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Home My WebLink About0055 CIRCUIT AVENUE - Health C�! ��.u�' 'i�th2.n.l.c�_ � / ��. �� 1 r� i j. l j 1 I i i i S I Tr t, I No.... ....... 3a 4 — FiRm.�.................. THE OARD OF ALTH FHEAc TH TS f !L- OF..... . ............................................ .......................... �Piiration for iaposal larks Towitrurtion rrnait G� A lication is hereby made for a Permit to Construct ( �r Repair ( ) an Individual Sewage Disposal at (/� ---- - (� Loc n- "ess orof No!7--44- GG/ -'err r ., i —Address W �- a ......... "-----• ----•- - --- - - - •--•--------.. -•---- ns alter Address � C. `— Q Type of Buildin_gr Size Lot--- ----------------Sq. feet Dwelling No. of Bedrooms............. .............__.._.Expansion Attic ( ) Garbage Grinder ( ) `-4� Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures . -----------•-----•-•--•-•-----•-----•----•-----•------------•-•--------------•--••------ W Design Flow...................t$_73_-.-------_-__gallons per person per day. Total daily flow............._._....__ _-------gallons. P4 Septic 'I. quid capacity------------gallons Length................ Width---------------- Diameter---------------- Deptli_-_______.__..-. W ,. W Disposal No..................... Width-_-./�. ..._.._ Total Length-____20.._._ Total leaching area.. .d' __sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area____-_----_.__.--•sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----_--___-___-_---__--. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-___-______-_---.--_-. -- ---- --------------------- ------------------------------------••---••------- O Description of Soil_____________ _ J� - ------------------------- �"k -''Q ----.. GA G -- ..... V Nature of Repairs or Alterations—A swer when applicable.................. __________________________________J_----_---__--.-----__-_-------:... ..-•••---•••--•---•---------------------------------------------------------------------------------------- ------------------- 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 issued by the board of health. Sigd...... -•• ---------------------------------------------------------------------- ----------------------------- - Date Application Approved By---- --------- --- - --� - 73_ Dat. 7� Application Disapproved for the olio "n reasons:. ._/.__s_ ___________ ______________ __ ___________________ _ __'�------ �.A. ? / .- 6. E A Date r Permit No. .... Issue&................................................ Date No.--- ....... Ficicz-2.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................... ..............OF..... ...... ....... Appliration for Bhipsal Workfi, Tonstrurtiou Vrrutit Application is hereby made for a Permit to Construct Or Repair an Individual Sewage Disposal Syptem at: d e ---7---------.......Z. --- -------------- .................................................................................. on AtiessNo a ... .........r:VC......e.. ................... ---- ----t . .............. Owner Address' ....................................................... ......................................... ........................................................................................ Installer .-I Address Type of Building.- Size Lot---L---------------------Sq. feet Dwelling—No. of Bedrooms............................---------------Expansion Attic Garbage Grinder Other—Type of Build'Ing ............................. No. of persons............................ Showers Cafeteria Other fixtures ..................................................................................................... ------------------------- Design Flow..................... ............gallons per person per day. Total daily flow....._ -----------gallons. Septic T '.iquid capacity _-_----gallons Length________________ Width ---- -------- Diameter---------------- Depth---------------- I C-411 H&V No. ...........:........ Width.:J......-------- Total Length............e To tal otal leaching area.:�X ...sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.___.....__......... Total leaching area-_--------------sq. ft. Z Other Distribution box Dosing tank �4 0-4 --------------------------------------------------------------*.. Perc6lation Test Results Performed by..... Date---------------------------------------- .Test Pit No. I................minutes per inch Depth of Test Pit_._..__._........... Depth to ground water---_------__.___-_--.... f1, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------- -------------- ............... ............ 0 Description of Soil----_------- n I ... . ................................. ---------------------------------------------------------------------------------- '? i�r U ............................ ................... .................4...........2................ .4. ........ ...... ----------------/-------- -_,!_4 z.t Z..... -------- Z4 ---t---------- ---------- 4,d Z q U Nature of Repairs or Alterations—Answer when applicable---_---------------4 ------------------------------------------------------------------ .......................................................................................---------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed 'Individual Sewage Disposal System in accordance with the provisions of Article :kl of the State Sanitary Code— The undersigned further agrees not to place the system in operation,tintil a Certificate of Compliance has been issued by the board of health. pia Sighed i �------------------------------------------------ -------I'll-,--------- Date Application Approved By------------ .......... ......�.`4 ----------- ?7- 11....................... _ 7--- Date Application Disapproved for the following reasons:............................I------------------------------------------------------------------------------------ .........................................................................................6............................................................................................................... Date 'Permit No..............................I............................ Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... .... Za .........1:1...........OF. . ....... T'Wrtifirate of Tontpliatirr THIS IS TO -CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by........77------- ...... . ............. I........................... -- ----------- --------------I-------------- i'n's't'a1'1e,_r------------------------------------ -------------------------------- ..........at........L�... ---------------------------- r 7 has been installed in accordance with the proV64ons of Article XI of The State P Sanitary Code d sc ribed _b�e$d in the application for Disposal Works Construction Permit No................ ............ dated----- ..1.7 ..........__. THE ISSUANCE OF TRIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F T I 4A I"S C-!�QRY. DATE................ ... ...... .. ... ........ Inspector........... ------- -------------------------_- 40 THE COMMONWEALTH OF MASSACHUSETTS -S 3? .1, —4— BOARD Qf HEALTH ....... 4��.............OF............... . ..... ................ .................... No..../A .. FEE---Z ------- .............. i3iiiVaua'I lVarkil Cann *arartion rnait Permission q, - ( is. hereby granted------------------.......................0 to Constru t y �I .r. ' - epai ) an I Y- p., , lil idual Sewage Disposal. System ) il atNo.-- -------------------------------------------------------------------- 7 Street ,as shown on the application`for Disposal ks Construction RerTm*t No.. .. ......... .A)ated---- ------------7.,!. ............ 7- --- ----------- .. .... o ........ Board of ealth DATE 7 2 1,g�l- ------------------------------------ FORM HOBBS & ARREN. INC.. PUBLISHERS f YI I 1�0 � i r v Y