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HomeMy WebLinkAbout0022 PUTTER LANE - Health (3) UNWv-k4l 9OC �. No. •-----.7 - 24.................. ,THE COMMONWEALTH OF MASSACHUSETTS I i BOARD OF HEALTH rO-LU.AJ................OF......BA4.R.N-S.7- .i34Z..----........-----......-----•----------- Appliration for EliipooFal Works Tonitrnrtion Prrmit Application is hereby made for a Permit to Construct (ll) or Repair ( } an Individual Sewage Disposal System at: --"-----k 1-:-..1�✓.e9z^vwis.�.0 4.T: C�? ............................................................. Location-Address or Lot No. GV4Yi _ •�'.......... . ........... .................... ......1--,--- \r1 5.........----•-•----......---........................................ Owner Address Installer Address Type of Building Size Lot._fJC'_11'V..._..Sq. feet V Dwelling—No. of Bedrooms.......... _Expansion Attic ) Garbage Grinder (No) pa, . Other—Type of Building _ ,��............... No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. W Design Flow........../,Z.0........................gallons per per day. Total daily flow--------3`._3to....................._gallons. W Septic Tank—Liquid capacity/QtJr2..gallons Length .��..`.'.. Width`��--_'/0..`-:Diameter................ Dept - area x Disposal Trench—No. .................... Width...._............... Total Length..____.............. Total leaching area_.........._........sq. ft. Seepage Pit No.......f------_---- Diameter.....&-_'------ Depth below Wet.....6. � .. Total leaching area..�Z.O.j..sq. ft. z Other Distribution box (� Dosin tank ( ) ti Percolation Test Results Performed by ......... Date_.,_ l ,._.vs�,/�7 ,a Test Pit No. 1..-'__.7v....minutes per inch Depth of Test Pit----1-3..l_...__. Depth to ground water----------------- Test Pit No. 2..G.2...minutes per inch Depth of Test Pit..l�_.r______.. Depth to ground water........................ (� ••-• -•--........•-••-•..._....• .............•••------••--...-•----..................•--•-•-•------•---•-•-•--•_..•-----•--------•--................--•••- O Description of Soil-- �� G.®.�9t' ,i9�/� 5't/$S�t�.------ `r-./. �._rr..1 /.rf/�..... IZV'.�. va?!!'��r91 5�1�. ....Oo.4t�ttlprJ.S -� "1!--.....7 ?__�'l!<�- ............................................... 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 THTI11 5 of the State Sanitary Code— The undersigned further agrees not to place.the system in operation until a Certificate of Compliance has,,beem is hued b the b and of hea th. Signe ---• .............................. Date Application Approved By....... �E,�llj � ----•------ 7, /Y7 67— ate -- APPlication DisaPProvedfor the following reasons------------------------------------------------------------------------------------------------=---------•------ •---•-•--•--•••-••-••••-•-•--•-•-•-••-------•-...••---•--••-•...--•...........-•-----•-.....--•-•-••---•.I--•----•---••----------•-••--------•---••--•----•-•---••--•-......---•-------•.....•--•-•- Date Permit No......................................................... Issued_.....!....../` -7 Date No.. ._. .....:... FEs.............................. .fPgE COMMONWEALTH OF MASSACHUSETTS .... BOARD OF .HEALTH �r WWI ....... , ppUratiun for Uiivuual Works Tontitrnr#iun Vamit Application is h4y made for a Permit to Construct (P ) or Repair ( ) an Individual Sewage Disposal S stem at • ... ..77-9A_._44AIX_-=.._..!�!L...1�.r;�A1N1. p_r�A�"....... ... _ "`.........�------------------ ------------- -....-•--------•-........-- l � Location-Address or Lot No. l f :i, `i Owner Address FWj ... ` •-:---=-•'.`�'.� �-1r`�i\:x .�r l +v�: 1 i_L..........:................................................. � Installer Address Type of Building Size Lot__/, ._ .......Sq. feet v Dwelling—No. of Bedrooms.......... __..:.. _Expansion Attic (j ) Garbage Grinder fi10) "a Other—Type of Building p ' ( ) ( ) _/__\l./''�j►_______________ No. of ersons________.__._____._.________ Showers - Cafeteria Other fixtures ...................................... •• _- _ M- ----------------•---------•------------ Design Flow---- ...�,t!0.......... _gallons per per day. Total daily flow------ •--•--••-•--•-•-----•_. lons P4 / fie �' w Rf WSeptic Tank—Liquid capacityt!+�0_t�_.gallons Length8.... Widthf_.e�(�---- Diameter________________ llepth_.__ �___.- x Disposal"Trench—No _______. _____ Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._.____/__ :____ Diameter___._6_.._.._.__. Depth below i" et___. *_ _ Total 1 Ching area._,e .O.'_n+.___sq. ft. Z Other Distribution box (� Dosin tank � + '-' Percolation Test Results Performed by d,S!AAA___A•___ ff +!#"fir_ tl"_______ Date_1r Test Pit No. L!9 --...minutes per inch Depth of Test Pit____l__ _♦...... Depth to ground water________________________ fz, Test Pit No. 2_4:sZ_..minutes per inch Depth of Test Pit__ ?_:_.____.___ Depth to ground water________________________ } --•-------•----•----•-•-- ................................. O Description of Soil �r 6 , �cz '1+1__,tjt.t![ly .S'cl T !� _,� �� 1 4 1_&P. 5 +'4..4.&-----Sr�r._�. �v ar. rant ,r�:''- Z rex ,' too.4�"S' 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 TILE 5 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. Signe :........... .................--•••••--•-_ _ , Date Application:Approved By.._•-- ^�,l�;R fiG � ' ! �� ate Application Disapproved for the following reasons:_..-----•-------------•------------•----•=--------------------•----•----------------•---•--r--••-----•-••---•--- ......-•-•-•----•----------••-•---••-----------•------•---------•-•-•---------------------------•••----- !. Dale PermitNo......................................................... Issued.---• .--^-f` - --jam-- Date F _ t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............€....;.:.::..................OF............. ........................................ TrrfifiratrVof TompliFanr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or'Repaired ( ) by.........``--1_.5:. -._...rz... t----------Z'........3_...---•----------•---•------Installer...........................................................................................•-- j— 1 �.a I { at -----•--•-------•-.--------•--•---------••- -� ------ r. has been installed in accordance with the provisions of T _ F 5 of The State Sanitary Code as de cl-ibed in the" application for Disposal Works Construction Permit 'o. �027________________________ dated___.: ........................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL)L FUNCTION SATISFACTORY. DATE......... ....--_..__l.__...... ..7.........._.._.. Inspector_... = THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................OF........ t ._.._........ No.- ------•A•-- ••- FEE........................ Diupu.sal 11diun rrani� Permission is hereby granted 'u/ ��" `=--------•-•-------------------------------------•- .. ---•--. to Construct ( Yor Repair ( ) an Individual Sewage isposal System 1 atNo. - ` ._...- �` --=--------•--.,_,�-•---------'..._..-----•.-� -••-------------•-......••--••-•--•-••----••••---••-••--•---•••-•----•••------..........-- Street i +9�.; as shown on the application for Disposal Works Construction Permit �___________ ted...`__��� � D Board of Health DATE------- ---/:L- `-----G f----------------------- ------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 4 -_-------_____ tk Lf v 53.IJ �t7.z0 - a 19 -ELEV TOP TE H0L - , LOT 4 7 N , PA vL M✓.f fe et'A./ _Z n/S PE C?D F', f D/S r _ ELEV. sago LOT 5 LEACIlyPlT 70 RESERVE ( 7- C) -36 LORM i 00 tFsr " 0 120" AND SUB SO/L SEPT/C O ± , 10 rn,vK 40 { /3 36 /5 6 MEDIUM 23+'� ..o- -...— �zi3 1 SAND PROP E 4#+I 40 ! A3t1 _- j! 39"f �� of ti' �h?' ELEV. 8. 5 NO (,JATE R. 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