Lot 30 Title 5 Application/Permits 1993 CI Cr' grvV
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THE COMMONWEALTH OF MASSACHUSETT
BOARD OF HEALTH
...._. City OF Aier.tt1a13p]ton
Apphtaturu far Mama! uEurks Cnnstrurtinn Pernti
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot 3Q.....1)54 1e..I id.;e...aaad.
tgcatioq—Address
Roland Tnloodeau
0 er
Jean &
._.. installer
Type of Hu
Dwelling—No. of Bedrooms S No. of persons 111 Other—Type of Building
Other fixtures loos.
Design Flow 5.5 gallons per person per day. Total daily flow 550 ll th._g
Septic Tank—Liquid capacity.-15II$allons Length 1.0..'.. Width 5e1-7'Diameter eP
Disposal Trench—No. 3 Width 3 ' Total Length 15.0 ' Total leaching area 6.82---sq. ft.
Diameter Depth below inlet Total leaching area. sq. ft.
Other Pit No tank ( )
Percr atiotriTest box (x) Dosing
Percolation Test Results Performed by P: Co sultants, InC,
Test Pit No. 1. 2...s Depth minutes per inch Depth of Test Pit. 6.0" Depth to ground water. B.4
minutes per inch Depth of Test Pit Depth to ground water4.ad*aaSt-to 70")
Test Pit No. 2 P
p-8" Topsoil 3"-36" Fine Sand
Description of Soil 72"-120" Coarse sand/some fines
or Lot No.
..Ak..Can teLnur g...La_,....LOm3meadaw.,...21A. 01106
Address
Address
Size Lot__.3.S.6.A2 Sq. feet
Expansion Attic ( ) Garbage Grinder (%)
Showers ( ) — Cafeteria ( )
Date.__.7/6/9 2
36"-72" Sandy/some silt
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed
the provisions of TITLE 5 of the State Environm�tal
system in operation until a Certificate of Complian has
--(Signed
Individual Sewage Disposal System in accordance with
The undersigned further agrees not to place the
t -d b th board of health.
Application Approved By
Application Disapproved for the following reasons:
Permit No.
Issued
CHECK OR FILL IN WHERE APPLICABLE
No.
THE COMMONWEALTH OF MASSACHUS
BOARD OF HEALTH
City of Northazaton
IHOMAS
PAUL
IACKIVICZ, 1R.
9 27114 �O
te/ST :e;
Appliratian far 3Jispasnl Marko Clantitrurtian
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewa! Disposal
System at:
NPt...3.04 .aia;21a21L1z.^._aoa d
Jean u aolaniacen OKteau
n
f / Installer Address
Type of Hu(dding Size Lot }x642 sq. feet
Dwelling—No. of Bedrooms S Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons 10 Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 55 gallons per person per day. Total daily flow 550 gallons
Septic Tank—Liquid capacity..1.5Clitallons Length 1.0' Width...5 .1.71 Diameter Depth.. '
Disposal Trench—No......3 Width 3' Total Length 1507 .9 Total leaching area o82 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( X) Dosing tank ( )
Percolation Test Results Performed by VIA Consultants) Inc. Date 7/6192
Test Pit No. L2.a....minutes per inch Depth of Test Pit....u.O" Depth to ground water a4"
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water(adajaat.to 70")
G-J" 'Topsoil 31r-3b' Pznc anc 2a°-77."3anryysome silt
72"-1201f coarse sand/some amines
or Lot No.
44..Lantarau=Y...La......LnnniaaaaQ 4..Jj&. 01106
Address
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 Environmkntal'Code 4L.:The undersigned further agrees not to place the
system in operation until a Certificate of Complianne has Ieeen Issued by the board of health.
/Signed ( d a L%—
J \r`' hp
Application Approved By (•-) e / F i-
Application Disapproved for the following reasons:
Permit No. Issued
Dace
THE COMMONWEALTH OF MASSACHUSETTS
CA BOARD OF HEALTH t
OF ��,T� � Tl �
QIerttttrate I1I V unpliHrir
THIS IS Ta $TIF , That
by
at 1.
has been installed in accordance with the4provisions of TIT
the application for Disposal Works Construction Permit No.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT
SYSTEM WILL FU TION SATISFACTORY.
a / 5j
ge Disposal System constructed C n) or Repaired
DATE
5 of The S e Environmental Code as desc ibed in
c The
dated f }i I]�,.
BE CONSTRUED AS A G A.RANN,TEE�THAT THE
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
—y— BOARD F HEA H
OF � Gf
Uinpnnttl rinr(/ ' (TaTann
Permission is hereby granted Se'G it__T....Sili@.et,.X
ttrttun
nmtt
to Construct ()a or Repair ( ) an Indk�iduTil Sewag 4sposal System
at No...LAI' 3C / 1'I..E. l>n.../s'LCJ
as shown on the application for Disposal Works Cons
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eir j
DATE
`ri
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Street -
uction Permit No.°,-_1/".71 (par 7o. Ye14-:. 1 aIr