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HomeMy WebLinkAbout0240 PUTNAM AVENUE - Health 4A2 AJ, 0/CO/o CutLess File Folders 48420 Tops-Products.corn/Pendatlex MADE IN USA $00/c,iPCF P4 v c2 v N ,���` ...�..:...�....... >� Z .. t Fps............................. THE COMMONWEALTH OF MASSACHUSETTS v3 BOAR® OF HEALTH U �' �.� ] p�(o _.--.......-.i-OW.0.............oF.......... ��-n a. J. c .-........-... 1 Appliration for Bigpnaai Works Tanatrnrtion Vamit Application is hereby made for a Permit to Construct ( &,�or Repair ( ) an Individual Sewage Disposal System at: . ..� r. . ._.. ............. �r..... ...... ..._ ---...--•........................... " Location- ddress or Lot No. --------------------------..... .0 -• . ...........--..-----......._ .................------------................. Owner Address W � Installer Address ,,�� • ! Type of Building Size Lot....•....-�. �-.meet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -----------------------------•-- . W Design Flow................. ..................gallons per person per day. Total daily flow........................._`3.3 ....gallons. WSeptic Tank—Liquid capacity.16 allons Length---------------- Width---------------- Diameter--.-------.----- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------I--------- iameter........0------- Depth below inlet.......&........ Total leaching area..._`4?G0..sq. ft. Z Other Distribution box ( ° Dosing tank ( ) ~' Percolation Test Results Performed by.......- �-__.OY-6------------_-_-_- Date........71.1,.711t2......... Test Pit No. I-----°L!----minutes per inch Depth of Test Pit........131,!... Depth to ground water--- "............. Test Pit No. 2................minutes per inch Depth of Test Pit---................. Depth to ground water........................ -------------------------------•---•----••------•--•----....------------.................--••-----•-......................................................... 0 Description of Soil----------------------------------------------- --•-•-••--------------------------------------------•-------------•-----•---•----------•-••-•---•------------------- JM.�� '-..r. - r --------------------------------------------------------------------------------- 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 TITLE 5 of the State Environmental 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. Signed ... . ... ............................................................................. .. ------....------- -- -- - Application Approved B _ 'Z1e - - - d Pp PP Y ,------ ------ -- --------------------------------------- I}ate Application Disapproved for the following reasons: ................................................................. . ........ ................................................. i ------------------------------------- ------------------ ........................................ Permit No. ...... ------------ Issued --------------- `- �J ..... Dace '---- - -- Noy , ..::2 tf FEB.I....� . THE COMMONWEALTH OF MASSACHUSETTS g_ BOARD Off` HEALTH ............. 0W-i -►4......_.....OF......... .....''..h.,.............€ L•53...... A1141 iratinn for Bispnott1 Works Cnnnitrudinn Prrutit Application is hereby made for a Permit to Construct ( 1,�or Repair ( ) an Individual Sewage Disposal System at: Car .......................... . . --l .��r,;; . ......---- �„ .0 t .... •-••------ ••--•---.... .._ ........... .._..........._. Location- � or Lot No. ......... oj.......... �amts�...--••........................ ...............•-•-.......---------•-•-----..........-----•....................................... Owner Address •--------••---------------•-•----•-•------.................------_._....._............_........ .................................................................................................. � Installer Address � r d Type of Building Size Lot............................Scl. et U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) U W p.l Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures W Design Flow................. 1._............._._..gallons per person per day. Total daily flow..........................13.P....gallons. WSeptic Tank—Liquid capacity.10.9 allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width..-..._............ Total Length.................... Total leaching area....................sq. ft. ......... .... ..... De th below inlet.._.... �Q.. ft. Seepage Pit No..._..___:_�:._._..eiameter p '.__.___.. Total leaching area............. sq. Z Other Distribution box ( ' Dosing tank ( ) Percolation Test Results Performed by.......... 1?. . "'' ._ "__ ....................... 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........................ P4 ----•-••••------------------------------------------------••---•-•--....-•-•...................---•......................................................... 0 Description of Soil--••---------------------------------------- ------••---•.......-•---.....--•---•-•------•••--•-•--------•••--•••...--•---•-----..................................---• V --•------------••-•-••-•--•------•---•......---•. l:»! -............. 1`u'a .......... I'� -----------------•-----------------------------------------•---------•----------- W .......................-................................................................................................................................................................................ VNature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------•---•------•-------•-------•------------•---- -------------r....................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. Signed ------------------------- Application Approved BY = � /.?' ���?........�, ...y I��/..,(//Jf��/ Application Disapproved for the following reasons: .......... .. . ......... ... .. ................... ......... . .... . ... ............................... ---------------------- .---...-----.........--------------...__...---------------------------.... . ------------------. -- ---....._ ............------------ ------------ Permit No. ....... .- ------------ Issued .....---- -- ----Z---`--- ,--.-- I?ate THE COMMONWEALTH OF MASSACHUSETTS ... BOARD QF HEALTH FO.. �.l..... OF ........... .-r-rt rJ . .................................... (9E>r#tftrato of (�ontyliattrE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------------/----- . ...........i ' .__.....................------...._.... --- --.------................�.... a.. f .............................................................................................................................................................. at .................. ' has been installed in accordance with the provisions of TITLE 5 The �W.. ironmental Coe as desc 'bed the application for Disposal Works Construction Permit No. __- ---......... dated _.. ".��.. :..... 11 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . -- --- ----------------- ------------------------- - --------------- Inspector ------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !�',��� OF....... .:1......€.4�7 "d..�.ds. .................................... ,,/ No(....................... FEE.-.-............----•-•. Dislinsal Workii Tnni�i inn rruti# Permission JKhereby granted----------------/--,/.. ......--�•• = 'G................................ ......................................... to Construct( Zor Re air ( a ndividual Sewage Disposal Sys ............ .. R Streets as shown on the application for Disposal Works Constructio it NoA�� ate ............................... j © � Board of Health DATE.._..----/ ............................. FORM 1255 HOBBS & VMARREN, INC.. PUBLISHERS