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HomeMy WebLinkAbout0211 MONOMOY CIRCLE - Health (2) �IJ �1�nc�/�o �+��� ��-. o /9� ��a a - '� f v e S 069, FizE . ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH - OF...:............. -------------- Appltrattnat -for Uhipvfial Works Tottfitrurtilatt Vanift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - ....... .................................... Lyrat on-Add �f / o Lo�No L .44 --•-L........- Ow r Address ......••....................'•----------•••- .. ..-'------------- Installer Address d Type of Building Size Lot..., q. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ._------------------------ No. of persons.-__-_-_.._._--_------_.-_ Showers ( ) — Cafeteria ( ) G4Other fixtures .--•--------------------------- - - --- -- - --------------- -------- W Design Flow..................... ��-----------gallons per person per day. Total daily flow--------- �._.. ---------------------------- Design WSeptic Tank—Liquid capacitvjAX.60gallons Length---------------- Width..__........_... Diameter-----....___-__ Depth.__._--__._.. x Disposal Trench—No. ..................... Wic tl�. .. otal L jh---- ._� otal leaching area-•--•------------•--sq. ft. Seepage Pit No..................... Diameter _ _. _ __: t Li toe ____ ______._._.. Total leacling�area....._..._.__....sq. it. Z Other Distribution box ( ) Dosing t ev ` gip`— /� � ~" Percolation Test Results Performed by.-._ - � ..::....................... Date___.....__._____._.__.___._._____..._. al Test Pit No. 1________________minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...-------_.-..--..._... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat r--.-..-..-_----.--....__ ---•------• -------- -----------•-•---•----------------------•--••------------'---'-'•-"".......•- r Description of SQiI--- - --.. - - -- ----. -- --• ---------- �.�.... ... ..---. . .....- - ,J it ry ............. .. G;. ...---.---.-_----__--___-_--_---._-_-__---._--.__-._---.__.-. _._. .. .__ ._. VNature of Repairs or Al erat ons—Answer when applicable..---------------------------------------------------------------------------------------------. •------------------------------•---•----------------•-------•--....-•--• ----------------------•---------• ----------------------._---......---.--•-•-••--••--••-------•------------------------------- Agreement: - The undersigned agrees to install the aforedescribed Individual Sewa Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned f ther agrees not to place the system in operation until a Certificate of Compliance has been!>ji by the:bo h lth. A s Sign ----------•--• ..........�`' D e A lication Approved B o `��`= '� - 77 --------- PP PP y----- -r -' "'- Date Application Disapproved for the following reasons--------------------------•• •---- ----------------------------•------.............................. ................................................................................................................................. 1 Date PermitNo......................................................... :� Issued.......��,�". .-- ....................... _------------------------------------------------------------------ ------------ -- - ------------ //ML THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i Appliration -for Diii u,ittl Works Towitrurtiott Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: I.UWion Add � �/ Lo1No ............ r-- --- !! ....... ---•----- �+ / -------------------•----- a !"• ... 0 --•••--•••••-• •------•--.._•-----•-•••--• Address.+ ---- •-•--......•-----•-----•••-- Installer Address Q Type of Building Size Lot... feet U Dwelling—No. of Bedrooms_______________________________ _ -Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________ No. of persons_____:____________________:_ Showers ( ) — Cafeteria ( ) P4 Other fixtures --------------------•----•-•---- � Q -�- ---------------------------- Design W Flow......................z�--C)---•.-.--..gallons per person per day. Total daily flow_________ _ --- ______-___-.__-gallons. W Septic Tank—Liquid capacity/ allons Length---------------- Width_-_----_--.---- Diameter---------------- Depth.---_-__---_-- x Disposal Trench—No_ ____________________ Width__.__ (-otal ___ __ otalleaching area-_______.___-______sq. ft. 4See a e Pit No_____________________ Diameter_. ""xP g t --------- Tota lead 'ngi... sq. ft. z Other Distribution box ( ) Dosing tJ ���� •� a Percolation Test Results Performed by----- "+�df'��•C '---------------------- Date........................... ------------ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__________-___-__-___ L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa r------------------------ wa--•------------------------•-------------- ..................................................= ------•--•-------- D Description of Sail- - ----- 1 ........... ..'"�x_r °hr ......... W ----------------------------------------------------------------------------------------------------------------------- UNature of Repairs ror7lleravrons—Answer when applicable------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------••----------------____-_-------------------------------------------------------_____--•---____-------... Agreement The undersigned agrees to install the aforedescribed Individual Sewa Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned f ther agrees not to place the system in operation until a Certificate of Compliance has been is.,mcd by the b h lth. e Application Approved By ...... ..... - • - -- -'Z_r!L_------ -- -------- _� d .�--------- Date Application Disapproved for the following reasons:___________________________ ________..........................................................._-------_....... ...-•--•-•-•----••-•--------•---•---•-•-•-•-------------------------•-- .................................................................. ............................................................. Date PermitNo......................................................... Issued........... ............................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ...:....OF.................. ... ....!,. -s--...L,............................... %Lprrtifiratr of f�lampliaurr T S IS CERTLM That,the Individual Sewage Disposal System constructed ( or Repaired ( ) J-" by....- - --•-mil- ------ ...................................................... ---- .................... --- -- Faller •----....---- at..... - ••• ......u`'.° ------- '7�L . _ ..~ .= = - ---- ----•--------------- has been installed in accordance with the pr, v' ions of A 'cle XI of The State Sanitary Code s des �,d.,�h,e application for Disposal Works Construction Permit No&-__�11---------------------- dated_._ _r!!f_ --------�-............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G3, ARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector................................................--••----•---•--------....._..._....-- THE COMMONWEALTH OF MASSACHUSETTS BOARD HE�'1101t_4 .7 ,......OF....... .. ------- ------ No � ... FEE:_ Permission 's reby. nted___ ____-_ 4........ ___ to Co c or Re i ( ) an Individual Sew isposa stem at No . �07 ----• .__... _--- -�-- -•-- . ... Street as shown on the application for Disposal Work onstruction r o--- ____ .___� •:•---- -•--- •• ------ -- -- ard of Health DATE-{ -- - r---.... .. FORM 125 .& WARREN. INC.. PUBLISHERS - - � 1 77�._731�_,.�­�_­_.­_­ 1. - -_ �--- -I . - --.-.--—_.._ �- . -I - -, ­_­­__­___­­I -111---.. ­.____l . , '�_ , - �� I , , . I I - . � . I 'TZR I 1,1.11 I- f �4,I I I , ,� I .1 1 �-QM, , ?,�-, "r. ., .".1�11.�. , - ­',!­!',l 11 1­1 " �;­,�,�, '.." 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