833 Application & Permit 1993 reAOIhX
E.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
t✓_ ,,
.y . . OF...... ORTMltl if 1_Q.?J
Aunliratiun for Works Cionstrnrtion jrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal
/stem at:
WE.5.711-mITDAt! RD
La � l aa.e„
....aivieS)_f Aaare.a f
Installer
ype of Building _ Size Lotc.: :.f?.1 MR
Dwelling—No. of Bedrooms `- Expansion Attic ( ) Garbage Grinder
Other—Type of Building J!L.lei:-r.92d' No. of persons....6 Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow .S5 _ gallons per person per day. Total daily flow 446 gallons.
Septic Tank—Liquid capacity i>aa gallons Length../ZGe" Width 68 " Diameter Depth Co*"
Disposal Trench—No. Width Total Length 2 re Total leaching area sq. ft.
Seepage Pit No I Diameter Depth below inlet Total leaching area..4 5.----sq. ft.
Other Distribution box ( ) Dosing t ( M�H Qi �'2�- 93
Percolation Test Results Performed by Jia6WAii.$ AI Date 7
Test Pit No. L..Z'..t' minutes per inch Depth of Test Pit. /0 Depth to ground water.��
Test Pit No. 2 minutes per inch Depth of oof�ffy Test Pit t y Depth to ground water
$� 6i657-,-jdm RD
M2QL itnn p].n s ,t1e-
Description of Soil 015
Nature of Repairs or Alterations—Answer when applicable SAGE SL)S4Th 1 Oefe2P
5Gmak,6 otpa.93.L_ • . .n
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.
Signed
Application Approved By
Application Disapproved for the following reasons'
Permit No
Date
Date
Date
Issued.
Due
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH „gica
OF
htrrtifiratr of alompltattrr
by THJ.A,{S TA CERTIF , That the Individual Sewage Disposal System constructed ( ) or Repaired
Gk . ...vl --. -.-..
833 6.1“_A L.-- n .tauu
.�
C4
rt
ras been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described inn,the
application for Disposal Works Construction Permit No f— 9 M dated a.'3 - 15...)
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL NCTION S A I FACTORY. ,[Z� (� �J _ P�J __
DATE Inspector �`yCliy )C�µC��(
No ' / 3
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF _ /11 tA C // t,
nrko@Tonotr
j �tuttun 1ermit
°is}Tnonl
Permission is hereby granted
to Construct ^gr R V
at No „`71.a—� "+/"�
/ail -20.3
dividual 5 . gage Disport system
FEz?
street
as shown on the application for Disposal Works Construction Per rt2itN
/6 Fir3
DATE
FORM 1255 ASJA. SULKIN.
Bo4Twi