HomeMy WebLinkAbout0078 FRANKLIN AVENUE - Health (2) �� � ��
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration -for Bio oottl Worko Tonstrurtion Prratil
Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual Sewage Disposal
System at:
1�= 1= �/ i ---------------------------�O-�--- ----- ----------...................
Loc tion.Address or Lot No.
JQ_Y.— � �_u l.�Y.................... ..... X_.7_-8- ------.-1. rr�k Nr -��� 5 S-
Owner dress
,5 ----------------------- ` .�ti
Installer ti r Address
d Type of Building Size Lot............................Sq. feet
U Dwelling— p ( ) g ( )No. of Bedrooms..._____------------------------------------Ex ansion Attic Garba e Grinder
p0-1 Other—Type of Building f).h_!✓C a______ No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixtures --------------- ------------- -
w Design Flow------ .. _._:_.:.____gallons per person per day. Total daily flow----- .....................gallons.
WSeptic Tank—Liquid capacitv_,L'"gallons Length........ ...... Width---------_.._.. Diameter-------.__.--__ Depth...__-_--.__...
x Disposal Trench—No_ _________ ___�_,�Width.:._.._._._.. _ To Length____-__-____----_--- Total leaching area--------------.-----sq. ft.
Seepage Pit No.�'_�� —_ mite ...:_ v p elow inlet__ _________________ To al leaching a ea.. 0_ .....sq. ft.
Other Distribution box ( ) Dosing t'�Cnk
z
a Percolation Test Results Performed by--------- ---------------------------------------------------------------- Date-_--.-----------------------------------
,� Test Pit No. I................minutes per inch Depth of Test Pit_.___-_--__--______ Depth to ground water.._.__--_._.__.__.-----
fi Test Pit No. 2________________minutes per inch Depth of Te Pit-------------------- Depth to ground water__.__.___-_.__._-___---.
9 --------------- --------------------------- ------
O Description of Soil---------------------------------------------------------- .ti _
x
----- - -- - ------------------------------------------------------------------------
w
V 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 b.e issued b he of he
igned
/
- ---- --P -----
--- ----------------
-- Date
Application Approved By........... .... "--- ----...
- -:__0�..... ------/Z-�� �-/--/�
Date
Application Disapproved for the following. asons------------------------------------ ----------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------- ------------- --- --------------------------------
Date
PermitNo......................................................... Issued---- -7L ------------_--.-
ate
No... Fss..............................
* THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
40
Zip lir tine fur Diiyas i lVorks Tons tion Prntit
Application#is hereby made for a Permit to Construct ( ) or Repair. (401 an Individual Sewage Disposal
System at ^Y'
LocationAd tress or Lot o.,
Owner Address
W " '^
Ins, filer '" Address
Q Type of Building Size Lot,.,...........................' Sq. feet
U Dwelling—No. of Bedrooms__ --------------------------Expansion Attic ( ) Garbage Grinder ( )
!� No. of persons -.•________________________ Showers — Cafeteria
a Other—Type of Building A. .. p S ( ) ( )
w Other fixtures . --
Q --------------------------------------------------- ----------------------- ---- - --
W Design Flow._:.. .................gallons per person per day. Total daily flow.___... .� �__ _... _gallons.
Septic Tank Liquid capacity_��'i-gallons. Length---------------- Width................ Diameter__-.__.._ :_._. Depth. ----___.-. .
x .Disposal Trench No Vidtlr_______ ___________ To Length_-__•__-_-___---_. Total leaching area------- ------------sq. ft.
y . 4Seepage Pit No arl5� t�'__._ e below inlet__ .._. Total leachin trea. 0- .-_-_-sc ft.
(. :), Dostng k (z Other Distribution box ' ') �. (� �� Q >
V `
a Pit No 1 Y` minutes per.inch Depth of 1 e'st'Pit____________________ Depth to Date.__.._____ter------------------------
Test, -_ -----------------
Test
Percolation:Test Results
ground water
Pit No. 2.......:........minutes per inch!,,Depth o/Tles Pit'--____-___:___:_____ Depth to ground water-_._---____-__-___-___--- ------- -= -• --------- ------------------------------------ .
rDescriptton of Soil
U ' I-- ------------------------- ------ --- ------ ----- -. --' - '-- ------------------------
W.
V Nature\oflR epairs or Alterations ':A' swer ,When-applicable ------_-__--- -_ _ -_. ............ . .
i -- -- .. -
1 -----------
-- ----- ---------------------------------- ----- -----
Agreement -.
t 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 untih a Certificate of Compliance has been issued by the board of health.
T
t.
' gned ............................ ................................
r " r Date
Application Approveed B . �jl� ....
Date
Application Disapproved-f or:.the'f ollowang reasons:............... ------------------'
„-----
r ------------------------------------
n t Date
Permit No: .. 4 r :.__. :.,; • . ;Issued ..................
- -_ -
Date
.THE.COMMONWEALTH OF- MASSACHUSETTS
t' BOARD OF HEALTH
...
rxti ellfiiatrm pllanr'#�
S IS D-CERTIFY, I*cd, ewage Disposal System-constructed ( �r Repaired41
y -- --------------------- ------------•---------
^ �___ �r f--. f. nsta er ,.y� k
lias en m ailed m a cord citht provisions of Ar cl�Th... t tfary Cod
at -----------------------
p e as d scribed)n the
application for Disposal Works Construction Permit No.:__ ........... dated.........
,l :;. • .• Niq THE ISSUANCE OF THIS (CERTIFICATE SHALL idOT°:BE CONSTRUED AS A ARA TEE THAT THE
'systEM WILL YUKCTI0 W1r SA I F CTORY.
DATE- •/ -- ----------------------------• Inspector- -------•.`= .................................
Q�
THE COMMONWEALTH,OF MASSACHUSETTS
BOARaD-''OF HEALTH
OF
No..... V oc� FEE
x ' 0'11..
pispn,i or nnnfitr ion rr, it e
Permission is hereby granted-----_- ... ._.
to Co)4on
ct' (� � Repair ( an. ndiv' al Sewage t sal Syste
at No r f -- --.-7----- Q 4
treet
as sho the a licatioli for Dis 'sal Works Construction Permit o__________ ___ ___> ted...__./_X��- - -
PP P
o eat �
DATEJ.;?' a._7 .....=---------------------------------•
FORM 1255' HOBBS & WARREN...INC.. PUBLISHERS - --- �
•yam, ! 'sy`
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J. CRAIG MEDEIROS
ruc ing V DulldVng
wFeinnis, Mass. .pg 8
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