Lot 34 Applications & Permits --•-■■■-nrrommipeoupp.r......•■••••• •
I
t rNo 7'
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
/I �/ BOARD. /OF.�H�yEA�HEALTH
L�7!. .. OF.._MO/C77ligi itnA/
Application for Bis{Insttl rr,arks Qlonstrnrtion j rrmit
Application is hereby made for a Permit to Construct (-4 or Repair ( ) an Individual Sewage Disposal
System at:
kiateardOteNg
LOT 321
Lot No.
.6.05 PA/gm-lay ✓star
—eat/ a,
Inst
Type of Building ,/ ��'•%
Dwelling—No. of Bedrooms 4 Expansion AttS( y'-Garbage Grinder (X)
Other—Type of Building No. of persons Showtrs ( ) — Cafeteria ( )
Other fixtures �p
s gallons per person per fay. Total daily flow gallons.
Design Flow.._ r
Septic Tank—Liquid capacityGS�gallons Length /0 Width S Diameter Depth
Disposal Preach--So.
Width 3 Total Length-/.QSq. Total leaching area 5� sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( .4 Dosing to ( )/',,_,., //
Percolation Test Results Performed by_. A-'..0 zC/Jr1�1�1�- Date_..1n/(>1F 91;3
Test Pit No. 1 4A minutes per inch Depth of Test Pit...$6 /01 ?Depth to ground water Sb er r-
Test Pit No. 2 '4' minutes per inch Depth of Test Pit._ 6 Nndt6Depth to ground water.
a
Description of Soil
5 brinfin4 %3 -a
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of TITLE 5 of the State Sanitary Code—The undersig + further agrees not to
operation until a Certificate of Compliance ha issued by t'loar health.
Application Approved By Dale
9 01
Application Disapproved for the following reasons
Permit No
Issued.
Date
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
airrtifirate of Olumplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at
has been installed 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
FEB
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratiott for Diisuuual lif;arks (gonstrl uuu 3Prmit
Application
hereby made fora Permit to Construct (y) or Repair ( ) an Individual Sewage Disposal
Appl is ere y
System al
SANE: zfrxicitc Zvi-1;4-54
ec . . . dress
Address .l7R�
Wa Installer Size Lot
Type of Building 4„ Expansion Attic ( ) Garbage Grinder (X)
cia
U Dwelling-No. of Bedrooms Showers ( ) — Cafeteria ( )
a4 No. of persons
Other of Building
a. Other fixtures Total nail flow cr. .Q gallons.
Design Flow ..JS gallons per person per�ay. ye Depth �ill
i Sbb Ilons Length_/P Width._.. Diameter P
Septic Tank—Liquid capa..9 i A Total Length./.Q.) .--Total leaching area.....r.. . sq. ft.
OG• Disposal Trench—No. .-- ---- Width Total leaching area sq. ft.
• Seepage Pit No Diameter Depth below inlet
Dosing task ( ) -� to Q,(�%3
isl
— Other Distribution box sA Date.... ..
Percolation Test Results Performed b
y._,�'�J...�ti�l�r _pt _,�s
.1 Test Pit No. I__. minutes per inch Depth of Test Pit... N7 D�[h to ground water._
k, Test Pit No. 2 � minutes per inch Depth of Test Pit... P
a
U Description of Soil —e -' CYD4 93 —.—.0
Nature of Repairs or Alterations—Answer when applicable
ACI
greiSie
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syst Agreement:
in ace
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not o place the s
operation until a Certificate of Compliance has been issued by the board of health.
Signed
Application Approved By
r ' -f
Application Disapproved for the following reasons:,„,-
Date
7/ Lend'..
'..
/ / / _l
Date
Permit No
Issued.
nate
by
at
has been installed in accordance with the provisions of TITIZ
application for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT
SYSTEM WILL FUNCTION SATISFACTORY
DATE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
O F .
Trrtifirtttt of Tomplittnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed
or Repaired ( )
Installer
No
5 of The State Sanitary Code as described in the
dated
BE CONSTRUED AS A GUARANTEE THAT THE
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.
Dinpnsttl —
Permission is hereby granted r .�
to Construct ( ) or Repair ( ) an,Individual�AKiBe Dt f al"�.ysteM L! 7 r-'
fl
Wr ' V
nrito hinnstruttinn %rrmit
FE
at No
as shown on the application for Disposal Works Construction Permit No Dated
Board of Health
DATE
FORM 1258 A. M. SULKIN. BOSTON