HomeMy WebLinkAbout0118 CEDRIC ROAD - Health (2) /l8 C.ec�,-r G �2o�-p
C�r�-err'✓r'!l�
No. --------• F$$...............................
THE COMMONWEALTH OF MASSACHUSETTS
®AR® OF HFALTH
-- - --- -------OF. ...........................
Appliration for Raposal Works Tonstrurtion rautit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
........... �5 . ... �� .... ......................... .. ...................... ..................
.. . . .......
\� Locatio •A d'ess or No.
......................... . ....... . .... ....................' .............. .. ..............
Owner A.dress`
W ......--•........................ . ....:...... ......... .... ................... ................... .Ll�1tL11.!.e........ ... ......'__..... ..Installer Address ���
Type of Building Size Lot... ..................Sq. feet
0-4 Dwelling—No. of Bedrooms.___.�.�_..,_,�� .......................Expansion Atti ( ) Garbage Grinder ( )
a Other—Type of Building _..'. .. ? o. of persons.............
Showers ( ) — Cafeteria ( )
Otherfixtures ..........................----.....................................................................................................................
g p p p y y gallons.
W Design Flow.......................il..o......_.:._..gallons per person per day. Total daily flow_........s�,2..�..�L.�.....___.__..._. ....
WSeptic Tank—Liquid capacity../ allons Length.-............. Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width;
._.. ..._._..._.. Total Length.................... Total leaching area.....................sq. ft.
3 Seepage Pit No..................... Diameter..____. epth below inlet.................... Total leaching area..,16.....sq. ft.
Z Other Distribution box ( ) Dsing 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........................
p ------•..................•---••-•-------•-••-•---........---------••--••--•---•-_...................-----•....
Descriptionof Soil........ --••--•. ----•-•••-•-•..................................................................................................................
x
c ........:-••--•---••-•-•....._....•--•--•-••••-•-•----••••-•-•-•--•----•-•-•-•••-••--------••-•-•••••-•---••--•••._...••-•••-••-••..........••-••••.......................................
W
UNature 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 NI of the State Sanitary Code—The un igned further agrees not to place the system in
operation until a Certificate of Compliance has been sued by
o r f health.
JJ/TT//(✓� P Signed. _._ .� .9........ ............ ................................... ......... ..�
Application Approved B Date
PP Y •..... -------• •--- -•-•-••-- .............. ............••.... 7-•..
.--'. ate 3
Application Disapproved for the ollowing reason `
...............•-------....-•---•-•-•----•---------•------------•••---•------•-••--•-----.....---•---------••-•----•-----•-••----•---••:----•-----------•--------------•------------........-•••••--•-•- .
Date
Permit No......................................................... Issued...Cep -';�/11, ---..---.---
No....... ' _ Fins..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE LTH
Appltration for 43is rooat Iforko Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual' Sewage Disposal
System at
.................. .2�.... .. : )w.............r . ! . ............. .. ........................... I - `:s'?: ` .�. ..............
? , Location, Acjdyess •/ orb ViNo 1
........................
jL.f1 !�:''` .... t'� .fie.'::'......... ........................ ..........._.
W � O�v , f i d✓ yj��; t Add'rese-,,
•-•-••......-••-••-••-•••• .. 'x
a ..................................
�^ Installer 4 Address ..
UType of Building~ •'`',,;' Size Lot.... ._ ......Sq. feet
a Dwelling—No. of Bedrooms Expansion Attu ( ) Garbage Grinder ( )
p, Other—Type of Building __ Il�ao. of persons............... ........... Showers ( ) — Cafeteria ( )
Otherfixtures ..........................I...--•---••--•••-••••••••---•••-.................................................i ----•--•--•--••-•--•-...........---•----
Design Flow................ ;-�:
W g .......,.�._Y�..._......_.gallons per person per day. Total daily flow__._.._..:................................gallons.
WSeptic Tank—Liquid capacity_._�Z?jallons Length._........•..... Width................ Diameter...._._._....... Depth................
x Disposal Trench—No..................:.. Width....................Total Length.................... Total leaching area..._................sq. ft.
Seepage Pit No..................... Diameter. ....1= Depth below inlet.................... Total leaching area..:' r :...sq. ft.
Z Other Distribution box ( ) Ddsing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.--_-___-.-_--__----__--
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
..............................................................................................................
ODescription of Soil..._....`: ...................................
U -------------•--...--------•-------•---------------...----------------------------•----------.....--------•-------...-•----••-----------•-------•-------•------•-----•--••-............-
W
UNature 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 undsigned further agrees not to place the system in
operation until a Certificate of Compliance has been sued by,te oard� f health. -a
Signed ��. .......r.. � _ .'��
Application Approved By................r:. 1,rr.
Date
Application Disapproved for the fdowing reasons:''---------------
a ------•--•-•-•---
----•--••-••••-•••••••--•----•-••---•••-•••-•................••-•••--......_...-_....................................._.....•.....••••.................•...................•••••....•......•...•••.......
Date
PermitNo...........................................=•--........... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
f BOARD OF HEALTH n
�. °�'.:`...........O F..... K fi � ;.... `r �.....�;. ..... ... ......................................
Tatifirate of Tootpttttnre
THIS IS TO CERTIFY,✓That the Indivittual,$ age Disposal System constructed ) or Repaired ( )
by----------------_------ f= � � . ,.
/ ---• s---
,� 9 �r tiller f!
at.
a
has been installed in accordance with'the provisions of Article I of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No--------2— - ----- ----- ------------- dated--------- �:��.!$..._.._...._.
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONS,TRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. ^�
DATE.....
aY
r •• "._..:.... Inspector - t. . ..�.... '�
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH.
r�......OF..... tl - �!
........................... � �J
No........ ...:..
�..
whipjasat forks TottfUnq
witt Prrmit
Permission is hereby granted................... .. _.2...--t ...................................................
to Construct ( ) or Repair,( Ir�lviflual Sewage Disposal System
atNo..........:Z` .. • '� ... f,; ... '':f ' .._.. ` r�' .................................................................................
Street .
as shown on application for Disposal Works Construction Permit No. <.........: Dated-------,, ,c= t T.............
-------------------•-• ... .........
v -d of Health
DATE.----
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS