HomeMy WebLinkAbout0206 CEDRIC ROAD - Health 206 Cedric Road
Centerville
A= 149—086
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THEBOP'1RDALTHCOFUASSAC TSLE-'TTS
.................OF.... 1f— .II�-11 '..............................----------
Appliratiun -fur Biipuuttl lVilrbi (nunutrurtiun Vaniit
Application is hereby made f� a Permit to Construct ( �®repair ( ) an Individual Sewage Disposal
System at:A�-_P-(o X0
ll
--------- ---------------------------- -------------•------------- .._ .._.........
L catio Addr or Lot No.
0 .._._....__A...................•____... ......... _. ...
._................. ....... ...._. ...._. ..dre.........__..............................
Ow er --_------ Address
Installer v s Address
Type of Building 4- -ff- Size Lot....../� ------Sq. feet
Dwelling—No. of Bedrooms---------------------------------------_----Expansion Attic ( ) Garbage Grinder ( )
`L
p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Ga Other res ------------------------------
w Design Flow........... ... :.......................gallons per person per day. Total daily flow......... _ ____—_..........gallons.
WSeptic Tank—Liquid capaci _gallo s Leng ---------------- W'dth- ----..---- Diameter___.-.---------- Depth----------._..--
Disposal Trench—No. ............. Total leaching area.._. __sq. ft.
, - - _
� Seepage Pit No________ ___________ Ia r...........__......_ ept elow inlet________ _.. .._. Total leaching atrecl.......-----------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) ��� � �' A�_-7- 7J
aPercolation Test Results Performed bY---------- --------------------------------------------------------------- Date---------------------------------------
,� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_..._.--_-.-_-._-.-_..
�14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_-.--._--__.---.__---. -
,+ -------- ;------------ _.... a
O Descriptio of Soll-------Q 4-----
U --------- ------------------------------------------------------------------------------------------------------------
------------------------------------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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has n issue by the and of 4�plth.
Signed : ............... ------------------------ -------
Date
Application Approved B _._:. . . __ �. .. &:7-/--
Date
Application Disapproved for the following reasons:--------------------------------------------------------------•-•-------------------_----__._-----••-•---•-------
--------------------------------------------------------------------•--...---------•------•-•....------------------•------------------------•--•----...--.------•----------------------••---------.-----
��- Ite
Permit No......................................................... Issued....J-2.-
ate
-+ . i
.. ... �' Ficiz c)..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARDl-' F H 7, TH
4rW�....._.........OF..... .... •-:.....................................
Appliratfun -fur Mgpuiitt1 Works Tomitrnrtiun Vrrnift
Application is hereby made for a Permit to Construct ( L-)�or Repair ( ) an Individual Sewage Disposal
System at: 1
L cation Addre s� or Lot No.
/f Ow er Address
a = _ •.... ---- •----. /(�„r -------------------••-•-------•---------
� Installer a r, Address /j,��
Q Type of Building s Size Lot..........-("_______________Sq. feet
Dwelling—No. of Bedrooms-_--_-_-..__�'------------------------Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building -------------------_--._-- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
0.1 Other fi.:tu es --------------
W
Design Flow............ ..............................gallons per person per day. Total daily flow......._........«_......._......----gallons,
WSeptic Tank—Liquid capaci�,,v Y?)-f}gallops Lengt ____.__. .•.__ W}idth.. ...... Diameter-----.---------- D_e)th
Disposal Trench—No_ __________________ Wi f_ ........at. o hm _______.. Total leaching arca__ _: �'Z~..sq. ft.
x � 5�
� Seepage Pit No.---------/��� a e er.................... 1jepth below nlet..._..._ --- Total leaching_area..--------------..sq. ft.
z Other Distribution box ( ) Dosing tank ( ) D,�- -
Percolation Test Results Performed by------------------------.................................................. Date---------------------------------------
,� Test Pit No. I ______________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 ..............
O
Description of Soil.------- -/V----- ....... ------
U -----------•-= :--l F�4
---------••-------------------•----------.----•-•-•---••---------------------------------------------------
W
Nature of�Repairs or Alterations—Answer when=='---•-•-----------------------------------------------------•-••-•---...----------------•------•----------------
U P' 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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the bo.ard of health. �.
),
tgnecl. fA �. / ,- Lx /
1 J Date
Application Approved BY----------- Gam. • ................------ L !/�-s --------
Application
Date
Disapproved for the following reasons-...........................................-•___..__...._...._.____.____.._______..............._...__..._.._.._.
-----------------•----------•------------------------•---•--------------.-----------•--=----•-----------_--------------.-------•----•-•---•-----••--.----------•-----------------•_-----••--------------
Date• � g _
PermitNo......................................"------""-"----- Issued-=--/ ------^< ..................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD: OF HEALTH
............ .... ..'�.``.M�V..........O F...!•'fir::..!l/...'f tF.�.................................................
Clrrtifiratr of Tv iph 71r
THIS IS TO CEIis�IFY That thk' s s Individual Sewage I s m constructed ( C.-)or Repaired ( )
by
has been installed in accordance with the provisions of A icl'�j I .f The State Sanitary Code*as described in the
application for Disposal Works Construction Permit No------------ ............... dated...__/�'..1.?..-...7_ �.......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR A ,A GUA TEE THAT THE
SYSTEM WILL UNCTION SATISFAC Y,
"""' °- ,
DATE........... ='---_.: .----------- ---- -•----------------- ......... "�`� Inspector_---- ---------=---------=------------------------------ ---------=--------------= .
THE COMMONWEALTH OF MASSACHUSETTS
` BOARD OF HEALTH' J �'
3r9 ._ t� h.. ......OF.......% Cvt:`, z'..:.. : ...................... ----
No............ FEE--- ..............
Di-tiVaiiat. Norkii TITiazitrur-tiFfr t
Permission is hereby granted..... ` ! s
-----•-- ..................
to Construct or Repay( ., ) an)Individual Sewage Disposal System
Street
as shown on the application for Disposal Works.Construction P it _______________ Dated'__ �_-�.��" �� ........
.�I� ---------------------------------
Board of Health
DATE._....._.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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