The URL can be used to link to this page

Home My WebLink About0036 PUTTER LANE - Health (2) 4(40 LA., Get a�+'1/1bf iSESSORS MAP NO:EL .__� No. ........_..... w�C �s�� ........... THE COMMONWEALTH OF MASSACHUSETTS 1Yt�i�t�S BOAR® OF HEALTH ....... v `- ..............oF� . ..................................... Appliratiou for U44puual 10orko Touutrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( anndividual Sewage Disposal System at Location-Address or Lot No. ._..... C7_Iu —.-•----------•-------------- ......................-•---................s. �,.............:........................................... ner Address W �� S Instalier Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms....._3...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------------- --------------- . W Design Flow........ --t1...................gallons per person per day. Total daily flow__._._..<. _ ..................gallons. 1:4 Septic Tank—Liquid capacity............gallons �_ength................ Width................ Diameter................ Depth................ Disposal Trench No..................... Width....9........... Total Length..._.5i;��... 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........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ r%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_____-_--___--_•-_-_. 9 -------------------------------------------•-......----•-------------------.........----•-••---••_.......................................................... 0 Description of Soil........................................................................................................................................................................ x U W x -------------------------- ----------••......-•-•-•••--- ------. ------------...........••-----•--------------------------•-----••------------•----•••-••------•-----• .................. ............ V Nature of Repairs or Alterations—Answer when applicable_____A�Q A_________ ____ f�5..__._, w------_-----_._.___•. l�f "` uSsv_ '1 - ......d -�. gs�.l.�v ......�St.F toaa Sf� T ' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i' :. p }of the State Sanitary Code—The undersigned further agrees to e the system in operation until a Certificate of Compli b the boar h Signed.---••-••-==....... .............. .................. ......... ......... ...��D•"-.•_ - Date Application Approved By--------�" ------ --- -----------—- - ............ ----------=--------------•--......---------- . Date Application Disapproved for the following easons:.................................................................................................. - --------------------------------------------•-----------------------------•-•----------------••---------•---•••-•----•----•--•------•-••----••...----------...------------••-•---------------•---....... �_._.. Date Permit No...... .................................................... Issued....................................................... Date 1'� No................-....... FE .... ...�._........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _0.Lts w..........of...... ..ay.w-.. - -� ( �-e. Appliration for Disposal Works C omtratrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. `17 �� ` owned Address- ] r ]. .. .±p�e=_e �...................................... ......•--•--t_---7--......J-C_r�i(✓1 i ........ o•..' '.•...................... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-----2............. _._..Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ..._-••••--•--- --------------• - - ••------------------- ----------- allons per person per day. Total daily flow__....�......C....................gallons. W Design Flow......�--�-------------------------g P P P Y• Y - 1:4 Septic Tank—Li uid capacity............gallons Length................ Width___ .�._....._ Diameter---------------- Depth................ 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........................ 0i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 .......-...................................................................................................................................................... DDescription of Soil....................................................................................................................................................................... W U ---•--•-------•-----------------------------•---------------------------------------......-•----------...........................-------•-------......--•-----------•--...----••---•----•••....-•-••-•-- W Nature of Repairs or Alterations—Answer when applicable.___ 4,60.................� `/_/�?�._._. _..._ j L441 U P / ! 7 � '! - .._gr4� �✓Ss a �------ _,,aC /� S Q-vv'�_......... A91-g k............-t. � �aa...- .. . Agree _e The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia s��a7b-mrissu b the boar' of heal -. Signed--• -- ... •••. Date --) Application Approved B vt s. =�'�f._. Date Application Disapproved for the following reasons:---•----------------------------•-----------•--------------------------------------------------••--------•••••-- .....--•-•••-•••••-----•••....-••••••-••••-•••••••-•••••----•-----•-•-••------•-••••••-••••••-•••--••••-- ---------------------------------------------------------------------------- ------------------ Date Permit No..........�:Ei:r'z....Lz--is.�------. Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH U.. .(N.........OF... �.....t.c.�..vt `�:�j ........................... Tprrfifiratr of Toutplianle THIS IS T6�IFY,- the Individual Sewage Disposal System constructed ( ) or Repaired by----------------------------------------- -� ....-----------------...------------------------.....----------------------- Installer has been installed in accordance with the provisions of TITHE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ------- dated__.._?-.,I._._._._t=_-----_____�_(........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. WILL FUNCTION . �n DATE..... ------....................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS C BOARD OF HEALTH . w.....OF............. 1r..�_.�. . - ....................... 1�' J o-:•••••••................. FEE........................ Dispoll Marko Tonstrnrtion omit Yg Permission is hereb granted....... .........................•-------------.........--------....---••----....... to Construct ( ) or Repair k__4 an Individual Sewage Disposal System Street \ as shown on the application for Disposal `'forks Construction Permit No.� ............... Dated....... ............... •.7 Board of Health DATE.................... t 1 /J FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS