HomeMy WebLinkAbout0517 OLD CRAIGVILLE ROAD - Health ,�� �a�o - � a3
ASSESSORS MAP NO: —
PARCEL NO.:
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
c�� wvt..."..............OF.... .
ApplirFa#ivaa for Uh4pus al Works Ton.5trurtiuu thrmit
Application is hereby made for a Permit to Construct ( ) or Repair (*) an Individual Sewage Disposal
System at:
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L cation.Address or t No
-- 1.akkA , sonc��c� ---------------------------------------------------- 1�._D_.�r .C!G!!� i�f -- •
Owner Address
a .Ail--eOWLW..----------•----.-------•----------------------••--•------------- ��� m4��..s>��-t �s���Q�.>�.-----------.---
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..............................X----------Expansion Attic ( ) Garbage Grinder ( )
pa,, Other—Type of Building ............................ No. of persons--...................--...-- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- --
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 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 ( )
0-4 Percolation Test Results Performed by.......................................................................... Date............................-----_----
,4 Test 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.....--.--..............
...-•------•..................•--•--••-•------•-----•-•-----------------............•--•........._.. ........•............--•--......--••-•-•.....-•-...---•-
0 Description of Soil.............................................................................................................................................-.........................
x
V -•--••-•-•-------------------•---------------•--•----•----------------------•------.........-----••-------•----------------•------------•-----•-----------------•-------------------------••-•-------••-
W ---•----------------------------------------•---••-----------........----•-••-•--••----•---------------------
x Natu e of Re a' or Alteration —Answer when a It ble.-1�+4 ...Joao- Oat.. +�G._. .Axl t••��•-
�QY..
r ---------------------------•-------- --------------------------t----------.....--...-----•
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TTTL y g g p y`�of the State Sanitary Code—The undersigned further reel not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sined. ---------••-••------------•- --•+�:._ .........v ate
Application Approved By•••• ....... ...... � _). /S-4.
..........
Date
Application Disapproved for the following reasons:------....-•---•-----•---•-----••---------•---------------•-------•--..........................................
------------•-----•-----•----•...............•-•-----•-•---------.._.-•-----------------.._...--------------------------------•..-=----•----•------------------------•----------•--•-•--••--------------
Date
PermitNo......................................................... Issued---•------•---•-----------------------------------------
Date
FEB...:........:............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF \ 1HEALTH
Appliration for Uiipnsal Works Tomitrurtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( -) an Individual Sewage Disposal
System at:
.5�� old c �R� �i1 �4�� +A�,in . ..e �' �- - --------------------------------------------------------------------------------------------------
- w.
L cation-Address or:1,1 No.
ckA -----------------------------------------------.....--••---------------------------------
owner ° Address I /I
a Al Q •••acllc^ .......................................... �ctrr� r�e�s.. t1e�s 1rIY1�#Ci ]`�T ---...----
InstaLer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.............................X..........Expansion Attic ( ) Garbage Grinder ( )
a Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ..----•------••--•-------------• .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
0; Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................
xDisposal 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water..._-------..___.__-----
44 Test Pit No. 2................minglespe� r inch Depth of Test Pit.................... Depth to ground water.......................
x ... ..�...�- :-
D Description of Soil_/"^:
W
UNatu�F7e` of Repairs or Alterations—Answer when applicablek;!?.;tq:0--_f f3q! e;A�<��_.
S o--ta:.�a5 -
r
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i-I t.
p 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 off health.
Signed .. �� ` e ycn���. ......................................
�= 25._...............
Application Approved B --------------------------------------•-----•-•-•-•--•-- .........- ./Jal�._
_ ' __
PP PP Y EI +
v Date
Application Disapproved for the following reasons:--••----------••-------•-------------------------••-------•-------•-----------------••--------•-----•........--
•-••••-•-•••-••--•••••••••----•-•--•---•...•-•----••--•-•-•-••-•---••••••--•--••---------•---••--...••---I•-•--•-•----------•------•---------•-•-•••------------••••••--•••--••--------••---•--•••-•-•---
Date
PermitNo--------------------------------------------------------- Issued-.........................................-------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
! 1.. ,t�•ea. HEALTH
...................OF...1 6—RAJ a G
..................
Trrtif iraV of Tompliatta
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by �..?. ...-------------------------------------------------------------------------------------------------------
Install
has with the provisions of ` e Sanitary Code ZANTEE
descri' ed i the
application forlDispo alcWorkseConstra tion Perm t I ..tom > The�Stat- dated..... �, ___._...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUl THAT YHE
SYSTEM WILL FU ON SATISFACTORY.
DATE S f -------••-•----•-------- Inspector.
�UuyG�4j THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Y •r••e,W W. ..............._...OF.... r,k.I�:.. .................................................
1\I 0 .................... FEE..O....:...............
Maps nrkii nns#r Uan rrutit
Permissionis hereby granted-------- ----- ------ � .................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Street
as shown on the application for Disposal Works Construction Per D" ted---i--------------------------------------
-----------•----. ----•- ---•••••.
t .'S.......
Board of ealth
DATE Z.
FORM 1255 HOSES & WARREN, INC.. PUBLISHERS