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Home My WebLink About0088 CONNEMARA CIRCLE - Health L ;7- (e T CO 4.,c (44-/c /OlAim V S,gi !ram .r,s s,' 3- -7 GoAiAcEgrW N- v- '7 i r • O L CA W l • j � n o CIN � G R rT O J THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......... .........OF......� �Tii9l,7L..�f...... APPI.iration for Bifipoiittl Workii Cnomitrurtton Punift Application is hereby made for a.Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----------------------- -•---------•-----------------•-----• ............................. ...... QLocation• ddr ss F^� N or Lot No. /� Owner �/d� - Address Installer Address UType of Buildin Size Lot..... ..........Sq. feet Dwelling No. of Bedrooms----------------z�_____•_--_---___.Expansion Attic vo Garbage Grinder (AI)o aOther—Type of Building ............:--------------- No. of persons---------------------------- Showers Cafeteria ( ) Other fixtures ..... ---------------------- W Design ..........................gallons per person per day. Total daily flow............................................gallons. WSeptic T.nt,--Y iquid capacity------------gallons Length................ Width................ Diameter................. Depth................. x Disposal Trench—No. ..... ... . L�VVidtll............. Seepage Pit No..IAW....s ....... Total Length.................... Total leaching area--------------------sq. ft.- .�iameter-------------------- Depth below inlet-------------------- Total leaching area..__..-.-.--.-__-_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 14 Percolation Test Results Performed by...... --•................................................................ Date........................................ Test Pit No. 1----------------minutes pet inch Depth of "Pest Pit.................... Depth to ground water......................... (14 Test Pit No. 2-__--___•-.____-minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ - 0 Description of Soil------ ..� - - - -- - W ................•-......---.....----•------------ r R = = z•: �� s a.�s � -- 1 ------- x ...-•--•--------------------•-•-••--•--.....----.....--•••------------------------•------.._-------•...----------- U 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 \I 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. Signed_.... -- ---•---•----• � --- ............................... • Application Approved By.. .:......... Date Date Application Disapproved for the f owing reasons:.......................................................... ........................................;...................... d� . 1�� . ................/ Date Permit No. / = Issued. — ........................................... Date l -- ----- - - ------------------------------------------------- -------------- No-••-•••.............. Fss..lQ.:..U ......... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ��-..........O F...... If?L.E......�.... .. App ration -fur Dis�rusttl Works Cnunstrnrtiun Prrmit �rApplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual`Sewage Disposal System at: -------�`-...�.r-------C� R.. . C 1-�------------------- Location- r ss N � Owner /� d ;1 Address 1►3A 0 S. Q Installer Address d Type of Build eNo"'of Size Lot..... U�_tdi'.V----Sq. f et U Dwelling Bedrooms..............._+'^'________.________Expansion Attic 414J Garbage Grinder ( V `404 Other—TY�of Building No. of persons___________________ ________ Showers (I ) Cafeteria (-•--)- a Qt�ter fixtures ----1 - -a � --- 11 `- `---! ------------ -------------------------------------------------------------------- --- - W Design Flow__y'_I_ 1_________________________gallons peperson per day. Total daily flow............................................gallons. WSeptic Ta"n1�1 Liquid capacity-------------gallons Length---------------- Width._:......... Diameter............----- Depth................ x Disposal Tre4ch—No. ..... __ 6!,V�/idth____________________ Total Length.................... Total leaching arca.....................Sq. ft. Seepage Pit No..�,6_Q(1____s��iameter____________________ Depth below inlet________________.___ Total leaching area..................Sq. it. z Other Distribution box ( ) Dosing tank ( ) ~" Percolation Test Results Performed by...........................................................................wDate........................................ a Test Pit No. 1__::_:----------minutes per Inch Depth of Test Pit____________________ Depth to'ground"water.._.___...._._.._....... L7. Test Pit No. 2................minutes per inch Depth of`Test Pit-------------------- Depth to ground water........................ 04 O Description of Soil....... :.:..::.. ............. . ----------- x ................................................... =------------7-eJ t -...... --�S�kUG�t'�-------�--._...---... U .....----•---------•---•-------------•-------------------._._.___._---•----••-•-----------•-•-•••--....._.._._..--- ...................................... rP1' C U 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. --- Slgned -__._...-•---•-----_. ... --•----- Da-------•-------.. te Application Approved BY !'+ = /� ------------------------------------------ Date ' Application Disapproved for the f owing reasons:........................................= ----------------•-•••••••-•----- ---•----------------------------------------------------------••-= -••-••••••--•--••-----••-••----------- ----------------------------------- ,_._1--:_. Date Permit No.••••-l1,r........................................ Issued.- .........'-..................... Date ZI•► G.� I �e Y, THE•COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ ......... OF.... - r 011rrtifirttte of TvmVlittnre -�'•` THIS IS TO CERTIFY, That e Individual Sewage Disposal System constructed ( ) or Repaired, ( ) Installer ? at-•••••••.4at 400------------ca_*114 eww G m,.aa-------- Y�YI�'F//5-----•-- lias been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------- dated.... ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WIL NCTI SATISFACTORY. DATE. = :... :� ---------------- Inspector �: a�, <,A ��` �' I J•- :.. .. :;.:' „'•:--, •. �� •• � THE COMMONWEALTH OF MASSACHUSETTS s �G�D�f1L S•T ", "- - • `/DDG�.fif• J.I. BOARD OF' HEALTH t` ' .el9.&asl�si� J�3• a.W. ........OF...................................... ......................................... E �. �is�usttl lurks �uristrurtiun �rrmit Permission is hereby granted........ U. TO0 " ..fGS to Construct or Repair an Individual Sewage Disposal System -l.4, at No _A..r� �__ 6e. G�It9A.4 c Me 4e /y ................ •--•- ------- i ^:. r.vb;:`•.�,,: u« Street as shown"on;the application for`Di'sposal Works Conskructio'h 'P ' No.___��____ Dated... % '_�..7..�_7 ........ 'Af� ________ _.__ th DATE = Z ` /�...........::....:..r:___.:, oar of al FORM 1255 gHOBBS & WARREN, INC PUBLISHERS P•.. [ ; f}vS {I0 `-1 4•` I '3 ea l•� [ Zx, 3 .. y +' - -t..r+ ^�•.{•4..>'•;rtfve*K�?.as+2.'♦"r`�.4.."rc--_ - --- ... - �,a y+•..+•."""�"""""'• ,tit' h• ... , C 1 '` ...` ' _ t .ram .7� .. - .. - ' rp . `', ram • ��, -..:_ - _.. �. .. .. i W t 01 'r JK.w ,t � ��.,Y,♦ Gam' •...�.�/ E.�d..�/g�� 74 h REG. 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