520 Septic Applications Permits & Compliance CHECK OR FILL IN WHERE APPLICABLE
A?
. No. a) -- % E'ER �t.e� ,..I.,
THE COMMONWEALTH OF MASSACHUSETTS S,�P`f OF
BOARD OF //HEALTH Y'q3-'
7+- 0'099 (. '/y OF.....A4Y/�I, sip/nn 9F FRE
4
1ppliratinu fur Elinpnsttl 1lturkn (>Iunntrurtinn 1erbi[
Application is hereby made for a Permit to Construct ( vic or Repair ( ) an Indic idual �p
System at:
[tore e J9a !' "'"sic,
piocatbn-Address . Lot No.
Ott , L Nfo + rti Tr kA �r...C'd G.Qlh.FN Mass
Owner Address
4
cj
Installer
Type of Building
Dwelling—No. of Bedrooms — Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
- Design Flow SS gallons per person per day. Total daily flow .3 3 D gallons.
Septic Tank—Liquid capacity/060 gallons Length Width Diameter _ Depth Sides
[.
- Disposal Trench—No. ._.Z____.... Width Total Length 80 Total leaching area r .p sq. ft.e 1161.
' Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( /) Dosing tank ( )
Percolation Test Results Performed by e/' %r" CL F/'45 Date i4 n 1 7 t! &y
Of
Al 11 Test Pit No. 1 H minutes per inch Depth of Test Pit if4.-7Z Depth to ground water zC
A 4 a' Test Pit No. 2 << minutes per inch Depth of Test Pit,, 72 " Depth to ground water 7b
Address
Size Lot /2 79ij flc3q. feet
Description of Soil.._LID.-<14S e'rl
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 21TI 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is]yfl b%the oard of he lth.
Sign
Application Approved By
g'f
/7---._.......
Date
Application Disapproved for the following reasons
Permit No
—Fy
Issued
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
,�O�Fp HEALTH
/i/D,Q 1
OF Q n
( rrtifirttte of fbnmplittntr
THIS IS TO CERTIFY That the I�nd"ivt al Sewage Disposal System constructed (jrj Or Repaired
at F/oe Nceipt gi Insaller�(Ai,/4r ki e- -ii)
has been installed in accordance with the provisions of TIT' 5 of The State Sanitary Code a de' r'b in the
application for Disposal Works Construction Permit No as—gy dated Dade
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
SATISFAC�TORRYY. /f
•
DATE ,FFf�'K.�,..../Zj./! 77 Inspector �jt'e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH /
C:4:-. / *7 r
i
Elinposttl nrfsr, hlnnntrnrtinn rmit
Permission is hereby granted /I'C' S25 pv e�L--e_-!1 d
to Construct (✓S or Repair ( ) an Indjvii4al Sewage Disposal System .-
at No :[.u•1.:.rYt/ er 2
FEE
street
as shown on the application for Disposal Work' Construction Perms Toy-
Board of Health
DATE C/../ /ay��
0 HM 1255 HOBBS & WARREN. INC.. PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
' No
THE COMMONWEALTH OF MASSACHUSETTS
ARD OF HEIjyLTH
OF
Appliratian far Disposal P R arks Tuns
7419-S326
it 'Permit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No. of persons
Other fixtures .. . ... �Q
Design Flow £S gallons per person per day. Total daily flow ...
Septic Tank—Liquid capacity../.(SCiQallons Length Width Diameter Depth...J
Disposal Trench—No. Width 3' Total Length 30 ' Total leaching area 44 C
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by
/.A -...f'�C. -....
Expansion Attic
Addr
Address /-
Size Lot Sq. feet
Garbage Grinder (J()
Showers ( ) — Cafeteria ( )
gallons.
r. 1 if Date Yl./iv../ �P..._
Test Pit No. I ?.minutes per inch Depth of Test Pit .0...2.!‘ t Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
Nature of Repairs or Al lions—Ans er when ap icable
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 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
Application Disapproved for the following reasons•
Date
1 Date 5 v 11 Date
Permit No
Issued_
3> 311
o
THIS IS,Tp C`HRTIFY
by KR,
SCE 7c.Ec , c �.
at
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
of
Ted-tartar of Qtnmpliatur
hat the Individual.Sewage Disposal System constructed ( ) or Repaired ( k)
C nn AA- k—vc,
,-installer
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No -? '2E- dated / ./1 I I? (
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. - --
DATE Inspector
THE COMMONWEALTH OF MASSACHUSETTS
--BOARD Of HEALTH
OF
No
Far
13ispnstr,Hill arksC onstrnrtiun remit
Permission is hereby granted
to Construct ( ) or RePak.(K) an Individual e�wage Disposal System
at No �,L...`� j- r kC C� t' I �_•
as shown on the application for Disposal Works Construction Permit Nu... .,..:. Dated
DATE °2' / r-1 S 0 L Board of Health
FORM 1255 A. M. SULKIN, INC.. BOSTON