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HomeMy WebLinkAbout0054 MONOMOY CIRCLE - Health (2) lfionofflo�- �-I, r-- No......... a..7.. Fma.......1r�... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE T V f . ._.. OF....... (� ApplirFation -for Bhipuiittl Works onstrurtioaa rraaail Application is hereby'made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal S stem at: 1'I',N!P.'h y--•-•... �1 � IDS = : Location.Address or of NNE Owner Address •- Installer Address d Type of Building Size Loki._.:__________.._ -------Sq. feet U Dwelling—No. of Bedrooms------------- -:-----____-__-.-_.--___Expansion Attic ( ) `=Garbage Grinder ( ) A, Other—Type of Building A"_�ntt---------- No. of persons...._ Showers ( ) — Cafeteria ( ) Q' Other fixttl s ------------------------------ -- Design Flow........................._..___..._.....gallons per person per day. Total daily flow._.......... .® _....._.__._.__.._..ga gallons. WSeptic Tank—Liquid capacity—PO—_gallons Length_-__5_.A.__. Widtli.S..C. � Diameter................ Depth_-_-�.`.. x Disposal Trench—No...:................. Width-_..______..___.... Total Length-------------------- Total leaching area---------------—�_sq. ft. Seepage Pit No.............j..... Diameter. P;7 Depth below injet.....___ _.._____ Total leachin area_.----------------sq. It. z Other Distribution box ( ) Dosing tank ( ) ova 2 _7 - `�' Percolation Test Results Performed by.---�-if_F�____..04).-0 2� a ...... Date--------------------------------------- a Test Pit No. I................minutes per inch Depth of "Pest Pit-.._-______-_--__._. Depth to ground water..-.-.__-----.---.--.----- �14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water............-............ .. O ._.... - Description of Soil---------------- f� ?� -i - x -------------------------------------------�� �� 1.'Z 1/ �_ _ �� 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has sued by the board of health. Slgned - ------•- ... ` '"-•--•-•-----• .� Date Application Approved By----- -- - --- _ ------------ ------ ----..�-$ 7 7'- Date Application Disapproved for the following reasons:...........................................•--...__---•----------....---•-------..._.................---••••••-- ...............................................................---•--......•-------•----------------••-...-•-••-•-•---------------•-------------•......•-------------------------•--------------------- Date Permit No......................................................... Issued.. A/o -.0 ?- Date No THE COMMONWEALTH OF MASSACHUSETTS BOARD F H.E T ..-..O F..... Application -fur Bhipoii al ar�6r otuitrurttuaa rrutit Application is hereby'made for a Permit to Construct ) Repair ( } an Individual Sewage Disposal System at � A)0 LRCi- C C_yQ'r. r1) Ash �(o , ` . . • Locatio ddress o of No. corm t � ` �''? .................. ............................RAYS 6 EY w �- L� . , _ ................... W - l l�' f l �WIJr -J !�1aLe j ------•--------- -••---••-----•-----•-•----•-�-... --•--- --•---•--t-- � ` Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building IfAIK-0.......... No. of persons_..- _ «'. Showers ( ) Cafeteria ( ) 04 Other fixtures --•-------- -' ---------•-•-•--------------••----------------..----•--- ------------------ --- ---------------•---.----.--_-- W Design Flow____________ __ �______.._`. gallons per per-son, r�day. Total del flfl�w..............................0 ___-.._.__...g to S. P4 Septic Tank—Liquid capacity ..gallons Length__.:_.___._. Width !. Diameter________________ Depth...._ _ .. .,. x Disposal Trench—No.,__________________ Width._.._..... .__.____ Total Length.................... Total leaching area_.._.._..___..______sq. ft. Seepage Pit No_____________ _____ Diameter-_0O© Depth below inlet-- .._._... Total leachi�ng area..._._-------____sq. fI. z Other Distribution box ( ) Dosin tank ) 0,06- `"2 2" -(, '~ Percolation Test Results Performed by._. Y F -.--_--t?A u 7'��....................... Date--_..____----__-_..-------------------- a Test Pit No. 1________________minutes per inch Depth of Test Pit..------------------ Depth to ground water...---.-.------.__-.__.: G14 Test Pit No. 2........:.......minutes per inch Depth of Test.Pit..--------_.-------- Depth to ground water-_---.-..__---..-__--_- ptr �, y ------ ------------------ ---- -- Description of Soil-------- -- �?l ....--•------ ------ : ..:, .. w 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 further agrees not to place the system in operation until a Certificate of Compliance has ssued by the boarcLgj health C Sig, d .. ._.. 'Jet - -- Application Approved B Date PP PP Y = .--- -------- -- - -----JY."'$'� r�`7---------- • ", a .` •----- Date Application Disapproved for the following reasons-------------------------------------------------'------- ------------------------------------------------- Date 'Permit No................. ...................................... Issued ---............------- Date r THE COMMONWEALTH OF MASSACHUSETTS AlJ- BOARD OF HEALTH 4�l��ll�l e,-6 _ ..... /"t�' .? ..:.......OF.......d. + T7 - � �rrtif ir�atr of f�uut�liatnrr T TO T .1Y, That the Individual Sewage Disposal System constructed ( or Repaired ( ) t by ...... # -----------------•-----.......-------------------------•-----•-•- a ller -- In has been installed in accordance wit the pI vision of A e XI of The.State Sanitary Code as described in the application for Disposal.Works Construction Permit No.C, ------1-!?-.7---------------- dated_...�!_:__�"'....._�._......--_........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE;CONSTRUE® AS A GUARANTEE THAT THE 'SYSTEM`Viler L FU CTION SATISFACTORY.. G�`� . . DATE. ---- fy_�-------••-•-•-•......--•------- Inspector•---(,,�....... C .If THE COMMONWEALTH OF MASSACHUSETTS 9�'' BOARD F HEAL.. H 1 .......--- . .................... F ....... ............. .. ......OF.':: .No....... --4!..... ......... nu trudivaa ramit Permission is ereby granted----- ---- " ...----••--•-----------------•--------.......-- to .Co No st ct r Re ( ) an I/ividual wag is s yst 10 ._R ____...._ __. -------------- .Street t as shown on the application for.Disposal orks Construction P it N . .._ :-___ --- Dated------ ----"'.----- -------------- ............ .Board of H t• DATE......................................... FORM 1255 HOBBS & WARREN. INC.. 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