The URL can be used to link to this page

Home My WebLink About0097 CEDRIC ROAD - Health (3) 9-4- =J -L - F$s.2,....................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .Olrry-- ------- -----OF Appliration for i5isposal Works TaniArurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 1 _ System ay: p ......... �..........6 ....,1... .......... ....... ...----...---. ........................................... .... --•---Lo�n"A --- r Lot No. ............. .. j l .. .... .... ....-,_ Ad ess Installer _ Address Type uildmg Size Lot... -_:S_l!_"_" Sq. feet U Dwelling—No. of Bedrooms__ __ ____________.........___________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building .�111_�__ ________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 Q Other fixtu_res •--••--•------- -••-------•-•-•••--------•--•---••-----•••••----------••----------•••••••-•-----••••--•----••-•••-----•--•-••-••----•-------••--.--• W Design Flow.............�_ ____________________gallons per person per day. Total daily flow.........�.f-?_.....................gallons. WSeptic Tank—Liquid capacity/ Length................ Width................ Diameter................ Depth................. x Disposal Trench—No_____________________ Wide�,._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------_------- Diameter.... epth below inlet.................... Total leaching area.::��d__'�,_..sq. ft. Z Other Distribution box ( ) D sing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water__________________.____- t3� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................. a' ••-•---•- ODescription of Soil------ �... ----------=------------ ------------------------------•---------._...---------------........-------- vI-••-••...--------••--•----••--•••---------•••----••••---------••-•-•-•----•--•-----------•--•-••--•-------•--•-•------••••••--•---••-----•-•--•-•--•-•---••---------•--...-----•---------------•--••-•-- W V 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 been is by th�boyq of health. Sign d... . ._...... Date .t....... Application Approved By.._._.... fl;at/�%_ ----•• ...... ........... Date Application Disapproved for the following reasons__________________________________ ________________________________________•._....__........ .:---•------....._. ................•-•-•-------------------------------------------------------------•---------•-------------•-••--•-------•-•-----•--••-•••-----------•-•-•-----•--•-----•----•....---.....--------------- Date PermitNo-------.................................................. Issued..._ ................... l� « No....-4" �-•�-U F$s .. ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , . : t...... .........OF 66 t� Applira ivit fairTitiposal Warks Toustrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat{ j :,. ........ .. ... , "'`:J:.':. ' ...... r i 3 ......... . ......................».........,........................,...,. a a Locatt9n Ad23rese• tior Lot No .................e -mw..a 6. . I "� as ..e ..7...sl.e3p e"`�A...e ..e q .; f e ... f... a"�.`.'.a�sq................... ,.. Iy—�� ,r''•�,Owner i( )j (• '-, .4 Address .::... l� ..gal;a` " r7._.. .. 3.,�• ... ..d': .i,wax,.r}w..iric..+" f" h`.i"w"�;-$ ........M—I ..... .... .... .....:.. �M .... ..... .... .... .,..... ........ ... 'lip Installer Address r (�Q Type.of uilding Size Lot___ ..1..............Sq feet Dwelling—No. of Bedrooms ... ... ......................Expansion Attic ( ) Garbage Grinder ( ) Owl Other—Type of Building :'":.. �.,.`.^ ... No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ...............I.....................................-----------------------------------•-----------------...------..........••-----••-------------- W Design Flow.............ry. . __..___. gallons per person per day. Total daily flow._._.._._' ' gallons. -------------••---------- WSeptic Tank—Liquid capacity,1 � Fgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.............. . Width � ----• Total Length.................... Total leaching area...... --...sq. ft. Seepage Pit No..................... Diameter....' +uDepth below i>�let..._......_.________ Total leaching area_.._.. ... : sq. ft. r Z Other Distribution box ( ) D(i ing tank ( ) F Percolation Test Results Performed bv........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...._--_--_-.------.---. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - .r ,.* '---------------------------------------------------------------------------------....................... Description of Soil ...e ...................... __....... xr v .------•---•.....•-•--------•-••..................••---••-----•---•----•--•--•...-••••---•---. ......-----•-----------------------------------•--------------------•---•---•----•---...----......-----------•-------------------------------------------------------......_._....-••-•---........:.... 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 been is e by thplboa 4 of health. r. v r rSign { 5.0, lr aL. B(DAte Application Approved BY----- { .:...... Date Application Disapproved for the following reasons------------------------------------- •------•-•--•-•••--•--•••-•---............................................ -----•................................•---...------------------........--••••--•-•. Date PermitNo.......................................................... Issue(i....................................................... Date ,THE COMMONWEALTH OF MASSACHUSETTS rf BOARD �?F HEALTH Trrutirate of Tomplianrae , ,• THIS! IS TO CERTIFY, That the Individual Sewage Dfi��sposal System constructed ) or Repaired ( ) #y at ..............................................---- - ---------------- --- •----- ------ ----- -------- ......... .----•-. ...------.............-•-•-••--- has been installed in accordance with the provisions of Article "of e State Sanitary.osl`e� r in the application for Disposal Works Construction Permit No......................................... dated.._.---------.._.•.__,____________.._............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY." DATE..........................•-----•---•---•-----•-•------------------............. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS -_-� BOARD,,-OF HEAL T i �.,.^ �; / A -_., t... .. O F....2.. ............................ No......................... FEE .................... Permission is hereby granted . ?�4 �. a to Construct ( ) or Repair an lnclfv>dual SeA g-e ,sal System ... . .............. .. .... .... . ••......_ ...... •••....... .. .... Street as shown on the application for,Disposal Works Construction Perm1 o.. Dated........................................... Bo••• ard'of Health DATE................................... ... . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "