70 Applications & Permits No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Fr io 'ev
Apptiratiuu fur Dispu, ttl Iliurk5 Tartan riign ermif
a Permit to Construct uct or Repair (,�an Individual
Sewage is hereby made for ( ) age Disposal
System at: V ^ .
coc Adaf 0411-3 or rAnac l n°,t
.°:taller A
Type of Building S e Lot Sq. feet
Dwelling- No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow gallons.
acity
Width
Diameter Depth below inlet
Dosing tank ( )
Performed by Date
minutes per inch Depth of Test Pit Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
Septic Tank—Liquid cap
Disposal Trench—No.
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. I
Test Pit No. 2
lions Length Width Diameter Depth
Total Length Total leaching area sq. ft.
Total leaching area sq. ft.
Description of Soil
Nature e Repairs -A or f-- o9s—A when app le
AgreThenu �`11a�'// ed Individual Sewage Disposal System in accordance with
the provisions of TITLE S of the State Sanitary ned further agrees not to place the system in
operation until a Certificate of Compliance •—• b y�. y health.
door;it,
Application Approved By
Application Disapproved for the following reasons
Permit No
2--f
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
«rrtifiratr of fdnmplianrr
THIS IS TO C IFY at e !mil iduat Sewage Disposal System constructed ( ) or Repaired (44
tall
at
has been installed in ae ordance t the provisions of TITLE 5 of The State Sanitary Code a.§.a.§. described in the
application for Disposal Works Construction Permit No 3""1 7 dated -27/477
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
e p // 1 >
DATE —j'4- 1� I i..J-.LD..j7 Inspector - �U""
6
No at `(—���
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
flispolog4Iffork
Permission is hereby granted / X6-A
to Construct ( )t r e ( Indiwd,
at No �,/--
as shown on the application for
is
DATE 3.//4 %O�
alonotrotto, hermit
Y- jer
sal System
Street
Disposal Works Construction Permit NoLS i.-..
FORM 1255
C. BOSTON
Boaryof Health
No 11.1/
THE COMMONWEALTH OF MASSACHUSETTS
,BOARD�OF HEALTH
di- OF e 2. 1
1 pplicatiun for 33iupnnl rr arks Qluuntrurtinn 'rrmit
Application is hereby made for a Permit to Construct ( ) or Repair (' ) an Individual Sewage Disposal
System at:
74 . <?' .* %`-
,i._J...Ci.ka-d ...-J -/
trk.1 es... LtL1< Li,
InetWlc
ado
or Lot No.
Address
Type of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building No. of persons
Other fixtures
Design Flow
Septic Tank—Liquid capacity
Disposal Trendy—No
Address
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
gallons per person per day. Total daily How gallons.
gallons Length Width
Width Total Length
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by
Test Pit No. 1 minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pi
Diameter Depth
Total leaching area sq. ft.
Total leaching area sq. ft.
Description of Soil
Date
Depth to ground water
Depth to ground water
Nature of Repairs or Alterations—Answer when applicab�CTS / L. .rc,ti ta./e%>
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issues(by th board of health. L
7-
Application Approved By
Signed —Cisi�G'"tt d'-(f Q/.-
- €_2/
o�te_
6c / r / C?/
Oath
Application Disapproved for the following reasons
Permit No..../--.9.1
Date
Issued &-.C. Sr_.1.91J
n
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
QIrrtifiratr of fumplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
“1-1. 1^1 OF f r FEe,:...,.'.ii
13ispuSm13 nrkn Innstrnttinn 1rrmit
Permission is hereby granted,.e.L 4't'aft, rj
to Construct ( ) or. Repair (irr'') an Individual Sewage Disposal System
at No f L'.... :F d .4.
Street
as shown on the applicaltion for Disposal Works Construction Permit No. f. Dated..;; ak..,._�.,.'....LZ_��....
;.+ ::t:4 : 1....; ...: and Ifea:.:i'..
Board of Iicaah
DATE
FORM 1255 HOBBS 8 WARREN. INC.. PUBLISHERS