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HomeMy WebLinkAbout0060 HAWSER BEND - Health 6o May/r?er Bey/ CtA 4crvl fit 5 M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR OSUSTAINABLE (��y NIN.kECYCL® INITIATIVE CONTEMIO°!e Certified Fiber Sourcing POST-CONSUMER wwwS9.01 flrem.wY SROIIVO MADE IN UM GETV(GANIZEDA1 SMEAMM No. --=• .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LT ✓L .... .OF... ..... . ................" ........ Appliratiun -fur M_gpogat Workii Tomitrurtion Prritit -Application is hereby'made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System ....�J......... --•- — eation_ ess •or•I.ot rNo. •---------•- ---- --•-------•---- •-•----- -'-----------------------•-•-'-•- ................. ------ --------• -______--------------------------------------------- W er Address ,W1 ----------- --------------- -•--- •-- --••-••--------- ........................- .. .-- •---........................................ � Installer !r�'�GL Address d T e of Building YY Size Lot--- feet U Dwelling—No. of Bedrooms____._._._.____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -____. _- _ W Design Flow----------- -------------- �......_gallo.ns per person per day. Total daily flow........ ---------------------gallons. .15-10 WSeptic Tank—Liquid capacitKa=0_•g"allons Length---------------- Width---------.---_-- Diameter---------------- Depth-----_-•---_---. x Disposal Trench—No. __________________ W; tal Length_______ _________ otal leaching area--------------------sq. ft. Seepage Pit No.____. ."""�7Ji '.t� � ____ _____ _______ Total leaching area--_______-____.__sq. ft. Z Other Distribution box ( ) Dosing tan ( �G As' -77 .: __ ......... Date____ 2s=-_77 Percolation Test Results Performed b W Y- ,� Test Pit No. 1................minutes per inch Depth of,'Test Pit_................. Depth to ground water-..__-__-_____-__-__-. rZ, Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 04 ----------}----------- -- ------ - -------•-----`-- -------------- Descriptio of Soil s� "��'- 'al - 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 Article NI of the State Sanitary Code—The undersigned further agrees.not to place the system i operation until a Certificate of Compliance has been issued by the bbdof h alth. Dat Application Approved B Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ---•--•-•-----------------•-•----•----•-•-------------------•-----•----•-•-•-•---------------------------------------------------------------------------------------------------._...---•------------- Date PermitNo......................................................... Issued........ ^ =.... ................... Date L0.CAT10 SEWAGE PERMIT NO. VILLAGE I N S T A LLER''S T�{{�TTNA�7MAE & ADDRESS T QT+�ES, J GLLA:.fir'C ,AT^ , 1'S T�"I T,T A 1082 Faid tao� r, a• B U I L D E R l;entO""Rx e, •,:6W'N Ell len'e!ville, Mass. 02632 DATE PERMIT ISSUED �- DATE COMPLIANCE ISSUED ®� �� , ; �. ��/�v'AI cit/Sic.+/� � .� � '� 1 v :��6" ���s� ���As� ��r���i No.._... I,< Fl��..j. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH = tr Applirtttiun -f ttr Di_qpjaiittl Works Ton.strurtion Prrutit f Application is hereby'made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal System.at•v �z 0 ` fir,-,•�<.`�• 'L.. y rsrc C ."-^„ „�"c"/�-7 0+' �f ' ......-- --•-------•----••-......-••--•......-•--------••......----••------•-•---•••---•-•----•- ------....--•-••••• ----••----•----••------• -----•......--•---------•. n�y.Address ,/?� ' �gcatio f F•'"°Sr or 4Lot�rNo. •------• •••-------•---------••------ ------•-•---••••--------•--••-------•••-------•-.......... ~ --•--------•---:- Owner. (� !..................... •....±.. Installer "r - --�d-�t...es"�.sL.eS.— ' f/ ress UType of,Building L Size Lot_._'�.���._.xr�_; _.Sq. feet Dwelling—No. of Bedrooms--.- ...__.--_-----------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building __.__-----.-______________ No. of persons...__--_----_---_-_--_--_- Showers ( ) — Cafeteria ( ) Other fixtures _... -----••---•----------- Design Flow............. .. .. 11ons per person per day. Total daily flow.......n _ _- �._.________._._....-_gallon~. tp q g ath Width-------------- - Diameter----------- .... Depth.-------------- +'G Septic TI Liik—Liquid caulcity -__ gallons Len M Dis osal Trench—No _ Width -_ :_- Total Lennth - 49'Total leachingarea............. ......s ft. w s'r ,.e f_1---ice --- ..aJ_-.•'/ t.--�j .� ` Q• Seepage Pit No____________________G ameter__� ___._..___._ Depth'15@o mle Total leaching area......________.sq. it. z Other Distribution box ( ) Dosing tank ( aPercolation Test Results Performed by._..--. , _ __.. ,. Date---- ____------ HTest Pit No. 1................minutes per inch Depth of Test Pit-------............. Depth to ground water........................ 1:14 Test Pit No. 2----------------minutes per inch Depth of'Krest Pit-------------------- Depth to ground water------------------------ fi ----------•---• -- --------------------- ----- - Description of Soil 1,! ..,,��"" '- ¢ems g ------ --- ------- W + V 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 Article XI 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. I f gsined %+ ------ - --•-•-•- _�'"' / sX .O'�„r� Date----•-•----•--- Application`Approved BY------------ r .............. ;y Date Application Disapproved for the following reasons'=.............---------------- --------------------------------±-------------------------•------------------- - -------------------------------- Date Permit No................................ l ---------� --•-------------•--..._. Issued---40_7�7?. � `r Dite THE COMMONWEALTH OF MASSACH.IItSETTS BOARD OF HEALTH_ ............ ,�r�tif irtttr �rf f�laut�litt�trr '�;�---- _ THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) Y -------- -" t -Installer at......... --- .c. ............. �`e..- /� r r has been installed in accordance with the provisions of It I bf,�r�te State Sanitary Codj.aiq desr,?il7d 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. a DATE................................................................................. Inspee or..::.••----------------------....------------......---•----- µ:' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH- r f....-. ,. ...................... No........................ 4m. FEE • �i��tt�ttl �rk,� ����tr�rti�aat �rrutit I Permission,,is,hereby granted_,.. --------- •---- '` - ---------------- = to Constrt+vt-k( ) or Repairs(� ) an Ind vidual Sew`age t posal''Sysfe k hi 6°!"l..-• 'Street ,� �: rr/�✓' y "'�.`lf ' as shown on the application for Disposal Wors Construction'Permtt N _._-_"��____. Dated.--.._.......... ....................... Board of Health DATE...... FORM 1255 HOBBS & WARREN. INC.. 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