HomeMy WebLinkAbout0088 HAMDEN CIRCLE - Health Sg
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No.............../....... ..............................
THE COMMONWEALTH`OF MASSACHUSETTS
BOARD F HEALTH
.f'Lwl-..........OF... .. ...---------------------------------- -
Appliration for Bispvii ai Works Tonstrurfinrt rrmi#,,=-
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..............o , .. �V......... .........--, �: _. .�----� � ---.......
Location-Address or Lot o.
? Ow er „ Address
Installer Address
Type
g Building Expansion Attic ( ) Size Lot_._. _C�_ _ _ ...._Sq. feet
a DwellingNo. of Bedrooms.._ Si Garbage Grinder ( )
aOther—Type of Building .. � No. of persons....... Showers ( ) — Cafeteria ( )--------------
es
d g Other fir g ---------------------------
. .Septic Tank—Liquid ca acit I�:� allon P person g P __._.yWidth.._- ly flow___....... p .____. ._.._.gallons.
DePi n Flow.__..._.. p y gallons eLen th per day. Total Diameter________________ Depth....__..--------
Disposal
Trench—No. ........ _.... Width..._.. Total Length e..... Total leaching area... .....s ft.
- - �----------•- g - - f g q•
Seepage Pit No_________ _________ Diameter....___ _ _.___.... Depth below inlet_._.. .. .... Total leaching area .y�_ ._.sq. ft.
Z Other Distribution box (,��- Dosing tank ( )
Percolation Test Results Performed by....... _ . . ..... �_WDate------
Test Pit. No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....______._ __..._
f3. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.4
_ > _ ...................fit --
O Description of ------------
l ._ til�c
V -------------•-•-----•- ----•,' 1-�/----- ..-• ----
W
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 THTL 1i; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee • sued by the boar health.
>gned-------- . . ----•---. . ..... •- �... ................................
Date
Application Approved By---••••-- . ---- �Pf ----`-�®"2-®..-7�----•-
Date
Application Disapproved for the following reasons: ---------•-------------------------------------•••-•-•••--------•---•-• ---•--------..•--•-
......................................•-•.....--•...------•---•--••--••••--...--------.......--------••--•----••--••------•---••--•••-------•-•-------••-•-•---•----------....--•----•--•••-----........
Date
Permit No......................................................... Issued_._ -f3.......................Date
�--_--•.- ------
Date
vo
L0CAT SEWAGE PERMIT NO.
VILLA E
INSTALLER'S NAME & ADDRESS
B U I'L DE R OR OWNER
DATE PERMIT ISSUEDZa z-9
DATE COMPLIANCE ISSUED
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No................_....... FRs...........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F• HEALTH
....------..0 F..... .... ....
Appliration for Disposal Works Tnnstrur#inn Vrrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
...............` ., . .' ' ..�'. :, ......... - - ... - .._.........----
Location.Address t tm. orl
' _ -�,3,.r t`�Z! _�_ ..•--------------•-• •- 2 1'"_4�,r ............
r Owner ,r r Add eas ,�r/
� Installer P Address
� Type of Building Size Lot............................Sq. feet"
U Dwelling—No. of Bedrooms................................. .Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building .. ' rIo. of persons........d Showers ( ) — Cafeteria ( )
Otherfixtures . --------------------- --------------••--•--....---•-------- •••-••-•---•---............----------- . --
W Design Flow.............. . .......gallon per person per day. Total daily flow____......, . .>.._._............gallons.
WSeptic Tank—Liquid capacity.a gallons Length.......---- Width----14........ Diameter................ Depth................
x p .................... Width.-----A........... Total Length......................
leaching area....................sq. ft.
Disposal Trench—No Diameter........ Depth below inlet.._.._ . Total leaching area.. s� s ft.
Seepage Pit No. P g ;•; � -- q
Z Other Distribution box ( . Dosing tank
'—' Percolation Test Results Performed by....... 1. .1 7' r44e .....
W
Test Pit No. 1................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---. �f.. _
----• ---/---- / --------------••-...----
- ---.
x Description of j O 1-7••--- --- ..... « _ "" !� ------------------------
W ••-•-------------------•-•-----••------•------ --------------------------
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 m lI rr,LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
I-.
operation until a Certificate of Compliance has been,issued by the board of,liealth
f r t3 .. .f
Application Approved By....... .. . --.. ►�Fx . !?a t71
Application Disapproved for the following reasons:----•....................... ..............................................................Date---------_._--
. ------------------•----------•••----•-----•••---•--•---•••••------•---•--------•-•--------...-------•--••-----------------------------•---------------•••-•---••----------------••--------•------------
Date
PermitNo...................................................••.... Issued--------........------------------......-••=............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
:,
OF.... ......r IQ
C9rdifirate of ToutAl1 attrr
THIS IS T,,h CERTIFY, That the Ind yi ual Sewage Disposal System c�onstruc.ted (�or Repaired ( )
by.................... , l?""r _.e;: '"' "� =t ',, mot �•�f -----------------•-- .................------------
Installer h.
at...................... --- X. �... r t I f r!'. ..................... �....._
has`been installed in accordance with tlie.,provisions of T _ •� 5 of The State Sanitary Code as descri ed in the
application for Disposal Works Construction 4".Permit No ... ..../.X3................ da.ted--- .....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCT ON SATISFACTO Y.
DATE............................. - Z .......... Inspector......... ........................... ..................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. tlr
., - 'fd''O.OF.---... .f ems .... ..`' ..._...
N1.. ... F4E........................
Permission •s hereby granted.......77 I ........ :_ s ' ...... � ......... :62_
to Construct (` or Repair ( ) an Individual Sewage Disposal S stem—
at No..----- .• _._ � A r`� , ' -----•---•-- •-----' - --.-..---••--
.... .._-,-.
7 Street
as shown on the application for Disposal Works Construction Pe mob No.... ......:......_ ated--_.. ___-2.,4`. ...........
r. ------ , (s/ jam` .........................
Board of Health
DATE..................-............................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS -
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