203 Application & Permit 1991 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
of N.oRTt9Am pTbA/
m at:
atiun far lithpusni
rr
urks Tunntrurtinn Permit
hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
sV. v. T& R°' -o
rem -I is 63
Installer
# 20 ,E
2QS syg.v&..sz R0f90
Adds
Address
Size Lot_WO S_s9r feet
Garbage Grinder{—}-
Showers ( ) — Cafeteria ( )
of Building
Dwelling—No. of Bedrooms 3 Expansion Attic
Dther—Type of Building 51c?G,.(h.. No. of persons (ca
Other fixtures
;n Flow 5.5— gallons
c Tank—Liquid eapacityP.P.Pgallons
)sal Trench--No. '-- Width
age Pit No — Diameter
r Distribution box ( bdr Dosing tank
slation Test Results Performed by iiht.
per person per day. Total daily flow y'.9.5 gallons.
Length..L2:(a° Width `$u Diameter._ Depth.4.2 '
Total Length Total lunching area sq. ft.
Depth below inlet Total leaching area sq. ft.
<f%M- LG'r MAI&NNIS Date 3- W-91
a
Test Pit No. I minutes per inch Depth of Test Pit ,$...!} n Depth to ground water_5 i3
Test Pit No:// +3 minutes per inch Depth of Test Pit L i " Depth to ground water �O r
ription of Soil O!$ — 54.8.�J0)% - iiu� big rE- iv Joss!-.O�4
we of Repairs or Alterations—Answer when applicable. & aik,... . ND RO �1LIN
sysSEN\. - woo 6.0mco_._ or G.C..O. E
ement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
'revisions of TITLE 5 of the State Sanitary Code -- The undersigned further agrees not to place the system in
ation until a Certificate of Compliance has been issued by the board of health.
lication Approved By
Sfl
7 J�z 30) O./
lication Disapproved for the following reasons'
Date
Permit No Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O/F- ,�H,E/v�LTH
OF
fliertifirate of Qluntpltanre
6
THIS IS TO C Tp'FY, That the Individual Sewage Disposal System constructed
seen installed in accordance with the provisions of T_
cation for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL
TEM WILL FUN T ON SATISFACTORY.
'E FUN
_g /%-/
or Repaired (X)
5 of The State Sanitary Code ,s diein rihed in the
dated 3 .!
NOT BE CONSTRUED AS A GUARANTEE THAT THE
Inspector 7S
THE COMMONWEALTH OF MASSACHUSETTS
�_ �. . BOARD OF HEALTH
OF
Disposal
'lermission is hereby grante
>nstruct (,) or Repair an Indivj)nal Sewa¢¢ Disposal System
a X 6 3 ,a,„ ' t. ,v ,_ c y zr—,
street
awn on the application for Disposal Works Construction Permit No '
(toast
4, -e /
tan lrrmtt
FEE
E / /
1255 HOBBS & WARREN. INC.. PUBLISHERS
Dated.-
Board of Health