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Home My WebLink About0125 BLANTYRE AVENUE - Health (2) �S �1.��yre. f}�e. ,Cn.� aa� ��o � II 60 - No..-•--f`-1�--....- Fics./a:........`.... THE COMMONWEALTH OF'MASSACHUSETTS Jt� BOARP F HEALTH � a �w . _...... OF, .. .., .. ... - .. s-- - j -........... _ - Appliration -for Riipoottl Workii Tonotrurtion VProiit Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal Sy / tz- Location-Address� �_ or Lot No. _�._ri? r?... -'a[,`�G= !12�� 7-7 Owner Address a 2 r4 ........................ --•.-- .�.r�-.�i2 v�[t cam----------------------------------------- Installer Address UType of Building 2 Size Lot----------------------------Sq. e ,.a Dwelling—No. of Bedrooms__._..._...«-�...........................Expansion Attic ( ) Garbage Grinder ( 0 p, Other—Type of Building [.A&t?��!l:yNo, of person5--------( --------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------- --------------- - -------------------------------- W Design Flow------------- ....................gallons per person per day. Total daily flow----------- .............. jW Septic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---------------- Depth.____.__..--. r x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area..............------sq. ft. Seepage Pit No..................... Diameter.................... Depth beOlow inlet ------- Total leaching area------- -------._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) 6- �e - " Aa— 7J Percolation Test Results Performed by.......................................................................... Date----------------------------------_--. a Test Pit No. L_______________minutes per inch Depth of "Pest Pit.....................Depth to ground water....____.-_._____.__.._- �14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.......---_-__.-_.-____. .••---------------------- -- ---- - ---- - ---------- x Description of Soil--------------- ................... .. _ - _ h ..__.... -••---- o ------------------------- -...?--• _ .......�...... .._........._..._...� ..--------- W --------------------------------------- --------- ------t .:-+-v.— � !— ---- ----- _ ... ---- - ---------- ---------------- V Nature of Repairs or Alterations Answer when applicable.. ------------------------------------------------------------------------- - �.`•---•--- ".✓ 1. _ _A `•-',__a.:_y...... ----------•--------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions,of Article XI of the State Sanitary Cod�/j�1 The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'gsu d y the board of health. � �-� // jed-- ....... 1.--•----•••--------------------------- •....._....__.a�...._�Ica } � / Date ,� Application Approved By._:. . . -- ------ :. .�" . i r„„ Date Application Disappro d for the following reasons: . ---------------------------- `- _ - w.,LL�c `y fv.��%to ��• � L3e Date .• _... 1 PermitNo.................................... Issued..................... ---------------------------------- Date 0 No........'S......................... F�a. �,/.. THE COMMONWEALTH OF MASSACHUSETTS, BOAR(DF HEALTH _.. � '.►1 .. ._..-- .OF ........ 7-4- . '" Appliration=fur Uitivoott1 Works Tonstrurtion Permit Application is hereby made for a Permit to Construct (L..� br Repair ( ) an Individual Sewage Disposal Sy t: ............ ........4. V"// ... --------------------------- . ..... Location-Address or Lot No. ,• -- Owner C _ Address .... Installer Address UType of Building Size Lot----------------------------Sq. f e Dwelling—No. of Bedrooms..-__----..--?----------------------------Expansion Attic ( ) Garbage Grinder (No Other—Type of Building !� �'� ?!�C �+No. of persons-------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------- --------------------------------------------------•-•------•--------------.------•----- -- - - ----- W Design Flow............Sp.....................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--------------------- Diameter.---_-____-_____---- Depth below inlet.................... Total leaching area......------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) 64- RC" - r1` R G- 7.5' 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------------------------ ----------, ----- --------------• ,t '----------•------•--------------------•------- •---............................. Gf Descri tion of Soil.............. ____. ...-.._.____ �C u-* r a ---- .. -- U Nature of Repairs or Alterations—Answer when applicable ,(a/1la-*1/1-1- --- - ---r. ,�=„ -----`-- --®``-��• - t , ---- ----------------------------------------- -------- ------------------------73........ = ------- --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Co e undersigned further agrees not to place the system in operation until a Certificate of Compliance has been • _u d y the b air health. i ned- -------------- �"'-}�:..... Date Application Approved By.. �.�Lle -%!"�"" '. .7'. 7& Date Application Disapproved for the following reasons:. ----------------------------------•- ----.---------_---------•--•------------------ --•-----•----------•-•--------------•-------•-------------------------------•--------•-•-----••-----------•--.----•-------------•--•---------------------•-•----•---------------------------•--• ....... . Date t PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOAR OF H AL }�I l/ ...............0 F... ......................................... T-Wrtif irateof 0.1,11mpiiaurr THIS IS TO CERTIFY, hat the In idual Sewage Disposal System constructed �orepaired ( ) by -. _-.. ..._.. � - --•------------ ----------------------------•---------------------------------------------------..................... ---_ _ ,,, •..� has been installed in accordance with the provisions of Arlitk XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.--. dated ` 7 /� -. ----•----- THE ISSUANCE OF THIS CERTIFICATE-SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE � SYSTEM WILL FONCTION SATISFACTORY. DATE------------------------------------------•--•-................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEA TH /r/7d �. . '1. � :....... OF !. ..:.......>..1. >......................... No 7iootturk Cnort.6trlrtiu$ rrmi ,� D tea,-.ter-- .�z. Permission�t�ereby granted---------J<_1__1"L_'?r__'1)_1711__1 3�.> �---•-•-•-------...._...._._.. to Construct (4 r Repair ( ) an Indiviiddual Sewage Di&pwW•.System at No---------------- .............................. .. .....•........ ......... ---------................................................................................... Street as shown on the application for Disposal Works Construction rPkpmit N --------- -- ------Dated ............. a•----------------•-•-•--------•---- B DATE ----7C---------------------------------- oard of HeIt FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS " _ I E<ISTrAd h 9 sz �1.9 2%� �i � r kk-- 32A ! ?a# G'ErJ77I ice'I.ti JE t� .. . . .. k /LL LL6V: T .4001/,6 Z'0' .4D PLAIV PLOI Z7.4 PLAN 2E FL-i2«:A/C& : .'.1rti Z-0 y +9 >'4''"'" �.tye„ ..xy�,`t:Jv'.,`✓ //V X::',!,4i Al T AVL-R66Y CEQ TLIAT TA/E EXiST- �'/` /NG FOUAIDAT/ON LOCAT%pN 1S THE 8U/LD/.NG SETC�AC.t�,�E�JGii�EM�,v7 OF T/qE TO1-V/n/ OF 2 . � - pier,.C.2. Tin<C. /4 7-af'Y ten✓. z .t,�✓« ` 1~ ' / — N B Gf//GGObI/S!: Y.42M0 UT1/f'�.2T�.4. i WeC�u^QU4-f i di 1.7 01 Ln 1._ u - K ca 1 S- 'r �x- VE=u'* `\ `�� PTI G TA ou r _ G� 0 � Q 0 T / ------------- WT _ ?0'- ._ CL. 10.5'ToF F-oUuPAYrou10 � M � h . 1 CL- W At-5 N t--D T 1,4 M', 11= tt• x - -- Yt4 L` ' P 0 1 P L P 0 FDC _/ L F—) E Pe C) P E: 'F2 T Y 0 F- � 9 �T JOSUN WMTNEY �1 �y [1! +-i ;'Y i�� Y � tom. Q�'s l; T T ' � t:�:N ; 'S' C .'.. Y r � � N VI ��J E•L E:r C 14l 3O p 1 GA!_` r` p`�6IyrE�'� a, � CGET t►JCH z 4'