The URL can be used to link to this page

Home My WebLink About0050 ELLIOTT ROAD - Health (2) 5D -- a'f8-13a-- �" • 7 y7 - No..----- .............. Fa$..�..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF.......... Appliration -for Di iVosal Workii Towitrurtion Mani t Application is hereby made for a Permit to Construct ( ) or Repair (//I'an Individual Sewage Disposal System at: ------------------------------------• ---------------------••--------•--------•--•----------•--.....••--•-••-•--•------••--•---•-•--•-- yLoca n-Address r t No. er �.�L�C✓.11.�[.G�A..dre -•- - --• --•-- --• --•- -- Installer / Address Q ype of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures -•---------------•---------•----•-------------------------------------------------------------------------------------------------------------------- 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--------------------------------------- a Test Pit No. 1................minutes per inch Depth of "Pest Pit-._----___--•-__-- Depth to ground water---.-_-----.-__---__.... f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------.--.--.---.- t�' ---------------------- ----------------------------------•---------.........--•-•----•--••-•---•---•..................................................... 0 Description of Soil...................................................................................................................................................................... X U •--------------------••----•---------------------•---...---•---------••-•-------•--•---------•••-------••----•-••••--•---•.....---•-----•---------•----••........................................... W ----- --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when ap licable . _--_—/7�_ . . - -- ------------ �.r�...� �� - - --------------------------- Agreem t: 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--issued by the board of health. 11 SI ne ---• -- �- Da e Application Approved By -- - --- ----- ----•-• ------- Date Application Disapproved for the following reasons:----.•------------------ -------------------------------------------------------------------------------- ------------------------------------------------------------------------=---------------•---------•-----•-----•----------------------------------------•--------•-------------------------------•----- _ �. Date - 76 Permit No............. _ ;.':+ Issued...•-2'-Y•'................................................... Date y-------------------------------------------------- ---- --- - - - � y No.---�y-----.•----- ;3 FEa..... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OR HEALTH Appliratioo -for Ui,�Voottl Tonfitrurtion Prrotit Application is hereby made for a Permit to Construct (:,,) or Repair (&,-),*an Individual Sewage Disposal System at: E> � ..... -lmot '!----------------------------•--•------- .......................................... oca n-Address ..--•--. . / �J /fi r t No, ......--•----------------- Installer Add' e ype of Building Size Lot............................Sq. feet Dwelling'—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons.--_--____________-------- Showers ( ) — Cafeteria ( ) 44 d 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. it. z ;.Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------------_------ ..................................................... Date------------------------------------... .a „ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-----_.............. Depth to ground water....-_.--.-..-..-..-_--. (4 �1, Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water......_---___.----_----- P4T . ---------------------------------------------------------------------------------------------------..................................... ----•-•----------- O ` Description of Soil-----------------'----------------------------- U - w ;, x -------------------- ---------- --------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- U 'Nature of Repairs or Alterations—Answer when ap licable.t/LQ .. .....J!!") __ .... . .. ............ ---------------------- Agr`eem t -The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with -.,the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in ".ope�afion until a Certificate of Compliance has been,issued by the board of health:. Signed...... ,,,Application Approved By,._. / Dak Application Disapproved or the following reasons_______________________ ___ ___ _ '°e ate 2 � Y�. Permit No. Issued. 1 -- ------•-•---- . .......... • Date THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH . .. ittrtr�e T IS ;, ed p ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (4-1 b3� - ---- -- -------•----------------.-Installer --- • '-' ---... -- ......• --- - -•-- ----'----- has been ins n a o? an`ce with t vi j: e 0XI o ate Sanitary Code as described in the application for Disposal Works Construction Permit ,.�_/./y:_,_t_�__________________ dated...._._________.........__:__.......__.......... THE ISSUANCE OF THIS CERTIFICATE SH N�'T RE CONSTRUED AS A/4UARA14rE>�''r�R T THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---.. .... 7 -------------------------------------- Inspector--------1� -------•-"-'-'--•--"--•"- �1r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �s ............OF...... . .. ......:.::::............................. Dinvo,6ttl. or notr�trtioatrrmit f Permission is hereby granted-----------i--------- ---------------- to Constru t ( ) or4__epaia "dvi is* S wage is at No. ---------- = = '� treet~pplicisposal Works onstructi n �"t No__________________ Dated..____....____._::__._._......_.___..... as shown on.t ..............................T/J� �� / f Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -