Loading...
HomeMy WebLinkAbout0179 MONOMOY CIRCLE - Health 179 MONOMOY CIRCLE Centerville A = 191 — 223 F I i S M E A D No.2453LOR UPC 125U smsad.com • Made to USA ' OjF1 "s ww G) �- No.......... 1.Cl91... FR$.., ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ...........OF. - ........................... Appliratiun -fur Disposal Works. Towitrurtiutt Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal PP Y ( ) P ( ) a P System a -- --•------- --------------- -------- - ----•----------•---------••--- Location-Address or Lo 0 ............................. .......... O e Address •........... ----------- •-••-•----------------------•--•--• ------------ Installer .f Address Type of Building Size Lot... rJ.. Sq. feet �-, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garb Grinder Na) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtiires ---------------•------------------------------------ -----------------------•------•------------•-------- W Design Flow. ................�_--_----------__-- tllons per person per day. Total daily flow......... a _-'-..........gallons. WSeptic Tank Liquid capacity' Q allons Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width--------- T 1 Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------/--------- Diameter._ __ DZ below inlet __________________ Total leaching area.._--.-__--......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �/b%4i77�76/.���i-i a Percolation Test Results Performed by-------------------------------------------------------------------------- Date-_-------_----------------.---------.-.. Test Pit No. 1----------------minutes per inch Depth of "lest Pit.................... Depth to ground water._.__--.--_-_--_.-.--.. rX Test Pit No. 2................minutes per inch Depth of Test Pit._______-----..--___ Depth to ground water------------------------ ------ r G Descri tion of Soil.____Q '�_, _ _��-_�! `�__�' _ _=-�� �- �� �� w 7- = /ram �---- /_.z.-��qp—/�" �w(�n �[//J� `I V- - -`--- •� 4_•.....................................•.---...-...- ----------------------------------------------------------------------------------------•--_----.-----._--_-_____-..._____--___-_-_-_----_-.____-_--..._...._____........-.._-_--_____--___-_____-_----. 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 Article XI of the State Sanitary Code—The undersigned fu er agrees not to place the system in operation until a Certificate of Compliance has been ispled, y the boa f he h. Sign( ..... ....... --------•----•--.............. ..................... 5 / 7 Dat Application Approved B ��� k'1 ---- ---- Date PP PP Y ------------------- Application Disapproved for the following reasons______________________________________ - -•-----•--•--------------••--------- Date--••---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 7 .....Date....... ' Permit No......................................................... Issued...... �/ Date LOCATIOPJ ' �9 EWD.C;E PERMIT MO.J ,. 1 II�ISTQLLER �E ADDRESS BUILDER 5 ►.1 &MF- ADDRESS DLaZ'E PER"VT O A,TE COMPLI W ACE ISSUED ; I_ I I a® THE COMMONWEALTH OF MASSACHUSETTS BOARD. F HEA T .........OF...... .. . ......................• .. AVVIiratiuu -fur Uhipuual Works Tuufitrurtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at' Location-Addreys/s� �1 or Lot o rs _ (((/// n. ...................................... .._..- ....._�'. .._._ ..................................... ............ /P �� 0 el. Address Installer Address UType of Building ` Size Lot.._,1...-�._._ Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garba4e Grinder ( ) p.l Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ________________________________ _ W Design Flow- ------------------ _...............gallons per person per day. Total daily flow___.__.._ . .._"............gallons. WSeptic Funk Liquid capacity-�, � allons Length________________ Width------.......... Diameter._...-..-..-_--- Depth.-__--_.-.--. x Disposal Trench—No. .................... Width................. Total Length...._--------------- Total leaching area--------------------Sq. ft. Seepage Pit No---------/---------- Diameter../%.......U__. Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank 0// 7` 76 ec -9zL aPercolation Test Results Performed bY--------- ---------- ------------------•-----------------•---------------- Date--------------------------------------- Test Pit No. I................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...---.-------- (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ---------------------------------------------------------- •-••--•• ------------------- G Description of Soil .. ,-/�-�s .� <r-�• ��' �� wx -------�...- -7-------- .. - .�7 ... r _ .� _ � w- -v- .�� --------------------- x -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•-...------•--•---- 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 XI of the State Sanitary Code—The undersigned fuglier agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar d-of he 'th. _ Sign Dat Application Approved B !".. __.... PP PP Y '� r 7. - Date Application Disapproved for the following reasons:.... --------- ------------------ Date PermitNo...........................................----.......... Issued.------ ?`Z ...---------•---•--- Date THE COMMONWEALTH OF MASSACHUSETTS �--} BOARD OF HEALTH .............OF......Z�..e.2-1 i.4-.1..................................................... Trrtifircatr of Ifomphatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by---/-- ...........................te a ...............................................r , j - -�-------------------------------------- -----------�---�--------------------- -f .......... J �- / Insztaller - :=-•-•'at. B J `r.l�--... ? ....f hasinstalled been in alled in accordance with the provisions Article XI(of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-(�-=__'__-_ _ <_.<_______________ dated... -__ _.7..:...!_ -_............_.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST © AS A GUAR NTEE THAT TIME SYSTEM ILL FUNCTION SATISFACTORY. DATE------. 7--7-- ._Z�..--•----------------------------------- Inspector---- - --- - ------------------------ ---(�I�LZr THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �..................OF. �,::.....a.-...-----..........................------.......... ell No. ...... •----• r ` FEE.. .............. DisVooal grkii Qlamitrurtiuit Vrrutit Permission is_hereby granted.-•"`-------/ l� �-=12' a-�•--••----------------------------------•--._....------....•........... to Construct (f' ) or Repair ( ) an Individual Sewage Disposal System r / at No.. = ^, �..- .................../ vim ._.�- - �- ? �.-__... -- Street as shown on the application for Disposal Works Construction Permit No------_---------!!L Dated.._5`.._j_ z_ j------------- /� Board'of Healt> f DATE----7-------k-•`--- Y----------------------------------------•-- (/ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �+ t.ATE SUBJECT -''SaiEE'h No OF C HKO BY'a LiATE JOB NO. 1 i t 77 75 'V,f •Nit iAN "4 ^^V 76 Sh�aE,✓oV' ��'�'��,� Ca�tlFG�f'�'S 7"G rv,�' I - ZoAllml Z,�V ✓S- 0/- r/Yor 77t:;W-o/ 0,,cr. a--1 P4 r 4 zo TG � e F ou�va.�7ia.v Louvriot1 CEIATEQViLLE t AS,-,. 'l0 P R �ttiea INC AL PET I i� �2', REG�S'C LAN C> V R>IEY ' �n A-J-k S MA L L_