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Home My WebLink About0273 ELLIOTT ROAD - Health (3) id 4 No.ft-_------------- F��. Cam................ THE COMMONWEALTH OF MASSACHUSETTS BOARD�� H EA _.- Apphra tiou for %waasal Works Towitrurtion Prrutit 0� Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal systezn t: 4 a -- ...... ......... ... .... 6....... ......... .....Lo'at' Ad ess /j� .. C.. 'd:.d�.. 9CYr0........�[.. ---.. fs:lElf.: , wner Address ,:. r Installer Address Type of Building Size Lot. ..9 l...Sq. feet Dwelling—No. of Bedrooms............. Expansion Attic ( ) Garbage Grinder ( ) .... `.4 Other—Type of Building No. of persons............................ Showers — Cafeteria dOther fixtures ••--••------•---••-••••----•••-•••--•---•••-•-••••••--...................................................... ----------- -- WDesign Flow..................:...C � .;.....gallons per person per day. Total daily flow....._.. .. ........---......-.gallons. WSeptic Tank F 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.......L'9........ Total leaching area..(_5... ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................---------.._._...............__.... Date........................................ Test Pit No. 1—.............minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ rX4 Test Pit No. 2................minutes per inch Dept of Test Pit.................... Depth to ground water....................... W ------------ ODescription of Soil................•..... = �. ••r•---...-•----------......----------'------•-•-----••-•-•-•---------------------•-...----..................••. x V -------•-----------•-------------------------------------------•--••••-----•----•-•--•-••--•----••-----------------•••-••-•-•----------------------•-----------.---------.------ W 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 d by th oa�of health. i ne ...... : Date l' r Application Approved By............ ,-- ---- -----. _...---• ==1------ - ��J-- - --- =----- .a. ��-D--- -.----- Date Application Disapproved for the following reasons------------------------------------------ ............................................................... ................•----•••----•-•--•---•--•--------••-----------•••--•--•--••--•------_........._..._..........•--....._.....•------•--------------.........-•------------••••---••-------------•-•....... Date Permit No.... ......................................... Issued••-•.. -- ............ r No•-•e`-`....•--._....... Fln$.. .r................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T!� e �s�ems"{ � !" v1 "----- . OF ..... ................. v Y Applirativit for Diiivasal Worko Tutuxtrudijan Vautit Application'is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal System �t 3�T 3� '-7 Add d'�•�e 8fP' ............................ . ' t - .. - rrif,,. `t ,L'oci.i .Add�fess 1i % .r �« .+?: p or.... O ,. aeeealem$IASZ�4 ..¢ipeKgpses(6`'y':.jFw .s ..en.n s.n.�.a0...r.sL'Lt ,.•,.'Yt ..... h. ` V4ia W !f tuner •Address _ ✓ .�. ( e�.. ,.................. .. ........................................ ................._ �✓' ,... stzlIer Address y �A Type of Building Size Lot_ 'r'3�. %�Sq. feet Dwelling—No. of Bedrooms.__...._, Expansion Attic ( ) Ganage Grinder ( ) aOther—Type of Building -------------- ....:_ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --•--------------------•---•----•-••-- ----•-----------•-------------------••--_..... ...._. W Design Flow.................:.. : _... tllons per person per day. Total daily flow -._-.__. tl..__gallons. WSeptic Tank Liquid capacity_/.�i•k allons Length................ Width................ Diameter................ Depth................ Disposal Trench— o..................... Width Total Length .... . Total leaching area....................sq. ft. -_---. Diameter_ •._. e th below inlet Seepage Pit No____ _______ „ p ..g �?_...... Total leaching area.__...;, ... t. Z Other Distribution box ( ) Dosing tank ( ). Percolation Test Results Performed by------ ...............-...................... ------ __.. Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water............_---___----. fsl Test Pit No. 2................minutes per i ch Depth of Test Pit-__--_--_-_-__---- Depth to ground water--______---------------. 9 .............. ...,. ----•---•-•----. ----------------------------•-----------------.--•--------------•.---- ODescription of Soil ------------••.... -----•--------••---•------•---••••--------••---•••-------------•-•---•••-••-•-- V -------------=--•---------------------------• •-------------------------------....................................................... W UNature 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 iss�d by theAoard of health. ¢ , rLf . - ate Application Approved By ..... Application Disapproved for the following reasons:--_ .......:. ......... .:....... ....... . . ........ ............................................ ------------------------•-•----•---...-=•==----•-------------.....--•-----.........------•--•----•--•••--•-••--------•••-•-----•-----------------•-.._......--•-----•--•--••----•--••-•-•-•----......._. Date PermitNo........................................................ Issued........................................................ Date .THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH >,. a ......w....... Tntifi ate lie Tilutphanu 21S IS CERTIFY,That the Individual Sewage Disposal System constructed ( ` or Repaired by-- F/�r .. kL p _.. $ _- .. . ------ f ''r, y3 r r^ •...,44 r Installer r at... a ' a "f r'c5 a •'•'f---- ---- r ----_ ,� y . a-Y has been installed in accordance with the provisions of article XI of The etate Sanitary Code as described in the application for Disposal Works Construction Permit N0............fl ____`_______________ 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 r� HEALTH ......... No.......4.L.` ......... FEE..a ,. Permission isl ereby granted--. , to Const�ct � or Pjepazr/( )mar .indiva ti e ge Disposal Syster>4 at r._ c .. ......� Street f . as shown on the application for Disposal Works Construction Pe Zit No..,4 ........ Dated � r r � F .................................. y1 /H08B of IILaIt f� $oa iDATE :.FORYI 12 & WARREN, INC.. PUBLISHERS -