HomeMy WebLinkAbout0131 HOPEWELL LANE - Health 131 Hopewell LANE
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L ® CA ION � SEWAGE PERMIT NO.
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VILLAGE
I H S T A LLER'S NAME & ADDRESS
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D U I L D E R OR OWNER
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DATE PERMIT ISSUED q
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
--•.......................................O F............................................----............---------............_..._..._
o A pfiration for Dispnstt1 Works Tonstrnrtiun famit s
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Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
system t
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.......................................
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o ionAdde n� � Lat No..._.-----.....••-••-..... -----
Address
Ins alley Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms.......... ..............................Expansion Attic (1W Garbage Grinder (�A�
'4 Other—Type of Building ---- No. of persons___ Showers — Cafeteria
Otherfixtures ------------- •--...-------------•--••-----•-•----------•--------•---•-•---•--------•....--•---------...---------
WDesign Flow...........:................................gallons per person per day. Total daily. flow............................................gallons.
WSeptic Tank—Liquid capacityA?.`__.gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.........I............ Diameter... !_ ..... Depth below inlet.....4........... Total leaching area..'_L)-_A....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 .. ------------------------------------
-----........
--------------------
•-••---------------------------
---..--------------•-------------------------------------
O Description of Soil----------- --------------------------------------------------------------`
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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificat ompliance has been ' sued by the board of health
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Date
Applicatio Approved By-- ----------•------ / r
Date
Application Disapproved for the following reasons-------------•---...--------•------------------------•----------------------------------.._......---------••-•...
-•------•••----------•-------•------....-•--------------•-.........--------------:_...-----••-------...------•---•----------------•---•----•--•--•-----------------------•--•-••--•----••---------------
Date
PermitNo......................................................... Issued.......................................................
Date
No........................ *........._...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARh OF HEALTH
........................'.._......---.....O F.......................................--------------------..._.....__..........._..----•-
App iratiun for Disposal Works Tonstrurtion rrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
4
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Location-Address e or Lot No.
Own a Address
(I "� '� •---+---------------- ---------------------------------- -----------------------------------------------
W ............... . ...
Installer v Address
d Type of Building Size Lot___________________________Sq. feet
Dwelling—No. of Bedrooms___......3...............................Expansion Attic qv6) Garbage Grinder ( /�)
aOther—Type of Building .--- 7 __ ____ No. of persons___ ____________________ Showers (,� ) — Cafeteria
dOther fixtures .--•....... -----------------------....------------------------------ .............................................................
Design Flow............................................gallons per person per day. Total daily flow........................................._...gallons.
04 W Septic Tank—Liquid capacity�!e.!°___gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No._.:.......... Width.................... Total Length.................... Total leaching area.................... q, ft.
Seepage Pit No.....Z._._______ Diameter___ Depth below inlet__.__........... Total leaching area_)___>_.!%_....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by__________________________________________________________________________ Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water________:______________.
44 Test Pit No. 2................minutes per inch .Depth of Test Pit.................... Depth to ground water........................
Q+' •------------------------------------------------------------------ -------------------------------------•-•--------------.._---------•--.............•••_--
Descriptionof Soil -- ------------=--------------------------------------------------------------------•--•-••_---
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 of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate/Of has been�ssued by the board of health
1 S>g e i _ �5�iv._. . i-'.jam-¢?gin, '•- ;!,, .f .........................
Date
APPlicatio Approved BY ......... _ !. ?•/_..
�.
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------•-
.................•-••-•------•-••----••••••---•••-•---•-------...........---•-•--._....---...•-••--•...•-'--••-•-••--••-.....•----•••--- --•••---••-••-----•-•-------••---•----••--------•--••-.....•_---
Date
PermitNo....................................................._. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
(Inrtifiratr of Toutpliunrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by............................ --%---------f --------............ ...._........_..----- ------------------------•----------...-------------------.....-----------••----------._.-....._
���� Installer
at-------------------------�--=`---------------------------- == " = = �--------------------'=-_-:---------------••-•-•------------------------------____----------------
has been installed in accordance with the provisions of TITI� 5 of The State Sanitary Code as described in the
.application for Disposal Works Construction Permit No..._.�`?___-:_l.G__�1__ dated________________________________________________
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CO TRUE® AS ARA EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...........a`'(�--- ..------- Inspector
THE COMMONWEALTH OF MASSAC USETTS
BOARD OF HEALTH
�'� - ...OF.....................................................................................
No. /� FEE. -f��--......
......................
Disposal Works Tontrnrtion rrntit
Permission is hereby granted.....-------•••••�' '...........
-----------------------------------•---........._------
to Construct ( ) or Repair ( I an Individual Sevtrage Disposal System
atNo.................................. -=....----- -- ..................... ..........................�/ = = ----------------------------------•------.._.
Street
as shown on the application for Disposal Works Construction Permit-No....._............... Dated..........................................
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Board of Health
DATE...........3 ..a y.�}.....
FORM 1255 A. M. SULKIN, INC., BOSTON
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REGISTERED
CIVIL GINEER n
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y D !5P®SAL PLAhJ
Z WALTER WALTER
o E. —a P.
SMITH, JR. `" OLDHAM' N
#15128 No. 23207 � �
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1 CERTIFY THAT THE FOUNDATION
SHOWN DOES NOT VIOLATE ANY
. E JSTING ZONING REGULATIOd OF ��H of r��s
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THE TOWN OF.A BAe&isPA6 L-t-.
o WALTER .
P. r.
OLDHAM
#23207 c-o
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