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Home My WebLink About0035 LINDEN AVENUE - Health (2) 35 l�nd�n 416 ; 04- No.`.::. :; e� � Fps.. ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r -._10WAI....................OF..... . . ApplirFa#ion for 11hipsal Workfi Toms rurtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: �:. :......... -------------•------•--...................--------•---.........--.-----------..................... J Location (-Add r s-/ or Lot No. --------- .�-{��, !!�G!!{! ...... ... ............ ............................................. .............................................. W Owf�r Address a .............. Qan!!��„�..... 1 ... •............................... ................................................... ........_......------•....... .._..........._.. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...,___ ._.---•------------------------Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building No. of persons _.. f� YP g •-•--------------•--...--•-- P Y............... Showers ( ) — Cafeteria ( ) 0.' Other fixtures ------------------------------------------------•---- ••••-•••••--••-••------•----•-•---••... d i w Design Flow............................................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 ( ) . aPercolation Test Results Performed by.......................................................................... Date..................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._____..._..___.....___. P+' •------------------------------------- ..... •-----------•-•-•----------••--------------- ------------ ---------- •-------- ----------------- ODescription of Soil........................................................................................................................................................................ -•-•-------•-•-•-••---•--•-••••••••---••--••-••-•--••-•••••••-•••••......--------..._.. x U ••••-••-••-•••••-•••--•--•-•••--•-•--••-••--•-•------••.._..-••-•-•-•••••------•---•-•-•----•--•••-•-•--•-••--•••-•--••--•--•-•--•••••••----•--•••••••••-••--••-••-•••••••--•-•-•-•--•-••••............. w _ V Nature of t airs or Altera on Answer when appl ble_.... __.._...,lt1f�_ ___________________-•••-•-•••••...... � cs-- ...... ...... -- - - ------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITi U 5 of the State Sanitary Code—The undersigned further agrees not to-place the system in operation until a Certificate of.Compliance has bee iss ed by thbb �r o heaSignedz Via.. ........... 7 _ �__ " -- . ...... ate Application Approved B D Date Application Disapproved for the following reasons:......................../........ ----------•---------------------•-••............•••. ----.......... ------------------------•----------••--................................................................. ---------------------------------------•-•----------------------------------------------••-•--- Date PermitNo......................................................... Issued-....................................................... Date �11�� , Fps. J� No. --• -... .. .. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .-.IDLt1-i—-------------------OF......I J e �/ ......./3L ....................................... Appliratiun fur Dhipaii al Worku Tonutrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: a ..e...--•--...---.r......... %==!•.. .° --------------•------------•-•----•--.....-. .....-----•--------------... ..------. Location•Address / r or Lot No. . .............. . --------........-•-••:....---............... --........--•---------•-•-•-----•••---.......------.............................................. % Owner F Address a / .. i Cai----------_----�'------------------- --------- ---•----------------••---•-•------------•-•-------•---------------..-............. Installer Address Q Type of Building ' Size Lot...........................Sq. feet Dwelling—No. of Bedrooms......../...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons....... -------------- Showers ( ) — Cafeteria ( ) Q, Other fixtures ...................................................... W Design Flow............................................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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--___________-__•-_____. i G% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Q+' •----•••--------------•-••••------------••--•------•-----.......---------------.......••----.......-.-----------•--------.._--------------------------------- Descriptionof Soil........................................................................................................................................................................ U ----------------------------------------------------------------------•-----••--•--------------•----------------- -------------------------- •--.--••--• ---- -••----- .W --------- -------------------------- U Nature of Repairs orAlteriations/— AnsweF,whenapphcable_.._.., 1n. :/_..',_/-._�_:S_s_•.-'y_-/_--�.-."-?_-_-_-_-_-.------•... r.................................... ........................................................r ................................................✓ _.. ..............Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?',; 5 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. Sign - --�.�.�� t/ ------•---------------------------'----.--••--•------' -- j/a.c `�� Date Application Approved By......_ '2.......__ [.___11 �'9 �` fr----------------------•• ---•- �_� _.... Date Application Disapproved for the following reasons-------------•-•--•--------...------------------.......-----•-------------------•----------•-----......---•--•-- ..............•-----••----------------•-••--••--•--------•----------------••--------•----------....--••-----------------------•-----•••--------•------•------------------•-•--•-------------••--•------- Date PermitNo......................................................... Issued..................••-••---•--•--...-----.....---•-...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................,- . OF.....�1��'!P•! .S. if .................................. CIrdifiratr of Tamptittnrr TH-I:S,IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (.X) by........ fir'r .. ...... ��:........ .... _ w nstaller at............... = �...... --- has been installed in accordance with the provisions of ITl E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit l j__._Y -------------------- dated-_. ._ _.f..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED�AS A GUARANTEE THAT THE SYSTEM VLL FUNCTION ATISFACTO Y ...... Inspector...........DATE..... ..L...�........I..1.... Cy v�!.......91 ................................................ Z� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y O F...............................' ................................I........ No._.....!...f1 ...... FEE.......:................ Miji alt urku. Tunw#r ,x n ;permit --- Permission is hereby granted ------ 1�^ �!_... -----------�" -- r•........................................................... to Construct ( ) or Repair r("�) an Individual Sewn ge Disposal System / at No v_ Y-=` Icy •� K:`'........,toms EGG r r '"-2c r 4 �` .............................................. ` Street as shown on the application for Disposal Works Construction.,-Permit Non___ti.......ef.. Dated.7_�f_.z_.` 717 Board of Health DATE-------- --- ---- •-- -----•---• ...................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS