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Home My WebLink About0046 CROSBY CIRCLE - Health (2) /-�Lo C,r-05 r. , (ant , No. �� Fsa .................... THEBOARD COMMONWEALTH FtMASSACHUSETTS P'1 f f� , f-1 a ....................... r _._.OF. ... .. ..... ....: AVVIiratinu -fur Ui-qpu.itt1 Works Tontitrurtiuu Vrrutft Application is hereby made for a Permit to Construct (Vor Repair ( } an Individual Sewage Disposal System at ........... 0.42 42.......50 -- -- -----•-- . `Locatt�on•Ad ess of NO, _7 •---- 0 ve Ad sW . -•• -- ---•---•••••--•-•• a - - - - --•------••-• Installer Address UType of uilding Size Lot____________________________Sq. feet a Dwelling—No. of Bedrooms----------- __------------------------Expansion Attic ( Garbage Grinder ( ) aOther—Type of Building _...___... ---__ N� per ous____.---_�^°--__--__ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow_ .... ---•-, �- all ons per person per fay. Total daily flow------- : ---gallons. WSeptic Tank�iquid capacitons Length Width ameter. Depth 71 x Disposal Trench—No. ____________________ Width__________ .,_ __. 0 1 - tal leaching area--------------------sq. ft. Seepage Pit No..`C______________ Diameter�� ______ pt ow Yl e __ __ ___.__.______ T al leaching area..__.._____.___..sq. It. 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.........____._._..____ , G� Test Pit No. 2________________minutes per inch D pth of Test Pit._-___.__._____.____ Depth to ground water-_._._.--__--.._-___---- a = D Description of Soil------------- - _- U ---••-----------------------------------------------------------------------------------------------------------------------------------------------------•••--•--------------------------------------- VW -------------------------------------------------------------------------- --------------------------------------------------------------------------••------------------------------- --- 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 further agrees not to place the system in operation until a Certificate of Compliance has b issued th and of health. Signed-- ........ - - ----------------------............ ' / � Date Application Approved By---------- ez, L .. . -7 Application Disapproved for tlae following reasons_____________________ ----..Date-----•._ -••••-•-----------•--------------------•--•-•--------------------•--__•-----•-•••=-•••-•••••-•-••--•-._••--••••••-----•-.......--•------------••...-------_._.---------._._.-------•._...-------_•--- - -, Date Permit No................................................... Issued � v! Date •.•.•••••••••.••••••••••••••••••••••••••••.•.•.....•.•••••••••.••••••••••••••••••••.••••••••••••0...••......•...............0.. THE COMMONWEALTH OF MASSACHUSETTS BOARD -F HEALT . .7'8..........'OF.... F...... ('2Glt�' .......... ....... - �rrtif iratr of Qitiuliuurr T I IS T, T That the Indi dual Sew e is osal System constructed ( ) or Repaired ( ) y. -•- -�- -----.-- ---- --------� b In a er > r" has been installed in accordance with the provisions of _ .r cle XI of T>e State Sanitary Code as described in the application for Disposal Works Construction Permit ...... ............ dated.... . __ ---------?A( ___. THE ISSUANCE OF THIS CERTIFICATE SHALL_ NOT BE CONST ' E® AS A GUA13ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. KI DATE..... ro f Inspector •---•-•--...-- --•-•-•----•--- ,� ........................••.............................................................................•......./................ . t THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH . .........OF.........1. .:.. !. ------ zz 7 � ,,No. y. ----....--•--- �i��u � � nu�trurtilaat -runt Permissio is hereby grante --- --- / --v..................l�lr--••--- to Construct Rep ( a ndividual,§ewage sposal Sykte�m 9 at Nop / �JB` ------------------------------------j°- ----- ---•-- ` Street as shown on the application for Disposal Works Construction P No.. _. ._ _-__ _ Dated . . ....... ...... ------ ................... �_ Bo d o ealth .- DATE - - ------------------------•--••-•------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .V y � No. .....< Fs$. :............. THE COMMONWEALTH OF MASSACHUSETTS BOARD .. F HEA T ..... _- =OF........ - ........... ..:.... ....-..-- Appliration -for Disposal Work. Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal system at sb bca Ad ss •------------ : ..... - -------------- ----------------• ........................... .... wAdd -• --••---------•----••--•-------•----•-- -•---------- ----- ---- ----- Installer Address UType of ilding Size Lot............................Sq. feet Dwelling—No. of Bedrooms__-______--�------------------------Expansion is ( Garbage Grinder ( ) Other—Type of Building No. of*per . _________ Showers — a g ------- -=- ( ) Cafeteria d Other fixtur "` -------------------------------------- es Design Flow__..___._.__ _____ _________ llons per person Total daily flow----------- -_ _..gallons.` � Septic Tank Liquid capacit lons Length---------------- Width---- ameter....... --------_Depth---------------- xDisposal Trench— o_ ___________ _ Wi tl ._.__._._ To 1 al leaching area--------------_____sq. ft. Seepage Pit No.... Diameter ___ ow a ________________ 1 leaching area___._._________sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Nr �W, Percolation Test Results Performed.bY--------------------- .................................................... Date........................................... Test Pit No. I..............__minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-_______-________....__. fX, Test Pit No. 2----------------minutes per inch D pth of Test Pit.................... Depth to ground water---------_------------ P4 ••-••-_------ -_- 0 --•-----------------------------------•------------••---------•-------------- Descriptionof Soil-------------•----=--•-- -�!Zo, --- •-•-----------------•---•--------------...----•------••--••--------•-•--•--------•-----•-------------- x . w VNature 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 further agrees not to place the system in operation until a Certificate of Compliance has beA issued th rd of health. OS Date Application Approved BY - ''Y''� �;,� ----- --- Date, Application Disapproved for the following reasons: ............. •------- ..............•--_-----_---_-----•-•---•---•-•--•------------••••-------•----••--•------------------------•- -------------•-------•----- .............................................................. Date Permit"No.--------•---------------•----------••---•----••-•------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT Y- 740" � .....................• .. , ........ .... .......... (Entifirate of ( ompiiaurr T IS T T That t e Indi dual Sew e Is sal System constructed ( ) or Repaired'( ) bY ..-- s. . --• ------- . •-- ...►- lop Ins Iler -----------a-401- * ------- at,,-.. -: G ----- ( .. Lowe has been installed in accordance with the provisions of : r cle XI of Tl}e State Sanitary Code as described in the application for Disposal Works Construction Permit No-____ =:"- _______ ______________ dated....k7.12..A_" THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS Ae, BOARD O HEALTH OF. No....:.................... FEE---- --:.... op"', Permissio -s hereby grante -- -----•- ----•'•----•-- •------- - - -•-- •- - - •--to Construct Repp ( andividual ewage sposal Syrttem [/ atNo . .......................... ............................... • Street \ as shown on the application for Disposal Works Constructio P No:__ .___ Adof ted_. '...............................- -- - ----- - - f Bealth • DATE..............................-................................................... t FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -