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Appliratiun for Disposal Works Tonutrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 13Olt A17. � 301_ �73_: : ... . .._.._.. Location-Address or Lot No J rZ3 .:Zi/�s_..-•--•---...---•-------•...... ....................... 2 9� �cs r n�........ - ...............................................- - Owner Address Installer Address dType of Building Size Lot....1_ls 11 Q.....__..Sq. feet Dwelling—No. of Bedrooms.........�L VQ....................Expansion Attic ( ) Garbage Grinder (jW Other—Type of Building t�i4�0k t6'' 4(No. of persons..........2............. Showers 2 — Cafeteria a' Other fixtures -- ...................... . -•-•-•..•--•-----••-......-•------------- -•-•••--...................-•----•......--•-•--•............. W Design Flow.............;4;73...................:':gallons per person per day. Total daily flow.........3 .....................gallons. Septic Tank—Liquid capacity./49 ,Gallons Length................ Width................ Diameter................ Depth................ .. Disposal Trench—No. .................... Width.................... Total Length................. . Total leaching area....................sq. ft. Seepage Pit No......... Diameter........./0..... Depth below inlet................ Total leaching area....27.v...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •--•----•-----------------------------------------•-•--•--•-•--.....--------.........-----------•---.......................................................... 0 Description of Soil........................................................................................................................................................................ W ---.................................................................................................................................................................................................... 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 TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued b, the bo of health. Sined-- �.. .................................................... Dat . Application Approved BY ..._.._. .--I - � Date Application Disapproved for the following reason ......................................................••-----•--•---------------•---------............----•• ---•---------------------•-••--•-•-•------•-•--------------------............------......._.........-•---••----••--------------•----•-•---------•-•-•-••-•-•-•••••---•--...-••••-----•--•--•---••-_----- Date PermitNo......................................................... Issued....................................................... Date q3 , No......:................. Fmc............................... THE COMMONWEALTH OF MASSACHUSETTS cam, '3 tOARD OF HEALTH 17 3 '....._.-.-.. .- _._................OF.........................................----------------------......_.. Alip iration for Diiipoiial Workii TomitrUrtiun 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: j- - Addr Loca tion tion ess . 4✓ ��.. � _.5.. ....... -" 29 � or Lot No C,�J` bra:,✓' Jr �Z� ..._ ..•.......• ^• Owner Address a ,�v 14d k,-7/V v-. Installer Address d Type of Building Size Lot...../ ........Sq. feet V Dwelling—No. of Bedrooms.___........................................Expansion Attic ( ) Garbage Grinder (ry� p,, Other—Type of Building No. of persons....•...__.7�.............. Showers (2) — Cafeteria ( ) QI Other fixtures .................................. W Design Flow............. ..........................gallons per person per day. Total daily flow---------- ....................gallons. WSeptic Tank—Liquid capacity.O.QVailons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length_....._..........r. Total leaching area....................sq. ft. Seepage Pit No._...-__--._._______ -_._ Depth below inlet.........!....... Total leaching area................._sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix •-------•--•----------------------•-----:..........•-----------...........--•-•-•----.........•.............................................................. 0 Description of Soil........................................................................................................................................................................ W VNature 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 TIT L Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued b the b6aPj of health. Signed ......................................................... ............D.-......... Date Application Approved By.................... ......✓' . . ............................... r - 1 )---........ ` Date Application Disapproved for the following reason ............................................................................................................... ...............••----•--......•••----••-••-•••--••-••••-•••-•.......---•-•-••-••--•.........•------•••--•--•--•-••--•-------••••--•-•-•••--•••-•••-••••---------•-•••••-••••-••••--•-••----••••-•---•--- Date PermitNo......................................................... Issued....................................................... Date _ J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... (Irrtif irer of Tnntplinurr THIS ,S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.. ..-. ......rs/<I?...1 y✓........................................................................................................................................................... Installer at-•••• mot-S f± f do it l2 0 - --------------------------•---..............••-----•-••-•---•-........ has been installed in accordance with the provisions of TITL, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......... ._~_,�. ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �-�� DATE................. --��..'----------------�........................ Inspector........ b6 -tl__1. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �✓ - ...........................................OF....................•.••• ----•.._....... No.. FEE.....:... ........... Bilivollat Ivor !tnistriation rrmit Permission is hereby granted............_ to Construct (1-"� r Repair ( ) an Indivi2al Sewa Di s osal ystem atNo. .......................................... ..� .......€r......"o ti. .,4` .......... '^`''-------•----------------•-----.------.-- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Board of Health DATE---........................................................... FORM 1255 A. M. SULKIN, INC., BOSTON I k r -i 72 .2 - I.Iff/0 LOCATION SEWAGE PERMIT NO. V VC1. ALL ER'S NAME i ADDRESHWv ff I8 U I L D E R OR OWNER " y ��g DATE PERMIT ISSUED 1/0 //:z4 DATE COMPLIANCE ISSUED 7 � �- �`e 1 V zu W �'` L 7 vc, OF 0 Td Isc'AL"E",IIPA D47, 0 VE FDjV' DVI H, �6�PADE,,2,fe ISH N ti,-7A IC-7 F 0 MADE-V VFP IA C Hl 7 v )�?IF C 5-D If u v 7 I7 r 4 5MT�� I P_ D, p ILL ON, BO)7 -S T Bul TION�L '314" TOii P TALL VA/ VF PECAST CONCE W7� /0 A51 FD PENFOPCEVi Ii N H�, 0 7EI F -AIVK SEPTIC , 7 SE 'EXC A INS TA L L �SA IN IA V F -11N A/Ck- P.TA L ii6ENEA MA 7,F-1 F_A CE EXtA YA T D M, TE TAL'A -----PE P& E A P IF CL A/V, CL AY �,FP EF T IV E DIA ME 7FR IP_ A�tA IL CHING ' IT GENERAL 'NO TES 11V, _TACL,:�l 0 L VEL'LL ELEVATIONsi,�i�A A L plprs -IF,5 YT EMM,US'T�,BF TP O)A�IN Tk OP '9CHEDULF 40 ,P VC. �p r T-OBSERVATION.,BOAPD- OF- HE A L TH MUS T THF BF, NUTIFIE_/V CONSTP 7- 7' K/0. Z 7Z,3,WHE OA rl UC TI6M-IS -C 1PLETE, PPIOP, _PCOLAION PA TF-7:TO SA CKFL L ING �frN. _t1v PL A IV MUST �BE_ �AIPPA i4� ANY : CHANGES ,Ilm rqIS _S� -D L R Y THE, BOA ,Wl TNE 5E ?Y.PD OF 'HEAL TH' Alv,6 cAPE a A SUP VE YIN&, to IMA TER r A L S A 1VD INS TA L L A TION SHA L L �.T,M I5F. �iFA L DESIGN'. � ' D TA COMPLIAN6�E W-T TH' �,,THE iS T4 TE SA N1 TA�?,Y , DA TE:�0 L6tAL-APbTCA,0LE'"CODE T1 TL E "V A A REG PUL ES I�D UL A'tION'S-H: A PPOAI� S:FPOM PECOPD Z:I PLANS AND/VOP 7 7' i-'Dlc5P0,5 A L BE ,,��OLAP PUPPt)SE A F 7- 00 ZA PD ��VE (9 D.:T�Y, vA A NK GA A PPO VIL)EW, 4.0_PTIC A _0 PEDI GPD 7'P[,IL t 000 GAtLOM SDE�WA Li- RE A 9 �5 C TA NK 67 OT OM A PEA T EG N L E D , Ir)L EA Cl:lINt5 PRO V10f: Gpo IPPOP 4 OSED E 4.EVA TIOAl PECA.9 T CONCRETE UP I EA CHNG P1. ........... -P VA TIM PIT 4,i�v L 0 _-DISTPIPLITION BOX vcl A DISPOSA IPPOPOSED SENA 6c , ---------- IL' A Ci Ii L7 ,- Ij,�A PE O� ro-0-1 E p TANK: �IVES DA� VrD IPESEPIVE E �L'O,T��,, ' I A "OP"ROAD N1 c� OAVII PNSTAlm;7fLE, `- ,,-HYA VISP. 0PT2" '; `MA00 .VA av HARL-))olp, '�V VR 8 IT E 7.-ti7i-PLA�V PLOT A A -SCA A,P