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Home My WebLink About0463 ELLIOTT ROAD - Health Y 463 Elliott Road =. Centerville A _ 227 113 1� No. 4210 1/3 ORA 100 / � l f d4g, No..........._ Fps. .... wr.»•- THE COMMONWEALTkd OF MASSACHUSETTS BOARD F HEALTH ............ ............OF......... ... TIC 3 CG _...a....................................................•---- App ira#ion fur Difivnlital nr�l �►� � ° "is n ernti Application is hereby made for a Permit to Construct ( ) or Rair(' �)1 an�I'ndiwdual Sewage Disposal ep System at: ....................... /....................... /i r Lt No............................................ Location dress� /3d .. ..../J_fgs� .---•-------•--••--•---------- --- o ........ /V1 .... Address moo.....Aj....zq/2L��........................................ ��,�S T�iS(�....�1!11.�5.... !�!LA ........__ :... Installer Address Type of Building Size Lot_-�M.........Sq. feet Dwelling—No. of Bed ................................... Attic ( ) Garbage Grinder ((�j P4 Other—Type of Building __.._...................... No. of persons___ _ ._ Showers — Cafeteria Q' Other fixtures ---------------------------------------------- W Design Flow...................... ...............gallons per person per day. Total daily flow............... 3. ....................gallons. WSeptic Tank—Liquid capacityA4 __gallons Length._4P_!___ Width.__'`P..... Diameter_5_'�o...... Depth_4,".3___.. x Disposal Trench—No_ ____________________ Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.AAQP-________- Diameter....1.K.t..... Depth below inlet..... .__4__........ Total leaching area..................sq. ft. z Other Distribution box (r`) Dosing tank ( ) h//;,p .e`- a Percolation Test Results -Perfi& by........ t4! .___�?�11;? .=X.,16;/t ..' ate__✓i _...ill KA.............. Test Pit No. I........-___min&es per inch Depth of Test Pit..... ____ Depth to ground water_,M-#-- -........ (s, Test Pit No. 2........�___minutesper inch Depth of Test Pit---CW...... Depth to ground water.. _______ -------------------------•••-----•••••••-••••••••••••-• ...._.....•••••-••••-..._...•••••---•.............-•••••-•...--•--•••••••-...-•---•--••...-•_•-•-- O Description of Soil...... I_ w_`i -..:! ` : VNature o Repai or teratio s—An e " hen applicable_________________________________________ _______•-i .............. ...... Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e issued by the board of health. dL '4^'r ',.� Signed... ' ... .. 3/.Gg�_..._..._ Date ication Approved By......... _ - - ..... ......................... -------------------• --••-•-------- Date Application Disapproved for the following reasons----------------------•-•---••---------------•-----------------------------------•-............................. .......•••..................••-••-•-••-•--_..••••-...-•--•••••----•••-••••••••-••_- Date PermitNo......................................................... Issued_....................................................... Date .................. ... .......... THE COMMONWEALTH OF MASSACHUSETTS 4 g BOARD qF HEALTH ` ., ,, oF._ .. ........ .. . .................. Appliratiun for Disposal Workii Tonstrurtiun rrrmh Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_......_._.....�L..............................................................+ . a ............................ ..... .........------........---............... Location-�/Address y or Lot No. _ • = .€a le�l ?. °.f fin....-!'! f"/.............................. ................... €. C_FS.............. !&� ✓ .i�. W Owner Address ,.a ----.PU _ ......................................... E _s...... ' '. a. Installer Address UType of Building Size Lot. 172..........Sq. feet 1-, Dwelling—No. of Bedrooms.........3.................................Expansion Attic ( ) Garbage Grinder (f-) aOther—Type of Building ............................ No. of persons._ 4! __. _-_- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------•••••--•---------••••-•---•••----------------...---------------.............-----•---------• W Design Flow........................3_ ...___._....._gallons per person per day. Total daily flow----_.___.--.-------_--••-_--_.........._gallons. WSeptic Tank—Liquid*ca.pacity&_PV..gallons Length.A Width..57'P..... Diameter Ir'Q__..... Depth-4,.".3..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.✓P47_0.......... Diameter.__,�_K!&...... Depth below inlet... #O-........ Total leaching area..................sq. ft.. Other Distribution box (✓) Dosing tank Percolation.Test Results Performed by......�>_. F e?49A ------------------- Date. !.' Test Pit No. I........ .-_-_-minutes per inch Depth of Test Pit....4e....... Depth to ground water_,* ........ (s, Test Pit No. 2........:.....minutes per inch Depth of Test Pit..-Z 9'�....... Depth to ground water._Z t- - ....... ------------ •--......•.....................................••••---••--•- Description o Soil------. .. d x W - �- ... ..................••----..._--.--••- ................ . .. --_-ifteratiois .. _.._. .A.__... ... ..______..__._ _•........................_......._.......__..... U Nature o Repa' s Or —A he. ......n applic blg .. IfL 'Ito 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 begin issued by the board,,Of health. Signed.4 `' ..... . 1 - .1 r al ......._ ---- ..... .......... Date Application Approved By........... r_. i_.. ,�- .. . _ .::..•.........:..:..... Date Application Disapproved for the following reasons-------=--------------••--------....-................................ ---------------------------•-•----•-••---•---•--••---------•----•---------...--•---------....-------•-----------------••-•••••••••---•----•-•---:..•--••-•-•------------••----•--......-----•----....... Date PermitNo......................................................... Issued.................................. ( ........_.._...------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T. ...........O F....... .................... �rr�if�rtt#e of �unt�fi�aat�r #" THIS I 101R. TIF the Individual Sewage Disposal System constructed ( ) or Repaired-( ') by wW --- f ...... • f�Install �,� f tat--••--• - ••--•--1�_�_1!z.�t' ---� (� "• -•----- - -----• - - - /1`'�� •--._.. has been .installed in accordance with the provisions of T 5 of The State Sanitary Code as'$escribed in the application for Disposal Works.Construction Permit No_ �_._ .................. dated---- .................. ,j THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 'SATISFACTORY. p , DATEf ,d...........................:.... Inspector......... �. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH e / I i............OF......... � ....................... No............ FEE..* ....._-.-.-- �i��r��t1 u un� n anti# Permission js hereby gra`ed�`." P 7" r to Constru or a a• n Indivi ewa a Dis osal ja, at No.'" 1 _ ,r :F� ""' ,�vi ./.f}1..,.rZ '. G1'- Street as shown on the application for Disposal,Works Construction Pwnit N Dated......- .. :4011........... ----.....-•--- Board of He It - DATE.:::.:...........'-- / ------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS } LOCATION �' .SEWAGE PERMIT N C I 0 ;;I�± t! rzj _ VILLAGE INSTA LLER'S NA E i ADDRESS 111401*01-R OR OWNER DATE PERMIT ISSUED 3 --1,7 � DAT E COMPLIANCE ISSUED ` �� ./ � �� y N � � �� _� � � �� , '�P � O /r, 4`f .-� J� �� W � �0 ✓ �..� - . ;, .,", LOC TION SEWo.C4E PERMIT UO. VILLAGE , r �2V ilt�L — — — WSTALLER5 ► && AE 1,� /ADDRESS ` —l-0 1 .) a- —Cn.P-"f-'o — — — — — — — — !L)c ko w I C- A � - BUILDER 5 Q &MF— �. ADDRESS DIaTE PERMIT 15SUED DATE COMPLI &MCE . .ISSUED ., O �o t -14 El L 116f I/ Sox L 15 L A L_A_ TO dE C^ST t Zo%,J >x x►.. L+�,k..E t� ® ® a-- At_t_ ,5EPTIc TA"v.:S r _ LEA CN t"6r coe ,�, de ` I 0 01000 000 - t w1JEi�T Et-EV�T'to..AS t >L.�Ept&4 z.J6n gym The � _ 0 , ,� on IL A. e.A�uS oF 2 ?' 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