HomeMy WebLinkAbout0007 HOPEWELL LANE - Health G
No. �P Fxs..... L....d....._
THE COMMONWEALTH OF MASSACHUSETTS
. 4 BOAR® OF HEALTH
............... ...............................
Of
L pphration for �i n l urk� Cnoa� r i�aaz pr�tff
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: L L
.1-.Q1-. '------------------- ---- --.��_ _--........ �a..r...--u1.-T------_----.-_-loz s
i Address or Lot No �-�t fL/
Own s Address
w .. M_RYY(_�� . ---.a+ r G�....,t..t.L.c-(�!;
-----------------------------------
Installer Address
d Type of Building Size Lot----------------------------Sq. feet
V Dwelling—No. of Bedrooms----------- ___________________ _Expansion Attic ( ) Garbage Grinder ( )
~ ____________________________ No. of ersons.-_-_______..-_-__-______-__ Showers — Cafeteria p., Other—Type of Building p ( ) ( )
a' Other fixtures ......................................................
Design o jOD�allons per person per day. Total daily flow.......�.0.j.......................gallons.
w Desi Flow_..._._.:_
WSeptic Tank_Liquid capacity------------gallons Length................ Width---------------- Diameter---------------- Depth__--________----
x Disposal Trench—No.__...__ __� .Width .... ........... Total Length.................... Total leaching area--------------------sq. ft.
Gyy s:;0-
3 Seepage Pit No...../QD_O_____ Driameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( YY) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.....................................
aTest Pit No. 1----------------minutes per inch Depth of Test Pit---_--..____..______ Depth to ground water.-.-___----_______-.-.--
G14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-___________________-._.
9 ---- -------------------------------------------------------------------------------------•----•----.........................................................
Descriptionof Soil -----•-••----------------------------------------------------------------------------------------------------------------
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 Article aI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ' b
Signed . -•--•-••... . -- . _ . ------------------- ---
ApplicationApproved By............... ----'--� - ---------• ------------------------------------------ ----------------- Date-------------- .
Date
Application Disapproved for the f o wing reasons:..
Date
h
- Issued. .....7 -•--•-
Permit No.
o /
Da e
'`` --• ..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
• . > � E� OF
f���T�ia1 -�
Appliration for Biopotial 18orks Toni#.rurtion Prrulit
Application is hereby made for a Permit to Construct ( .) or Repair ( ) an Individual Sewage Disposal
System at: _
Locati -Address _ or Lot No ��
------.... c3 rsr /�' j -= "s� '.__G_fOc t'
- --....................................................
Own . r• , Address
af'._.. :....: r � V �1 t1--iIYR �-----------------------------------------
Installer Address
Q Type of Building _ Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms--------- --------------------------------Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building'..
YP ------•----•------•--------- No. of person s-_..-.------�_--•-.-.-.-.-: Showers ( ) — Cafeteria ( )
� Other fixtures --------------------------------------------------------- -----------------`=...._...-----•-•`---------------------------....--••-------•-•--.-----
Design Flow............ ..._.'.................gallons per person per day. Total daily flow------- -%?_s'-----------______.____gallons.
W. 464)CY
WSeptic Tank—Liquid capacity____........gallons Length-____---_-___- Width________________ Diameter---------------- Depth.____-_,_._..---
x Disposal Trench—No..............:. __- Widtl _____ ___________ Total Length.................... Total leaching area--------------------sq. ft.
'J ° `
Seepage Pit No._____/o'-00 '7 Diameter.................... Depth below inlet.................... Total leaching area------_-----------sq. ft.
L�
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY----------- -------------------•--------------------...------ •--•-------•• Date--------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water-___________________....
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water________________.____-.
•----•-------------------------------------•----•-•----....----------------------•-----........----.........................................................
0 Description of Soil---------------------__.
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 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 ' e' b tk> -b '
�f 1
Signed #�. -•--- --. --- -- - /rj"'�
•-----------••--....
�.. Date
Application Approved BY - - � .
D
Date
Application Disapproved for the f ol-owing reasons:. Z - -------------------
.........................................- -- - --------- ----- ----
Date '
r
Permit No.------•---•. Issued `� ---.----- ........
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.............r.....................................................................
Trdifiratr of Tooipfianrr
THIS.IS TO CERTIFY, Tha,Lthie Individual Sewage Dis osal Sy tem con tructed ( ) or Repaired ( )
s
by = ............................. y 11. . ...74k4-4►14-K-----•-•-------------------- ----- ---------
n Installer.-
has been installed in accordance with the provisions of Article f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No........ _'....................... dated.......f...�._: �` `�`. r"e'"�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E® A _A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY X.
.
. ,
DATE------ �� ---------------------- ......................... Inspector-•---- ----- --
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.................
NO. .._: ._... FEE........................
Uiapoaa1 orks Eonfi ion mull/
Permission Ais hereby granted = °-' =
to Construct (') or j; pair ( ) an Individual Sewage Disposal System
-----------------••---•-••-•--................. -------------------------------- ----------------------------------------- .............
Street
as shown on the application for Disposal Works Construction mit N ✓�i__. c. Dated___
f Health
DATE...
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -