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Home My WebLink About0018 CEDRIC ROAD - Health 19 Cedr►c �d ce n-t'ervf lit 12,6 /// s M EA® No.2-153LY UPC 12934 smead.com • Made in USA 3g SUSTAINABLE FORESTRY INITIATIVE I GruBed Fi6u Sourcing WANAIPOWULUO 1 LOCATION SEWAGE P JRMIT NO• VILLAGE r� I N S T A LLER'S NAME & ADDRESS &5 B U I'L D E R OR OWNER mk 1e , IS CCDM 20 ibf-4AUE DATE PERMIT ISSUED �� DAT E COMPLIANCE ISSUED 9/-3 A- Tb .PIT i A -To P%T $- 76 -rew is -- g-ro PIT t 1 - -Tp PR a 0 o p-$a� 71 NO.......� _.......O THE COMMONWEALTH OF MASSACHUSETTS BOARD Z�FtEALTH�W�..............OF................... ..... ............ Appliration for Disposal 'Workri Tonstrnrtiun thrutit Application 's hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal. System at: r .............. ------ _....�...----•--------•- .•--•-... .. .... .....---•-------... ....... . .---••----•...�.--------•---. ...........................................lG�c Locatio ress o o. Owne ddres --------------------------------------------------- -----..!� ... ... -•-•.... ...... ..... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.....- ....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther 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........................................ W 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. a •-•••----•-•----------------•-•••••••••-•-••-•••.....••-••-.......•••--••-•----•--•---------•-------......................................................... 0 Description of Soil..-•-----------•-----•-•----•-------•...........-•-•-•......--=•------------•-------------•-•-•-•••-•-•---•-•••••----..............--••--••....---•---•--•---•-•...... J... ,94d...----------------------------------------------------------------------------------------------------------------------- W •-•--••••-••-----------------------•••-•--------•••------•-•----•------•----•---------•••-••-•-------------•. 2� G n�a plicab .- --dL �Q - - -- - ----•------- Nat 4 of Re irs or,Alteration Answweir w� nA / li '�.tc,L 6- - �/ jl� ---------•------------ ....----Y•--- -•-- ......A -------- ... Agreement: v The undersigned agrees to install the aforedescr' ed Individual4e. Disposal System in accordance with the provisions of iI:'1,;:. 5 of the State Sanitary Co —The undersier agree not to place the system in operation until a Certificate of Compliance has been ' ued by th board . Sined....... ................ ............. .................. ---..................... --......5fl? C!l Date Application Approved By.........'...A....:. ....... ...................•-•--•---- Application Disapproved for iZ following reasons-------------------------------------------------------------...............................Da.t .............. ..........................•---•-•-•--•--......-----•-----•------••---.....---------...---------....--------•--•••--•-•-•-•--------•--------•••-•-••-------•••---•--------••-•••-----••-•--••-•--•-•-•--- Date PermitNo..---G-X••R ........................... Issued_.................. ................................. Dattee No................_....... a Fxs.:7..............:......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .........................................OF...................... .................---............... Appliration for 11itipuiitt1 Works Tnntrnrtion Frrutit Applicatiom-is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: — P✓t CE'/�ti Z- �� Location Yddress or Owner r Addres/ l /� Zvi �Yx�/' f r.D t J TE .G .............. --............... ... Installer Address dType of Building i� Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.....-......................... .Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building No. of persons............................ Showers Pa YP g -------------•-•--•--------- P ( ) — Cafeteria ( ) G4 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 ( ) aPercolation 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........................ •-••----------------------------------------------•----•---•---.........-•--•--••--•---•-•------•--.........--•------------------•--•••--......--------....-- 0 Description of Soil......................•-•-......----•-•-------•-----............-•------------------------------------------------------•--...-----------------------•......------------ W ••••-•--•--•................•------•---•---•----•-------------------••---••---..... ----•-- U Nature of Repairs or,Alterations—Answer when applicable....-.._ ...__... !-...!t •---�� ..--tl/Z {��•-•-• �----.......... C, rt..... /,%r.7�- --r, .....�`"Agreement: / /I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A I T.I- 5 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 thelboard of hea th. Signed.................................................................................. C> 25// 9/ Date ApplicationApproved By--•-•--...:i�........................................................ ............................ ........................................ Date Application Disapproved for the following reasons----------------------------------•-•-•-•-•------------........----------------...----------------.............. ......--•-•------------------------•------•--•----•---------------------.....••••••--------•--•••-------- Date Pprmt A — THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1---) .............OF.......... ................................ Tntifirate of Tourpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( t-Kor Repaired by.......... ...... ..................I........................................................................................................... Irl't 117 at.......... ................ .................................. ......./'atz:......( ..... .......................... has been installed in accordance with the provisions of TII�1� of The State Sanitary Code as described in the application for Disposal Works Construction Permit No— .......... dated-__......-_.................................... Q THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................... 1-711,2 ............................. Inspector....... ,�.z........................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , ........................../ .... .............OF............;//-'./I....._',rJ, ,/r /� ............................................................. No.........__'. ,7 FEE............... ... Dislimal 10orkii %'Donstrurtion an it Permissionis hereby granted................................................................................................................................................... to Construct ( ) or Repair an Individual Sewage Disposal stern at No............Z I � , /Disposal. .................................................................................................................................................................................. Street e— . / as shown on the application for Disposal Works Construction Permit No..../............. Dated............................................. '�'-0� �- .........................................:'i.../( , ................................................... Board of Health/ DATE...................7........�).? ....../...).................................. . ... ... .. - FORM 1255 HOBBS & WARREN, INC., PUBLISHERS