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Home My WebLink About0115 CEDARWOOD ROAD - Health 116 Ceda-rw0 0d o Co i:.(-, 0/ ®4$ r TOWN OFIBAItNSTABLE LOCATION/ C�,e t)op SEWAGE #_KY-61 Q_ VILLAGE t SSESSOR'S,._MAP LOT INST'AI.LFR'S.NAME Sk P'HONE NO. ;1 J� ry �2'CJI14 SEPTIC , ANK CAPACITY ��: LEACHING FACILITYAty'pe) _(size) ,/oc)C� ! NO. OF BEDROOMS r PRIVA,IiE WELL. PUBLIC WATER c,h. BUILDER OR OWNER *DATE PERMIT ISSUED: DAiECOMPLIANCE ISSUED, { VARIANCE,:GRANTED: Yes ;_«. No ; I1 �k #� Ilk THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH OF............. ..................................... Appliration for M-4paoul Works Tontitrurtinn ramit Application is hereby made for a Permit to Construct (V/) or Repair ( ) an Individual Sewage Disposal System at: _ Location-Addr ss r Lot No. Owner Address w � .j _._ .XC P.®r?.........--•--•---------------------- ....ROAD........?41 :a��.1.�-1�......... a Installer Address Type of Building Size Lot............................Sq. feet U N Dwelling—No. of Bedrooms-__------•---------------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures -------------•-_---•_---- ............................................................................................................................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_---_----_-__----._---_- G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---__-_-________---____- 04 ...............•.................................................................=........................................................................... 0 Description of Soil........................................................................................................................................................................ x U ---------•-----•-•••------•--•----------------•-•-------------•--•-------•-•---•-•-------------•--•---......-•-••--•----•-••--•-•••-••--••--•-•-••--••--------------.................................. W ------------------- --------•-----•-•--------------•---•••----------•---•-•••----•••-•--------------------•--•-----------•--••----•••-----••-----•-•-•-••----•-•----------••---•--•-•-••---------------- UNature of Repairs or Alterat' s—Answer when applicable.-AD/.?070tJ------U�__N-___.1- ....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 'THE ^�� the provisions of'THE 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...../ --one..---9.�.92 -------------------------------- ....1.� Date Application Approved By................ .. '---------------------- .............. Date Application Disapproved for the following reasons---------------••-----••-------------------------............................................................... ------•-------•------•--•-------------------•---------------...-----------------............--------...--•----------•---....••-•-----•-•---•--•----•---•••-------••-•-•. ............................... f Date {�►1-Permit No....... .'v6.......................... Issued....................................................... No.....4..La/(e Fmc 747......-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 6:i6c...................................... Apphration for Dispatial Works Towitrurtion Prrulit Application is hereby made for a Permit to Construct (V/) or Repair an Individual Sewage Disposal System at: (f—r-,Q A Q Wo.pj��._.;? 7 ....O..A.f> J�................................... ---- cation lcsj.....YX .................................................................................................. / -Add r Lot No s N A72'. . ................................................ Owner Address ....hk-)CCAA�RT .9,,,�.................................... RJUAD....... ............ 1.4 Installer Address Type of B lildi Size Lot............................Sq. feet U 2!No. of Bedrooms------j Expansion Attic Garbage Grinder Dwelling -------------------------- 44 Other—Type of Building ............................ No. of persons......_................._.._ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width..____.._._..... Diameter._.____..._..... Depth....._..._...__. Disposal Trench—No..................... Width.................... Total Length..___............... Total leaching area....................sq. f t. 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit______._....__...... Depth to ground water-._____-____-__-_. -__. a •-•••---••........................••••--------••-••-•--•---•---------------••-•..........•-••-----•-......................................................... 0 Description of Soil........................................................................................................................................................................ x - U ...................................................................................................................................................................................................... W ---------------------- ----------------------------.................................................................................................................................................... U Nature of Repairs or Alterat' ns—Answer when applicable-171:%&)1.rj.0.t,.j......Q.-N-----A ..................... ...................... ............ • .........I --------------4 ---------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in I— I operation until a Certificate of Compliance has been issued by the board of health. tl� Signed-----fl,.4si....... ................................. .... Date Application Approved By............... ... ........................ ................. ...... Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo.-----. -------------------------- Issued-------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .......OF...................... ...................... Qwwrtifiratr of Toutplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by......................... ............. ........................................................................................................... In taller ................................... ........ at.........................1.1.2�.. . .......... .............................................................. has been instilled in accordance with the provisions of TIITIE. 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 SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HEALTH Adl(j�.........................................................OF.7......0 N o.. PEE...!..,............. Rspaoal ,Vorkv Tonotrudion " rutit Permission is hereby granted..............p�4------ .......................................................................... to Construct or Repair an Individual Sewage Disposal S s,t atNo................ ...... .............. ........kla............. .......................................................... Street as shown on the application for Disposal Works Construction Permit No..'-u - - ------------------------------------------------- --------------------------------- !� n Dated......................................... Board .i Health DATE.................. ............................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS