206 Septic Application Permit & Perc Tests 1995 CHECK OR FILL IN WHERE APPLICABLE
Fins
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C/r/ OF , gr/14//1,'/vc/ //hss
ppliratinu fur ljisiauzal rc arks kinnntrurtinn ]rrmit
on is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
2/0 y vos/G( GUT CO( <_/ zi ;/idea) /e'/, /(/c9X/7//7�,P73N
//Ot//t/ar� d S 7 /' 1. f;,et.) ,E'G1/2JJ iZP/'.rd.c/ tO n-74 et
Owner
Address
Installer Address /'X/
Type of Building S'%��" "'�/ Size Lot /- Sq. feet
Dwelling—No. of Bedrooms // / Expansion Attic (/yG Garbage Grinder (yq'S
Other—Type of Building AP_1` , "le-, /No. of p{ersons 69 Showers (() — Cafeteria (/J0
Other fixtures fG)/t. ez.2.1.._Lr..2/!/-/ 4i. .Criet tt.rern't-e Pit) /K/$
/
Design Flow /J.Q _ gallons per person�erday. Total daily flow...//L! /? / .i.CL/gallons. /5
Septic Tank—Liquid capacity/3 4allons Length__k._-ftWidth _ • Diameter Depth 5—
Disposal Trench--No. _Z Width BCC`_. Total Length..ioe Total leaching area. sq. ft.
Seepage Pit No Diameter Depth below inlet. ./Z:" Total leaching area sq. ft_ tc'pZ
Other Distribution box (/ ) Dosing tame ( ) /i07/GN ? 3?4 �/ Z S/�,' S 3
Percolation Test Results Performed h �y ./ -4<l// fa( Date 61/4(a/de....
Test Pit No. 1/0 minutes per inch Depth of Test Pit 9.8 Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Ty/—z__ 0-1 G/-S r'O/9Ln/ 9 —Z S// , /: t/l2/J
Description of Soil S.0e £'0/L .rf 7„14....g %'-4/27 ,7't:. / / //t.
G'�/T/>/ C *2... n.l f/<'o /09 " AO unto' //3
> )/5 0 - 9c'/S 6O/9/n /e 5S// r/
Nature of Repairs or Alterations—Answer when applicable__57/74-'0
: .7..L� /e — 2/-- cOfl�1/
S/> 7.% .E._f✓ ✓�CZ.4"
- 9¢
Agreement: /LCd S!//j/(ie /ea // 7G yo ' Ant:4wz p
The undersigned agrees to install the aforedescrihed Individual Sewage'Disposal System in accordance with /¢t
the provisions of TITLE S 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.
Application Approved By
Si
Application Disapproved for the following reasons•
Data
Permit No Issued.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF N
(�ertifirtttr of (dnmplitt
THIS I LERT Y That th ''vidual Sewage Disposal System constructed or or Repaired
by
Installer
has been installed in accordance with the provisions of '"IT 5 of he e S it ry Cotk a deec bled in the
application for Disposal Works Construction Permit No �/ dated L/ ji3 '.)S.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUjD AS A GU,(.RANTEE THM THE
SYSTEM WILL FyNCT ON SATISFA�CTCORY
DATE 1..../..../.. Inspector
No 7
THE COMMONWEALTH OF MASSACHUSETTS
I BOARD 9F HEALTH
/
/i S
Oispn 1I Itlnrku Cinnutrurtiatt firrittit
Permission is hereby granted ...1-'2 " .:"14' ' 4 tom... .-.. .to Construct (4 or Repair ( ) a Individual Sewage Diyion System
l..-3f:GDf s �`V t¢-"^o Permit o r), (]ated....
at No_..,,r� 7
as shown on the application for Disposal Works Construction Permit o... iL/
of Health
DATE
FORM 1255 A. M, SULKIN. BOSTON
ast .NG. /10 — Test NO (If 'required]
CC ' Reading Time �7 Reading r., Time
(^,N /�/!7/"C/ /4-40trage Saturation(1S&tn)
`Saturation (15min) „�
1,P¢ ":9y
, Isla /b/a
.11.39 /&/ , L° ' /S"/
o;:re,�j' /3% ') /414
' 5;,714- f[//Y /
e_ 33 /c '/Z
)/'/2 -
4&537fl 10 '/y
Perc.Rate ,a" (2 Min/inch Perc.Rate
Ground Elev. G - Ground Elev.
Depth of Hole ,�^ �¢'� Depth of Hale .
Test Pit - ! 9 J
Depth Soil Description i
ri — //a%s° Zc,9,97
//-/g " c7/LfV c'S iro2c
/fl'/_�G ` C_U1,ns,gGjreite
� ae c7p wire Cad4 c. f bawd`rJ-
1 4,1 5-64 it /i%i
Groundwater Depth 90° Elev'. /1.,ce Q roundwater Depth Elev.
Bedrock Depth. Elyv Bedrock Depth Elev.
Ground Elevation L�j,j"p' !/ P.O.. Ground Elevation
S.G.S. Soil Designatl�� / f6' Seasonal High Water Table?
Bench Mark: Elev. Description
DEEP TEST PIT/S
7/39"
ee
3:x/3
3 1a¢-
Min/inch
Test Pit -
Depth Soil Description
COMMENTS:
EC 2 52/1/ J
L/4/
Test No, •
Reading •
'Saturation ((Smin)
Perc.Rate
Ground Elev.
Depth of Hole
Time
Min/inch
,�) DEEP TEST PIT/S
Test Pit - - / ."—/
Depth Soil Description `
O -s" OrZcl-9
¢' 29" rC 4tV S,9N-
267 750 rX24,0 'tea
seed O 28
Groundwater Depth 25 Elev:
Bedrock Depth Elev. _S10/2-
Ground Elevation
S.C.S. Soil Designation
Bench Mark: Elev.
Seasonal
Test No ( If required)
Reading Time
Saturation(l5min)
Perc.Rate Min/inch
Ground Elev.
Depth of Hole
Test Pit 2 •7 r2
Depth Soil Description
oA _5f // O.%S/a '-i'- "
y- v c70%/ " t.579,2 ' zfie,
09/ -/ 5
74.1/ /
Groundwater Depth Elev
Bedrock Depth' Elev. '
Ground Elevation — 1
High Water Table?
Description
COMMENTS;
N
/V;zkrts.
Tp
/or •
Co/e'f' //Ocd6u-/
,20,07 .