HomeMy WebLinkAbout0136 CONNEMARA CIRCLE - Health � 3 � con
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD HfE: T H
t ...........OF............. ... �:....a.�. ............
A liratiuii -fur Uiii uiittl Work T11mitrurtiuii rrui t
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: i7. � ��_
Ate... .,... 0 ...._..���'C _.... ----•----------••---•--------------•------- Lot No.--••--•-................-..............
Location-Address
.�!�4pq.c_..0 .!''............................. * .. . ' Z.. .......................................................
Owner Address
-� ............................................
Installer Address aa
U Type of Buildm Size Lot.:/,) ..7 ----Sq. feet
DwellingLeN. of Bedrooms.__.__:_.. ............................Expansion Attic (W Garbage Grinder (1vyj
aOther—Type of Building ............................ No. of persons............................ Showers ( /) — Cafeteria ( )
a' Other fixtures
--------------- ------------------
` W Design Flow_.....,_________ ___ ___ _____ Mons per person per day. Total daily flow___.._ ..............gallons.
- -
W Septic Tank�:I iquid capacity_/. _ allons Length................ Width................ Diameter_._._..._._._... Depth._.____.__.._...
r
x Disposal Trench o: yIi t l..?'!�,Wepth
Total Length..... Total leaching area....................sq. ft.
Seepage Pit No .. below inlet_..._._..... Total leaching area..................sq. ft.
z Other Distribution box ( ) ''`'' Dosing tank
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
Test Pit No. 1................minutes per inch Depth of "lest Pit..................... Depth to ground water........................
G%, Test Pit 'No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ........................•-A
_.. •.....-...................................................
0 Description of Soil----!............... ..................................................................................
U •-•••••---••--•-•-•------•---------------•----••-•••••--•--•--••--•-- •-••••-----••--•-•--•••••••-•-•••-••--••......-•••-----•--•---------------------------------------•-............--
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 XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued by the board of health.
Signed..__.... --. ......... ................ ....................................... --------------------------------
`
Date
Application Approved By............ � ls� .��' .,�
dace -
Application Disapproved for the following reasons: ................
...............•--•---...--•----•----•---•-..._..........---...............-•-•-•-•-•------•-•-------•-•------........_.............•----'----- -- ----------------------------------------
Date
Permit No. Issued---- ....7,571.
Date
Faa.. .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F H T `
'
O F........... ....................... r.
Apptiratiun -fear liiipuiittl Vorkp. Towifrnrtimn Pumit
Application is hereby made for a Permit to Construct ;) or Repair (-; ) an Individual Sewage Disposal
System at
•�. ..... ---_. ..............••. -----• ...:....-----
Locaion-Address N or Lot No.
Owner • � .Address
So --=-----. ............................• -•---------------------�l�1fi--`-!
_ nstaller Address ....................
d Type of'Buildin Size Lot.�t .. ---____Sq. feet
Dwellin No. of Bedrooms----------------------------•----_._----Expansion Attic.( Garbage Grinder ()V
Other—Type' of,.Bitildin ._._........ -` ----
a .., YP � ...,•,, g ....-•---•----.. No. of persons--•-------------•-.-:--__-_- Showers (e ) — Cafeteria ( )
dOther fiat Tres' '------------------------------------------------------------------------ ................
W Design glow ___.__:_..___ gallons per person per day. Total daily flow.... gallons.
WSeptic 1':utk Liquid capacity ., gallons,; Length________________ Width................ Diameter................. Depth................
x Disposal Trench o ..: _. ��1�i h�. ..:' _ Total Length..... Total leaching.arca.._.___._. ---2-sq. ft.
Seepage Pit No . �t Diameter De th'below!inlet__- _-__ - Total leaching trea................ sc ft.
�• •P :--- g t .. 1.
z Other Distribution box (. ") • Dosing tank ( )
a Percolation Test Results a Performed bY------•--•--••-------------------•-•---•-•.:-------•--•--;-----••-...:.__..=Date......-----
Test Pit No•. I.........:.....mmutes per inch Depfh,of Test.,Pit_.____:__._,.....___ Depth'to ground water.........:...............
f7, Test Pit No. 2._._:___,.__._minutes per inch Depth of'Test Pit______________ Depth to.ground water---------
---------------
,. ..................... .. ......ii4 -••••--•••••.............................
Description of Soil-:. - - . ► etrt ........... -------- ................... ...----.. .........
U• .________________________________ ...•.r -f .._._.....___._._..__.________.__._......_._.__._______.....
...................................
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1W ................................................... .................................•--•--.----•__-.__-_______-_-___-__._..-_--__:.-__-_.-i._----__------._•---.-__-_-_-__.--.__-__-_-.-_.______--_._..
'U Nature of Repairs or Alterations=Answer when applicable.........................--:"_....-_........._..........__._............::.;.__-.-_-._-_---
---------------------- ------------------------------------------------------ -................... ------------------- ........................................................... -------------
Agreement:
`" 4 y"_jt
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'k n issued by the board of-health.
Signed-_--=" ' ....... ... --•--...... •--••- -•--- :----•--•-- --------------- `- ---- '
t IDat
•, •�, Application Approved BY------- -- ,- '::. - -: - - - -
Application Disapproved for the following reasons: _.......__`................ ...
Date
PermitNo.............................- -------- r Issued...........................................................
Date
t. THE COMMONWEALTH OF MASSACHUSETTS
i BOARD F HEALTH.
..........O F.
'y r. 01.1,rrtifirate of•0amplianrr
t ' T I 1 RTIFY Th e Individual Sewage Disposal System constructed or Repaired
� � e Dis g
r
P �' P
-- ------ - ------
k I' ler A
` at At................._..-•-•- ...:-----
has' een"Instal ed in accordance with the provisions of Article I of The State S nitary C le descr ed 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. ;
DATE-----•-••------•.......................•-------•-------. ---•-------------- Inspector........ --------------------....................--•-------...........:_..---
THE COMMONWEALTH OF MASSACHUSETTS
r _ BOAR.D HEALT
r •
_ •
i
No....... : ..--- '.. --FEE ,
%rivqs4l Workii LIT n 0411 rrmit , -
Permissionoi�hereby granted_... .,�.._ - .....
to Constru / or a air an Individual Sewage Dispo �ysfe
atNo._,•. `"''� -... Street. .. .... ....... . --- ...---•---- •-•••-•
as shown on the application for Disposal Works Construction,• • mit N _.__ _ _ _ _ _ Dated.:.(Q. ..x . ...
_ . .
Board of Health
' DATE...............:.. .. .• - �• -
# FORM 1255•HOBBS &•WARREN. INC..'PUBLISHERS •j, ^ '' 'v` - `
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