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Home My WebLink About0035 AUDUBON CIRCLE - Health (2) �i.�' �duNvs� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal VT Sy�stemjat ..........&h--------------- ...................................... & .................... - �k ------------------------------ 'd�&_(d........ ------ ........ . .................................... --------------------------------------------- Owne, Address doo Dwelling—No. of Bedro Seepage Pit N---------------------- Diameter../ ._�_ epth bel;jnIet.................... Total 71chii g area------- -----------------''---------`-------------'—``-----^—'------------'--- /\grcoozeot: _ 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 od ig system in operation until ~ Certificate "^ Compliancey has been -----' ----'' igned-_ �_ -- ------ -------------- ------- ---- ------------- ate Date Application Disapproved for the following reasons:...............................7 . --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- »at" � Permit l000ed-�................................................... n"m -'''--'''-------------------------------'-- '---' '- FRIC .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... -----OF ApVtiration"I""or Uttyusal lVnarks Tonstrurtion Puniff Application is hereby made for a Permit to Construct or Repair an In ividual Sewige Disposal S?y2 ate &... .......--- -----------0.6-------------- -----------------............................................................................. Location Ar No. ;,-*............... ..........<%2 ............................................... ....................... On( Address .................. ................................................... ................... 4 Installer d00 Address U Type of Building - Size Lot----------------------------Sq. feet 4 4& Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder Pam., Other—Type of Building -------------------__--- No. of persons__-_____-_-...-__-____._-_- Showers Cafeteria P4Other fixtuLes ------------------------------------------------------ ---------------------------------------------------------------------------------------------- Design ow........... W Di Fl --------------------------------gallons per person per day. Total daily flow__.'Z.P0_P----------------_-----gallons. P� Septic Tank—o Liquid capacit?61-00-gallons V-en W �gth---------------- Width---------------- Diameter....-.--_....._. Depth_-.-----___---. Disposal Trench o- -------------------- Width...... -- Total Length.................... Total leaching area--------------------sq. ft. --------- Seepage Pit No-------------_------- Diameter.1104'OS- epth below inlet.................... Total 11achl';Ig area....---.- ft. Other Distribution box Dosing tank ( Percolation Test Results. Performed by-------------------------------------------------------------------------- Date.........................I--------------- ,4 Test Pit No.-I..... per inch Depth of Test Pit.................... Depth to ground water----------------- ------ f14 Test Pit No. 2------------...min.utes per inch Depth of Test Pit---------------- Depth to ground water------------------__.-. ----------------- ----------- .................................................................. 0 Description of Soil___________________ - -------W.................................................................. ------------------------------------------------------------------------ .............................................................................................................................. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 undersigne further agrees not to place-the system in operation until a Certificate of Compliance has been_jssUjjpd by the boardoAhealth. ... ........... . igned. ------- ............ ........Qpw� 4� ................. ........ ---------------------- Date Application Approved BY------ ................ ................ .... . ... Application Disapproved for the following reasons........................... 11-7.................................4Date.-.............. ........ .................. ........................................................................................................................................................................................................ Date PermitNo......................................................... Is'sued.!!t...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................0 F..... .............4��....................... (15rdif irate of Tompliaurr T S R I CEaY, That the Individual Sewage Disposal System constructed (Al�®r Repaired by---- . .. . .. .. .. .................... ------------------- ............ ..................................................... nstaii OLi at. . ......... . ............ if------ - .. ...........4........ ..................................................... has been installed in accordance with the provisions of Article XI of The State Sanitary C?,de s desc *bed in the e _;i e a for Disposal Works Construction Permit No---- dated.... application . ................. .... .. �--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR-UMAS A U RA EE THAT THE SYSTEM WILL F4NCTIO SATISFACTORY. DATE...............P.-f Ir---------------------------------- Inspector............. ...... -------------------- ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD O-g. HEALTH OF............ .. .....40...Z0.40 . ........................................ N ..... ...... FEE. ............. �i� u ttl' s CIT rurtiq Permit is. ereby granted.... ........... Permissio anted....n 1�--- --------- . ......................... ............ .................. t( r Reppff ( 4 Ind' Sew�Dispo. I..s V -------------- --------- ................ System at No Street as shown on the ap plication for Disposal,.Works Construction Perim ............. ... . ... ... .. .......... .......... ................ --- ---- ........ is el Board o H Ith . .. ........DATE. �,V- --- -- ----- ------ ---------........................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS G ° �d I t �I �a C