HomeMy WebLinkAbout0284 MONOMOY CIRCLE - Health (2) r
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....................... Fizz .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD gF HEALTX
.....
f'V- ---.OF........ ....... - - - -......- --- ------ --------------Appliration -for Diiipviial Workii Totuitrurtion Vrruift
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
SysteM at:
.......... ...... .. . .. ........................... ----------- -------------------------
.
cation- dress or Lot N
... .......... . - -------- ....... ... ..... ............................ ............ ..........................
wner Address
. .......... - -- ------------ ........................... ..................................................................................................
Installer Address
U Type of Building Size Lot_.'_ __'rV_0__Sq. feet
Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder
Other—aQ Type I of persons_-------------------------- Showers Cafeteria
,, of Building ............................ No.
Other --Ijx ur s- -------------------------------------------------------------------------------------------------------------------- ----------�1_;-----------
Design Flow.............. ..- .. ............. gallons per person per day. Total daily flow------------- �_ ......gallons.
9 Septic Tank—Liquid capacity/HP-gallons Length................ Width._-__ ..........Yameter..... ---------- Depth----------------
1 11. leaching area------------
flo�_ a—
Disposal Trench No 'A taA 1. Dail,,
.4L4 ota4-leach* -----sq. it.
re. -------sq. It.
Seepage Pit No. OTmeter-------------------- Depth slow inlet_... .._.... QAI leachnig
Other Distribution box Dosing tank -7 L
I e
Percolation Test Results Performed by-------------------------------------------------------------------------- Date.----------------------------------- ..
,� Test Pit No. I................minutes per inch Depth of Test Pit..._..........._.... Depth to ground water.--._---_--_.--.__.____.
rX4 Test Pit No. 2--------------_minutes per inch Depth of Test Pit...._...........___. Depth t und water.-.----.._-.__..__-_._-.
P4 Z-------_---------------- P AY6
0 ------ ------------ --- ---------------*------------------------------
.........—-------- - - -- -------!------------------------------------
Description of
Z4
----------------------- -------------------------- ---
U ................... ....................................................................................------------------------------------- ------
W
Z ------------------------------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------- ------ -----1
--------------------------------------I-
----------------------------------------------------------------------------------------------------------*----------------------------------------------------
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 undersigns further agrees not to place the system in
operation until a Certificate of Compliance has been sue by th rd o health.
n ...... . ..... .... k 7
. - -----------------------------
Application Approved BY---------------- - . .... ...
-
Application Disapproved for the following reasons:......I............................... ...../--- ------------------------------------------------------------
.............................................................................................................................. -------------------- --------------------------------
Date
PermitNo......................................................... Issued.---.. .--- ---- --------------
ate
-------------
N
'NO.......................... Falic............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... ... .......... 0 F...................... ............. ---------------------- ........................
Apptiratian -for Dhipviial Works Tonfitrurtion Vrrmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
Syst at:
. ........... ... ..... ..... .......-- --------- --------------------------- ........... .....................
(Location- dressor Lot N
....... ------------ .. .... ....... .. .... ... ..... ............................. ........... ......................
wner Address
......... ........... -----*--------------------------------------------- --------------------------------------------------------------------------------------------------Installer Address
Type of Building Size Lot_./Sf "9__Sq. feet
Dwelling—No. of Bedrooms------------- ................ a.............................Expansion Attic Garbage Grinder ( )
Other—Type of Building ------------------------_-- No. of persons---------------------------- Showers Cafeteria ( )
Other fix res,,% ............gaons per person per Total---------------------------------------------------------------------------- --------------------------- -----------
Design Flow..................411MV. 11 day. Tl daily
164, flow----------- -1-------------------------.._gallons.
Septic Tank—Liquid capacit,4VOP-gallons Lep9th---------------- Width....• --------- ameter------_-------- Depth----------------
Disposal Trench No th.....CZ.,.Jotaal,0041144.e.r... . . _ t,+leachingarca------------- ------sq. it.
e ow
Seepage Pit N, ------- Dgmeter---------------------1)6�th el inlet.... ...... g4l leachino—rey.........I-------sqAt.
0';;�
Z Other Distribution box Dosing tank r- %.��
Percolation Test Results Performed by------.................................................................... Date--------------------------------------
Test Pit No. 1..............."minutes per inch Depth of Test Pit_..__............___ Depth.to ground water..-._---_--.--.--.-_..
fZA Test Pit No. 2................minutes per inch Depth'of Test Pit------------------- Depth und water--.-.._-_-_--_--_-_-----
................................. .......... ..... ................ ..............................
0 Description of-S ......
------------------------ ---- -----a------------------------------------
*-----------
......................................................................I.....................................................................:-----------------------------------------------------------
U
------------------V-1--------------------- ----------------------------------------------
---------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable.:..-------------------------------------------I...................................................
- ------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------
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 undersign further agrees not to place the system in
A V6
>7
operation until a Certificate of Compliance has been su bythe r;dhealth.
e ......... ... . . ..................................
71-
Dale
Application Approved�By----- ----- ....40 ate . ...
ate
Application Disapproved for the following reasons:......- .......................... ... ............................... ..... ...........................
'Pp
.............. -----------------------------------------------------------------------------------------.................................................................... --------------------;7Date
PermitNo........................................................ Issued-.-- .. .... ........ ........... ........
Da
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9f HEALT
0 F. .. .... ...... . ............
Trdifiratr of TOmphaurr
T S S TIA, That the Individual Sewage Disposal System constrticted (4 0®r Repaired
b
/ Udf
.... .... .... .... .............. ............................. ...........j.............
-------------------
'000, Install
.................................................IJ........... ......a 4W.......
Article XI of The State Sanitary C dews d lb d in the
has been installed-in accordance with the�provis�i oi�_�.rt a es;r e i
application for Disposal Works Construction Permit No._._.!�44----a------------- ..............
THE, ISSUANCE OF THIS-CERTIFICATE SHALL NOT BE CONSTRUED As A 6ARANTE"E THAT THE
SYSTEM .WILL;FUNCTION SATISFACTORY.
DATE................................................................................ Inspector------..............................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD '9F�HEALT
C— .7 0 . . ..................... ...............F*.......
'�71' F ... ............No......4-
.................... EE.
IT Pali 0 a'
Permission is hereby granted---- ........A
n- ------ . . ......... .. .......................................................................
4� I S t m'
to Constr or Rep n Ind�ividual-Sewage pbwl S
a .... ..................... .... ... ..... -------------- ------- -------- I..........................
.7�
Street
W
n I pose} Sy t n
as shown on the a hication for Dis osal Works Construction P No- ted_A�
'o 1j'S
.......... ...........
oard of ealth
DATE------------- ...... ....... ------- ------ ------- ...................."I-----
'12.
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e FORM 1255 -HO S & WA/EN. INC.. UBLISHERS