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1133 Application & Permit 4L;•SOU p do Ti o hNog 'A OF JAMES ANTHONY WACIA 41- No 29101 hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal —Rabe fl-Le n r/e- /33 Gusbi(dq v Z LXY %r% q� 2 J THE COMMONWEALTH OF MASSACHUSETTS OA OFH H C� or /Aor/��y�-, -74",✓ n}rlirntinn fur flisntnsnl 3 arks Cnnnstrurfinn O NISLS...o_w 7 gyp?; litelagetPTON PUS OF HEALTH Type of Building y z Dwelling—No. of Bedrooms +`4 Other—Type of Building No. of persons Other fixtures t Design Flow -^ Ce6 . gallons per person per day. Total daily flow nO o gallons. Septic Tank—Liquid capacity/50gailons Length Width Diameter . Depth Total Length Total leaching area sq. ft. zt Depth below inlet Total leaching area..,?..+..-L..sq. ft. ler a 7/ Ad...ds=sart:757;406 v Address Size Lot Z 6 � rmt. Expansion Attic ( ) Garbage Grinder (b().L(T/ / Showers ( ) — Cafeteria ( ) 4//ALt�p Disposal Trends—No. • Seepage Pit No.7' $\/.. r Other Distribution box ( ) Dosing tank ( ) — r Percolation Test Results Performed by -{:_4:.6f L4._ !L "yeA"w Date.. 5-A7/56 Test Pit No. 1 3 minutes per inch Depth of Test Pit...7-7 a'' Depth to ground water 7 r Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Descri tion of Soil. 3 1“1-0-p /.l..t `f 5 c7 — . Nature of,Repairs orAltera/flops—Answer ben app/l bke /' f \ �@.OMCC_ fX/3.1 N✓5� S�.d/S .07 E_... /C d '—,v/ /1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be ssued by t e board$ health. 4 er Application Approved By Application Disapproved for the (allowing reasons 701/.7 T'[e ndt Permit No Date Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TH OF m rriifuntt at ftnm}Tlia THIS INS �Q C$$dif�' . he Individual Sewage Disposal System constructed ( ) or Repaired (�) by �s p�FL �( at 1133 14.) nMaiIu has been installed in accordance with the prov'ons of TIT F 5 of The State Sanitary Code a e'cribgil in the application for Disposal Works Construction Permit No — p5 dated I d-�7/1r..5 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE NTEE THAT THE SYSTEM WILL FUNCTION T, / SATISFACTORY. �(^ n DATE [ 2i 1.. .1.55 Inspector No -5 IS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l fin}Tnnal van Qinnntnwtinn permit ' 1 FEE Permission is hereby granted to Construct) J o Repair ( j Se?aFF Disposal System at No FI —..1 `r: '-.rte.__. / sem as shown on the application for Dispos`/a)Vin Construction Permit No -I-i= Dated /..y..r:.79/it,- Ed;del . yr DATE f Jl:.: FORM 1255 A. M. SULK! // 5 BOSTON