HomeMy WebLinkAbout0169 CEDRIC ROAD - Health (2) 0
No.. ?9--'- F�$.....1 ....�........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
----------OF..................................... ............ .......• ----........
N12 Appliration -for Miip ial Workii Towifrurtion Vanift
\ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
J System at:
------------- ' ANT -r �lG
Locat- Address. or Lot No.
-C�-
ner
a � ------------------------------ --------------u---.-----------------------
Installer Address q p,
UType of Building Size Lotc�-_-____.._�._1_---Sq. feet
Dwelling—No. of Bedrooms-------- ---- .__.__-Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building -__________________________ No. of persons.--__.___---___-__-_-___-.-_ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------ --
W Design Flow-------------_�0.___._..____.__.. gallons per person per day. Total daily flow.............. -w-gallons.
� Septic Tank—Liquid capaci40_o__-_gallons Length................ Width._-_.____._-. Diameter---------------- Depth.---------------
xDisposal Trench—No_____________________ Width..........._... ._.. To al Idngth....__......_.._.___ Total leaching area_.-.--..----._.___-_sq. ft.
Seepage Pit No`&VAO-------- Diameter__.S� w - let ... ---• Total leaching area -------sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) B �C may``"' _ ` G_ 2 S
Percolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------.------------.
1.4
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...-. -__-____.--__---.
_ _ _ _ K _ _ __ __` _____.
------ -- ---------------- --------------------------
Description of Soil '� Q�• W �-
x .---------------------`�" - =----C t'� ass x�ef u't 4 ------�- l�S�`e►a�
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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee sued by t bo r of health.
Sig = ------------------------------ -----C�_`rD--� 7..�-
te
Application Approved B - --- -- ---- ----
PP PP Ys
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
------------•-------------------•---------•--•--------------------------------•------------------•------------------------------------ -----------------------------
Date
Permit No......................................................... Issued.----- _I
Date
No..... ....... Fsc.....rt1..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH,
............ .... ._ _ ... _.. -- .OF.............................................
Appliration -fur 11,i uiittl Workii Tontitrurtion Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
yJ / ................ '.. ..1. r. '- /
:.' 4
"--- .... ._._---
Location,c Address ! or Lot No. /7�
{. .......!a_ls v ��f u U '�-•-_h _./3 !tea c! c�.-_�•�
Owner -4\ Address Q
---
Installer Address
d Type of Building Size Lot -3___5��_ ---Sq. feet
Dwelling—No. of Bedrooms---------3..............................Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------ --------Y-----------------------
W Design Flow--------------�'10...................gallons per person per day. Total daily flow-------------- __ _.r-�..Qgallons.
Septic Tank—Liquid capac/W_O----gallons Length---------------- Width---------------. Diameter____------ .-- Depth.-- ............
xDisposal Trench—No..................... Width----------------____ To��^l��ngth-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No-/_QUU...__.. Diameter_.. _er- p limb '/ ___--_-• ept e ow inlet,;__-- y-:-------.-_-- Total leaching area------------------sq. ft.
r
z Other Distribution box ( ) Dosing tank ( ) '�' / ,-' "`" '�. G, % 5'
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date..............-.-----------.--------_-
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water-..__-.-_._.._._-.------
(4 Test Pit No. 2................minutes per inch Depth of Test Pit._-_____-_.____-___- Depth to ground water.-._-______-_--.---__-
= = f = �1
O Description of Soil---- 0-='.._.....!� ccic:..f�v� � (m - �;! � O f-�*..-- 1---------5 �-�`=�`',----- ---�"�--
- 5..-= =------�'t�' 1 ... C' _ ` { '',`> l�s�+` �`Cfc� 'ate-'(------_-----
w
x -------------- -------- ------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 \I 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 tlie board of health.
Sig ---- �.
/zs
Date
Application Approved B - --.--7-�_'----
PP PP Y �- `` -�.r 1.lki'3 v
Date
Application Disapproved for the following reasons--------------------------------•------------------------•-----•-•-••---•--•-------------------------------------
--...--••-------------•-•--•---•--•-•--•-...........--.-------------•---•---•---- -------------•--------•..--------------.........---•--•--••---............-----•--------------------------------•-••••.
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�
/ ,.......OF.............1�.1r-..Gr2...............................................
(Irdifirate of Tontplianrr
hat the Individual Sewage Disposal System constructed (/) or Repaired ( )
by T fe 0 CER;---E— vrr---- ............................................................ -------------- ---------------------------
Installer t _
at.� ----- _� c.e /�L _ �-�(r-----------�4y11.1----�1-----..---- c.......- `J------------ ------
has been installed in accordance with the provisions of Ar ic% X1 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. -_-2_�l___�__-•__--_-_- dated.-.'C..., ?_.'�_- Z3.............
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 OFF HEALTH'
/Zc..Y2............O F .hj.Wit,. !-------------------------------------------------- �•.J
No.....a Iz...... FEE/.e.................
VPermission is hereby granted--------- =i !-tom
to Constru ( ) or Repir ) an Ir}Ejiv dual �w Disp Sys �m ,
Street nn r
as shown on the application for Disposal Works Construction mit o. _ Dated___dQ----_--5..-.---_-______
-Ls-/. .s.v
Board of H th
DATE--------------------------------------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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