Lot 7 Septic Permit 7/11/62 IN WHERE APPLIC,
CHECK OR Fl
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow q gallons per person per day. Total daily flow gallons.
Septic Tank Liquid capacjj'ty./ t 0 gallons Length Width ... Diamete
Disposal Trench—No. 41^ Width Total Length...J O O r Total leaching area
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Perforated by Date
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Depth
�SO sq.ft
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to
operation until a Certificate of Compliance has been(issued by the boa lld of h
Application Approved By
Sign
`� v—r_ed ....�' . ..I
_ /r ‘` U
in accordance with
place the system in
•
1! 1262
tf Date
Application Disapproved for the following reasons
Permit No Issued
THE COMMONWEALTH Or MASSACHUSETTS
BOARD OF HEALTH
l.N/1, OF....J.�t'u' "LaIrr7""'r7
U &YItfintle of Otmmpfianu
THIS I ;TO rCERT6FY, That the Individual Sewage Disposal System constructed (✓ ) or Repaired (
by �1L ' ' ' .f got et 04'.
a -t- f.LL
has been installed in accordance with the provisions of Article 11 of The State Sanitary-Cod as dxscribed 'n the
application for Disposal Works Construction Permit No !R1 dated... ' "r / ,i.IY# &.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A AR NTEE THAT THE
SYSTEM‘WII,L FUNCTION SATISFACTORY.
( �DATE.... °t ) °Z inspector
Installer
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF liC+%iis"_rr-{��
Disposal i,, Its O$ui��g^''tr 0iutian Jrrmit
Permission is hereby granted fw A (22 k C/,
to Construct ( l4royRepai;. ( ) an Infividual Se vrage D po`,1 System
at No
(1,4 -'.r*„-e ,z. l
Street
as shown on the application for Disposal Works Construction Permit No 1' Dated s"'"'"
11.evil..s i Neff'-e.'9/yl
J
Boa d of Eleagi
FEE
DATE ‘14-1.2.t1.-
FORM 1255 NOBBB & WARREN. INC., PUBLISH ERv