HomeMy WebLinkAbout0218 CEDRIC ROAD - Health 2. 18 Ce d t'j c
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S M E A D
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
FOIEESSITNRyABIE MINAECYCLED
INITIATIVE CONTENT10°A
CeAded Fiber Sourcing POST-CONSUMER�j�
wwwsripropramorp
aN-01270
MADE IN USA
GET ORGANIZED AT SMEAD.COM
LOCQTIOKI 5EW6,GE PERMIT MO.
VILLAGE z4,
11,1 LLER E ADDRESS
l3UI ER 5 Q A E DDRE SS —
DNTE PERMIT 155UED b _7-2L — — —
DATE COMPLI W ACE ISSUED : =�_�6
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No.---... . .... Flns..............................
THE COMMONWEALTH OF MASSACHUSETTS
- BOARD H EA H /��' ��7
.......i ... .. .. ,......--- .OF........... •/I .......................
1
Appliration -for 'Mipmat Warkii Tontitrnrtion Vrrniit
Application is hereby made for a Permit to Construct (t,4 Repair ( ) an Individual Sewage Disposal
System at: � � °
................... ...................................... ..............• . .............................
Location•Ad O ! ................•....or.Lot No.
/��../......... !....... --•_-----••-•--•-----------•-------------------
w Address
................. (g✓ •-•-- •- -----...
nstaller Address
U Type of Building Size Lot.__—e- . feet
a Dwelling—No. of Bedrooms----------3------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ___________________________ No. of persons__.--_--__-__.._-______-__ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------- ----------•---------------...---•------------------------------------------------------------------------------------•-----•-------
W Design Flow............ ....................... Mons per person per day. Total daily flow............�. ------------------gallons.
WSeptic Tank—Liquid capaci)�M allons Length---------------- Width-____-._ ----_.- Diameter................ Depth_-_--_____--._.
x Disposal Trench—No. .................... W' otal L th_-.___ ___... _ - Total leaching area--------------------sq. ft.
Seepage Pit No...._..__-
---• ---__--__------._. o t Total leaching area------------------sq. ft.
§ Z Other Distribution box ( ) Dosing tank ( )
~" Percolation Test Results Performed by...................................................................... --• Date----.-----------------••---------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water--_-___--_____-_-_._-__.
f� Test Pit No. 2................minutes per inch Depth of Test Pit-_______-________- Depth to ground water__.-_-_-______-_-__...__.
------------------------------------ -•----•--•---------•------•----------•--------•---......•--•--.........................................................Description of Soil________________ _ ,t�,y �L-.,-____-____
x �+• ------- -----------------
U70•-------•/ V_1_--T--•-•--------------•-•--•--.---•------------------------------------------------
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 NI of the State Sanitary Code— The undersigned further agrees not to plaee the system in
operation until a Certificate of Compliance has/We issued by the board gqealth.
g
Date
Application Approved By------ 0e
Date
Application Disapproved for the following reasons:----•----------------------------•-------------------.......----•-----•------•-----------....----..._......----
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
'f Date
Permit No.............................. Issued -y........ .................................r°
n
No....... .../b. .....
THE COMMONWEALTH OF MASSACHUSETTS
�. BOARD H E Atr� 7
OF...........
Appliratiun -fur Bi,ipuiittl Norkii ( onstrurtiun Vrrntit
Application is hereby made for a Permit to Construct (L-40r. Repair ( ) an Individual Sewage Disposal
System at: (?CAW-.
r `T
i
--...------•-- ............................... t- .y`- ----------------------------------•----
Location-Ad B or Lot No.
Ow a /� / ----------------------•-------•---••--•-•--Address
W ---- --
Installer Address 7
Q Type of Building Size Lot...........jC�:'.•Sq. feet
Dwelling—No. of Bedrooms..._--__-.--3-----------------------------Expansion Attic ( ) Garbage Grinder
aOther—Type of Building _-._-______________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures --------•---•-•- -----------------------••--------------------------------------------------------------- --------------- ..................
Design Flow............. ...................... allons per person per day. Total daily flow................ 0—_-_--_-_-----..gallons.
WSeptic Tank—Liquid capacit�,Bt,�allons Length---------------- Width.......--------- Diameter................ Depth----------.----.
x Disposal Trench—No--------------------- -W --- otal Le th_._.___ __...._. Total leaching area_.__.__..._..._._._.sq. ft.
Seepage Pit No.........-yl e o in --------------- ---- Total leaching are a------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by----------- ......................................................... Date-------------------------------- -----..
W
Test Pit No. I................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_-.--.-.-_--__----.--_--
W ----------------------------------------------------------------------------- ...............................................................................
0 Description of Soil---------------_ , , �'_......._'�':=.f'<K-•---•--•---------
x p,
IJ _ —
Ua -= ¢
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 ee issued by the board o ealth.
0/
Sign' 7 G:.
-•-------- ------•----- ----
Date
Application Approved By------- .. �
Date
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------- -------------------�------- -•-----•••---•---
Permito.------f� ----------------- Issued............-/ o --7-----......Date•--•-------
THE COMMONWEALTH OF MASSACHUSETTS
-r-L:4--0.. �.BOARD HEALT /y� - '7
Trr#ifiratr of Tompliaurr
THIS IS TO CERTIFY t the Individu 1 ewa Disposal System constructed ( or Repaired ( )
by......... --- ----------------....................... ... .
Installe
tnT <<- - - /�1L9.5--------•-•-----•----------•---•--•-------••----•---
- _ r
has been installed in accordance with the provisions of Article NI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----------`q.t. .................. datedI----_--_---_'__gip---. .�..._.......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE / � ------. Inspector `'��
-- ------•---• •- ------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE /T� /x—/� .
O F �' ���Ee�'C
/f��.-- .............................................................. /
No.......... FEE.•..----.............
Permission is he y granted '- ---..-..... .-•
to Construct ( vf R pa' ) an divi al Sewa��f spo. lfyj
atNo. --7•..... -!5*�...---- � . -------------------- --- ---•--------------..........--•--------•.
Street
Work
Construction Perm' .._�� '...__. Dated_____.... �..as shown on the application for Disposal .................
--• ---- -- --- --- -----------------------------------------------
'HBoaird of ealth
DATE DATE.......L_..-a ----------------------•----------------•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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