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Home My WebLink About0067 BLANTYRE AVENUE - Health (2) 6r7 bja6ye- Ave. , daA � o u r N -.....2: .�� a�.�- F�S............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ...............OF.......................... :............ ;ke"�pfiration for Ui ipoii l Works Tomitrurtinn omit v, Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal PP Y CaC) P ( ) g P System at: C,® s 13 14- ,.ns c,vo p,ss essvYs - - •-•-• .... ... ..---- �" C o a -tion ddress ^� y or Lot ¢. . . Y� - ------.... .l��h...��A �^�Nl_ti!.�ti...... �1�... Owner Address a 1 ` B .t9.4s11d ................ --------------•---•---••-•-----..._..---•------•----...........------•--....... Inst er Address f Type of Building Size Lot__& ). Q '..Sq. feet �--� Dwelling—No. of Bedrooms-----V._O.Y`r'_.......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers 0.� YP g -----•---•-----•-----------• P ( ) — Cafeteria ( ) Otherfixtures ••••--•-•--------------••-----••••••-•••-•-•--•---•••---•••••••••--•--•-•-•--•-...---------------••----••--•••••°-•••-••--•-••-••----............__.. W Design Flow............V._0.......................gallons per person per day. Total daily flow.......... .....................gallonse WSeptic Tank—Liquid'capacitylXli�q__gallons Length................ Width................ Diameter................ Depth_......... x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq�-ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test,Results Performed by____________________________________________________...._.. __._-._ Date........................................ ,.a Test Pit No. 1.......a......minutes per inch Depth of Test Pit---------9_i..... Depth to ground water-----�i_..'............. Test Pit No. 2___________.....minutes per inch Depth of Test Pit.......... ....... Depth to ground water------ ................. O Description of Soil...... x VW ••••-•-------------------------••----------•--••-•-•---••••---------••--•--••--••-•••-•-------•••••--••••-•••••-----------------------•-••••--------•••-•-••---••---•-•------•-•--------•--••---••-•-•-- Nature of Repairs or Alterations—Answer when applicable..........................................................................._.................... ----------------------------------•-----------------------•-------------------•-•-••-•............_-••_.._••-••--•-------•-----•••--------••-••••--•-------•---••-• .................................. Agreement: The undersigned,agrees to install the aforedescribed Individual Sewage Dis 1 System in accordance with provisions of TITLE 5 of the State Sanitar Code—The undersigned further ree not to place the system in- the _ operation until a Certificate-of Compliance ha een ued-by t o z of healt gned-•--,. ...... .............. •........... ....... / ---•- /aD• Z ........ Application Approved B - .............. ...... ...... -- _`cl✓:--••-•- Date Application Disapproved for the following reasons____________ _ ----------------------------------••••-•----..••---------•---••-•--------•---- •••••••-••-•-- •--------------------------•-------------•-------------•-----.._..-----------------------..._..---------•--•••--•••-••••••••-•-••---••••--•••---•••------•--•--••------•••••-••-•••-----•--•----••------ Date PermitNo......................................................... Issued....................................................... Date No........;2.... ?... ` F�s.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH YnJ:• ."lr 0 .. ..... ............. ......OF.... ........................ ...................._.......--___.........._..........._.... r A.-ppliraation for Disposal,Works Tomitrurtion trutit A Application is hereby made for a Permit to Construct ( ,} or Repair ( ) an Individual Sewage Disposal „v Syst ......-- --•-----•---•----......--•-------••------•. .........................••---...------•-----•---••-•--------...----••------_....: .---_.... L atiola- �r..e.ss. or Lot No. OH/ner� Address . ��•`.k!S ' '------------•--•-•................... ......•-------------•-----......_....----------......_..--..•.----................._..... Ins er Address UType of Building Size Lot............................Sq. feet �., Dwelling-6�No. of Bedrooms............ ______ ________________Expansion Attic ( ) Garbage Grinder ( ) ati4. aOther—Type of Building ............................'`No: of persons.__.._...._........_...._... Showers ( ) — Cafeteria ( ) dOther fixtures ......................•-•--------------•-•-----------•------------........__.._....-------------- W Design Flow...................5.-is..�.._.._....__ .gallons per person per day. Total daily flow__..._�j�y(�____'..................gallons. WSeptic Tank-L Liquid capacity.�&gallons Length---------- Width................ Diameter----------------- Depth................ x Disposal Trench No-----------------•--- Width....1.-,z-_...... Total Length........2.6_. Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below i let__...__.._..__.__... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to /52�. aPercolation Test Results Performed by__________t04iLL6___... ,,�,'tr._______.______ Date... Test Pit No. 1-----------------minutes per inch Depth of Test It.................... Depth to ground water........................ 44 Test Pit No. 2._....I!-, ___..minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------- ------ ---- --- -- .......... D Description of Soil........... -"--�--......_ Syr Ctll__ �.- �' '� x /J - W •---••••.-•----•-------------------------•---•-•-••-•-•-- ...........................................-----•-•-----------------•----•------••---•-••--••-----••--------•--••----------•-------------- U Nature of Repairs or Alterations F Answer when applicable.............................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposa in accordance with the provisions of TITLE, #5 of the State`Sanitar ode— The undersigned further ag ees not to ace the system in operation until a Certificate of Compliance has a iss y th ar health. gned � +�a� +. ApplicationAPProvedBy=---------- ---- ..- ----------. .................... ..................... ----••-•------ ace._.... • Application Disapproved for the following reasons:-----•------------------•-------------------------------------•-•---------------•--------------------.........._ ..............•--•--........----------------•--•-----------...-•-•-••...••----•-- Date Permit No....................................................... Issued.................... f.. Date TH9'QOMMONWEALTH OF MASSACHUSETTS r s• �,,f BC ARD OF HEAL 0.......... ......................o'F....... ...................,..........:..................................... T-rtifiraatr of Toutpliaanrr z--M- THIS IS TO IF Thakthe Individual Sewage Disposal System constructed ( or R aired ( ) 6 a -------- at...... •• has been installed in accordance with the provisions of IP j Sly-the State Sanitary.Co$0'as:;des7i1 d in the application for Disposal Works Co nstruction Permit No________________________________________ dated---_.....-...._._.._______.__...._._._........ THE,IS_502ANCE `OF THIS CERTIFICATE SHALL`N®T BE C®EdST6tt9ED AS A GUARANTEE T�IAT THE SYSTEM 1@►11'LL '06NCTION SATISFACTORY., DATE........-- ''. -----------------•----------------------- --••---•_... In§pee or....... ti'--........ ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ...........r .......OF. No......................... FEE........................ . 'Riupouaal Works Tonotrurtion motif Permission is hereby granted.................. = !' ..................... to Construe ) or Re pal ��ndivi l ewagg,.l�p �� _ at No.. ........' i . i Street __ as shown on th"e application for Disposal Works Construction, Pe - ____ f._ ----- ____. -----_------------- i ` Board of Health DATE...... ,:.t'=--------------------•-------•-••----........................... FORM 1255 HOBBS & WARREN, INC." PUBLISHERS �� VM 77T' ION Cot t ( N • fir' _ +� � wl . • Q I x t.vT�25 ,�3,�r s� Wes`" � +-� �r�r �:r•a;~ .�� t 4 , ., ItG +4 1 s �. _ I ?L �' *�,�•�L- #�.'__1' •p►sv�t�-tea s�� 'U�' 3'�L�+G{��it_�.`-s►4bkM�r as^i. r A� V f- 3, :S, ( - � .. 'U w. �•_. + "'" "� t�I"-4v1� �•P ,�Cs!' t , n; �, tr�-�-a� f1 �o "¢'r *6�� t � �`t�:•(32+��c4;�4��;5 c �107 wmrr i 1 sir.� /1�►,�: , �, �t yi � .� ., � - �. Log(.: c� -f Flo.44Z _ �'•�•w 31�.r� {iw >. 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