HomeMy WebLinkAbout0066 CASTLEWOOD CIRCLE - Health 66 .Castlewood Crrc'le r
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5EW`O,.C,E PERMIT M o.
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ASSESSOR S MAP NO. PARCEL
L.00A/TION A SEW.AGf PERMIT N0.
VILLAGE
MAJ jr
INSTA LLER'S NAME A ADDRESS
S U 1 L D E R OR OWNER
DATE PERMIT ISSUEV-
D
AT-E�•COMPLIANCE ISSUED
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No. `'1'l.L. F�s...�//...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD/OF HEALTH
/ .................. ... ..................OF. .. ........ ..........................................................
(� Appliratiuu -fur Ditipuutti Works Tuuitrurtiuu Punift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System t:
. .............................................................;11..................................
o do . dres or Lot No.
. -
.--
•... . •.••.. • -• ....... ............. ..•. ... -- .........Ow r ` Address// -
Ir
Installer Address
UType of Building Ex ansion Attic Size''Lot---7700 Sq. feet
Dwelling—No. of Bedrooms.. - g7o'? 3 ......-_.._ p ( ) ff Garbage Grinder ( )
aOther—Type of Building .. ..--...-.. No. of persons............................ Sho,. ers (� ) — Cafeteria ( )
as %�' .-•- --
dOther fixtures .........................................................................................................................
W Design Flow ------------ --'fd----.-.. .__.. "lions per person per day. Total daily flow........-- .-.. ...-............gallons.
WSeptic Tank Liquid capacity....__.. allons Length................ Widtl ...... ......... Diameter................ Depth................
x Disposal Trench— o. ............. ��1�id li To < Total leaching area sq. it.
,�c�
Seepage Pit No:---i�.---_-_.--- Diameter/Q.//...... ep in et�C.,; ._ Tot leaVltini, ea---- ------------sq. it.
z Other Distribution box ( ) Dosing tank ( p ' `o b`
•" Percolation Test Results Performed by-------------------------------------------------------------------------- Date....-------------------------------.....
a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.....----------------.
fZA Test Pit No. 2................minutes per inch Depth of Test Pit..--................ Depth to ground water........................
Ct+ d......t�... n
--------- ----- -- -
Description of Soil ----- ---U LL�
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 be issued bu the-board of
Sign ----- -
l --------------------------------
ate
Application Approved By....... �. ... . . . ..l�.. ------- -------•--•------ = .'-7
Application Disapproved for the following reasons:...........................
--•--•----•................................................ Date ..---------•-
--------------------------------•---•.....................----•••-•=-----••-------•----•-••--------------------•-••-•--...............--------•-••.......:.•••----•-........................---•--.••---
Date
PermitNo......................................................... Issued.--- ?-� ---•-------
Date
.7—
No...................... FEs. .A ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFHEALTH
.................. ... .................o F.: :............------------....................------
Apphration -fur Diopuottl Workii Cnunotrurtion Vrruiit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System t
.___..Z;Z. M ewe _________________________________ ___ __________
.........................................
io V"'v oc�t - dres or Lot No.
�
OOw r Address
........... 4,0__1A., _1�1 � i-_ ..................................................................................................
V Installer Address /y
Type of Building Size Lot... ............----------Sq. feet
Dwelling—No. of Bedrooms_. .... 3.....................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building -��!< ^t.�_______. No. of persons____________________________ Showers (� ) — Cafeteria ( )
a' Other fixtures ......................................................
d -----•------
W Design Flow.................:.. �U---------------- Mons per person per day. Total daily flow.._.._.. -_ .--__- .____...........gallons.
WSeptic Tank 4 Liquid capacity_ Ilons Length................ Width...... ......... Diameter................ Depth.................
x Disposal Trench—Po. .................... Width ......... __ _ To al' e�tg Jl_ Total leaching area---------------------sq. ft.
Seepage Pit No......_.. "`' p %t Total,lea hill tre`t..................sq. ft.
......... Diameter .. e t ow inle _________ .._ D'
z Other Distribution box ( ) Dosing tank g7 J
Percolation Test Results Performed by.......................................................................... Date---------------------------------.-.....
Test Pit No. 1................minutes per inch Depth of 'Pest Pit.................... Depth to ground water........................
/Li., Test Pit No. 2................minutes per inch //Depth of Test Pit-------------------- Depth to ground water__.-_----_---_--_----._.
O � G�.J _ ... r .._./.___...�___..._�_.. .........
v��•-.-n -_•-•-•----.7..Z �...v r-_--•`J�-:�i-lJ`uDescription tion of Soil 0-
------- li (_P -- jV ........•------------------!x ..- . _---.----------lei-,��S G�.�� . .. .�.... .. - -----�-......jc L/------................ _..............
-------------------------------------------•----.............-----------------------------------......._............------------------------------------------...._......---•----.....---------------
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 beSA issued of . .
Sign d...... ...... -• -•---•.._�' ---- �
✓�� 1�� �� Date
Application Approved BY----... ./........ -�--v-=L'�t. 7 Date
----�._-:.�_.�.--•7
Application Disapproved for the following yeasons:....................................................................................•-•----Date ......------.
---•--.......•...................•--.--_.._._.__.......------------------•-••---•--••-------•----------•....----••--•---•--•-----•-----•-----------...................__.._.._..............._._.....----
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
,Xet�� -1
........ ........OF........... . ...... ...........;....................
/ Trrtifiratr of fXomplianrr
I )IS i0 CERTIFY, hat th wage i al Systew constru ed ( or Repaired ( )
by -= = - ---------- ----------
` U fistaller 7
has been installed in accordance with the provisions of Articl$.XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.- -- _.6._.`............ 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/HEALTH
C%J...v.' .OF..... .ve !L............................................
No.................... FEE. ...........
Di-rupoottl Notkii Tongtrurtiu Vrr
Permi�Sion i hereby granted------ fi' �-----': ��� --� -� .... ......................
to Con uc�t ( or Repairn Individual Sewag isposal System
G
/ i1 i� t .�' (' /_ ..li/fir// G.� ...... ......................................................................
at No. --- --- - '�-1 ..... . -------- - A..-,__�/�_
street / �
as shown on the application for Disposal Works Construction Pprmit No.____ -~......._
�/�.-�/j ------•------•--•---
-----DATE..�---'-------------------------- --------------------------------------
Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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AsBuilt Page 1 of 1
ASSESSOR'S MAP NO. PARCEL `�o
LOCATION SEWAGE PERMIT NO.
VIIlLLAGE
F.l•/�Ir,. n.1c r�,��.� r•
INSTALLER'S NAME ADDRESS
I U I L D E R OR OWNER
DA 'T PERMIT ISSUE
DA MPLIAN�CE IS/S—U�E '
j"V(4� Si1r.D .�"��I �•t�-�`4'C*�VLfC.
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=273070&seq=1 8/8/2018