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Home My WebLink About0038 CEDRIC ROAD - Health (2) 339 THE COMMONWEALTH OF MASSACHUUSETTS BOARD OF I—iEd`g/Y/L i H ".V.N-----------------OF.......... fate.N..,FTA.b11 ' Ap liration for Uhiposal Works Tonstrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........,............�a ........... �eC!> c .... 0.�. .....................Cef��!!,�� cation-,Address or Lot No. ............N..O .C.1.? a......./. ?. .......S �?.................. ..... s h LC .......�.!:!.d!e:...................,1 Ct! `v>.I-I:I �}— Owner r Add -� a ...............1..[.�?XYlC' ..-. ®.��Q.N�.`''.. ........................-....,.. .........T.��.. %}!�!Pis.....hBs.(l................................... Installer Address Q Type of Building Size Lot........� _____Sq. feet U Dwelling—No. of Bedrooms..... ........3....._.___...._.._____Expansio Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building _�l/��.._{�_�.�,lo. of persons_______t.................. Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------•-----------------•••••••----•••••--•-- W Design Flow.......................%_0................gallons per person per day. Total daily flow............73. WSeptic Tank—Liquid capacity/ff7-!.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft. J sN Seepage Pit No_____________________ Diameter___'...8_.. P��Depth below inlet.................... Total leaching area____ e__�sq. ft. A 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_...___--_--_---_--__-. w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-_-___-_-__-_-__-_-_-. Descriptionof Soil......."WA✓-k XAY.P.......................................................................................................................... x W V Nature of Repairs or Alterations—Answer when applicable................................................................................................ .... --- -•••-•-••--••- Agreement: The undersigned agrees to install the aforedescri d Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Co- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ed by the rd of health. - 6 �/V Date Application Approved By-----`�/J f �`� ----------------- ... -� .� .. _.._.� i. Da Application Disapproved for the following reasons:.......... .... ------------------------------------------------------•---•-•-•-••--• -•----•--•••-•----- Date PermitNo......................................................... Issued........................................................ Date No......................... Fes$.... ..`.--'rr+..�:....... •_- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH M / ✓..........................OF..........f ...-:.r....5......... .� ' . t/f✓ Appliratiou for lliivao al Warks Toustra iou 'ern it Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...........�;1. ......................`:.!. ......................................4 .. L.c�.O' .t..k. ....................... ............. ..................... //Location Address (/'� r or Lot No. J/`' / ...... ...................if J ' :.......1.. ....t..f ...... ^ 2—� ................ .. ...:..... r 1.1}t.......i.v.:7.t.r..�':.. .....,... ;}E 1 - e W Owner P Address I ..' f a ................t .:_::`.: -........I�:L.:.:�3a'.:' .`.'..�1................................ .. _....v-- i'-r•_• C ..::._n r .......k'.=--._v.__._._........----•-•-•---------• Installer Address Type of Building Size Lot------ 9.....Sq. feet Dwelling—No. of Bedrooms..............__.ir.d....._..................Expansion,Attic ( ) Garbage Grinder ( ) Other—Type of Building �'r f�- x 4 F a g __;,,:_.__..___:.�.a[�._: No. of persons------- Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------•••--•-----•• --------------•----•-•--••---••-------•--------•--•----.....•-••••-----••---------•-------••--••••.._._•-- 11 W Design Flow....................: ..y!................gallons per person per day. Total daily flow_________._.2J,2_ --------------------gallons. Septic Tank—Liquid capacity &.'.7-_gallons Length................ Width---------------- Diameter................ Depth................ W Disposal Trench—No_____________________ Width.................... Total Length...._............... Total leaching,area.....................sq. ft. : :. . Seepage Pit No..................... Diameter._._._.:'__ ;,,,IFDepth below inlet.................... Total leaching-area....a Q:...� 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........................ 44 Test Pit No. 2................ininutes per inch Depth of Test Pit-------------------- Depth to ground water........................ z---••---- ............ .......----------------------•••------------------- O 4-: Description of Soil________ u..°f___ <<: =:_: _ ----•------.....••--------------------------------------------------------------------------------------------•••-•. v .-•-.........-•-•-•-•----•••----••••-••-••---•-----....-•-••••-••••-••-------•••-••--•----...-----•----•-----•-••-•--•---•-----•••••-------•••-•-•-------------••-----•-•---•---•••................. .. 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 Cod ;�� The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beenjOZd by the rd of health. ( , �S ck l ne - �a .0 � : Date Application Approved B --- ;--. ........................... -- - Application Disapproved for the•f ollowang reasons__________............................................................ ---••-••-••.............••-•-••-•••--••••••------•---------••--••--•--------••••••••-•-.:.............--•---•••••••••-••...•---••••............-•------_...-•-••----••--••---•-•-•--•••••--•---......... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............� � ........?............OF......� ��. f_r, t�. R1r . ' ..................................... (lertifir ate of Toaatph aurr THIS,,-IS TO CERTIFY,. That the Individual Sewage Disposal System constructed( ) or Repaired ( ) bt rr ..:..:.. .ti ,.....r' _. y... .. r Installer at `:�..•. • ...-- '-_----- �rP E` ------`---------------• ............................................................................................ has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... :...... ._. dated- .._-- .. _ _ � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A ARAPITPE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I'•.j y" yam` DATE....... .. « ' .-----•-•--••......•.�- --------•-- ------------------ Inspector.............................-....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. }, No.` ...._.................. FR. R.5110 i at, orko T�ttstrurfivn f rrmit Permissyian is hereby granted. .,t r-- --:..._ . � ......:.._ ......................................................... .. to Construct ( ) or-.Repair. ( ) an Individual Sewage Doposal Systski f atNo..................: . r f... !:_d::. ..:.. ........................... ......:: !........................................................ ........... Street as shown on the application for Disposal Works Constructio Permit No..... Da t df f; ................... , ,• , . . •-•-••-•----•---••--. , DATE ! � ..e:•r: --;r� Cj/,s�^��v� ,;5 �1 Ifs -.-.-._.... .f .erg .. ;-� •._'. ............................... FORM 1255 HOBBS &.WARREN' 7NC-, PUBLISHERS � ��