Lot 9, Title 5 Application/Permits 1990 U
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
/' BOARD OF HEALTH
err ,I�
y OF . Di2-T#j?%>Jjo25...t/
ppliratinn fur Eliunitual iflnrks Olunntrurtinn Prrmit
SP..trfr
is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Cj1 P..GE /e)D/Q r.
at. \adm: or Wt N
�22Het%_�• ii1.Er!�1NS.L' 1 .�7_.�F;,�a %2Fa Na. So
Addre
1(c
. Owner
Installer Size L z ....4_, �/_ 1..
Type of Building Size Lot [ 151C srieet
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder (ft,)
Other—Type of Building No of persons Showers ( ) — Cafeteria ( )
Other fixtures �
Design Flow r � gallons per person per dpy. Total daily,flow 4.ty..O r gallons
Septic Tank—Liquid-capacitalOgallons Length. .417 Width... r Diameter Depth.
1.1
Disposal Trench—No. 3 Width a' Total Length 90' Total leaching area._&3 ._sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
•
Other Distribution box (K)
Percolation Test Results
Test Pit No. 1 7
Test Pit No. 2
Dosing tank
Performed by pt•1 titn.s FX— ENS • Date 5.-22-27
minutes per inch Depth of Test Pit...$f" Depth to ground water 77 as
minutes per inch Depth of Test Pit tt e Depth to ground water
Description of Soil
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 Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance s been issued by the board of health.
7/ /9G..._....
7 ,ift'a
Application Approved B
Ap plication Disapproved for the following reasons
Permit No
hate
Issued
Daze
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEATH
�✓� OF
hlertifiratr IIf QQIImplia.fr
THIS IS TO fijERaIFY„ ,'('hat he Individual Sewage Disposal System constructed (x) or Repaired ( )
at / ((�. m Iu � .0
at !'.`.Q—nl /_-rte
has been installed in accordance with th provisions of `f'°y 5 of The State Sanitary Code des ibed in the
application for Disposal Works Construction Permit No L7`90 dated Code/a.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS U% S A +ARAE
SYSTEM WILL TION SATISFACTORY.
DATE fadl# T1 ��-zt Inspector 77' Y .
No
T E OMMONWEALTH OF MASS CHUSET�T7S/
BOARD�` � ` "r
/ OF
�isflII�ttl itl` irl@InlirtwNswiit
Permission/is e b e a�nt ed
to Construct "S- ro Repai/` ) wank ...�},S, ewhi e......
lspo y
No 7- IC
street
as shown on the ap catnip for Dis sal W ks Construction Permit
�9 /9>0
FEE
DATE
FORM 1255 A. M. SULK! , BOSTON
3/55-0
Board of Health
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEATH /
OF hirrtifiratr at hlnmplia r
T IS T CEO/TIFk, ; at the Individual Sewage Disposal System constructed O� or Repaired ( )
at AriMt by ... " r gar 1
#f�
�T F 5 of The tate Sanitary Code as dlscribed in the
has been n for Disposal p accordance Works o s the on Permit N dated . .� — 11 —— S1
application for Dispersal \Yorks Construction Permit Ko.......��..._� / f
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUED S A GUARANTEE T AT THE
SYSTEM WII,yq,fUNCTI/a- lq7 TORY.
DATE ��( 'LQ�..i�tl1/Y' L , Insptttor