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HomeMy WebLinkAbout0010 WOODCREST ROAD - Health 10 � cr���-, �,�v����� �. �; .� a L.O CAT ION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDREE S OR OWNER S C /Z: DATE PIRMIT . ISSUED DAT E COMPLIANCE ISS'UED 7 4 ` ....1,l� 1. ar No. ..... .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �... ................. Appliration for Diopoozii Works Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: �. ....:...... �' .s.l.............�....4....�..: ........s.. .............---------------------..Z- .................................................... oc tio.n'-Address or t No. ' f.2!r ------------------------------------- f lC Qyvne 1 Address ...-----•----------------------- � Installer Address Type of Building Size Lot.... ® 201.Sq. feet Dwelling—No. of Bedrooms.-_"..................•...............Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building pi yp g ----LjA1*.D___... No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -------•-------------------------•---------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................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 ( ) 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........................ Descriptionof Soil........ .� P?.."............................=-------------------------------------------------------------------------------------------------------------- W --••-------•-------------------------------•----•-----------.................................................... --- ....•----•......-----•-•••••......./-- -- --- ------- .•...----------. V Naturee Repairs or AlteratioiAnswer when applicable_. __....1® f1--. f _ r1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TAITL U 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been Xs d by th and of health. f Signed..-- = •--- ............ ................ JApplication Approved B .�._ ...... Date Application Disapproved for the following reasons:............................................................................................................. ................................•-.........-•-•-------•..._.....-----------••-•-•-...._..............---.._...•-••--•......._...-•---•••------------••••-••-•-----------•-••--•••------•-•-••---...._.... Date PermitNo... -... .................. Issued........................................................ Date Fssl ..._............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�,/..,')..........0F..../__ r-.��...-�1 ........ ,c ppliration for llhipas l Vorko Tomitrar#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... ............................. .................................. ........................................ T •c lion-Address or jot No. .....G......... Add ess Installer Address �O�� q li Type of Building Size Lot.... ...................S . feet. I..I Dwelling—No. of Bedrooms....lI'�V.................................. Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------•--------•-----------------------------------------------------------•------.--.--------••---------------.----.. W_ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-----•------------------•-------•-•----------•-------•--•--•---------.... Date........................................ �4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------------.......------------•.......--........•--------•............-•--------•.......••------------------ Descriptionof Soil - /Uj) ---------•-----------------•-------------------------------------------------------------------------------------------------------------- V .--------------------------•----........--••--------.....................---•------....••------•---------......--------.......--•--------•-•-•--... U Nature oLjR�ePairs or Alteration Answer when applicable.._ .___.ld4O .......................e G.. / ........ •--------------------------•-----------------------------------------------._....---------------......_.._..•....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI ILL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been�sdthe and of health. Signed...... O Z21=�� . .............. . ---- / D,at Application Approved By---.....�� `. -;�.n,,��x.�,_.r..._. ............>. � G --..� �� D .... ....... ..... Date Application Disapproved for the following reasons---------------------------------------•...-------------------•--------------•----------•--....-•----...••--- -•.......................•-•-•---•-•----.........-------••-...---•------••-•-----•--••-•...._..._..-•--------------...............-•--------------------•----------...---------...------•--•---•--•----- G Date Permit No....(Ez----— Q Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ter#if irate of f9ontphattre THA IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired Installer ,� jF has been installed in accordance with the provisions of TIT F// 5 of T State Sanitary Code des ,i I the application for Disposal Works Construction Permit No.... L F�.."'..7_ _._....... dated.......{._ -_���7._..-.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI TIS ACTORY. DATE....................................... .._ 211�� Inspector.....J�--------------------•--.................----.......---•-•-•_..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (�' / 7 -� -� 11iopoottl work To frM #ionfirrmit - Permiss>on x hereby granted... 1c.:2:.... ._..... �r.-`%I =-' . _. ...... ........................:. to Construct ( ) or Repair (� • Individual Sewage Disposal vS Street as shown on the application for Disposal Works Construction Permit No.._E.........7K--D ed.... i T - DATE. I �_� . Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON ' r No...... Fiz$.Z.,.......:......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH . U bnq IZtyt OF . .... 1,*- _... . .. Appliration -fur Biipuial Workii Tatui#rurtton Vrrnift Application is hereby made for a Permit to Construct ( or Repair ( an Individual -ewage is sal System at a - or- ----- •- - ........1.1-7-- -----• --- ----- - - TALtion- dress ? or No. - -- •- . •- -• __23- M W - •- -- dr - - - ... Ad ess Insta er Address U Type of uilding Size Lot�_ _ __Sq. feet Dwelling No. of Bedrooms_____________ __________________________Expansion Attic ( ) arbage Grinder ( ) Other—Type of Building ____________________________ No. of persons.--_______-______._-.-__-.-_ Showers ( ) — Cafeteria ( ) Other fixtures ..... W Design Flow_ ________________________ Mons per person per day. Total daily flow___.___ gallons. �f Septic Tank Liquid capacity/./_(___gallons Length---------------- Width.._..._.. ..._ Di .... Deptli.___---_.-._. xDisposal Trench—N ______________________ Width_______ ..`_..p��Iah____- ____ __Total leaching area-.--._.-_--______-_sq. ft. Seepage Pit No_____ ______________ Diameter ._ ..�Dn e Total �l�irea..._-.-_-.__-____sq. tt. Z Other Distributio box ( ) Dosing to ) - �r WPercolation Test Results Performed by__________ _____------___ ____(� '__�_. ....... Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of 'est Pit-_._...-__-________- Depth to ground water_.....___--_---._-.-___. f14 Test Pit No. 2................minutes per inch Depth of Te it---____-_________. Depth to ground water-_._-.-.__-.___-_-.-_-_. W -•------•••---------------------------------------------- .................... ................................................................. O Description of Soil--------------------------------------------------•----- x U ------••••----------------------------------------••-------•---------•--•-•---•------•-••-•-••-••--•--••=--------------•----•...------------••----••---------------•-•---------------.._.....---------- W x --- --------------------- ----------------------------------------------------------------------------------------------------------------------------••--------------------- ---------------------- U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------__________________________. ----------------------------- --------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with he provisions of Article YI 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. Sig d.- �: .__. f--- --- -1-- ----- Dat Application Approved By...... - - —•------- --2' --��7-5--, D to Application Disapproved for the following reasons---------------------_------ - ------.....---------------------------_..-------------•---------•---• ------------------------------------------------------------------------•------------.-••----•---------- ------------------ Date PermitNo......................................................... Issued........................................................ Date No...... FE$. .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD�,eff HEALTH ,: , d -� Gi. , Appliratiuu -fur 4mpoiial Workii Towdrurtiuu Prruuil Application is hereby made for a Permit to Constru t ( or Repair ( an Individual wage is sal System at a ...Jam'... . AO rAi. _V�� - 71 . ...M!tion- dress �} -•�o..• �f ----- - - - •- --- -- -- - ---I6r - - __....... OW Addr ------- - •' -• - - --- --- y------ - --'^mot--•--._ _' _.G`S%l - Insta er Address U Type of 'uildin /� Size Lo q. ff �'_S feet Dwelling No. of Bedrooms_:_-__-___�..........................Expansion-Attic ( ) arbage Grinder ( ) aOther—Type' of Building ___---------------- ------ No. of persons............................ Showers ( ) — Cafeteria ( ') Q' Other fixtures _ d - ---------------------•--- ----------••------------------------------ -- ��, W Design Flow_. _______________________ lions per person per day. Total daily flow.._.._ . !.+._._.____.....gallons. " Septic Tank Liquid capacitvlT-r -_gallons Length---------------- Width--------- Diameter_--__.._ __--- Depth.____- x Disposal Trench—N _____________________ Wi l ._... ._ .._.. _ of 1 ...Total leaching area--_:-.-.__-_-.--____sq. ft. Seepage Pit No ._______. Diameter _. ._`iD �`� `inlet �:._:_:___.__.__ ToAac�' area._----------------sc it. . --- 1Other Distributton box ( ) Dosing to y►► aPercolation Test Results Performed by._--__.__ .._...._.__. _...d_w"_ r:.__.�'" __._...__ Date_____________________________--_-__-. Test Pit No. I___-------------minutes per inch Depth of 0 'est; Pit-.--_-_____.-_-_-._- Depth to ground water.---.__-_-__-.-_-_..__.- f� Test Pit No. 2................minutes per ifich Depth of Te . it......._--._-_._ Depth to ground water......................... -------------------------------------------------------- -------•------•----•-- Description'of Soil ........---•-•--•--...._----- :: " ---------------- ----------- --------------------------------- x W ___________-----_---_____"-----------..___.-__..._.--_---............._..._...------------------------------------------------------------------------------------------------------------------------- . V Nature of Repairs or Alterations—Answer when applicable-------------------------------r---:____------------------------------------._._--_.-_--_----_-. ,.. --------------------------------------------- -------------•--••---------•------------••-.......------------------.... --;-----:------------------------------------------------------------------------- Agreement: s 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 been issued by the board of health. Sigi .. ----- ----------------------------••-- - VeApplication Approved By----• • --. a Application Disapproved for the f ollowin .. asons: ,- .------------- --------------------------------•-•---------.•-•--•----••------------------- ---------------------------------------•------------------------ Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL ..OF....... . .. .... .. .:::. ................... # �rr#ifir�tr of f�uttt�riitturr " ' IS IS TO CERTIFY hat thy tnp,�Viif(Ial S wage po al System tructed ( ) epaired. .--••- • . -•---�-o. - aller at_.. V --- r has been installed in accordance with the provisions of Ar icle XI 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 CONSTRUE© AS A GAARANTEE THAT THE SYSTEM WILL UNCTION SATISFACTORY. ' DATE �' ------------------------ Inspector �, A � -------- • s THE COMMONWEALTH OF MASSACHUSETTS; """* BOARD F HEALTH rj 'd .........-OF ....... No.... ..�+ FEE-0=................ up at VPrWrit v Permission s reby granted-__- ... _ z to Constr or Rep it ( ) I ivid al age Dis sal ys O 1 at No.-- - .-,(/--�•• �1 �' � =�' *rr` ------r-n-•----------------------------------------- Street - as shown on the application for Disposal Works Construction P No.___ _ � ».. ----- ated._. - f' . 7L� "Board of ealth s,r DATE--- �� / V !/ �A,4 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS DAY LJ DATE WHOL SALE a � i w s t _ 1� I4 l v t �� Off✓' fr��- � � � ®C� v