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Home My WebLink About0330 ELLIOTT ROAD - Health (2) 33 D b/11 '04#_ aa� - o �35� .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH W.Al ................OF..... MI2 11�- b�� Appliratinn for Dispos al Works Towitrnrtinn rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal \� System at: } 3� ------..... -------- -----------•-•--•-......--•------------------------------•--•- Location-Address or Lot No. ner Xddress Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms______;�-------------------------••--____Expansion Attic ( ) Garbage Grinder ( ) � Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other xtures d . ---•------------------ ------------------------------------------------------------------ W Design Flow........ ___V----------------------•.-_gallonp per person per day. Total daily flow...........SD._.C)....................gallons. WSeptic Tank—Liquid capacity/jf C?CJ_gkrfs ' Length................ Width................ Diameter---------------- Depth_____________--- x Disposal Trench—No............6.,(... idth.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No._l�Il1Q_/ 4-DiamAer....._._.__.4_... Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution boxy( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water._____________________:. �14 Nest Pit No: 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --------------------------•----------------------------•--------------------------------------------......................................................... O Description of Soil...........""--...$AoSiay....=-------- '--------------------------•-----------------.--._---------------------------------- x 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 Code—The undersigned further agrees not to place the system in operation until.a. Certificate of Compliance has been is§ped by t boar of hea th. Signed_ --- ---- -- ------------ --- ---ram�" ---- Date ApplicationApproved BY...............................................................................................•. ................................... Date Application Disapproved for the following reasons-............................................................................................................... -----••--••------------•-------•-----•--•-----•-•-•--------------------••---•---------------•-----••-••..•-•-----------•------------•-•......------------.----•------••---•---------•--------•-------- ` Date PermitNo........................................................ Issued----..... ...J` ---- •-� --•--...-•-- D to Fim �........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ; .....10..W.Aho.................OF.....J14 Application is 1ereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: _Jed. a r .................................................................................................. ..................!�... .....................................P" ------ Location-Address or Lot No. fit _.r.............................. ------------7...41-1V............ .............................................. 7 ;'Idd,ess wner .............................................................................................. -- ----- --- -----------------7........ ... Installer Address Type of Building Size Lot-----------_--------------Sq. feet U Dwelling—No. of Bedrooms------2------*---------------------------Expansion Attic Garbage Grinder ( P4 Other—Type of Building ---------------------------- No. of persons.-________________________-_ Showers Cafeteria ( Otherfixtures -------------------------------------......................................... ......................--------------------------- ..................... Design Flow...... g ns per person per day. Total daily'flow........... - -----------------.'_:gallons. 0, ....................gal]6' P4 Septic Tank—Liquid capacity/1-ICY&-ga-fron's' Length________________ Width_---,---_-...... Diameter__-.-.-..--.____ Depth.--------------- Disposal Trench—No. .......... . __ Width____________________ Total Length_._.__.__._.____._...................... Total leaching --------sq. ft. 't area....-------- Af Seepage Pit N0.14)00..4,0L- Diameter_-_________Z----- Depth below inlet____________________ Total leaching area--------------_--sq. it. Z Other Distribution box/� Dosing tank Percolation Test Results Performed by-------------------------------------------------------------------------- Date_________.________.__.-__:__._______-_.. Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--._-____-_-_____--.---. rXq Test Pit No. 2................minutes per inch Depth of Test Pit_..._.___.__________ Depth to ground water__-.__-__----______-__-- --•-----------•---=-------•-------------------•-•----•------ .......................................................................................... 0 Description of Soil.......... AA&ZAI•.....n........ --------------------------------------------------------------------------------------- U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ..........................................................................................................................I-------------------------------------------------- ------------------------- 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 Code—The undersigned further agrees not to place the system in operation until a Certificate of Coftipliance has been is by b d P : boar o of health._we '0 Signed--k Date ApplicationApproved By............................................................................................ ............................-------------- Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ................................................ ----------------------------------------------------------------------------------------------------------I----------------------------------------------- Date Permit No......................................................... Issued- f ----------- ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF........... ....................... Tntifirate of (111,omphaurr THIS IS ERTIFY, at the Individual Sewage Disposal System constructed O or Repaired ZZ, by...... ................................... ............................................................................................. Installer .............. ---------------------------------------------- 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.____..;?. ..............._ dated.__..._.. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BECONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY. ,S,� .................................. Inspector/.?, A --------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ 1-0 A--' OF........./—?/f 71f�I ..................... ..................... ....... .............................. No......3 ---ei FEE...' %TUI 'ft urtil n prmit ----------- Permission is herebyl granted---- .................................................. ---------- to Construct O or Repair an Individual Sewage Disposal System atNo........ ......... ------------------- ......... ------- ...... Street as shown on the application for Disposal Works Construction Per�ffip No.___,_ Fa-t4ted------------- ----- ...... ------w-------- Board of Health DATE__....... .... ... ....... ................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS