Lot 26 Title 5 Application/Permits 1993 CHECK OR FILL IN WHERE APPLICABLE
No tr'7.'9..3.
THE COMMONWEALTH OF MASSACHUSETTS
Flea....._: ._...
BOARD OF HEALTH
C/T�J Or ..AkKr 1912-09
A�rplirtttim/m for Uizpoottl arks Cnnnstrntfiun 1rrmit
Application is hereby made for a Permit
System at: �1,!
!.47ZPE.s , 0 &)`tsi't AlYi
kilt Repair ( ) an Individual Sewage Disposal
Installer
Typ e of f B 'Id' g
Other Type of Building . p
Other tur
Dwelling—No. of Bedrooms Expansion�ttic
_ _. ..
No
of ersons
Address pp�� /
Size Lot...Q.Sa..16 &. 6..t
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
L66
Design Flow gallons per person r day. Totals ow 1 s. .
'gn u� P Pe tP3t °� t
Septic Tank-Liquid capacity/5 -Widtons L�ngth_ . ._Len Width Diameter Depth_p�} ���r��S
Disposal Trench—No.
(p......... Width S Total Length Total leaching area._2,5 .+�q. ft.
Seepage Pit No /iameter Depth below inlet Total leaching area. sq. ft.
Other Distribution box (Vj Dosing ,t� `QQO a /,t aZ
Percolation Test Results ii J_ Performed by r�t" .. S' C. ._I Y.KL� Date...L..l.S/..O d 7Y�
Test Pit No. 1 IT minutes per inch Depth of Test Pit ‘:... Depth to ground water 10
Test Pit No. 2 minutes per inch Depth of Test Pit 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
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to
operation until a Certificate of Compliance has been issued by the board of health.
Application Approved By
Application Disapproved for the following reasons
in accordance with
place the system in
-53._...
�
D to
Permit No
Date
Issued.
Date
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Fitz. sd
)pplirtt tun for 3Jiipusttl rF nrks Cltanstrurtinn jrrmit
✓f
Application is hereby made�br a Permit to stth s ( o a (") an Individual Sewage Disposal
System at:
0/ or Lot No.
eocauoa-Address
Owner � '� Aaaaaa
1106E /'t't:y�-- 24a Address
VI .�nl p'./•-±��P(: stal Cr �/{p ��, {�� /,H�,tddress ,_ sq. feet
6 Type DS&) $W62E 60R f 6 Expan`s-'to tAtJhcn(Fl) 1 ar age Grinder ( )
Dwel]i No. of Bedrooms No. of persons Showers ( ) — Cafeteria ,l
'-t Other—Type of Building P
tat 6 Other fixtures iSA` /"
Design Flow g person per day. Total daily flow
W o ngth Widtlg Diameter Depth
a Septic Tank—Liquid capacity Set Total leaching area sq. ft.
W• Disposal Trench—No. Width Total Length g
Diameter Depth below inlet Total leacbin[ca sq. ft.
• Seepage sir No Dosing tank t I IOPI S
Z Other Distribution box ( ) /cop orm g ( YZ�a t Date
Percolation Test Results �Yerformed by j.,
a Test Pit No. 1 minutes per inch"Depth of Test Pit Depth to ground water/59
unutes per inch Depth of Test Pit Depth to ground water
u, Test Ni No. 2 P % S
To.
a / #2,9/ igler et6 iOts'i9
O Description of Soil ry. it.
x
U /
ty Nature of Repairs or Alterat Answ P,09.5&/�::- ""'(7 _.!J
£7-aA 5 No/..--.tic_
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Agreement:
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.
nett
Application Approved By ( -/t'L'�'t(
Application Disapproved for the following reasons
Date
Permit No
Issued
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF • LTH
/
�.��' OF
CIE/ ._�L/G
(ltrrtifutttr of (llnmpt anrr
THIS 1 TO CE(ZTIFY, That the Individual Sewage Disposal System constructed O'j or Repaired ( )
Dien
at installed i
o The State Sanitary Code as described in the
has been installed in accordance with the pr visions of TIT1='. 5 � datA[.
application For Disposal Works Construction Permit No +2-1/'- f-i
THE SSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S ARANTEE TH T THE
SYSTEM WI47l� FUNCTION SATISFACTORY. / �
DATE /VP-1— /9�, Inspector /
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Oispn ny,ks kinnntrixrtiun lirrlait
Permission is hereby granted -h.DL.G°I
to Constru ( ) or,Repair ( ) an IndiyIkluakSewage Disposal •vstem
y - C. / iy LIf I'S /t- I
at No w N J Street
as shown on the application for Disposal Works Construction Permit No Dated t
FEE
aoam of Health
DATE L.. . l ._..�...�_...d
FORM 1255 A. M. SULKIN. BOSTON