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Home My WebLink About0068 CEDRIC ROAD - Health (2) Ong fed-riAG<-RoFro CP44e-r✓i 1 c& 7,....... Fiez............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF....AVLI'Vtv_�......... ........................................................ Apphration for Disposal Works Toustrurtion rnrAft Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at ...... ... .................... ........................................................... "L"O"t"iF......... .......................... .................Alo.�-. ........ ..... ... ............... - — - ..-A ......... .. ........... ...... a--- .................................. ... Add......... ..................... . ............ ....944_)� 1.�� i�.. ........."...... .......... . ........C. .... . .......... .... Installer 1 Address Type of B i ing7 Size Lot.._. .......Sq. feet U Dwelling—No. of Bedrooms--------------------------**---- -Expansion Attic Garbage Grinder a Other—Type of Building ...... lv ........... No. of persons................9........ Showers Cafeteria Otherfixtures ---------------------------------------------------------------------------------------------- Design Flow................ �5_0 .......................... -gallons per person per day. Total daily flow..............0-97?..................gallons. WSeptic Tank—Liquid capacity/,61D-gallons Length................ Width......._.._..... Diameter....__.......... Depth................ Disposal Trench'—No. .................... Widtli.. Total Length......__.__......... Total leaching area............. sq. f t. --- -------- Seepage Pit No..................... Diameter....� �. epth below inlet_................... Total leaching area.aP..D�sq. ft. Z Other Distribution box ( ) ] osing tank ( ) ...... Percolation Test Results Performed by.......................................................................... Date........................................ �4 Test Pit No. 1................minutes per inch Depth of Test Pit..._........._...._. Depth to ground water....______._............ fTq Test Pit No. 2................minutes per inch Depth of Test Pit.._____.........._.. Depth to ground water..........._.........__. 04 ................ ............................................................................................................ 0 ;�J........ Descriptionof Soil.......... ............ ................................................................................................................. U ......................................................................................................................................................................................................... ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .................................................................... .........................................................................o...................................................... 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 behe boar C-ol. ealth. Signed.........._.ell............................................... .......................I...... Application Approved By........... Date ............................................. ......... Application Disapproved for thAfollowitky reasoig ......................................................................................Date.............. ....................................................................;....................................I...... ......................................................................................... Date Permit No......................................................... Issued.-.2/.-..2___6'/_7;,,?..... Date - ------- - ---- ---- No.-... .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ®E HEALTH a ..101................. O,F.... ............................................. Apphralion for Disposal Vorko Tonstrurtion Vrrmit Application is hereby made for a'Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ...............:;............................. ° ,�.r�.. .. , .P .. ....... ................................................................................................,. s bcat on Address l e or Lot No. r ... i W Qit�er ``r Addr a .......---•-----.._._.ax' "�'�"' :d '' ........... aM^v.er__.�^.;r... '_::5�?'"_' .................................. -. Installer Address UType of Buing Size Lot____Yu' ______.Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Pk Other—Type of Building . `�.......... ...... No. of persons................9........ .Showers ( ) — Cafeteria ( ) Otherfixtures ...•---•-•----•-••--••----•------ - -------------•------.--•...----------------------------------.._.. d *;� . W Design Flow..................::_______.............gallons per person per day. Total daily flow............._�_�f-!:..................gallons. 04 W Septic Tank—Liquid capacity,,tt//9!2.gallons Length................ Width................ Diameter................ Depth................ DisposalTrench—No . r ...m _. o a leaching g .................... -----------•.sq. ft. Seepage Pit No. _..-__.-_ Diamete .... . ept below inlet................... Total leaching a ea,,� < --sq. ft. z Other Distribution box ig;ing 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................minutes per inch Depth of Test Pit---------_.......... Depth to ground water-----------------_...... •• -• - O Description of Soil......... °'��` .: 5 x U ........................-................................................................................................................................................................................. W VNature 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 been issued by the Poar of? ealth. Signed.............- _-.._......?..j.,--••...--•-•--••�--..'". •-------.._--•......... ................................ .' ,1� Date Application Approved By............- .............••.-•.•.-------------------•-------•-- Date Application Disapproved for tlae following rcasAi s---------------•••...•••-•••••••-••-•-........................................................................... ---•............. ..........•-•--•-•--•••---••--•---•.......••---••--•••••--••-••••--••--••---.............•-••-•......----- ----- . . K ........................................ Date Permit No........................................................ Issued Date ^' X THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH�1 l - ^� e � t✓ :....::. ......�.............OF &Y,7........ ........... ................................................. Tertifiratr of Toutplinurr THIS 18"TOACERTIFY, That tk�?�Individual Sewage Disposal System constructed ( ) or Repaired ( ) {� ti, � '1 .........................•._•_•__•__........ _--•___.....................y............. 1Insti ler � �� t f" y4 4.AL1r has been installed in accordance with the provisions of Articlef_lie State Sanitary Code scribed in the �s application fof;Disposal Works Construction Permit No...... >.. ....................... dated---- :_____.__ 73_.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED #S A GUARANTEE THAT THE SYSTEM it Il L FUNCTIOP SATISFACTORY. ep DATE._ '::.-� �' ............. Inspectors ` :rrP ° "..:.. �.?.... ; THE COMMONWEALTH OF MASSACHUSETTS } r y y BOARD„�-..�OF HE�ALT ....... OF..... .................. -----....................................... No . 7 ,......... Di ipotial, works C ,n#yurtfon Prruttt ✓� ' rw Permission.is hereby granted. = ---- ,..--•-.,_..•---•-•....................•--- to Construct e$air ,a vidual Sew Dlspoos. System ( ) ( P Y i atNo.............. . ..... .,..,_... .............................� ""`� r".��: _��. .;... ......:.. ...:.. Street as shown on the application for Disposal Works Construction Permit No.. ......... Dated..._>, ........ .4............... P 73oard of"liedith ........................, DATE I 6ss RM 1255 HOBBS & WARREN. INC.. PUBLISHERS a y;r