HomeMy WebLinkAbout0215 COMPASS CIRCLE - Health Ckck,
LOC I N SEWAGE PEgTZ7
VILLAGE
INSTA LLER'S NAME & ADDR SS ,
BUKDER OR OWNER
DATE PERMIT I S ED
DAT E COMPLIANCE ISSUED_ �9
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F• H- EA Tf-0
�•✓......................oF.
Appliration for Bispvii al Works Tonstrnrtiun Vamit
Application is hereby made for a Permit to Construct �_A or Repair ( ) an Individual Sewage Disposal
System at:
.... .. .%. - ..................... ................. ......._.._......--------...------------.
. L ion/-/;�d�dres or t No.
... r_.... ._- --•_____________________________ __ $._. L - c�o ...............................
O er Address
a -----------------•---• ••-••-----......
...... . ..... . ...._.........._.__...
Installer Address
Type of Building Size Lot.....l AtSkO._..Sq. feet
Dwelling—No. of Bedrooms---- Garbage Attic ( ) Garbage Grinder ( )
p, Other—Type of Building . .. ... .................. No. of persons.......6.................. Showers '( ) — Cafeteria ( )
Otherfixtures ----------------•-------•----------•--.-_--_.-----•-----------------------------------------•--------------•-----------------_--••-------------------
W Design Flow.......... .S...........................gallons per person per day. Total daily flow.............,3 .D..................gallons.
WSeptic Tank—Liquid capacity_Z �dgallons Length___________ ___ Width---sF_.._...._ Diameter................ Depth................
x Disposal Trench—No..................... Width.___...__......____ Total Length......... _.____.__ Total leaching area..._�r '..sq. ft.
Seepage Pit No......... ... ...... Diameter.___.__.. „l Depth below inlet ........_. Total leaching area...2d. _ s ft.
.. - P g / q
Z Other Distribution box ( ) Dosing to ( )
'-' Percolation Test Results Performed by.... °�__.___ i'V z...e N......._. Date.._
Test Pit No. 1__Z2-_-•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........................
--------------
------ ----
O Description of Soil............ 1� �! �./._?...... ..
x
U --------------------------
••••••--••--•---------
.._..-------------------------------
•----------------------------------------------
•-----------------------------------
.....------------------
-----•-•--
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 ofiTL; 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 board of lieIallth.
Signe --------- - -14------------------------•-__- ........ S f .
Application Approved B
PP PP y---••-•. •. .
Date
Application Disapproved for the following reasons:........................ ...................................... ..........................................
-----------------------------------------------•---•-----•--•--------------------..._........----------...---....---•----------------------------------------------------••---•••-----•--••-••-----_.._..
77 ate
PermitNo......................................................... Issued_.... G ---------'
Date
7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
.......................OF...-.. �...... ....... ..
, �... ...........................................
Allp iration for Dispog al Works Tontrnrtion 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
�- �Loc ion- ddress o= t Now ................
y �.. ..,(ryJY :.9..............................................._... _... y ._...._../ .C.::':......1....C." :...................................
e
w /� Dwyer / Address
..... .- /.�............................................. ..................................................................................................
Installer Address
Type of Building Size Lot......jai. Li feet
Dwelling—No. of Bedrooms.-....... ..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building _Af a............... No. of persons........!?................. Showers (v') — Cafeteria ( )
dOther fixtures ------------------------------------------------------------------•-•••------•-•-•-•---.-------•-------..............--------.......-----...--•--....
w Design Flow.......... .. .........................gallons per person per day. Total daily flow................ )...............
...
W Septic Tank—Liquid ca.pacity..f�-.'. gallons Length............`.'`. Width---?_........ Diameter----------------
Depth................
x Disposal Trench—No. .................... Width...... ............ Total Length.._.___... ._ Total leaching area..... ^..sq. ft.
Seepage Pit No.._•...../--____--_ Diameter......... Depth below inlet..._, _........ Total leaching area....2A 1-___-sq. ft.
Z Other Distribution box ( ) Dosing tan} ( )
Percolation Test Results Performed by.....-/--v`?�-n?. .......5.��c±. _`_ "!!c:�.__..... Date._._/{!�U--�`�.of{ r
minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 1___ ___�.._.
Lz, Test Pit No. 2................minutes per inch 'Depth of Test Pit.................... Depth to ground water---_....................
--^------.....I.................... .... - ......
..._....f ..__....---^-- ._._............_..._'
O Description of Soil............. �e!` .. ..y..-•� !.. (• ... J` �...
c, --------------------------•-----•...••----------...-----••-•-••--•----------------•------•------•----------•••-•••----------------•--- ....................
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:i I E 5 of the State.Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of,Compliancewhas been issued by the board of health.
..
J
g ,_r'_........_. Date/
Application Approved By....... ----------------------- ----- t•3 -Ifl":-... '
Date
Application Disapproved for the following reasons--------------------------............--------------------------------------...---------.........------•--------
.
Date
r
PermitNo....................................................... Issued.......................................................
rl Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'i✓....................OF....... �✓ ,............................................................
(In#ifiratr of Tontpliatta
n
THI. IS TO �E TI Y, T at the Individual Sewage Disposal System constructed-.(.A or Repaired ( )
by .... '-_.... '�.......... ...... .........................................
...........•-•--------------................:`.....................................
Installer,
has been installed in accordance with the provisions of ` of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N VAK-17-.----........ dated....AI-jt-1 :---------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FU CTIONt SATISFACTORY.
DATE •---•.. ._`' .......� ....---..------------- Inspector.... :. _ ----
THE COMMONWEALTH OF MASSACHUSETTS
�--� BOARD O HEALTH
t ✓r>r< ........................OF....../�.`��s....till .:..._. ................
FEE.:.............:.......
Disposal Worka';>� tr ion ami#
Permission Is hereby granted.. � -------
to Constrict ( ) or ReWit ( ) a/Ind' 'dual Sewage Disposal System
at No.......
�►�/ ....
---------•----------------------••------........-----•---•-------•---................
Street
as shown on the application for Disposal Works Construction P� N �____ _________ Dated... ............
-•------•-•...................•----
oard of Hie/�
DATE...... G ... --------------------•------•--.....
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Y'-
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