HomeMy WebLinkAbout0995 PUTNAM AVENUE - Health 995 Putnam AvejuC
Marstons Mills
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ai
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HEA_jjh �
Appliration -for Dii oiial Works Towitrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
-.��----..�'��....................... ----- - --•---..-.......------
Location_Address or Lot No.
UC/------------------------------
�j Owner /�I�a$% Address
In a r Address
QType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building .---_-___----------------- No. of persons..-_____-_-______-._--_--.-- Showers ( ) — Cafeteria ( )
a' 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. it.
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..........--.._-----.--.
f� Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water._-__-___-_-__--___----.
a ----------------------- -----------------------------------------------------------------------------------------••---------------.._....------------------.
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
U
W ---------------- ------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------
V Natur If R r or Alteratio s—Answer n Wplicable-------------
.... :.... _._----..--_-_--..-----------.---.-..-.-.---------------_------
------------------------
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A rnt:
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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 ssued by the board of healt .
Si ed .-- ./.. ------ "�-
Application Approved BY.-¢%':x`'''_`` - ----- XI! ..� ._......_..
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------•-•---------------...--------------------------------------------- ------------- ---------------------------------
Date
PermitNo......................................................... Issued...... -•---------•----
Pat
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THE COMMONWEALTH OF MASSACHUSETTS
. ,;. BOARD PF
H EALT
0F..... f
. ....... ...... t .......Applirtttion -for Bi,ipoottl Vorkii Tonti#rnrtion Vrrnfi#
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at: -- --------------
-------- _� ----
/j Location.Address or Lot No.
r �.... ----------------------•- ----------------------------------------------------•---•-------------------------
Owner Address
-',C�� � -'=.�.J'i.f; _.. ........................... ..................................................................................................
Irtaller Address
UType of Building Size Lot---------------------------Sq. feet
-, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
0.1 Other fixtures ------------------------------------------------------ -------------------
w Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons.
WSeptic "lank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter................ Depth--------------.-
x Disposal Trench—No---------------------- Width.................... Total Length.-----_._----____-_ Total leaching area--------------------Sq. ft.
3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet__-____________-•-- Total leaching area..__--.-------..--sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
' 4 Percolation Test Results Performed bY........................................................................... Date----•----------------------------------
Test Pit No. I______________-minutes per inch Depth of Test Pit-.-_-___-_______-. Depth to ground water------------------------
L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ -•------------------------ ---------------------••-...----•-•-•••--•--••----•----•-•--••--••-••••••---•--•-----•--......•---...--•••------------------------
0 Description of Soil-------------------------------------------------------•---•-------•----------------------------------------------------------------------------------------------------
x
w
J Nature-of Repairs.or Alteratiops—Answer �y,Ilen applicable.-_______________1.- -;mA
,� .y --------------------------------------------------------------------
Agr/ement:
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 beer issued by the board of healthn
rr /r/r
". ! Al.
Stgmed •. ......r�.!...r/1
ate
Application Approved BY ;�! - ., `
D
Date
Application Disapproved for the following reasons:.........................
••-•--•--.....................................•••.............._. ......-•----.
.......................................................-.................................................-
------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
Ct...............0F.......... r,... ,.
IvErrtif irtttr of fIomplittnrr
THIS IV TO C,#RTIF '., 'That the Individu /Sewage Disposal System constructed ( ) or Repaired ( )
d tlr
by--••- w • ••- . -I--------- le .....•• ................................
stal r
at..... 'f ��=��`" ..._.. ---
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.--(,c.��-j)___--_ A-'_°'___---•-__--__- dated_... �;Z<_ ; '�.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........................................................................----• Inspector...................................................................................
_TH-E;�OMMONWEALTH OF MASSACHUSETTS
)BOARD OF HEALTH
r
No........................ FEE.. :_--••..........
Permission is hereby granted_-' ' f �� `1=f'• 'rJ
to Construct ( ) or7Repair ( an Individual Sewage Disposalr}Kystem / Zell
at No:'. 'F €, r r fa r+ f` ( = �-'
k �
F e, Street , /'
as shown on the application for Disposal Works Construction. .Permit No.�_--__:__1,------ Dated_.__/ .2.__~: !'•....
Board of Health ....
DATE.-' �s - ,.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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