221 Application & Permit 1986 r
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ci-ty OF Aloe,"Iva nip f G(1
Appliratiau far Biannual Rinks Cnnnntrurtinn
s
Application is hereby made for a Permit to Construct (- ) or Repair ( an Individual
System at:
2.21 a y den ✓i lie. React
Location•Address
A&1
LO ra- .Kasen tA.s
ieLievidt
a:s:.cer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
/ )
flow._G.b Q gallons
Septic Tank—I iquid capacity ' gallons Length Width Diameter Deptl
Other fixture
.23./ fio.Y eken✓i I12 0' Road-
Address
Address
Size Lot.if' Sq. feet
Expansion Attic ( ) Garbage Grinder (AP
No. of persons Showers ( ) — Cafeteria ( )
Design Flow � ' gallons per person per day. Total daily
Disposal Tagta No. 1 Width a- 1 Total Length 46.
Seepage Pit No Diamete- Depth below inlet
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results, Performed by F..1i....F. /;OS r
Test Pit No. 1 (O r-iinutes per-inch Depth of Test Pit 9 to
Test Pit No. 2 minutes per inch Depth of Test Pit
Total leaching area_.9ha sq. ft.
Total leaching area sq.n G ft.
Date_orm .ag i*
Depth to ground water
77 "
Depth to ground water
Description of Soil_El.SGl9.S-12,fl
iNatu e of Repairs or Alterations—Answer w.lten applicable
.54.J0 ..Ian ![ !l .-toad hi ,
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Ti �- 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.
Application Approved By {-.J -- f
ign
- J {t„c
Application Disapproved for the following reasons
Permit No
Date
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �pF HE
OF LTH)
rrtifiratr ufCionntpli�ttrrV_L��
THIS :S CE . That the In dual Sewage Disposal System constructed ( ) or Repaired (L4--'
by ( Installer
at
has been instilled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
fli5pvuat 6:arks Otuustrurtiun tirrittit
Permission is hereby granted .1-,-(-24../.-. /` 1C✓.11.1.1..t
to Construct ( ) or R it ( an Individual Sewage Disposal System
at No l -r Street
FEE
as shown on the application for Disposal Works Construction Permit No Dated
rs r
ri
DATE /-4-e--"c_ l_..L1._r=-
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
Board of Health