,

THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH Z22@/t/.. ............ oF .... /.1..m!:/-r4?0./.J.~!.!..:;(s...

ApplitutWll fur ili!!pu!!ul lIIiIurk!! <1tUll!!trurtiUll Jrrmit Application is hereby made for a Permit to Construct (vY"or Repair ( ) an Individual Sewage Disposal

System at : </7 'f ... ~!. .. .? ...... c:. .. ~ ..... ~?~4?..~z:../-//.{;?. ..... ~<?.!:?. . .QJ. .... A.@...Y.:!::T.~ .. ~!7SS .M. .. %.!'!..yA!.?!.~:~:~.:.~~.::t.z. ... dC!£?0...Y.. ..... /:!.-t..~s.~:.~:~ ............................... __ ... . .......... ~·::bLb.g::;L .... £.7.S-l;~~;.i:t.~............................ . ..... MQ."'~.\\.}\t-«. ....... M·~;;::;:· ·2 .. i28-·····~7i·-;;:~-J Type of Building .p Size Lot ....... ~ .................... Sq. feet

Dwelling- No. of Bedrooms . .....2 ....... ;:;r .... =:;;t; ................ Expansion Attic ~O Garbage Grinder (dO Other-Type of Building ~:fL~ ... No. of persons ..... 6? ................ Showers ~ Cafeteria (PO

Design FIOW .. ~t~//a~s.::::::::::::::::~~:;~:·;;;;~~~~· ·T;;;;j··~i;·ii~~::·.;)L2::;;;.3.:!.Z;::?t.;Ji~-;;~: 4/ L Septic Tank - LiqUid capaclv'a2c:gallons Length ... 8..'<R.'Wldth ..... ....... r. Diameter ................ Depth .. ..:r.:::-..... . Disposal Trench - No . .dJ' ............. Width.3.6.?.~. ~ .. Total Length ... ,!?? .. Total leaching area. ................... sq. ft.

;:~~~g~i~~tib~~~~·b~:,;; .. i~·i Diameter···D·;~i~~ .. ;~!t' b~)5'I~~.:; »t~ leacl~ )'MS··· .. 38·~· Percolation Test Results _ Performed by ........ w...f.S/...F.:./.Z.:&.L:2:1: ............ Date. ..... .57~?/?~ ..

Test Pit No. 1.../.5 ...... minutes per inch Depth of Test Pit .... .:::f..<? ..... Depth to ground water .... ..a~!1 .. Test Pit No. 2 .. /~ ... minutes per inch Depth of Test Pit...s.:~ ... Depth to ground water ..... ,?IA./El.. . . . m ····· ·····O·;c;;······cTrS'Z2iJ9/75··2?::.··T·······-;··· ·-;R·····(?V·?Fs-;iJ/Z··/3-:-

Descnptlon of SOlI ........... -<..7.. .............. "8.. ................. /'" ........................ · .. .L~ .. .5.i .. ?71{./f ....... ~<2 .............................. ;/2c5 .............. a0::7,f12g.0.r.:?r.c?:~./ .. r./..f::C= ..... k.(.!./...l'7'f. .. CC'L~..t:.J .... Ad2 .. d...~ .. Q . ........................... : ... .... ;T.7!/ .. :.& ...... .c::::c8.. .c2Z5..:.C..c2!:t!.'?::1 ... df:.:/~ .. .s::/..? .I.':'U .. s:?.!..<3...$.~.(~ Nature of Repairs or AlteratIOns - Answer when apphcable ......... /~ ...... .7..::? ... E/~ .... s:zc...z:Z/h L-L.-................................................................................................................. 7'O:::-.. '7.z= ..... CcJ..qc.s;;e··9.e.--a:·~p7 Agreement: 7"Z-/Zt;? :5>L-)rl./C;;;,e.4~/ r-/LL-

The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wit~A;;7 V the provisions oi ?ITLE 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 by the board of health.

. . --J# ~ "')gi n .%. ... R~.~ .. ~.' ... ~ .......................... : .. ~~!~.~~ .. . ApphcatlOn Approved By .... C/~., .z=.... . ......... ...... ~~ ......... ry. ~ ....... ..2..;2 ....... ....... :/. ~. Date

Application Disapproved for the folio . 9 r ons: .. ...........................................................................................................• _

. N e:?C/-/2.. Permit O •.•.•.•.•.•. l .. : ..................................... _ .. n.te

Issued. ..................................................... .. n ...

\ THE COMMONWEALTH OF MASSACHUSETTS (rIJ.J,J. ~ fVl~19 ~·······~::;~:t;~:m. .,/1 1

THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ~Repaired ( )

~1~z:::::::;t:L::~~~:Ii.:;::::::::::72.:;Zi:~,;Z::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~::~::::~ has been installed in accordance with the provisions of TI T IE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ......... £':Ir::.!."?"......... dated .... ........................................... .

THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.

DATE. .............................................................................. . Inspector ................................................................................... .

'.

THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH .. .)'ZIL//t'.'/ ...... OF .. ... /1/..J. .. J./-c .... .f.? .:;:z= .... .,f ............... :::: .. c.:..

I

!\pplitutiott for mi£ipo£iul mork£i Qtott£ilrudiott Jrrmtt Application is hereby made for a Permit to Construct ( J.--or Repair ( ) an Individual Sewage Disposal

System at: '17 If .... LL./..j ' .. __ ..... L..:t:? .... ?.. ..... LJ:2L?..:Z./.:.L.z::. .. ./ / LLL .. ./:2..L .L :)- ... 4~ ... -.L-. ._;;..L.._ ..!. • . //SS

Location· Address or Lot No .

... ~ ... bL! -C./'...IL.IL .......... R..L ...... 2..:2 ..... :L:/ .<c. ....... /. ...... L::- .. _::.::;:;:: ..... __ ..... _ .................. ____ .... . 7·~' Owner 7 """ _ Address

Installer Address ../).,,; ,., -" J Type of Building Size Lot .. .?,.32..e ..... ~q. reet

Dwelling - No. of Bedrooms .. ~ ................................. Expansion Attic (AJ.-o Garbage Grinder ( / )/ ? Other - Type of Building .,..<'.e,: .... (.""/ , .... ;No. of persons ..... .L ................. Showers ()/5 Cafeteria ( .;<iVa

Other fixtures .. -....... -.--.-... ~ ._ . .,t2.cr;. ____ L.~d __ .. .::-~- _____ ._. _______ . ___ . _______ . ___ -............. -......... ~-.-.---.-.-.-" ...... " ....... .

Design Flow ......... //6J ..................... gallons per perMn pet day. Total daily flow ...... 77"·········;:>··"'·;··oP'?Jlons. <:? / 2-Septic Tank - Liquid capacitV-6,L-'j:allons Length .... ;rc.:"/:. Width ..... ; ....... Diameter ......... ::::: ... Depth ... ::y-.... Disposal Trench - No .... .2 ............ Width .. ::::?6< .. f ... Total Length····0Z9 .. .''rotalleaching area .................... sq. ft. Seepage Pit No .............. ::::::'. Diameter .................... Depth below inle!... ..... ..... /./. Total leaching area .................. sq. ft. Other Distribution box ( I ) Dosing tank ( ) /-,:f' ~,,/ .?..,.? ~ / /' S .?.P 7 Percolation Test Results _ ~erformed by ...... ··· p..-..;r ·T-~"'·~.·0.··&7' .. y ............ Date. ...... =......:-/"";?/;.<.;;t" ... .

Test PIt No. l .... /:& ..... mmutes per mch Depth of est Plt ...... """.~ ..... Depth to ground water ..... V7..7;9'. Test Pit No. 2 .. j;.:7= .. minutes per inch Depth of Test Pit ..... .::r:.c ... Depth to ground water ...... o V7-7 ..

..... _._-_ .. _._ ..................... _---_ ... _------.-----.... _ ..................................................... -... ~ ........... -.- ......... " ........... --

Description of SoiL. .... ,.LL::i .. _,t ..... •.... :::--!?.-C..<: .. :.:L.c;".t,/..r.: . .7. .. 6'=;/, ·····:7"·r ····'·;:···:F.L.·"...:··5- ·r-=···A~··-/? C' ............... &.? ...... v .. y.L·······'C.··7-r·····r·~""'·/ ... /-I .. /'. ········pf77""r-;rr···· c··;;/j,L·L·····-:····7b:7·//.r·C ··· ···························:·· · · ····/."/·';;-·:··c·········5·~/:···,·.c·y<··5"-:/ ·"3;1-··,9"]···~·//····5;1·t'· ";/" ·/···· z:;;r.. ··S "Y"c. Nature of RepaIrs or AlteratIOns - Answer when apphcable··········/If····=··7~·····r-7·/(;;;6~· · · ::.,-.r .... ·77/,/ L. .................................................................................................................. 7. ... _. 7 ·;r·······r""'·y"'?"7'f'r·? ;r,?';··z:<::.·' /' -/ Agreement: 7."1" /Z0 ~/" / /~"P/7~/ / "" L

The undersigned agrees to install the aforedescribed Individual 'Sewage Disposal Syst[m in accordance wid}&,""", / the provisions of 71 TLE 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 by the board of health.

~ _."" ... \k .. L'\L. ... "',~.................... .3:: .. ,.\=~ .. 1 ....

;;~~~;~~~'~~~::::-~~~~?:~-~ nate

Permit No ............ f..~::l.?::. ............. ____ Issued. ..................................................... _ n ...

\ THE COMMONWEALTH OF MASSACHUSETTS (tIJvI) :9.,..

fYl ~4Y )ft,, ~~~?;~::un- . /1 I' ' THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ~Repaired ( )

t~~:::::::::;g;::;;;;~:;;;:;::::::::::""2/;:LZ~.~;~:i::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~ has been installed in accordance with the provisions of TIT I.E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ......... ~V"'.I .. ?........... dated ......... .. .................................... .

THE ISSUANCE Of THIS CERTIfICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL fUNCTION SATISfACTORY.

DATE. .............................................................................. . Inspector ................................................................................... .

THE COMMONWEALTH OF MASSACHUSETTS

Q u ,Z- .. u~#.u~~:~AL~~~.~~ ............. u ....... u ..... u..... #"crI~ N o ... L.7.::::.......... FEE .. "._ ..

mi£ipO£iru mOrk£i QtOtt!ilrudiott Jrrmtt c! /('00(1::: 0 I Y Permission is hereby granted ....... ~d ......... ~ ... ~~ ........................................................................ __ ..

:~ ~~~.~.~~.\;.~~#5."l.i.[;~~:).z~~;:: .~s~etll ..................................................................... . as shown on the application for Disposal Works Construction P "N ... ... f,(-c"./...2.. D~ted."hh I~~._.¢ts:z .

/ /.. J... . •. -(:/-•• /f'~Q. ' DA TE ............. ..2./ .. 27.r.I-9 . .y............................. ~ d of

FORM 1255 A. M. SUL.KIN . BOSTON

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