40 Application & Permit 1991 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
■),.. try' OF Ndg-ThiPPY)1774A1
Appliration for Elisposal ligurito Tonstrurtinn Venni./
lication is hereby made for a Permit to Construct ( PI or Repair ( ) an Individual Sewage Disposal
t:
it&BJeY&Y P 12)VE * 4-0
?JAEEC__ gtrr io En or La N.PRI C
P CamaLLE.7
I aller 8715 Taiii Mr/34 Ad
Building
3 Size Lot- .-feet
4 AKA& Ewq
filing—No. of Bedrooms Expansion Attic ( ) Garbage Grinder (f-1-7-
er—Type of Building .5thfra alli.117 No. of persons 4, Showers ( ) —Cafeteria ( )
Other fixtures
Flow 55 gallons per person per day. Total daily flow .....495 gallons.
'ank—Liquid capacity — gallons ;..ength — Width "-; Diameter — Depth —
Trench—No 4- Width Z Total Length 44 Total leaching area-5.20 &f.i2ser-ft.
Pit No Diameter Depth below inlet Total leaching area. sq. ft.
istribution box 001 Dosiadankj
ion I of447 eity E Illaawevo Date 3-1-gl
t Pit No. 1.-25-....minutes per inch Depth of Test Pit 1U' Depth to ground water. YE
t Pit No. 2 -- minutes per inch Depth of Test Pit lei" Depth to ground water 15"
iatfiS.._ _
ion of Soil Sida‘Off- 51(t5P, P7)ME .5,129.D 4 CM?
of Repairs or Alterations—Answer when applicablenlitt- egwrip.4- faLC-IiYfr ysnael
:-ePtcaast.6- ngs. 01117 — 44.5- zsarne./6
nit:
undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
fisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
in until a Certificate of Compliance has been issued by the board of health.
tion Approved B
Limn Disapproved for the}allowing reasons.
1/253/4 (
Viet/
..th
Permit No
afiku-71
Issued.
Date
Hate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
OF
erlifinde of Tontpliattr
ndividual Sewage Disposal System constructed ( ) or Repaired Al
m installed in accordance wit he provisions of 5 0 The State Sanitary Code asisd? ed bed in the
ition for Disposal Works Construction Permit No dated f/Z.
HE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
EM WILL PUN TIONpTISFACTORT.
3
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0 HE TH
pt
.714; OF
EirfP0
errnission is hereby granted .0.
nstruct ( ) or Repair Ch() an Individtkil
'91:= L
yn on the application for DisposhliWorks
auiiuu formit
Sewage Disposal System
FEL
s""t 211- -
Construction Permirlti, . Dated
, za-te
v Hoard H Health
E 41.2./.11,1
1255 mOsas a WARREN. INC.. nualisH555
2-