Lot 15 Septic Permit 10/10/62 CHECK OR FILL IN WHERE APPLIC.
Dwelling—No. of Bedrooms ,.j Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity %?gallons Length Width Diameter Depth..
Disposal Trench—No. C .
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. I
Test Pit No. 2
Width Total Length Total leaching area. - sq. ft.
Total leaching area sq. ft.
Diameter Depth below inlet
Dosing tank ( )
Performed by Date
minutes per inch Depth of Test Pit Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beg issued by the Ima.?di of health. e
Sited ' , r J4°..::a, i
Dale/;s
Application Approved By
Application Disapproved for the following reasons•
by
Dab
Date
Permit No 1 Issued
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF , /4 f.
Qtntifirattee of To liana
Date
THIS IS TO.PRTIFY, That the`Indtpidual Sewage Disposal System constructed ( ) or Repaired
(( ,I .� 'r..i c ' a J. (�
at (f'�-•T N lr t' �,�i il�j}-eyib Tnehllee
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No 1 7 dated e%4�../_�!,..,(.y(� 'L
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM MULL FUNCTION SATISFACTORY.
DATE !'^Y-s «e..L.I 6
No
Inspector...k,
AEI )7 ri .s... ,,.E(i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF - a-rail
Uispns$
nrkn Otpuatrurtinn Permit
FEE
Permission is hereby granted
to Construct (ifl-or Repair ( ) an.Individu�l. Sewage Disposal System
at No ,f-r--4
Stitt ! 4
as shown on the application for Disposal Works Construction Permit No......,:....._.... Dated
DATE
•
%i
FORM 1255 HOBB• & WARREN. INC.. PUBLISHERS
•
I
Board of Eealth