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Home My WebLink About0053 AUDUBON CIRCLE - Health (2) J /�i � � �a �� 0 N� � # •-- Fz�a. 4 � ,1 THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH .._..... ---..OF.....V........................... .. _.......... Applirtttinn -for Bitipwial Works Tanotrnrtion Vamil Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal i. • PP Y ( ) P ( ) b P System........ . ............. ao.C.K�.....d44................ ocati -Address Owner r—G44./'- —I ------•-•- -- . ---••---•--••------•••--••-••-•-••••••••---•- ------/----•--------- -------- ------- ,le-7'C--'(/ _-_-_-________--••-•----•-----•---------- Installer Address UType of Building Size Lot. ....�I_,ra_._i.....Sq. feet Dwelling—No. of Bedrooms----------------IZZ-------------------Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) 0.' 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---Stz__ --- Total Length------------_------ Total leaching area--------------------sq. ft. Seepage Pit No_____________________ Diameter......._—epth below inlet.................... Total leaching area---_-_.______-_sq. ft. z Other Distribution box ( ) Dosing tank ( �— Percolation Test Results Performed by___________________________________________________________ ___ Date............................__._._-..... a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------_--- rX, Test Pit No. 2................minutes per inch hDjee. h of Test Pit.-_______.._________ Depth to ground water......_..__.___..___.... G ! ••--•-..i..• r-- -------------- Descripio of So`.----- -P- .. rr- ----a---- Y --- -------- �+ /��/� V `-----_ �F---------•�• ��1.Q.P..'� 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 Article XI of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has be&Clr�D• th boar of health. igned •-- ---• --•-•-••----•--••••----•-------•------ Date Application Approved BY --- •-------- r----- --------- -- ._ .T/.1 y_7 .. . �� % bate Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ----------------------------•------------------------------------------------•------------------•------- Date PermitNo.....................................................--- Issued........................................................ Date Z7 No...... /.7........ FEs......Z..6.;............... THE COMMONWEALTH OF MASSACHUSETTS .- BOARD OF HEALTH Ccz_ Appliratinn -for DiiiV tittl Works Tonstrurtinn Vrrnift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r f, f . Location-Address � r f, � or Lot No. Owner, e, Address � Installer Address U Type of Building Size Lot_.Z__�-- rJ� Sq. feet Dwelling—No. of Bedrooms_______________ _______._____-_-____Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _-.__.._.................. No. of persons..__________________.____.__ Showers ( ) — Cafeteria ( ) dOther 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. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet____________________ Total leaching area._.__-_._.________sq. ft. z Other Distribution box ( ) Dosing tank ( ) :6- 7-3 v- 7 3— Percolation Test Results Performed by------- ---- ............................................................ Date......................... ------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2..............__minutesper inch Depth of Test Pit.................... Depth to ground water------------------------ Ri ................. ¢F S_ i -' ,^ 4 Descripti/ of Soil------ ��y� -' 't x ---------------------------------•---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- 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 \I 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. I tied- _ .. _Dat.e-------------- Application Approved By-= -- -- ---� ---- /101" �---.-'.•'--- .Z11Sa7te . Application Disapproved for the following reasons------------------------------------------------------------•-__-------•.•------------------___________----_.---- -•-•-•---•--•••---------•-----------------------•------------------------------------------•------------------•---------------•-----------------•-••---------•---------------••--------•---------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.. ...n.....O F............. ...... � T rrtifiratr off f�rrmpli�tnrr ... H IS O CER"l Y, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by........ .ems.-- �4-------- o .4 has been installed in accordance with the provisions of :� ci/ of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-_. - _____ dated---�d._--'Z _ ...---._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILLIFUNCTION SATISFACTORY r ,f< - DATE `? ' y' � Inspector_ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH No. ....... FEE-'-- i> nr�ttl rk Tl� �trrti�$trrntit ?L-- t Permission is hereby granted----'- ----- ' ---t ----�.r�-- --------------------------------------------------------------••--•---•-•- to Constr l( � or Repair an ndiv-dual S ge-Dis a:�a] System at N �Y . .. Street as shown on the application for Disposal Works Construction Perm' J_. �/�.-�_.�____________________ +' i ------ --j• --l-(--'•----- ----------------- / e , DATE------1 .: � 71P- ----- ----- Board of alth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 22 0 a0 •0 (/ In i J ,o, <11� �tCHti-3D yti7 LAMM k/lTH l00 �.C•C.'.TI TEY-VIt_L-, ,/VfAs ! G�.k'�'i�_ -/ T;-��.t_ .t•t-+ t-, �a t�iJD. S�Jcy„v!J !==�,r/_�� 1��,�'�R�t.�G� PL4Q vtv, -zlz C'{'"b,i, 5s TH�"_; ('-�1_.,�Lf•J 1',� !.:UT �_`-�:�. ,K `i.' D�.,-J ItF� Uri?"•f=:t_'.�/1l _l_5 -ca /t��.�ti''i' � 'a •f-J `jAAA . 3•,