HomeMy WebLinkAbout0344 ELLIOTT ROAD - Health 344 Elliott Road
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L THE COMMONWEALTH OF MASSACHUSETTS
BOARD H SALT
0F............ .:. __ " .......... ....
Appliration for I i-4pnoal Works. Tonotrurtion rrutit
Application is hereby made Permit to Construct ( ) or Repai a ndividual Sewage Disposal
Sy�t
- .:.1.. ...........f�..---•-•-----.. ..........................................
. . ... ... - r.
Loca an.Address % or Lot No.
wne - Address
,� r. ... ¢..... .............. . ........% ..................................................................................................
Installer Address
QType of Building s� Size Lot............................Sq. feet
DwellingZ No. of Bedrooms........... ------------------------Expansion Attic ( ) Garbage Grinder ( )
A4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ...............
Design Flow.............. gallons per person per day. Total daily flow..._....__._.___._ .._ ._
Septic Tank-V-Liquid capacity ___.gallons Length................ Width_._.__._._..___ Diameter................ Depth................
Disposal Trench—�No.................. Wic th. —6 h-•--- [-- Total leaching area sq. ft.
Seepage Pit No. Diameter -___-___. Depth bw m e ______ ___ ____ g ....sq. ft.
j Total�eachin area._._.__._.. _
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................minut er inch Depth of Test Pit.................... Depth to ground water........................
-------•••-•----- ------------•-•-•- ....................................................................................................................
0 Description of Soil.............
--------------------
V -----------------••--.......••-•-----•--•-----•-----------------------•------------••--•-•----------------•----•----------•--------•----•._...-----•-•---------------------•---..........-•-------------
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 Article XI of the State Sanitary —The undersigned further agrees no o p e the system in
operation until a Certificate of Compliance ha e � � e y th , hea h.
gned •. ---•-• . .........--- ...............
ate
Application Approved By....... .............. .....•--- !fir.... .------------ ---
Application Disapproved for the fo wing reasons:........._._...........�.... ................ .. .. . ......VZ... ate .__...
y
Date
PermitNo......................................................... Issued..... ••-• ....D . . ..
-- - — -- - -----
r
No....: .,f FnE..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
Applirattun for MoVotial Marko Tonotrnrtion Vantit
Application is hereby made fora Permit to Construct ( ) or. Repai anrIndividual Sewage Disposal
Sys. . zu..e 1 4),.,��.. �!� .
Locatgon-Address ,."" or Lot No.
-
! iv,
�iOwner f Address
v
... .. .[ --•----------------------------•-•--.-•---...--•-•-....---•-•-•--------------......-•----•--------
------------------ --------'-•-ti---------- :..._ _._ ._.....
�'Installer Address
Typeef Building - Size Lot............................Sq. feet
U Dwelling�No. of Bedrooms---........' .........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
� Other fixtures . . ...........=n---•---------------
W Design Flow.................. 47 ....... allons per person per day. Total daily flow..................V. ��.........gallons.
em
WSeptic Tank�-Liquid capacity04.....gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.......:.... ..ttTotal Lehgth.......X......I.. Total leaching area....................sq. ft.
Seepage Pit No. . ......... Diameter �_ D pth t� inlet ' Total leaching area... q.._ s 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........................
(z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.----_________-__--__-_
-------------/...............
=--------•.. -------------------------------------------------------------------------------------------------------
0 Description of Soil........... ?� ...
x
MW
---------------- --------------------------------------------------------------------------------------------------------------------------------------------
------------------••----••----------------------....---•--------------------------------------------------------••--•.........---••-•-------------------------------------------------•---•------------
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 further agrees not-to'place the system in
operation until a Certificate of Compliance has been is-sued,l y the.•board of'lhealth.�,Signed� .. t�W.-Z-Z-V
{
f
Application Approved By....... .. *" r, ..f.yD'ate
{ �
Application Disapproved for the following reasons:...................'!.---- ------- ---------------------------------------------------------------
- / Date
PermitNo......................................................... Issued....... � ;7•------- ---..
� Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ,H�,EAjLTH r--
�� CIrrnfirab of Tomplianrr
THIS IS TO CERTI Y, That the Ind c,�,u 1 Sewage Disposal System constructed ( ) or Repaired ( )
by__.......: .4r ..�.j -=. v' :..1 ...... .Instal...••.... ... ........ ^.. t ..............................
at..... :: ............ r.:.t,,!• ........ .............. . .......... :•��a+ !"''�/`., ' .�" ................................
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No _A., ."�.-��M.................. 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
f+,. '{ ...... "...`r '� ...........OF..... t-. .k ` .rm._.. "'.'::..:.........:�"".............. ..�w'...+r+--.r. w�•.-
No...-•••-...-•--.� ..... �,, FEE.. w.
,o::
Permission is hereby granted.- /,�� --- --I------- r:.' ' -''� =: :.. ......--•---•.......................................
to Construct ( or Repair�( ) aIndividual Sewage Disposal System
at No..2 .--tt' _ ........�l C Z�!/ �-��_'.�.-.......�. . :. ((( .. .------ --------------
t r street ,C
as shown on the application for Disposal Works Construction Per it Noe. .:. �...,.�Dated_.� �'�-�..!.1 �.r:?......
r: r � r' ' l _:x,I!.........................
Board of Health
DATE---•-•• .. ...... ............. ...........
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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