1163 Applications & Permits THE COMMONWEALTH OP MASSACHUSETTS
BOARDaOF�HEALTH
OF -T-C. k.!i.rt!YI
pplira#inn for Disposal Rnrks Tunstrnrtiun ilrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (el an Individual Sewage Disposal
System at:
A
va_ �
X H
:^ r $d .i L- Address
-�� r*x•nes v' Size Lot Sq feet
Type of Building Expansion Attic ( ) Garbage Grinder ( )
Dwelling
ther-Type of Bedrooms No. of persons Showers ( ) — Cafeteria ( )
Other—Type of Building
Other fixtures lions
Design Flow gallons per person per day. Total daily flow -�
gallons Length Width Diameter Depth
Septic Disposal Tr nc Liquid rapacity Wiadth Total Length Total leaching area. sq.ft.
age Pit No Total leaching area sq. ft.
Seepage Pit No Diameter Depth below inlet g
Other Distribution box ( ) Dosing tank ( ) Date.
Percolation Test Results Performed by Depth to ground water
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 ground
I :4.) AAdme.N' '.Lff t t-_-tire)
of Soil
Nature of Repairs or Alterations—Answer when applicable .i.,
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
tire 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 of health.
Signed _ rl�t
i is
Application Approved By '.41:4t-4-€4-
Application Disapproved for the following reasons
Permit No
A.J
Issued....
i.`
I1
Date
c. 2,
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(:4- OF / (rrL 11.
rrtifiratt of Contvlixnrr
THIS IS TO CERTIAVY, That tbP,Individual
I1 G
as been installed in accordance with the provisions of Article XI
pplication for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE
IYSTEM WILL FUNCTION SATISFACTORY.
i
age Disposal System constructed
or Repaired (
No
of The State Sanitary Code as described in the
dated
CONSTRUED AS A GUARANTEE THAT THE
C
Inspector c :P �"�._e.1_-I,iY-�aa_1.a�.9
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
LI
k
�in}�nsnl orks &m trnftion Permit
Permission is hereby granted %=-1-'e Y0"'N-
to Construct ( ) or Repair (-I) an Individual Sgvap' Di5¢41 System
at No -.:a1 street
as shown on the application for Disposal Works Construction Permit No :w:._`
Dated U� /%.
k '-" Board of HealtL iJ
DATE
FORM 1255 HOBBY & WARREN. INC.. PUBLISHERS
, z73
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF .
Ex_-3 ' d G
Appliratinn for lJinpn ttl ifinrkn (guru itrurinn Irruuii
Application is hereby"made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage
ystem at:
04
S4-61,! o nc
.a ..S auf ' .
taaacr
, cross
'vpe of Building
Dwelling—No. of Bedroom,
Other—Type of Building _.
Other bxtures - --
-t n F low- allot per I 'tsmn per day. Total l la t tlow
Disc Liquid gallons Length gth o F- tth Diameter..Disposal Trench—So. Width Total I u;th-
-
Total leaching
Seepage Pit No Diameter Depth below inlet Total leacliing .ue
Other
co Distribution To box ( )
Dosing tank ( ) Date,.
Percolation Tea Results Performed by - h of Dept] to water _.
Test Pit No. I minutes per inch Depth of Tut Pit- - __ Depth to ground tr:-.'--
Test Pit So. 2 minutes per inch Depth of Test Pic- _--
Disposal
or Lot
Size Lot.
_._Expansion Attic ( )
No of pia tons__ -- Shovers ( -
Sq. feet
ige Grinder (
- Cafeteria ( )
gallon
Description of Soil
Nature o[ :ep tj terCx.1itc z_s a ns° 41 4 npp �(e /
44414„4,02E1 in cc d.rce with
place the sytcn in 0 Li F4 - 1 �'fi.�LIJ-4'
The undersigned agrees to install the eforedescri ed Individual Sewage e Disposal System
Agr ementt
the provisions of Artie;e NI of the State Satter Code 1 h undersigned further agrees nor to
operation until a Certificate of Conipiiance Itas been issuj d by the board of he lth. (
S d i - l J
Application Approved uy-. --
Application Disapproved for the following reason
Permit No_-773
G 1977
Issued -
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
hlertifirate of Olontpliattu
THIS IS TO CERTIFY, That the Individual Sewage Disposal Slstem constructed ( ) or Repaired
ins been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERTIF'CATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
No._r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L.�_. OF_..'.
fliopnoa1 Marko Tunstrurtinn Permit
Permission tuc is hereby a a ued� :SAL
'LL'
e Disposal i
to Construct ( ) or Repair,( )_„aJi Indivi l�ital Se� P Y
at No ye r"fl.(:LL'- t 1
I ^` f siren
i /
L
as shown on the application for Disposal Works Construction PcwV4 Date/No ���� d—- -
ci
gmrtl of H alto
DATE
FORM 1255 HOBBS B WARREN INC.. PUBLISHERS