HomeMy WebLinkAbout0702 PUTNAM AVENUE - Health 702,Putnam Ave n v Q-
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A 039 112 `
4 LO CATION `;T SEWAGE PERMIT NO.\
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YkLLAGE
O-E 28 N N is
INSTA LER'S NA Mi ADDRESS
R U I L D E R\ OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ^
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PLAN RcL=ErEEi'J�
^4fi LONG. .BOND DRIVE O i f. 1•'i ��1 �, � �, (. l
i 1, ,:Cilr'1't3 ;AF+.1.40'.13'J9 MASS.
ti2GEi4 r .�`�r'.•�Mi�.;1- •�t d;? t._f' f
t cc
RTiFY THAT,T. E
btd THIS PLa1P�. IS L_oC!*tl D o d T�:L: f:i t�R''.G)
't t�t./ .L' .1 r�1 AS SHOWN HERED�i AND
r+Tyt�A7 �T�.�t;oit ;!�k,3 TS% ;
THE zo�i�PaQ LAWS_ '
��L��.�� l41 � "
No..••1f-�---•- Faa............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration -fur Disposal Marks TottMrurtintt Vantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ' ) an Individual Sewage Disposal
System at:
.---•---_------------------------------------------------------------•••----
Location.Address or Lot No.
�.( Owner Address ,
irf-
Installer Address
UType of Building m Size Lot�0,.S/ ________Sq. feet
Dwelling—No. of Bedrooms........... Attic (/V�) Garbage Grinder (0
per, Other—Type of Building ____________________________ No. of persons.--___-_.-.-___--_.----.-- Showers Cafeteria ( )
a' Other fixtures -------------------------------- -
w Design Flow--------------------------------------------gallons per person p r�day. Total daily flow--_-__-____-_-_----_---t;Pq..........gallons.
WSeptic Tank—Liquid capacitve`'.-'.O..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..............------------ ------•-----
,a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_----..__.--..-.--..-.
�14 Test Pit No. 2----------------minutes per inch Depth of Test Pit..................... Depth to ground water------------------------
Ix - ------------------=-----------------------------------------------•--------------•---•-•----------•------•---•----------------------------------------•------
ODescription of Soil--- ---------------------------------------------------•---------------------------------------------.---..-----.-------------------------------------------------------
x
w
VNature 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 Article YI 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.
Signed •-- -
�
• Date
-
Application Approved BY =% - ---------------------•-•-----•--•-----•----••--•------•-----------------•- ...........
Date
Application Disapproved for the following reasons:.......................................................................................... _.....
-------------------------------------------------------------------------------------•-••-------------------------------------------------------------------------------------------------------------
Date
Permit No.--- Issued------------------------------------------
Date
••--• Fnic..............................
THE COMMONWEALTH OF MASSACHUSETTS
�� BOARD /O�F HEALT/H
1.U. A _...--....OF..-.......-/J-✓-r�-�/!!--5-.%;./C-- ..........................
Appliration -fur Uhipoii al lVarkii Towitrurtivaa Vrruzait
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: n
--------------------------------------------- --------------------------------=••• ��.,: _.�. -�•-•-----••--._...•---•--•.._._•-••--••--........----
Location_Address or Lot No.
...............................�. /Ins��..--T%�r./s�......................... .............................................�.l,. f ,.y% , ,I,�s..
W Owner Address 4
,a --- inGs-••--� !�/��w ---- -.c�/�-ss�.� -:-� ' � •%rf
- p S feet
� Installer � Address �-
UType of Building _9 Size Lot_ ..._�_ f_____ q.
Dwelling—No. of Bedrooms-_-__-___-__LZ__________________ _____Expansion Attic (No) Garbage Grinder (�
Other—Type of Building No. of persons____________________________ Showers — Cafeteria
al Other fixtures ......................................................
___--••-•------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------- ........gallons.
USeptic Tank—Liquid capacity-"'0_gallons Length................ Width................ Diameter................ Depth................
xDisposal 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------------------------
1:14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__-__--____--________.-.
W ••---------•------------------------------------------•-•-•---•-••-----•---------------•---•-----------------------------------------------------------------
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
X
U
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 Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued bytbtbe board of health.
Signed-Z''' L' 'i --------------------------------------- --------- 6 -------
Date
Application Approved B ? - -----------••-•-•--••-•-••-•--•-••--•-•-----•-.-...•_.._•--••-----••-•------ •----•---•/'-- - -- ------.---
PP PP Y - Date
Application Disapproved for the following reasons:----•---------•----•---••--•--•-•----•-•-------•-------•--------••-•-•----•-•-••--•-•------••••-•----------•----
...................................................... -•-----------•--....-•-•-----.._..---••-------_..----------------------------------------------------------------------------------------- --•-•-
/y Date
PermitNo.•-• Issued.-----•---------------------------------•--•---••-••----
`1 Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFf/HEALTH
............�.C'??.a:.✓.............OF............... .... . -:--..........................-
Trrtifiratr of TVAImpliaaur
THIS IS TO C- TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by .._... _
�
-w-
� ------•-------•----------------------------------------------- ------------
a er
atG : =_... -Y-------------------------------••---•--•----•--•--•-- ---------
has been installed in accordance with the provisions of Article X.I f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No s��._ ___________________ dated_......;��:._1/...____lr_____________•
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE
SYSTEM WILL WNCTION SATISFACTORY.-
DATE............ ........... Inspector. -- --- -••-•- .................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,1..� ?^�1: ..........OF................ .... --!�'-`-'�C.,r�J Lam..------------•--.......
No...........••------••-•• FEE........................
Bispuiittl urk,i Ton trurtivaa Prrmit
Permission is hereby grant d-•••••-••-------- - -----------
_
to Construct ( � or Repair /fin In idu�1-Sewage Dj•�posal Sy teg
at No.--- --f"e___Jr r�-__.____°--tip...... .......,.✓ � �..c-._...__��_:f�.
- '-=
Street
as shown on the application for Disposal Works Construction Permit No.... ........... Dated----//"_/`
-----•----•-------------•--
_._....__.-•----•-------•--------------------------------------------•---._...---•--_.._._..••-----_•-•-
Board of Health
DATE..................................---------------------------------•--•-••-••---
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
t .6 �FAcNPr
I L o--� 51 14.4 J/ .� wa ?54, }
f 1 v
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= CERTIf1ED'.'''w 'PLOT ' PLAN
LOCATION Co-riU I v t. . to.551. , //
SCALE C�►• . . . . DATE .� 1. �Q�cP
a� THOMAtS E. ICI LLEY CO. PLAN REFERENCE .. . . . . .. . . . . . . . . . .
�` g. `,� . LAMA sv�v��rc��s. ..; , • ��'�. . .�. � �3G6A8-C,��t��"'�"�rI ,
a ttF 346 LONG POND DRIVE
SOUTH YARMOUTH. MASS. ) ,
I CERTIFY THAT THE F VNi W rl0J'J SHOWN
t-- D.
-�^� ON THIS PLAN IS LOCATED ON THE GROUND
���= D. RI-rNl.Ty �f,JsT AS SHOWN HEREON AND THAT IT CONFORMS TO
-rt.E�,,,�.... THE ZONING LAWS OF THE TOWN OF
�` 5AF-X-5T'ABLfr, . . . —WHEN RUCTED.
�c NN15 , DATEJVOk��,��t�# t�, '
PETITIONER : REG. LAND SURVEYOR