HomeMy WebLinkAbout0415 OLD CRAIGVILLE ROAD - Health N SMEAD
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
Oo'TATPMIN,RECYCLED
INITIATIVE CONTENT 10°I
Certified RberSoercing POST-CONSUMER
wwwsfiproDram org
SR01290
MADE IN USA
GET ORGANIZED AT SMEAD-COY
Cap
No.... 6..�.. 9` Flcs..... _............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF...........................................................................................
Appliratiun for Disposal Works Tonstrnrtion 1jamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
C . .::�►1. .. .......................--•....-------•'------... z!r .........................................
or
.....ocat n-A s .....-•-•................................... Lot No.
Owner .. —Address
Installer Address
Type of Building Size Lot....Y.6- l_t-.Sq. feet
V Dwelling—No. of Bedrooms__.._.......
.............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
114 Other fixtures .........................
W Design Flow............................: O.......gallons per person per day. Total daily flow...... ...........................gallons.
WSeptic Tank—Liquid'capacity>+�..gallons 'Length--- Width..-..-5 .!?��. Diameter....-.=..... Depth.5' "...
x Disposal Trench—No..................... Width................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.........../...... Diameter....... Depth below inlet....Ca............ Total leaching area...Z�7...sq.. ft.
Z • Other Distribution box ( ✓) Dosing tank ( )
Percolation Test Results Performed by.. A ..� ..X.V#-�e!_ ,�'.............. Date..? ✓�f . &..............
a Test Pit No. 144-. .Z...minutes per inch Depth of Test Pit....Za........ Depth to ground water........................
fi Test Pit No. 2................niinutes per inch Depth of Test Pit.................... Depth to ground water.............._.........
-
a ---------------------------•--•----............ -......---......................•-••••••--•--••--•-• ........_..•----._...........•--••••-••-.....--.•.---
O Description of:Soil . ........ ...............................................
_
-----
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 iITU' 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Cer1,tite of Compliance has been issue by the boa d�healSigned. A -_.. _...••••.
.. _ ......
XA plication A roved B
- .....
Application Disapproved for the following reasons---------- ----------•--•-••-•-------------•----------•--•--------------•-----•----------......-----.....---•-
----•-------------------•----- -Date--------------
PermitNo.-----•.................:.•-.............-------'__._. Issued.......................................................
1., Date
ASSESSOR'S MAP "NO.N -7 PARCEL &f' y:-W
LOCATION _ SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME i ADDRESS
OWNER "
DATE PERMIT ISSUED �. 96
DATE COMPLIANCE ISSUED q-
��� . �
rG
aa'
r l� 3
r No------------------------ Fs$............._...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---------------- ------------------------OF..........................................................................................
Allp irntion fur Disposal Works ( instru Lion Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
-A!-� 1.�.__.Gr . .G....�.1.!.e....�.1.�:....._,�:..)-.�e. ....--•-----------------------•-------� 22.....----...-----------..................
•` Dpcati
�n-A r s .-.or Lot No.
...._-`."`ti............................•.... ..................----- .................................................
Owner Address
Installer Address
Type of Building Size Lot....Z4. 4..'_..Sq. feet
U Dwelling—No. of Bedrooms............s.............................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q•I Other fixtures .................................. ..•---
W Design Flow..............................5` ......gallons per person per day. Total daily flow.....3.�?a...........................gallons.
WSeptic Tank—Liquid*capacity.�: gallons Length-_- Width.. .'. :_ Diameter....
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..._.__._.../........ Diameter.......L ........ Depth below inlet.._.... Total leaching area.__Z G ...sq. ft.
Z Other Distribution box ( ✓) Dosing tank ( )
Percolation Test Results Performed by...z4eU...r'".Q.�.'.!,:_.._(:_!/_. '%' .............. Date._.-- ..:: -._-_--------.
Test Pit No. 14f- LZ...minutes per inch Depth of Test Pit........:3 .... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Pa' _---------------------------------------------------•--------------------••••......--......_...------.........................................................
ODescription of Soil '- -T i r-g l 3...._.... I...... C=._: �,.✓ ` r' '✓ ---------------------------•-------.----•-----
W -•••------------------------------------••••-----•-------------------•---------------•------•-••-•--•-••---.....•-••••------•------•--•---•-----•---•---•••---•--•-------•-•............-•.....-----•••.
UNature 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certi to of Compliance has beent boa d of heal /�/
Signed
�{ -•�-�
Application A roved By--•--••--••-•--...------•---•-•-••-•---.. ,: ..._....f.--------•-•----- -•------- ----14�1--e-r-
Application ate Disapproved for the following reasons:- ------------•-----------........------------------------------------------ ----------
...................•--•-••-•--------•••••••••-----•-•---•--•-------...------•••----•------.............----•--•-•--•••--•-•-••-•••--••--•••••--....•--------------••-•-•••--------'-Date ....---.....
PermitNo................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ...............OF........ .,...........................................
Tertif irate of Tuutplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (K) or Repaired ( )
y---•------------•---------------------------0...... —"
�nsta�lier ` ,
at e C �j �-------------- l�,u �I ' �........ � V
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..... ............ dated...... ..-...��_.�.. _6._..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................I�..'�......��.------------............... Inspector................... ...............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
6. O F........... ..`....... ..............................
No... ...... .� FEE.._7. ...........
Dispnsn1 Workii TwOnstrudivit rruti#
Permission is hereby granted..........................`#'•"•er a�� �-.. ._V..__ ......... .�C..... 1d ..
to Construct (x) or Repair ( ) an Individual Sewage Disposal System
at No...................................... .1 L?..L t................(_.12.11..IiG.�I.!_�.� = -C
Street
as shown on the application for Disposal Works Construction Permit No..<?6.-.7_g4 Dated........
...................... .. ...........
Board o ealth
DATE..........I..................................................................
FORM 1255 A. M. SULKIN,INC., BOSTON
1 -1
I ' I
,
; t �d
I
I
177 .. i I i 32.2 •.� i t
I
0 { + Y
A.
r I�
,
S
23P - - -
- -- - -
3?5
- - 1 6:rx 6`.1 otd. 2!G22 .
t
(U 2. ;Rohe 14 6U0. S ,
•
' ,
'gpd
t� I i ,
,
, � I
I I
�51.4
octd
.. i . _
�o lutiew �oacl �141 wale ; ' j �dH �:"..0260 l;
l _ _
NO
1.
1 I
I
I
Sul 1500
v �t
b- rl,rr
o ��, 6 1� 6:1
i,
f
;
1I 1 i
{ t
I
� ,I
-
! rS�Le O i_Pc d in Id yQ.vL7�t/��JO�� MCA
1
Olt
' 22, 14howvc
1�eu, Cow 2!
geta
u a;t6 co an i a��un> d r .t�crrt.
i. i }
,
: r , I
�. ! ��/,�
I cKe, ,� ;. 1 1 _ I ,..
t �. r
f �r f I
1 N 'LVUil. .;e w ' -Y +_� - �!
L ;
p.
LI
and1 I
r� Af_ gam. 4qm;' �F.,yq
( honey
�
�/ 9 �
IANfl�
,
, I
i�, .wfALXt� ! i