The URL can be used to link to this page

Home My WebLink About0162 MONOMOY CIRCLE - Health 1 162 Monomoy Circle 4 A= 191 -195 Centerville SMEAD No.2-153LOR UPC 12534 smgd oom • Umb in USA IWU6®NiFLS1�OOIJCrW SFI OF D*SRPWOM" CERTIi1FD SOURCJNG UIIAIWSiiPi000RAMOIEC w LOCATION SEWAGE PERMIT NO-. VILLAGE CZ�Z77/7 VILZE- .INSTA LLER'S NAME i ADDRESS ��C �DEvFto�inE�� CG�O• B U I L D E R OR OWNER tc)I c c-i 9M I HyS DATE PERMIT ISSUED /,z t DATE COMPLIANCE ISSUED AsS /YIAy %9/ Loy- ''/9S Ce/l ot/ wI/t vD� a ' i _aP '0 6 r � a C s t }� >y rY No....CU............... .,. Fns... A............ THE COMMONWEALTH OF MASSACHUSETTS day BOARD OF HEALTH 1� N'^!...............OF........J H NS << , ppliratiou for Dispati al Works Tomitrartiou Vernfit Application is hereby made for a Permit to Construct ( ) or Repair (✓ran Individual Sewage Disposal System/ at: rn '/ / .........._�. _.._..N_:_!GN�!!fig`!. C� G� --....�l!...... ..............`-��---......V./.....--•--...--•--•--•------------•----.............------. tion-Address // or t No. i a.W AP 1O� ,/Vr b"Y /!L-GLE -----......-w........_---------------= H 1.------------------•------•------------------ ---------------...,r..�........----.--- ----.......----------------------------------- Owner Addres . Ec oPS . �.�-�,cc Installer Address dType of Building Size Lot............................Sq. feet UDwelling—No. of Bedrooms..............` ___..._._.._.__.___._.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ..... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__________-_-_------__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•---------------•-••--•---•--------------------------------•--•--------------------...---------•......................................................... Descriptionof Soil................................................................................................................................ ------------------------•------------- x W ------------------------------------------------------••-•-•----------------•--------......•---._...-------••-•--•------•----------•---••-•••-------••-•--•-•----•----•--•-•----------•-------..._...... VNature of Repairs or Alterations—Answer when applicable........A_27?............2......... ......:T� ........... '71 u!nfi. ............ w ..G..': S SE E w i�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iTi y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been i ed y rd of health. Signed .... -•--------------•--------- -�/� J Date Application Approved By........................................... --�--•---•----------•--......._..--••- --------f z t/ R Da t - Application Disapproved for the following reasons----------------------------••------------------------------------------------------------- -----------•--- ......................................•......•-•---•••----------•-•------....---•--•------••------•••----•-...._..--•----------------------•-•--••-------------•-•-----------------------•---------•--. Date PermitNo.......................................................- Issued-.----.....----------...--------------------------...... Date No....-..----6........1 Z Z Fps ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .N................OF.........l�- !/cn/57r/Sc t' ---•----------------------------------------- Appliration for DWpootal Works Towitrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (&-01"an Individual Sewage Disposal System at: .......... .GN._P.0 G:J •'1zC t .....••••--------�c. Gr OZ jlcsation•Address / or t No. VV 6 l!nr / l"!�l $ �(?� G/y G/�.G.� t�//r[L L ............... _»............_._.............-....._._...__........_..._.._._.............. .........._..__... ...................---...--..__.................................... Owner C t G(/^ = �e�C ��// / " /A .Addre -•......................................................•-'._L...._.. .._..------.....-•-•//......_..__.....(..._?._ ............................ Installer Address Type of Building Size Lot-----..-•--------------•-.-•Sq. feet Dwelling—No. of Bedrooms..............J�.........................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Buildin YP g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. . WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... 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........k....._..._.. Depth to ground water........................ P4 .............................................................. ••--.....................•-••-•-----•.........----------------••••---- ...................... 0 Description of Soil.................................................................... .....................t. U •-••••-•••--•••--••••.....-•••---•-•-•---••-----•----••••-••••••••••••••-------••--••-•.............•-------••-••----•-•---'-•••••--•------•-•-•--•-----•-•-••-•-•••••••••-----------•-•••-------------• W UNature of Repairs or Alterations—Answer when applicable........A.21?.._....__.._7...____...4.E �ti.._. � �'?s............ L�(.. (G!r_ f S / w��F w ..Ct.l. S F CCG� �iPF Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiT=. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i eWye rd of health. Signed /<�`�� r� Date Application Approved BY ...... / ------------- Z -j .6.. Dat Application Disapproved for the following reasons:----•--------------•--•-•---•---------•-•---------•-------------------------------------------------------•••... --------------••••--------....--•...--••--•--•------••----------.....---------••...------...-•-•----...--•-••---•-........--------•-••-•---.......---•••-•-----•----------••-••------•--••--•--•-------- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF_,HEALTH ........r.V.................OF............................ ..................................................... TntifirFatr of TontpliFanrit THIS IS TO CERTIFY, That the Individual Sewa e Disposal System constructed (>Z) or Repaired ( } by......................................................P. :..y 't.:).� � l.r�� I e •--- ----------------------------•--•---- IInstaller at -- - 4 - G��U r C f C- V has been installed in accordance with the provisions of TT T'r' j of The State Sanitary Code as de• r'bed in the 1-L SZ application for Disposal Works Construction Permit No......................................... dated_...J_Z-. ....4__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............•--........------. ,7;=I �� ` � .................... Inspector.... ----•----•-•------------------------....----....-----...-----•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................." OF...~ X 'D /IFnv^r'f]r'r t CG— v UFEE./ Q( CJ .... ............................................ No..........-•-•--......._ � ....................... Disposal Workii (Iffonntrttrtion rranit Permission is hereby granted........... �----------- .........-----•••............•--•••••--- to Construct ( ) /or Repair ( an Individual Sewage Disposal S stem To O G�.Gi G"/ Ci T C G r: n v' •r. at i�o. ....._... .ern_..... . •------------•---------- --- = ----- ................................... tree as shown on the application for Disposal Works Construction Permit tNo...b._.r�....?Dated....... 9_ .�G............ .........................._....... —----- ---------•-_-•-------- Board of Health DATE.......... .... .. ... ---------------•---•-----------------•--•-- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS