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Home My WebLink About0201 MONOMOY CIRCLE - Health (2) f yj'l,�.v�n Gr . ,C:e,,� �� l� �._ �. F ............... THE COMMONWEALTH OF MASSACHUSETTS 44JJ BOARD OF HEALTH .OF........_................... ...... 011 ,� lVaratiuu -fur Biupuiittl Norku Cnurtutru rti.uYt Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at�• -"'_ i....................................ale r-O ........................................................... �Lo on_Address or Lot . ........'`�................. ....-"-----••'-•"......-'-"......-••"'--"---"... .............. - ---•• ----••-----------------------•------. Owner Address a — -------•-•.................•............... .............. — —� Installer Address Type of Building Size Lot_ J,_� __Sq. feet U Dwelling—No. of Bedrooms......................_. _Expansion Attic ( ) Garbage Grinder �rlo) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOt xtu s �---------------- W Design Flow_________ ______________________ _____gallons per person per day. Total daily flow-______L___ ..0.....................----gallons. __ W gailons Length___________ ___ Width..___.....-..._. Diameter___......._.____ Depth_._.____ ..._ --. Septic T<<nk/-Liquid capacity_, x Disposal Trench—No- ____________________ Width........... _ _. T a Total leaching area....................sq. ft. Seepage Pit No.._._. ..._.. Diameter_ __ _ � el ow inlet_ _ __ Total leaching trea.___.___._.____.sc ft. / P �j . g t 1 z Other Distribution box ( ) Dosing tank ( ) Ole-- es'""� — /' 7` 76 . aPercolation Test Results Performed by.......................................................................... Date.....................:----------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...__-.___._--.-__------ f=, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ------------------- 0 Description of Soil --r----- .-.��..+,+ �..... �j��G/v�k. ._.._..--�� -U-k' - `�f = tl �rrF U -- ------- ---------------- -- - x •--------•••••- - - A 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 further agrees not to place the system in operation until a Certificate of Compliance has been issueo by the board of health. ned- •---- ----�---•-----....- ace , Application Approved By--------------- �°�� r - �PP PP -- Date : Application Disapproved for the following reasons:-----------------------------------r----------.--._-_--.--.-=.................................................. ---..-•-•-----•--•-•------------•--------•---•--••------------------•--•-•----------------•-•------------•---------•----•-------•--•----------•----•-----------•-------------------------•-------------- Date PermitNo......................................................... Issued........................................................ Date Fiz$...F....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Or HEALTH .......OF....... ........-- - � . .................. Applirtttion -fur Disposal Works Tonstrurtiou Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System,at s Locdtion- Address �7 /� or Lot�Yd. Owne ddress . ...�" .... r ..yam . A......... Installer Address UType of Building Size Lot./ ...e_�,—_Sq. feet Dwelling—No. of Bedrooms------------------- ------_-___----__-Expansion Attic ( ) Garbage Grinder VX) per_, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOtLisr _I T s ------------------------------------••---------------------------...____-----------------------------------............................... W Design Flow_........�_ _____________s_�"-_-__.gallons per person per day. Total daily flow...... WSeptic Tank-Liquid capacity, gallons Length................ Width................ Diameter-----........... Depth---.--------._. x Disposal Trench—No- _____________________ Width.................... Total Length__----__._.____----. Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet t.�.7......,�_�}}'._........ Total leaching area-_._._-_--___-...sq. ft. z Other Distribution box ( ) Dosing tank ( ) aj9- PO* — /` 7- 76 - aPercolation Test Results Performed by-------------------------------------------------------------------------- Date._-.-----------------------------•-•--- ,� Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water..-_____-.___.__-._.-.-. rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w � , -.... ... _ �•._ water.-.--._---_--_-..------- ------------------- ----/�---- ----- O escrpton o Sol--- : _.:....... _ � --------------•--•------------------------------•-------------------U � u 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 been issued by the boar4 of health. ned ,.._ Date_ Application Approved By------------- - l- �I 1 - Z-Dace - 6--- Application Disapproved for the following reasons:---•.................•--•..... _--•-•------------..................'-•-•-----.....-•----..._•--•_.. ...................................................... ----------------•----•-------•---•-----------------•---•••...----'-----------•-----••---•-•---- ----------------------------------............... Date PermitNo......................................................... Issued....................... ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :.............OF............ ..................... , Trrtifirtttr of f�omplitturr THIS TO G�,411 "fIF That the Individual Sewage Disposal System constructed or Repaired �� g P ( P ( ) by.......... _----------------_ ----------------------------------- ................ It�stalle r - - •-----`r=•-� -•'-•..... . .... .. ..� -- •---•---------•------- has been installed in accordance with the pro'6isions of Ar ' 1 Hof^The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... ...........�...�,s--'...__.___ dated....y.________C.-_7_;�................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL.FUNCTI -N SATISFACTORY. DATE------ ��__�...............•-. Inspecto .-------------- ------ Z_Z ------------_-_------_--jTHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF ......... �V No.--""-----'-_.�._ FEE./ ............... his ustt Qlanstrurtiou Vamit Permissio a rS hereby granted----- ---- --------------------------------------------------------------------------------------------------- to Cons tact ( ) or Repair ) an Individual Sewa Disp al Syste <' at N __4,--=/-s--- -----•... . f b� j 1�' /�G �'l4 r------S ------ I.................................... Street as shown on the application for Disposal Wort.Zonstruction&Pit N _________ _____ Dated_-.._._ `.`�C� �G PP P #------------------------- Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 1 I i M O/,/U M U OF WILLIAIIf GJ, N Y �e { L 1 L,... ►\.l Na l9334 -� -c-TI U Q V i k c rrr=y TNA r T/467 0477V U SRO w N o ti TH/5 P1-AA) COAJ FO l?/' 6 70 I 7i 67 e y LAWS OF 7-11 C TU AvN �,G P.I.E� � 1 Q AU Cal=" ,(jA�N TA�3�..C" ,e G✓ 5 - N v�1''c G �LC:G1 a"T1.=S I.h,I.JQ SURV�' I2S U 5-r�;.2\/t L L,, M 4, gS w R 1 1._.OT s� lit � � r f A4 ONO Al �4z Of 4 'r WILLIAM yG� iv Y f ,P C(o 1 y334 4 c T-rr~� THE r 71145 1=UvAvOA77vAJ �, �.►� i L.L �►. , TN/S '01-A"J CCau,G`G ?/�-/ 7 0 7V,!F a nlVIIJ6 /3Y LAW5 OF TYE 7-0wAJ \u dr- e A,eN T,a lo/, 4 '- 'E3 C� S5-rL`� -V1LLl tAA, SS