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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 .