)y DATE PERMIT ISSUED 1� �� 172 DATE COMPLIANCE ISSUED r �o �� �5 ��� mac. t�� " �� ��� ��� ��� 3'' i �3 a ��� ter. �, 1 No................ ... �$... �1'�................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T � �.�-...0 F................................ ... Appliration for Dispasal Warks Tnnitrurtuan Frrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst.... --- -- ...............& ........ . __. 5 ion.Add e or 14 No. ....... ...... ....__................ .. -......d...+_..................... ..... ...... -•---•. er- � Address e Installer Address 0 T of Building Size Lao..../..................Sq. feet ,. Dwelling—No. of Bedrooms....... .................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Aq Other fixtures .., W Design Flow............`._.-0........................gallons per person per day. Total daily flow............ P__0.........__..........gallons. WSeptic Tank—Liquid capacity/ gallons Length................ Width................ Diameter__..__________ Depth................ x Disposal Trench—No..................... dth............... otal Length--------- _._____ otal leaching area....................sq. ft. Seepage Pit No.. -_ c_____________ 't '4 o _ Total leaching area .0.P....sq. ft. Z Other Distribution box ( Dosing tank ( —0"e" /S- 7 '—' Percolation Test Resu s Performed by..... _ ......_........�L s ....... Date....Z%z.7- �X—.-•77....... Test Pit No. l l.a'.......minutes per inch De of Test Pit.................... Depth to ground water........................ f3;, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........-_.__.......... x +.................. ... ....---•••--- O Description of Soil-- ®-- `-�--• d �^.'.... ��� -�?1R x W VNature 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 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. 7 S ... ...._ _r�sI ned %� �6 Date Application Approved By.../ � %` ter. 1 a lame"" �.... Date Application Disapproved for the following reasons:................................................................................................................ ------•••---••••••••..........•••--•-•-•--••.......•-•-•--•••-•--•••---•-••--••••-•-----•-•-----•---•-•-•-•••-•--••••-•-•- -------------------•-.....................................-............. Permit No...............:................ / Issued__.._. .. - C-- / a ----------- Date No— -----------— ...41 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T r ......................... ................. w. .................... ........................ Appliratiou for Dhiposal Workii Tomtrurtion Vamit Application is,thereby made for a Permit to Construct (41 or Repair an Individual Sewage Disposal Ss ................ . ....... .......... ...& ........ ........................................................ ion d s- or 14 No. ....................................... --------------------- . .. ........ .................. ..... .................. .......................................... er Address -A......... -------------" installer ---------------------Address - of Building a.6./A().....Sq. feet U T Size Lot V------------- Dwelling—No. of Bedrooms...... ...............................Expansion Attic Garbage Grinder Aq Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ..4.. ....... ............................................................................................................................ Design Flow............. . ........................gallons per person per day. Total daily flow...........3_9­0.......................gallons. 04 Septic Tank—Liquid*capacity/ Ions Length________________ Width__.__.___.____._ Diameter................ Depth................ Disposal Trench—No...................... idth...............___p,*Fota1 Length______.___ ......../otal leaching area___._ _______sq. ft. Seepage Pit No -IPA r! J.�.-.Tq#hk' L-aSkk 7(�00.,S- -.-sq. ft. z Other Distributi*----- ----IT, on r5� e 11 Percolation Test esults Performed by.......................................................................... Date........................................ Test Pit No. I................7'nu3tys per inch Depth of Test Pit.................... Depth to ground water________________________ Test Pit No-2jP_..j* Mr t oun water________________________ ,��IPMAth of Ttst Pit..�............... epth 9,9 d .................. ........... -------------------------"*----------------------------- or 0 Description of Soil........... ......................................................................................................................................................... U ....................................................................................................................................................................................................... ...................................................................................................................................................................................................... U Nature of Repairs or Alterations ' Answer when applica,ble;..........................................................e.................................. ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install .the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE ',5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of�C79jnpli'ayce has been issued by the board of health. 6/* 6 Application Approved By....................................................................;............................... ........................................ Date Application Disapproved for the following reasons:............................................................................................................... ..................................................... ................................................................................................................................................... Date PermitNo......................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .........OF.... .......................................................... Tntifiratr of Toutpliattrr T IS IS TO CE�RT� ,�T the In�dvid all Sewage D o al Sys t constructed ) or Repaired grn 0. U .... ........... "Alinst, .... .................ly...........V................... 0. at........ ........ ....... ............................................ ...... ... ............................. .......................Me ----------------- has been installed in accordance with the provisions i L f The State Sanitar/,fodVgk d"i ed in the applicatio.n,,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..............................I.................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 7PAL BOARD.,-OF HEA �H ......... .......................OF.... .................. ............................ .... ...... N0........................ FEE....._... Mtn- Per m- issiog is e�by granted.. — V� 0 @ 1 ...............................�4.............................. .. .......... ................................, ...... ......... to Co e u e ge s s n�s�tr ) 0 ' or R an ludivid atN .. .... ..."........ /------- ------ Str as shown on the application for Disposal Works Constr 0 - - --------.(Dated......................................... .................. A................................................. Board of Health DATE.......... ..................................... ---------- FORm 1255 HOBBS & WARREN, INC.. PUBLISHERS KEPT-1G -rA"V- = 3sov lc=o % _ .4-99S(-PD. USA I OOC:5 S.Q.L.. ✓���� 1 I .t)15POS4,L PIT - �sE loon GA,L• �-�7 SamwALL AV-EA = lSo S.F. IC-7o S1= )c 2.S = 37S G.P.D. _ Bc,TTOM r11zEA t Gip S-. 'X sc> sue. )f ► .o - So S.P D. P•T C� TOTAL 425 2� d s�4 � Pt—WcDLQTIOLJ VOTE ►.l ~L m i w' 02 Lr--%. 3Z� f ` r �il�v�r�✓©� tea. 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