35-216 (4) ,
Finc
44 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
GAPy
tion is hereby made for a Permit to Construct (X ) or Repair an Individual Sewage Disposal
LADYSLIPPER LANE LOT NO. 23
Owner Address
Type cfBo��og Size Lu��������__-�� f�� '
I�meDioQ--yJo. c� Be�rouo`o'--_u,---------.--_'.-Expansion Attic ( ) Garbage Grinder (X )
Other--Type of Building ............................ No. c6 persons............................ Showers ( ) -- Cafeteria ( )
04 Other fixtures.� —_._------_-_—__.---._----_.—_...—_--'_--_--___.
Design Flow-1.10 per person per day. Total
8ry6c Tank—Liquid cupucitl.5.0.0---gallons Leogthi^16........ Widt6.t/.8........ I)iamctcr—_'--.. Dcpdh.A& --
Disposal Trench--No. .................... Length.................... Total leaching area... ................sg. ft.
~~
Seepage Pd Nn..... ....1---' D °G».X.0" below iolet.k��.......... Total leaching arnu.29.3.......sq. {t.
Other Distribution box ( ) )
~~ Pc�oa6noIe� R�� Pw�000cdby.�& -�.°' K� ^�Y�� D��..��_� 8�i
Test Pit No. l ........minutes per inch Depth c6 Test Pit.....2.1'.'-- Depth u/ ground warcr.NON��_'—'
� Test Pit No. per inch Depth of Test Pit............ ....... Depth to ground water........................
0 Description of Soil
....'..............._ ......'...._.....'�................ .............................._............ .......................................................................................
............. ...................................................................................................................................................................'......................
U Nature m6 Repairs or Alterations--Answer when applicable................ ...............................................---'---------
... .............................................................................................................................. .......................'.............................................
'-g'-_..__.
The undersigned o to install the ufnrcdcocrHe6 Individual Sewage Disposal System in accordance with
the provisions c67IAT L8 5 of the State Sanitary Code-- The undersigned further agrees not to place the system in
operation until a Ccr66cuuu of Compliance has been issued 6ythe board nfhealth.
Signed..................................................................................... ..........................
"
ApplicationApproved By.................................................................................................. ....................
um°
Application Disapproved for the following rm"owx:..............................................................................................................
_
-----''-----------'-------------'---------'-------------------'-------'--''--'-------------'------
Date
PermitNo....................................................... _'_
Date
THE comMOwwvsAcrH OF MAssAcHussTrs
BOARD OF HEALTH
................C.IT�~�____����___���THAMPTO��______________
�
�
�
�&�rrtofuuo4tr u� Twx4�pl*nurr
THIS IS TO CBB77F}'' That the lodivi6uxl Sewage Disposal 57uten^ constructed or Ilepurc6 ( )
6y------------------------'------'--------------'------------------------------------------'------
at ��
_________�-OT_NO.__�� ER_LA ._._____________________________________________
has been installed in accordance with the provisions of TITLE 5 o The State Sanitary Code as described in the
application for Disposal Works Construction Permit Nn------------.—'--- 6nte6---------.-----.--
THE ISSUANCE OF THUS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE cOmMowvvsALr* or wASsAo*ussrrs
BOARD OF HEALTH
----_____CTTY_«�F__h��9TH&MpTOy�_______________
I�u---._-'_.--- Foo........................
Ropind Marks Tonstruction Permit
Permission �
{y hereby #rxotc�.----._—LAYY!�EN��-����wE.��...---_—'_---.............................................
to Construct (a ) or Repair
at No......-------.----_-'_���-'!���-'����---�cy��������'/.��.�—��.�....._--.---------' ...............................
Street
as shown nothe application for Disposal pJork, Construction Permit l0o.................... Dated..........................................
----------'----'----'-'------'----------'----''--
Board aHealth
DATE—_-.---_-----_-.---..............................
ronm 1255 xooeywWARREN. INC.. puousysne
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