HomeMy WebLinkAbout0150 OLD CRAIGVILLE ROAD - Health (3) t
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THE COMMONWEALTH OF MASSACHUSETTS '\
BOAR® OF HEALTH
............................OF..... ..............................................
Appliratiun for Disposal Works Tonstrnrtiun lirrmit
Application is hereby made for a Permit to Construct (p-)"'or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
------Boc.--�. L1.....��r.:.: 1:l�5 rt .............
/� ��"✓ . Owner Address
. -----------------------------------•--------
Ins aller Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms........._.'--........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building i?rto- No. of ersons...._._ --__•---__.____ Showers
a YP g ----- - -�--------- P --- ( ) — Cafeteria ( )
Q' 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 ( ) +
aPercolation Test Results Performed by-•-•---•----•-----••-•••---••-•---•.....--•---••..............••-•...._. Date........................................
Test Pit No. LA- -.....minutes per inch Depth of Test Pit.................... Depth to ground ater........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 --•---------------------------------------------•-----------•--....-----------.............._•---•-.............................O Description of Soil----- =- ' ............. ... , OnI-e-----
-------------- ----------•------------------------------------------------------------------•----------------------------
W
U Nature of Repairs or Alterations—Answer when applicable...__...........................................................................................
------------------------------------------------------------------------•----...--------------•--...._ ::.........--...-----•-----........-----•------...---------------------........---•--..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of:ITL, 5 of the State Sanitary Code—The undersigned further agrees not to place the`system in
operation until a Certificate of Compliance has bee ss ed the boa 1151,
Signed �. .....� / ._
....--_._...
Date
Application Approved By............: :
D
Date
Application Disapproved for t e following reasons:.................
............. ------........
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---
/ , Date
f�
PermitNo. ---------------------------------------- Issued..................................................... �Z
Date
..-�
No...., - _ Fims...... ... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF . I-1EALTI-I
OF......;�23°":{x$:.:41�! C?i.: �4 ^;
,
Appliratiun fur Bil Vail al or Tontrurtion
Application is hereby made for a Permit to Construct .(P�or .Repair ( } an Individual. Sewage Disposal
System at:
......
Location Address' or Lot No
Owner, Address
a ___ _,dr-s�`,f{J'-•^--- �!...........- ............................................. ....------•.. ,. _... ......... ._.._.... .... .. '
In taller Address
Type of Building Size Lot............................Sq. feet
.............................................Expansion Attic ( ) Garbage Grinder ( )
Dwelhn No. of .Bedrooms °
Other gT e of BuildingNo. of ersons....... - ............. Showers
P.1 Other fixtures ..................................... P ( } Cafeteria ( >.
r Ions., .'
W Design Flow.;__. `=_ _______________________gallons per person per day. Total daily flow._._._.....___._... gal
WSeptic Tank—Liquid capacity............gallons Length................ Width................. Diameter............... Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area.....................sq.<ft.
eepageitnbuit rion box ie/ Diameter................... Depth below inlet.................... Total leaching area..................sq. ft.
z (' ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................ i
:a 'Test Pit No. l.r :{ ......minutes per inch Depth of Test Pit____________________ Depth to ground water........................ t
041 Test Pit No. 2................minutes per inch Depth of.Test Pit____________________ Depth to ground water...................
... ----• -- --• ...............................
O ton of So _____ 'Desch _ -
W t -3... .. ----•-.--' -•--- ....................................................
•. .. 3
_..._..-----•------------••-----------------------•'--...-----------------•--•-•••-----............-----------•.. ...............................................
V Nature of Repairs or Alterations—Answer when applicable________________;.._._......____._..._._._______._._____________._._________.._.________.___._..
..,.�......"""'""
Agreement:
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 y the board'of l lth.
Signed--•- - -----
/ � Date
Application Approved By------. --....................................................
Date
Application Disapproved for t e following reasons--------------------------------------------------------------------------------•--=-----------------------...._
.............................................•----•--------•-----•---------------•------•--•-••--•------------------------------------.--..----•--------------•-----------------------------•----------.
Permit No..:................ � r
3�G ��� Date
Date
:THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
N .--.... .. ................. ry
THIS JS TO CERTIFY, That the Individual Sewage Disposal System constructed O or Repaired ( )
' c;
............................................................
a
-•-------••-
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application forlDisposal 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
� TG. '` ..........OF._..._. .............................................. �`�✓
No........52...:........... FEE..._....----....../.
t �ru �a1 ork �unotrttrtion rrntit
Permission hereby granted__.__.-_f4yr_...................................
�' hflelel
x
to Construct ( ) or Repair ( an Individual Sewage Disposal S stejnr-t,� -yw, Vlee
at No.........4 Y -W1 ..._6-141> £�f4 f1/C�� �el Are_, " y
-- ...............----------- -----•......--.___...----------•- 7
<• w Street * L/ 1�$1, -+nv
as shown on the application for Disposal;.Works Co nstructionrPermit No._�_�'�__�_..______ Dated_____ ..._._. ;_:'...'
t� PP P ? ;
G ...........................................................
/ Board of Health
DATE.......................................................
r
+
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •±' - 4n,�,"$'
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d , Irs• ,.`LEGEND ., r
K {ir "'" CERTIFIED PLOT PLAN :' _.,F E�(15SA"ING :.SPOT ELEVATION 0><0 '
< '` E�XIS'TING'� CONTOUR p -L _ ,+. , _ _ ___ v. �-�, v_.
�#, F#NtSNED �SP07- ELEVATION 10 0 i ' ° - ' `
FINISHED CONTOUR -- 0 -- 41?/ N �S
� l'T o x'f;j�s#f.',':`t l +. .,k j,c - ..._. - { k+ „,,-b .:f, 1`.
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r�+fi APPROVED 80AR0 OF HEALTH � � �]]]] y , f 'I nl
G '.f .FkIaK ,3. y i ,at ,.\ t It 4 ` �� �\� •��— '�., � � 1� +'
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Vic" t+,�ATiE t:f ,r`t AGENT F IS'� j9 3S SCALE /"_ 30 = DATE S 4"k.,.,?.r
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'' t' CDREDGE ENGINEERING CO. /NGa 'fl ,F.
` _ , . CLIENT _L g�L ;i
": �,k %� ,- r ` ---A - - , I CERTIFY THAT THE PROPOSEDI'{
EGISTEREYC REGISTERED) �a g��,, A, JOB NO _`79 D:2-5 BUILDING SHOWN ON THIS PLAN .: r, ,•.
CIVIL >' LAND I CONFORMS " TO THE ZONING, L' AWS'~'
, .1 E.NGINEERS�, , 'SURVEYOR DR. BY A{ A_`M OF ARNST L M xt
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-- i°' SHEfT� OF-s -2 � DA 'E . REG. LAND SURVEYOR ;<f
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TOTAL A'j7lAlA7LwDr A=LOPV 42Ai-./A24V'-,Soil- resr.10*11.4n:-*sOil- 40
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No....... ' ' �' - o� FIeu..�.. ....
THE COMMONWEALTH OF MASSACHUSETTS
B®ARD F�HE LTH
O - . �-110-- --------OF..... . . ...............................
5b d' Appliration for Disposal Works Tonstrurtioo Vrrmit
Application is hereby made for a Permit to Construct (/Kor Repair ( ) an Inds* idul7l Sewage Disposal
.----
Loca'on-Ind .Add ss t No.
�I;ner Address
Installer Address
Type of Building/ Size Lot...� j. .___.Sq. feet
U Dwelling 4 No. of Bedrooms__________________ ---"-___-___________Expansion Attic ( ) Gafbage Grinder ( )
Other—Type of Building __._______- No. of persons............................ Showers — Cafeteria
a' Other fixtures ... -------------------------------------------------
---------------------------------------------------------------------- ----------------------------
W Design Flow...................... . .................gallons per person per day. Total daily flow.......... .. ._......._-__-._._gallons.
WSeptic Tank i--Liquid capacity.�,�__gallons Length---------------- Width---------------- Diameter---------------- Depth_______-____..-
x Disposal Trench— o..................... Width.._...._ �Q Total Length.................... Total leaching area------------___._._.sq. ft.
Seepage Pit No..___�_-_______-- Diameter/.17rD,p`._!!fDepth below inlet-----/___......._ Total leaching area---LYS�'_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__..__-__-__._._-__-----
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-_________________--
- - - - --------
O Description of Soil......--___ Cr�•a.. .. .... ._. '
-------- --
x
V ---------------------------------------------------------------•---------------------------------------------------------------------------------------.------------------------------------------------
W
UNature of Repairs or Alterations—Answer when applicable.______________________________________________________________________________________________.
--•------------------•-----•--•-------•-----------------------------------------•--•---•----•-•----------------•---•-----•-------------------------------------•--------•------._-----------•----------
Agreement:
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 undersigns urther agrees not to place the system in
operation until a Certificate of Compliance has been issued by th board lth.
-- ---------------------------------- -------------------------------
D to
Application Approved BY _ 4 !! ---- ------------------------
Application Disapproved for the-following ye0ons: ___________________________
--•----------------------------------•----------•----•-----Date--------------
.....---•----------------------•-•---•-•-•----------------••-••-•-------------••--•-•--•--•••--•---------- --------- ................---••-------------------•-•---•-----•-------------------
Date
PermitNo--------------------------------------------------------- Issued........................................................
Date
• /off .,t.
No..--.. ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
T... OF
Appl ration for Uiiipusaf Workii Tomitrurtinn Prrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individu 1 Sewage Disposal
System at:
Loc ion-Add' ss A Lot No.
& � ---------------------------------------
VC Address
W '
Installer` Address
d Type of Building Size Lot- ------------------------Sq. feet
-
U Dwelling No. of Bedrooms............................... ..........Expansion,Attic ( ) Garbage Grinder ( )
H
ri, Other—Type of Building ____________________ ______ No. of persons....................._------ Showers ( ) — Cafeteria ( )
a' Other fixtures .......................................................................... ..
W Design Flow--------------------------------------
.-_----gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic T lnlc/- Liquid capacity/ -.gallons Length---------------- Width_-------------- Diameter---------------- Depth--.--_-.-.-_-_
x Disposal Trench—No..................... Width------- _ Total Length.................... Total leaching area------------- ......sq. ft.
Seepage Pit No...../.............. Diameter/'A �_�&pth below inlet..... .----------- Total leaching area.._ d_;&.-..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.-.-__--_-_-____-__---_.
f14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--___-_--_-____-___-----
-- ----------
DDescription of Soil_____a..__._. __ ___ ------------------------------------------------------------------------------------------------
x
U ---------------------------------------------------------------------------------------
W
VNature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------
Agreement:
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,t,further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of Health.
-
Si ned ` 1 lR_ f-f --------------------------------
" ~ /
D to
Application Approved BYA fr
Date
Application Disapproved for the following re ns:-_-_-_ / `
-----•-----•--•-------------------------------------------•---•------------------•----------•-----••----•---------•--------•-------------------.......•••--------------------------•-=------------•-----
Date
PermitNo......................................................... Issued.........................................-------------•
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD, OF HEALTH
..................OF....
dL
(Irdif irate of (9nmPlianve
Y THIS IS TO CERTIFY, That t Indiv• ual wage Disposal = tem constructed (4 or Repaired ( )
b ......... 17
��1
I statNOT
�
at---.pf.•. - > •-•- 'A!�k`__ � +t,�,- +' k¢ --- ----- - -- ------•-•---•-- --�----- V
j has been installed in accordance with t�lie provisions of Ar e S e Sanitary Code as de7;7_3
ibed in the
application for Disposal Works Construction Permit No------- __...���__- dated..... ._�_._ -----------
THE ISSUANCE OF THIS CERTIFICATE SHALL RUE® AS A C,UARAPITEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............ ----------•------------------•-. . Inspector.......V-.-'----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH.
OF.... ---......
No........................ FEE_ -----
Bhivniial Enrkli Tnnn ru inn ermit
Permission is hereby granted_.::..' =:= =_.......-• -- - -
to Construe ) orRep,i ( ) an Indiv I 'S w e Disposal osal System
at No. i.- W. '
:_
Syr r. d �
• - - � •' Street
as shown on the application for Disposal Works Construct./ Z4Zermit No_� =_� ated-_f_ _ __ _ - ____._..
� ;ot ----------------------• --
DATE------. --- - ...............................................4 r W ; . soar
1
s /
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS '