Lot 15 Septic Applications Permits & Plans CHECK OR FILL IN WHERE APPLICABLE
No. 77 2FEE
_33
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H EALTH
i OF <krfrtie,.32,4 fni
Appliratinu -fur +3ispnsal i,f arks Cnnuntrurtinu permit
Application is hereby'made for a Permit to Construct Vol- Repair ( ) an Indic idual Sewage Disposal
System at:
41,14412,12-R-4 Ad4pss or Lot No.
to pao,i-Aa p..
Address
/ ]nstallet Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms ._.3 Expansion Attic ( ) Garbage Grinder (--
Other—Type of Building No of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow :2 gallons per person per day. Total daily flow J 0 d gallons.
Septic 'tank—Liquid capacity) 1LO.gallons Length VVidth Diameter Depth
Disposal Trench—No. Width . .0 ' Total Length e ' Total leaching area E.r y sq. ft-
Seepage Pit No Diameter Depth below inlet Total leaching are' sq. tt.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results n Performed by Date
71 Depth to ground water_ .'Le-
Test Pit No. 1__.x minutes per inch Depth of Test Pit .:.1LC
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
-..,_+
Agreement
The undersigned agrees to install the aforedes<ribed 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 issued by the board f health. ,
�
Signed}y� , .�_ �t t - yq /' ,/
Application Approved By -4�/-{i`:�`t.t.I •l� s ll��j /{
ne
Application Disapproved for the following reasons
Permit No
J2-3
Issued ',LQ.±tfr I� /j. --
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Qtrrtifiratr at «Irnnplianrr
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 NI 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.
DATF Inspector
+111
No...1J-se'
Permission
to Construct
at No got-{
as shown on the
DATE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
fL1 of I/ci //tl'., <-))._ _ ..__ . .
£dt#rasal Works Lnnstrurtinu tirrittit
is ereby granted
_or Repair ( ) an,Individual Sewage Disposal System
street ,
application for Disposal Works Construction PeLryit No_./._=-..3/ Dated
-1 d of gee
FORM 1255 HOBBS & WARREN. INC
PUBLISHERS
FEE 2 to
A2'i'LI AULL
No.'733 F„,13--Lea
THE COMMONWEALTH OF MASSACHUSETTS
BOARD /OF HEALTH
OF l
P ppliratiun fur Ditipatial 3iinrk.i C!tmt itrurtinn 1rrrait
Application is hereby'made for a Permit to Construct (4 or Repair ( ) an Indic idu:rl Sewage Disposal
System at:
.. ' ,(i+-ct,.e I1..1,5
Of..: ':-, , ._ Ades
a
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms__ 3 Expansion Attic ( ) Garbage Grinder (A-1r'
Other—Type of Budding _ No. of person; Showers ( ) — Cafeteria ( )
Other hxtu es _
Design Plow o L gallons per person per day. Total daily flow 0 6 gallon.
Set "Hid(—Lapv I cal:mitt' 0(f :dlons Length Width llr:netc De t •
Disposal Trench—No. AViclth. .oilL_ . . Total Length.301 Total leaching arca__6 O ef ,q. t-,
Seepage Pit No Diameter Depth below inlet Total leaching an
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by_..... Date
Test Pit No. l fits-- minutes per inch Depth of Test Pit 71 Depth to ground .Harr
Test Pit No. 2 minutes per inch Depth of Test 1 t Depth to ground wars _
Description of Soil
Nature of Repairs or Alt era'ions—Answer when applicable
Agreement
The undersigned agrees to install the aforedescrih ed Individual Sewage Disposal System in :tccord:mce with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place tl c system in
operation until a Certihcatc of Con tpli:mce Ica been issued by the board of health. _1
Signed g �'_Ya>n4JL xi.1 ^�"„
Application Approved By iL(0-16IJ `%%q//SGL14n_
Application Disapproved for the Mika
H as
i/ /91A
tg reasons'
W
a
[ti
V
x
U
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
c f{t OF WO!'tham,C/CO
v7.
.1 OF H4S10
S MILES 1. a'T
H U 6
20623
Application fur Qiupuittl ifiurku Cnnttsirzutiun Prrmit
Application is hereby made for a Permit to Construct ( A.) or Repair ( ) an lndividual Sewage Disposal
System at: tita pn-4- / °•'e off
It /S
t. rarto .did -
I /nnclt Ave '17'.1c-.17,574 nt,.;k4 NA
On net
ttistatier
Addres
Type of Building
Dwelling—No. of Bedrooms 3 Expan
Other—Type of Building _ No of per uu
Other fixtures
Design Flow ,SC /21-5-`` gallons per person per day. Total daily
Septic Tztnk—Liquid ctpacik _gallons Length Width
Disposal . —..e A&0 Width ate Total Length 2/
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing gta�nk ( )�A` p
Percolation Test Results .Performed by elt m .e West ����t�(_k Date ,S'2,S - 73. .
Test Pit No. 1 Depth of West Pit %C` Depth to ground water ne2e
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
ON 29
Size Lot /SZC % Sq. feet
on Attic ( ) Garbage Grinder (V) Y Cs
Showers ( ) — Cafeteria ( )
(low 3C`0 gallon;.
Dinnierrr De ib k ji.
Total leaching area ._3i4''_sq. ft.
Total leaching area sq. ft.
Description of Soil Ce 7.-C 52,_2j/4 a'ki% [OQ.�%C. t!d_/fit....�/:AV E7 2€__Sptl-1LRS
been ?elm() V-ed 'f4VlS. 1/11.$ a't e9
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed individual Sewage Disposal System in accordance with
the provisions of Article NI 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.
Signed
Application Approved By
Application Disapproved for the following reasons•
Data
Date
Date
Permit No Issued
Date
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