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Home My WebLink About0065 MONOMOY CIRCLE - Health &5- /YI��Iarrld 'r,� �f NW 'GONJ1SNR lest ON 0££0 t adn 1/Id IIJd Fnn.1.4..................... THE�®P°i�®ALT Q� F ETTS HEALTH ...........OF......... .. .. . ... . . ,� fir iiQ fur Ulsp ua.l .>arkti Tumitrudian Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... -- ...................--••••--•- ------ .................................................. 7L n-Ad es qr No. ..... Ow Address a =� Installer Address Type of Building Size Lot. -/:_•--_----•-•-----Sq. feet aDwelling—No. of Bedrooms.......... ............................Expansion Attic ( ) Garbage Grinder ( ) p� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. W Design Flow.............i ... ...................gallons per person per day. Total daily flow..............�..4�')..............galIons. WSeptic Tank—Liquid capacity. gallons Length................ Width_------------- Diameter................ Depth................ xDisposal Trench—Po- -- ------------- Widt _:...__._ otal L gth_:_ .__._......... Total leaching area.................... ft. Seepage Pit No..... Diameter.. _' l e Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to ( ) ro�— a 0a _ jf — ;=j Percolation Test Results Performed by......................................................................... Date........................_............... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' d O Description of Soil ...�.. -t � 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 XI of the State Sanitary Code—The undersi Aed further agrees not to place the system in operation until a Certificate of Compliance has beenisslied by the boar of health. Sign •... ••-- •----------•--..... -----•-••---••-••-• •-•----•---•--•-----•-••--•-•--- �r � .r............. D ate Application Approved By--.--- . / j .....�.e Date Application Disapproved for the following reasons:--•••--••-••-•-•---•----••-•----------------------------------------------------.............................. ...------•-•-•-•-•.................................•------•-----------------------------••-•-------------I-••-•-------------••-•-------•..._......----•------•..........--•----•--••......---•••••....... 0L 7 pate PermitNo......................................................... Issued..... ........................................... Date . . No...�-��- ', • ';fp FEE.14..... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL, 1 . ------..OF......... ." .. .................... Appliration for Mopoal Workii Tonstrnr#ion Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......ca �z...-----•--•------ ----------•-------..."' `.... .._. ... ............................................ L n-Address or Lot No. :... . �. :.: ---------------------------- ------•-----------------------.---_--_ --------------_------_____------------•-------•------- W - OWn Address w=IV ................... ;.. Installer Address QType of Building Size Lot_ : _ .......Sq. feet aDwelling—No. of Bedrooms___..__.______________________________Expansion Attic ( ) Garage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) PaOther fixtures --------------------•--- ------------------------------------------------------------- J g ------------ .1 W Design Flow............. ._._______.__.._.__gallons per person per day. Total daily flow............. ..............gallons. WSeptic Tank—Liquid capacity. gallons Length................ Width................ Diameter---------------- Depth------------- x Disposal Trench— o____ ______________ Widt __ otal L h ............... Total leaching area....................sq. ft. Seepage Pit No. Diameter w t�(" �_ /�,,� _. ... Total leaching area..................sq. ft. Z Other Distribution box (' ) Dosing to ( 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........................ P4 . . Description'of`Soil................................. W •--•---------------•-•-•--•--•••--•-••--••••-------•--••••••......-•••--•-••••......-=••.......................... •••-•-------•••-••-•----•--••---•-•-•-•••••••--••---••............•------------_.... 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 undersigg ed further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar Hof health. Sign ..• ......... "" ................................ Date Application Approved BY------- -- ----- .... •. "" `� / Date Application Disapproved for the following reasons------ ---------------•- ......................................................... ......--••-•-•-•------------------------------------•--------------------.....--••--•--------------------------------••-•--•-------------------•----•-------------------•------------------------------- Date Permit No. ` ---_.. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4' ...OF........� ...........:: ...................... T I 0 C TIFY That the Individual Sewage Disposal System constructed ( 14-0�7 Repaired ( ) by .... ....................... -------------------------------- ---_. ............................................................. r JAstal at. • - �` C --•---t•- --• -• --•------•••-----•-••••-•-•------------•---•------•••-•. has been installed in accordance with the pt�isions of Article XI of he State Sanitary Code as described in the application for Disposal Works Construction Permit No------- '�" "L"'�_____________ dated_14_ J C*-...7N........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A}TGUARANTEE THAT THE SYSTEM WILL FUNCTION..SATISFACTORY. DATE................................................................................ Inspector......................................................:............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD 0§ HEALTH No.. �_.. J `�! .....OF �'7` ......................... FEE.. Mopsk Tuanitrnrtion ramit Permission is hereby granted----.._... I---------------------------------------------------------------------------_ to Constr. ( or Rep ) an Individual Se a Di sal S at No.... ��"` ��1� - ..Y............ reet V,;._en .....••---•-••............................................................ shown on the application for Disposal Wor Construction Permit 1 ated "� ��I ......... -- —� Board of eaIth .. •----••................................................... FORM 1255 HOBBS & WARREN, INC., PUBLtSHERS - i 6 x 3 I L 3 ! # R iZ�j it ` 7 - 1 i �' !i 4 �- J t� • '� � i ,,, - / r�Z � � - , �- -_..�.�E._..w...�....».W.,.-..............+tee, ..,...,,...._..... � i�r_�4 Yk^.......,�(�S _ - - �� -i. I i .. I � 'f f � � A f �,,,. ! � � 1, -$�, i {� � � �, _ _�i 4 f s � ��'. � ,. �. {4.._ __..._.....e.� ± b � 7 I�r!W i%a' _. I i{ � *� a� * 4 S � " ' g � � �,� � -'r' �. �� jj L L YY � t .� �,� _l � s �.� - �� . i I i '+rY f �� j I 2e { 1 �� 4