HomeMy WebLinkAboutGilbert St. #s323, 331,339, 347 - 6/18/1986TOWN OF MANSFIELD PERCOLATION TESTREPORT BOARD OF HEALTH
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TOWN OF MANSFIELD
APPLICATION FOR ON -SITE SEWAGE TESTING
Number II ; f�
Datev )L-2/E-Zk /9l'y
Fee
Lot to be tested, address4>r
Owner of Property
PhoneL�
E
Engineer
Licensed Inst
Addres
1. If lot is on an existing street you must get a numbered address from the
Town Assessors, in order for the Board of Health to take action on the
application.
2• Fee $100.00
3. On -site sewage testing in season December 1 to April 30.
4. All seasonal testing applications MUST be received by March 31.
5. You must know before the Townts Engineer comes out to your lot, as to
where you wish to have on -site sewage testing done.
6• Recuirements needed at time of testing;
a. Your own engineer
b. back -hoe or similar equipment, which would be able to dig 10-12 feet
for pits or galley trenches.
c. enough water for on -site sewage testing
7. Permit will become invalid if percolation test is not performed within the
ourrent percolation season, provided that the season has not been suspended
by the Board of Health, or if an out -of -season approval is granted.
1 copy
for
applicant
1 copy
for
treasurer
1 copy
for
Board of Health
TOWN ON MANSFIELD PERCOLATION TESTBOARD REPORT BOARJ OF HEALTH
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MAP LOT STREET ��G%7�YS��T-�/rOWNER/BUILDER !f/jJlitCT�SAt; X—xe
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TOWN OF MANSFIELD
APPLICATION FOR ON -SITE SEWAGE TESTING
Number
Date
Fee Paid Z-Q1.l.2i
Lot to be tested,
Owner of Property/j/ ,r /�,5
Phone�_��
Address /�-,-C�
Licensed Installer
Address
1. If lot is on an existing street you must get a numbered address from the
Town Assessors, in order for the Board of Health to take action on the
application.
2. Fee $100,00
3. On -site sewage testing in season December 1 to April 30.
4. All seasonal testing applications MUST be received by March 31.
5. You must know before the Town's Engineer comes out to your lot, as to
where you wish to have on -site sewage testing done.
6. Requirements needed at time of testing:
a. your own engineer
b. back -hoe or similar equipment, which would be able to dig 10-12 feet
for pits or galley trenches.
c. enough water for on -site sewage testing
7. Permit will become invalid if percolation test is not performed within the
current percolation season, provided that the season has hot been suspended
by the Board of Health, or if an out -of -season approval is granted.
1 copy
for
applicant
1 copy
for
treasurer
1 copy
for
Board of Health
TOWN ON MANSFIELD PERCOLATION TEST REPORT BOARD OF HEALTH
MAP LOT STREET � ��LG���-r-!�-j OWNER/BUILDER l�/J/,J f �57;ac�
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TOWN OF MANSFIELD
APPLICATION FOR ON -SITE SEWAGE TESTING
Number.,
Date V �U,n /Gl�✓
Fee Paid Z4�10� G')
Lot to be tested,
Owner of Property/j` / ��.
Phone
EnginesrTT�� f
Licensed Installer
Phone
1. If lot is on an existing street you must get a numbered address from the
Town Assessors, in order for the Board of Health to take action on the
application.
2. Fee $100.00
3• On -site sewage testing in season December 1 to April 30.
4. All seasonal testing applications MUST be received by March 31.
5. You must know before the Town's Engineer comes out to your lot, as to
where you wish to have on -site sewage testing done.
6. Recuirements needed at time of testing;
a. your own engineer
b. back -hoe or similar equipment,
for pits or galley trenches.
c. enough water for on -site sewage
which would be able'to dig 10-12 feet
testing
7. Permit will become invalid if percolation test is not performed within the
current percolation season, provided that the season has not been suspended
by the Board of Health, or if an out -of -season approval is granted.
1 copy
for
applicant
1 copy
for
treasurer
1 copy
for
Board of Health
TOWN Oh MANSFIELD yPERCOLATION TEST REPORT BOARD OF HEALTH V
MAP LOT STREET] /^`G� y/ OWNER/BUILDER )"you
WITNESS BY
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TOWN
OF MANSFIELD
PERCOLATION TEST REPORT BOARD OF HEALTH
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WITNESS BY
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TOWN OF MANSFIELD
APPLICATION FOR ON -SITE SEWAGE TESTING
Number Crf.
Date
Fee Paid %�. (,'2)
Lot to be tested,
Owner of Property
Address Z42
Engineer
Licensed Installer
Address
E
1. I£ lot is on an existing street you must
Town Assessors, in order for get a numbered address From the
application. the Board of Health to take action on the
2. Fee S100.00
3. On -site sewage testing in season December 1 to April 30.
4. All seasonal testing applications MUST be received by March 31.
5. You must know before the Town's Engineer comes out to your lot, as to
where you wish to have on -site sewage testing done.
6. Requirements needed at time of testing:
a• Your own engineer
b. back -hoe or similar equipment, which would be able to dig 10-12 feet
for pits or galley trenches.
c. enough water for on -site sewage testing
7. Permit will become invalid if percolation test is not performed within the
current percolation season, provided that the season has not been suspended
by the Board of Health, or if an out -of -season approval is granted.
1 copy
for
applicant
1 copy
for
treasurer
1 copy
for
Board of Health
F-