HomeMy WebLinkAbout0011 ELDRIDGE AVENUE - Health (2) �i ���d�- ���
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No... ,A��. ._. FnE zz....................
n t A� THE BOARD
®� �®COMMONWEALTH Fu c ^CH SETTS
1l " OF....
t� -rle-�_ _�
, pphration for Utdpasal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at
.... . ....AX ............ ........ ........__QQ Loc on-Ad s or Lot No.
--------- 4d- ----- - ......
W Own Address
a ........... ---- • •---••----------------
Installer Address
Type of Buil I Size Lot 0---------_Sq. feet
Dwelling Wo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ___________________________ No. of persons_-----.----___________--_- Showers ( ) — Cafeteria ( )
d Other fixtures ----------------------------------------------
W pg g P P P ................................................... - g
W Septic Tank Liquid capacity gallons per
hn per day.VrdOlal Bail floDtameter.:.............. Depth-- gallons.
x Disposal Trench—No..................... Wi h.........__, 0 1 gtQ___----.--_ Total leaching area________-___--_____-sq. ft.
Seepage Pit No. ------••••-- Diameter t et...............
Total leaching area----------------`.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.--_---------_--_____.-.
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_--..___.________---.
a+' ---------------------------------------------------------------------------------------------------.........................................................
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
X
v -•-•--......•----••---•---------•-----------•---•-------------••••------....•-••---------------••-•-•---------------------------•••---•-----------•----•------•---------•--•--•---•------------•--------
W
V Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
--------------- --- -----------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the afdredescribed 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 n issued by the board Wofhe4ealh,Signed._ L '» 60 1
Date
ApplicationApproved BY-1....;-....................................................................................... ------------------ --------------
Date
Application Disapproved for the following reasons:-------••--•-------------------------------------------•---•-------•--••--------•--•------------•-----.--•••---•
-------------•-•••------••--•----••-..----•---••----------•--•-•----•-------•-----...-- •--------
----- --
O / /ItS
Date
Permit No. ----•--------------------------------------------- . Issued..-- / s '=-
Da e
No.-- _ .1._.. Fxx .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F t-�E l"
., _ O F......
Aliptiratioo for Eiovooaf Yorks Tool#rortioo Prrotit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys em at: 7-4
j f
- ---•--------
Location A ress or Lot No.
dl'
'� ;P Ow r ' Address
a .. .'e4 . . •_4........................... -------------------------'--------....------...----•-• ------•---
� `Installer Address
Type of Buildin Size Lot/ -______---Sq. feet
Dwelling No. of Bedrooms ..._.._.... ........................Expansion Attic ( ) Garbage Grinder ( )
`PLILI Other—Type of Building No. of persons--__-_______•_______________ Showers — Cafeteria
f4 Other fixtures -------------------------------
Design Flow_ . ............. ..---•.,_ __gallons per person per day. Total daily flow----------^_....______ ... gallons.
W ,
WSeptic Tank —Liquid capacit}�..--.____gallons Length................ Width_ ..__._._..____ Diameter__-_-.-.----____ Depth--.-__---.------
Disposal Trench—No..................... Wi th..._......� �.. o"._' en 1 _ Total leachin area.___________________s . ft.
�ttSeepage Pit No._____/............. Diameter _.______.: w°islet.......�............ Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( )
0-4 Percolation Test Results Performed by-------------------------------------.................................... Date----------------------------------------
aTest 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.................................................................................................. -----------------------------------------....------------------•-----
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 1I 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. ) &V ram~
s �
. fit°" ? :� , = '� _ I a is h--------
Signed(;")- .
th ti'w Date
ApplicationApproved By.-...............................................................................................
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------•--•---•......-•-'--•••-
-----------------------------------------------------------------------------'------------------...------------=---------------------=-----------------'---------------------------------- ------------
Date
PermitNoz • ............................................... Issued.-- ............................
Da e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD j.QIF HEALTH
....... ..:. :::+:..........OF.... ... .. r ..... ...............................................
Trr#ifira#r of Tomptiaorr
IIS PTO �ERTII That �e Individdl Sewage Disposal System constructed ( ) or Repaired ( )
by...fira- .... .- `------•------
T_ _- _ 4�,allerxc ..... °' 7 mat ---------- --------•••----•-•-•••----
has been installed in accordance with the provisions ticle X of The State Sanitary cod? as dqscribed in the
application for Disposal Works Construction Permit No................... . ........... dated- . ....�: -___-___..__.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A CUARANTEkTHAT THE
SYSTEM WIL FU CTION SATISFACTORY.
DATE. _�_/_. �P� ............................................ Inspector—'.ter ---------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
�..�..�.
No.. --.•--. FEE•... -
Permission hereby granted= r = = _:� .!...
to Cons ct pair ) 9 dtv dual ewage Diat NcV
s sal System
1
1'-:- • ..
t eet ,,t1
as shown on the application for Disposal Works Construction y rmit N ____�;�;__. Dated. 4r� q ..........
�. G✓
20
w,r Board of Health r,
DATE.. _x. � ---- c
'----^ ..
FORM. 1255 HOBBS & WARREN. INC.. PUBLISHERS -