HomeMy WebLinkAbout0178 HAMDEN CIRCLE - Health ����, P •
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LOCATION SEWAGE PERMIT NO.
VILLAGE 3oq - a��
C—
I NSTA LLER'S NAME i ADDRESS
B UILDE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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THE,.COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...--....OF......6,il ................... ..........
Appliration -fur Dispusat. Vurks. Euntrurtiun PPrntit
Application is hereby made for.a .Permitto Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: `
L.r.clli................... ........ ... ° ° '... ::.
or Lot Location•Address
�1 J .(
Owner / dressy
--------
Installer Address
s
U. Type of Building Size Lot..../17._ /_ __,___Sq. feet
�-, Dwelling—No. of Bedrooms. ___________-k______. _-________Expansion Attic (� ) Garbage Grinder ( )
aOther—Type of Building ___________________________ No. of persons--- - ______. Showers ( ) — Cafeteria ( )
f4 Other fixtures --•------------------------------------ - _ ...
....................................................a_e-----------------
Design Flow........��........-------------gallons per person per Total dail�flow______ _.____;_-_____________---___-_-_gallons.
WSeptic Tank—Liquid capacity/.,#0Akallons Length____, Wtdth Diameter::;_. `Depth---------------
x Disposal Trench—No. ......_._........... Width......t------------ Tat tl Length �i `;Total leaching arel___. :__ sq ft:
See a e'Pit.No. Diameter'.... ...__._.:. __-De th liel4- 'inlet._ `'Total'leaching area -'sq; ft.
P g I - P ,4 ,
z Other Distribution box ( ) Dosing tank //
Percolation Test Results Performed b �.-- d 1':N2 (.t_l�.G.,S GS... ._ Date... _�l� _-7
y , S� / .
g Test Pit No. 1_______________minutes per inch Depth of Test Pit................. round water---
Depth to a
L� Test. Pit No. 2................minutes per inch Depth of, Test Pit-__.._.__..___...__. Depth-to ground"water...�IfJ..V 4L�r-L-
---------- ------- ___ t =
O Description of Soil �-� �.C[ 10"_3
U ------------ ---•--------------------------------- ----•----••--•-------------------------------------------- - -
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
the provisions,of Article \I of the State Sanitary-Code—,The under"ighed further agrees,riot to place the system in a
operation until a Certificate of Compliance has been is ed`by the board healt .
gned--- ----- --------------- .......
Date
-:
Application Approved By - �1 !1 = - �----- ? -----
Date
Application Disapproved for the following reasons===-=---------------• -----._._...----•------------------------•------------------•---._...----------------•-•-
_________________•---•------•-------------------------------•--••-•-----------•-•---•--•-•---•................................... _---- -------•--•--•-----•---•--------_-•--•- ---•------
Date
71
PermitNo.....................................------------------- Issued.......- . --
Date
---------------------------------------- ------ - -
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....... ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF ....
Apli iratinn -fur Di.gpniittl Workii Tonotrurtion Vrrkiit
Application"-,is hereby made,for a Permit to 7Construct ( ) or Repair ( ) an, Individual Sewage Disposal
System at: j
t a
�r
Y Lpeatron Address or Lot,No. i Y.
�. . /............ ........56L' /.&I
+" Owner ddress
1 e%
..�. ---------------------------------- ---•• ........
Installer Address
Q Type of Building ,�� Size Lot.._.V------- '_...Sq. feet
Dwelling'—No. of Bedrooms---. 4_ ___Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building .. _ __ No of persons - -----------------_ Showers ( ) — Cafeteria ( ) I.
w Other fixtures .......................................................
Desi n Flow-------- ..
W g __ _____ _ _ _____________gallons per person per/lay. Total dall� flow._-. -----_______.-_--_......____...-------gallons.
WSeptic Tank—Liquid capacityl.6/0Vgallons Length---Y--------- Width---V.......... Diameter---------------- Depth._____--_--._.
x Disposal Trench—No..................... Width------ Total Length-------------1t... Total leaching area_..-- --•--_-_.__--_sq. ft.
Seepage Pit No.-__ _____________ Diameter.......tF......... Depth below inlet..4.�............ Total leaching area. ----sq. ft.
z Other Distribution box ( ) Dosinqnk ( )
a
Percolation Test Results. Performed by--- --- .1..?..r _.____f,t.. .... Date-_ ' _._,ate
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................
(� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water__-�)16�...ft/2A11
P4 ---------- --------------------- ---------••- - --------
O Description of Soil. � " `"^ �� c - iM� ---------- _-
x
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
the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board f healt . •_
- ---------- --" -
� —- ---------------------------
Date
Application PP lication Approved By----- !' r6 -- ---
Date
Application Disapproved for the'f ollowing reasons:..........................................................................*::.
.._...-•-•-•----•------•-•--....---•---------------------------------------------------•-•-•-••----------
yDate
PermitNo......................................................... /" �� T------------------ Issued.--------� ---------------------•---•---••--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... A.. ... ......:.OF.. .... ,.. �?v -. : ..> h...........................
Orrrtif iratr of 6implianrr
TH S TO CERTIFY That the Individual Sewage Disposal System constructed (X) or Repaired ( )
by... „ -------------------....
Installer
at.....a4�-.�. -// ......ram. ..... ,..f _ ---------------_---.--__--_--.--••----------•---------_---------•---__---------•
has been installed in accordance with the provisions of `r cle XI�of" The State Sanitary Code as described in the
application for Disposal Works Construction Permit N :X._.-�, .k..fr................... ..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------ 1 )�.. ---------•-----------•------------- Inspector----- ....................... •------------•-•-•------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No. �T .. ... .. ..OF.... . .......................
�i_Xup op At orkii Tgn,6tru.r ingt ,. rrmit
,
Permission is hereby granted___._ ___ _.. .�.. ------- _ ._ia�. .......
to Construct (�(j or Repair ( ) an In ividual Sew ge Disposal System
at No.... �.. 4--7........1_a_4e ..Cy__.V..--•--- r.t..l'.� ..11—
Street 77
as shown on the application for Disposal Works Construction P�ert �._._.__ -_-_ Dated_�___.....................................
Board of Hea
DATE--------------------------------------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y,.t;
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