Lots 12 & 13 Title 5 Application/Permits 1992 CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
or ALORT-9flni 70.W
ppliratinn for Bispu nt
FEZ
'irks h[nnstrutlinn Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
tis
Wit 4 /3
I if
or Lot No.
Address ,re" tti
Type of Building ))���� Size Add Lot— '.7 A
Dwelling-No. of Bedrooms T Expansion Attic ( ) Garbage Grinder (f�
Other—Type of Building SIM. ...(rin1. No of persons Showers ( ) Cafeteria ( )
Other fixtures
Design Flow
a
55 allons per person per day. To dailx flow 6fa gallons.
Septic Tank—Ligr Diameter Depth
mdcapactty.(.p ions Length_fZ%.._. Wtdth...rp y
Disposal Trench—No._-3.. Length
....__ Width � Total 7J ' Total leaching area...J 22sq. ft.
Seepage Pit No ,( Diameter Depth below inlet Total leaching area_ sq. ft.
Other Distribution box (1 t Dosing tank S ) ,,,'�r-
Percolation Test ResyIts,L Performed by.......&NA CaSi. U.Crgvy S .././14,Date M.i/_ 5 /9i ai
Test Pit No. ]3_11.7 minutes per inch Depth of Test Pit 0h' e Depth to ground water 0
Test Pit No.f3j minutes per inch Depth of Test Pit t Depth to ground water 901 r
gi._.S i G7b5flND�/ 7LL
Description of Soil &ZTSS — .SQ%(3S0.LL —
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Iggg dividual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State San tart' •..e \T} undersigned further agrees not to place the system in
operation until a Certificate of Com.liance ha been ue �4 he board of health.
Application Approved By
D
S: -7sys
Da e
Application Disapproved for the following reasons
Permit No c_9.F
Date
Issued.
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
''A.pplirtttinn fur flispnsttl twits C unstrnrtinn ljrrmit
et
Fax
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: p (
0a._ PtEi : bKt
`t
Installer
Type of Building
Dwelling—No. of Bedrooms t ) Expansion Attic ( ) Garbage Grinder (17,/
Other—Type of Building .i«m-'.ts....azt]. No. of persons a Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 55 allons per person per day. Total daily flow 4r,;.% gallons.
Septic Tank—Liquid capacityJ60 alions Length../.24f. Width r.J4�e_!Diameter Depth�t
Disposal Trench—No. .3 Width 3 - Total Length /1J a Total leaching area.._f'220.._sq. ft.
Seepage Pit No /Diameter Depth below inlet Total leaching area_ sq. ft.
Other Distribution box (VI Dosing tank ( )
Percolation Test Results Performed by Al K. ... .._CON014...2. M.,TS Date.. 418/ 5 11.1 Z
Test Pit No. 1j..1.9` minutes per inch Depth of Test Pit &' Depth to ground water tabs
Test Pit No.l$ minutes per inch Depth of Test Pit 9' Depth to ground water 9.40.,1
/3
or Lot No.
t4
Address � � �
Size Lot —r 2^. .Ac�.egr-eeet
Description of Soil On -- CtP._7....SLLJ/ 540-0.
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 TITLE 5 of the State San tary Rde_Thp undersigned further agrees not to place the system in
operation until a Certificate of Compliance ha been irs ue�,�})y{f he board of health.
Application Approved By �r
Application Disapproved for the following reasons-�
Permit No 93
Date
Issued
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Dr/ OF Ar-iri>'r%7ij�fl9Y%9!v
hrrtifitatr at QLnmptianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by {//Suitt i'-GRAY installer
at...Lors- /LAVa1.eti /37.994-547. Gf_ IW O {O.f.F 94%-aw,W.e)
has been installed in accordance with the provisions of TITt 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No -.. '3 dat a ZS' s
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUA ANT ,�iIAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE
SrArY-rYre9s
�i
]ispn Qinnntruttinn ihrti�tif r
Permission is hereby granted C .. C Pi fy_1L.g�1� O ( J r. ) La 4--n")
to Constriy� or Repay. ( ) an Individual Sewage DisFos7-al System
at No...,/.^.i4.....$ /
Street /G[�
as shown on the application for Disposal Works Construction Permit 'w"p-. ....---- .pa 1./..i
Inspec
aifte
1.1 =;p 3
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEATH
� /Gt--�
No —73/3 of
DATE -P.( i. i / % L....1
FORM 1235 A. M. SULKIN. BOSTON
H ilth