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Home My WebLink About0044 KELLEY ROAD - Health (2) yy NJ� N �,xw S i i i {.. t&R14MEWEALTH DEPT, No—S7 MA 026 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q...w .............OF..... �%�< 3.�a� ....................... Appliration for Disposal . arks Tonstrur#inn Wratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .............a--L......e............,................................................. ...... ............................................................. Location•Address No or t �o. ...........�c�.Q ........ ------ Address ---- .......Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic (' ) Garbage Grinder ( ) `4 Other—Type T e of Buildiil p� yp g ............................ No. of persons............................ Showers ( ) — Cafeteria Q Other fixtures .......................... . . ...................... W Design Flow...........�.5....................gallons per person per day. Total daily flow__...k.-L.-��---........ ............gallons. WSeptic Tank—Liquid capacit} .gallons Length..l.a-_6..._ Width...to... ..... Diameter................ Depth__. 6...... x Disposal Trench—No. .................... Width.................... Total Length.......... �� Total leaching area....................sq. ft. Seepage Pit No.......c`'�—.._.__.. Diameter__._...J_C - Depth below inlet_..dl.....--. Total leaching area..................sq. 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-----•---------------------------------------------------••---•---•-------..............----------...........................-----........._.....----.-_.... 0 Description of Soil................................................................................................................................................................ c.� ---------------------------•-•-•-•--------------- ---------.---------------------..... •-------. ---------- -----..... --------- ----------------------------------------------•------------------------------- ------------......•--------...--------•-----------------•--------------------•------•---------- ......................... U Nature of Repairs or Alterations—Answer '�� -gip ..--'t-' -�---------�a �.....-- ....... a'ti`.., Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of AIT:..i: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha nays ed by the b -off heap r r Signed_.. = -------•-- -•-�/— .. /� Date ApplicationApproved By---••---•I....---•-----•-•----------••--•---•---•--------------- --------------------------- - Date Application Disapproved for the following reasons-.............-................................................................................................. ....................•----•---•-----------...........---------.....------......------.....-------------------------------•--•--•-----------••---•--------------------------------------------••--.....--- Date Permit No..... K:S_:-/.-D$3--------------------- Issued-....................................................... Date la A"Elf A, r W_ Z`"� Stx r�l01 - 73 -- le) �._.: THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH Appliratilan for Disposal Works Tons#rurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at.: ............ .... .......:�..l.�.--. c .....------ . ................ ..•- ► 5!r- .vc!n a.5....... I .. Location.Address ° ................... .._. cl ........ ) ,�r��,i _ 6 . T \ ,�uAI S o. ,�Own� `'�'�"� Address j.. ........................ ••-•••-•--- '=- -Q--/ ?v- .. .. ...............��....------------...... --y-----'--�--=.:4....:�r7'x`'��.�.�5....�1�7� ............_. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of,Buildin O yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ................••---•-••--• _- �.. Design Flow.......... '�� ............• .gallons per person per ay.-Total daily flow... .. :._.l W g . Width... Diameter... W Septic Tank—Liquid'capacity�!�"�_gallons Length_.l._._._...__ ............... Depth__L/�gallons. x Disposal Trench—No..................... Width._.................. Total Length._.__.____._._.�._. Total leaching area....................sq. ft. Seepage Pit No......;�,:....... Diameter........ Depth below inlet...:��,L ..... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ o: ..-•---••••-••-•--•-••-•--•-•-••-••••••-•-•---...--••-•...-•......................•-•••--•-••...._.........---•-••-••-•••.....•---......_..............._.._ 0 Description of Soil.................................................................. V ------------- -•----. -----------------.................... .------------- -------------------------- •------ •--------------- •-------------- ------------•------••----------- U Nature of Repairs or Alterations—Answer when applicable...._:._W 57 A 1\--`�'�{•�-�•_�T•_.•---�-.�ti�c�..'t-1�c,z s_i��}r ................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LIT%.- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been-issu�edd by the bo rd-of-health. Signed. ._.: - - .[/ Date /� � Application Approved By......... 4 .......................................................................... D L Date Application Disapproved for the following reasons:----•-------------•------------•--------•-----•-•---------------------------•---•----------••--•--......._.-•--- .......•-••-•---•................•----•.......-----...•---•-••---•---....•----••-----••••----•••---•••--•.............................................. ............................................ Date Permit No.....�_.��`..."1 •3...................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �—— —T, ^— —— __.. ` BOARD OF HEALTH a ...........OF........1`a. . Ws? . '....................................... (9rdifiratr of (toutplittnrr THIS IS TO.0 RTIFY, That the-Individual ewage Disposal System constructed ( ) or Repaired (��'" by------------------------------- Installer at...................... ...... e ------------------..-------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Perrnit No...... ��!�_�............... dated........ '............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E® AS A GUARANTEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATEl"`A .... 1 ---.. .... ��. ............................... Inspector........---•----- . ....... -- •--- ........ ........ 1 - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. ... ..n....Ad JV........ :OF........h� ..Y..w �. � e .................................._........ ...... FEE...tia., :.C- Disposal. Works Tonstnu tion Permit Permission is hereby granted........... a�1..?_ Y...___. .. ? � ._ ................................................................... to Construct ( ) or Repair ( —)-an Indiviiduual Sewage Disposal System at No.----•••-••--•-•....�.6o....... �>. .\��1._.. Street as shown on the application for Disposal Works Construction Permit No...-........._._-, Dated....n.................................... DATE.. �s",:r s ,i Ir :,ua% o 4-r:oc-H ?'iT5 S-T o N E �3t:pc -CC-6 s PQ ..//�� T9 e DYE J ti G � �c1EaN ovT -ro �Q�►cE r —;u IfIl"P y o' K rE-LL Y RD, 13 ?-oo� C Ai�f- LEAN SEP'C'\cS Lr