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7jNo.. .... .... Fxs... .......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...................OF /.4z& ts..1 . .-._moo---._.....-----.......--
, ppliratiun for Disposal Works Toustrurtiun rrrutit
Application is hereby made for a Permit to Construct ( kor Repair ( ) an Individual Sewage Disposal
System at:
Location-Address
or Lot No.
......................---......�. !c............---....•----.........--•-----.............--.-•--- -•--._.......... ....------.....--------- r s.......----..__....__......_.......
Owner ea,,..— A e s
190JL a.--------•---•----•----•------•----------•-•................. .... ..._..... •-------------------------
Installer '� Address
PQ
UType of Building Size Lot_i�f -- .__Sq. f et
�-, Dwelling—No. of Bedrooms...........�.............................Expansion Attic ( Garbage Grinder g o
�`4 Other—Type of Building No. of persons............................ Showers
YP g ----•---•-------•--•-------- P ( ) — Cafeteria ( )
44 Other fixtures ---------------------•--• •----•-•-•-•---•-•--•-•-•--•-•-----•-----•.......-•----......----••----•---••--.
w Design Flow..... ............................gallons per person per day. Total daily flow........ l.�_ -_.._..__._._._.----------------------------
lions.
WSeptic Tank—Liquid'capacity-1.�.gallons Lengths=(c... Width-14--8__- Diameter.'._. Depth_ =_ -
x Disposal Trench—No. ......I............. Width......... Total Length.._� 2.......... Total leaching area_. -----sq. ft.
Seepage Pit No.............. ____ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box Dosin nk ( �
Percolation Test Results Performed by-_ Ate a1W'A a....� ........... Date.V ly-c.?•['__A-c) 5
Test Pit No. LA�.Z......Minutes per inch Depth of Test Pit....14.......... Depth to ground water-----� ,�7°-_-______--
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(4 .............. •• ,....•.
0 Description f Soil...D.4 _�-CQ..____ .?.�a_� ,1.4_.__2.� ____... _
P z . ;
x -•-•• •. ------tea -s- - - = -----------------••--------•--------------
------------------------w
U 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 ii;!L- 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 b he oard of health.
Signed..... ........... ...... °............................
�je���y g�
Application Approved By... _ 7 ! s...... ..
Date
Application Disapproved for the following rea ns:................................................................................................................
............................................................ .....---•-•. ---••--- ------------•--------•------••--..._-•--•••--...--•-•-•-------
Date
�!
Permit No...... �•-•-- •-- --•------•--• ----------•----- - Issued.......................................................
Date
193
LOT-
Fim......75.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,-
77V.Cjvujo•............ ....................
Appliration for Uhipaaal Morkii Tomitrurtion ranfit
Application is hereby made for a Permit to Construct (yQ_ or Repair an Individual Sewage Disposal
Sy tem at:
.A_I'A' �U i LA
.................... ............ a.......q .,4
...................................... - - - - ------------
Location Address or Lot No.
................................................................................................. ................................................................................................
Owner Address
............................................................................................. .........................................................................m.....................
Installer Address
Type of Building Size Lot-1S.t57.5..Sq. f t
U
Dwelling—No. of Bedrooms.__.........15�------_------_---------Expansion Attic go Garbage Grinder
Other—Type of Building ............................ No. of persons._...................._.__.. Showers Caieie'ria-,("...'
PL4 Other fixtures .........................................;..................................................................
0 ...............*-------------
* Design Flow.............S!5..................__..gallons per person Ver day. Total daily flow-------1A................................gallons.
* Septic Tank—Liquid capacity.1CM. allons Lengtlll?�....&(.. Width..'.Ar7a Diameter_------------- DePth!5..='Fb
Disposal Trench—No. .......I........... Width....1�.......... Total Length....UC—>........ Total leaching area... •
ft.
Seepage Pit No----------------- Diameter-------------------- D5p h below inlet.__..._.._.......... Total leaching area..................sq. ft.
Other Distribution box Dosin t k
Z Y� x n W4 Q
Percolation Test Results ... a C.,
Performed by. 4%4G IM. ...... Date_A.VKIE� --------
)' y-- -----------
Test Pit No. I_472_.minutes per inch De�rp�)tihl of Test it....�21*
......... Depth to ground water_._-- ------------
Test Pit No. 2................minutes per inch Depth of Test Pit...____._.._____._.. Depth to ground water------------------
0 D....e-.-.s-.c-.-.r-.-i-p--t-i-o--n----o--t----- ..............................................................................................................a...n.............N.......6......-..-..-..-..-.5......A.........-..................._....._.....
.. oweax.....& . . ......................................................UU -
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'T'L!-: 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 b e and of health.
3T
Signed..... ............ .... ............
..... ........................ .. ........................
t
Application Approved By.A. e........ I . 0... .. .......... ...Q/ 5. ........
Application Disapproved for the following rea ns:...............................................................................................................
Date
PermitNo....13. ................ Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
OARD OF HEALTH
......ro .................
Tntifiratr of Tomplianu
THIS T CTRTIFY'Aat the Individual Sewage Disposal System constructed or Repaired
by.....__... ----AWYO........................................................................................................................................
k aJ . All.1 L - A a V1— jLLgC-at...... j0fi ANIxY...r:..'-V a1M11
has ---------------------------------------
been installed in accordance with the provisions of of he�tate Sanitary Coe 3A described in the
O�Dpf
application for Disposal Works Construction Permit No...... ....... ..... . ........ dated- --- - --0,5--------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NO CONSTRUED AS A ZUA ANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
...........................
DATE.................I....n. ............. Inspector............................-- --------------------------------------------
THE COMMONWEALTH OF MASSACH SETTS
BOARD OF HEALTH
..............row/V......0 F*.B/4. A. Ll�................
N(F. Mipaiial Workii Tomitrurtion "prrutit FEE./...................
Pe is hereby granted.,,-T04/A/----AAL�7_6.......................................................................................
r to Con or Repair,! an I;idividpal Sewage Dispospl System 0. 0
A.VILstreet .. .. ..............................
at N
as shown on the application for Disposal Works Construction Pe a ed.
I ...'y..........
.......... .... ..I.. ...... ------- - ...... ............... . .. .........
Board f Health
DATE.......... /3- (2/&0.1..............................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
w.
ate. OF
P"TER
SULLIVIN � . : 'S.E 64EE-tZOGZ
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No. 29733
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