8 Septic Applications & Permits CHECK OR FILL IN WHERE APPLICABLE
No FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF /t'rl 1 5ani,o fen. .
.Applirattan for fli5pn.ial 311nrho Qlnnztrnrtimt Perini
Application is hereby made for a Permit to Construct (A) or Repair ( ) an lnditidual Sewage Disposal
�O
System at• r irl[ meal' ' / arse ^Et 'q
/.. .' .... - .- p4 4 t �e
on..
LO.6 erf 1E•
Owner
InstaCcr
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No. (7
Other fixtures
3
Address
Address
Size Lot 15-0.58 Sq. feet
Expansion Attic ( ) Garbage Grinder (V) ye.
prisons Showers ( ) — Cafeteria ( )
Design Flow 4 gallons per person per day. Total daily flow 300 gallons.
Septic Tank— Liquid capacib(al?L grdlons Length Width Diameter Depth 6}
Disposal ft EL.ej _ Width IS Total Length g/` Total leaching area SW sq. ft
Seepage Pit No Diameter Depth below inlet Total leaching area sq. tt.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by O1-
'✓ Date_5- ZS-7 3 -
Test Pit No. I 2- minutes per inch Depth of "It t IS[ �0,0 Depth to ground water O02L"
Test Pit No. 2 minutes per inch Depth of Test I'it Depth to ground water
Description of Soil 0-4 Cl ./c.c.re SQ/)d Sal /cos
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 follow
9
easons•
Date
Dam
Date
Permit No Issued
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Trrtifirate of tdnntplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
at -
has been installed in accordance with the provisions of Article AI 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
No l /
F
THE COMMONWEALTH OF MASSACHUSETTS
aU&R7NRnrra n/ MASSACHUSETTS
tip{iraiiun for ptSposai Sgstrm Tourtrurttolt Prrtuit
anon is hereby made for a Permit to Construct
vl an On-site Sewage Dispo at System at:
Location Address or Lot No.
Owner's Name,Address and Tel.No.
$ Dvu(�iif DRIVE
�� Dun/pi-di Q2
�
C&
$U)y
Installer's Name.Address,and Td.9o,
ft a, C hi'106
Designer's Name,Address and Tel No. 11
—,vt al E. ✓YI AG
p G 5-2
1't ..J
Al, Firms RD Aleg 9Rrr071av
06 /n�n7}tl1E RD -lue
igmpz*a, g
Type of Building:
Dwelling No. of Bedrooms
Other Type of Building u.s1 Thaw No.per Persons C Showers ( ) Cafeteria
q Other Fixtures -
Design Flow "10• 7 Z gallons per day. Calculated daily flow
Plan Date ��%� 4 Number of sheets / Revision Date
Tide 0 s - te. . a -. F.. L- _ ter. /t ui i .d
.Cwar'asa8C
336
gallons,
Description of Soil
Nature of Repairs or Alteratigns(Answer
hen applicable)
R&pcac f Iua6- 5o1L
Date last inspected'
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance h. teen i ue this Board of Health. /_
%gned let� Date 3/J7/ ' '
� 31/4 G
Application Approved by Jr xi J Date
Application Disapproved for the allowing reasons
Permit No Date Issued
THE COMMOMWEALTH MASSACHUSETTS
A v /kill MASSACHUSETTS
" `
Certificate of Compliance
hi In-site,Se age Disposal System installeell or rep ed/replaced
i for A—A1 CV ( »l-CC z) to
'ba%,beerrc9nstructed in
le 5 and the for Disposal System Construction Permit No L Lr dated
Use of this system is conditioned on compliance with the provisions set forth below:
THIS I TO CERT/F
h �
at
accordz ce with[the provisio of T
(�
Jr
The issuance of this certificate shall not be construed as a guarantee that the system will tune 'on a7sAeet
ed. This
Certificate expires on
DATE
qa a
Inspector
C%IONWEA H OF MASSACHUSETTS
No. MASSACHUSETTS
piSposa1 JgSLem/�Construction Permit
Permission is hereby granted to �"i Gr l_�D lr�0 U �4 4 �l
to construct ( ) or repair( an On-site Sewage System located at ge ! -
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special conditions.
J/ , (5S 6 g
All construction must be completed within three years of the date below. _
/144 j r
DATE
FOAM'255 Pev.3 g5 A M SULKIN OOH-BOSTON.MA
Approved by
I
HERE APPLICABLE
No...
lay Fx /. va
THE COMMONWEALTH OF MASSACHUSETTS
,(
BOARD OF HEALTH
oF
Appliratiun fur tinposttl Marko tuu5trurtion Wroth
Application is hereby made for a Permit to Construct (1)or Repair ( ) an lndit ideal Sewage Disposal
System at: alaYj+-L-
a._ 44 t.iLot
111101tfr at Adana=
stoner
Type of Building " Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder (6T
Other—Type of Builcling No of pt.r of Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 64 gallons per person per day. Total daily flow _306 gallons.
Septic 'l ank- -Liquid capacity6Ue_g:dlonsyy�Length Width Diameter Dc}nh
Disposal Trench—No. \\idth_016 a Total Length 301 Total leaching area 0_QQ sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area al. ft
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by // Date
H Test Pit No. 1._0'ts– minutes per inch Depth of Test Pit C� Depth to ground water.,42reLLe
Test Pit No. 2 minutes per inch Depth of it> Pit Depth to ground water
Add,
0 Description of Soil
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 AI 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. �
Signc - _ .. � f ] t'J.LS<er.
Application Approved fly _ .. ..... _ _`CAt i _aitz if74
Application Disapproved for the following reasons'
Permit No it:X_)
Issued
Dat
/1,...).9-7;
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
QlPrtifirate of fdnntplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
m.t:aitr
at
has been installed in accordance with the provisions of Article N I of The State S:Lnitary Code as described in the
application for Disposal Works ConTrnction Permit Nn dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector