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Home My WebLink About0794 PUTNAM AVENUE - Health i y �,�1- 1 � O i STAPLES �� No..............(°......... Fl�s..... 1l:................ THE COMMONWEALTH OF MASSACHUSETTS ®A F I-t E LT 00� T��--``J------......o,....... . .. ....... ... .... Appliration for Uispwial Iforkii Tiltuitrurtivit Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal L q Sys em at: ........ 11-4-1 � 1 t1 Address or Lo ...... . --...--_ r ................ --:11 L--.0- • .. .. -• •_.. --------------- 5 Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms..............._.__.___..__._.__Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P-1 Other—fixtures .--••-•-•--•-••••••......••-•--......••--••••. W Design Flow........;_4...........................gallons per person per day. Total daily flow........17!_ ....................gallons. WSeptic Tank—Liquid capacity__-___--_-•gallons Length................ Width---------------- Diameter................ Depth................ Disposal Trench—N _-•-•-_____�dth............ Total L n th___.___ ___.__.... Total leaching area..........._...._._.sq. ft. Seepage Pit No..._..__ .0 -------------- s b Total leaching area..................sq. ft. - %�� Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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........................ -- _- ---- Description of Soil - --------------------- o c W ---------------------------•------•--......-••-••--•--------•-••••••-••••......---••••-•------•-...---•••••••----------------•••-•-------------••---••••••---••••--••-••--•-..._........-•----------. UNature 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 XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue the board of th. Si d_ t f.,V. ••---•-••---- - Date A lication Approved B -= L%1>lr!L --•__•-•-- --•---- t�l� 1-- ---_-l7- PP PP Y---•- y� -� •- Date ......•••. Application Disapproved for the following reasons:_._ ___.. ............................................................•-•-----••----•------._.......-•--------....-••-••-.._.......-----•--------.....••------•-••--••-----••---•-----...•-----•-.......--•••--•-- Date PermitNo.......................................................... Issued........................................................ Date No......3..10.......... r Fss....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEA LT 1 t . ... ..-- .... ---------------------------------•. Appliration for Diiipoiial Work, (foustrudion Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: L#oeati Address I or Lo /N6. It ................ . : ? ........................................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms................. s:.........._...._Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ..... No. of persons............................ Showers — Cafeteria P4 Other fixtures --------------- --------•---... . W Design Flow_______.. ..............•...............•__gallons per person per day. Total daily flow------- ' _ __5:....................gallons. WSeptic Tank—Liquid capacity............gallons Length_______________ Width---------------- Diameter-----_-_____-___ Depth................ x Disposal Trench—No. ... 5dth ... Total Length Total leaching area....................sq. ft. Seepage Pit No . ,r f aameti � `" i De tli be Q ifilet -+ Total leaching area__________________s ft. ! - P g q 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 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil e O � a • : -- _ 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 XI Of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been`issZ0 the board of health. It .. - Date A lication Approved B -__.__ PP PP Y U � .------ ------- Date Application Disapproved for the following reasons:------•------------------ - ................................................................................ -•-••-•--•---•--••---•--•-------•---------------------------------------------•----..........-•-------.....--•••-----••..-•-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH L �...............OF..... >. .... .................................. Tntifiratr of Tomptiartrr THIS IS TO CERR4IFY, That the Individu�a Se Disposal System constructed ( ..}�-or Repaired ( ) Y �, Installer at /J ._C._ !t»e _ �f t�+!i � w �r t , 6JrI -• _ •- F 6-----_--..----has been installed in accordance with the provisions of 4rfjtQe XI of The State_ SanitaryCod described in the __-applic;ttic:n for Disposal Works Construction Permit No.(Z� ...... __-__.•._--_-__ dated_..��__/��_/_..�.��_____. THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ... 12, .................. Inspector......... ....... THE COMMONWEALTH OF MASSACHUS TTS BOA D 9 F HEALTH / No......................... FEE.... ........... Disposal,Vorhp Tonstruldion Prratit Permission is hereby granted...... - -.. -.-----: r ✓,: r ................................................_ to Construct ) Repair (<-)—a "'}n Individual Sewage,, Disposal sal SystIle ;17 atNo.. `�...•• / l i t om_ ...._ �t... --•-- ................................................ Street as shown on the application for Disposal Works Construction Dated/l--- IC-------..- i �j /' -•�� oard of Healt�- DATE...: _.....[.... 7....-••-•----....----•-••--------•-....------ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 6 o-�- 2 9 43 ------ -'t-r I � Ll � E e,` 20000, t a L o-r 3 a r �s r•1 a�r'`�7eFt;.,lfa`� a }t C Ry-R FO D PLOT PLAN ' A ! Ir' i frJttr� ,vx'J LOCATION (7'1 - t;Ty i 04!`5 �✓r r jtf��v y 1, r SCALE . .?. . ..r' .t . . . DATE PLAN REFER ENICE U'r"?-`T: . :�' .�.t• �7;�s''', t:i•iv 7..(}Ir(n 00:'tiD t7RAVE -1 .;t:t:OT��rT 4�A1aArd+:si:i't"ti, riFAS°„ . . e 032GC4 . . . . . . . I CERTIFY. THAT THE r�!..ir�tllve:l'it\tr.� SHOWN ' }� ON THIS PLAN IS LOCA:YED ON THE GROUND \ / �• l� R\P A LT Y 1 R U`n"f" AS SHOWN HEREON AND THAT IT CONF'OIRMS TO j c"' THE ZONING LAWS OF aHE TOWN 0'4F 7 0 I 11 A I :\ i:S)T R E E T ..� v �: :F,.� r X_.i':. jlsb/WM EN GCa'�:,�� t ;1 f 0. "'"�i V) t p`'V 15 DATE .`•. �.�1;:�"` .``.l ,t;."f7 46'i";t.,.j..•rt �..r'„�.f j 74 F f 3 ION ER 7• J• Z I;77Gr LAND iU 31A G 09 t