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Home My WebLink About0093 CIRCUIT AVENUE - Health G3 U>c�., � fie , /M >' � ION SEWAGE W A E PERMIT NO.� LOCAT G f. VILLAGE V6 R yan'v)s INSTALLER'S NAIVE i ADDRESS Cl, 19 BUILD R OR OWNER DATE PERMIT ISSUED J�/I DATE COMPLIANCE ISSUED, f � M 1 � � v GJ M .�....!1... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ) . ...........OF............t lJ" J ...................... Appliratiun for Bi_qpustt1 Works Tomarnr#iun Vernfit Application is hereby made for a Permit to Construct ( ) or Repair (L-j an Individual Sewage Disposal System at: rr....�. .).: ........-Y..3 un............................. ................ Lo ation-Address or Lot No. _.....Y.11..a 2J.. ss ------ .....--. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other fixtures --------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 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___.___..........._. Total leaching area..................sq. ft. 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.......----..........--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................---- ............. --- ----- .................�_..._.. .. iE�O Description of Soil---------------------- �.� l� �d - - ........- - --._... x U •-•--•-----------••••••-----------------------------•-----•----------.............------......------------------------....------------------------------------.......------....---•--------.........---- 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 TAITILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the b and of health. Grp . gne Application Approved BY---•-- --- -----•....................•----------......_.......................... -------A" Date Application Disapproved f t following reasons-------------------------------------------------------------------------------------------------------•----... ........................0........•........•-----...........................------.....................................................•................•.................•..•-•...... ......-------- Date PermitNo......................................................... Issued.................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .( ` ...........oF............. ? _s, _.,b) ....................... Apphratiou for Dhipoii al Works Coat #rttr#ion rani# Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: Lo atio e Address } or Lot No. ......................_........ . � `tt................ ...... .... ..........lr l d �^ :�L.,.. .................................................. J 1 Owned .P. Ald ss �. �y •jj. ._4_. �:�'� �1/__��.....-•••...........................•••-- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________ .... No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .............. ••-•-----'.............................................................................................................................. w Design Flow........................................... per person per day. Total daily flow............................................gallons. 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.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •---•-•-•--• .............. O Description of Soil_____________________....................... x 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 TITL L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. f ✓ g � JJ e Efate Application Approved By_ ................... � C'`...__..- -�`-'�"------------------v..._..--•---------•------------------------------"" ------�-•-/�/� / j Date Application Disapproved f t following reasons:........................................................................................... ....................................................... -•••••••••••-•-••--••••-•-•-•--•---•-•••••••••-----•--•••--•-••••--•••---••-•--••••••-•-----•••--••••-•••-•••••------•••••--•••-•-••--•-----•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ..........OF.........dr,� %f �rr�,,1/. ....................... Trr#if irtt#r of Toutpliatta THI. IS,,, 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( °-- ffw •� 4 ns�allerle has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod as ,des ibed in the application for Disposal Works Construction Permit No._Klf:--- ______________ dated., .................... THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM WIL F CTION SATISFACTORY. DATE....-P. . 1.. --------------------------------------------------- Inspector........ ...................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH �r...OF.....� 0 :5/F k ............. ............ No......................... FEE......� ..'� yorrkg Tons udwitt .erns' y, Permission is' hereby y granted"--J:-1 ! '57 ---` !1.. ..................................... to Cons ( or Repair an Individ a Sewa a Disposal System at No. � _�'l!%1".�.__.....��....--...---.�t l, �d W. ------------=--•..................................a 6e ....... Street as shown on the pplicaiion for Disposal Works Construction Permit No_____________________ Dated.......................................... ..............................••--•-•••• --------------------------....••••••••-•-•••......-•_•- �G� (/ Board of Health DATE---."1......... ............................................................... FORM 1255 A. M. SULKIN, INC., BOSTON