HomeMy WebLinkAbout0043 CEDRIC ROAD - Health (2) �� C'��IG {2D�-�
vl tC.�v
t�-a - �� C
i
�� - - �
No..... F$s...r .... ._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
►..............OF.....6...AA................. ..
Xvphratiou for R_gvasal Murky C onstrurtiun Permit
Application is hereby
hereby made for a Permit too Construct( )) or Repair ( ) an Individual Sewage Disposal
Systemat, ,a21 ._ ... d.V.&44L6 ....... .. ... ...... .................................. .............................
A' ocati ddres L .. or Lot No.
n Add;
�... �. ---------------••••...
......---•- -•-••-... - .................
Installer Address
UType o uilding Size Lot........Z�--�?...Sq. feet
Dwelling—No. of Bedrooms.__..__._. Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building __ __ _____. No. of persons............C............. Showers ( ) — Cafeteria ( )
dOther fixtures ----------------------------------------•-----=---------•-•-••-••••••--•-•---------------...•-•----••--.......-•----------•-•---••---••-••••.........
Design Flow....................�0......_... ...gallons per person per day. Total daily flow............3.�.._.._...._...._..__gallons.
WSeptic Tank—Liquid capacity/ --gallons Length...........7.._. Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width ...... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter...._Y Depth below inlet.................... Total leaching area..3A.� ..sq. ft.
z Other Distribution box ( ) osing tank ( )
aPercolation Test Results Performed by-------------•---••--••------•-•-•--•--•••-••......-•------•-•--•••••--.. Date.......................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ODescription of Soil-------------- 0 ...._....----------------------------------------•------ -------•----------.------------...................----
W
x ------------------------------------------------------
•---------------------------------------
.-•---. ------
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 bee sued by thedbDard of health.
' Sig a --.. ...C..- ................................
i
Dat
Application Approved By.-= ��- • --•-- ..... Z 'Z ----•---•-------•-_- ----� ;... -•�---7
fiace
Application Disapproved for the following reasons---------------------•-------------------------------------.....--------------.................._................
------------------------------------------------------------•---------------------------------------.......------------------------•-----------------------------......-•------------.......----•-•......
Date
PermitNo......................................................... Issued..------------------------------........................
Date
4
No..t - ....... Fn$. :....:..............._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... ,'........... OF.....- .a, �......
Allvfirati�n for Dhip sal orkii T�ntr ion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System atd , [i � p�
...... r•( ocati ddresq�� ............ ;2 or Lot K,0" .frp r ......_...,
............ MYi'Y;;2s....d .st'... ....tr::h'. .......<............... .. - .... .. j� .... ...Y.,,,e�°�.;�
rO�vne d -i Addr s
Installer Address
U Type ofuilding Size Lot------- r;.q__Sq. feet
f—� Dwelling—No. of Bedrooms..........*s,—,::..........................Expansion Attic ( ) Garbage Grinder ( )
aOther
-Type of Building ..!.; ": 9 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................
xDisposal Trench—No_____________________ Width.,.............. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter_ �' p garea ----"* q•z..f ,. Depth below inlet____________________ Total leaching _ . ...s 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___.__._____._____.____.
fsI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-A" -••--•--..._.•-•••- -.......•-•---------------------•............
..........•....................
...••---------------
o
Description z ., ,..�
iption of Soil
......-----------------------•---•----------•-----......-•----------------""--------"--""-------"---"----------"-----"-------......---------•--•----------••--
x
W
x ----•-------------------------------------•--------------•-----------•--------------•------•••--••-•----------•--------..............................................................................
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 bee sued by he b Jard of health.
Signed. ; :'=='--:.....Awra _
......................................
......•................... ................................
Date
Application Approved By ---------
------ g
Application Disapproved for the following reasons--------------------------7____.....__......._..._..___........._._.........-•----...........-•---._...._...
---------•--....-•---------------------------"-------------------------"-"------...-•-•---•---"--"-------------•--•------•--------•-----------•--•-•----------•--•--•----------•-•-•----•------•-.•----•
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�.. ..
... ...... ........... ...OF..... k':."'YF^ ..',."�..
......... .............................................
wertifitatr Lit Toutpllttnrr
TI IS, IS TO C b rjfY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by.
5Y j h
R.� 4V +..+�,-. d' n.R"y Install?,-
at. - ............................. ------------------ --- -- - 'r ;a�+K t � ..
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..WA
..______,_��_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A ANTE T AT THE
SYSTEM WILL FUNCTION SATISFACTORY. �Q
DATE................................................................................ Inspector.------......... .1Lh.B .vll.
THE COMMONWEALTH OF MASSACHUSETTS
f BOARD OF HEALTH
.. cis a OF.................
... �'v.. ..... ................... .................... `.`.........................................
No....414.1;1........ FEI �... ..........
�i��n��1� �vrk� �g�t��rttr#tnn ��rruti�
Permission is hereby,.granted............ .. c ¢. .......................................� ...
....................
to Construct ( ) or Rep it (I ) an In�Iiv}�ual Sewage Dispos ystem ,
at No ��Z r „ r� . t „
2� �" ..... •u5..., ... ................... -----...._...... •--- . ---......------........--...........
Street ,��//
as shown on the application for Disposal.Works Construction Permit No.....T/A.... Dated. *...:..........
�,
_.� . ; �--�---- ----------
DATE...... .._..,:_. ,,..
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS