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Home My WebLink About0105 NELSON LANE - Health c: 105 Nelson Lane A = 126 - 092 Marstons Mills J Amw i 3 9 EOCAT10041 SEWAGE FERMIT NO• 041 MILLLAGE , INSTALLER'S NA E t ADDRESS 8 VILDEJR OR OWNER DATE FERMIT ISSUED DATE COMPLIANCE ISSUED t. ,e-rile2�6.mll oc� 1. 9 No....t Fizz..... D............. Q5 THE COMMONWEALTH OF MASSACHUSETTS l-- BOAR® OF HEALTH I --.OF.......................................................................................... 1'1 Appliration for Di ipasal Works Tnnitrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System•at ........ d �� °�' .................. •---..._............... ..0 r Lot No............................................ / ao 6on- r s ............ _ .._._.... ...... ........ --- W 4 -�Z Address Installer Address � d Type of Building Size Lot..._.:,�_ Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—Type T e of Building ............... No. of ersons........_._..........__.___. Showers YP g ---------•-•- P ( ) — Cafeteria ( ) PaOther xtures .••--••••-••••••-•-••-•••-••-••......--•-•-••-•-•••••••••••••••-•-••--------••---------------------•-•----••---•--•--••••------..........--••-...••-• d W Design Flow.......... ..._.....-�`9_7:�Cgallons per person per day. Total daily flow........R_e)....................gallons. . - � Y64 W Septic Tank—Liquid capacity. ��allons Length___,��.... Width___..... Diameter________________ Depth..... ..... x Disposal Trench—No. .................... Width..................... Total Length....._. ...,.... Total leaching area...... _ sq. ft. Seepage Pit No........./-------- Diameter...._ e-'0__ Depth below inlet........ ......... Total leaching area...ff� ...Zsq. ft. z Other Distribution bdx ( Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.............._----- Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ � ----------------------------------------- ----•-•••• ----- ODescription of Soil•• .... •.... 'f...... ....---------- -.. -•--- a ---y---------" ---- - I •. -A U Nature of Repairs or Alterations—Answer w en applicab e----------------------------------1`___-_ --- y � (.. • ••••••.......--••••......••-••-. ......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT S,;;, 5 of the State Sanitary Code— he and rsigned further agr s not to place the system in operation until a Certificate of Compliance been iss y t and o iea igned •••-•_... • --•. ... • . .... ............................. X................... Application Approved BY•-• -••••• '•c'�:e=------------------------ -----•----------------- ... ---• Application Disapprove f o he following reasons:---•------------------------------------------------------------------------------------------------------------ -•-••-••---••-•••••••---••---•-••----•-•--•••-•-•--••---•••••-••--•-•-•---...-•---•................••----••••••••--•--•---•••••••••-•••-•••-•---•-•-------------••-•-•••••. ......--••••......•---•-.--- Date PermitNo......................................................... Issued....................................................... Date Fm:s.....�r...r................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --•.................... .......--.......OF.............-- --•----•----..........-------.....................---................... ApplirFation for Dispas al WorksZomitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at . , ......... __.. f --•^ ocation. }dr s •--- 8. ............. .......... •-•-•---•-----.............._..or Lot-No.----------...........----•---..........-- -•-••-•---�,�. .� ._. . � � ....... ...........••--•----•-----•--.-.------•--- ------••-• ... -------•-------------------- w' O � Address W �` �:� .. ".. ...........•- ---•-------•-••-•---------.....__.........._._....._........_..--••--- Installer Address , Type of Building Size Lot____ _l Sq. feet U Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder per-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other"XU res ..Design Flow_.__.. ____._ gallons per person per dpay. Total dais flow____.-. gal " lons. WSeptic Tank—Liquid capacity..$$ Mons Length__ ____. Width..:,.n.._....... Diameter................ Depth......_ x`t' Disposal Trench—No -------------------- Widt�.........._...... Total Length......... _�__._ Total leaching area---- _______. .sq. ft. 3 Seepage Pit No_____________________ Diameter-__.- __._._.__..._. Depth below inlet..... Total leaching area.. q. ft. z Other Distribution box ( Ar Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W .. ............ .................................... 0 Description of Soi _ _l .. ....... ..............A a_A_. ------... ..` '~ "-----m"�a,�_ �----------------- w ....... asw[!-- �•"�..__ _-'"a.......... ............................ , - ... r .. ram �n ------ U Nature of, Repairs or Alterations—Answer wien applicable..................... .. ..... ..__ ' �. ......... .................-....................................................................................................................................................................................... Agreement:- The undersigned agrees to .install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiTI,;=. 5 of the State Sanitary Code-The un ersigne I further agr s not to place the system in operation until a Certificate of Compliance been issiAl�by tl oard of seal V . Application Approved BY-- ------ - ---------•- ............. ............................................... - --------- Date Application Disapprove f o he following reasons:................................................................................................................ -•--------------------------------------------------------------•-............•---------.....----•-----• Date PermitNo--------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... i� �.e ii �unt�rlt�anrr THI S' O*C FYI e I a zge Disposal System constructed or Repaired ( ) by :_ =- '............------------•----------••---------.....----.._..----.................----------.........----._.........------•-- Installer at........ -- •. --•--- •-•-• -•-- `'�'� ---------••--- •••••--••------------------------••-•••----•------ •--•-- ---------- has been installed in accordance with the provisions of TIT r 5 State Sanitary C,e�de s d ed in the application for Disposal Works Construction Permit No.___ _ ._ _.__.._... dated-..w�1. .�............................... THE ISSII CE 37F THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GUARANTEE THAT THE SYSTEMMFJUTION SATISFACTORY. DATE.... .............. Inspector...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F....................--•-•-......._..............................._......_............ No . ............•---• � FEE... .7�.............. j i rar nstrurtion Permit Permission is eby granted..-- `••... -• •--.------•--------------------------------------------------------••------...................----- to Construc ~ "�w R Da,3,rr,( I ividual Sewage Disposal System atNo ••-- ••-S• 1 1!...:..... ..:............------------•..----------......---...---...--•- ---- .................. Street as shown on the application for Disposal Works Construction Permit No..... ... ...,a ated•.• .....___:r' .... . .......-•....... ................................ ........ -•-••---•---•---••-•----•--•--•-•---•-•••.............. Board of Health DATE..-•-•-•----------•-------------------------•----------:�._•-•----•-••------ FORM 1255 HOBBS & WARREN. 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