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1192 Applications & Permits CHECK OR FILL IN WHERE APPLICABLE THE COMMONWEALTH OF MASSACHUSETTS //�� BOARD OF l..tZf, of /�8",`t ALTr1 --11 Fax `7T'_ )ppliratian or i3ispuzat re arks Tunstrurtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .. or Lot No. jfil�.�r....... .cr Fes..ez:.. ... .. .........._._...._. L1 ... Location Aaa,„ ....__�. .t (l p.c f fa i f 8071; t , Address G /-�t...� Address Type of Building L. Size Lot Sq. feet Dwelling—No. of Bedrooms g 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 S--g..O,2 gallons. Septic Tank-Liquid caflocity/..cagallons Length Width Diameter Depth Disposal Trench—No... CI Width 2:2. Total Length...Z.&_CL... Total leaching area../5!.y.Q.sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Installer 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 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. ed Application Approved By �t--��� '1;2 Date Application Disapproved for the following reasons' Permit No Issued_ Data Date by at has been installed in accordance with the provisions of TITIE 0/5 of The State Sanitary Code de.fi ed in the {. application for Disposal Works Construction Permit No .D v dated....- 77-- .� -- ./ 7'0 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GU A NTEE AT THE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAJ..TH OF Qlrrtifirate'nf Qlumpli+tnrr THIS I,S3'Q�CERT�P'Y, That> ndividual Sewage Disposal System constructed ( ) or Repaired ( ) ---Inshlln SYSTEM WILL �INsTIC}N SAJjs€AfiTORY. DATE ( i+ Cl/ �y L/CJ Inspector No L.D..."."..L.Cd THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Disposal nrl flipnotr inn ¥rrmit Permission is hereby granted r? Ql �h _,^..' to Construct ( ) or RepaS_ ) an Individual Sewage Dispostal 35ystem at No /./..1{.. - g6_..f�,si..4..y.. ..:..-�........_. 7i s� as shown on the application for Disposal Works Construction Perni Ng^ ' .E. Datted?2/L.r/2 DATE �; -9_' L.) .76 255 A. M. SULH(N/.e INC.. BOSTON FORM I23 (_.%Board of Health CHECK OR FILL IN WHERE APPLICABLE ANTHONY GRACIA No.29701 FOISTI THE COMMONWEALTH OF MASSACHUSETTS _47--��BIOARD �O/F HEALTH OF nit fur Biiipnztti rc orb Cnnnntrurtian hermit Application is hereby made for a Permit to Construct ( ) or Repai System at: an Individual Sewage Disposal S—c f..L_Y.te. LoD;Pa`(I..e(V `J-,`,' L.- or Lot Na Cl Address 1i/staffer Address Type of Building Size Lot. Sq. feet Dwelling—No. of Bedrooms s.Jr Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons Showers ( ) — Cafeteria ( ) Other fixtures Design Flow .T,r gallons per person per Oay. Total daily flow iir r0 gallons. Septic Tank—Liquid capacje6a0 gallons Irength / • Width...r Diameter Depth¢ Disposal Trench—No. '��f{{ Width..lt2 Total Length.a2 .�...LtTotal leaching area /110 sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box X) Dosing tank ( ) p Percolation Test Results Performed by.. 3'/9 ter,c:4-7, AS Date...Z.:V-2J Test Pit No. I as minutes per inch Depth of Test Pit 9/ Depth to ground water — Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Description of Soil ,5./AVAP 9 1:4411 r ea S edoeg/Pc7 i) 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n issued by the r health. Signed. Application Approved By Application Disapproved for the following reasons Date Date Permit No Issued. by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF QQrrtifiratr of ainmplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer at 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 dated_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Disposal lili nrhn ftnnstrurtinn 1rrmit do Fae..S7/e) Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No Street as shown on the application for Disposal Works Construction Permit No Dated Board of Health DATE FORM 1255 A. M. SULKIN, BOSTON