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Home My WebLink About0057 FIDDLERS CIRCLE - Health (2) � �� c��1�:��rs C..`'t P �- '�� . i �` ., P e i i I i Ii 1 I J�%Ecvc(foco Z UPC 17734 ILO.2 1_ 5_ 3CR -co HASTINGS, MN THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA NO........�7. . THE COMMONWEALTK OF MASSACHUSETTS BOAR® OF HEA TH ?....... �. � ....OF............. -•-- �1 Appliratiun for Uispoii ai Works Tomitrnrtiun rrm- Application is hereby made for a Permit to Construct (-/--) or Repai ( ) an Indi_ yidual Sewage Disposal System at: / �(�� 1 ..... 1/1 .....01-.,R&L.i ...........Z7�!.�4!Y !1 Q� L............................a=�--•----•---........................ Location-Address or Lot No. = 1 4r..�-- ---•---•............. ....ff....!3_r�_c k�.r>. '�! ��?.1�....---------------•-----------......... p Address Jo4W nstaller Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_._._.......................................Expansion Attic ( ) Garbage Grinder (kc) z> �-] Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) - a ..w Other fixtures ----------------------------•--- • - Desig'n Flow........ . ............................gallons per person per day. Total daily flow....... .o.........................gallons. GCS Septic Tank L Liquid capacity'".°0....gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No........J........... Width...1Z)......... Total Length__ . ......: Total leaching area.......... ....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below in t ... al leaching,area..................sq. ft. z Other Distribution box ( ) Dosing tank -- '-' Percolation Test Results Performed b .. .- (,�.c ... Date.... a Y f 4 , ,,.Test Pit No. ---- ....minutes per inch Depth of Tlest Pit.................... Depth to ground water........................ — Gx "" "' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 ------------•---rt �. ..... O Description of Soil....... 9- ...)- 2- a.c� --------------------- •............. Cam* ---------------------------------------------------------------------------------------------------•-------------..-----------•---- 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 iITI 12 5 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 of health. igned-r ----------------•--- -'........................_.... Date 77 Application Approved BY ' = r.. a -C;{�� Date Application Disapproved for the following reasons:..................................................................................7C........................... ---------------------------------•---------------...----.._.......--------------------------------------------------------------------------------------------------------------------------------- Date ----.-• Permit No. - Issued ".:..:-!.1*--.�. ---... �''� Date No..--=... t THE COMMONWEALTH. OF MASSACHUSETTS ,. BOARD OF HEA H 0 F...............64.� Aur iration for Ui ivviiat Works Tow1rnrtinn VirWif Application is hereby made for a Permit to Construct (0105 or Repair ( ) an Individual Sewage Disposal s System at r rr - Location-Address - - or Lot No ` } g F ...._.... :. _t �2 t... . ?1!_f• i]f................. .. db !. ........................................ n. ' Owner Address W ............... ......................... ...................................................................... In � e_r " Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.____ ..............................Expansion Attic ( ) Garbage Grinder (vA) aa, Other—Type of Building ___.___. ........... No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . ,. v . ---------••-•'--'---•---.....__-•-••- W Design Flow........ -__ ..__ gallo�ns..per person per day. Total daily flow......... 3 .........................gallons. rx:; Septic Tank Liquid capacity..'_:__._gallons Length______ _______ Width . Diameter................ Depth............... Disposal Trench—No. 1 __:_...__. W>dth Total Lex>gth _. T t 1 leaching area._........ ..... ft. :.: Seepage Pit No..................... Diameter____.__._ _.___.___ Depth belo *f t._____..... ..... al leaching area___ .._......__sq. ft. z Other Distribution box ( ) Dosing tatkk ( U4 X4"iv '-' PerEolation Test Results Performed by. ._ �.. __r:=__.__1 ►�- . a� Date___l _'_.t', Test Pit No. I...1t ___minutes per inch Depth of Test Pit___________________ Depth to ground water---------------------_-- (i, Test Pit No. 2.................minutes per inch Depth,.of Test Pit....................,Depth to ground water........................ f a � '.. O Description of Sol - y �` x U Nature of kepairs or Alterations-Answer when applicable............................................................... -------------------------- i ?: ----•--•-'-................ __ ..__•••• •---'-'-----. ---•'-• . --•••----•--. --- --- --•--••••-••--- -------------- Agreement,:. 3 - The undersigned agrees to install th' aforedescribed Individual Sewage Disposal System in accordance with the provisi bg of LITTLE 5 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 of health. Signed " ..............i Date Application Approved BY ---- --• __._.... ... = '- .°:_...._._ PP PP ---- Date Application Disapproved_for the following reasons:................................................................................................................ ..- ......• --------• •• --••---•••-•-•.................................................... Date PermitNo----- -------------------•-------------.................................. Issued_----=''' ---------• ........................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ......................................... f�r�t�firtttr of f�vr�t�fi�nr�e - THIS, S T, C FY, Th- e Indivi al Sewage.Disposal System constructed ( ) or Repaired ( ) by.-" = ...... a I staller . ......& has# een installed in accordance with the provisions of T r j of The State Sanitary Code as d cribed in the application for Disposal Works Construction Permit No... .__ ..._/Z_7_____.____. dated--- _____________ THE ISSUANCE OF THISTC' RTIFICATE SHALT. NOT BE CO RUE S A GUARANTEE THAT THE SYSTEM WILL FUPI01 N�SAT(SFACTORY. DATE..... ..� - ................................................ Inspector.... .. ...... ► ....... 61 $ Y w v THE COMMONWEALTH O,F:.MASSAC.HUSETTS .5 BOARD F HE-ALTH y No._._... + FEE........................ Disposal or nn� � tern rrmtt a Permissio a ereb grante __________ ____ to Const u t ( e f air an ndivld Sevc e D> Sys Street- as shown on'the application for Disposal Works Construction P Dated.___``2_�:`__��:•:..... � --•------------------------- "bard of Health DATE.......... FORM:1255 HOBBS & WARREN,. INC.;-pU.BLISHERS: -7 77 777 Xz '0 Lb t� wk Lub-� <:::�A m VlOFV-'Q6T0Q AAA 4A -MAP wl� C,L AL I Z, Ll Pl-DuEJ CIe -!;A L1-f oFL&IIII I to vt� -n C- 7-,& P4 L &.4 u 121E l000 A4�:> Slt>L-vJALL to vZC2 I -10 %00� al,L 14D' cc, 'IV top VT A�s i�;t::) 0 m 'MA�ss, e-,�-6t 6;- S.",.,11 V5.-r '0 cl " I CH L If t 4;rl t ,el WMA,: OF LL C4J ,Tm-