HomeMy WebLinkAbout0131 OLD CRAIGVILLE ROAD - Health (2) �3� O101; CzzwSv�ble
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD F......OF. . . .HEALTH
. -- ----•-
Appliratiutt -fur liiipu. ial Worko Tomitrurtiurt Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
ocation-Address or Lot No.
........ ........... •. ............... ... ................. ................................... ------....-•----------------------._............----
W
wne Address
stalle p r Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-------- ..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P4 Other fixtures
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.
Seepage Pit No---------------_---- Diameter--------------------- Depth below inlet-------------------- Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a .Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water---.--_._-__.__..__
rX, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.._._.---_-__.___.____
9 ---------------------------------------------------------------------------------------------------------------------------------------------------------
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
, o
u --------------------------------------------------------------r---____________________-..--_--.---_-.-._.....___________ _ .-_______-----.-_-_._..
•F7I '�-'I� Nature of Repairs or Alterations—Answer when applicable.._. ---/..., �QQ_
-- ------------------- ------^--------------- --------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Co e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee .is ued by he boar h ltl
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Signed---- -- -L LL7 1 d_///4 i ;. ,3
. D1te_
ApplicationApproved By----------- / --=-------------•---------------------------------------------------------- ........ .-
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------•-.----------------
--------------••--------------------------------.....----------...--•----------•-------•---=------•-•-•-•------------ ----------------------------------------•-----------------------••----------------
Date
Permit No.... Issued.................. -/./.�6 .25...........
��--------------------------------
Date
r E
r !
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
4.0
.. OF... cii!..... .. .. .
Appliration -for Ui,i oiial Works (�onotrnrtion rrntit
1 Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System a :. .......... ...... ............ -------4.,4....... ------ . . ......*.W. ....... ..................................
•
r
ocation. ddress or Lot No.
- ---- ..................•.... -•----•--•••--••••....------•---•--•----•----•-------•-••••-•-
n Address
staller Address
Type of Building Size Lot_._-_------_--------------Sq. feet
U Dwelling—No. of Bedrooms------- --------------Expansion Attic ( ) Garbage Grinder ( )
�-+
aOther—Type of Building __ :_______________________ No. of persons-________--_.._-__--__--___- Showers ( 1, ) — Cafeteria ( )
Q Other fixtures ------------------------------------------------------ -
W Design Flow............................................gallons per-person per day. Total daily flow__:_:-:."':`" ........................gallons.
R, Septic Tank—Liquid capacity.........:tg4llons Length----------------- Width................ Diameter Depth. .--._. --.
W
xDisposal Trench—No..................... wSh------------__:.__:: Total Length-------------------- Total leaching area-__--__-_-._. . ---sq. ft.
Seepage Pit No_______________---_ Diameter-4 --------- Depth below inlet'-:'::.:............... Total leachingg,treys___.--_-_-.__---sq. ft.
Other Distribution box
Z
aPercolation Test Results Performed by r- �?.--. __________________________` 'Date__ _..:._._:
a Test Pit No. l----------------minutes per>r►ch` Depth of "Pest Pit..,.__:'`----; ----- Depth to ground water_. _-.-_-.-..--.-----
rs, Test Pit No. 2................minutes per inch Depth of.r:Cest Pit.--_-:--_-_________- Depth to ground water-----:-------.__-_--.-.
I�{ --------------------------------------------------------•----__----------_____-_____......................____._._.____.....___.............._•._.______.--..
Description of Soil_ .. ,..
--
.....
W ---------••--- -- ----- ---------------------------- ----------------•-------------•---•----.---•- -- .-
1 V Nature of Repairs or Alterations—Answer when applicable " Q
1
- ----- -------- -------- - .......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary C e—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be is ued by he boarl It
Si ned
g e
Application Approved BY------------- '-------------------------------------------------- ......... --------/1--/A �-��
Date
Application Disapproved for the following reasons:--------•--•---•--------------------- ---------------------------=-•-----------,---------------•---------
------ ------- ----------------- -------------------..-=•-------------- ----------------------
Date
Permit No. -7 70 Issued------••............. :!_1 G�Z ...........
--------•------•--•-----• Date
yf
,.;.THE COMMONWEALTH,OF MASSACHUSETTS
BOARD OFF HEALTH
s ., .....t�C•fT....i1:�......0 F........`... �,7 _.;-L.r.,'c::l:
a Trrtifiratr of Tomplianrr
THIS IS TQ. CE RT7IF , That the Individual Sewage Disposal System constructed (r.,qr Repaired
.. -..........
by ! = - ,�
/ 11nstaller
at.......-.... j
has been installed in accordance with the provisions of Article XI of Rhe 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 GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7 7-o .............../`!WA A''........OF......... 17?t.!L!�41.4 ................................
No...... ....... FEE........................
J
Dinpimal/� ork,i Cnon�s tion "rrm t
Permission is hereby granted -1. r—e...----••-------------------•-•-----....-•-•----------------...----
to Construct QK ) or Repair an Individual Sewage Disposal System
P ( )
atNo d-L _:---------- / ...................
,> � A.. �� "•r':'s;1% �n�`^ �,�
as shown ott th'e application for Disposal Works Construction Permit No____ ____ ______/Dated:--:-------._--_------------------------------ - '
----- ----- ---------------- -----•-..
r
Board of Health iF';
D
ATE ! —A.—IX
FORM I255 ,HQBBS & WARREN. INC.. PUBLISSi ERSt
Its �.y�_ ..K .. ,,.�� -� ��.'F•_e � � .� �� t �^ � ,u:+r,+cy._. �.�.,»�. °�� may. r„,�, ` a. .�-��.
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