HomeMy WebLinkAbout0082 CRAWFORD ROAD - Health 82 ,,Crawford
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04/08/2005 15:04 9782495617 ATHOL HOSP ER PAGE 02
SENT BY: 60RTOLOTTI {ANST; S094289399; APR•S 06 15:10; PACE 1!2
$*RTOLOTTI CONSTRUCTION,INr.j
( P.O.BOX 704,MARSTONS MILLS,MA U S
Q $08.771-•93" 508.4Zs-89m So&4I8-93.
SEWA,OCR DISPOSAL,SYSTEM EVALUA ON
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A Sketch of the propcdt and sewage disposal eompononis Mug.s�U" y this form.
R6S1Dlr COMM C USE
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, f Bedrooms: Type of Business _.._
gt Crintler- . W.-Star Softener: -Sq.Ft.of Bidg:
l ther Water Use(APp es) MP/pf Employe
�. Water Use Activ
ear Round: ,6eaMasi: _
ater Source: . Water Source:
SepdG S ikem Ins Date : Tftl
Component No. Size Length Type .to r, J.to Conditions
Well W4 I xod
tic Tauk1081
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Box
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ch Pit A
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Trench
01Chambence of Ground StetNo eicnownence of Breakout/Overioad Yes( j No } ekaownence of Overflow ro Surface Yes O No '}:j okaovvence.of Lush Grow&Around Pit/Cesspoolycs O No ('f nknownding T.iquld in Pit U2 or More Full Yes( ) No '� sknownce tExcessive ulred Yes( ) No i nluown ( )
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04/08/2005 15:04 9`d2495617 ATHOL HOSP ER PAGE 01
Phone: 97 8-249-351.1
2033 Main St. Fax-, 978-249-561.7
Athol, MA. 013,31
Attention: -
Department:
Company Narne: AN
Facsimile Number:
Date & Time Sent:
Number of Sheets
(Including Transmittal Sheet):
From: Q
Comments:
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