Lot 23 Title 5 Applications/Permits 1989 CHECK OR FILL IN WHERE APPLICA
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF i.Js of li:CrE)2'U
Application for Bis{fosttl
is
FitaS S _.-..
orki Tunntrnrtion Lermit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
TA2.. HAP[-C lid' 12.0A KRT11!QM PT0 Ml`1 ._..-
_.
or Lot No.
a- a
<LiFf- 4-A C.wEXCIQVAT!M�
w((..t_t X}HS LP /1 MK
Installer Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers (2) — Cafeteria ( )
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow fa VO gallons per person per day. Total daily flow
Septic Tank—Liquid capacity Sat'gallons Length Width Diameter Depth
Disposal Trench—No. 2- Width 3 t Total Length IC Total leaching area_ 72,0
Seepage Pit No Diameter Depth below inlet Total leaching area..
Dosing tank ( )
Performed by Date
minutes per inch Depth of Test Pit `t Depth to ground water 76
minutes per inch Depth of Test Pit 7 r Sr Depth to ground water
41 416 gallons.
Other Distribution box
Percolation Test Results
Test Pit No. 1 'i
Test Pit No. 2 S'
Description of Soil
sq. ft.
sq. ft.
pout
GREY S141tBy TILL
RED sl3N0 V x7r2�
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 Sanitary de—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has is ed by b ar of health.
Signed
Application Approved B
639
Date
Date
Application Disapproved for the following reasons
Permit No
7
Issued
Date
CHECK OR FILL IN WHERE APPLICABLE
Iao
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Appl ratinn for Disposal rc arks Ctnnstrurtinn hermit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System : 4.
LoT 23 at6� krl7(t RoAO foK'rHNHP" oN / 141
or Lot No.
Et2
Lotton-Aadressc
O7-7
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No. of persons Showers (2) — Cafeteria ( )
Other res
Design Flow bb
Septic Tank—Liquid capacity 1 Sg°
Disposal Trench—No. .t—
Seepage Pit No
W(1_,Ji1/! 5nUmze"" frier
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
Other Distribution box
Percolation Test Results
Test Pit No. I y
Test Pit No. 2 g
Description of Soil
gallons per person per day. Total daily flow ii I/0 gallons.
gallons Itength Width , Diameter Depth
Width 3 Total Length I Total leaching area 7`0 sq. ft
Diameter Depth below inlet Total leaching area sq. ft.
Dosing tank ( )
Performed by Date rr
minutes per inch Depth of Test Pit 1 �Y r Depth to ground water 7fJ
minutes per inch Depth of Test Pit 7 -5 Depth to ground water /QNC
GPEY SANBY TILL Ike ) $/aN0 4 4'I Rh
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 Sanitary e—Th undersi ned further agrees not to place the system in
operation until a Certificate of Compliance has b n iss ed by b rd o{health ,It/L F}9
Signed. �l INA /
Date
Application Approved By -
Date
Application Disapproved for the following reasons
Permit No 37-frj
Issued //Ain
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CM' OF N�/�%/il/g/i/%7
eirrtifiratr at Qlumplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by C4./.5c CAmPIC aXCAVA;iqG - cm lcs.LnMS.BuKE.rJ3i.R
at. tor T23 `12 70J1rA74f 1179‘e Fono Pk-WE>~ANN N/.PR/S
has been installed in accordance/with the provisions of TITLE 5 of The State Sanitary Code a; described in the
application for Disposal Works Construction Permit No 37-if dated_.....Li .I3•�tv
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTTE TIW THE
SYSTEM WILL FUNCTION SATISFACTORY. �-
DATE lL�.2er/�9 /Inspector !/ 'C
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH \.
I
OF
Oinpusal
Permission is hereby granted
to Construct (X) or Repi1( ) an Irldi i lual Sewage Disposal System
at No
as shown on the application for Disposal Works Construction Permit No ' Datd,d,a .
rr
urjs (Pagination f rrmii
a
FEE
DATE
FORM 1255 A. M. SULKIN. INC.. BOSTON
Board of Health