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Home My WebLink About0557 OLD CRAIGVILLE ROAD - Health ce,(� \@., /// S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR pRESTRRY MIN.RECYCLED WNIATIVE CONW10% CcrtfiedFberSouraiep POST.CONSUMER wwwsbpropremarp SR 012M MADE IN USA GET ORGANIZED AT SMEAR COM No THE COMMONWEAL-N OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F......................................--------...-----------•----------•------------------ AvOra#ion for Disposal Works C onstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair () an Individual Sewage Disposal System at: . 1._...Q.l ? � --------- ----.�. S?.�� e------------•. ............................................... Lac tion•Address or Lot No. ..`M. �Q� ------.. A c.�.� ............................................... ----•••---•-------••--...........-•-•.....--•-• -•----................---•------••---------... Owner Address a a ----5X-....--w..P.s_-.:: An� s Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p' 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_____-__________--____-. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W --------------------•-------••--•---------•--•---••------------••••-•-•-••----------•-....---•-•-•-•......................................................... 0 Description of Soil-....................................................................................................................................................................... V .............•---••--•-•-••-----••••••......-•••-•-••••••-•--•••••-•••••-•-••......-•---------••----••-•-----•------••••-••••----•••••••-•-•-------•---•---•••••-•-••-----•-•--••-•--•------•-•......... W ...................................... ••--••••••• -•••-•---••-•--•••-••••---•---------............--•---.....................................................V Nature of Repairs ox A.1terations—Answer when applicable...W.M.13&iA.-M1f&'-_,2--_ !8...F�o... `! S Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code—The lwqersigned further agrees not to place the system in operation until a Certificate of Compliance has b en iss e the oard of health. Signed_ _.. 3.: .". .... Application Approv - -•-------•-------- '3 Date Application Disapprov for a following reasons----------------------------------------------------------------------------------------------------------------- --...-••--•--••---------------•••....---•--••• •-•••--•----••--•--•--••---•---•-----•-.....••------...•---•------------•---•--•-•--••---••-•-•-••-•-----..............--•---------.Date-----......... PermitNo......................................................... Issued-....................................................... Date 2 2G -F7. LOCATION p/�/i SEWAGE PERMIT NO. VILLAGE. INSTALLER'S NAME i ADDRESS ( ` .2 n C-e3 ��( ✓ J 2!�dt'r�� /17 BUILDER OR OWNER �- - GATE ER IT ISSUED 3 DATE COMPLIANCE ISSUED I 1 2V I `4 �1 t p; .... Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ . .................OF....................................... Appliratiun for Uiipuiittl Works Tonstrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal System at: I - �?� ?,,�� ............................................................... Locatlon-Address or Lot No. ................................................ ............................................. .... ........._...._. W Owner Address . ST e_s_x `�. Installer Address UType of Building Size Lot______________________•____•Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••-••••-••----------------••-•-•-•-•-••-••-••-••••---•••-•••-•---••••••••--------•••••••••-•---•--.........................................................0 Description of Soil........................................................................................................................................................................ W I V Nature of Repairs or Alterations—Answer when applicable---!. _cl� _l_+A ,�------ ... t' Asm A.s..g.e.< ...�.Q 1 1�.Qe e-z tt----3-1 ` --------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLij 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss0ed b the oard of health. t/ Signeck ---- .rr� --------------------------------•. 2 t 19 .... _1 �a Application Approv B• ' =.................................................................... � Date Application Disapprov for a following reasons-..............................•........_------ ----------.........__---------------------.............. ............................................. ........••••------••-•-•.....••-•-----•••....••----t••-•-•••--•-•-----•--•--•-------------•-----•-•••----------•--------••----•••-------•--••-•---••_•-- Date PermitNo.............•------------------•••--•---•••-._....._... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...............................................................I...................... L Tn#ifirttte of 6m' 11 ianre THIS S,TO/C�ERT ,` That the Individual Sewage Disposal System constructed ( ) or Repaired /�/ s' ` b ....-•••_ &4,~- ' '..... ;- ! -- --------------------•----_________-----------•----------•-•---------_ y-•••••-• -.._ .._-•••--•--_.... s � �� `�.., Installer at _�- ! �; --------------------------------------------------------------------------------------------------------- has been installed irccordance with the: ovisions of TTLy, T�_,he State Sanitary Code as described in the application for Disposal Works Cons t u 1on Permit No.___..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO S A GUARANTEE THAT THE SYSTEM WI F CTION SATISFACTORY. _. DATE.... = ___��-___________________________•-----------_____-___------ Inspect ie .......... THE COMMONWEALTH OF MASSACHUSETTS ? BOARD OF HEALTH /» S.4' ...........................................OF...................................................................................... No....................... FEEI.f oow........... Permission is hereby granted____. __s......... - =---..... �e . --•-• . -•--•-••••--••••------•-••-•-•...--•-••---•-•------•-•-•-•--•---•-••-•..................... _ to Construct ( for Repair In ividu I'Sevt a e Disposal ystem at No. .... r f�� d ._7r�.� '�4- -------- - -y----------•-------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit �_.___.___._ Dated...............................V .......-•-- .............. ,......................................................................:............... Board of Health DATE................................................................................ FORA 1255 A. M. SULKIN, INC., BOSTON