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Home My WebLink About0162 CEDRIC ROAD - Health 63i. Ced ri C rd� C.eATerv; ►it� m—'o 81 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10°(0 Cer6Ted Fiber Sourcing POST-CONSUMER www.afipropram.orp W1290 MADE IN USA GET ORGANIZED AT SMEAD.COM LDC p.` SEW C4E PERMIT 1U0. V� VILLAGE 1NST ER ►J - E � ADDRESS BU1L R 5 t.J LAE DD ESS - - - - DIlTE PERNA T 155UF-D DATE COMPLI h.MCE _ISSUED:. .-- - .- t 6 ✓� �/ R r� GC 7 - � / THE COMMONWEALTH OFMASSA;HUSETTS ORD ` � — - -- ------- *OF....... ........................ Appliratiun -fur Uhipuuttl Works Tot utrurtiun Vrrnttt } Application is hereby made for a Permit to Construct ( or Repair ( } arL Individual Sewage Disposal System at ��.. ( � -- •- - Location-Ad ess� or Lot No. Owner Address W . : / L� dr ` s a /�:�1 Address UType of Building QV�J Size Lot...-__./ -----Sq. feet .-, Dwelling—No. of Bedrooms__.................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ------_------------------- No. of ._persons - - .------- - -Showers --fete.._._(__...). d Other fix res _ _____________________________ P S ( - Cafeteria W Design Flow.____.____.....................gallons per person per day. Total daily flow..._...._....:,�,.e1_rD..................gallons. W Septic Tank—Liquid capac��C9naallons Length Total n t�idth-.:-.'----'----T tal leaching area.�eel)�__._.s ft. x Disposal Trench—No_ ......._______ _ W4t] g g q- Seepage Pit No...... 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 "Pest Pit.................... Depth to ground water...------------._-.-. - L� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......-----.-----___.... P4 1M�i�l1 1........ , _ .---- ---- - .._ G�-.- - D --- -escri trnf -soil------- ------ - � - ® 0 f ..........--------------------------....................................................................................................................................•__...-__-_----___--________---- 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 YI of the State Sanitary de—The undersigned further agrees not to place/thestem in operation until a Certificate of Compliance has e issued by t boar of healt Signe ?. /.� Application Approved BY ....... ............ Z24. ate -=------------------•••-- mt�' Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- --••-------••-•--------••-•••---••----••-•-----------------••--------------•-•---•-•---•-•--•------------------------• ---------------------------------------------------•----------------------------- Date PermitNo......................................................... Issued.......=......... ................................ �Daatete No.._._` f.............. ......... �THE COMMONWEALTH OF MASSACHUSETTS BOARDRF HE�tm OF............ . ........................................................ ............... Appliration -for 43Wpa5al Works Tonstrurtion Vanift Application is hereby made for a Permit to Construct Repair an. Individual Sewage Disposal System at* > .................. Z.............. ----....... ------------------------------------------ ------------------------------------------------- ----------------------------- Location.AdaTess or Lot No. .................. - ----- .............. . .................................................................................................. Owner Address ................................................................ ................................. Install Address U Type of Building Size Lot.... ----- -------- Sq. feet --- - Dwelling—No. of Bedrooms_ ................................Expansion Attic Garbage Grinder -1 a4 Other—Type of Building ---------------------------- No. of persons-___________________-____-__ Showers Cafeteria 44 Other es ----- ---------------------------------------------------------------------__Desi n Flow.............. W .........................gallons per person per day. Total daily flow............ .................gallons. WSeptic Tank—Liquid capacill"' allons Length________________ Width_.___..-._..._- Diameter-_._---_--___-_Depth--_-_________--. x Disposal Trench—N N,�V th.................... Total IAngtV------------------ Total leaching sq. ft. 0----------------_-- Seepage Pit No............'0-,!51.--eD6,n4, t6r................./,,.�wede4�t. .... ...... Total leaching area----- -------....sq. ft. Other Distribution box ( ) Dosing tank ( ) 6'6-IOC'4. 3-C/- 7/1 Percolation Test Results Performed by----- .................................................................... Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit-_-_______________.- Depth to -round water_._._-___.-...._-__.... 1:14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-_...__._..________. Depth to ground water__-__-_________-____-_-- P4 ..... xw escrlp,ion o t, f e; ...................... - -- - ----- ------ - ------ ----------- --- C ................................................. U ................ ✓---- d-X 0 D -—---------- ��--- --------- ---- ------ f--- --------- - -------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- 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 ode — The undersigned further agrees not to place /hes stem in it' operation until a Certificate of Compliance has -e n /i s s ued by tVboard of health 44-'o �/ _�/7(Z1 igne ------ ....... .................................... ............ Sig Ln ................. .... ............. Date Application Approved By---...- -------------- . .... ............. ..... ----------------- 7Z ;�7 Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------- ...................................................................................................................................... --------------------------- ----------------------------------- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL ............................................ f Trrtifiratr of Tompfitturr THIS IS TO CERTIFY hat the Individual S age�sposa System constructed ( or Repaired ( ) -•------------- '--.----`________---•------•---'... .......�----------•----------•------•--•----•----_'_----------•--- has been installed in accordance with the provisions of : ti e XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ---. ---_9i___________________ dated.... .-.Z_ `_.�_�_.._........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------- ��......e- ,( ----•------•••-• Inspector•-• -- . -- ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT t✓� �L tic No.- . ......••-- FEE........................ Di�potial ark,q C�ntt��ttTon rrmit Permission is e y 2 Z l� �=i? --------------------------- tor'� anted---------- ------- -------- --- � -------�---------._.......----•---....-------•-•-----•-•-•-•---...-----•-----.. Construct ( or an 1n1vv d}t age Gisgcysal S em ( } g atNo.......................------- -- -•--•-................ ,..----------•------•......�•. Street as shown on the application for Disposal Works Construction er it N Dated___ _ _' __ -7 J ----------•---.... -- ---- ------------------------- Board of Health DATE. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS a ' 'fit � ,� m1,`.ak r• rb,�' li 1.-i Y i, tyq! ell, 4 11I Q ' yi 1 'a` ky�V r P Z. 41, 40 n ` k 5i, +h f p cS4 W�c' OT r-7.7 ,-✓�+ a 5 I S�y I ri Y r'* ��: 47 2.1 /49 �G A/.J 2 G'G O r2/✓tr�C� ;,ti/ a `} �• C � 8 R �` ��_� �d�,� �e% �- �Z--- C/� G �a��•�� :,I�� ,� ,FRS ' d dV�./ dti/ 7 a// P� •`/ / L 0 C r9 Tc%D O.V TNFr 7"t.A97- /T Lti� Of GOAAA-COd--r4A 77o ' ��, `G.AfNs Oti' T'N�' TY�tw/✓t✓ ®�' f�I'' �. 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