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Home My WebLink About0027 HAVILAND WAY - Health Z 1 HCJ vi/AAd Way IN S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10% Certified FiberSourcinp POST CONSUMER ww.Vs4r0gramorp S%0I2W /��gyp/��MAADDE IN AUUSAAS"tM No..): Finc...5.�.. ... THE COMMONWEALTH OF MASSACHUSETTS .,i BOAR® OF HEALTH /L, 57' .50 .. `��..... ....................OF.........................................._.............................................. Appliratiun for Bi-spuuFal Works Tontitrurtiuta amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: i r ` ..A.......... LocaCion-Address or Lot N . ....... rf Ill.!✓��/�lr/_zk�......................................... ...........I__ ��.� _4L�GGG.'1..../1f2�a,C� ..................... yy-- / Owner Address V.Z Installer Address Q Type of Building Size Lot...................:........Sq. feet U Dwelling—No. of Bedrooms....... _-------_-_-_-._•Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ............... Q -- •--------•----------------------------------------------------------•----------------•-------------•----------- =99 W Design Flow..................... - .. _gallons per person per day. Total daily flow..... ....................gallons. WSeptic Tank—Liquid capacity.!_-M-7Pgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width......._------------ Total Length....................Total leaching area--------------------sq. ft. Seepage Pit No_hcw�OA Diameter---&.k-------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (i/f Dosing tank ( ) aPercolation Test Results Performed by._ � �-..",l y__ —.............1.__.._..._............ Date.._ --17--.�`--_--__.. a Test Pit No. I.........0—__minutes per inch Depth of Pest Pit...../.3.._______ Depth to ground Test Pit No. 2........ .-_minutes per inch Depth.of Test Pit....../. :'__...... Depth to ground water......4) ..... P4 -•-•--••-•••-----------•-•••---••-•-•••----•-•--•--•---•---•----••-•---••-••....................•---.....-•-•---•--••-•-...-- ............................... Descriptionof Soil.....................................................--.................................................................................................................. x W ------------------------------------------------------------------------ --------------•••••-•-••--•--••---••-•---------...-----•--•••••••--•••---------------------••----••------------ ------------- UNature 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 TLi y g g p y of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certiticate of Compliance has been issuedby t e board of health. Signed.......... ........�'�.� ......................... Date 7 r l . •• Date jA .ic.1i.n Approved By•-•-•-•--_. -- .................................. -----------•------" .............. Date Application Disapproved for the following reasons--------------------------------------------------•-...---------------------------------..........--••........--- ---•-•-•-•-•----•-••.._......--•-----••---••--•---•-------•------••-•-----....•-•••-------•--•-----......._ Date PermitNo......................................................... Issued........................................................ Date -17 *J-1 A LOCATION SEWAGE PERMIT NO. VILLAGE 6�L, INSTA LL R S NAME i ADDRESS e U I L D E R OR OWNER DATE PERMIT ISSUED �. 6 ._ � DATE COMPLIANCE ISSUED 1C _ I �` f� �� !/ a. � ' i '9 � �� .®� �� ,� 1 - No..�... ��.". ✓ FEs..�t. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :......:......... ....................0 ......................................................................................... A p irFation for UhgpwiFal `Works Tomlrurtion "amit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: ........... ..........:....... sue'' ------. -- .-------------------------- Coca ion-Address [> ` or Lot N '�b.vr !l�is>rtf 1 .ra �'.f.�fr: F=iv �rGF/ Owner Ad ress a •... .... '� ---- ----- --------- ------------- ------ ------- Insta.�---ll-er Address QType of-Building Size Lot____-•-.--_-_..............Sq. feet V Dwelling—No. of Bedrooms ..................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. 'of persons............................ Showers — Cafeteria P-' Other fixtures ---------- _ W Design Flow..................... gallons per person per day. Total daily flow----- ....................gallons. WSeptic Tank—Liquid capacity_�.� gallons Length................ Width-----------_---- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No... Diameter---o.X_........ Depth below inlet.................... Total leaching area_...............sq. ft. Z Other Distribution box (V_� Dosinga;�nk ( ) Percolation Test Results Performed by._. _ C:... .. .................................... Date... __-1_,I_-_ "7.__.... ,tea Test Pii No. I.........%�:"::.minutes per inch Depth of Test Pit------1Z... p ground._____ Depth to ound ..__ Test Pit No. 2........A#4-..minutes per inch Depth of Test Pit....! ......... Depth to ground water-----A�l...._... ----------------------------------------•-----------•---------------------......._..........._------......................................................... ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------- ----_-_------.----- W U ... •------------------------------------- •-------------- .------ •------------------------------------ •--••------------------•------•-----•--------------------------------------- ------------- W ----••--------- -----------------------------------------------------------------------•------------------------------------------ ••--•-•••-••-•----••-•-•...---•••--••--••-•----•••--•-----•-------••- UNature of Repairs or Alterations—Answer when applicable._--_--------------------------------------------=-t............................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i I:� p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss b t e board of health. Application Approved By............ �--,�" /..'�..... ... .-•--•.............................. ' -------------------Date -•----------- Date Application Disapproved for the following reasons:-----•••-•-•-•---••----•••-••-••••-•-•-•••••--••---•--••----••--••-•-----------••-•-•------••---=-••-••......--- ......•••••--••-•-••--••••...--••----•--...•••---------•-----••--•--•-••-••------------------•--••••••_....•••-•-•-••-•...--•--•-----•-••••-••--••••••---••••••••••••---••-•--•-•-••---••---•--•--------- Date PermitNo------------------.......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................A.....................OF..................................................................................... Tertifirate of ToutpliFanre THIS IS TO T Y, Th t the Individual Se &age Disposal ,SySte onstructed ( ) or Repaired ( ) by---------------------- -- --- /�' --------Installer--------------- has been installed in accordance with the provisions of TITI J �oJhe State Sanitary Code as described in the application for Disposal Works Construction Permit No------•- ----.___J____----••-_______-. dated----.-------.................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY. � y--------------- Inspector --•- DATE........................................I/........:... ( l'- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \� . t ...........................................OF..--•-----.--....................._......------...................................... No.= _ FEE...5................ Rapos aT or �ontrudion ermit Permissionis hereby granted -------------------------.---•••-----•••••••••--••••.....•-•-----••-•••-••••••••..........--•---...............----...... to Construct ( ) oz, pair ) an I, dividual Sewage Disposal System ! J atNo........................... !/tJ!? ..........bz: -tr ---------e ................................................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated---------------------------------......... Board of Health DXTE................................................................................ FORM 1255 HOBBS & WARREN. 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