HomeMy WebLinkAbout0100 FRANKLIN AVENUE - Health (2) 7 \
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No.--. _ . aq a, I q FR$ ; . ........ ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA T
.. ..
-- OF....... . . ... :...... ----
Appliration -fur Big ao iiat Works Tnnstrnrtinn Prrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S stem at
-- -- ----•••------------•---•----••.................
Location-Address or Lot No.
?. if
c'� �-1f-40....^.............•.... ... !''_/7��Y ✓v�lil .-----•-----------•---------------
O erA�r ............ ..
Insta ler Address
dype of Building / Size Lot----------------------------Sq. feet
U
Dwelling—No. of Bedrooms................. ........Expansion Attic (i/) Garbage Grinder ( )
ri, Other—Type of Building ............................ No. of persons---------------------------- Showers (/ ) — Cafeteria ( )
Pa Other fixtures ------ ------------------------- -
W Design Flow---��._............ __....._...gallons per person per day. Total daily flow.....A.kQ__--__:__----------------gallons.
9 Septic Tank—Liquid capacity/11..1-0_gallons Length---------------- Width........... Diameter_----_-..-_--- Depth---.-_-----.-._.
x Disposal Trench��Lo�_ - __Wr
th-------------------- Total Length-------------------. Total leaching area.........-----------sq. ft:
Seepage Pit N p,#, r' � tam ................ Depth below inlet.................... Total leaching area.3 P_Z"_--sq. ft.
z Other Distribution box Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date-------------------------- ------------
aTest Pit No. 1................minutes per inch Depth of "lest Pit-------------------- Depth to ground water.._..-_---------.-.-----
(� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.--.-.---.--._--_--_..
a ...................... -----------•------••----•--•-•----•----••--••-----•---.....------•-------••----••-•----•-------------------------------.
ODescription of Soil__JA_A/h..... L -•-----•-•--------•---------------------------------•-•----......_....-- --------------------------------
v x
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 bee "issued by the board health. /
Signed -----� ----- --------------------------- -----?.4d7 ---
Date
Application Approved By......... . --------• _ ............ --------------------
Date---------------
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------•---------•------•--
..•--------------•--------------•--••------------------------------------------------•--------•-------....-----------•-------------•----•-•--•-----------•-------•-----------...----------------------•-.
Date
PermitNo......................................................... Issued.........................................................
Date
----------------------------
ti
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i
.,A. F>�s.°..2......................
THE
BOa4 D , F OF MASSACHUSETTS
„
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f
r
x s OF. ✓ r
Appliratilan -fur Miipuiitt1 Workii Tomitrurtion Vrrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System-at:
A-0, f 0 91 Q . �= 44/ems.
Location.Address or Lot No.
W 'fit r Address
f /� f'd/v ✓ �!
/as —t" yy�'............ r....... ............. ...................
f J Installer Address
vType of Building✓✓ Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms-_. ------ -----------------------Expansion Att�( ) Garbage Grinder ( )
`� Other—Type of Building Q, YP g. ------------••............:. No. of persons....--------•---------____-- Showers ( ) — Cafeteria ( )
PA Other fixtures -------=------------------------
ggallons per person per day. Total daily'flow............................................gallons.
W Sepric 4,1411yo—Liquid tv.__..______gallons Length_-_____;-_-__- Width._---_._..._.. Diameter................ Depth___..._-__--
i�'
x Disposal Trench—No.--__-___-_:__-.__- Width-------------------- Total Length-------------------- Total leaching r a
.... ft.
Seepage Pw 'x°"-� ./I,�) Ameter.................... Depth below inlet-----------_-------- Total leaching area......I-----------sq. ft.
Z Other D6friW56Pbbx ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date.................... -------------------
a Test Pit No. 1----------------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---------------------_-
9 --........---------------------------------------------------------------------=------------------------------------------------------------------------
D Description of So'1__- .�___..f- !-
x S� if- ------------------------------------------------:---------------------------------------------------------------------
U
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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee `issued by the board of health.
Signe 7- --- _ } . '------ --------------------------
Date
Application Approved B
-----------------
Date
Application Disapproved for-the following re ons-------------------------------------------------------------------------------------------- -------------------
7' Date
PermitNo.......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD . OF,YHEALTH
............. ............................OF........................................................... .........................
7 Trrtif�irat�r of f 'Untplialtr-r
TH S IS��O CE,RTIFY`�Z at the I�r(i iduuaa1l ewage Disposal-System constructed ( ) or Repaired ( )
by..... �'' y.��...- 7�� G=`c ^--------- _ f f ........_
C..
has`been installed in accordance with the provisions of Article XI of The State Sanitary Code as des ribed in the
application for Disposal Works Construction Permit No------ -•------------•--•
dated-.._ _;,=. _ ��..__.__._..
ry
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----------------------------------------------------------------._.............. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH-.
/ ............ ...% .. ... OF.....�,, -.-7.! -L�•�-`.. ......�, :r�-r /..........
No...✓�.. ............ ,�,
` FEE1- 4-
Bin:vo al Workii TonRrurtion Vrrotit
Permission s hereby granted-* --_'-____--"'_ �� ........__J._.._t�.�.._ { -- ------------------------------------------•---•-:--:
to Construct (r-�,Ior,.Repair n I:ndividual/Sewage Pispos,aI S stem
�L at No. ' /. .E'er x- � ------...
�. °2 ✓ °�a (� / V Street �'1.
as shown on the application for Disposal Works Construction Permit o..____!____ Xk°ated_ ._ b�",l. .......
Board of Health
DATE.... --�I --------
FORM 1255 H BBS & WA REN• INC.. PUBLISHERS
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