HomeMy WebLinkAbout0472 ELLIOTT ROAD - Health V 2 E/hart Rd
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SEWAGE PERMIT NO
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INST L R'S NAME & AD RES
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED 77
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
._.......OF.... ..i G A ---�-1�..................................
Appliration -fur Biupuuai lgorkii Cnunutrurtion Vrrmft
Application is hereby`made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal
System
1___'_// ® T
---------------------------------------------`-------•••----
r oc-' Addr o Lot No.
- -----•--•--•....................... ?:XS3�7... i. �.� <,r T
Owner /�ddr ss •—
Installer Address
Type of Building Size Lot..,L_..-�/6__(j------Sq. feet.
Dwelling—No. of Bedrooms------------ Expansion Attic Ob) Garbage Grinder
aOther—Type of Building ,C"�P�! ._.-__--gc L�o. of persons.--_.-.__ _____________ Showers (� — Cafeteria.( )
Other fixtures •---a-C.J- ..... S,lA`''' (u6 &!?---5---T---5°v/
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..14010.--__. Diameter.4._Xt Depth below i let...................,Total leaching area----_--_-----_-sq. it.
z Other Distribution box ( ) Dosing tank ( ) �'®�' t— 6" ,/ -77
-
aPercolation Test Results Performed by......... ---------------- ------------------------------------------ Date--------------------------------------
,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_---..-..-----.......
�14 Test Pit No. Z................minutes per inch Depth of Test Pit.................... Depth to ground water--.----.-----..-..----..
------• ----•• -----••-•...................----------------- - ----------
0 Descriptio o f oI `"/ .- va - 'c''��' �-
x
a
x ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------
U Nature of Repairs-or Alterations—Answer when applicable..----------------------------------------------------------------------------------------------
----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ -----------------
Agreement: 1
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b rn,
d e board of health.
Signed .... ...... --------•--•------------------------•-- .�•= �.•/
ate
a Application Approved BY ... � .... --•------------- ............ --�7-----
Date
Application Disapproved for the following reasons----------------------------- -----------------------------------------------------------------------------------
-----------•----------------•-----------------------------------••......-••-•-•-•-•-•--•-- ......................................-----------------------------------------------------------------------
Date
Permit No---------------•----......----•------ Issued.••.
Date
F f
No.................. _--- FEE.../. ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.Applirattnn -for 13hip sal Works Tomitrnrttnn Vrrmft
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at:
----...°......'�/men T----............---------------•---•-----------------<----------- ----------•--------- e ..........................................................
]]�� (/�+► ! . Add Lot No.A � ..
. / ... ------.....
Owner dd ss
a ................................................ •----_-----------LIA 0 ...............................
Installer Address jam„
Q Type of Building Size Lot_./v_._$145.;g......Sq. e
U Dwelling No. of Bedrooms._ -Ex Expansion tic
'--' g— -- •� �-- ---•• ---• P� „ °'� 'Garbage Grinder. a
Other—Type of Building Flu;. �l 1 0. of persons- "Showers
a YP g -- ------- . - - P .'Z.} Cafeterta ( )
d Otl fixtures --- � .------ - 5/�ow rrb- o!9de5 } X. -•- i'�'` �,W. a- We3�1 h
-----•-----••----
Design __________________________gallons per pet-son per day. Total daily flow-----------_--- 6 ___ .....gallons.
W n rlow______ _.____
f Septic Tank—Liquid capacity _gallons . Length_____ _________ Width---------. __ Diameter-----.----------- Depth.__.___.__...-..
Disposal Trench—No- ____________________ Width____'_•-_ Total Length.................... Total leaching area.--._.-______-_-_-_sq. ft.
Seepage Pit No._I.G"Q------- Diameter_I_XY"--- Depth below lillet____________ ____ Total leachingarea------._-.--_____sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) "00040' Wit w j$'%,A/,
Percolation Test Results Performed by---------------------------------------------- ............................ Date-----•-------------------------------...
xa Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground'water.._-_-_-_--..-__-___--
w Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_._.-_____-_-..----.---
--------------••-- •---------•-- ._..._- -
D Descriptio of mSoi --•-- ,�--- l " ._
W
VNature of Repairs or Alterations—Answer when applicable............. -_.._....................... ......................._-..-.--.._____..._.__...
?.,
i
-----------------------------------
Agreement:,
The undersigned agrees to .install -the aforedescribed IridiylduaL;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
operation until a Certificate of Compliance has b I d e.board of-health.
Signed. ---=...... -----`-"`------
Application Approved By----••• . . . -_._---- . ---------- ...........47..� re'��-----
Date
Application Disapproved for the follouiing reasons:-------•----_-==-------'----------------------------------------------•••--------•--••••-•--•-•----------------
••._._....•-•••--•..........................._. ---•--------••--•••------------------------------------------------•-•--------------------------------•-----•------- ................................
C�-
Permit No. b'; Issued. c - -- Da
te
ra Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L.. . ...............0F........ ........................................_.,.,,.......
tv
Tntif irate of fflTompliaurr
THIS IS T9 CERTIFY, That,the Individual Sewage Disposal System constructed ( <r Repaired
Y
----- -- ----- -------
I taller
..
at_. _y. _ ` --------••-•---------------•-•-
Iias been installed in accordance with the provisions of I of The State Sanitary Code as desctibe_d,„jn the .:
application for Disposal Works Construction Permit No. ____• ..----�-�-"--� --------. dated-------�''"_er:�' �------------------
THE 'LSSUAIdCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI L FUNCTION. SATISFACTORY. = `
DAT)✓- Ins ector: 50
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
.. .- ^Y
.� ......OF..... � ° ... .'. r
I�
No._...:_... FEIiF
Birivalr �nnitrnrtion Wrm t Permission hereby gran d_...ja
-_' , ---' - ''°- •\......
R to Constr or Re I i al S e i oral "t' - ------------+_
at Nem
o.. _ _ �_`
7- .. .... ........t-6....... ------- - ------
street
as shown on the application for Disposal Works.C-onstruction Per o ,y ..............................
-----_-----
:' i •�DATE = - Board of'�Health' •
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= -/-:. _ �---------------------------
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FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS -
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH '
------ - -------- --------------. � .
No..................... FEE ...........
r 01onfitrur ivu rrutit
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Permission 's ereby gra ed-- . ° s
to Constr or Re I, v- ual S w ge i osal stem '
Street
as shown on the application for Disposal Works Construction Per o ____ _______ Dated__________________________________________
_ .��,Z� Gam— ...
Board of Health
DATE........................................----------------------------------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS -
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