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HomeMy WebLinkAbout0032 CROSBY ROAD - Health 32 CROSBY ROAD 229-129 CENTERVILLE i • UPC 12543 No. -3LOR �+4 V r14GR �/N OWNax.a:na: No................... Fics..... .............. l THE CO-hMONWEALTH OF MASSACHUSETTS iy BOAR�g0l= HEALT Appliration for Dispa—Dal Works Tonstrnrtiun Fermi# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System any O D��� - .. ..� _ �............... .............. - ..... -05:- .......................... Location-Adder - or Lot No. lo� caner w � a .� L------------------------------ ��/ J. �- ---- .._ Installer Address A ��/ Type of Building Size Lot..........�---------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------••----•----•---•••----•--•--•-••--•-••••-••---•-•-..._.•-- W Design Flow...........���2..---- .-.------•---_gallons per person er ay. Total daily flow-------- - '��__�_ ..................gallons. WSeptic Tank—Liquid*capacity..) %allons Length.!�;'.).P. 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 (L4 Dosing ( Percolation Test Results Performed by---- :: � ` ' .------••` Date Test Pit No. 1_/ —=minutes per inch Depth of Test Pit........./�- Depth to groun water.___. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..................................... ,...... O Description of Soil (r�.....- ��....... t l _ .. 02.�......----------•------••-------------------------------. x ............. 0 W .......................................... - _ �--------------......................................................... -----`--��•--------------------------------------�----a - --------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------------------------------------------•---•-----•--•--•-•-•-•------•-------•--•-•-----------•-------------------•--•--•-••••••••---------•---•--•---••••••-•-••-••-•....._......•--- Agreement: The undersigned agrees to install the aforedescribed Indivi ial Sewage Disposal System in accordance with the provisions of iITLij 5 of the State Sanitary Code—The un rsi d further agrees not to place the system in operation until a Certificate of Compliance has b en, s ed y thgAo of health. Signed--` .-•.........................................---- . •...aA. • ••- . .. i � / Date Application Approved By------•------•-•-•-•---•••• �--••...........................•------- ..........�..� 1 Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- .......................•----•-•----•-----••-•-------••---......-----•-••-..........-•----------------...-------------•-------••-----------..._.....---:•--•-•-----•--••-•------•-------•-••------......_ Date Permit No......... ` ` -- issued ._. b .�`___._-....------ Date _� _ -- -�---- -- - -- ------- ------ _�_- .��W�_ �_ ----------------------- ------- No......................... �, FEE..........:�.............» THE COMMONWEALTH OF MASSACHUSETTS BOA R r OF E AL OF.:........... ...............................................-........................ AVVliration for Bispaaal Works Tonxitrurtion ramit Application is hereby made for a P4-�. Construct (t'°�or Repair ( ) an Individual Sewage Disposal System at• n l .... •------- . l � - Location-Ad s /� s or Lot N ! ..._... t.✓ c� f _I / /ice ----------------------)_... ...... . ..--••-----•-••. ---'- . .....•-•......-- _ _. ./' j'- /III _,.Owner !). .............•............. �—.�'�_...:: _ _1-._�'1.1!_..° .................-----------.................... Installer Address f; Type of Building Size Lot.............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------•------•----------•--•--...---•--•--••---•-•-----••------------._..........--••-----•-••- W DesignFlow............r� ._ gallons per erson• day. Total daily flow____-•_--__ Ions. g P P P Y Y -----•-••--•.gal WSeptic Tank—Liquid capacity_ R'Vgallons Length%`•).-_• Width................ Diameter................ Depth................ x Disposal Trench—No...........- ................. .._._............_........... Width_ Total Length Total leaching area.,...... ---sq. ft. � � Seepage Pit No 1______________Diameter.._.) '_:........ Depth below inlet.................... Total leaching area.--...............s q. ft. Z Other Distribution box ( Dosingk ( 4 ?/ � ! ` = �r�' Percolation Test Results Performed by-__ _ _ :?`_.'. _ -- Date _. a x a Test Pit No. 1-4.�_- .minutes per inch Depth of Test Pit........ r___ Depth to ground water-__- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---- .... O Description of Soil.....— '� ? ^l -fit t - - - ..- - V y,----•----•••••-•--......•-•••------=••••••-•••••. ----- --•- ----------------------------------------- . .............................. ' �.i � U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------••-----------------------------------------------------------------------....----------------------.....----------------------------------•---•-••...•------••--••--- Agreement: The undersigned agrees to install the aforedescribed Indivi ual Sewage Disposal System in accordance with the provisions of TITI1 5 of the State Sanitary ode—The u ers' d further agrees not to place the system in operation until a Certificate of Compliance has Veen) ue by t b of health. F Signed_. ._•. ......... ........'""'"`-- _.,,,. ..�-.... ..`�". ApplicationApproved By.......................... -...—.......... ---"•......................................... .......... �n;7e/-- Application Disapproved for the following reasons----------------------------•--------•-------------------------•---------------------..................-•......-- .............•••--•••-----•-----•-•---••------------••-•--••--•--•--••-.......--••----.......-•-----•--•-•-----•-•-------•---••-•••---••-•-----•••-•--•----••---••-------•--•--••---•----••-----......_ ate Permit No........ ... `� S? �� -. Issued._.. © ..... .......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,-QF HEALTH t `i"/Y ...........�"''.................OF...... Y'R, -............................................ (9rdifirate of Toutpliattrr THIS 0 C ERT. F ',That the Indiv' u Sewa Is osal System constructed ( ) or Repaired ( ) P 3 { '`� -••--------------------------------- bY-•-••--••-•--•--•--••--....-•--• -----•.._.. ••--••-•..... .- ._ ------------• ------------ f Instller has been installed in accordance with the provisions of TI IFe 5 of Ths State Sanitary Code as described in the 2 application for Disposal Works Construction Permit No.... _. .-- _. ..:.... ...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE COPSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE � = Inspector. - - ---------• -•-• .... .................. r THE COMMONWEALTH OF MASSACHUSETTS BOARD Qf HEALT r r + / . AF- ..................OF..........., .. ...! '........--_... ..._...... No.............�.�1� /� FEE--- y �i��u�� u� �on��rttr�iuZrrnti# Permission is h reby granted....... ..... ............ r_: t to Construct (✓ or . tr _an Individual Sewage Di at No............. = � ...1.. - _ --•--. -- -•••----•------•----•-•.................. Street as shown on the application for Disposal Works Construction Permit No..... ... ......... Dated................................._........ .'_ Board of Health DATE.-----------••--••-•--------•--------------•-•---........................_._._ FORM 1255 A. M. SULKIN, INC., BOISTON �,aI�.IGLC- FAMILY - 3 BEpROOM 1.10 GA2BAGE 6¢.,a,IOEcz. , p/\II.Y FLOW/ s 110X 3s 73or.��;! Q - 330x15O% : 49�'G.t Or- ,�EPT1G TA K ' � �.. usE loon GAL. o15Pos�►- Prr u6E Ivoo �Gt_. 150 5.F BOTTOM 50 5.1' X 50 'ToTA1.. C6.SIGN = ,4Z5 PE2GoL.AT10►J MATS : I'llN 2MIN o L ` S 12'�-��Z� ~ { C,3 61 ULLIV to V N1r 'STr.Nr: No LEAN 9 1 co ET iJAN110►j I! �55•0 ' f �EMQ,I ALL UKSU,T'i3L_C 141,11\7& ilL TOP F►.IU= - 'f6%'T 3666 r •y�y q 9 NoL� �o•9-8g I C-t�4� �� 1, 1, I�, � / luau p�ST. INJ. Gnu. / 1000 3• LEAc u '0 PIT INV. N w I T u 1' t'/3/�i•I%L 4 � VJA��IGD 5 6TvNe - A Gt=Q.T1F1GD PLOT PL.AQ _ ✓ UFI L6 CL 12• Wo SCALE ScAI:E+ 1'- �, ? V A.TFc 10. 2A.9- !' ►1 ova E 2 �,zo E? p L.p.► j fl ILr TN T T1+If= --Pv4CLL,k.1C`. SuovYN gQ%LSCW GOMPL`(5 1n11TN"[NE S 1 cELlt-1{r J A►�� S 6T p�e►GK R.6 Q�I Q 6 Mt:N'Z'� o f -t N� ' 'TOWN O� �AK►-tSTq'c3L� AND IS lD- 6 A C,L,OOD LOGA.TED •WIT —L74 IN : f �'•. _/ gAxTE2� tJ�(E INC. REG I S'c E26v'►.Au Ti11�j PI.QIJ I�j Nam' f's�'i�D AN OSTIc2VILLC• i IW5TP_uMEW•T Sue.Ve.-Y aE pt=�SE'r5 SUOU� .�,. �� sicFnTCP OE'fER.'^I►�� L oT APPLICA►- r.-f LOCATION � r `3 S E W A G PERMIT NO. VILLAGE 0,e�i, Lo (cq t'U-� I INSTA LLER'S NAME i, ADDRESS cc BUILV, OR OWNER v DATE PERMIT ISSUED lO 34, -94 DATE COMPLIANCE ISSUED ' ��a Y'� i�� _S-�, 1 `