600 Application & Permit 1993 CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C t I t/ OF NUR.l rl.t)/71. /Lt
Stratton for 3ispmittl Ulnrks Cnnnstrurtinn j rrmit
( p'an Individual Sewage Disposal
n is hereby made for a Permit to Construct ( ) or
System at: E.
Location.A4dress
Owner
rt? Cry ILDc
Installer
Type of Building
Dwelling-No. of Bedrooms ��No
Other-Type of Building $.b-4.G
Other fixtures gallons.
Mons per person per day. Total daily flow �-$1. gd
Septic Tank --7 gallons p p y
Septic Tank-Liquid capacitycc.ya_!bFallons Length - Width - Diameter Depth
Disposal '1r ' l?-No
Width..../2 ' Total Length ,/± r Total leaching area._3..ia sq. ft.
th below inlet Total leaching area_ sq. ft.
GO
or Lot No.
Address
kit: fD h �,.t1Ad 72-0 .. /441 p.
Address
Size Lot T ;,34-13.h/ t
Expansion Attic ( ) Garbage Grinder-4-4-
of persons 4- Showers ( ) - Cafeteria ( )
Seepage Pit No Diameter Dep
Other Distribution box (tom- Dosing tankC )t �, /��)
Percolation Test Results Performed by l loo
Depth of Te t Pit
Test Pit No. 1 minutes per inch
Test Pit No. 2 minutes per inch
Description of Soil
1 Date ^= ..._Z.L_.d5-9 3
Depth to ground water
Depth of Test Pit Depth to ground water
GLT.S _ 5.i >u 1 L - I'LL=1) `ZB.-n CE/Z.Odz.t_
Nature of Repairs or Alterations-Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 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
Signed
Application Approved By
Application Disapproved for the following reasons
Date
Data
Permit No
Issued.
Date
Date
by
at
has been installed in accordance kith the provisions of Ti
application for Disposal Works Construction Permit No. 3
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT
SYSTEM WILL,,FUNCTION SATISFACTORY.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
=�-
ertifiratt of Couplin
THIS IISO CF�j2T That e Individual Sewage Disposal System constructed ( ) or Repaired
The State Sanitary Cod as de' riry7ed in the
dated 4' -2-•
AS A GUARANTEE THAT THE
BE CONSTRUED A
n
I e /9113 Inspector l
THE,COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAI,FH
.. �.��(/. /{��t . f.L J-4" FEE
No. 1.3 /' OF ci
Eliopoo urkw Ctonstrurtjun er it /" • ,
C t� 1
ii °
Permission is hereby granted -..� (_�_:�.._!?rJ-l(.E...F.--_--./.:=r`-L'C_.. ._.-. .. -r�
to Construct ( ) or Repair ( an Individual Sewage/Disposal§ysfem
at No (4E;nt-2 {'T.+t.JN:_(._ . -.- . .-/..L e
1,„ -'. /
i ),� < �G----1
as shown on the application for DisposaY�i'orks Construction Permit No,{a=�1�-- Dated/ /
1 / I Bot of}teilth
DATE iy,YY[�/C�. .� r
FORM 1255 A. M. SULKIN, BOSTON