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HomeMy WebLinkAbout0110 HAMDEN CIRCLE - Health //o Hamltn Ur., l�nns f 7 No Q� FKM_2j�............. THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF` HEALT ...._... .... .......OF........3...� :....... ......_1lBJECT TO APPROVAL OF --- --- - --- ----- B STABLE.CONSERVATIO Appliratiou for UhipaiiRl . rkii TOBt,Btrur 1ItIt Pr (MISSION Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage,Disposal system at oca/t on'- d s /� o t NOLwner* Ad a Type Installer ddrL a.A�� T e of Building � Size Lot__1__�(__ ________ _____Sq. feet V Dwelling—No. of Bedrooms---------------------- _---_Expansion A tic ( ) Garbage Grinder ( ) Other—Type of Building ___�.� _ No. of ersons__________ _____________ Showers — Cafeteria Otherfi ----------------•---------------------------------------------------------- _-•---- W Design Flow............ _ ___ ___ ,,�qy� gallons per person per dad Tot al d.il�fl��+v____.._..__. __ .............._gallons. G4 Septic Tank—Liquid capacity M.-gallons Length_... _Z!_.. Width____ .._./-... Diameter________________ Depth................ Disposal Trench—No..................... Width.................... Total Length.._...___. _I_..t I../Total leaching area....................sq. ft. Seepage Pit No--------/----------- Diameter------- ---------- Depth below inlet_....._. Total leaching area.4,r1�l__..sq. ft. Z Other Distribution box (f-Q, Dosing nt4nk ( ) Percolation Test Results Performed by---,lY 'Vl!Y 2...��`_'_Z' ... AAIY7------ Date-.�_.. - aTest Pit No. 1--__---________minutes per inch Depth of Test Pit.................... Depth to ground wa r--__--------_ ......:, j Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......... (___. a ...•• - .... - ------------- ----•- O Description of Soil - � �l�N -•------(� . - - - - - - -- - -- x U 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 TIT1Z .5 of the State Sanitary Code— The undersigned furth�agrees n o place the system in operation until a Certificate of Compliance has bee ssued by the board of •� y Sig . ---- - --•••---•---------------- _- Date Application Approved By.........� � ..................... ..._. 7 7 •7'-��_-- Date Application Disapproved for the following reasons:.....................-----------------------------------------------------------------------------............ _ ..........................•-•----------•----•------------•-••--------------...------------------•------•--_....__....__....------•-------------------------------------------------------....... ....... -- 1 Date PermitNo-----------------------------•---•--•------------------ Issued_--_t"d - . 7�. --. ._..----• ........... Date .%may �;•' No................/-"W Fps.... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " f ApplirFation for Disposal orko Tomlrurtion Wimi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual 'Sewage Disposal System at � Jf , l .............. .. _• - �Locauon dd ss y - or t No .M Owner ` A ldress Installer Address ,r � U Type of Building Size Lot._�! _. ::Sq. feet Dwelling—No. of Bedrooms;___. lk-)_____________________________Expansion Atic ( ) Garbage Grinder aOther—Type of Building __ zr't_� ia? No. of persons_ ______l _____________ Showers ( ) — Cafeteria ( ) Otherfi ----------------------------•- ••---•---•--•---•---•--- ---- ---------• = .._......._..--•-----•--- g gallons per person per"day. Total daily fl© ___:__. ��__+� ___ gallons., W Desi n Flow_______________ _ P4 Septic Tank—Liquid capacity/ gallons Length.....X_�:._ Width._+�( e . Diameter_______ Depth................ Disposal Trench No..................... Width.................... Total Length............. Total leaching area____: Sq. ft. �. Seepage Pit No........ .......... Diameter ___ __________ Depth below inlet.,. __ i .......Total leaching area. {�. sq. ft. Z Other Distribution box ( } Dosing tank ( ) Percolation Test Results Performed b 1-f __:-•� iC� Y.__ ts�''& Date ` � ' Test Pit No. 1:...............minutes per inch Depth of Test Pit__.__.__.___________ Depth to ound water-__._._.__._ _.. P P P � (� x Test Pit No. 2________________.minutes per inch Depth of Test Pit .............-- Depth to ground water........... 41_,: rr O Description of Soil--••••-- / - G! .._......... ' " Z .`.------� - ................................................. x s. V ---•--------------------•-----•--....--------•-----------•--.._..----•-------•----.._..----------------•-----•----•-------••....••-= --------------------- -•-• F w. . ' - ----------------------------------------•=-•------------------------------•---•------------••--------------------•---------•----•----------•------ ....-----••- V 'Nature of Repairs or Alterations—Answer when applicable______________________________.................................... .....:..............__'.._._._. -. -•-- .................................. ----- ----- ..Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System,in accordance with a the provisions of TIT12 5 of the State Sanitary Code The undersigned furthe}-,agrees not to place the system in k operation until a Certificate of Compliance has been ssued by the board of hed,/ISi 1 �. - - Application Approved By-------- �' ! •--------------- 7,47-Ate, ........ Date. Application Disapproved for the-following reasons______________ ____•.____________._:_____.__________.___-____ ______ -_-_:-- -___.__. : ....................••-•----•--------••-------------•---------•----------.......----•-----•--••---------------------------•----••-----•---------------------•-- tr. Date } Permit No................................... ----------------------- IssuecL........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARDF HEALTH O x TrrtifirFatr of nrr: r THIS IS TO CERTIFY, That th&Individual,�ewAge Disposa S*ystem constructed (" or Repaired Y •- ......................................................... I ap ..r - : ? .. ! ''� - .�. r✓�w'1... ., - --n=L.r+�r at. ---- ....................................- •................... .................... has-been installed in accordance with the provisions of TIT; 5 of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No....*_/____121$......_..... �`�da.ted ...._ .. ..74f..._____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE r' SYSTEM WILL FUNCTION 'SATISFACTORY.. r�{ DATE._...•- .............................................................. Inspector ....................................... THE COMMONWEALTH OF MASSACHUSETTS k : 4 BOARD OF HEALTH r. 7�' kv+ ....:..: ` No a FEE._ - .. ..... ................ _ iortt oro �ottioat rrotit, s: 'f Permission is hereby granted---•- '... +�' ! to Construct ) or Repair ( ) an Indwldual Sewa Disposal System s .................. ••--•-• ......... Street as shown on the application for Disposal Works Construction Perm o.______ "f --_. ated---•-• l ...'.._�.---•--•-- ...................._ Board of Health DATE +ff.._ `: _ r, -FORM 1255 HOBBS & WARREN, .INC., PUBLISHERS - LO.C,AT10 `;, SEWAGE PERMIT N0. VILLAGE I N S T A LLER'S NAME & ADDRESS BUILDER OR OWNER z2zaa DATE PERMIT ISSUED �� 7 DAT E COMPLIANCE ISSUED { 3 L s 1 � a � � s e Av' Alm "�`d 3,"t.-•-� '?>4�-'s3 rl, .'�J....p f". tyr,�'t �'�. `o ^9u. a._� is F 'dg _ }�. t'� f'C•. , �:,� t,'. s - w = .g F ,[ t4 .y<. ,.�.23` •�jlp,'�-• '3r ir: cr�'L-..`� R _ s'',- :r � � .. - -J J �,i s +�P ..• r �7'�.4 f g:r r 3 _:2.�J S 'J. .'q .•J Y' � ��'.a e J� IT •_t #c l�� -`Y� 3F _ fY� + - g .y,1�'f- •.-xad�t �--...x7, • - "E ,�.3r' afi dt •ate ,,,, >." yA :; }' a- - ; 11 k 4 'rt '.^:,. -r�, y�i.. ,r�.��"-."a�. �t��r�'y :: 'rr� � t-:s ai•.z '� ,f. 5 'k s.•� ���+� na �� �_ t�� � 7 . 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