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Home My WebLink About0104 CASTLEWOOD CIRCLE - Health (04 C04Lwood Ur. o D :LOCATION /�//yc ! /// �iS� EWAGE PERMIT NO. to I r/X'�I ( 7 WQG l �4t. m 5� - 105- VILLAGE I IIfST LnLER'S ' NAME i AD-DRESS GUILDER OR OWNER . iF DA T E P ERMIT ISSU E►D s- DATE COMPLIANCE ISSUED I a o ,to r D y 1 i No.... Fxs. ....�............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 0 !I>.........OF..........- /dV(`�%�'•• ..................................... Appliratinn for Disposal Works Tonstrnrtiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( �an I_ndividual.lSewage Disposal • System at: .... ------------------------------------------------------------- ��// LJ .iOo w- .... '.....or Lot.No. e-- ..............................................-•------•---•----.................--••--. er Address 1 ) .. Installer Address UType of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons..................:--------- Showers — Cafeteria Other fixtures ------------------------------•• . W Design Flow............................................gallons per person per day. Total daily flow................f...........................gallons. WSeptic Tank—Liquid'capacity__......_...gallons Length:............... Width................ Diameter.__..__--______ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ' i t �1 Percolation Test Results Performed by.......................................................................... Date--------.------------------------------- aTest 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........................ O Description of Soil... 19.11� iQdll ----------------------------------------- ------------------------•---...........___. x W ••----------------------•-----------------------------•••••-------------------•-------------•---------=--------------- -------- ..... ---------=----------------------•-------•----••-•------------------------•--••---------------------------------------------------•-••---------------------- --------- --------- Agreement: z The undersigned, agrees to install the aforedescribed. Individual Sewage Disposal.System in accordance with the provisions of TITLE 5 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 he bo d of health. 00, Signed -- •-- --•- .---/.c.... ..... . •-- ---------- ---------•-- IN, Date Application Approved By........... �2: ............................. --•-•-•----- 1--........•. Date Application Disapproved for the following reasons:................................................................................................................. -•------...---•-----•----.....-•-•-----•-•--•----------------------•---••-•-----------..........------........-•---------•--------------------------. ......--•-•••••••=-•-•--------•-•••--••-•----- Date Permit No......_.5` .A-..----....D5 _.._ IssuecL---•--------. 5..... Date ____- I------------------------------------------- - ►r � r � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............Z.. ........................OF........:�...... ....r Appliration for Disposal Works Tlantri dion •erntit Application is hereby made for a Permit to Construct ( ) or Repair (e an Individual Sewage Disposal System at: y// ... ytf.._ °.'». `.?:��r�r 'J 5..........�f. ........ / f�r%P.:a�............................................................................................ Location-Address or Lot No. ........ ......r '.j>1:.................................. ................................. ................................•.......... .............................................. u e Owner -, __,: Address m t Instal ler Address Type of Building/ Size Lot............................Sq. feet V Dwelling.�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ................................. . Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid'capacity........'...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by•--------••-------•••--•---•-------------••-----•---•-••-------•-•--••--- Date.................................------ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r •------• -. . •••----.;. .. ............... ..------------•-------•-•-----...........--......---.....----------------------.........-----....-- ODescription of Soil.........�,•- �. r: .!.:.A....-----•-•--------------------•-•---------------------------------------------------•------------- x U •••----•-•••---••••-----------------•-....................•---•--•-----•----------...----....---•-•-----...•----•-----•...-••-•-•...------•------•-•-••---••-----•---•••-••--...........---------------- W -•-•--•----•-----------------•---••••..... .•---•-••--•-----..........-- VNature of Repairs or Alterations—Answer when applicable-------'.____ :-''' 4 f........ :' ......C-14aaJ- ----------__. -•---------------------------------------------------------•---•--------------------.......--•-•---•----••--•--------•=-----------------------------------------------------------------•---•--•---•-••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA IE 5 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 board of health. Signed �l:r• t �". w' ..._`_ ._.. . -= ........... == ti /t Date ApplicationApproved By.. ---------------•-_........--•--------------------•---••---------.....................-• ............................... Date Application Disapproved for the following. reasons:------------------------------------------=-------------------------------------------------------------------_ ••----...-•-•-•-------•.....................•------------•-••-----•-------•------•---..........--•-------'----------------------------------------------------------------------------------------------- Date PermitNo.......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... f�rrtif irttte of. f�unt�linnrp THIS IS T,0 CERTIFY, That the Individual Sewage Disposal System constructed (. ) or Repaired �r-•'e!.� ..s.. y+ r «... ?......•.. ... .................•............_ Installer ............................................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described 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 S TISFACT RY. DATE.................................. -•• � .....•... Inspector.-1 -----------------------------------.....---........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3 1. �;='P" i 'f�<................................. � I. � r ��' 1. No.. ........ FEE .......:......... Disposal Works (gonstrnrttnn rrntit • 11� r%r . ...A�. s'.��':j_.______I`-_._ C t� r n^ Permission is hereby granted....T.t. . :_.fix..; ,_ Gi ---------------•--................. to Construct ) r Repair ( n Individ al Sewage Disposal System at No...... x....... . �_:*`��f�J: 51................................................................`rStreet as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .............•-•----------•--------------••••----•-•--••-•••-•--•-•-...-•-----•-••------•.-•--••--•----- Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC.• BOSTON