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Fss. . ............... ;� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................O F................................_...........---------------..........------.............. Appliration for Diopoottl Workii Tonotrnrtion Vami# Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: ]5 Cn.... r'S 1.1a1 2...I...... .... ....... .P.7--.....L.!........ Location-Address or Lot No. ..1�,! 1I1 � �.! ......,=.�^.�.e,c...... ......... ....&j k..--..T21.---._.�...71., :t 1.e .c 7,4....... Owner Address ........�.0.5...... ...................... ......•-•---------•----.......................------•-----.....---................-------•----.... Installer Address d Type of Building Size Lot.................... .....Sq. feet U Dwelling—No. of Bedrooms........ ..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other fixtures .............................. . . W Design Flow.................... ...'.?Q...........gallons per person per day. Total daily flow--------------- ..........gallons. c4 Septic Tank—Liquid capacity.M.O.gallons Length................ Width_............. Diameter__._...,........ Depth................ Disposal Trench—No._.�................ Width..l.�.......... Total Length..Z-..(y/..... Total leaching area.:_ ___._.. .....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area 2 sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minute's per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------- •---------------------- --.......................................................................................... 0 Description of Soil..............................................................................................---------------------...---------------------------------•-••------------ x V ...............................................•-----•------•--•.....................------------.......-------------•--•--••--------------•----•----•....••----------------•-------••------------------• W -------------------------------------------------------------------------------------------------•---•--------------------•-----•-----------•---•----•--••••--------••---------.....--•---•------------- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------- --------------------------------------------------------------------------------•---------------------------------------------------------------------------------.........--••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI L 5 of the State Sanitar Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has a issued by the board of health. ID { Application Approved By--•-•-•.-- . ..... .:....-•------------------....................................... . ... Date ...... Application Disapproved f o h ollowing reasons:................................. . ....................................................... ------------...------------------......------....._...........-------------••------•-----•--------------....----------••......------.........._.. Date PermitNo......................................................... Issued_....................................................... Date 040-T /6 Y6 LO CA2 ION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS SUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED Ifl 13 a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Location'-'�-jWr-ess or Lot No Owner Address Installer Address Z- Other Distribution box ( ) Dosing tank ( ) -.-----_'.._-_-.-.'--_...--..------_'-_'__._'---_-.—'.---'-----_.--.-----.'-''-_'_____-- Agrermeot: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TIT 1Z- 5 n6d the system in operation ' liance has .'ee� issued by the board of health. ------'-- ------ ��,"-_-,-`� Approved -'--. __--_-____-__--_-------'----'-- -------'�'-'���------- Application Disapproved fo ollowing rxu^omx:.-------.--------------.-------.-_------_-'`--'-------- ----------'--'----'--'--'-------''----'-----'-------------------''-----'----------'----------- ' Date Permit - Date / ! , r*E .CoMMowvvsuLTnoF MAssAoHussrrs BOARD OF HEA t' ' ' � .........................................K�F.--_---_......................................................... TH1_ 4" Trrfifiratr of Tompliatta ERTIFY That t e In ividual Sewage Disposal System constructed or R'epaired by staller has been installed in accordance with the rovisions 0' TITLE- 5 of The State Sanitary Codpellis jxscu*bed in the THE ISSU NICE FITHIS CEkTIFICATE SHALL NOT BE / SYSTEM WIL ION SATISFACTORY. '~~^^^^-`r -^--'-------------------- ^~~p`�"" -'--------------'--'-'--'--'----- rHs oomMowvvsAcrx or mAseAo*ussrrs � BOARD OF HEALTH ..................................���.��F���������������__��������� N°=-^`—^'---- FEE as shown dn th lication for Disposal Works Constructi Permit/ ....:,,,.e.-:-:yAated.4�� -------f Permission is bAfeby granted..... �^ ....... � o"a� �---'---'--- oard -L� V ronw IAA.`~ �&5,Ugu 'DATA __ -- st Slu&t_E P-aMlL-f 3 BEozooGtG Vo 6AQ8t►Gl=. Ertl LJDEIZ ' I. _ . �. -j - - ': . `j .—; i� '7 p - AV& =t A4 Lam( VLO�k/ ■ 3 A 110 � 3�o GPI : r i� sW=TIC ,TAJ-JIZ 83o x Ic o 70 • d95 PQ } i VSF-- (000 'lsL1l.. f., i ( '..j Lw_A r_4A ' 1`l eti n . U S E.:'1- C=L" DI FFuS5aZ r i y I { '5tDEWALI. &OREA _ "10 SF: - 4� d$Xl•o8)�2.5)' - l94 GPD. ; ; :i; iy- :>. . . -Borrom At�A - gas sF 1 f !_: ;1 jfi 1 clZ 7f'Ld��t.0, lea CORP. i �� i I t Y i• px # r t � r �, It' •"�'oTAt_ St 6N ASS 6'1'•D• : : t (�y�, Th `�Y !-Ir P�z1.otJ�.TtoN L�.T� l ILI AnW. o(Z,lt:�K• 7. y1r-;i J. 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