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